Dr. Nagler's Tinnitus Corner
Sign up Latest Topics
 
 
 


Reply
  Author   Comment  
allancurran

Member
Registered:
Posts: 41
 #1 

Dear Dr Nagler

I hope you are well?

You may remember me from a couple of months ago....the chap that played a piano for an hour like an amautuer and suffered an increase in his Tinnitus?

Unfortunately I have to report my circumstances aren't much better - worse if anything.

I've continued to experience my normal constant piercing high pitched whine, which since the piano incident seems more intense.  On and off over these past four months, predominately at night I get a beep bee beep beep beeepppp in my left ear but since Thursday last week this has become louder and featuring at some points even throughout the day and especially creeps in and is loud at night.

My emotional state and my sleep is all over the place and I am not engaging in healthy habits.  I have, since this started, been sleeping poorly, waking in the early hours whereupon I'll experience the start of physical anxiety symptoms [I have lots of experience with anxiety and I now recognise the early signs that can lead to a panic attack] which cause me to run out to the local all night garage, purchase a pack of cigars then return home whereupon I virtually smoke [and inhale] the lot in my garden until I'm wretching.  And/or I will take 20mg of Propranolol to fend off the anxiety symptoms.

Its also freezing cold here in the UK and I think I have a touch of a head cold as my hearing has felt a bit muffled at times over this past week.  I'll smoke cigars throughout the day provided I'm not at work.

I've also upped my anti depressant Effexor [we call it Venlafaxine here in the UK] to 125mg.

I've also been using an in-ear white noise generator [purchased by me 10 years ago] a lot lately, often to the point where it masks the beep, but not always the whine.  I told off that webpage from a pleasant chap who's opinion I respect that I shouldnt be using a white noise generator.

Why am I telling you this?  Well I think the aggravation in my left ear has come from my piano originally but as I've been careful to avoid loud noise exposures during these months [but not overprotecting] I cant understand why this beep has suddenly become louder and more intrusive since Thursday and I'm wondering if you can spot anything in the above scenario that might be contributing to it or even causing it?


Finally - new noises - do the fade generally speaking or am I stuck with yet another noise?


Thank you.

Allan

UK

 

 

 

Dr. Nagler

Owner
Registered:
Posts: 1,768
 #2 
Hello Allan -

Very sorry to hear of your continued struggles.

I honestly do not know why you might be experiencing this sound or that, nor do I have any way of predicting what will happen in the future - some sounds fade, some do not.

But for a moment, please allow me go back to something you said early in your post.

You wrote:

Unfortunately I have to report my circumstances aren't much better - worse if anything.

What I would like to know is what strategies have you been using over the past couple of months to make your circumstances better? It seems that basically you are "giving it time." Giving it time is not a strategy. Giving it time is what you do to provide the weeks and months necessary for a strategy to work. So please tell me what your goal is in all of this, and how you are going about purposefully achieving that goal. Once I know that, I may have some suggestions for you.

All the best -

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
allancurran

Member
Registered:
Posts: 41
 #3 
Thanks for a quick response Dr Nagler.

Strategies? Predominantly self destructive. I sleep 2 - 4 hours a night (not out of choice, I'm just waking up after that amount of time) which means I'm spending part of the night up in the wee small hours, which is the ideal time for the imp of the mind in the form of anxiety to play havoc (the dark and the quiet play tricks on my mind) which I counter by smoking myself to death with cigars and popping Propranolol, whilst pacing back and forth in my back garden in the freezing cold and rain, like a lunatic.

Depression is managed (not very well I might add) with anti depressants. I did try getting back to the gym but I'm sure the cardio made my tinnitus worse (I do plan to go back and try something else like swimming). I tried mediating in the evening after work but found myself falling asleep and I'm the sort of person if I get 5 minutes snooze I'm re-energized for hours and I'm up all night again.

I'm starting counseling this week and have ENT appointment (where I'm going to ask for a referral to their Tinnitus Clinic)

That's about it. A mass vicious circle. My tinnitus is severe I'd say...loud, piercing, more than one tone, can be heard all day, every day, gets worse as the day progresses.

I'd love to get 6-8 hours sleep again, wake at 6am, go to work and talk about stuff I watched on TV the night before instead of obsessing about tinnitus and praying to God to take me from this mortal coil, but that's what this condition can do to people.


allancurran

Member
Registered:
Posts: 41
 #4 
Sorry...my goal...to have my baseline Tinnitus back and return to my normal self again where Tinnitus was still present, but had no emotional impact on me at all.
Dr. Nagler

Owner
Registered:
Posts: 1,768
 #5 

Wow. There's a lot to unpack in your above two posts.

