Monsoon Journal

By: Dr. J. Douglas Salmon, Jr.

*Adapted with permission from Multi-Health Systems & Dr. J. Douglas Salmon, Jr. from Rehabilitation Education and Coping Pamphlet Series

Is Something Wrong with My Brain? Permanent and lasting injury to the brain is uncommon for any- one who has remained conscious, or who was unconscious for only a brief period of time, immediate- ly after an injury to the head. The longer the person has been unconscious or unaware of events following injury, the more likely that a serious brain injury may have occurred. Referral for neu- ropsychological evaluation is often the best way to determine whether injury to the brain has occurred, and if so, how it is actu- ally affecting the person’s thinking abilities. Other Factors Interfering With Thinking Abilities Memory and thinking difficul- ties are common among people who have experienced many types of injury, illnesses, or stressful life situations.

These dif- ficulties are generally considered to be temporary and will usually go away completely once the per- son’s recovery has progressed far enough. Several factors may cause such thinking difficulties even if no brain injury has occurred. These factors include:

1. sleep difficulties in gen- eral, and not getting enough sleep in particular.2. pain related to injury, which often interferes with con- centration, preventing informa- tion from getting into memory in the first place. 3. dizziness, which may dis- tract or overwhelm the individual while trying to learn or take in information. 4. medications, which may produce drowsiness or create specific problems in concentration and memory (many sleep and anxiety medications, and some depression and pain medications are the worst in this regard). 5. anxiety or stress, which interferes with concentration pre- venting information from sinking in. 6. depression, which can temporarily alter the chemical balance of the brain. Each of these factors alone is known to produce concentration, memory, and thinking related dif- ficulties, even when the other fac- tors are not present and even when physical injury to the per- son has not occurred. When all these factors or many of them are present together, then it becomes quite likely and typical that the person will develop temporary disturbances in concentration, memory and/or thinking. Pointers to Improve Concentration 1. Avoid distractions caused by others or yourself. In order for a person to remember anything, he or she must be concentrating on the information so that it gets into memory in the first place. To ensure that the maximum amount of information is stored into mem- ory, it is crucial to make sure that the environment is free from dis- traction. Thus, when it is impor- tant to remember something, make sure that you are in a quiet environment, free from distrac- tions like people passing by, T.V., radio, noise, and a lot of activity.

At a restaurant you might ask to sit at a quiet table and face a wall rather than in the open restaurant area or window, both of which may be distracting. Sit near the front in a movie, play, or lecture to avoid distractions. 2. Write down important infor- mation. 3. Repeat information that you have heard from someone and watch the speaker’s lips while he or she is talking. 4. Use timers or notes to remind yourself to do things. 5. Take care of the most important tasks at times when you feel the most alert. 6. Upon your doctor’s advice, minimize your use of medication by seeking other solutions such as massage, heat, cold packs, rest, etc. 7. Deal with your feelings - don’t bottle them up - by talking about them or writing them on paper. 8. Keep active by participating in hobbies, doing light chores around the house, visiting people, doing volunteer work, reading, writing letters, or doing anything that will help to keep your mind off of your condition and prevent you from worrying too much. 9. Eat nutritious, well-bal- anced meals. 10. Minimize your alcohol intake. 11. Exercise regularly, but consult your physician first. 12. If you feel it may help, speak to your family doctor about a referral to a mental health pro- fessional. 13. Educate yourself about your condition by asking your family doctor questions that you have and by reading educational material.

Additional Non-Brain Injury Related Reasons for Thinking Difficulties Concentration and memory are very sensitive functions that can be easily disrupted by a wide variety of underlying conditions including the common cold or flu. Various commonly occurring psy- chophysical conditions like med- ication side effects, stress, headaches, depression, sleep problems including insomnia, excessive daytime sleepiness, dis- rupted sleep patterns (say from shift work or jet lag), and other sleep disorders such as narcolep- sy, etc. may cause secondary memory and thinking difficulties until the underlying problem is resolved. Studies have revealed that people who had respiratory, gastrointestinal or other infec- tions or even bumps and bruises from a fall are more likely to experience varied types of cogni- tive decline due to a protein (tumour necrosis factor-a) involved in the inflammatory process.

