The Differences Between Males and Females with Brain Injuries

by Tayeb Benjaafar

What are the differences between males and females?

This is an age-old question that no person has ever been able to truly figure out. What makes a male and a female so different from one another? Genetically, males and females are 98.5% identical. In fact, we even share the same hormones and critical organs (brain, heart, lungs, stomach, etc.). Fundamentally, it seems males and females are more alike than we think?

Meet Odette Harris

Well Odette Harris, a professor of neurosurgery and brain trauma expert, began to explore that very question through her research. Harris never intended to bring sex differences into her line of work because it was believed that no matter the body, a brain is still fundamentally a brain. While analyzing data from the Department of Veteran Affairs she realized that there is in fact a huge sex difference in the aftermath of traumatic brain injuries, and nobody is exploring it.

The same type of injury in both males and females has a drastic difference in recovery based on a person’s sex.

Photo of Odette Harris

Through her studies, Harris, director of the Traumatic Brain Injury Center of Excellence at the VA Palo Alto Health Care System, found some insane trends. It was found that females with some form of brain injury trauma and other possible severe injuries saw vastly higher rates of substance abuse, depression, memory problems, and even homelessness along with a vast array of other troubles than males with the same type of brain trauma and injuries.

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Continue reading “The Differences Between Males and Females with Brain Injuries”

What Does it Mean to Have Expressive or Receptive Aphasia

By Dr. Lori Bartels (reprinted from SATBIL Magazine By Walter Kilcullen)

Expressive, receptive, and mixed aphasia are terms that get tossed around a lot in the hospital after a stroke or brain injury. Medical professionals tend to describe aphasia to the families as receptive aphasia, expressive aphasia, or mixed aphasia. This is a generic label families hear early in the recovery process.

Thinking of aphasia in this way can be confusing. I frequently see clients incorrectly diagnosed because the physician isn’t familiar with the predominant features of each type of aphasia. Their job is to say that aphasia is present, so they try to classify it very early in the recovery.

All aphasia is receptive and expressive. Each person with aphasia, no matter what part of the brain was damaged, has difficulty with ALL language skills – reading, writing speaking/language, and understanding – when compared to pre-stroke or pre-injury language skills. These skills are all affected by aphasia, but some of those skills are relatively better than others. The keyword here is “relatively.”

Aphasia affects language input, such as reading and understanding speech. “Input” is something that goes INTO your language system. Reading and understanding are two different forms of input (written words, photos, or speech) and they must be processed in your brain to understand them.

Aphasia also affects outputs, such as writing and speaking/language. These are skills that let you get things OUT of your brain. You think of what you want to say or write and you say or write it. Or you listen to what someone said and say something back to them.

If someone has expressive aphasia, it’s supposed to mean that they can’t speak or write well. In terms of input and outputs, the outputs are much more affected than the inputs. This is how we would describe something like Broca’s aphasia or Transcortical motor aphasia. Understanding in these aphasias is relatively better than speech. The predominant feature is that the person can’t speak effectively. Broca’s aphasia, for example, means that while the person doesn’t understand the same as before the stroke, their understanding appears to be much better than their talking.

If someone is described as having receptive aphasia, it’s supposed to mean the opposite – that the inputs are much more affected than the outputs. This is how we would think of Wernicke’s aphasia or Conduction aphasia. Understanding in these aphasias is relatively worse than speech. Although the first thing you may notice about Wernicke’s aphasia is that there is a lot of speaking but no real content, the speech is flowing. What is lacking is a real language, so it’s the opposite of expressive issues.

Mixed aphasia should mean that the client’s inputs and outputs are “equally” affected. This would be closer to a Global aphasia diagnosis in which the person has very little speech, say the same words over and over, or has no speech. Their comprehension has also been severely affected. The majority of people have this type of aphasia right after their injury while their brain heals.

Expressive aphasia, receptive aphasia, or mixed aphasia may be used incorrectly to help categorize your loved one’s aphasia. It can be very confusing to families to learn something completely different in the beginning. This affects the treatment progress of the person with aphasia. If you are starting off with incorrect information, you’re going to make treatment choices based on that information. If you have acid reflux but are diagnosed with heart problems, you’re treating the wrong problem. There is a distinct difference between treatment approaches for receptive, expressive, or mixed aphasias. Don’t be afraid to get more than one opinion – knowledge is power.
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Dr. Bartels is a published aphasia researcher, presenter, author, and founder of The Aphasia Center Intensive Aphasia Program. She is an aphasia diagnostic expert and treatment expert with over 13 years of daily experience. She helps families with aphasia all over the world plan their recovery and exceed their goals

COVID-19 and PTSD: Assessing the Pandemic’s Toll on Mental Health

(Reprint from https://medicine.yale.edu/news-article/covid-19-and-ptsd-assessing-the-pandemics-toll-on-mental-health/)

Illness, grief, job loss, social isolation, uncertainty, and other pandemic-driven stressors have contributed to an increase in psychological distress on an unusually wide scale. As researchers and clinicians continue to grapple with the psychological fallout from COVID-19, a growing body of literature has examined the prevalence of post-traumatic stress disorder (PTSD) in the general public.

