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Archive for the ‘anesthesia’ Category

I’ve just discovered my new bible–the book that explains me to me perfectly. Louis Tinnin, MD and Linda Gantt, PhD’s The Instinctual Trauma Response & Dual Brain Dynamics: A Guide for Trauma Therapy is THE book to read if you want to understand all types of early trauma: invasive medical procedures and infant surgery without anesthesia, sexual and physical abuse, abuse from foster care and orphanages, burns, rape, combat trauma, and captivity. The book discusses the authors’ understanding of how the brain copes with trauma, how the symptoms manifest, and how to best heal survivors of trauma. It  describes techniques and strategies in-depth and gives many excellent examples of cases in which people have successfully resolved their traumas. And, perhaps most importantly, the text is understandable to a lay person. I applaud them for this.

I feel immense gratitude, for this book has explained things to me that I have not been able to get a handle on no matter how I have tried. I’ve had SO many revelations and I’ve only read half the book. Here’s an example of a life experience that I’ve gotten a handle on: The difficulties I had learning to scuba dive were instantly clear to me. The book affirmed the fact that I was intubated without anesthesia before my infant surgery. That is, a breathing tube was forced into my throat while I was strapped down so that I could be breathed by a respirator. (Right now I am staring blankly out the window, slightly ‘frozen’ just thinking about it.) The scuba equipment replicated the respirator, sound included. I’ve always felt shame and disappointment about the fact that I could not become a scuba diver (especially since I was a marine biology major at a university in warm water Florida) and now, my experience is completely understandable. Post traumatic stress symptoms from the early trauma took over, a condition that I did not know I had at the time. Had I known, I would probably have been able to work through my reactions and soothe myself as I went along or even avoid certain reactions altogether.

Here’s a big excerpt from the book so that you get a flavor of the narrative and a glimpse into their approach. Go slowly. You’ll get it. They really do try to make it clear to a non-scientist type reader.

“Humans are double-minded. They have dual brains and dual minds. Yet, they do not know it. They have not known it since they first became toddlers using speech and verbal memory. That happens around age three when the two cerebral hemispheres begin  to exchange information across their maturing connection, the corpus callosum. When one hemisphere becomes dominant over the other, a compelling illusion of unity develops. This is when the individual acquires ‘I-ness”and begins life as a unitary agent in the world of verbal communication. The dominant hemisphere (usually the left) becomes the verbal brain, with a mind that operates by the logic of language and imposes a sense of self as unitary agent with willed action in linear time (past, present, future).

“Dominant verbal consciousness rarely yields to the nonverbal mind except during one’s instinctual response to trauma when cerebral dominance surrenders to nonverbal survival instincts. When the person recovers from the lapse of unity caused by trauma, the instinctual experience remains outside of verbal recall, unremembered in words but unforgettable in feelings and images. The nonverbal mind, unconstrained by narrative structure, remembers it all: the fear, the thwarted impulse to escape, the near-death experience of the freeze, the altered state of consciousness, the automatic obedience, and finally self-repair (as in animal wound-licking).

“We contend that it is nonverbal memory of the traumatic survival experience, held as unfinished and forever present but outside of verbal consciousness, that causes posttraumatic intrusive, avoidant, arousal, and dissociative symptoms. Understanding the brain dynamics of cerebral dominance, verbal and nonverbal thought and memory, and the interaction of verbal and nonverbal minds can lead to specific therapeutic measures for posttraumatic disorders” (Tinnin and Gantt 9).

Until we extract our trauma story from the right brain, post-traumatic stress often has its way with us. And if the trauma occurred before the age of three, then strategies other than verbal recall, such as drawing, must be employed. Stay tuned for more about this book. I’ll quote some of the case studies and share more of my impressions. In the meantime, you might want to go to the authors’ website for more information: www.traumatherapy.us or to Dr. Tinnin’s blog http://ltinnin.wordpress.com. Get ready to get clear.