Caregivers of these patients may observe the effects of the secondary cognitive impair- ments as thoughtless or hurtful remarks or unreasonable, demanding requests. In most instances like when one experi- ences the common cold/flu, the thinking related symptoms will readily disappear as the person’s health improves. If however, the underlying condition persists, then many of the above tech- niques may be helpful. In addi- tion though, it is important to inform your family doctor of any persistent concentration, memory and/or other thinking difficulties in case they should be investigat- ed in more detail.

Contd. from Pg 1

A rate hike isn’t the only event that could lead the Canadian dol- lar above the greenback. In the latest Global Positioning Strategy report, CIBC Analyst Zafar Bhatti identifies four other factors that could help lift the loonie. Among them are: - World demand for com- modities: increased demand for commodities such as oil, minerals and fertilizer “could result in a stronger Canadian dollar as exporters repatriate profits.” - Resurgent capital markets: Canada is one of the friendliest environments for foreign acquisi- tions, says Mr. Bhatti. “If the cap- ital markets finally get an appetite for merger and acquisitions then Canada could be one of the first places to see the benefit of for- eign inflows.” New Democratic Party leader Jack Layton in the meantime has called The Bank of Canada to pay more attention to the impact of the strong Canadian dollar.Speaking to reporters outside the parliament recently he said, “The Bank of Canada needs to keep a very close eye on this situ- ation, because it can be devastat- ing to parts of our country.”

*Adapted with permission from Multi-Health Systems & Dr. J. Douglas Salmon, Jr. from Rehabilitation Education and Coping Pamphlet Series Communication Styles People respond to and com- municate their symptoms in a wide variety of ways. Some indi- viduals, for example, may not allow themselves to react to or communicate their symptoms related to pain and illness, while others do so frequently. When individuals choose to ignore their symptoms and keep them unknown to others, they may experience undue hardship, espe- cially if they’re already in distress, as a result of trying to cope with their symptoms in addition to other responsibilities. This can seriously strain their coping resources, and make them vul- nerable to increased symptoms or other effects of stress. As well, they may not allow themselves to be assisted by others, although such assistance may often reduce their burden and help foster a more rapid recovery.

In situations where symptoms are communicated often, the “constant communicator” may isolate him or herself from others because of what may be per- ceived by others as continuous complaining, attention-seeking, or negativism. This type of person may push away otherwise sup- portive individuals and eventually as a result may have to cope with the burden of stress alone. Coping with such stress without the support of others may fuel anxiety and may lead to depres- sion. Striking a Balance The goal when developing a strategy for communicating symptoms to others should be to strike a balance between these two approaches, by controlling the amount of discussion that focuses on your symptoms and at the same time inviting others’ assistance to ease the burden of stress. Such a strategy can con- tribute to a quicker recovery. Communication Tips ” Constant complaining turns others off. It is best to communi- cate only those things which are of greatest concern to you.

It is also essential that you help others to understand what you are expe- riencing. Avoid describing the symptoms themselves; instead, explain how your symptoms make you feel and relate your situation to a similar event in their life in order to generate discussion regarding how the other person coped at the time. Sometimes he or she may give you some ideas to try. ” Don’t just tell people about your difficulties; let them know clearly and simply what they can do to help. You might try saying for example “it really helps when you encourage me to go out,” or “it helps when you make me laugh,” or “would you mind help- ing me with the groceries”. ” Exchange chores or do a favor for a friend in exchange for your help. For example, if you are not working and he or she is employed, it may be helpful to do something for him or her during the day that is difficult to accom- plish after work. Such an exchange will likely make the other person more willing (and less resentful) to do something for you.

” When something bothers you, avoid criticizing others, but let them know how their actions affect you or make you feel. You might say, for example, “when you play the music loudly or shout, it makes me nervous, and it makes my pain worse.” You might also explain that, because you are not feeling well, you are more easily hurt by criticism or more likely to become angry when somebody opposes your view. ” Encourage others to help you problem-solve or give you tips on what helped them in simi- lar situations. If there are certain activities (chores, hobbies, sports, etc.) that you feel you can no longer do, speak to others about these things to help you think of other ways to engage in the activ- ity (with or without their help), or engage in other enjoyable activi- ties that can replace the old ones. ” Seek people who are sup- portive and who are willing to help you. Spend less time with those people who seem less sup- portive, who are critical of you, or who tend to be down a lot them- selves. With less sup-portive peo- ple, you may wish to engage in activities that require less conver- sation and take the focus off your difficulties.

