A journal of healing

Posts tagged ‘trauma’

What is PsA and P?

Psoriatic Arthritis: PsA is an insidious disease. It is very misunderstood even by the medical community. It is hard to find a specialist who can really guide you. There is no cure and it is progressive. PsA has a partner, Psoriasis or P. They are not mutually exclusive. Each has their own issues and pathology. It is rare to have PsA without P but you can have P without PsA. Both are considered auto-immune diseases and often have other co-morbidities. All this is evidence based information.

And much like other diseases, they are triggered by stress and trauma. If you understand the ACE Study, it all makes sense why diseases like this are becoming more prevalent. It seems lately more and more people are being diagnosed with some form of chronic auto-immune disease. Is it because so many of the baby-boomers are of an age where disease is a common part of life? Or is it because there are more studies done and better research as to causes of crippling diseases in senior citizens.  I think it is both.

I have been involved in two research projects. One was for P and the other for PsA. The one for P was fascinating. They were looking for the correlation of outbreaks on the skin and stress. We were divided into two groups. One was given only exercise and nutritional information and asked to make lifestyle changes. Fortunately, I was chosen to go into the other group. We were going to be trained on Mindfulness Based Stress Reduction techniques. MBSR is now a more common approach for people dealing with issues such as pain. Back then, it was pretty new and out there. Jon Kabat-Zinn developed the program for people with cancer and pain.

The program was several months long. We met once a week. We talked about our week, our disease, anything we wanted. Then we meditated. Sometimes we did yoga. This was a several years ago. The instructor was the Chief MD in charge of the Oncology Department at the Medical Center. He was very progressive for the times. Now, there is a requirement that all med students take MBSR. Everywhere you look they are courses on Mindfulness and stress reduction of some kind. This is progress. But I live and work for a very large medical center that is also a teaching hospital, a university and a research institute.

But with all that, they still do not know much about PsA and P. We do not have a lot of doctors who are rheumatologist in the area. I am fortunate to have a good one. But even he will admit it is trial and error. And we have had some egregious errors. The course of action is to put the patient on a drug regiment which often includes steroids and progressively stronger biologics. Even the manufactures say there is high risk associated with their drugs. It is also known that they only work for so long and the body becomes immune to the drug. Then you have to start over.

In North America and Europe, between 18 and 42 percent of people with psoriasis, an inflammatory skin disease, also have psoriatic arthritis. In the United States, psoriasis affects about 2.2 percent of the population (7.5 million people), making it the most prevalent autoimmune disease in the US. (http://blog.arthritis.org/psoriatic-arthritis/psoriatic-arthritis-psoriasis/)

Nothing is more terrifying than knowing there is nothing you can really do to stop the progression of a disease that is ravaging your body. And there is nothing more frustrating as seeing the deterioration of your body and your ability to be independent. The medications all have side effects and some of them include cancer.

I have always had this disease. It got much worse when I went through my divorce. I believe the stress triggered the eruption on my skin. Doctors, including a dermatologist, could not diagnose why I had this rash everywhere because it did not look like “normal” psoriasis. It was though. I had always had issues with my joints, but was told it was because I was fat. But when my hands curled into claws and I could not hold on to anything, I finally was sent for testing.

PsA is possibly genetic. I had psoriasis as a baby but they called it eczema back then. You cannot catch PsA and P is not spreadable. There is no cure but you can put it into remission. I have been blessed to do that several times including right now. I have only a few skin lesions.

But from all the drug switching and the use of such powerful drugs, I have diabetes. My pancreas is whooped. My insulin levels are normal in the afternoon, but in the middle of the night they drastically peak. I am on medication now for it that adds a lot of weight….. Makes no sense because as you gain weight, you insulin resistance goes higher. The shot I am for the PsA also puts on weight and also increases your glucose levels significantly. It also causes high blood pressure, which is also not good.

