More morning brain boosts

I came to my senses and rode the exercise bike again this a.m., before I did anything else. It’s amazing to me, how much more awake I feel, after I finished my (relatively short) ride.

One of the things about TBI is that it can slow down the brain’s processing. That makes total sense, if the usual connections are sheared and the impulses need to hunt around for other ways to get where they’re going. It’s like the Loma Prieta earthqake in the SF Bay area back in the late 1980s – a former co-worker of mine spent 4 hours trying to get home from work, when the drive usually took them 45 minutes, tops. All the usually routes were washed out or diverted. And when they got home, their apartment was fine and there was no sign of anything having gone wrong… but all the dishes and glasses were lying smashed on the kitchen floor. Apparently, the building had rocked one way far enough to open all the cupboard doors, empty the shelves onto the floor, and then it rocked back and closed all the doors neatly.

I tend to think about TBI the same way — especially Mild TBI. Our world is rocked, and things get broken inside, but then we get rocked back into place, and as far as anyone can tell, we’re just fine. But all our dishes and glasses are lying smashed on the floor — and we have to tread carefully to not cut ourselves.

And the routes our thought processes normally take to get to and from where they’re going are also diverted and changed. So, it takes us longer to get where we’re going.

Absent restoring my brain to its original condition — as if there ever was such a thing, as I’ve been having mild TBIs since I was 7 — I can do some things to help it along.

This morning, I did some of those things — exercised, and then had a big glass of water, ate my breakfast, and took my vitamins. I am religious about breakfast — high fiber cereal with rice milk, a cup of coffee, and a piece of fruit. I’ve really cut back on coffee — I have a mug in the morning and another in the afternoon (no longer the 3-4 big mugs each day). And when I have it, I make a point of eating something while I’m drinking it, so it doesn’t upset my stomach.

This morning, I had a banana with my breakfast. I’ve read that a banana and coffee will help your brain work better. The potassium in the banana helps, and the caffeine helps with the absorption. Or something like that.

I also (amazingly enough) remembered to take my supplements.

• B-Complex for my nerves — very important
• Chromium Picolinate — helps my body manage insulin production and helps with how I use glucose in my system — also very important
• Fish oil from Norwegian salmon — deep sea, algae-fed fish which have lots of good fatty acids and Omega-3’s
• Evening Primrose Oil — for the Omega-6 essential fatty acid gamma linolenic acid (GLA), that is said to “support the body’s heart, nervous, immune and reproductive systems. The GLA contained in Evening Primrose Oil is a nutrient used by the body to maintain healthy cells and vital body functions. Evening Primrose Oil enhances the health and strength of cell membranes throughout the body, and promotes a proper inflammation response. Evening Primrose Oil is also used by the body to maintain healthy hormone levels.” (Note, I’m not including an attribution here, because it comes from a sales site… nevertheless, I think it’s interesting information. If you really want to know what site it comes from, you can Google the above sentences in double-quotes.)

Basically, my morning brain boost is about helping my brain get going in the morning and stay that way. I take the B-Complex to help my nerves, so I don’t get physically taxed by stress, which then fogs my mind. I take the oils for the brain and cellular support, and I take the chromium picolinate to help with how my body handles glucose.

The brain is the Number One consumer of glucose in the body. It needs it to survive — to think properly and to keep its energy level up. There’s good reading over at http://www.fi.edu/learn/brain/carbs.html — I’ll post a tiny bit of it below, but please follow the link to get the whole story.

Brain Energy Demand

Your brain cells need two times more energy than the other cells in your body.

Neurons, the cells that communicate with each other, have a high demand for energy because they’re always in a state of metabolic activity. Even during sleep, neurons are still at work repairing and rebuilding their worn out structural components.

They are manufacturing enzymes and neurotransmitters that must be transported out to the very ends of their– nerve branches, some that can be several inches, or feet, away.

Most demanding of a neuron’s energy, however, are the bioelectric signals responsible for communication throughout the nervous system. This nerve transmission consumes one-half of all the brain’s energy (nearly 10% of the whole body’s energy).

Read More…

Interestingly, one of the points of this web page is that the brain needs carboyhydrates to function properly. It pretty much pointed me away from those low-carb diets that everyone is crazy about. Especially with my head injury history, I’m not going to deprive my brain of its primary source of energy — carbs. I’m just going to be smart about it.

