Your Health in the Aftermath of the Terrorist Attack

We at the Hospital for Special Surgery extend our deepest sympathy to you for losses of loved ones, or homes. We also know that, even if you weren't among the injured, we have all been traumatized by this terrorist attack. We offer our on-going medical support to you and your loved ones. Please call your physician if you have any concerns for your health at this time. We are here for you. We are dedicated to your health.

What Happens to Us

After initial shock and disbelief, our bodies quickly mobilize forces for self-protection and survival. Our autonomic nervous system takes excellent care of us in crises by putting out adaptive stress hormones, such as cortisol and epinephrine. Our digestion slows. Our cells start storing fat for fuel and energy we may need to survive. Other physical reactions include: rapid heartbeat, increased blood pressure, and increased, usually shallow, breathing.

Almost before we are aware of it, we are ready to fight the problem or flee from it. Some of us "freeze-up" in the first few moments. Some of us may have functional challenges to mobility; so our impulse to fight or flee may be at variance with our ability to do so.

The thinking part of us then gets activated. We try to make sense of what is going on. We try to figure out what we need to do - can do, not do - next. Shock and disbelief give way to gradual understanding and action.

Other reactions may occur in the hours and days that follow, depending on the degree of our exposure to the event or threat -- or on our perception of the danger we may have been in. Some of these reactions may include:

• nervousness,
• being easily startled,
• recurrent memories of images we actually witnessed or have repeatedly seen on the television;
• feelings of being out of our bodies or disconnected to what's around us;
• sleep disturbance;
• bad dreams,
• tearfulness,
• irritability

These are usually normal reactions to an abnormal situation.

We've all heard about Post Traumatic Stress Disorder (PTSD), but that describes a person who, over time, persistently experiences these and other reactions. What most of us are experiencing now are normal reactions to the abnormal situation. Or in some cases, we may be having acute stress reactions -- especially if we were actually in the "front-lines" of the situation or if we perceive that we were in immediate danger of not surviving.

How can we, as people with rheumatalogical and Orthopaedics conditions, cope with the aftermath of the WTC attack? And how can we help our children manage their stress and manage their conditions?

Tips for Coping

Many patients report that stress triggered the start of their disease and is a contributing factor for exacerbations or flares. Also, if you have challenges to mobility, you may have increased fear and stress when faced with the dilemma of having to move yourself or your child with a disability quickly to safety. How can we help ourselves and our children cope with the aftermath of the attack? How can we restore our physical, mental and emotional balance for our health?

1. Please know that the reactions described above are, in most cases, normal reactions to an abnormal situation. Sadness, anxiety, angry feelings, sleeplessness -- even periods of "feeling nothing" -- are usually normal responses to this situation and to the loss of loved ones. If you are feeling overwhelmed emotionally or spiritually or if these reactions persist, please seek assistance from a mental health professional or spiritual advisor. Call your doctor, a local hospital, or your place of worship for assistance.

2. It is healthy to talk with someone you trust about your experiences, responses and feelings during the attack. Talking is very therapeutic. But you need to avoid re-traumatizing yourself. So avoid watching the constantly repeated TV coverage of the tragedy. And avoid constantly and repeatedly reviewing the details with friends and family.

3. Similarly, be careful about what your children hear - from you, from others, and from the TV. Children especially need to be restored to their usual routine as much as possible, including their sense of safety and security from their caregivers. Children know what has happened, and teachers and parents are trying to help them make sense of it. But they don't need to continue to witness the disaster. And they don't need to hear their parents and other caregivers continue to review painful details again and again. Television reports, re-plays, etc., should be limited.

4. The breath can be a key to help balance the autonomic nervous system (our "stress management" center). If you find yourself feeling anxious, or your heartbeat is increased, or you're irritable - take a "breath break". One of our volunteer chaplains, Sister Maureen O'Looney, CSW, teaches a simple technique called "squared breathing."

Imagine a box: 

Imagine slowly breathing up and around the box. On 1, slowly inhale. On 2, hold your breath. On 3, slowly exhale. On 4, rest. This technique will begin to calm you down if you do it at least two (or more) times in succession.

5. Restore routines of daily living! The more quickly you restore your usual daily routines, the better you will manage stress and your disease. Eat regular healthy meals. Drink plenty of water to flush out stress-activated hormones and to restore normal functioning. See your friends. Watch your regular TV shows. If you have trouble sleeping, then just rest, meditate, or pray if that is your custom.

6. Take your medications in the usual way at the usual times. Do not increase or decrease medication doses without checking with your physician! The only exception: if you experience increased symptoms and your physician has previously given you instructions on how to change your dosing in response to such symptoms, then follow the instructions you have been given. If you have not been given such instruction, call your physician if you experience any changes in your condition.

7. Exercise to restore, maintain or increase flexibility and balance. Tai Chi is an excellent form of meditative exercise for mind-body balance. So is yoga modified for your particular condition. At Hospital for Special Surgery, we offer classes in Tai Chi, Yoga, Bio-feedback, Stress Management, Acupuncture, and Medical Massage through our new Integrative Care Center. For information on classes call: (212) 224-7900.

8. If you or your child has a functional disability and/or are wheelchair dependent, alert your neighbors. The media reported many stories of wheelchair-dependent people being carried by co-workers down many, many flights of the WTC to safety. Part of coping is communicating and planning. Post a universal symbol for the disabled on your door in your building. Ask your neighbors and building staff for help before an emergency situation arises. Have a plan - for immediate situations and for a longer term evacuation, if the need arises.

American Psychological Association Websites

Excellent websites are available to help us at this time. We recommend the following sites provided by the credentialed mental health professionals of the American Psychological Association. When you access the website, click on "Public Information." There you will find many sections to help. We especially recommend the following:

• Coping with the Aftermath of a Disaster
• Reactions and Guidelines for Children Following Trauma/Disaster

Getting More Help

Finally, again, please remember that we at the Hospital for Special Surgery offer our on-going medical support to you and your loved ones. If your reactions to this trauma are persistent or you have any concerns for your health at this time, please call your physician for advice. We are here for you. We are dedicated to your health.

posted 10/1/2001