Tuesday, June 29, 2010

The Fear Of Being Trapped, With No Air, And No Escape

image by binababy, sxc.hu

Claustrophobia Can Be Cured Through Cognitive Therapy

It is quitting time and you punch the button of the elevator. As the door swishes open, you notice there are just two other persons from the upper floors standing inside. You get in, the door closes and the descent begins. It is a long way down, as the elevator halts on every floor, absorbing many more people. Soon the small cubicle is cramped with home-bound people, all of them facing the door. You look around, and you suddenly realize that there is not much air around. Your heart begins pumping wildly. The hands become clammy, and you can actually feel beads of sweat forming at the tips of the fingers and drenching the armpits and socks. The head suddenly feels very strangely light - perhaps all the gray matter in the brain has ballooned because of so much blood flowing into it. You get a feeling of being trapped - oh my god, when will the ground floor arrive! A wave of panic washes over you. The person whose shoulder touches yours gives you a sideways glance - you sense that they have sensed what you are experiencing. Soon, the indicator shows floor zero, the door opens, and everybody tumbles out, you included, into the open air. Ah. That was one more claustrophobic attack that got over.

image by elestren, sxc.hu

Now picture this. You are roaming the streets of an ancient flea bazaar, shopping for an antique piece the kind of which you had seen in the home of a friend you always want to be one up on. After inquiring at several shops, you finally see the light of recognition in the eyes of a vendor who beckons you to follow him inside the shop. You follow him. He opens a door that leads to an anteroom which is enclosed and without any windows, the only light coming from a zero-watt bulb, holding what appears to be a lot of antique inventory. But he does not pause here. There is another door at the other corner. He goes toward it and opens the door, half-turning around to signal you to follow. Your curiosity piqued with the anticipation of finally laying hands on what you were after for a long time, you cross through this door without any thought. Where you find yourself in is a room so small that only two people can stand close to each other. The room has an apology for a bulb that must have been installed there by the vendor's grandfather. You look around and suddenly realize this is an airtight room without any windows. What is worse, there is hardly an inch between you and the stack of decor pieces jutting out from the wall. The ceiling is so low that your head will touch it were you to raise your heels. And the door automatically shuts behind you. There is just no space to breathe. The vendor is pointing you to something in one corner, mumbling in a hush tone that one subconsciously acquires when in the presence of something sacred. But you are in no mood to listen. You are hyperventilating from suffocation already, and the only sounds you can hear are your gasps for breath and the loud thuds of the heart beating against the sternum and the temples. You want out! You don't want to be there for one more moment. Absolutely frantic now, you whirl around, push the door open, rush wildly out into the middle room, startling a mouse on the floor, and only when you are absolutely, totally out of the shop, on the road, in the open, the gentle breeze taking mercy by cooling the perspiration from your face and the sweat-soaked clothes, that you come back to your senses. Sounds familiar, this?

image by ilco, sxc.hu

Claustrophobia is easily a psychological disorder that is the most overlooked and most under-treated. The reason is that the sufferer learns how to avoid the onset of this condition by creating the defense mechanism of avoidance of such situations in the first place. To the claustrophobic, not only do enclosed places create a feeling of entrapment, but also they lead to a feeling of restricted movement, with the possibility of escape shrinking by the second. If you have seen a wild animal that has always spent a lifetime roaming the free space of a jungle, entrapped for the first time in the confined space set by a hunter, you will empathize with the condition of the claustrophobic; that is if you are not one yourself. Indeed, if neurosis has to be induced in animals in a lab setting for the purpose of experimentation or clinical trials, one technique is to subject them to confined conditions. The threat of suffocation, the fear that there may not be enough air left in the air around us to breathe, is a primeval fear that we carry from the womb, and handed down the ages as heritage. In the case of claustrophobics, this fear gets exaggerated. Is it some bad childhood experience playing itself out again and again and in a more sinister manner? Or is it the mechanism of survival against odds becoming over-protective? The etiopathology is, as they say, a mystery inside the proverbial enigma.

image by plrang, sxc.hu

The treatment of claustrophobia is no mystery however: it is possible to treat a claustrophobic through cognitive therapy techniques. One's disassociation of one's feelings with the perceived threat of both suffocation and movement-restriction can be achieved through a clutch of techniques such as systematic desensitization coupled with counter-conditioning, and even regression hypnosis and neuro-linguistic programming. These do not involve any pharmacological intervention whatsoever.

