Dr Chandril Chugh

Bi-Plane Labs-Advanced Technology For Neurovascular Procedures!

Bi-Plane Labs-Advanced Technology For Neurovascular Procedures!

Time is of the essence when it comes to neurological ailments. Be it a stroke, aneurysm or head trauma, fast, safe and timely intervention is essential for a good outcome of the patient. Keeping this in mind, the best hospitals in India are investing in Biplane Labs for Neuro-intervention.

This technology aids in the Diagnosis as well as treatment of disorders related to the brain, spinal cord, neck and face. 

Diagnostic:

• Digital subtraction cerebral angiography
• Digital subtraction spinal angiography

Therapeutic:

• • Cerebral aneurysm,
  • Subarachnoid hemorrhage
  • Stroke/ Paralytic attack
  • Intracranial hemorrhage
  • Carotid Stenosis/blockage
  • Brain arteriovenous malformation (AVM)
  • Spinal arteriovenous malformation and fistula
  • Cerebral Venous Sinus Thrombosis
  • Inferior Petrosal Sinus Sampling
  • Carotid-cavernous fistula (CCF)
  • Dural arteriovenous fistula
  • Extracranial (brachiocephalic) atherosclerosis
  • Extracranial (head and neck) and paraspinal vascular malformations
  • Head and neck tumors(paragangliomas, acoustic neuromas)
  • Intracranial atherosclerosis
  • Tumor embolization of Meningiomas and brain tumors.
  • Nosebleeds
  • Nasal angiofibromas embolization
  • Facial AVM  embolization
  • Intraocular chemotherapy
  • Traumatic vascular lesions
  • Vasospasm

• Traumatic Brain Injury

How does the Biplane Labs work?

Dr. Chandril Chugh, Senior Consultant and Head of Interventional Neurology of Max Super Speciality Hospital, Saket says, The biplane labs system produces high-resolution 3D images of the blood vessels to the brain. As the brain blood vessel is highly complex high-quality imaging ensures safety to the patient and is paramount in delivering good results.

This system uses 2 sets of imaging sources & rotating cameras, each moving freely and independently, capturing the image at the rate of 30 frames/ second and from 2 regions of the patient’s head – front to back & side to side. Colourful, detailed, real-time images of the blood vessels are shown on a monitor, where the neuro-interventionalist rotates the image, to plan for further intervention.

 This system works like a GPS for the neuro interventionist by providing a road map to reach the desired location in the brain. Good image quality enables the doctor to perform the procedure both expeditiously and safely at the same time. Interventional Neurologists can safely treat disorders like aneurysms, arterio-venous malformations (AVM), stroke, nose bleeds etc. using minimally invasive techniques and thus eliminating the need for open surgery.  Using specialised microscopic tools, the neuro-interventionalist can coil and repair aneurysms, place scaffolds/stents in blood vessels to maintain a proper blood flow, cut off blood supply to tumours or AV malformations to stop further growth.  Neuro interventionist also helps neurosurgeons to treat complicated vascular tumours and intracranial haemorrhage. Due to the simultaneous imaging of 2 different areas, the amount of time to get the image & the amount of dye required is reduced significantly.

Advantages of Biplane Labs system:

• The advanced software technology that creates the detailed images of soft tissue and the blood vessels. This imaging helps visualise brain vessels, detect the primary site of haemorrhage & help the neuro-interventionalist make accurate and lifesaving decisions
• Minimally invasive endovascular procedures have revolutionised the field of brain and spine interventions and are replacing the need for open surgery. All over the world, these procedures are being done on a biplane machine due to its enhanced safety profile.  
• In a Biplane Labs system, the images are captured simultaneously from 2 regions –frontal view, lateral view, oblique view- which makes the positioning and repositioning of the patient less time-consuming. This ergonomic system is preferred over a single plane, where the positioning of the patient takes significantly longer.
• As mentioned before, the amount of radio-opaque dye used in a Biplane Labs system is considerably less compared to a single plane system. Therefore it decreases the risk of complications due to high volume dye usage.
• Biplane labs provide decreased radiation in comparison to single plane labs, thus are helpful in limiting radiation to the paediatric population. CT scan can be obtained in a minute during the procedure without shifting the patient to the neuroradiology department thus saving a significant time which is very crucial in neuro- intervention.

