** [Injury Clinics] Past Internal Injuries can lead to unlooked for disorders of blood and affect mood, mind and behaviour till discovered and treated.

Paula and I have concluded that all the cases we have mentioned in this blog are cases in which people have suffered physical injury and/or blood loss and/or blood changes in their past, which has affected their mental function as they grew older.

Past physical injury, acquired or congenital is , we think, is overlooked as a cause of future serious mental illness. Medicine looks only at current physical injury or current physical injury. And medicine NEVER considers past hidden physical injury as an important contributing cause to serious future behavior and mental changes. This is how medicine misses so many cases of past physical trauma causing future problems with acid base of the blood- in particular.

Let us take the very famous and much quoted case of that guy who had an injury due to a metal pipe falling into and through his head. Phillip Gage remained alive, able to walk, and talk, and looked like he’d recovered from his physical injuries. He unfortunately had cognitive , behavioural and personality changes afterwards. If his case had not been so famous, no one encountering him after the incident would’ve known or realized that the mood, mental , behavioural changes were due to an injury from his past; they would simply have ASSUMED [again what do people say about assuming?] that he had become “mental “ill. And as we all no, the mentally ill receive no physical care at all.

No one would understand that Phillip Gage’s vital signs needed to be checked routinely to look for any treatable effects of the damage, he’d sustained years ago, affecting normal organ function, including the motor function of ventilation and function of the heart and function of adequate responses to acid base challenges of the blood, all of which can be corrected even if the head, neck and torso injuries can’t. After treating what they could [pretend he is now in the world of 21st century rehabilitative medicine], he might have been restored to normal or almost normal function or he might require physical care for the rest of his life. Another famous case , HM, suffered damage to the brain and did receive lifelong physical care, since he could no longer function independently, despite still being able to think, talk and walk.

This is the real message that HM and Phillip Gage teach us. We have been , through no real fault of our own, negligent. And naive. All because we do not really understand anatomy, physiology and how physical injuries and syndromes [eg. accidental malnutrition [from having periods that are too heavy and from too much blood loss, for example], plus the food insecurity type of malnutrition], exposure [eg. to lead in the past causing injury], or past drug use or medication disasters [causing injuries which need supportive treatments]

We need to invent a new medical clinic , which we will call INJURY CLINICS, to investigate the past injuries , which the patient may or may not know about] which contribute to future episodes of psychiatric or neurological problems that we call encephalopathy or cognitive deterioration, or mood disorders personality change or psychosis or delusions or whatever language is chosen.

Injury, anatomy, physiology, peripheral organ systems-including pH of the blood- need to be considered when working up a mental, mood or personality change.

Ask Phillip Gage. And ask HM. Oh ya, if their memory for their accident or surgery has disappeared from their consciousness, they won’t be able to tell you. So you had better learn your ABCD’s….the algorithm used to evaluate physical injury, past or present.

Doctors need to learn which kinds of physical injuries can contribute to hidden [blood tests will not uncover them unless we know in advance what to look for which we can’t because blood problems affecting acid base are much too complicated and behavior changes can help compensate and be helpful for acid base regulation, but inappropriate otherwise. Remember that thermoregulatory problems affecting acid base of the blood can affect behavior in ways that are unconscious and inexplicable except that they may help to regulate internal physiological conditions.

Excuse our rambling …what we are trying to say is that injuries can affect physiology and acid base regulation in ways that the mind will not understand , but will be important to keeping the person with those past injuries alive. Physiology and acid base regulation will win out every time even if the patient goes crazy.

There is no easier way to check for effects of past injury affecting present behavior and mood and cognitive and activity level changes then to obtain the baseline vital signs at rest [preferably in an unmedicated person].

This is the reason why Paula found out about her past injury, of which she was unaware and is still unable to sense even though she is aware of it. Basic first aid [ABCD] will discover injury that might interfere with acid base regulation and thus with mood, mind and activity level and speed. And basic first aid training is easy to learn plus it is useful for picking up past injuries which will impeded pH regulation of the blood. And it can do all this while people are still well enough to walk and talk and think to any degree.

This injury, which in Paula’s case is a motor injury affecting her breathing rate [which is completely abnormal-too slow] and having nothing to do with her lung function, which is normal.

A ; airway, when she was sick, her airway was at least partially obstructed, as we know from the changes in her voice throughout her episode, and as shown by the loss of her singing voice [particularly the upper registers] and by loss of her ability to cough, or to gag, and her loss of appetite, perhaps due to the loss of motor defence of the airway .[ oe way to avoid choking is not to eat or drink]. All of this was unconscious and needed to be evaluated in the injury clinic using the basic ABCD injury format.

B ; Breathing, Most people have normal breathing rates [about 16 breaths per minute, give or take 4]. Some patients with past injury to parts of the body such as the neck and the torso and maybe even the upper airways [the parts of the tongue, mouth, throat etc..]

Counting breathing rate is key to detecting injury to the motor act underlying breathing, as well detecting injury to other organs, in particular the heart, the circulatory system and the liver and kidneys…oh and the effects on the health of the skin, hair and nails.

Paula has a baseline breathing rate of 3 normal breaths per minute, which is almost unheard of , because no doctor counts anyone’s baseline breathing rate. This tends to be done only in people who suffer terrible life threatening accidents [eg. car accident] or who have been shot and critically injured.

We need to learn more about past injuries and conditions which have left lasting damage in the periphery of the body. The motor act of breathing [with normal lung function] is an important clue to possible impossible to detect chronic respiratory acid base imbalance of the blood, impairing all other organ function including the brain.

To be continued and to be edited further,

Paula and I are taking a break from our Zoom coffee meeting to do some chores………..

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