image by barbaradin, sxc.hu

If you are a claustrophobic yourself, or know somebody who is, then you might consider getting in touch with a behavioral therapist with whom sittings can be arranged. A few sessions is usually what it takes to get rid of the fear, and begin to live life with one item less in one's baggage.

image by hisks, sxc.hu

[Claustrophobia is not the only fear that we may be bringing with us from childhood days. While the fear may have been first triggered due to exceptional circumstances beyond anybody's control, there are other fears that are instilled in us quite deliberately and consciously by parents and other elders with all well-meaning intentions. "Don't do such-and-such, else so-and-so will befall you or happen to you!" Do you remember these stern admonitions and warnings? Think and try to recall them. They must be there in some recess of your memory somewhere. Head bowed, we carry these admonitions and warnings and the associated consequences for the rest of our life, little realizing how they are damaging our prospects for happiness and prosperity. Here is an article that should help you introspect the path you have taken so far, and how it may have been shaped by the learning inculcated in you by people you had once looked up to, and perhaps still continue to do so: "Pinocchio, Everything's Fine With Your Nose". Here's wishing you all the best in your quest for discovering an admonition or two that can now be discarded.]

image by bertvthul, sxc.hu
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Monday, June 14, 2010

The Torment That Is Migraine

image by goroo, sxc.hu

Botox To The Rescue?

Those of us who suffer from the torment of migraine, or have seen some near or dear one being whacked by the scourge of this medical condition, can very well appreciate the extent to which the sufferer would be willing to go to ameliorate their condition. The throbbing, pulsating ache in one side of the head, often accompanied with nausea and vomiting, and in some cases intolerance to light and sound, is excruciatingly painful while the episodes last.

image by coscurro, sxc.hu

Found predominantly in females than in males, the condition has defied relief, not to talk of cure. Some prophylactic treatments work for some of the sufferers, but not for others. The prescribed oral medication does not work with every migraine attack. The only recourse to a sudden onset of the condition is often times to endure it and hope and pray that it will subside in the next moments. Medicos prescribe multiple drugs to manage the variable attacks; meanwhile life continues on the trial-and-error path.

image by dmoola, sxc.hu

What this translates to in simple terms for the migraine patient is time spent convalescing away from the fun and frolic that the other family members may be having. Picnics and outings have gotten canceled or postponed because one of the key members of the family got up from bed in the morning with a splitting headache that could not have been predicted in advance, putting paid to all arrangements. Marriage dates have had to be rescheduled because either the bride or the bridegroom - more often than not the bride - suffered an attack of migraine just as the wedding dress was being worn. A migraine-susceptible worker is always afraid of when the condition might strike next, and this drastically impacts their productivity at their place of work. These instances sound familiar? Well, the only comfort is that one is not alone.

image by ayleene, sxc.hu

In case it is of any help, there is a new research paper that reports the ameliorating effect of Botulinum Toxin Type A (BTX-A, or Botox) as prophylactic. Yes, the very same Botox that you use to remove the wrinkles on the face. BTX-A is interestingly the most toxic substance known to man, and yet it is used in treating muscle spasms and also for cosmetic procedures by the name of Botox. The US FDA has not approved the use of this drug in prophylactic treatment of migraine yet. However, the research paper I am alluding to has been published in the July 2010 issue of the journal "Clinical Neurology and Neurosurgery", available here: http://dx.doi.org/10.1016/j.clineuro.2010.02.004, and describes a randomized clinical trial involving the drug conducted over a period of ninety days. One group of subjects was treated with 50mg daily of Amitriptyline (AM), and to another group of patients was administered a 250 U injection of BTX-A divided into fifteen specific points around the head. The incidence of migraine was found to have been reduced by at least half in about 68% of the BTX-A-treated patients, as compared to about 72% of the patients treated with Amitriptyline. The advantages of the BTX-A over Amitriptyline? One, BTX-A is not an anti-depressant, which Amitriptyline is. Two, BTX-A does not cause any of the side-effects that Amitriptyline is infamous for.