Biplane labs for neuro-intervention, while more expensive, are preferred by the best hospitals in India due to its advantage. For more information, please visit the neuroscience department of Max Hospitals.

Originally Published On Max HealthCare - Biplane Labs-Advanced Technology For Neurovascular Procedures!

Also Read: 

• Sleep Strategies For Complex PTSD

• 5 Tips To Cope With Tragic Flashbacks

• The Effects Of Depression In Your Body

by Dr Chandril Chugh

FAQs On Carotid Artery Disease/Carotid Stenosis

FAQs On Carotid Artery Disease/Carotid Stenosis

1. What are carotid arteries?

These are two large tubes which take blood from the heart to the brain through the neck. You can feel them pulsating in the neck, if you press lightly (only one side) just away from the midline.

2. What is carotid stenosis?

Over time cholesterol may get deposited in the arteries and form a plaque which tends to block the flow of blood. As this plaque keeps getting bigger the artery may get completely blocked or occluded.

3. What are the risk factors for carotid stenosis?

High blood pressure, Cholesterol, Diabetes, Obesity and smoking are some of the risk factors.

4. Do I need to get my carotids fixed?

Dr. Chandril Chugh, Senior Consultant & Head – Interventional Neurology, Max Super Speciality Hospital, Saket, says not all carotid stenosis need procedural treatment, in fact, most don’t.  Treatment depends on a lot of factors like age, sex, risk factors and symptoms.

5. Does carotid stenosis increase my risk of stroke?

Yes, it does.

6. Can it be controlled by medicines only?

Yes, of course.

7. If I need a procedure for carotid stenosis what options do I have?

Carotid Stenting and Carotid endarterectomy (open surgery) are two options available.

8. I am scared of open surgery, what do I do?

Endovascular minimally invasive surgical options, can be used to do carotid stenting.

9. How long do I have to stay in the hospital?

Stay usually lasts for about 2 days. It may change depending on the clinical condition of the patient

Originally Published On Max HealthCare - Faqs On Carotid Artery Disease/ Carotid Stenosis

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• Here's How You Can Manage PTSD Triggers

• The Effects Of Depression In Your Body

• Alzheimer's Disease Effects On Brain

by Dr Chandril Chugh

Why sleep is important for brain health

Why sleep is important for brain health?

Skimming on sleep can cause a myriad of issues. Sleep is regenerative, restorative and rejuvenating. It gives time to the body to reboot and the brain to consolidate and refresh itself.

I can’t remember anything, can’t focus. Your brain won’t function optimally. Sound sleep is paramount for proper brain function. More than usual we hear people complaining of lack of concentration, decreased attention span, blanking out in the middle of a conference, poor memory and task execution. Sleep helps the brain to rearrange itself. In a way the brain is able to clear the clutter and form new connections amongst brain cells to function better. More the number of connections, better the memory and brain function.

Those mood swings are for real. Your brain regulates the hormones and the neurotransmitters. These chemicals are basically responsible for the way you feel. Chemical compounds like dopamine, serotonin, oxytocin helps us to feel good, happy and upbeat. Sleep plays an important role in their regulation. Lack of sleep can make you irritated, impulsive and angry. The moment when you overreact and have an outburst are more likely to happen when you have not slept well.

Lack of sleep makes you slow. Sleep deprivation slows down the brain’s ability to react quickly. Tired drivers and pilots tend to have more accidents and that is a well known fact. Sleep deprivation slows down the brain, akin to getting drunk. Just like you should not be driving under the influence of alcohol the same applies to sleep deprivation.

Beautiful are those who sleep. Literally! Consistently skimping on sleep can lead to dark circles, puffy eyes, premature wrinkling and sagging of your skin. Stress hormones like cortisol increase when you are sleep deprived. Cortisol breaks down the muscle and collagen in the skin leading to premature ageing.

Lack of sleep can affect your heart. Sleep deprivation can increase your risk of developing high blood pressure, which can lead to cardiac disease later on in life.

