Self-Awereness with TBI or PTSD

Also see my "What does PTSD look like?  I'm Fine, How are You?" post

A veteran slams a door, he hollers, he is angry.  Yet, the vet doesn't recognize that this is not normal acceptable behavior and doesn't realize there is a problem.

A doctor asks, "Where is your pain?" 
The vet looks puzzled and replies, "my back." 
The doctor then questions, "Where at specifically in your back?"
"Hum.." ponders the vet.  "It is kind of towards the bottom."
Upon examination, the doctor finds that the vet cringes with pain when his middle back is touched.
With a jerk and gasp, the vet replies, "That's it...right there."

  What is Self-Awareness?  

The above are two examples of a lack of awareness. In the first example, the vet may likely blame someone or something else, externalizing the problem and failing to realize that it was his behavior that was inappropriate.  The second example demonstrates a vet who does not even pay enough attention to his pain to accurately report where it is coming from.

In the most simplest form, the Miriam-Webster Dictionary defines this self-awareness as "an awareness of one's own personality or individuality."  But what is awareness? Why might it be difficult for some?  Self-awareness is something most people have to purposefully work at and be attentive to. 

Awareness, according to Wikipedia,  "is the state or ability to perceive, to feel, or to be conscious of events, objects, or sensory patterns. In this level of consciousness, sense data can be confirmed by an observer without necessarily implying understanding. More broadly, it is the state or quality of being aware of something."

I have found that many times people with Traumatic Brain Injury (TBI) and/or Post Traumatic Stress Disorder (PTSD) along with other disabilities often have trouble with self-awareness.  Perhaps denial, that great defense mechanism, plays a large part with people ignoring problems or disabilities and simply believing they are "fine." Delusions can also play a part in one's lack of self awareness.  Delusions of one's disability are common. Often people deny or ignore that there is a problem in the first place.  When one has injuries and problems, either visible or invisible, with the functioning of the brain there is likely to be lack of awareness.

With a lack of self awareness it is difficult for a person to talk about feelings, sensations, and physical complaints.  This may lead them to manage their emotions and relationships effectively.  Mr. Rogers sums it up nicely below.

“Part of the problem with the word 'disabilities' is that it immediately suggests an inability to see or hear or walk or do other things that many of us take for granted. But what of people who can't feel? Or talk about their feelings? Or manage their feelings in constructive ways? What of people who aren't able to form close and strong relationships? And people who cannot find fulfillment in their lives, or those who have lost hope, who live in disappointment and bitterness and find in life no joy, no love? These, it seems to me, are the real disabilities.”― Fred Rogers, The World According to Mister Rogers: Important Things to Remember

It is almost normal for many, especially soldiers, to ignore disabilities as much as they can and still believe that they are capable of much more than they can physically or mentally endure.  They may try to tackle a large project or attempt to attend a large gathering, yet not be able to finish the project or get through the gathering without panic and paranoia. Without adequate awareness, one can become frustrated, frustrate those around them, and retreat to loneliness, disappointment, and lack of fulfillment and satisfaction with life. 

Self-Awareness Theory 

Self-Awareness Theory states that when we focus our attention on ourselves, we evaluate and compare our current behavior to our internal standards and values. We become self-conscious as objective evaluators of ourselves.  People with mental illness, like PTSD, or TBI can have great problems with objectively evaluating themselves.  They can have problems recognizing reality and awareness.  

Additionally, a component of Social Psychology is that one wants his or her behavior to be congruent with the beliefs and values that he or she has.  When those behaviors and beliefs don't line up, there is conflict.  For example, when one believes that he or she should be the bread-winning worker in the family and is disabled and no longer to fill that role it can lead to cognitive dissonance and leaving the disabled person uneasy and likely depressed until resolution can be made.  One can resolve cognitive dissonance in several different ways. He or she can change his or her ideas to believe that the disability is accepted and that not being the bread winner is alright.  They might also pursue VA compensation or Social Security disability or other resources that  are available as an alternative that is acceptable in the place of being the primary wage earner.

Overcoming this lack of awareness

“Until you make the unconscious conscious, it will direct your life and you will call it fate.”― C.G. Jung

How does a person overcome a lack of awareness?  This can take a long time.  It doesn't happen immediately.  It is a process and for those with disabilities, it can be a very taxing and seemingly impossible task.  Awareness can start with a simple quiet reflection of ones surroundings and being mindful of what is present.  Quietly sit with your eyes closed and pay attention to what you hear or feel.  Do you hear cars going by?  The hum of the computer? Do you feel the weight of your arms against the chair?  Do you have a headache? Are you anxious because of your eyes being closed?

Next, one can also do progressive muscle relaxation training.  With relaxation training, one does a body scan paying attention to the muscles and the tension in the body.  The person then systematically tenses muscle groups, then relaxes them, noticing the difference between tension and relaxation.  The goal here is two fold.  First, the person can create a more relaxed state in his or her body and secondly, that he or she can be more aware of where they are harboring tension or stress so they can relieve that bodily stress by the contraction exercises.  One example of a relaxation exercise is that when you feel tension or tightness in your shoulders, that you pull them up towards your ears (like you are shrugging them).  Hold your shoulders up in this position for about 10 seconds and then release them.  Let them fall back down to the normal position and recognize the difference between tension and relaxation.  