Women’s Health Research at Yale, in partnership with colleagues at the University of Bordeaux in France and the U.S. Department of Veterans Affairs National Center for PTSD, published a paper in the journal Chronic Stress identifying 36 studies assessing PTSD symptoms in the general population, and the occurrence of these symptoms ranged from 5 percent to 55 percent of those being studied, averaging 26 percent across the studies.

How can these estimates vary so greatly, and can such wide swaths of the public truly be suffering from pandemic-related PTSD? Before the pandemic, about 3.5 percent of American adults every year were diagnosed with PTSD, with women twice as likely as men to have the disorder.

The American Psychiatric Association defines PTSD as a disorder in which someone experiences “intense, disturbing thoughts and feelings” for long periods following a traumatic event. Such a diagnosis requires, in part, that the event involve “actual or threatened death, serious injury, or sexual violence” either directly; as a witness; or learning of a loved one’s serious injury, an encounter with sexual violence, or violent or accidental death.

Dr. Mathilde Husky, professor of clinical psychology at the University of Bordeaux and lead author of the paper, notes that a life-threatening medical condition does not qualify unless it involves sudden or catastrophic events, such as waking up during surgery or anaphylactic shock. Husky and her co-authors question whether the pandemic “as a disruptive global experience can be construed as direct exposure to a traumatic event in the general population.”

Dr. Mathilde Husky
Dr. Mathilde Husky
Dr. Mathilde Husky, previously a postdoctoral student with Dr. Mazure and now a professor at the University of Bordeaux, is the lead author of a study on classifying the pandemic’s effect on mental health.

“As clinicians, when we ask about symptoms of PTSD, it’s always in reference to a specific traumatic event, with a significant level of shock,” Husky said. “In the context of a pandemic that is nearing two years in length, if I ask someone if they are experiencing flashbacks, the question becomes: flashbacks of what? Are they avoiding cues in their environment or situations that would expose them to things that would remind them of the event? Some people report a singular traumatic event in the context of the pandemic, but many do not.”

These findings have led the authors to question whether the pandemic can be considered as a single entity when it can affect people in so many different ways over such a long period of time, depending on their jobs, exposure to the disease, preexisting stressors, and psychopathology, and many other factors. And, as important, whether other existing classifications adequately address the health needs of individuals who experience stress not as a single event but as an enduring experience with varying levels of severity or shock.

The authors, including Drs. Robert Pietrzak of Yale and the National Center for PTSD and Brian Marx at the National Center for PTSD, suggest that the next research step should be to ensure that PTSD criteria are met when evaluating PTSD or consider another, alternative way of classifying perceived stress that is related to a long, ongoing adverse experience. In addition, the authors suggest researchers should gather data on preexisting mental health disorders and prior exposure to traumatic events to better determine the source of more recent symptoms.

“We must also continue to focus on how preexisting and concurrent stressors may disproportionately affect women more than men,” said Dr. Carolyn M. Mazure, senior author on the paper and director of WHRY. “There is a growing body of evidence showing that lockdowns, school closures, and working from home to reduce the spread of COVID-19, for example, have had a greater effect on women. Is this because women have greater ongoing stressors?”

BIAG welcomes our new Executive Director, Cassandra Palmer

The Board of Directors for the Brain Injury Association of Georgia is thrilled to announce the promotion of long-time Executive Director Jane Jackson to Director of Resource Facilitation. She, along with Dr. Chantel Davis, will work to pilot the all-new Resource Facilitation program in conjunction with the Georgia Brain and Spinal Trust.

Caregiver and Forsyth County support group leader Cassandra Palmer has been hired to assume the role of BIAG’s Executive Director.