Sleep your way to weight loss. Lack of sleep leads to hunger pangs and cravings which can derange your weight loss goals. Moreover the stress hormones slow down the metabolism and make it hard to gain lean muscle which in turn affects weight loss as well.

Immunity is dependent on sleep. When you’re tired and even moderately sleep-deprived, your immune function is compromised. Infections like flu, common cold are more common in people who don’t get adequate sleep and are chronically stressed.

Originally Published On Max HealthCare - Importance Of Sleep In Brain Health

Also Read: 

• Here's How You Can Manage Your PTSD Triggers

• What Is Parkinson Disease?

• All You Need To Know About Brain Hemorrhage

by Dr Chandril Chugh

Stroke: It's a Choice! Don't Call It a Disease

For ages we have known that prevention is better than cure, it holds true even for a Stroke. Stroke or brain attack is a lifestyle associated disease and it is entirely your choice on how you choose to prevent it.

Dr. Chandril Chugh, Head, Interventional Neurologist, Max Super Speciality Hospital, Saket,  says the majority cases of stroke are due to a sedentary lifestyle and an unhealthy diet. Also, some of us are prone to having a stroke due to genetic causes, which is a different topic altogether. Preventing a stroke is not rocket science and it can be prevented easily.  

Know about the Stroke Prevention Strategy

High blood pressure

The single most important thing that anyone can do to prevent stroke is to control their blood pressure. The easiest way to control blood pressure is through exercise and diet, if needed medications. Normal blood pressure is less than 120/80 mm hg and anything higher should not be ignored.

High Cholesterol

Second amongst the usual suspects is cholesterol.  One easy way to manage cholesterol is to increase fruits and vegetables in the diet, and avoid fried foods. Consuming healthy fats from nuts (almonds or walnuts), fish oils and oils like olive oils and flaxseed oil is also beneficial. If the diet doesn’t work then medications can come to rescue.

High Sugar

Sugar beyond the normal value is not good for the body. It is important to realize that, and eliminate or at least limit the intake of sugary foods like cold drinks, juices, cookies, biscuits, chocolates, sweets etc. One 500 ml bottle of cold drink contains about 55 gm of sugar which is equivalent to 11 teaspoons of sugar….you can aptly call it the Devil’s drink,  it’s not going to do any good to you.

Smoking

The smoke that travels through the lungs into the blood ,gets circulated throughout the body and gets mixed with blood, causing the blood to become sticky,causing a stroke. Stay away from smoking. There are two kinds of people who don’t smoke: The healthy ones and the ones who are paralyzed due to stroke.

Diet

My advice for diet is simple, you can eat anything that comes out of the ground (fruits, vegetables) or is white (low-fat milk) or sometimes pink (fresh fish or lean chicken).  Stay away from anything in a plastic packet or a bottle.

Exercise

A good diet with regular physical exercise is the secret to good health. If you follow this routine you won't have to worry about the first three points of the discussion.

Doctor

The last piece of stroke prevention puzzle is the doctor.

“Your brain is the Ferrari of your body, and you don’t take your Ferrari to a roadside mechanic”. Choose wisely.

Originally Published On Max HealthCare - Stroke: It's a Choice! Don't Call It a Disease

Also Read: 

• Here's How You Can Manage PTSD Triggers

• The Effects Of Depression In Your Body

• Alzheimer's Disease Effects On Brain

by Dr Chandril Chugh

Who Is The Real “Hero” Of Stroke Care

Who Is The Real “Hero” Of Stroke Care?

We know more about our clothes and cars than we know about our health and body. It is astonishing that we spend more time to research about which laptop to buy, but when it comes to our own health most of us take a passive approach. This deficiency of knowledge is even more evident when it comes to dealing with emergencies.  “Ït is too late now, I am sorry!”  Unfortunately, we have heard this line more often in the real-life than in films. 

The question arises, what can we do to change this? How do we tackle this deficiency? Dr Chandril Chugh, Senior Consultant, and Head, Interventional Neurology, explains this with an example.