But the main comorbid with PsA is actually coronary issues and kidney issues. The inflammation that causes the P and PsA also attacks the heart, arteries and other organs, especially the kidneys.  So far, I do not have coronary issues. However, my kidneys are in imminent danger of failing. Diabetes also impacts kidneys and so does high blood pressure. It is a circle of what is worse. Much like most auto-immune diseases, you do not die of the disease, but of the comorbidities.

I wrote this blog this morning because of a couple of reasons. One, people need to fight for better testing and more awareness of the PsA and P. The symptoms can vary as much as the way the rash presents itself. Two, we need better treatment that does not cause more issues than the disease. Three, we need more research as to see if there may ever be a cure for PsA and P and further studies related to trauma like the ACE study.

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Living the Ace Study

This past week was terrible. I did not get through it unscathed. I am wounded and in a bad way. Let me explain something about triggers and how simple things can dig so deep that it can immobilize someone. I again point to the ACE Study http://www.acestudy.org/index.html  about Childhood Trauma and the lasting effects of living in and witnessing trauma.

The effects of trauma are pervasive and unique. What triggers me may not trigger you. And how I react and for how long will also be different. The first thing that I learned when I became a Certified Trauma Professional is to allow the feelings. Never tell anyone what they feel is wrong, or over-reactive. What a person feels is their right. Trying to modify behavior by saying they are wrong to feel that way or try to change them can make things a whole lot worse. It is the same principal as working with grief. Time and reaction is unique.

Reaction to trauma is also a chemical and physically wired behavior. Neuropathways are developed as trauma is experienced or witnessed. When triggered, the body reacts out of protection secreting chemicals to produce energy for flight or arousal. Long time exposure will create a programed system reaction which often includes the shutdown of the body, anger and explosive behavior, and often a desire to stop participating in life. These are the three basic reactions of trauma: fight flight or freeze. A triggered person will resort to one or all of those reactions without a sense of doing it.

This prolonged constant flooding of chemicals like cortisol and other potent hormones designed for safety will affect the body and cause illness. It is proven. See Ace Study. And this reaction does not fade, but for many, it exponentially gets worse. And so in time, less creates more of reaction. For some it becomes over whelming and they cannot function. There is no actual cure for PTSD. The only hope is to learn to live with it and tame the Tiger so to speak. By exposure to more positive situations and learning to self-sooth and calm, many people learn to cope.

I learned that revisiting the trauma is not a good thing. The old method of recreating events and mollifying them does not work and is not healthy. You actually recreate a new trauma by doing that. I found that out too late for me as I spent a lot of time recreating my events in an attempt to grow past them. It did not work. It is enough to say that I spent over forty-five years in an abusive state caused by my alcoholic parents and an abusive husband. Forty-five years is a long time to be treated like shit; emotionally, physically and sexually mistreated. One does not get over that.

So back to this week: things at work are to the point that I am reacting by shutting down. It has progressively getting harder for me to be there. On Monday,  I was “in trouble” because I was being negative in a meeting. Supposedly I was grimacing and my body language was offensive. I swear this is what was reported. In the past I was written up for rolling my eyes. My boss is a terrible boss and the person who reported this is her mini-me. I understand the dynamics and I could spend a whole other post on how horrible it is at work. But let it suffice that my boss’s words to me were cruel and hurtful. She told me no one wants to work with me. In a previous accusation of misdoing, she told me no one likes me. She then said stop reacting like you’re the victim. If she only knew.

My Clinical Educator resigned after 27 years there.. I threw a reception for Margaret on Tuesday right on site. We had a fabulous relationship. She had my back, and I had hers. I would never have survived without her when I first started. Her leaving trigger all sorts of abandonment issues for me. She saw the mistreatment and the poor leadership. She left because she had enough.

One of Margaret’s favorite things is cake…. Well actually frosting. I had a special cake created for her. It was beautiful and fresh. I was sitting enjoying a small piece, minding my own business. The VP of Clinical was standing in front of me eating a large piece of cake as well. Then, totally unsolicited, he turns and says over his shoulder just as I was putting a piece of cake in my mouth, “should YOU be having that?” I was flabbergasted.