For example, go to a show, play cards, go to a movie, or play games. ” Request the support of oth- ers to encourage you and to give you a push when you are having a difficult day. Often, once you get going on an enjoyable activi- ty, you will feel much better, even if you initially wanted to be left alone or did not feel like being active. Having someone to give you a gentle push when you are down can be tremendously help- ful. Ultimately, research has clear- ly shown that having a supportive and positive social network can promote a faster recovery and a longer, healthier life. Always look for ways to use and improve your social support in times of both good and poor health.

Adapted with permission from Multi-Health Systems & Dr. J. Douglas Salmon, Jr. from Rehabilitation Education and Coping Pamphlet Series The following provides a gen- eral overview of the symptoms related to whiplash and mild head injury. As each person’s injury is unique, some of the information may not apply in a specific situa- tion. Therefore, it is important that the individual involved ask questions of treating profession- als to understand his or her own specific situation.

Where Do the Main Physical Symptoms Come From? Whiplash injuries are common following motor vehicle accidents and involve sudden strain and injury to the muscles and other soft tissues of the neck, upper back and head. An injury to the neck or head in a car or work- place accident may or may not involve injury to the brain and to sensory organs such as the eyes, ears, and nose. Headaches are very common symptoms following neck and head injury and usually result from injury to the muscles surrounding the head and neck. Occasionally, migraine headaches, or headaches due to injury to nerves at the back of the head may occur. Dizziness is also very common and may be the result of injury to the inner ear, eyes, or neck or due to emotional distress resulting from the injury. In general, neck pain, headaches and dizziness (depending on the reason for them) often require weeks to months to fully improve, and very occasionally, headaches in particular may never complete- ly go away. However, it is rare for these symptoms to prevent a per- son from living a meaningful and productive life in the long run. Ringing in the ears and hearing loss may also occur from damage to the inner/middle ear or nerves involved in hearing at the time of injury to the head. Poor balance may occur as a result of neck muscle injury, visual disturbances, or brain injury.

Loss of smell may result from certain types of skull fracture as small nerve fibres which connect the nose to the brain are torn. An evaluation by a neurologist is often best to investigate such concerns, which usually improve over a one to two year period . Concussion or brain injury most commonly affects an indi- vidual’s concentration, memory, reaction time, and thinking speed, as well as planning, organizing, and problem solving abilities. Permanent and lasting injury to the brain is uncommon for anyone who has been unconscious and/or without awareness for less than several hours immediately after a head injury. Generally, traumatic brain injury does not cause ongo- ing headaches nor dizziness directly but may result in changes in personality and behavior. Emotional problems (e.g. depres- sion, nervousness, and irritability) are usually caused by other fac- tors, but may be worsened by brain injury. Improvement in brain functioning generally occurs over a 1 to 2 year period, with the pos- sibility of ongoing impairment depending on the nature and severity of the injury.

All of the above symptoms are expected to improve in the initial stages to some degree, with the possibility of worsening being very unlikely thereafter, unless the factors below become involved.
Interacting Factors That May Slow Recovery A number of additional prob- lems caused by the main injury symptoms may slow recovery, especially if they interact togeth- er. Disturbed sleep is usually the result of physical pain, discom- fort, dizziness, emotional stress, worry, and/or inactivity. It normal- ly improves with the passage of time and improved symptoms. The use of medications (especial- ly certain pain, sleep and anxiety medications) can create side effects like dizziness, blurred vision, poor balance, memory or concentration problems. It is important to read the warning labels on medications and check with a pharmacist to see whether medications may be a contribut- ing source.

Because of the relatively long healing time required by the main physical symptoms, the person initially may be unable to work or do many of the activities that he or she enjoyed prior to the injury. As a result of stress, uncertainty over the future, lack of positive activities, and being out of the work force, the injury may begin to affect the person’s emotions/personality, social life, and job situation. Anxiety, depres- sion, irritability, memory prob- lems, family stress and conflict, and the prospects of unemploy- ment and shattered dreams also may be complicating factors. As new concerns are added to the situation, the main symptoms often worsen. The initial symp- toms also tend to heal more slow- ly when other factors become serious problems. Over time, all of these factors add to, and may worsen one another unless the cycle is broken by using positive coping strategies.