We had a 70-year-old female brought to the emergency room by her granddaughter for confusion and difficulty walking due to weakness on the right side. The granddaughter was sure that the symptoms had started right after breakfast. It took them 45 minutes to drive, so they were in the hospital within the first hour of the symptoms. The patient was evaluated and head imaging was done which showed occlusion of the left middle cerebral artery (largest blood supply to the brain).

An Interventional Neurologist intervention was necessary, who recommended Mechanical Thrombectomy. The patient underwent the procedure successfully and was discharged without any deficits. The entire family was happy and satisfied with the treatment. Now my question is: who deserves the credit for this good outcome- The Interventional Neurologist, Neurologist or the emergency physician?  I personally believe that the “Hero” of this scenario is neither of the above but, the granddaughter. If she had not recognized the symptoms and brought her grandmother to the hospital in time, then we would not have been able to achieve what we did. She was aware of the stroke symptoms and took the right decision of coming to the hospital. When it comes to dealing with emergencies like Stroke or Brain attack, information and knowledge are life-saving.

Below mentioned are the important aspects of stroke diagnosis and care.

How do you recognize a stroke?

STROKE: REMEMBER THE 6 S METHOD TO DIAGNOSE STROKE

• SUDDEN (symptoms usually start suddenly)
• SLURRED SPEECH ( speech is not clear, as if drunk)
• SIDE WEAK ( face, arm or leg or all three can get weak)
• SPINNING (Vertigo)
• SEVERE HEADACHE
• SECONDS (note the time when the symptoms start and rush to the hospital)

Can stroke be really serious?

If I were to say stroke is really bad, you will probably not believe me. Luckily, some studies have made my job easier. According to a study done by researchers in 2006 in the USA, a patient with ischemic stroke loses 190,00,00 brain cells every minute, about 14000,000,000 nerve connections are destroyed every minute and 12 km (7.5 miles) of nerve fibres are lost every minute. The end result is the patient gets paralyzed for life and becomes dependent. That's pretty scary!!!

Is there a treatment available for stroke?

Yes. The Stroke treatment depends on which kind of stroke the patient has. Up to 85 % of all strokes are ischemic (blocked blood vessel). For ischemic brain attack, there is an option of intravenous medication called tPA (recombinant tissue plasminogen activator) available which can be given to the patient within the first 3 to 4.5 hours of the symptom onset. The patients who have a blockage in a large blood vessel can be offered a procedure called mechanical thrombectomy, which involves removing the blockage in the blood vessel and restoring the blood supply.  This procedure is done through a small nick in the groin and there is no open surgery involved. Recent trials have shown that patients do exceedingly well post mechanical thrombectomy and have a greater chance to live life independently.

Till what time can you do mechanical thrombectomy?

Mechanical Thrombectomy can now be offered up to 24 hours from the onset of the symptoms but, sooner it’s done better the patient does.

What is the single most important factor in stroke care?

The most important part of stroke care is not the doctor or the hospital, it’s the patient! As most of the strokes are painless, patients tend to ignore their symptoms and hence delay the treatment. If the patient and the family are aware of stroke symptoms they can reach the hospital in time and can get treated.

Originally Published On Max Health Care - Who Is The Real “Hero” Of Stroke Care

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• Sleep Strategies For Complex PTSD
• 5 Tips To Cope With Tragic Flashbacks
• Self-Care Techniques For Trauma Survivors

by Dr Chandril Chugh

Role Of The Nervous System In Bipolar Syndrome: Know All About It

by Dr Chandril Chugh

Neurosarcoidosis: Symptoms, Treatment And Causes

Sarcoidosis is a chronic disease that involves a collection of inflammatory cells in an abnormal quantity. These cells together form a lump which is also known as a granuloma. This disease can affect any part of the body; however, its most common in lungs and lymph nodes. Lymph nodes have a bean-shaped structure and are present all across the body. They carry lymphocytes or more commonly known as white blood cells which helps us to fight any infection or disease.

Neurosarcoidosis is a Neurological manifestation of sarcoidosis affecting the central nervous system, i.e., spinal cord, brain and optic nerve. It is uncommon but a severe kind of sarcoidosis. While it most commonly occurs in facial and cranial nerves, other parts of the nervous system are equally at the risk of inflammation or abnormal cell deposits.  

