In the first few months after spinal cord injury, a high degree of stress or anxiety is common. Some of the anxiety stems from the situation that caused the disability – for example, a car accident, shooting, or war injury. In the heat of a life-threatening emergency, and even during acute hospitalization, the body is stimulated by adrenaline and energy is focused on survival. Anxiety is automatically blocked from mental awareness in an adaptive trick that allows one to cope with the crisis at hand.

Once the immediate danger is over and you are settled into a safe, albeit difficult routine, you may find yourself flooded with anxiety, replaying the trauma in your mind (in flashbacks) or having nightmares with terrifying experiences of helplessness, impending disaster, and loss of control. These symptoms of posttraumatic stress are common after any emotionally overwhelming situation.

Again, talking it out helps. Research on the treatment of people with severe posttraumatic stress reactions suggests that the sooner they talk about the experience and associated fears, and the more detail they are able to give, the less anxiety they are likely to experience in the future.

Patty became paraplegic following a bullet wound to her spine. She was at her niece’s home, their children playing together, when the niece’s estranged boyfriend barged into the house and shot both women. Her niece was killed and Patty was seriously injured.

Patty suffered extreme pain and emotional distress while waiting for emergency assistance to arrive. At the hospital, she was mourning the loss of her niece, confronting her own disability, and worrying about the emotional effects of the event on her child. However, after emergency treatment and medical stabilization, her healing progressed nicely and her spirits were remarkably good.

Once in rehabilitation, Patty surprised the staff by talking frequently and in great detail about the circumstances of her injury, her niece’s bloody death, and her pain and terror while waiting to be rescued. She told the story to anyone who would listen, to the point that some staff questioned the “normalcy” of her preoccupation. Yet Patty seemed immune from the anxiety that many expected of her. She was able to focus on information about her recovery, participate actively in her therapies, and maintain supportive relationships with friends and family. She was eager to learn how to use the wheelchair, to get well, and to get on with her life.

Patty was doing spontaneously what most therapists would encourage any victim of a trauma to do – managing and mastering the anxiety by talking about the trauma and the feelings it evoked. Talking not only “gets it out” but also elicits support and validation from others. Thus Patty, more than many patients, was able to make new friends in the rehabilitation hospital. Fellow patients and staff members saw her as courageous and determined. This reinforced Patty’s sense of self-worth and diminished her anxiety about using a wheelchair, learning bladder care, and becoming independent. She left the hospital with some realistic anxiety about returning to work and parenting with a disability and, indeed, real social and physical challenges lay ahead. But Patty was not overwhelmed or disabled by the anxiety itself.

*37/156/5*

Douglas had his first tonic-clonic seizure at 14. The initial CT showed a small abnormality in the anterior left temporal lobe, probably caused by bleeding from abnormal blood vessels. The doctor decided to wait and see what would happen. Six months later Doug began to have complex partial seizures, and he was referred to us. We began administration of carbamazepine (Tegretol) and discussed the option of surgical removal of the malformation both for the control of seizures and because the malformation might bleed again.

The lesion was removed when Douglas was 15, one year after his first seizure. He is now completing high school. He’s on the basketball team, and he lives without seizures and without medication.

When we recently asked Doug how he felt about all that had gone on he replied, “It wasn’t any big deal. I didn’t like having my beautiful hair shaved off, but that’s all behind me now.”

*150\208\8*

In the good old days, humans ate food to survive. In the good new days, most humans (particularly the fortunate ones in most First World nations) eat food to increase enjoyment of life. We equate food with love, happiness and success.

Because we like love, happiness and success so much, many of us eat as much food as we can get our hands on – and forks into.

You may have inherited a genetic tendency for being overweight (“everyone in my family is fat or chubby”), or you may have been raised in a family where overeating was the rule, rather than the exception to the rule. The end result is that you, over the years, developed food eating habits that have nurtured the fat monster.

You are today what you have been eating during the past years.

If you’re lucky, you may be able to fight your own fat monster by just cutting down on the amount of food you eat – without anyone’s help. Or you may need the professional help of a dietitian, diabetes educator or counselor to help you with your weight control programme. Whether you do it alone or with the help of someone else, there are certain things you need to do before you sit down at your next dinner table.

You need to create a list of foods you love – and really can’t cut out – and the foods you really won’t miss when they’re dropped from your diet. You also need a list of foods that fall between the loved and the not loved.

When you consider the foods that won’t be missed or are “iffy”, look for those that contain the most kilojoules. You’ll get the most bangs for your dollar when you cut out high-kilojoules, low-nutrition foods. One of the prime examples of this kind of food is alcohol (the drinking kind). When you drink alcohol, you are almost drinking the equivalent of fat in terms of the numbers of kilojoules. There is very little nutrition in an alcoholic beverage but lots of unneeded and, in your case, unwanted kilojoules.

Some people can get started on a weight loss programme just by giving up booze. Not only will they lose weight, they will gain many other health benefits. (Don’t be misled by the newspaper stories on the benefits obtained by persons who drink one glass of beer or wine every day of their lives, compared with teetotalers. There were many other variables in the lifestyles of the two groups – drinkers and non-drinkers – that probably skewed the results of these studies.)

In social situations where everyone else is drinking alcoholic beverages, you can quietly ask for a diet soda, a glass of iced tea, or an alcohol-free substitute, such as a Virgin Mary.

In addition to alcohol, you will be able to identify quite a number of high-kilojoules foods that can be eliminated from your diet. Think about the kind of snacks you consume while watching TV. You can easily switch to low-kilojoules snacks, such as no-salt, butter-free popcorn.

The act of writing down your list of foods in the love, don’t care, and iffy columns will help you take the next step-actually eliminating some of these foods from your life.

Your skills in blood glucose monitoring also can help you decide which foods should stay and which should go. You can see, by the numbers on your glucose meter, how some foods affect your blood glucose levels. Measure your glucose before you eat a portion of a specific food and then repeat the measurement one hour later. Experiment with different combinations of foods to see which ones produce the smallest peaks in your after-meal blood glucose.

Eliminate those high-peak “villains”, along with any foods that produce high blood glucose levels for hours after you’ve eaten them. Use your blood glucose monitoring along with your bathroom scales to see the weekly progress you’re making toward your weight goals.

*40/210/5*