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Archive for the ‘infant trauma’ Category

As it turns out, finishing the Anand and Hickey article, “Pain and its Effects in the Human Neonate and Fetus,” was relatively easy. The bulk of the chemistry and the neuroanatomy was contained in the first half of the piece, on which I reported in my blog post Feb. 10, 2013 “Just Above Water.”  I feel relief and pride in having accomplished what I set out to do. Following is some startling material from the article and my responses to it.

“Tracheal intubation in awake preterm and full-term neonates* caused a significant decrease in transcutaneous partial pressure of oxygen, together with increases in arterial blood pressure and intracranial pressure” (6). — Imagine a tube being pushed into your  throat without your having been anesthetized.  Any wonder that stress caused physiological changes to take place?  A baby would probably feel as though her life were threatened!

“Changes in patterns of neonatal cries have been correlated with the intensity of pain experienced during circumcision and were accurately differentiated by adult listeners. . . . neonates were found to be more sensitive to pain than older infants (those 3 to 12 months old)” (8). — Turns out that newborns are not just sensitive to pain but very sensitive!

“A recent controlled study showed that intervention designed to decrease the amount of sensory input and the intensity of stressful stimuli during intensive care of preterm neonates was associated with improved clinical and developmental outcomes. . . . the behavioral responses observed suggest that the neonatal response to pain is not just a reflex response” (9). — I want to say duh but am restraining myself. In order for the field of medicine to know something, measurements must be made. Data must be replicable. The scientific method is extremely important, but other ways of knowing should carry significant weight as well.

I am grateful that Anand and Hickey were able to prove scientifically what they observed–that infants suffered and often died from the uncontrolled pain and stress during and after surgeries and invasive medical procedures.

*newborns

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In a recent article  “Dosing Down” published in O Magazine, writer Robin Rinaldi states, “. . . nearly 23 percent of American women between the ages of 40 and 59 take antidepressants.” That’s a helluva lot of women. According to psychologist Dr. Bob Murray, “recent research has shown that men are actually just as likely to be depressed [as women], if not more so.” That’s a helluva lot of men. What’s going on here?  Why so much distress?

The answer is complex. This blog is not the forum to unravel all those threads. But what is important to note is that a good percentage of these folks, I’m sure, have depression due to unresolved infant trauma. It’s just not a subject that we talk much about. But there are those rare moments.

After dinner one evening, my friend’s husband and I were chatting. He asked me about my blog, so I told him about my infant surgery for pyloric stenosis, likely without anesthetic, and the years I spent depressed in my early twenties as a result. As I talked, he was leaning more and more forward and his facial expression was changing from interested to shocked. Next thing I knew, he was telling me about his inexplicable bouts of deep depression and the details of the surgery he had as an infant. It was astonishing. Fireworks were going off inside him, and I had the privilege of watching his sky light up with insight after insight.

One of my theories is that the rage a baby feels from an early medical assault is sublimated and unable to boil to the surface, and it doesn’t go away. The life-threatening situation takes precedence and, as Dr. Peter Levine puts it in his book Waking the Tiger, we go into freeze mode since babies can’t defend themselves or run away. We cut ourselves off from our bodies and emotions in order to attend to the emergency but then don’t circle back to shake off the somatic shock and recover our connection to ourselves. Post-traumatic stress can result, which reminds me of another story.

I was teaching a unit in medical humanities at a community college when a student had the insight that the nightly crying of her infant might be due to the 6 attempted, and the one successful, spinal taps he had recently endured. When I asked her if he had gotten adequate pain control, she stated that she did not know. She had assumed  her baby was given an anesthetic. Don’t we all?  My mother certainly had.

The groundbreaking research revealing that newborns do feel pain (see my previous blog post) did not appear until 1987. There’s a whole lot of people out there who as infants were subjected to invasive medical procedures and/or surgeries without anesthesia and/or adequate pain control. (And it’s still going on!) Could this be one factor in the epidemic of depression that we see today?  Absolutely.