As in, balance my carbs with other things — if I have bread, I’ll have it as part of a sandwich that has plenty of protein and extras on it, like lettuce and tomatoes and other stuff, if possible. If I have crackers, I’ll have an apple (fresh with the skin on) to complement it. And if I’m really craving carbs, that won’t be the only thing I have.

Well, anyway, I have a full day ahead of me, and I’m off to a good start.

It’s wild, how much of a difference just 15 minutes of aerobic exercise helps me. That, and my brain boost breakfast.

Stay strong everyone — and eat right!

A day that didn’t start with exercise…

… sadly did not go well

I decided this morning to forego my 20 minute bike ride and just get on with my day, but I found myself frittering away the hours doing this and that, rather than the project I am tasked with completing.

I also had a major meltdown this afternoon over changes in scheduling and unexpected things I had to do. It wasn’t pretty, and I felt like a complete and utter fool after the fact.

Oh, well. Tomorrow is another day. I’m headed out of town to a family event, which should be interesting. But the long drive there and back will be welcome. It will be good to get out of town for a while.

I’m looking forward to starting fresh in the a.m. Even if I only ride for 15 minutes, at least I can get a jump-start on the day.

On a related note, I came across this blog post the other day — Tired, Stressed, Fat and Depressed: What You Need to Know About Cortisol (New Video) It talks about how the one thing that will help you deal with cortisol is exercise and getting plenty of sleep.

I’d be interested to hear how cortisol and TBI intersect. Surely, there must be information somewhere. For that matter, I’d like to know how TBI and the endocrine system interrelate. I’ve heard that TBI can lead to major endocrine system dysfunction/upset, but it’s not widely known or understood.

Makes sense to me — the glands in the brain (and elsewhere) that produce all those chemicals must be pretty finely tuned (for example, the thyroid drives the whole body’s metabolic system on about a teaspon of its hormone each year — yes, a teaspoon-full of TSH does the trick for the entire body)… so if the brain’s finely interconnected circuits are re-routed, surely it must do something to the overall functioning.

Or maybe I’m crazy… being an undereducated lay-person, after all. I’m sure there are plenty of experts out there who can tell me/you better and/or different. But common sense tells me there must be a connection.

Anyway, it’s getting late (for me), and I need to get ready for this big trip. I just hope I’ll be able to sleep. I’ll have to see if the motel I’m staying at has an exercise bike and/or gym. Here’s hoping…

My early-morning brain treatment

A few days back, I was mulling my morning routine and how to fix it. I tend to wake up aroung 5-6 a.m., which gives me an early start on the day. I often jump out of bed with lots of energy and feeling like I’m rarin’ to go. But then I usually get bogged down in some activity or another — checking email or writing or fiddling with some piece of information. I might wake up early, but I end up running late. And although I have lots of physical energy, I rarely feel mentally awake until much later in the day… sometimes not till 3 p.m. Not feeling mentally awake makes it difficult to get into the day, let alone enjoy my life as it comes.

I don’t much care for the feeling of a foggy head, first thing in the morning. It’s a part of my life that I guess I have to accept on some level, as my brain has been rewired to move more slowly than I’d like. But I really don’t care for  it, mentally or logistically. My team at work has a status meeting first thing each Monday a.m., and for the past couple of months, I’ve been either late or too rushed to prepare properly. That’s a lousy way to start a Monday. It has a crappy snowball effect on the rest of my day. And the rest of the week.

This will never do. I mean, honestly… it’s just embarrassing. For months on end, I’ve been trying to get to work early in the morning, on Mondays and beyond. No go. And work isn’t the only place this is a problem. For weeks on end, I’d been trying to get some very basic stuff done — contact the insurance companies who are handling my fender-bender from June (yes, it happened over a month ago, and as of two days ago, I had yet to finish the paperwork), give certain parts of the house a long-overdue scrubbing, take the trash to the dump, mow the lawn, and so forth. A collection of standard-issue weekend tasks and some extra outstanding things needed to be done — they’re not optional — but they have gone undone. Like I said, this will never do.