Speeding Up Recovery

Here are some simple tips to speed recovery and that can also be helpful in recovery from other long term physical or psychologi- cal illnesses: ” Learn as much as you can about your symptoms by asking doctors and therapists lots of questions (keep a list of questions and concerns) ” Keep mentally, socially, and physically active as much as pos- sible ” Gradually build up your activity level ” Exercise daily according to a doctor’s or therapist’s directions ” Minimize medications (con- sult with your physician) ” Use relaxation techniques and coping strategies ” Keep your mind off your problems and focus on those things that you enjoy ” Don’t bottle up your feelings ” Do things that are fun and meaningful to you ” Maintain a positive attitude ” Spend time around positive and supportive people ” Set realistic goals for activi- ties you’d like to do If the individual is having diffi- culty coping, is not improving or is worsening, psychological treat- ment can go a long way towards promoting healing by helping the individual to cope more effective- ly and prevent the vicious cycle of interacting symptoms. If concen- tration or memory problems per- sist, especially as the other symp- toms improve, neuropsychological evaluation should be sought to consider possible brain injury.

It can happen with the sim- plest of actions. You could bend down to pick up a toy from the liv- ing room floor. You could reach down to tie your shoelaces. In an instant you may feel sharp sear- ing pain across your low back. You stand hunched over, frozen in agony. Within minutes you stum- ble your way to the closest chair or bed, where you are content to stay put until the pain diminishes. Your spouse or your neighbor will attempt to diagnose it best. You have suffered a “slipped disc”! What does that mean? Can a disc “slip”? Will it ever go back? Is it serious?

To fully understand this condi- tion, one really needs a quick les- son in anatomy. Our spine is made up of building blocks called vertebrae, bones that sit one on top of the other. In between each block is a disc that acts as a shock absorber while the spine moves. Each disc is made up of a thick cartilage-like layer on the outside, and a soft jelly like substance on the inside. The spinal cord runs through a tunnel within the spine, and from it nerves branch out, exit between each vertebrae and distribute themselves between organs and limbs. Sometimes, the jelly-like substance bulges or bursts through the outer cartilage of the disc. Depending on the severity, it is called a herniation, prolapsed or ruptured disc. In reality, the term “slipped disc” is misleading and inaccurate.
Though a disc herniation can happen anywhere in the spine, it commonly occurs in the low back. It is more common in those between 30 and 40 years old. As we age, the spine becomes less flexible and more susceptible to injury. Degenerative changes occur both in the vertebrae and also within the material of the disc. You are more predisposed to this injury if you are over- weight, lift heavy loads with improper body mechanics or if you suffer an injury like a fall.

Some people may never have symptoms with a herniated disc. Sometimes, the jelly-like sub- stances protrudes and touches or impinges on the spinal nerves. This can result in pain, numbness or pins and needles. Symptoms can either be localized or can radiate along the pathway of the spinal nerve. The severity of the symptoms can be related to the intensity of the pressure on the nerve. Most herniated discs in the low back can result in signifi- cant pain in both the low back and radiating down the leg. Besides the sensory symptoms of pain or numbness, one can also experience weakness in the extremity. If there is loss of bowel and bladder function, it is considered a medical emergency and you should get immediate medical attention.

Over 90% of herniated disc injuries will resolve in six weeks. Conservative treatment such as medication or physiotherapy will alleviate symptoms and promote recovery. The physician will ini- tially assess the patient and may recommend anti-inflammatory medication or muscle relaxants. Diagnostic testing such as an MRI or CAT scan may only be recom- mended if symptoms are severe enough or there is no improve- ment over several weeks. Rest is appropriate for a day or two. More than that will result in weak- ness, muscle and movement dys- function. Your physiotherapist will initially focus on treatment to relieve pain, either with the use of modalities like ice or electrical stimulation. Thereafter, the focus of treatment will be to resume spinal mobility and muscle strength.

Acupuncture or traction are possible treatment alternatives. If symptoms are significant enough or if conservative treat- ment does not relieve symptoms, surgery is sometimes used as a last option. The goal is to relieve the disc from impinging the nerve. Treatment options should be discussed primarily with your physician and not your neighbor. To maintain your back health and prevent reoccurrences of this injury, it is beneficial to strength- en your back and abdominal mus- cles. Having a strong core pro- tects your spine from impact and injury. Maintaining good posture also equally distributes the forces and impact of vertebrae on verte- brae. This maintains the integrity of the disc. When lifting heavy loads always make sure you use good body mechanics. Bend with your legs and not your back. Hold the load close to your body when carrying it. Maintaining a healthy weight will maintain a healthy spine.

For further questions please email mithura_rehab@yahoo .com