Causes of Neurosarcoidosis Disorder:

The Cause of Neurosarcoidosis is unknown. But some infections, immune system disorders or genetics can contribute to it. Also, approximately five to ten percent of people who have sarcoidosis in other parts of the body have chances to develop it in their nervous system. Only 1 per cent of people are likely to acquire Neurosarcoidosis, without having sarcoidosis in any other part of the body. Speaking of demographics, people between the ages of twenty to forty are seen developing this disorder, and it is more common in Swedish and African-American people; however, it can occur in anyone.

Symptoms of Neurosarcoidosis:

Symptoms of Neurosarcoidosis vary as per the part of the brain that has been affected by the disease. In some cases, it may exhibit symptoms similar to Multiple Sclerosis, a condition where the immune system attacks the covering sheath protecting nerve fibres and thereby disrupts the communication between the brain and rest of the body. The reason behind the similarity of symptoms is that Neurosarcoidosis also weakens the myelin coat around the nerve fibres.

To tell the difference, doctors perform a set of diagnostic tests including CT scan, Chest X-ray, blood tests and biopsy to ascertain if the symptoms are from Multiple Sclerosis or Neurosarcoidosis. 

Following are the symptoms of Neurosarcoidosis based on the area of the brain that has been affected by it.  

Brain or cranial nerves:

• Dementia
• Loss of hearing
• Speech difficulties
• irritability
• hallucinations
• Seizures
• Confusion
• Loss or alteration of ability to smell or taste
• Headaches
• Vision issues
• Facial paralysis

Peripheral nerves:

• Numbness and tingling
• Weak and vulnerable muscles
• Partial or incomplete paralysis in some body parts

Pituitary gland:

• Frequent urination
• Fatigue
• Excessive thirst
• Changes in the menstrual cycle for women

Neurosarcoidosis diagnosis

The diagnosis of Neurosarcoidosis can be a complicated procedure. There is always a room for diagnostic error in this disease as the primary examination involves the finding of granulomas. Still, the same can easily be the result of any other illness. For the proper diagnosis of the sarcoidosis, following three criteria are required as per the statement jointly passed by the WASOG (World Association of Sarcoidosis and Other Granulomatous Disorders), the American Thoracic Society and the European Respiratory Society:

• Clinical and Radiologic manifestation
• Granulomas not exhibiting caseation
• No indication or proof of alternative disease  

Once the disease is suspected, the diagnosis is further continued to obtain histological verification of the same, and estimate the degree & severity of organ involvement. Additionally, to determine the course of treatment, it is also evaluated during the diagnosis of whether the disease is stable or progressing.

Neurosarcoidosis treatment

Treatment varies based on the symptoms and severity; however, there is no cure for the disease. Currently, available medications/treatments help achieve symptomatic relief from pain without treating autonomic dysfunction. And they also sometimes lead to side-effects, seldomly severe, which is why one needs to discuss the potential side-effects of recommended medications beforehand and to decide if they are worth the possible benefits.  

Some of these treatments are - 

• Occupational therapy
• Pain management medications or therapy
• Immunosuppressive and immunomodulatory medications
• Physical therapy

Conclusion

Neurosarcoidosis does not have any standard prognosis as the severity, and the symptoms vary from person to person. And only two-thirds of people suffering from it achieve temporary or permanent diminution of pain & other symptoms and can go back to living their lives normally. However, those who do not experience remission need to continue the treatment and manage their symptoms throughout life. And to do so, a multidisciplinary approach is advised, which demands considerable participation of patients to work on somatic along with psychosocial aspects of this capricious disorder. Participation can be in the form of regular visits to the neurologist, coordination with doctors and therapists and a proper medication routine - right drug, right dose at the right time!

Also Read: 

• Sleep Strategies For Complex PTSD

• 5 Tips To Cope With Tragic Flashbacks

• The Effects Of Depression In Your Body

by Dr Chandril Chugh

The Struggles Of Coping With PTSD During Social Isolation

Social Isolation 

The term which we looked at as the preventive measure from an outbreak of a novel disease may have given rise to another pandemic. It may have helped considerably in the prevention of COIV19, but it certainly has an adverse impact on the psychological profile of people. The medical survey conducted in India in August 2020 on a small group of people to gauze the mental impact of coronavirus induced lockdown showed 28.2% of the respondents have PTSD, and the rest may not have been diagnosed with PTSD yet but have developed similar symptoms. Like excessive sweating, breathing troubles, sleeping & eating disorders, etc.