See this video on YouTube for a great relaxation exercise or watch a person do the exercises here to get an idea of what they look like. 

Be patient with the person as he attempts to learn how to be more aware.  Ask open ended questions to help them come up with answers for how they feel and ask specific questions when needed to help someone become more aware of pain or emotional awareness.  

Good resources on my shelf that I recommend to clients and students are:

• The PTSD Workbook. Link to this book on Amazon:

• The Anxiety and Phobia Workbook by Bourne.  Link to this book on Amazon:

Both these books are now available on Kindle.
Kindle eBooks

A few ways to save

John thinks that I'm queen of being frugal, yet we like nice things and we like to go places.  In fact we travel a lot and it is easy for expenses to add up.  Here are a few of the ways we've saved some dough this year.

Nov CVS deals for about $20 with $30 ECB back

Coupons and Sales

Obviously clipping coupons and shopping grocery store sales (particularly Buy One, Get One Free deals) are a great way to save.  We've saved hundreds of dollars by doing this.  John even asked for a coupon at Captain D's last week!  Sometimes coupons are a good deal but if it is for a product you will not use or would expire before you can use it, think twice.  You may be adding to your bottom line bill if you use coupons and purchase alot of items that still end up being high dollar that aren't really needed.  

If you print and redeem coupons from Swagbucks you can earn points to redeem on anything from Amazon gift cards to pencils and baseball cards to movies.  You can also earn SB (Swagbucks) by searching the web.  We have used some SB redemptions for baby shower gifts and stocking stuffers.

Search travel sites but don't always book online!

Most everyone searches Travelocity or maybe even Groupon before  taking a trip. If you are looking for a very specific location and date then searching, planning, and booking in advance is most likely the way to go.  However, if you are simply traveling up the interstate and don't know exactly where you will reside for the evening, you may want to use your smart phone to get some ideas of places and prices.  We have found on at least 5 occasions over the last 2 months that if you take your phone into the hotel with the online price pulled up, they will beat it.  That's right.  They will usually not only meet the price without you having the hassle of entering your credit card info into your phone, but we find that we get about 10% extra off.  Of course this would be a gamble to expect that each time.  Worst case scenario is that you then book online or go somewhere else!

February 2012 at Magic Kingdom - A much needed escape

We do like to use specialty travel agencies, like Mouse Tales Travel .  Kimberly or Lori can help you book a trip within most any budget, and plan out all the details of your trip.  That would include park tickets, park plans, and dining, amongst others.  Tell them I sent you and if you book a qualifying trip, I'll get some Disney dollars.  Then when you refer your friends, you may can get a bonus too!  We first booked a trip to the Animal Kingdom Lodge with Mouse Tales and two weeks before we went, John was feeling good and wanted to go to Mickey's Halloween Party the next day.  Kimberly gave us a few options and booked our trip while we were picking up essentials at Wal-Mart and all we had to do was drive to Orlando.  Priceless.  Lori helped plan a large family trip earlier this year and get flights and transportation scheduled for John's family and make reservations for our meals.

Ebates

We have fallen in love with Ebates! You get cash back for online shopping.  I wish I had discovered it sooner!  You get paid a percentage back to buy the things you are purchasing online.  Plus, you can get referral bonuses when  your friends sign up.  I've racked up almost $40 over the last 5 weeks.  For the first person you refer who makes a purchase, you get a quick $25 to be paid out in February.  My favorite deal so far was using an email coupon code for Magazines.com and getting 52% cash back.  I got two magazine gift subscriptions for $1.96 with $1.02 in cash back from Ebates! Cha Ching.

Shopper Card and Credit Card rewards

Don't forget to check balances on rewards.  I have redeemed my Sears shop your way rewards for groceries and other goodies that will total about $50 before the end of the year.  Also, if you have rewards on credit cards, check out the items that they offer.  I got a free car seat from Discover last year and with Bank of America rewards I got a birthday present or two for others.

A month without posts and a quick catch up

I realized today that it has been about a month since my last blog post.  I guess we've been a bit busy.  

 

We've made a quick trip to Indiana for John's Granny's funeral.  We made stops along the way at the Tennessee Aquarium, Rock City, and Tellus Museum.  We ate at a German Restaurant and Cheeseburger in Paradise.  We came home tired and decorated for Christmas.  We picked out a 12 foot Christmas tree this year.  Then, last week John woke one morning and had no recollection of our trip and even called his mom to see how his Granny was!  

We bought a bug...a Beetle, so we could get better gas mileage.  Since it takes us over 3 hours to get to the VA that John goes to, this will help out a lot. We got tickets via Vettix to the Georgia game on New Years.  

Boys posed for Christmas Pictures and we hurried to send out a few cards to close family.