So, yesterday I told myself enough was enough, and I decided to try something different… something I have been meaning to do for many, many months. I decided to exercise first thing in the morning when I got up. Not after I had my cup of coffee. Not after I had my cereal and fruit. But first thing. Being somewhat neurotic about getting my coffee first thing, I promised myself I would at least put the kettle on before I started my workout. I promised myself I would turn the stove on medium, then exercise while I was waiting for my coffee water to boil. And (hopefully) to make getting my day under control a little easier, I decided I would devote the 20-30 minutes of my workout to thinking about what I had to get done that day… Thinking through the stuff on my to-do list, planning how I would get it all done that day. Basically mapping out my day.

I was skeptical, at first, thinking that getting on the exercise bike was going to be boring and drab and monotonous. But you know what? While I was pedaling away, my mind was waking up and getting into the day. While I was pedaling, I was going over the things I needed to do — things I didn’t really look forward to doing, like fill out paperwork, but had to be done. I thought through the act of doing each thing.

I thought about my paperwork — how I would take it step-by-step, first getting out the forms, double-checking the info there, filling in what was missing, making copies, signing them, adding a cover letter, and mailing them out.

I thought about my morning chores — cleaning and taking out trash and running to the store to pick up food for the dinner party we were having last night. I walked myself through each of the things I was supposed to do — and I threw in a nap for good measure. Pedaling and pedaling, I found myself not at all bored, but actually quite energized. And you know what? My brain was thinking better, first thing in the morning, than it had in quite some time.

By the time I got off the bike, I not only had a plan for my day, but I had thoroughly visualized overcoming all the tricky pieces that I thought might keep me from succeeding. I had a visual of my to-do list in the back of my head, and I had “road map” for all the different pieces of my day. I had effectively “choreographed” my day so that I had a pretty good idea what I could expect to get done (and what wasn’t going to get done), and I had a pretty good idea how I was going to handle things, when they came up. I had a common-sense plan for what order to do things in — do the messy chores before I took my shower, and then take a nap after my shower (hot showers always relax me and make me sleepy)… and wake up refreshed and with all my chores done before company came for dinner.

And you know what? It worked. After I got off the bike, I actually felt energized and awake. That’s rare. The blood pumping and the sweat I’d worked up, really cleared my mind. And as I got into my day, I found that I was able to not only get the really critical things done, but I managed to quickly take care of a few jobs I usually do at a fairly leisurely pace on Sunday mornings. That meant that I gave myself Sunday morning off, ahead of time… which meant that I could relax with our company on Saturday night, and not fret about staying up later than I would normally. My Sunday morning tasks were already done, so I would have more time to rest and relax, if I needed a Sunday afternoon nap (which I usually do).

All this, because I got on the bike and rode, first thing in the a.m., with the express intention of planning my day. Not only did I finally manage to exercise, first thing in the morning — which I’ve been trying to do for many months — but I also took command of my day — and my life. The exercise helped oxygenate my brain and it helped focus the kinetic energy I have in the a.m. into something I could use, that served me well.

For good measure, I did it again today. Once more, I felt myself waking up more, feeling clearer, and able to handle my morning tasks better than usual.  Something so simple — 20-30 minutes of aerobic exercise (I do work up a sweat and get my heart beating faster) — makes a huge difference.

Best of all, I don’t have to stop my life completely to do it. Years ago, when I was working out regularly, I used to have to completely halt all my activity to go to the gym or go for a run. That was fine then, when I didn’t have as many responsibilities as I do now, but nowadays I’ve got so much going on, that just stopping everything to exercise isn’t an attractive option. But now my morning exercise bike ride can be part of my active life, part of my day, part of my “personal planning and strategy sessions” that help me live my life that much better.

I’m sure it sounds elementary to some people, and there are plenty of folks who already know this. But this “discovery” that I don’t have to halt my life and stop everything I’m doing to fit in exercise, and that the exercise actually adds to my productivity (rather than takes away from it), is something I’m really reveling in. It is good.

Or, perhaps more accurately, can LIVES be saved?

I had some feedback from one of my posts yesterday about Bob Woodruff’s recovery from TBI.