Why social isolation is a trauma?

The isolation was forced and was not practised willingly. One day all of a sudden, the entire world was shut down to prevent the disease we never heard of before. And then it turns out the situation is more severe as we started calling it a pandemic. So, as people were confined to their places, they experienced a feeling of no control over the circumstances, the fear of contracting the disease or losing loved ones, sense of despair as not seeing things turning back to their default state, etc. And coupled with all the significant personal and work-life alterations it led to, social isolation became the number one reason for PTSD in 2020. 

Why is PTSD treatment necessary?

PTSD exerts a damaging impact on mental and physical health and can lead to trouble in sustaining relationships. Besides, the risk of developing depression or indulging in deliberate self-harm is six times higher in people with PTSD. And they are also five times more vulnerable to other anxiety disorders compared to a person without PTSD. So coping up with this disease is essential. 

PTSD treatment can be anything from a simple change of habit to seeking professional help. It is different for every individual based on their coping mechanism and severity of the disease. 

PTSD treatment

1. Reach out - People with PTSD often struggle in isolation as they find it challenging to open up and share their difficulties. They are scared of having people not able to comprehend their situation. In fact, in many cases, people themselves don't realize that they are struggling with PTSD until symptoms become unendurable. We all need to understand that PTSD is not uncommon and that if it is hard to explain it to family and friends, then there is always an option of seeking professional help, but leaving it untreated is not an option.
2. Heedfulness - PTSD patients relive the traumatic event, again and again, and are overwhelmed with stress and anxiety in every minute of it. But by just spending two minutes a day practising meditation, prayer or any other mindful technique with a goal to focus on the present without the fear of past or future, can help in calming the body and mind. Although it may just lead to a moment of relaxation, it will bring back the taste of normalcy and hope that sanity is achievable. And before you know, these small regular victories will make a huge difference. 
3. Exercise - Exercise has commendable results in stress-relieving by regulating mood and emotions. It pumps up the production of feel-good neurotransmitters, known as endorphins. So, sweat out the PTSD. Make your own exercise regime. All you have to do is pick a physical activity that amuses you like yoga, dance, cycling, running, walking, swimming, etc. and practice it every day maybe just for 10 minutes to start with. Remember, the goal is to enjoy and relax, not to overwhelm yourself. Be consistent, set small goals and decompress. 
4. Psychotherapy/ PTSD Therapy: There are several therapies designed to help people cope up with the disease. The aim of this write up is not to tell you about the treatment you should go for. As the course of treatment will be decided once a thorough diagnosis is performed under medical supervision. However, we aim to let you know that there is more than one option for you to fight the disease. And that the treatment is customized as per psychological profile.

• Cognitive Therapy: This is a type of talk therapy that indulges you in deep thinking and initiates conversations. It helps you to put into words the thoughts that are seemingly inexplicable and thereby encourage you to pin out negative feelings or mental patterns that are keeping you stuck. 
• Exposure therapy: This PTSD therapy as the name suggests exposes you to the situation or the memory that frightens you, but without compromising your safety. It lets you re-enter the traumatic event that led to PTSD at the first place, and gives you an opportunity to process it, understand it which you might not have received when the actual event occurred. This therapy is suitable for patients who are in denial and fear to let their emotions out. 
• (EMDR) Eye movement desensitization and reprocessing: This is an interactive psychotherapy technique that combines exposure therapy with a set of guided eye movements. Along with letting you re-enter the traumatic situation safely, it also helps you to change your reaction to it for processing it better. 

Now you may think that the world is coming to an end, but remember this too shall pass and it's only after the darker cold nights, the sun feels brighter and warm.