What happens to me when something triggers me is I shut down. I go into this place of protection. Unfortunately, I am unable to speak. I remained in the room until the end of the reception. I never touched the piece of cake again. When I left the building, I burst into tears and cried all the way home. (I actually cried again when I wrote this) I had my fill of painful criticism and hurtful remarks. This is continuing to affect me as I have not been able to sleep through the night. I wake up and perseverate on all the nasty comments.  This is physically causing some nasty flares and a lot of pain.

I am hyper aroused and anything sets me off like a loud noise or small issues. On Wednesday, Joe’s car had a huge malfunction with alarms and flashing lights going off when we were going somewhere and I completely flipped out. I was so upset I was hyperventilating and curled up. We got the car home as we were not too far way but I cannot explain how terrifying it was for those four minutes. I was so bad; I took the next day off. I had to lie because they would never have understood.

I know what I have to do and I am working on getting out. But it is not so easy. I am lucky there will be escape. But how many other people are out there who deal with this daily? No one knows the effect rude and nasty comments can make. We all agree a positive remark can make someone’s day. Why is so hard to see what a offensive, uncalled-for comment can do?  We need to learn to be more sensitive to people. Kids are killing themselves or becoming addicted to escape the effects of bullying which is extremely traumatic. Bullying continues in adulthood and some people are true experts at being bullies. I have met many. How many people suffer in silence only to get sicker and sicker because the effect of childhood experiences haunt them as adults?

 

Harassment

This idea for this post came from my Doc friend’s blog. She was talking about harassment and where does the line get drawn. She had a patient who was making passes at her staff in jest, but it was still annoying. Of course it was annoying. It was harassment. And as I wrote back to her, harassment is determined by the person who is receiving it, not the person who is inflicting it. It has nothing to do with the intent. It is all about how something is received.

I also went on to say that for someone who has a traumatic childhood, or was a victim of sexual abuse or other violent acts, the response to someone’s intent to be funny has just the opposite effect. It can cause a major trigger that can put someone into a tailspin for days and weeks. They may not even know what they are reacting to. It could be a word or even the tone of the harasser.

Harassment can come in many forms. Often people think they are doing a good thing. But someone who constantly harasses someone from the concept of improving the person is totally misguided. What makes that person think they have that right? What makes them so superior to be able to comment?

As I thought about this all week, it hit me that parents come from a point of improving their child but when does it become harassment? Isn’t improving a child the role of a parent? Is there a point when the parent should stop trying to improve their child?

What about a spouse or your partner? Is it ok to harass them into doing something, especially when it affects your family or home? It probably is not ok, but it is hard not to do. I speak from experience.

My husband’s 28 year old daughter will not learn to drive. This makes me crazy. She is terrified, she says. She finally got her permit and then took one lesson. This took three years to accomplish. She said the lesson went ok. But she has made no attempt to continue.  Instead, she relies on her father to tote her around like Miss Daisy. I think he enjoys her dependency on him. Did I say this drives me nuts?

I am skilled in motivation interviewing. I teach it matter of fact. I know in my heart that I am not going to move either one of them on this topic, so I resort to harassment- truth be told. My intent to get his daughter to drive is based on the best interests for her. I want her to be independent and not have to rely on US for the rest of her life. We won’t be there. She has no other family and she has no friends. Her mother passed away at the age of 52. She instilled this irrational fear to drive in her daughter as the mother never drove.

The real reason the daughter won’t drive is because then she will be expected to do something with her life. That ain’t happening either. I know this probably irks me more than anything. What a waste.

Does harassing them help? Absolutely not. It only escalates my anger and frustration more. Can I walk away from it? NO. It slaps me in the face every time she calls her father for a favor. There was over twelve years when his daughter was out in California with her mother that she never called or spoke to her father. It hurt him to the core. But when the mother died, it was; “Oh, Daddy.” He can’t see it or chooses not to.