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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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The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.

Here’s an excerpt:

600 people reached the top of Mt. Everest in 2012. This blog got about 9,300 views in 2012. If every person who reached the top of Mt. Everest viewed this blog, it would have taken 16 years to get that many views.

Click here to see the complete report.

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I am psyched. I gave my first talk out in the world beyond the classrooms of The College of Alameda and it was thrilling. Eight women from the Women’s Motivational Meetup in Sacramento, hosted by Griffin Toffler, gave me their attention, listened to my lecture, and participated in a writing exercise at the library in Fair Oaks. Afterward, I felt so happy because I was doing what I felt I was put here on earth to do—tell my story, invite others to find out what’s holding them back, and share some tools that might help them to break through to their power.

Two major points keep surfacing when I think of what I want to discuss in this first post of the new year: belief and post-traumatic stress (PTSD). At age fifty, from my exploration in writing about my infant surgery, I learned that I was living my life from a false premise—I was broken and incapable of being fixed. This thought or wrong belief about myself sabotaged me at every turn. It had been unconscious all my life, operating below the radar, and so this lack of belief in my strength and power undermined me mercilessly. It’s difficult to write about this even now; grief surfaces, sadness. How painful it is to accept that I believed this about myself and acted from this false and destructive premise.

Writing about my infant surgery also helped me realize that I had post-traumatic stress disorder (PTSD) and had had it all my life since the operation for pyloric stenosis at 26 days old. Amazing!  I sensed that I might have it, my lover hinted that I might, but I was too frightened to investigate this possibility. In doing research for the memoir I was writing, I learned about the history of infant surgery and anesthesia, the nature of trauma, and the condition called PTSD. I read many books and scientific articles, which helped me realize what had happened to me. My hypervigilance, exaggerated startle response, re-enactments, difficulty sleeping, jaw pain, panic attacks, depression, anxiety, suicidal ideation, self-harming, eating disorders, and delinquent behavior as a teen were all explained by this syndrome. What a relief to finally be able to identify these symptoms and pinpoint a cause. And what a relief to know that these expressions of myself aren’t really me; they are actually due to a condition that is caused by unresolved trauma.

So here’s what I wanted the group of women at the library to know or get support for knowing—that it is possible to ReStory Your Life. It is possible to identify a deeply held belief or set of beliefs that might be holding you back. Talking is often not the best way to discover it. Through writing, artwork, and/or somatic work, allow yourself to learn what belief is obstructing you from being all that you know yourself to be. This idea was never yours in the first place. Work with this misperception to understand it and then change it. You are a most profound and beautiful soul. You are a creation of the universe. What is your real belief about yourself? Discover it. Find freedom after trauma.

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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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I love this self-portrait I made with colored pencils and magic marker thirty-two years ago this month. I am soft and peachy, vulnerable and open. All my features are accounted for (in previously posted artwork, parts of my face are sometimes either missing or in shadow). And my hair is like a golden crown.

This ‘photo’ was taken after having been in therapy with Lee O. Johnson for two years. When I first arrived on her doorstep, I was in turmoil. I didn’t want to try to kill myself again, so I showed up at the Berkelely Women’s Center where she was womaning the phones. Seeing my distress, she clicked on the message machine and ushered me into another room.

Oddly, she had me sit on the floor between her legs so that my back was to her chest. That was weird, but it made it easier to talk since I didn’t have to look at her face. “I need to cry, but I’m afraid my stitches will burst,” I said. “I had an operation on my stomach when I was twenty-six days old. I know it sounds crazy.”

She pulled me gently to her, and I leaned against her chest. “Go on and cry,” Lee said in a soft and motherly tone. “You’re ok now. The stitches won’t break.” She hugged me to her and I wept. I sobbed. I let myself have my tears. Hardened to my pain and grief for twenty-six years, I was able to find relief. The picture is evidence of my opening to myself. I had come home emotionally after all that time, one of the lucky survivors.

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