Zoe and Zak's Adventures to meet the PNW Trolls

With my niece, Zoe, at the Fremont Troll

A few months ago, I was scrolling my social media when I came across a post announcing completion of the installation of five Dambo Trolls in Washington. These trolls are large pieces made from recycled materials designed and constructed by Danish artist Thomas Dambo. An unrelated troll has resided in Seattle under the Fremont Bridge since 1990, originally intended to deter homeless people from living in the area, which was a few blocks from my apartment when I moved here. I took many visitors to mee the 18-foot tall Fremont Troll sculpture, but didn't know if trolls had any significance to the area. Washington is more associated with Sasquatch (AKA Big Foot), and my research has shown that trolls aren't really connected to the PNW, but these new masterpieces seemed interesting, so I decided to visit them. 

1990's Troll Toy

I also decided to learn more about the history of these fantasy creatures. I remember liking The BFG (The Big Friendly Giant) by Roald Dahl, who wrote my favorite book, Matilda, but have no recollection of reading tales of trolls. My brother used to have a collection of trolls when we were little, with the famous neon pointed hair and gemstone belly buttons.  Interestingly, those troll toys were invented by a Danish man named Thomas Dam, and these led to the creation of the Trolls movies that star Justin Timberlake and Anna Kendrick. I couldn't figure out if Thomas Dam was related to Thomas Dambo, but those names are way too much of a coincidence if they're not family.

According to Wikipedia, Trolls come from Nordic Folklore and Mythology and the word has a few different possible meanings including fiend, demon, or mythical magician. Trolls typically live in isolation, in forests, mountains, or caves, and Dambo shared that his installations use recycled materials to help the planet and bring people outside to visit nature. He's creating a "bridge between cultural and environmental stewardship." As I read more about trolls, I thought about childhood adventures and fantasy tales, but the isolation so frequently depicted also reminded me of some of my patients with chronic pain. I frequently work with teenagers experiencing chronic pain or illness, and it's common to see them isolate as their condition worsens, transitioning into a period of hibernation.

Zoe and Zak's Pain Hacks

I decided to write about the five trolls along with a review of a new children's book series written by Dr. Joshua Pate, an Australian physiotherapist, called "Zoe and Zak's Pain Hacks." (Link to buy in the US.) Dr. Pate has written a TED talk called "The Mysterious Science of Pain," that's a great five-minute video clip.  

I first learned about Dr. Pate and his work with kids experiencing pain in November 2021. While preparing to give a talk to coworkers at Seattle Children's about treating kids with chronic pain, I couldn't find research indicating what age kids start to understand the pain neuroscience concepts recommended by the Explain Pain Books so frequently shared with adults. I tweeted what I was searching for, and Dr. Rachel Zoffness came to my rescue. 

Not only did Dr. Pate send me a copy of his (soon to be published, now available in a book) chapter called "Developmental Influences on the Meanings of Pain in Children," he offered to meet for a Zoom chat. He was very kind to spend an hour chatting with me about the work he was doing and that he had this series of children's books coming out soon. His research, and there's loads of it!, determined that kids start to understand pain concepts around age 8, and he also explained how he conducted some of his research and some of the interesting things he had discovered. I found his reference to this paper where children were asked to draw whatever the word "pain" made them think of particularly memorable. Dr. Pate found that in his small sample of kids, those who were experiencing chronic pain drew emotional components like a broken heart or tears, which kids who did not have pain did not draw.  

Pia the Peacekeeper

The boxed set of books arrived at my home soon after our call and I read them right away. They're beautiful and fun to read, despite being about pain. I started to write a blog post about them way back then without the trolls, but the post felt like it was just me spitting out pain research and I prefer to write my posts connecting different thoughts, so I stored the books on my shelf, alongside my other fabulous pain nerd books, until the epiphany came to pair the books with the trolls. So here's Zoe and Zak Zoppins on their adventures with me as we met the PNW Dambo Trolls.

The first book in the series is called "Zoe Zoppins Nails It." It tells the story of "A Tale of Two Nails." Zoe's Uncle Ozzie steps on a nail and has intense pain, only to later find out that the nail went between his toes and didn't injure his foot at all. This story is commonly used to show that pain doesn't always equal tissue damage, and the illustrations and rhyming make it easily understood even at a young age.  The first troll we visited was located on Bainbridge Island, across the Puget Sound just a little bit west of Seattle, and is named Pia the Peacekeeper. Located on Salish territory, the Muckleshoot and Snoqualmie tribes collaborated on the development of Pia. These trolls are quite massive, and I had an immense appreciation for the size of their hands and feet. Having Pia hold the book was the best way to demonstrate the scale, but of course my nerd thoughts went to the homunculus and how much sensory input these trolls would have from their massive hands.

Frankie Feetsplinters

Second in the series is "Zoe Zoppins Lights It Up" which is based on this research from Lorimer Moseley, author of the previously mentioned Explain Pain Books and mentor to Dr. Pate. This study examines pain under different contextual circumstances. Zoe is tapped on her hand by a cold metal rod and rates her pain when there is either a blue or a red light shining in the room. When the blue light shines, the pain is less intense, but when the red is illuminated, the pain increases. I wonder if Dr. Pate chose this book to have a blue cover because of the storyline. Similarly, I recently participated in the 30-day course The Embodied Clinician with Sheren Gaulbert who I met at the San Diego Pain Summit. We also discussed the relationship between colors and emotions, so naturally I sought research on this topic and found this paper, which suggests this science is in its infancy, but that red has been studied and found to relate to increased attention and outward focus and potentially has an impact on performance. 