The bottom line is it still harassment, even with the good intent. I know in my heart I want her to have a life and not rot away like her mother did. I am sad that she is wasting her life. She has all the capabilities to do whatever she wants, but she chooses the easy way out. I have no right to her life. But boy, it is hard to keep my mouth shut. I am so helpless on this because she is not even my kid.

The bottom line is harassment is a person attempt to control. It is coming at someone from the viewpoint of superiority, or desiring some effect of change. I lived with harassment my whole life. Although it was sometimes masked in humor, it was my family’s way to control and inflict. Years of harassment left me sensitive to being criticized in any manner.

We cannot change people. We can influence them, we can teach, we can support. But it is impossible to change someone who does not want to. But damn, its hard not to do.

 

Don’t take this personally

“You’re too sensitive.” “I meant this is a good way.” And my favorite: Don’t take this personally.” Everyone time someone says those things; I know it is going to be a dagger in my soul. I am too sensitive. I will take it badly. And I most definitely will take it personally. Because that is the honest intent. Prefacing statements with “honestly” or to “tell the truth” does not excuse the fact that you are about to be mean. “It’s for your own good” never really is. It’s about you feeling superior to me.

Being an empath is not a pleasure. I see right through most people’s crap in a heartbeat. It does not mean that I can shield myself from the hurt. I never learned that part of survival. Because of that, I am very vulnerable to insults, even if they are shrouded in good intentions. They never really are good intentions.

When you are a large woman, you are a walking target for these kinds of insults. People feel so justified to say, “You would be so pretty if…..” “or you have a beautiful face….” People tell you how much better your life would be if only you could be more like them with statements like: “you should run with me some morning.” Oh Honey, if you really knew me, you would know I can hardly walk some mornings due to psoriatic arthritis. But you don’t really see me, so thanks but no thanks.

These comments do more than just hurt me. They trigger me. My family never lacked in cruel comments. It was a sport to see how clever someone could insult another. I was an enigma in the sense I was the only woman in my family who was large. I mean I am the tallest by 5 to 7 inches, I wore a much larger size (my Mom was a zero to 3) and I had boobs. I spent my childhood listening to “how much better I would be if I only…” This is emotional abuse by the way. I was deprived of treats, often subjected to ridiculous diets like green beans and Jello and constantly harangued about my shape.

[And this is how just writing about my childhood trigger me to justify it. I realized this when I went back to reread what I wrote:] My mom was in charge of the food in the house and meals were excessively high in carbs and fat. There was always soda and cookies available because the other siblings could gorge on them. They were thin. I was an extremely active child and teen often spending the day swimming or riding a bike for miles. I was not allowed to sit around and watch TV or even read. As a younger woman, I was very active. I only slowed down because of the PsA and if I did not have it, I would still be playing tennis and other activities as much as I could.

My family’s constant barrage of self-improvement comments were actually telling me how I failed. There was little said to counter the demeaning of the words. It successfully made me feel like a failure and that was the intent. I know this now, but it scarred me. So now when people make their veiled comments, I hear the disappointment in my mother and father and it brings me back to that time. When you have PTSD, it does not take much to trigger you.

When you grow up with a sense of failure, you have two choices: over achieve or lie down and whither. I overachieved. My success had not dampened the hurt I feel when someone is critical. I am so sensitive, that a look can set me off. I feel people’s disdain of me even if they think they are hiding it. I read people very clearly. It does not matter who or what the relationship. It does not matter if I love or hate the person. Their intent comes beaming through.

Next time you go to make a comment, try to remember that a large person already knows they are large. Chances are they have spent a lifetime trying to meet other’s expectations and have failed. They may not be strong, and your words will haunt them for days. You have no right to demean someone ever. If you think you are helping them, you are not. Get off your white horse and stop being so pompous. Learn that “right reflexing” (the attempt to take charge of someone else’s change process) does not motivate anyone to change. Understand your motive before you speak. Send love, not hurt.