Caregiver Study Opportunity

CAREGIVERS’ VOICES NEEDED!
We are looking for volunteers for a research study. The study aims to explore the needs, concerns, and quality of life of working-age caregivers of stroke survivors. Working-age caregivers’ specific needs and concerns have not been included in the majority of stroke caregiver research. It is important that working-age stroke caregivers have a voice and the ability to share their needs and concerns. The goal of this research is to study how unmet needs and concerns as well as other factors affect the quality of life for working-age caregivers.
First, we ask that you complete a short screening questionnaire to see if you are eligible to participate in the study. The screening will take less than 5 minutes. If you are eligible and you would still like to participate, you will receive a link to a second survey and you will be asked to answer questions about your needs and concerns, caregiver situation, social support, and quality of life. The survey will take about 20-30 minutes to complete. You can complete the screening questionnaire and survey online through the link. You can complete the screening survey at https://redcap.link/9zt852zk
You will receive a $50 Amazon e-gift card as a token of appreciation for your participation in the study. After completing the survey, please provide your email so we know where to send your gift card.
Risks include experiencing emotional distress, boredom, or fatigue as you may have to reflect on past experiences or as you answer a specific survey question. But the study poses no physical, social, or legal risks. There is also a risk of loss of confidentiality. To minimize this risk, we will maintain the confidentiality of your information in accordance with all national and local regulations.
Thank you for allowing me the opportunity to share my research study with you. . If you have any questions or comments, please call, text, or email me. I would love to hear from you!
Sincerely,
Dixie Rose, MSN, RN, ACUE
Ph.D. Candidate, Medical University of South Carolina College of Nursing
(903) 922-3292

It’s OK If You Struggle to Accept Your Health Condition

You may feel pressure to accept yourself and your health condition every second of every day, especially if you’re open about how it affects you. But no matter how you approach life with your condition, you don’t need to live in a constant state of self-acceptance. It’s OK if you struggle to accept your health condition — and it happens to almost all of us.

It’s OK if you need time to grieve the life you lived before your diagnosis. It’s OK if you feel like making different health decisions wouldn’t have landed you with a new label to carry. It’s OK if you can’t seem to believe that you have a diagnosis or feel sad, frustrated or angry that your condition affects you along with many others. The grieving process may take weeks, months or even years, but no matter how long it takes, let yourself process your emotions. You deserve time and space to move through every stage of grief without your own judgment of your feelings.

It’s OK if you’re having a hard day and hating life with your health condition. It’s OK if you feel like you took 10 steps backward on the road to self-acceptance and feel stuck in a place of self-hatred. It’s OK if you feel sorry for yourself as your symptoms flare up, and you desperately want a life that doesn’t make you feel like a professional patient. Whether your hard time lasts for just a day or stretches longer, remember that it’s natural and won’t last forever. You will have bad days, but they don’t have to define your journey towards self-acceptance or the ways in which you advocate for others with health conditions.

It’s OK if you worry about others’ ability to accept you with your health condition, even if you’re surrounded by people who care.  It’s OK if you have moments when you doubt your ability to find love or friendship or fear that your loved ones will walk away when they learn the intricacies of your condition. It’s OK if you have moments of mistrust and self-hatred as you struggle to cope with changing relationships as your health shifts. You are surrounded by love and support, but those moments when you believe otherwise don’t make your fears any less valid. You won’t feel this way forever, and your health condition may eventually make your relationships feel deeper and more fulfilling than ever before.

Self-acceptance matters, but in life with a health condition, it isn’t everything. It’s OK if you struggle to accept your health condition — living with an illness or disability is hard, and acknowledging the struggle is perfectly fine.

Why Medical Gaslighting Isn’t Always Easy to Spot

(Blog by Claire G and originally appeared on Through the Fibro Fog website)

Had I just been a victim of medical gaslighting as a woman seen by a male doctor? The thought whizzed through my mind as I almost stumbled out of the consulting room trying not to cry and headed straight to the reception desk to ask to see a different, trusted, doctor.

Why the question? Well, medical gaslighting can often be confusing and complex, and perhaps even unclear. How we are treated by a doctor can be bound up in medical language, as well as looks, raised eyebrows, silences even, that all convey something, but we aren’t always sure what. Was it a gendered response? One bound up in power relations? Or was I being over-sensitive? One thing I knew for sure was that it wasn’t the latter.

What is medical gaslighting?
As described by health.com, “gaslighting” happens when one person tries to convince another to second-guess their instincts and doubt their perception that something is real. Medical gaslighting happens when healthcare professionals downplay or blow off symptoms you know you’re feeling and instead try to convince you they’re caused by something else — or even that you’re imagining them.