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I’m sitting in my well-let living room on a Sunday morning on a hard folding chair, hoping both the light and non-comfy seat will keep me on task: reading the seminal article “Pain and its Effects in the Human Neonate and Fetus” by Dr. K.J.S Anand and Dr. P.R. Hickey published in the New England Journal of Medicine in 1987. Am I a scientist? NO. Am I a doctor or medical professional? NO. I am a survivor of infant surgery, carried out without adequate pain control and likely, without anesthesia. And since I consider myself a health activist of sorts, I figure I need to be as versed as I can in the subject about which I blog.

The study I’m reading was groundbreaking. It provided a point of view in the field of medicine that was lacking–that infants feel pain and that the administration of anesthesia and analgesics is necessary for babies who require surgery or other invasive medical procedures. I’m paraphrasing, of course. And I’m only half way through the article. Why?  Because in each paragraph, I’ve had to look up at least two or three words in my huge Random House Dictionary or the Bantam Medical Dictionary and then connect those meanings to the point of the paragraph in general, which sometimes requires my taking notes or drawing diagrams in the margins. Yikes! Who would bother!  That’s why people like Dr. David B. Chamberlain interpreted this article for us. He  wrote the essay “Babies Don’t Feel Pain,” in which he introduced the findings of Drs. Anand and Hickey and gave us a history of medicine’s thoughts and conclusions about infant pain. Thank you, Dr. Chamberlain.

But my having read Dr. Chamberlain’s article is not enough. I’m interested in not only my reactions to reading a challenging scientific article, but also my emotional response to what I’m reading. You can imagine how I felt when I read this sentence: “Despite recommendations to the contrary in textbooks on pediatric anesthesiology, the clinical practice of inducing minimal or no anesthesia in newborns, particularly if they are premature, is widespread” (2). OMG!  Couldn’t any parent tell you that his or her newborn feels pain?  If it’s not proven though–if no tests were done that provides replicable data–well, then medicine too often ignores what we all intuitively know. Frightening?  Yes. That’s why we owe so much gratitude to Drs. Anand and Hickey who connected the data dots. They provided the numbers and made the argument that the medical profession needed in order to change clinical practice.

Wish me luck in finishing the article!

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Robert Clover Johnson comments below on my previous post, dated January 21, 2013, about Robin Grille’s article “What Your Child Remembers–New discoveries about early memory and how it affects us.” I want to thank him personally for having the courage and taking the time to share his experiences and his knowledge with us. He is a pioneering educator on the subject of the trauma of infant circumcision, and I am honored to have him post on myincision.  His thoughts are extremely important for us all to consider.

Thanks for bringing my attention to the work of Robin Grille. I am perhaps a case study of someone who coached himself through various forms of regressive therapy to discover the sources of lifelong tensions and depression by opening up the repressed memory of infant trauma. Grille describes this process very well, though his description is so succinct that some readers might suppose that just a few sessions of exploring postures and breathing techniques might lead to such revelations. My story spans three decades with lots of distractions and detours and important life events intervening. But as a result of my therapy I know from personal experience that infant surgical trauma is deeply imprinted in the amygdala and can have serious deleterious consequences throughout one’s life unless dealt with in a very caring, sensitive way.

In 2005, I re-experienced the cutting sensations of my infant circumcision during a therapy session. At that time, I knew nothing about this surgery. This experience has altered my life in many ways. One of the hardest aspects of gaining this somatic knowledge and the book-learned knowledge that followed is learning how to share what I have learned constructively. Most Americans still simply do not believe that such memories can be accessed or that they have any effect whatsoever on adult life. Alas, these imprints do affect us and the news is not so good. In the case of circumcision, the infant is not only traumatized, thus losing trust in the benevolence of parents and humans in general, but also most of a man’s erogenous nerves are cut off and thrown away (or sold to pharmaceutical or cosmetic companies for commercial and medical uses).

Most people in our society have adjusted to this unnatural reality, primarily through suppression of information about it and the propagation of such lies as that “the foreskin is just a useless flap of skin.” (It also naturally lubricates sex, by the way, so the effects are felt by women as well as men.)  Fortunately, such organizations as Intact America and NOCIRC are gradually making headway and fewer boys are being cut than in the past. I urge everyone to look up those organizations online and become enlightened, if you are not already enlightened.