John ordered me an anniversary present and it is now on the wall.  He picked out a "silly face" picture from October's trip to Disney.  It is amazing to me that he has went to great lengths this year to try to remember holidays and events and strives to get presents.  We did have a few years when he forgot to get anything or forgot that there was an occasion to remember.  So, I'm grateful that he's remembered this year.  Sometimes he is early and sometimes the present comes late, but the effort has been there and he's taken the time to cherish taking pictures this past year.  For that, I am also grateful.  For the first 6 years of our marriage, John refused to take a picture at Christmas and we had very minimal pictures, especially of all four of us.  Now, he is often the one that asks to take a picture so he can hopefully remember that he tried to have good times or that the boys will remember that he tried to do fun stuff and spend time with them.

We've got presents for the holiday but we've also been able to give a lot and to teach our children to give, especially to those that are less fortunate.  We've donated to individuals we know, we've donated to individuals and families that we don't know, we've picked out toys for Toys for Tots, we've gave things to people that might not otherwise get anything for Christmas.  We've watched people with tears in their eyes be thankful for the gifts received, and I got a phone call from someone close to tears who was grateful for the gift that they received. 

Life has its ups and downs but it is best when shared with those you love and when you are able to make a positive difference in the lives of others.

Remember the Reason for the season.

What exactly is the problem? Thoughts on TBI & Fibromyalgia

Photo from www.brainline.org

You don't feel good.  You go to the doctor.  You take meds.  Hopefully, you feel better.  That's the way things ideally should work.  With the invisible illnesses it goes so much farther than that.  You don't feel good.  You go to the doctor.  He gives you meds.  You might not feel better.  You keep going.  You keep having symptoms.  Life can be quite miserable.  What is the real problem(s)? What exactly is it? What can we do to make it better? Will it ever get better?  It is TBI? Is it PTSD? Is it something else?

Here we are, over a year from the time that I brought up to the doctors that my husband had been having these "absent" type seizures.  He has went through a host of drugs, some with allergic reactions.  A few have truly helped his functioning.  The neurology department diagnosed a few types of seizures.  Then, they dismissed them as psychogenic in nature and referred him back to mental health.  We have been through the works and spent much of the last year and a half in various doctors offices.  

While it is obvious that stress makes most any illness more exacerbated, we have always thought that there is a more physical relationship to John's symptoms.  Even with a diminished sense of self awareness, he still has these feel awful days when he reports virtually no stress. 

John's case is complicated and that's why we bypass the most local VA facility to go to what we thought was a better one, yet so much is still left unanswered.  Fatigue, confusion, dizziness, sleep disturbances, daily headaches, and this brain fog of  taking long times to respond and trouble speaking were all symptoms we (and doctors) attributed to his Traumatic Brain Injury (TBI) or maybe his severe case of Post-Traumatic Stress Disorder (PTSD).  John has always had pain.  He gets compensation from the VA for arthritis related to some injuries and he takes daily meds for pain.  Last year, we found out about some nerve conduction problems in his extremities.  John would drop things or loose feeling in his arms and legs.  Now we have radiology reports that there are hotdog shaped tumor like places along John's spine and throat.  Part of what we have been looking at as a typical seizure like episode includes falls, change in consciousness, dizziness, vision disturbances, and a massive nose bleed out his right nostril.  This massive nose bleed has been unexplained by any doctor or medical professional and I've started taking lots of pictures when this happens so providers can see what I am trying to describe.  

An interesting finding for me was that I looked back into our first case management phone note from the VA Medical Center and found that headaches, falls, dizziness, confusion, and nose bleeds were his complaints before ever presenting at the facility over 6 years ago.  I remembered the headaches, because they dominated life.  They were terrible.  I remembered John spilling numerous drinks on a brand new room sized rug.  Within a year, it was past the point of being cleanable and I had to trash it.  John spent most of the time at home sleeping while I was at work and I didn't pay extreme attention to his daily routine or symptoms.  Then, looking back I saw these same host of symptoms that are only worsening. 

Last week, John spent a couple days in the hospital with chest pain.  It was unexplained.  EKGs were fine.  Blood pressure and pulse were normal.  It wasn't anxiety.  It wasn't stress.  It was just atypical chest pain.  A stress test ruled out any other cardiology related problems.  So, they sent us home without any real answer of why his chest was so severely hurting that he couldn't move, had trouble breathing, walking, talking, and feeling his legs and arms.  

John did some research on fibromyalgia.  Virtually every symptom that I can find and research fits.  Not one, not two, not 10.  Almost every symptom fits his unfortunate daily life experience.  From the emotional symptoms of anxiety and depression to the gastrointestinal symptoms, it all fits.  The neurological symptoms of dizziness, fainting, numbness or tingling sensations, ringing  ears, sensitivity to light, and noise intolerance all are real and present. Other symptoms are feeling spatially disoriented, balance difficulty, clumsy walking, dropping things frequently, difficulty judging distances and difficulty seeing what you are looking at. (Click here for one blog I referenced) 

John read somewhere on the web that the VA has linked a service connection to fibromyalgia and vets, particularly ones that served in Southeast Asia prior to 2002.  These vets were given a host of anthrax and other immunizations that may be linked to this and other problems.  So, these thoughts have sparked our interest.  We've already began to ask our medical providers for answers.  In the meantime, I thought I'd share this with you.  You can can offer any feedback that is helpful, it is welcome and appreciated.