Perhaps it would be best to take things one-at-a-time.

You know, of course, that tinnitus is the perception of a sound that is not associated with a sound wave. When a very loud external sound causes physical damage to your auditory system (like if you use a jackhammer without ear protection), the damage is actually caused by the mechanical action of the sound wave. Since tinnitus is not associated with a sound wave, no matter how loud your tinnitus might be, it cannot possibly do any physical harm to your auditory system.

Now, in your Post #3 you referred to "what this condition (tinnitus) can do to people." In other words, your tinnitus has considerable power over you. [Anybody who has ever experienced severe intrusive tinnitus will certainly identify with you in that regard.]

So here is my question ...

Since your tinnitus is not associated with a sound wave and therefore cannot possibly cause you any physical harm, where is all the power it has over you coming from?

Stephen M. Nagler, M.D.


__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
allancurran

Member
Registered:
Posts: 41
 #6 

Hi Dr Nagler

Thank you for the response.  I can see where you are heading with your question.

I realise that the power that tinnitus has over me is a choice I am making.  I understand that I am choosing to give it power rather than choosing a different mental approach.  The trouble lies in the fact that I cannot find it in me to accept my tinnitus.

But I'm sure that you more than anyone can understand and appreciate how tinnitus invades and impacts upon our enjoyment of life? Hell....just our ability to sit peacefully and in the moment.

For me when I wake up, I lie there and the first thing I hear is this infernal noise and I think 'Oh no, I have to face another day of this' and the thought of the previous day of struggling to engage with people, be productive at work and appear to be 'normal' comes into my mind and then that's it....I'm set up for another day of internal misery, which, by the end of it, all I want to do is vanish off the face of the planet.  Then at night, I know the next day will be the same.

Its like being in a dark room fumbling around looking for a light switch.  That light switch is a metaphor for that point tinnitus sufferers wants to reach where the tinnitus is no longer an issue, regardless of how loud and intrusive it is.

Its this point that I'd like your guidance on how to reach.  You mentioned strategies.  What mental strategies must I put in place to reach this point?  What should be my belief system? What physical or practical things can I do/try?

When I first got tinnitus 20+ years ago I struggled with the same issue and did the whole vicious circle thing of tinnitus = despair = despair because I have tinnitus = tinnitus is still there = despair, but eventually I reached a point where I just accepted it was there; there was nothing I could do and I just had to grin and bear it.

But this time around I can't find the light switch.  I can't accept it.

Is it just time?  Do I just need to ride it out and wait for that 'light bulb' moments realisation?

Thank you.

 

Allan

 

 

 

 

 

 

Dr. Nagler

Owner
Registered:
Posts: 1,768
 #7 
Quote:
Originally Posted by Allan
I realise that the power that tinnitus has over me is a choice I am making.  I understand that I am choosing to give it power rather than choosing a different mental approach.  The trouble lies in the fact that I cannot find it in me to accept my tinnitus.

I do not believe that you choose to give your tinnitus all this power. The power definitely comes from you, but you give your tinnitus that power unwittingly. That said, you can choose to take that power back, but it's a process. It does not happen all at once. Moreover, I do not believe you have to "accept" your tinnitus to overcome it. I certainly have not accepted mine. I do not want to have tinnitus. Indeed, I'd prefer to never have even heard of the word! Does that sound to you like "accepting" it?

Quote:
But I'm sure that you more than anyone can understand and appreciate how tinnitus invades and impacts upon our enjoyment of life? Hell....just our ability to sit peacefully and in the moment.

I can understand and appreciate your thinking - having been there myself - but that thinking is wrong! The problem, as I see it, is that you are viewing the world through the prism of your tinnitus rather than just viewing the world. That's how it was with me, anyway.

Quote:
For me when I wake up, I lie there and the first thing I hear is this infernal noise and I think 'Oh no, I have to face another day of this' and the thought of the previous day of struggling to engage with people, be productive at work and appear to be 'normal' comes into my mind and then that's it....I'm set up for another day of internal misery, which, by the end of it, all I want to do is vanish off the face of the planet.  Then at night, I know the next day will be the same.

... which is why in my opinion you would greatly benefit from counseling, specifically counseling with a therapist who has a lot of knowledge and experience in assisting others who view the world through the prism of their tinnitus.  