Robin Grille is right. Infant trauma can be remembered, and it has bad effects whether or not we consciously remember the trauma.

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I just finished reading an article “Centennial of Pyloromyotomy” in the Journal of Neonatal Surgery by Dr. V. Raveenthiran, a pediatric surgeon with SRM Medical College and Hospital in Chennai, India. Since 2012 was the year to celebrate the discovery by Dr. Conrad Ramstedt of the Ramstedt procedure, a surgical technique which saved my life as an infant, several articles have been published about the doctor and pyloric stenosis, Dr. Raveenthiran’s being one of them. In brief, his article discusses and evaluates some of the articles that report on the treatment of pyloric stenosis in the 100 years since Ramstedt’s discovery, including new diagnostic and surgical techniques.

A bit of background: Dr. Ramstedt discovered that he could best save babies suffering pyloric stenosis by cutting into the pylorus muscle of the stomach, in order to alleviate pressure and open the passage between the stomach and small intestine that had been blocked, and then by not stitching the incision on the pylorus muscle. (Previously, the pylorus muscle incision was stitched closed.) On Fred Vanderbom’s blog survivinginfantsurgery.Wordpress.com, he summarizes Dr. Raveenthiran’s article quite beautifully.

One point that Dr. Raveenthiran makes struck me most. He writes: “Colossal success of a curative procedure usually obviates the need for further scientific research by solving the underlying problem.” To paraphrase, Dr. Ramstedt’s surgical outcomes were so great, so successful, that the search for the origin of the often fatal condition in newborns, pyloric stenosis (PS), was no longer of immediate concern. Most of the article discusses the plethora of new techniques that have been developed over the years to reduce the scarring of the baby’s skin and to make the operation overall more efficient. What disturbs me though is the lack of energy being directed into discovering the etiology or cause of PS and working to prevent this condition in the first place. Pyloric stenosis has been known to humans for several hundred years, yet little is known about the cause.

I think it’s high time that medicine put a stop to PS altogether. Why?  I’m coming from the baby’s point-of-view. Surgery sucks!  The last thing a baby wants to go through shortly after he or she arrives in this world is hospitalization, separation from Mom and family, immobilization on a surgical table, and an invasive procedure or assault on the body. Years ago, the surgery was barbaric as anesthetic was often not used. An infant may have been brandied up (yes, given alcohol!), given a local anesthetic or given a paralytic, whereby she couldn’t move but was aware. Generally, from 1912 to the 1940s, no anesthesia was the norm. Then, the patient is left to cope with post-traumatic stress symptoms that can, and often do, persist well into adulthood. Over time anesthesia began to be used. (The history of the development of pediatric anesthesia and pain control for infants and neonates is a long and complicated one that varies significantly country to country.). Now more often in operating on babies with PS, anesthesia is administered, the recovery time is shorter, the baby is less isolated from family, and the incision is smaller. Yea!  But wouldn’t you rather be cured so that a surgery wouldn’t be necessary?

Dr. Ian M. Rogers discusses his findings about using antacid therapy to change the pH balance in the stomach and stop the pylorus from becoming super spasmotic and ultimately blocking the os or opening into the small intestine. (Read “Pyloric Stenosis-The Real Cause” dated June 17, 2012 in myincision.) He encourages doctors to give an antacid, if appropriate, as soon as the baby is suspected of PS to see if gastric changes will prevent the need for surgery. Ah, prevention–a breath of fresh air!

The 21st century should no longer parrot the paradigm of the past. It’s time to work in new ways. Albert Einstein said:  “We cannot solve our problems with the same thinking we used when we created them.” So while I am deeply indebted to Dr. Conrad Ramstedt, it’s time to let go of the thinking of the past by taking some of the focus off of all the new iterations of the Ramstedt procedure and proceeding to a new era in treating pyloric stenosis, that is, early detection, treatment, and prevention. Babies, parents, families, and the practice of medicine itself deserve it. Let’s try what Dr. Rogers is offering. Let’s get other ideas on the table, for example, reducing stress on the pregnant mother. Let’s use Ramstedt’s technique when early treatment isn’t working or wouldn’t be advisable. Let’s work to make Ramstedt’s technique a strategy of the past.