Jakob Two Trees

The second troll I visited was Frankie Feetsplinters who lives in Ballard, a Seattle Neighborhood that houses the Nordic Museum. It makes sence that this would be the location for one of the trolls, as the Nordic countries include Denmark, home of the artist. Frankie was the last of the PNW trolls to be installed and was assembled in West Seattle and transported on a flatbed truck to Ballard. The blue-grey skies of Seattle and the more welcoming pose of this troll were certainly not scary. I've never actually gone into this museum, but I hear great things about it and have tickets to check it out in early 2024. (Seattle pals - you can get free tickets to many museums through your library card or directly through the museum! The Nordic Museum has free tickets on the first Thursday of every month).

"Zoe and Zak's Brainy Adventure" is the third book in the series.  I think the illustrations in this one might be my favorite from the set, though the art is really great for all of them. This story explains the numerous messages that are sent and received when an injury occurs and how quickly they're processed, all contributing to pain which is meant to protect us. In an acute pain situation, the protection from pain is helpful, but in a long-term situation when the pain persists, it can become over-protective. This story shares many Explain Pain concepts, like "Pain does not always mean tissue damage." It uses virtual reality to explore the brain, though it doesn't go into detail about how virtual reality can be used for pain - maybe that will be in the second series if Dr. Pate keeps writing these! The third troll I visited was Jakob Two Trees, located in Issaquah, who is simply magnificent at 14-feet tall. I think Jakob was my favorite troll - a short walk among the trees that protect you from the rain, just like pain is protecting our bodies - but there were SO many people visiting, that it was hard to get a close-up photo. It was really fun meeting others who were Troll Hunting on these adventures. 

Oskar the Bird King

Book number four is "Zak Zoppins Retrains His Brain." Zak is Zoe's cousin who shares that he has back pain while they're playing. They discuss how pain can change and isn't permanent using different strategies such as calm breathing and imagery to re-train the brain when it's used to having pain for too long. This is an important message to use with kids with chronic pain because a lot of the time they're fixated on their pain being permanent and that there isn't any hope for it to get better. They're not yet exposed to slow and steady progress for most things in life and are more immediate in their thought patterns, particularly the younger they are. This book, along with the previous and next ones don't refer to a specific research paper, but rather encompass many studies about pain. If you search for "Retrain Pain," you'll come up with several papers, including an online company, that offers a certification for rehab providers which looks interesting (though I'm not familiar with it, so I can't recomend the program).

The fourth troll was Oskar the Bird King, located on Vashon Island. Oskar was the farthest troll from my house and of course it wasn't raining when I departed, but by the time I arrived, it was POURING. Typical Seattle. Oskar is the most intimidating of the trolls in the PNW, pointing at you and with eyes that seem to follow you no matter where you're standing. He's just as awesome as the others, even with the rain, but I didn't want my book to get wet! It's hard to tell from this photo, but Oskar is wearing a crown of birdhouses and sitting on a throne. There are actually birdhouses near the other trolls and Thomas Dambo's earlier work was to install birdhouses all around Denmark. He uses scraps of material from making the trolls to create the birdhouses and at some of the locations, they are painted and posted to indicate the troll is nearby. 

Bruun Idun with the whole set

The fifth and final book is "Zoe Zoppins' Action-Packed Action Plan." In this story, Zoe shares her action plan to use if she's having pain and applies it to different scenarios, like her belly ache when she's nervous about giving a speech in school or when she gets hurt playing soccer.  It's got some similarities to the previous book in that it's sharing some strategies that might be helpful for a kid experiencing pain and how to try to treat it. I particularly liked the focus on all the different activities that Zoe CAN do, rather than on things she can't because of her pain.  This is an approach I frequently use, encouraging patients to participate in whatever they can, particularly if it's fun, as the activities might help reduce their pain in the long-term. 

And the last troll I visited was Bruun Idun, located in the most scenic setting of the PNW trolls in a coastal spot of Lincoln Park in West Seattle. If you plan to go visit, you could take an easy walk from the parking lot, or you could have no sense of direction like me and turn it into a nice two-mile hike through the woods, culminating in a gorgeous view. Bruun Idun is playing songs for the orca whales living in the nearby Puget Sound. Music is one of the things that I often use with my patients with chronic pain as something to help them move and sometimes even let out their feelings.  We talk about matching music to moods, yelling along with songs that help them let out frustrations or crying along with songs that might also be sad. We talk about trying to go for walks that last the length of their favorite song as a way to incorporate movement throughout their day, potentially including the distraction of pairing it to something more pleasant if the movement is uncomfortable. And sometimes, I give patients the homework of listening to their favorite songs and coming up with lyrics that are positive for them to post around their house as a reminder of better days to try to bring hope and momentary happiness. Everyone could use more joy in their day, but sometimes when kids are sick for so long, it's really hard to find that. 

All in all, it took me three months, four ferry rides, and one very wet outing to complete my visits to all the trolls. Zoe and Zak's tales helped me to think about pain from a different perspective and taking them on adventures helped me to enjoy the PNW in the early part of this year's rainy season. I'm hoping to make a trek down to the Portland, Oregon Troll, Ole Bolle, who is 19 feet tall at some point, but of now, thanks for the good reads, Dr. Pate, and thanks for the beautiful artwork, Mr. Dambo.