Quote:
Its like being in a dark room fumbling around looking for a light switch.  That light switch is a metaphor for that point tinnitus sufferers wants to reach where the tinnitus is no longer an issue, regardless of how loud and intrusive it is.

I respectfully disagree with your light switch metaphor. This is a process; not an epiphany!

Quote:
Its this point that I'd like your guidance on how to reach.  You mentioned strategies.  What mental strategies must I put in place to reach this point?  What should be my belief system? What physical or practical things can I do/try?

The answer to that question goes beyond the practical limitations of a public forum such as this. I can recommend some articles and a book or two - but I imagine you have already gone that route. That is why in another thread some 15 weeks ago I gave you the names of two specific individuals (a cognitive behavioral therapist and a TRT clinician) in London, which is mere two-and-a-half hours from you by train. They are extremely knowledgeable, highly experienced, and ideally suited to address your needs. Had you followed my suggestion back then, I suspect you would be well on your way by now.

Quote:
When I first got tinnitus 20+ years ago I struggled with the same issue and did the whole vicious circle thing of tinnitus = despair = despair because I have tinnitus = tinnitus is still there = despair, but eventually I reached a point where I just accepted it was there; there was nothing I could do and I just had to grin and bear it.

But this time around I can't find the light switch.  I can't accept it.


Right. You are looking for a light switch that does not exist. That's why you need help!

Quote:
Is it just time?

Is it just a matter of time? No, not in my opinion. What you need is a strategy. Time is not a strategy; time is what is required for a strategy to work! My suggestion remains the same as it was in mid-October. Contact the two individuals in London, see one or both of them for an evaluation (they share an office, I believe), and ask them to assist you in developing and implementing a strategy that will help you overcome your tinnitus.

All the best with it.

Stephen M. Nagler, M.D.


__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
allancurran

Member
Registered:
Posts: 41
 #8 

Thanks for the response Dr Nagler

I opted not to try Dr McKenna because I know someone who sees him once a month and in between each month she has to write down what her thoughts are about T are every hour  and he then points out the catastrophic thinking; the black and white thinking; the fortune telling etc and unfortunately there's nothing new about CBT I don't already know.

I know when my thoughts are falling into one of these categories and even though I know it, it doesn't stop me thinking and feeling that way. 

When I'm in the throws of pacing up and down in my back garden smoking myself to death at 3am thinking 'This will never get better', countering it by saying 'Hang on Alan, that catastrophic thinking that. Is it really true'?  doesn't really do anything to help. 

But if I went to bed at night with the mind-set 'I have T, I don't like it and I'd rather not have it, but its there so I just have to get on with it', then chances are I wouldn't wake in the middle of the night and go into panic mode.

That's not to say CBT wont help others but I've been down that path numerous times.

How do people who have had life changing injuries or disabilities go on to become motivational speakers?  They must reach a point where they accept the situation as is? As you say its a process.

So what's the process? 

Must we all just ride the storm of anxiety and depression for a months or years; running around looking for that magical bullet; going for MRI scans that invariably come up with nothing; meditating; praying to God; crying on our partners laps; stuffing our faces with multivitamins that we read about etc etc etc before we eventually get to the point where we say to ourselves 'I'm sick of hearing myself, I want my life back'.

Or is there a shortcut?

I'm looking into something called Acceptance and Commitment Therapy.  Have you heard of it?  The basis of it is you have a problem, you cant control it; move it or  change it. Its permanent.  So the only option is to move around it.

If it gets me to the point where I can consider my T just part of me and just 'there' I'll let you know.

Best regards

 

Allan

 

 

 

 

Dr. Nagler

Owner
Registered:
Posts: 1,768
 #9 
Hi Allan -

Sorry for taking so long with this response. I wanted to give it some thought.

Please know that what I am about to say comes from a place of caring about you and about your well-being.

First, you write that there is nothing new about CBT that you do not already know. I respectfully disagree. You may understand the principles of CBT, but you do not know how to effectively apply those principles to your advantage:

"I know when my thoughts are falling into one of these categories and even though I know it, it doesn't stop me thinking and feeling that way."

So you are missing the forest for the trees. It is for this reason that I recommended a cognitive behavioral therapist with particular expertise in tinnitus. Laurence McKenna was one that immediately came to mind. Another possibility is Bruce Hubbard in NYC. Dr. Hubbard works via Skype - so distance should not be a problem. Plus, he is experienced in Acceptance and Commitment Therapy, which is something else you asked about.