image by mikecco, sxc.hu

The authors of the paper suggest that BTX-A line of treatment is more effective for patients with frequent episodic migraines and chronic migraines than otherwise. The facts that BTX-A is more invasive (injections in specific locations of the head), and is also more expensive than pill-popping need to be noted, however. It is still early days to go gung-ho about Botox, but there is no harm in consulting your regular medico for their opinion.

image by forwardcom, sxc.hu

[When the going is good, we hardly give any thought to divinity. But come the hint of adversity, and we run to our religious symbols for succor. Sidestepping the controversies surrounding the precepts and dogmas of religion and theology, science has investigated the impact of prayers on an individual's health and state of mind. And the results startle even the most devout atheist. Read about the results here: When All Else Fails --- Pray!.]

image by lprbrenda, sxc.hu
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Wednesday, June 02, 2010

Cognitive Dysfunction An Issue? Check Your TNF

image by juliaf, sxc.hu

This Protein Is In Excess In The Brain Fluid Of Affected

Are you forgetful? After hearing the caller's name on the other end of the phone, do you struggle to remember what their name was, after you kept the phone on its cradle after the conversation was over? Do you fret over where you had located the file the boss had given you the other day for safekeeping, and spend the rest of the afternoon searching for it everywhere in your cubicle or cabin, including calling up your friend with whom you spent the previous day's evening? Do you often forget that there is something you had kept in the oven or on the gas stove a long, long time ago; and only when nostrils smell that awful aroma that you realize your mistake?

image by cbicenhour, sxc.hu

Is concentration becoming an issue? A task that you could perform even while asleep is now gradually becoming a chore? A counselee was pulled up after it was observed that she kept posting vouchers in wrong accounts on the computer. She was ultimately transferred to a less cognitively-taxing job. Yet another counselee was fired from his job after he repeatedly made mistakes in counting the cash he used to collect and deposit to the accounts manager - he was suspected of doing it deliberately. It was the honesty he had been practicing in the decades of his service prior to the recent episodes of miscomputations - which prevented the management from initiating any legal action against him.

image by juliaf, sxc.hu

It is not surprising to see such people finding themselves increasingly at discomfort in handling activities that were rudimentary and basic up until a few months ago. Usually there is some other accompanying medical condition - such as sarcoidosis or rheumatoid arthritis - that aggravates matters. Things come to such a pass that there is always certain self-doubt about one's abilities: what if I forget? Or what if I do it wrong? One starts covering up one's gaffes with self-deprecating humor, and this humorous style then starts surfacing even before the gaffes happen. That's a sure-shot sign usually that self-confidence has begun deteriorating. Withdrawal from one's usual circle of friends and the usual banter over the phone come to a stop. Family members and friends sadly can do no more than empathize.

image by poofy, sxc.hu

In the midst of this fog of helplessness comes some light in the form of news of an intervention therapy that promises to ameliorate cognitive dysfunction. It was observed that the brain fluid of people with cognitive decline has an abundance of a protein known as TNF-alpha (or Tumor necrosis factor-alpha). In its benign avatar, TNF polices the immune cell movement. It triggers the programmed death of cells (known in medical parlance as apoptosis), besides a variety of other roles. But due to some unknown reason, the TNF sometimes transforms from benign to malignant. Its malignancy manifests in the form of cognitive dysfunction. The solution? Anti-TNF therapy.

image by cathyk, sxc.hu

In a recent study published in the journal "Joint Bone Spine", eight patients were administered Etanercept injections twice weekly, and seven patients were administered Adalimumab injections twice monthly. All the fifteen patients were 70+, from both genders. The patients scored better on MMSE, post therapy compared to the pre-therapy stage.

image by zeathiel, sxc.hu

So, is anti-TNF therapy the new miracle medicine? Not yet. There are several ifs-and-buts that need to be worked out, not least of all being the impact that TNF suppression causes on the rest of the physiology. Sifting through the ifs and the buts, perhaps some small population may still find the therapy useful, and side-effect-free?

image by ctalbot, sxc.hu

While on the subject of cognitive dysfunction and how one can improve one's cognitive abilities, here is an interesting thread on the self-development forum that discusses the outcome of a recent clinical trial conducted in the UK on brain games that claim to improve overall brain capability: http://www.selfdevelopmentforum.com/index.php?topic=5148.msg14453.

image by porah, sxc.hu
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