 

4th of July Liberties

 

I was born in America. I have never experienced anything but the freedoms we have here in this country. I do not know any better and so I take it for granted. I am disgusted by piss-poor politicians and can be vocal about my feelings. I am entitled. I take for granted the rights and liberties we have. But I am proud to be an American.

However, I hate the way we celebrate this holiday with fireworks. I personally love the display and the colors. But I hate the noise. It upsets my little Cookie.

Last night we were all sitting in the garden as is our ritual before bed. The dogs take a walk around the yard. We call it the perimeter check. And then we sit for a bit and meditate. There were a few little pops in the distance and Cookie was a bit nervous but still quiet. Then a neighbor set off a huge firework which exploded right over the garden. She panicked.

We ran inside and she took off for the bedroom. I had prepared for this and had the air conditioner and fans going. We crawled into bed and she crawled on top of me and shook. I finally calmed her down and she fell asleep next to me but in my arms. I thought we were ok when another one went off. She again crawled on top of my chest and buried her face in my arms. Finally they stopped and she fell asleep attached to me on my side.

I know everyone has the right to celebrate. I wish they would go back to making fireworks illegal in NY. There are enough displays that are set off by the municipalities to enjoy. I am sure tonight and the next night will be even worse for my little dogs. Browny does not seem to get upset by the noise. But he does get upset when Cookie is upset.

I wish I could teach them something I just learned. I am taking a class to become a Certified Trauma Professional. This class has taught me so much about PTSD and trauma. It is taught by Dr. Eric Gentry, who is an internationally recognized leader in the field of disaster and clinical traumatology.

He teaches that people cannot feel the effects of stress or trauma in a relaxed body. Seems so simple. But he explains in length how the human body is always reacting to triggers of some kind. People who have had extended periods of some form of trauma are in a hypervigilant mode all the time. There are chemical reactions in the brain and the parasympathetic and sympathetic systems go into over drive.  In short, our body is in control.

He explains that we need to be aware that this is always on in one degree or another. And we react by constricting our muscles all day. An example is when at the end of the day, you neck and shoulders are way up and hurt and you have no idea why. It is the constriction of the muscles that you held in a clench all day. We clench our muscles everywhere. It is one cause of leg cramps and back pain.

It is common now for people to understand the concept of just take a breath. Dr. Gentry talks about the power of just taking a breath. He talked about other methods for getting control. But the method I think is amazing and it works is called the pelvic floor relaxation. First you have to become aware of the muscles in you hip area. Do a few kegal exercises by squeezing the muscles that can stop you when you pee. Now just completely relax that area completely. Do that several times a day. Concentrate on those muscles being relaxed when something stressful is happening and you will find you won’t be as stressed.

The issue is that the effect only lasts for a very short time. This is something you have to do all the time. It only takes a second and no one knows you are doing it. Another method to use  is called the wet noodle. This is where you go absolutely limp in a chair for ten seconds. It is like a mini vacation. The effect of being in a relaxed body is how people are learning to deal with PTSD and every day stress.

I wish I could teach my little pup this. But for her, the only comfort is a dark quiet room and being held by her Mommer.

Trauma informed

little girl

I have spent a great deal in the past months seeing a variety of doctors for various reasons. At every visit, every time, the patient care-tech brings me back to the visiting room to wait for the doctor. It is their responsibility to weigh, check blood pressure and ask a few questions. One of those questions is the medical community’s answer to being trauma informed. It misses by a huge mark.

Being trauma informed simply means being sensitive to a patient’s history or the possibility of the patient being in a dangerous living situation. We are talking domestic violence, and all forms of abuse: mental, physical and sexual at any age. Being a trauma informed  means everyone on your team from the receptionist to the doctor is sensitive to how they treat a patient. Some may say this is over the top but the concept is very important to the true wellness of all patients.