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One can always be more free. As the year comes to an end and 2013 is upon us, it’s a good time to let go of things one doesn’t want to bring into the new era.

As a baby, I got wired for trauma. Being operated on at 26 days old for pyloric stenosis, a blockage in the stomach, set the stage. As a baby, my belly was cut open and part of my stomach actually drawn out of my body to fix the problem. In many ways, I am still frozen, holding my body rigidly as I cope with a trauma that occurred 60 years ago. Amazing!  It’s called PTSD (post-traumatic stress disorder).

So earlier this morning, I was sitting in bed with my legs extended, preparing for meditation. I settled in, covering myself with a blanket, allowing my body to sink into the earth and be held as I listened for my heartbeat and tuned into my breath. I realized though that my face was stuck as if it was frozen from the cheekbones up, including my nose. My lips were pulled back and my nose and brow were literally numb. I was smiling a weird lips-pressed-together-and-pulled-back type of smile, more like a snarl, and breathing as shallowly as possible.

What was going on?  I tracked the tension in the rest of my body–my shoulders, hips, chest–and realized that I was straining against something. Flash! In all likelihood, I was straining against whatever hospitals use to tie down infants who are going to be operated on. Back then, my head was secured to the table and here I was in 2012 still fighting to free myself.

Often in my morning meditation, I’m so busy dealing with the somatic repercussions of infant surgery that it’s a challenge to allow a meditative state to kick in. Some days, I simply deal with what I call somatic freeze and other times, I break through to information that my higher self has to offer.

One way I work with this rigid state is to allow my breath into the frozen area. I don’t forcefully bring breath in by taking a deep breath but simply allow my natural breath to return. I invite a quiet breath movement. In this process, I actually began to feel my nose and to exercise face muscles that I didn’t even know were there.

Another strategy to cope with PTSD freeze is imagery. During my meditation, a liberating fantasy brought excitement and a feeling of power.

I am a baby strapped to a gurney before surgery, wanting to escape. I rise and break the bands holding my head, shoulders, hips, and feet and grab the surgeon’s scalpel. It becomes a sword. I’m standing on the gurney now, a super-powered baby swinging her sword, daring anyone to approach. Oh, what fun!  I love watching their shocked and frightened faces. They run out of the operating room and I smash up the place. Oh, more fun!  

So am I suffering from frozen rage?  Am I stuck in that moment of facing my own mortality and being unable to do anything to save myself?  Yes!

I may have been given a local anesthetic before the surgery. I may have had no anesthesia but received instead a paralyzing drug. In this case, I would have been awake but incapable of fighting. Still I would have tried to be free. Certainly, my nervous system cried out, escape! Perhaps before being administered general anesthesia, I fought against being tied down. Since I had been starving for weeks and weighed only four pounds, I was pretty weak. I doubt though that I was fully anesthetized; the level of tension and stress in my body suggests I wasn’t.

My body has been engaged in a lifelong fight with itself and for the last 10 years, through meditation and Middendorf Breathwork, I’ve been finding freedom from this struggle. I am discovering my power. I am learning that more freedom is always possible. For 2013, I am getting a new face–less startle, more real. More truly me.

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In my meditation this morning, I heard these words: 26 years old. 26 is a number I associate with my infant surgery for pyloric stenosis. I was operated on when I was 26 days old and at age 26, I had a major breakthrough about my operation. 8 (2 + 6) was my favorite number as a child, and I was born at 3:26 a.m.

I was 26 years old when I realized that I had been holding back crying since the operation. As crazy as it sounded, I told the therapist who happened to be answering the phones at the Women’s Center the day I showed up seeking help that I’d had a surgery 26 years ago but was afraid to cry and break my stitches. She put on the message machine, took me into a nearby room, closed the door, and said some magic words: Don’t worry, you can cry now. It’s ok. You won’t burst your stitches. Tears broke free. It wasn’t as if I had never cried since the surgery, but I had withheld my tears, fought them back if I could, felt frightened when I did cry, and steeled myself to my emotions, afraid that feelings were dangerous. The surgeon had told my mother before I was discharged that if I cried, my stitches would break and and I would die. At 26 years old, I finally started to live.