I doubt there are any official figures of its prevalence, and if there are I can’t locate them, but those in the chronic illness community certainly know how common it is. Instagram Twitter, Facebook, and more are filled with stories of such behavior and its traumatic impact. It runs worryingly deep through the medical system — so much so that often patients enter an appointment expecting not to be believed. We anticipate that we will have to fight to be heard, and treated accordingly.

An experience of medical gaslighting
I went to my usual doctor about an issue, and he suggested I seek a second opinion in case he had missed something. I respect that suggestion; it shows he understands that no doctor is fallible. Ego was left at the door, and he put my care first to check the issues. So I made an appointment with the head GP for my doctor’s surgery.

It began well. Friendly, polite, as it should be. Then something went awry. I spoke of the issue and he didn’t examine me. Instead, he told me he couldn’t see a problem. I pointed out that maybe he wouldn’t be able to visually see it, but he could feel it. I needed a physical examination, not a visual one. It spiraled quickly. He refused, but without actually saying no. I got looks, contemptuous remarks and he spoke down to me. When I said I could complain about his behavior, he sarcastically said that was my right and to go right ahead.

How can we know if a situation was one of medical gaslighting?
In hindsight, it isn’t difficult to pinpoint moments of medical gaslighting in that appointment, but at the time it felt hazy and uncertain. I knew that he was downplaying, refusing even, that I had an issue. He said he couldn’t see it. Refused to examine me. Except he didn’t outright say no. He just didn’t, wouldn’t do it. I got silence when I said that is what needed to be done.

Medical gaslighting can be obvious at times. It can be an outright refusal to acknowledge the symptom the patient describes to a doctor or a downplaying of the severity or frequency of symptoms. It can be suggesting that the patient is exaggerating, often said in careful words so as not to actually use the words “exaggerating” or “making it up.”

Other times medical gaslighting can be harder to identify. Communication isn’t just through spoken words. It can be a condescending sigh, a raised eyebrow, a silence after a question the patient asks. Those forms of communication aren’t noted on our medical records, aren’t recorded in any way. If raised, perhaps it will be said the patient was mistaken. After all, such gestures lack concrete meaning and may be subjective in their interpretation by another.

I feel as though I am going to use the words “complex” and ‘challenging’ a great deal in this post. Yet medical gaslighting often is. It’s not clear-cut at times, or certainly not in a way that could be proven. I think the patient usually knows though. They sense it, feel it, get understandably angry by it.

The “it’s all in your head” line
For those in the chronic illness community, the sheer number of patients who are told their symptoms are “just” anxiety won’t be a surprise. Dysautonomia International describes that “prior to being diagnosed with POTS, 59% of patients were told by a doctor that their symptoms were ‘all in your head.’” In my experience, the same was true for vestibular migraines. Others have said they had the same experience in regards to endometriosis.

This is also an area of complexity. Of course, many people do have anxiety. It is a challenging condition that requires medical support and treatment. It certainly isn’t a lifestyle choice or a trendy “thing to have,” as some in society seem to believe. When it comes to a diagnosis of a chronic condition, the link (or not) to anxiety can be a diagnostic challenge. Does the patient have anxiety or another condition with similar symptoms? A racing heart, dizziness, feeling faint, nausea, and more can be symptoms of anxiety, but they can also be symptoms of POTS, for example.

When such symptoms are described by the patient, it is time for the doctor to undertake a thorough medical history, ask questions, perhaps conduct a physical examination depending upon symptoms, and refer for tests if required (which it often is). Falling back on “it’s probably anxiety” without due regard for other possibilities is lazy medical care.

And of course, chronic illness conditions and anxiety are further complicated by cause and effect. I felt as though I may as well bash my head against a consulting room wall on one occasion when I said, over and over, that it was the symptoms of vestibular migraine that were making me anxious, not that anxiety was causing the symptoms. I walked out of the room knowing I hadn’t won that “fight,” and angry that my experience had been sidelined for a pre-conceived view of the relationship between chronic illness and anxiety.

What is the impact of medical gaslighting on the patient?
Medical gaslighting delays a diagnosis, simply put. That delay then of course delays appropriate treatment. It leaves the patient in pain, or with other symptoms longer than necessary. It may mean that their health spirals into greater issues, potentially in an irreversible way.

The impact of medical gaslighting also has a psychological element. It is traumatic not to be believed in your pain. We go to doctors for help, care, and hopefully for some empathy and kindness in treating the issue at hand. To be disrespected by the very people who are supposed to put your needs first is distressing (to put it mildly). It leads to a distrust of doctors at times, something that can prevent patients from seeking help for further health issues.