For example, the patient who keeps coming back with bruises or injuries from falls. Very suspicious if the patient is only forty. Maybe not so for someone who is eighty. But in the case of the eighty year old, she or he may have a care giver who has been frustrated in having to provide care and pushes them to make them move faster, or hits them when they spill things. And the patient is not going to do anything about it because the next step is being forced into a nursing home. They are living in an abusive home and are trapped. They certainly are not going to be forth coming about it.

Patients who have experienced domestic violence of any form will react differently to the way someone approaches their safety bubble. What I mean by this is that everyone has a comfort zone for how close people can get and how comfortable they are being touched. Some people are huggers and touchers and love to get close to anyone, including a stranger. People who have been abused have much larger safety zones and very often do not want to be touched. This not wanting to be touched can range from the patient being able to tolerate it by disassociation or the patient who has a panic attack at the mere thought of having to be touched, which often leads them to not go to the doctor when they really need to.

It an attempt to becoming trauma informed, our local medical center has all providers asking about the safety of their patients? It is a useless attempt to meet a standard. First of all, it is not the doctor who asks this question. It is the care-tech, the gum chewing little twenty-something who is trying to beat a record of some kind by seeing how fast she can get patients in the rooms ready for the doctor. They change regularly and even so, I doubt highly any patient who is in a domestic violence situation is going to open up to that individual as if they are going to be able to do anything. AND… it is none of their business. The lack of sensitivity to the situation of an actual abuse situation is very typical. Unless there has been some form of specific training done with people who are asking that question, simply asking the question almost makes it worse. What are they going to do if a patient says, “no I am not safe. My husband routinely comes home drunk and beats the shit out of me and then rapes me.” The response to that can make or break the patient. The care-tech’s only course of action would be to type ABUSED into the chart. That works!

I would love to know how asking this question, “do you feel safe in your living environment” is the proper opening for a patient to disclose something so humiliating and degrading as being abused. And how many providers are even trained to handle the situation past the physical? Do they know who in the community is providing help for domestic violence? But the bottom line, most patients will not jeopardize themselves by spilling the beans about their crappy home life in a brief visit to a doctor, especially if there is not a relationship built over time with that doctor.

But being trauma informed goes beyond asking that inane question. It is things like how the patient is treated by everyone; from the rushed handling of the care-tech to the actual doctor. Patients who are victims of abuse will react from the way they are placed in a room and then left abruptly to wait for an extended period for the doctor. Letting the patients know if the doctor is running late, or checking in on the patient to see if they are ok would go much further to calm a nervous person. Having the doctor explain what and why they are going to do something BEFORE doing it will help also. Even the simple act of having them listen to the heart can be traumatic. Some doctors will do it over clothes, some doctors reach right in without warning for skin contact. Sometimes there may be a need to hold the patients head while examining their throat for example. This simple act can terrify someone who has had their head restrained in an abusive act such as forced oral sex. Lying down on an examining table makes anyone vulnerable, but for an abused patient, it is excruciating.

For some patients, the act of disrobing will send them back to a place of past abuse. These patients need a sense of safety which throwing them into a sterile, brightly lit room and demanding they disrobe behind a flimsy curtain does not provide. Then they have to sit in anticipation of being probed on a ridiculous scary examining table sitting in the middle of the room as if they were a piece of meat shivering in a paper gown. Would it be so absolutely terrible to provide a soft blanket to comfort and to also help with limiting the exposure while being examined? Something that simple is being trauma informed.

The patient is brought back to the exam room and sat down after being weighed. For some, being weighed is very traumatic. I know that doctors need the vitals but unless you are suspicious of your patients and do not trust them, can you not simply ask them what they weigh? Or make it part of the exam in private and not in a hallway where everyone is walking by. The scale calculates and the care-tech yells out the reading like everyone needs to know….and you still have your boots on. I skip it and refuse. Unless I am there for weight related issues, I know what I weigh and I will tell the doctor if they ask.