When I was a child, 8 was my favorite number (2 + 6). At age 8, I felt that life was full of wonderful possibilities and that my future held something exciting. I’d wake up eager to go to school and go to bed restless, excited about what the day would bring. My teacher loved me and I loved my teacher. I carried a little brown briefcase to school with my initials WPW on the latch. Homework was fun. Gym class was awesome. I liked the clothes I wore to school and the friends I had made. There were problems that upset me but overall, 2 + 6 was a time of hope and happiness.

The 26th day of July is when I was saved. My mother considered it my “second birthday.” It was also a day of anxiety, pain, terror, and anger as I was operated on in the early morning.  The previous afternoon, my mother had brought me to the hospital. I was down to 4 pounds. Once admitted, no more breast feeding, no more holding. Was I anesthetized for my surgery?  Many were not in the year 1952.  Was I intubated?  Given a paralytic drug instead of anesthesia?  Was I given a local?  Records gone, I will never know. I was rescued on the 26th and given new life. Life was also taken away, for my emotions were locked up, packed into a suitcase, and thrown into the sea. Still, the number 26 held magic.

26 has been a signpost for me. Years ago, when a friend suggested that I move into her friend’s studio, I wasn’t sure. I was also considering a small cabin. But when I heard that her friend’s phone number had a 26 in it, I immediately decided to take the studio, which I’ve rented happily ever since. 26 was good luck, survival. Though 26 was also restriction and pain, I saw it as a charm.

It’s time for a new number. I appreciate 26 and all it has been and meant, but my future demands new digits. In May, I’ll be retiring from full-time community college teaching and embarking on a career in public speaking and education, teaching courses in medical humanities, including writing as healing. I’m thinking about 7 and 27.  5 + 2 (’52, the year I was born) = 7.  26 + 1 (the day of my birth) = 27. July 27, 1952 was the first day of my new life without pyloric stenosis. I’m no numerologist, but I enjoy doing the numbers!

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I am extremely grateful to Fred Vanderbom, blogger at http://survivinginfantsurgery.wordpress.com. He continues to offer top notch information to those of us whose lives have been impacted by infant surgery. By researching medical articles on this topic in the US, Europe, Canada and around the world and interpreting this material for the lay person, he offers a much appreciated service to many. Fred’s blogsite gives invaluable insight into infant surgery through the lens of pyloric stenosis surgery–the stomach surgery I had at three-weeks-old. He had this surgery at 10 days old.

Recently, he shared research that he’d done on the treatment of pyloric stenosis (PS). He took it decade by decade, beginning with the early 1900s, and reported his findings to the best of his knowledge, given the available literature on this subject. As a result of reading his posts, my understanding has expanded greatly. While I had thought that in the US, anesthesia for infant PS surgery was not the norm and that the use of paralytics and restraint was, I see that the picture likely varies from hospital to hospital across America, or maybe from region to region, and is greatly dependent on time period. SIS has also made me aware that in parts of the world besides the US, following a more medical protocol, where medication was tried rather than surgery, was just as much an option as surgery.

One thing that I am very grateful for is SIS’s focus on helping others. Before SIS’s history of the treatment of PS, Fred  reported on adhesions that can result in later life from PS surgery. He surveyed the medical literature and helped the layperson understand the likelihood of his or her suffering from this condition and what one might do to find relief. SIS also offered solace and advice to parents who had PS babies and, before the surgery, had gotten the run around, i.e. told by medical professionals that their babies were just fussy or being nursed incorrectly or that they were just overreacting to their babies’ difficulties eating and digesting food.

I personally can’t wait to see what 2012 will bring to the SIS platform. It’s my favorite blog and one that I hope will gain readership as more and more folks and families hear about the support they can get from Fred’s work. Do click in and see if SIS speaks to you or anyone you know.

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