................

You write:

"How do people who have had life changing injuries or disabilities go on to become motivational speakers?  They must reach a point where they accept the situation as is? As you say its a process. So what's the process?"

and

"Or is there a shortcut?" 

The process is different for everybody, and there are no shortcuts.

...................

"Must we all just ride the storm of anxiety and depression for a months or years;"

No. You treat the anxiety and depression.

................

"running around looking for that magical bullet;"

There are no magic bullets - so running around looking for them is not just a waste of time; it is a prescription for disappointment and frustration. But you keep doing it anyway, which is one of the reasons why I believe you need help.

.................

"going for MRI scans that invariably come up with nothing; meditating; praying to God; crying on our partners laps; stuffing our faces with multivitamins that we read about etc etc etc before we eventually get to the point where we say to ourselves 'I'm sick of hearing myself, I want my life back'."

Allan, you will never get your life back. Severe intrusive tinnitus is a life-altering experience. Your life will never be the same. It can be better than it ever was (mine is!), but for sure it will never be the same.

Would you like a suggestion for something you can do in addition to seeing a therapist with particular knowledge and experience in helping people like you overcome their tinnitus?

Stephen M. Nagler, M.D.


__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
allancurran

Member
Registered:
Posts: 41
 #10 

Hi Dr Nagler

There is a possibility I'm not applying CBT effectively, I can appreciate that.  I guess I'm at a point where CBT no longer appeals to me.  When I first sat in front of a CBT specialist and said something and they pointed out what it was i.e. black & white thinking or whatever, I was impressed when they would point it out.  I had a moments realisation and I looked upon them as deities.

Nowadays I know what type of comment I'm making as I make it.  So I'm hoping ACT will offer me something new.

When I said 'Must we all go through xyz', I was speaking in broad terms and not specifically me.  You only have to scroll through Facebook or TT or any other webpage and its all the same:

'My T does this, does anyone else get this?'
'Has any one tried **insert snake oil of choice here**, and did it help with your T'? etc etc etc

You can plot the path a new T sufferer will take before even they know it.

I know I'm not getting my old life back...I lost that one in 1997, but we keep talking about 'the process' but no-one is defining what that is??

Best I can say is the process is like the grieving process.  We go through a sense of disbelief [how/why has this happened?]; anger [at ourselves for going to that nightclub or at a Doctor for botching that operation]; bitterness [at life for dealing us this card]; upset [tears]; reflection [on our old lives] and then eventually on to gradual acceptance.

What I'm trying to say is I've done this dance already when I first got T in 1997, but after a spike is there a way to skip to the end?  From what you're saying, there doesn't appear to be.

Yes, I would like a to know what I could do in addition that would help.

 

Thanks

 

Allan

 

Dr. Nagler

Owner
Registered:
Posts: 1,768
 #11 

 

Quote:
Originally Posted by Allan
When I said 'Must we all go through xyz', I was speaking in broad terms and not specifically me.  You only have to scroll through Facebook or TT or any other webpage and its all the same:

'My T does this, does anyone else get this?'
'Has any one tried **insert snake oil of choice here**, and did it help with your T'? etc etc etc

You can plot the path a new T sufferer will take before even they know it.


Knowing all about CBT, you certainly realize that your statement above is referred to in CBT parlance as the "Fortune-Teller Error." I am not in any way criticizing FB tinnitus boards or TT, but by their nature they attract individuals who by and large are not doing well with their tinnitus - or they would have no reason to seek out those sites in the first place. So you are concluding what your course will likely be based on the experiences of those who have not done particularly well.

 

Quote:
There is a possibility I'm not applying CBT effectively, I can appreciate that.  I guess I'm at a point where CBT no longer appeals to me.

OK. If I may take the liberty of rephrasing, CBT does not appeal to you not because it doesn't work, but because it doesn't work in those cases where it doesn't work. More specifically, CBT does not appeal to you because it doesn't work (1) for those individuals who have not tried it, (2) for those individuals who have tried it but have not applied the principles correctly, and (3) for those individuals who have tried it and applied the principles properly but for whom it simply doesn't work anyway. In determining that CBT is not for you, what you have not taken into account are the experiences of those who have tried it, who applied the principles properly, and who are totally thrilled with the result. I could be totally wrong here, but strictly from what you have written that's what it looks like to me.