Health care workers are highly trained. But in the area of trauma informed, there is much to learn. This study goes hand in hand with a comprehension of the ACE study, which identified the link of abuse to chronic illnesses. I have asked all the doctors who I see if they are aware of the ACE study, and none of them are. I am going to leave a couple of articles for them to read. (see below) We need to work on this information being disseminated and so if you found this helpful, read and print these out and give them to your doctors.

Ace study: http://www.ajpmonline.org/article/S0749-3797%2898%2900017-8/fulltext

PDF of journal article: http://www.ajpmonline.org/article/S0749-3797(98)00017-8/pdf

https://acestoohigh.com/2017/01/05/dear-doctor-a-letter-from-a-survivor-of-sexual-trauma-to-all-medical-professionals/

https://acestoohigh.com/2016/08/10/childhood-trauma-leads-to-lifelong-chronic-illness-so-why-isnt-the-medical-community-helping-patients/

 

 

 

Midsummer Dreams

Nightview 2015

The light has shifted ever so slightly in the garden at night. I have been doing an epic battle to keep everything hydrated. But even so, things are crisp or wilted. My glorious ferns are gone and the grass is brown and crunchy. The trees in their deprived state are dropping leaves early. I fear for how brown our fall will be this year.

I am not good with the heat. The other night, the little air conditioner in our bedroom could not overcome the heat and it was still 80 in the room. I find myself longing for a storm or two. I realize I could never live somewhere that was sunny perpetually.

I spend my last hours of the day in the garden readying from my Kindle. It’s so dry that the bugs and mosquitos are less and so the light does not attract them. I finished a non-fiction book intended to reflect on what it is like to live with PTSD. It was a story of woman who was raped by her boyfriend over a period of times when she was 16. She lived with his threats and never told anyone. The book revolves around her growing up and dealing with the ramifications. She is splinter from her family, her own choice, and ends up as a disenfranchised woman living in a hovel.

Although the book explained about triggers it was not a good representation of what it is like to live PTSD. The woman in the story goes to a psychiatrist and is “healed” by simple breathing methods and other mindful exercises. She meets a man and life goes on off into the sunset. Although the authors attempt to help bring awareness, I think she misrepresents the truth.

People do not ever heal from PTDS. They learn to cope. And while some are better than others, it still can rear its ugly head at any moment. Triggers come from everywhere. I was reading where a female soldier (nurse) who had PTSD after being in Nam was fine for years. Then she moved to a new area to work at a hospital. She started having horrible flashbacks and attacks. She could not figure it out when on a very still night she heard the sound of a chopper flying to the landing pad at the hospital. It was not the first flight since she moved there. Normally it was noisy with other ambient sounds and this was so subtle she never paid attention. But her ears did. They heard and she would start to have panic attacks.

The shift in light for me is a trigger. I am so sensitive to it that I am aware before it really gets to the point where it bothers me. Something about the afternoon light before sunset in the fall and winter makes my chest tighten and other sensations. It has to do with sunset around 5 pm. This was the cocktail hour when my parents would barricade themselves away from us and start drinking. Yes, this still affects me forty years later. I am aware of it and can normally deal with it. But I still get a stomach ache and my mood shifts.

This morning, as many Sunday mornings, I sleep an hour or two longer than normal. It is very common for me to have nasty dreams but there is a prevalence of one reoccurring situation and it often plays out in these stolen moments of extra sleep. I have no idea why and I cannot control my dreams. Even after being divorced for over 13 years, I still have horrible dreams about the way I was treated. I am not going to dwell by explaining this as I need to let the dream I had this morning go. But my point is PTSD does not just end.

I know what I have to do and will tend to it. The summer ending is always hard for me. We are off to the River for our long extended stay in a couple of weeks. That will help me to focus and ground. There needs to be more awareness of PTSD, and not just for Vets. It affects many people in many ways.