Also Read: 

• Sleep Strategies For Complex PTSD

• 5 Tips To Cope With Tragic Flashbacks

• The Effects Of Depression In Your Body

by Dr Chandril Chugh

Here’s Why PTSD Gets Worse Before It Gets Better

Here’s Why PTSD Gets Worse Before It Gets Better

“It gets worse before it gets better”- this is a statement often quoted by people who’ve undergone or overcome a psychological disorder. Well, it holds true for PTSD too. PTSD is a disorder that hits you like a wrecking ball - it is a wholesome that affects your mind and body, usually for a long period of time. 

Many a time the patient themselves take a long time to acknowledge the disorder or to even notice the symptoms before going for therapy. The person is in a state of shock and a kind of mental numbness. Trauma therapy can be mentally exhausting and can inflict more pain. The road to cope up with PTSD can be unpredictable. However, it is not impossible to navigate through it. In therapy, a patient usually goes through 4 stages. Going through these stages is like going deeper into an ocean where you don’t know what comes next. It can be scary and you may also be triggered at times, and things may get worse but eventually, you will get to the other end, much stronger. 

The first stage being of ‘impact’ that encompasses reactions such as shock, guilt, fear, etc. These are the first impressions after the traumatic event has taken place. A person may find it difficult to muster the whole event and is in a state of shock. This may last for a few hours or even days, depending upon the person and the severity of the trauma. An individual may experience helplessness, anxiety, shock, fear, or hypervigilance. 

The next stage is usually the denial phase where the person consciously or unconsciously denies the flashes, or memories of the terrifying event. However, if you’re consciously trying to avoid the event, you should know that it is only going to harm you furthermore. Suppressing emotions and bottling up your feelings will eventually lead to an outburst. It is not necessary that everyone with PTSD may experience this phase. Some individuals come to terms with the trauma and acknowledge what happened. In either of the above cases, it is important that you start finding a solution to the main issue. 

You can start by finding a short term recovery solution. This is known as the intermediate recovery phase, where one tries to get back to normalcy.  The individual may face several adversities but still, efforts are made to find immediate solutions to primary problems. There are two ways a person can respond to this stage. 

1. Altruism- the person may be amazed by the love and support of the people around and accepts it gratefully. The care received from others pushes you to take a step forward in healing. 
2. Disillusionment- here a person acts totally opposite to the previous one where the person may feel disappointed by the lack of support or feel intruded by it. Although, they still acknowledge the traumatic and take steps to overcome it, all by themselves.  

It’s very common to experience nightmares, flashbacks, and intrusive thoughts at this point. However one should learn to tame these symptoms. There is no timeline for healing; it entirely depends on the individual receiving treatment to be comfortable and accepting of what has happened and finally moving forward from there. However, one should always seek proper neurocritical care. Your mental health is of prime importance.  With self-care techniques, meditation, mindfulness, grounding, and breathing techniques you can control these symptoms and lessen their impact. 

This is the right step to initiate a process of dealing with daily life situations and not slipping back, since after you’ve acknowledged the trauma and try to heal, it gets worse. Nightmares, negative thoughts, emotions, and flashbacks.  If you feel like your therapist is moving too fast in the process, it is completely fine to ask them to go slow and let you deal with trauma in an enhanced and efficient manner. Image rehearsal therapy and several others can help you get a long term solution for recovery. One of the reasons why trauma therapy gets worse with time is because you’ve to deal with the inner demons by confronting them. 

The long term recovery stage is where one finds a permanent solution to trauma. While the person still might be dealing with the post-trauma effects, this is the stage that focuses on rebuilding oneself while dealing with personal problems. This is the stage where things get absolutely worse, your symptoms may get even stronger and wild. They can hit you at your worst. There is a possibility where you may be super upset with the phase you’re in and feel like giving up. At times you may even depend on stimulants like alcohol, drugs, or cigarettes. 

However, running away from these symptoms will leave you in a more deplorable and miserable condition. One should try to come to grips with the reality, give that one final push, and deal with the problem.  It is necessary to go through some tough questions and realizations to feel free and have hope for healing. 

After a storm comes the calm. PTSD may break you at first, but overcoming it will only make you stronger. Never lose hope in you and don’t let the inner demons control or hurt you. Remind yourself that these scary nights are going to pass and there shall be a beautiful dawn soon. 

by Dr Chandril Chugh