I also gave you the name of a top drawer TRT clinician in London who has tons of experience. Before we go any further, may I ask if you have you ruled out TRT for pretty much the same reasons you have ruled out CBT?

Stephen M. Nagler, M.D.


__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Dr. Nagler

Owner
Registered:
Posts: 1,768
 #12 
Tell you what, Allan. Let’s go about this differently. I feel like I'm confronting you, and that is not my intent.

Try this:

Most tinnitus sufferers have bad days and not-so-bad days. Or even good days.

Please give me one example of what would be a bad day for you. And give me one example of what would be a not-so-bad day (or good) day for you. Then I'll be able to tell you what you can do (in addition to seeing a therapist with particular knowledge and experience in addressing the needs of tinnitus sufferers) to help you overcome your tinnitus.

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
allancurran

Member
Registered:
Posts: 41
 #13 

Sorry for the late response. 

A bad day for me would be a series of consecutive days with loud T; cutting over most things in the environment, except the shower.  I say 'series of consecutive days' because when I have one day when T is loud, I hope the next day will be better.

But when that doesnt happen and the next day is the same, and this happens for a number of days in a row, it eats away at my resolve, gets me down; strung out tired and emotional.

But a bad single day isnt a bad day because it depends on what the previous day was like.  If the previous day was good, I can handle a bad day, but if the day after is bad, and the day after that, then that's when things go down hill.  I'm sure you can appreciate T is emotional and physical vampire.

A good single day for me is when my T is relatively quite, I can still hear it in the background but it isnt the dominant sound I'm hearing.  If the next day is the same then even better.  I then start to feel myself return to 'me' - the 'me' that I am and should be, had I not been afflicted with this condition.

But, we know the raging T is just waiting to come back at you with a vengenance.

 

 

Dr. Nagler

Owner
Registered:
Posts: 1,768
 #14 
Got it.

So earlier in this thread I explained why tinnitus cannot possibly do any physical harm to you and that therefore all of the power tinnitus has over you comes from you. My thinking is that the process of overcoming your tinnitus can be viewed as the process of taking that power back. You did not knowingly give it way, but you can absolutely take it back!

In your post directly above, you essentially equated a good day with a day when your tinnitus is not loud and a bad day with a day when your tinnitus is loud. As I have explained elsewhere, my own tinnitus is incredibly loud - but if you were to ask me to give an example of a good day, I might tell you that it's a day when my daughter calls from NYC just to tell me she loves me, and as an example of a bad day I might tell you that is was the day my father died. In other words, your responses indicate (to me) that you largely view the world through the prism of your tinnitus whereas I view the world through the prism of life.

Now, regarding what you can do on your own (in addition to seeking professional help like we discussed earlier) is to take meaningful, purposeful, practical steps towards viewing the world through the prism of life instead of through the prism of tinnitus. And, viewing the world through the prism of life, the very easiest way to guarantee that tomorrow will be a better day than today is to commit to spending an hour or two devoted to making a difference in the life of somebody less fortunate than you and then keeping that commitment. What will that do for your tinnitus? Absolutely nothing. But what it will do for you is incalculable. Because if you act like you view the world through the prism of life often enough and long enough, you will begin to actually view the world through the prism of life. And in my opinion in so doing you will be overcoming your tinnitus ... because you will be taking back the power you have given it.

When I speak of making a difference in the life of somebody less fortunate than you, I am not speaking of giving to a charity or serving on a committee, although both can be very noble endeavors. No, I am speaking of doing something "hands on" and moreover something that is not currently part of your pattern of activity. Examples would be working a shift in a soup kitchen, helping out in a battered women's shelter, bringing a meal to an invalid through the Meals on Wheels program and actually spending some time with that individual, or perhaps reading to some disadvantaged third-graders in an after-school library program. The possibilities are endless ... and so are the benefits!

All the best -

Stephen M. Nagler, M.D.

__________________

The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
-
David McCullough quoting Wilbur Wright
Previous Topic | Next Topic
Print
Reply

Quick Navigation:

Easily create a Forum Website with Website Toolbox.



Dr. Nagler's Tinnitus Corner is provided for education and information only. It is not intended for the purpose of providing medical care and should in no way substitute for appropriate in-person consultations with qualified healthcare professionals. By using this site, participants agree to hold Dr. Nagler and Atlanta Tinnitus Consultants, LLC harmless with respect to any loss, injury, claim, liability, or damage arising from following the postings herein.