I didn’t like the article at all – in fact I felt it did a HUGE disservice to brain injury and rehab – it gave the impression that there were these wonderful cognitive programs that could restore people to their regular functioning in a relative reasonable period of time, that these services could be tailored to everyone’s particular needs, and that so much has changed that brain injury is ‘curable’.

The reality:

The is little funding still for most services, most insurance plans cover very little especially in cog rehab – which may be needed for years to be helpful.

Recovery of any kind is YEARS – not months, not a year or two but YEARS.

There are no miracle programs – this is slogging through a lot of really frustrating activity, going round in circles, making mistakes over and over and over, training yourself to be disciplined about organization, planning, memory skills, rethinking your life career etc

While  I appreciate the Woodruffs bringing attention to the issue Bob Woodruff got top ranked care – the vast majority of people DO NOT receive ANYTHING like that – they may get a few months of cog rehab, some PT, and a year of neuropsychological counseling. The existing services for TBI are terrible, un-coordinated, cookie-cutter, short term, and severely underfunded. 90% of the survivors DO NOT get any thing that is customized – most do not get even half of what they need that would truly empower them and enable them to have productive lives with true quality of life
VERY little is still understood about tbi – especially mild tbi. There are probably many many people who have TBI’s and don’t recognize it as such – they are just considered ‘moody’ or easily distractible or have other issues in relationships etc. We know virtually nothing about how the brain works and organizes data, repairs itself or re-organizes after a trauma. Much much more research and money is needed to allow professionals  to understand tbi, provide better tools for helping people recover (whatever that may mean), better ways to diagnose and to eliminate the stigma involved. 80% of tbi survivors do not recover their previous employment levels, and equal numbers experience loss of spouse, family and or friends, NO ONE wants to tell a prospective employer they are a survivor. Most tbi survivors do not write books or go on tours or have understanding supports – they end up financially destitute or in severely reduced circumstances, alone, struggling and often develop addictions as a result.

The article presented a rosy cheery picture of tbi – just like having a hip replacement  – tbi is a life-changing event and is underfunded and not understood. there are no ideal treatments and many people end up overdrugged – even by the ‘professionals’. I get frustrated by such articles because they mislead.

Some folks in advocacy agree with me and others don’t. Some feel that any attention  to TBI is helpful and that at least by making it less strange it encourages people to accept that many people do have tbi’s and are ‘normal’.  So I admit that my opinion is not universal. I will also say that this was the second brain injury article by that paper that focused on a well-connected individual who got amazing health care – and in this other case that person did make a phenomenal recovery – again, the kind of recovery that 99% of tbi’s do not make. So some of my frustration is also based on that. I would love to see a “Ordinary Jane or Joe has a tbi” story – and what it means to lose your career, to lose your home, to have a changed marriage, to try and re-create a self, to have 3 months of cog rehab and told you are ‘fixed’ because your insurance ran out – to struggle in school, at work, to lose your job – all these things that are what happen to most Americans – including our Vets.

Healthcare is a critical issue in this country and tbi is part of that. It will be ignored and forgotten if the true loss of lack of care is not made clear.

You know… it’s true. The vast majority of us who sustain these types of injuries never get the help we need — many of us never even realize we need it… until too late (or almost). Personally, I consider myself extremely fortunate to have put two and two together before everything fell apart for good. I was awfully close to the edge, now that I think of it. I dodged a bullet. And I am incredibly grateful for the combination of fate, the world wide web, and my local Brain Injury Association chapter, for helping me put this together… as well as to my various therapists and friends and strangers who had the right info at the right time, who kept me from tripping and tipping over that very precipitous edge.

Not all are as lucky. And I have been lucky. I am very much aware that I could easily have ended up in much tougher straits than I am, right now. It was almost a fluke, that I even got a clue that I needed help. And while I have had to work my ever-loving ass off to get the help I need, and it feels like it’s been a long time coming, and I still have a long way to go, at least I have had the personal resources to launch into this quest for clues.

A lot of others don’t. They just get lost. Pushed to the margins. Out of sight, out of mind, out of luck.

I hate to say it (and I’ve felt a bit guilty about thinking this), but I’ve never been that comfortable with Bob Woodruff’s story and the way he’s been portrayed as a kind of “poster child” for TBI recovery. It’s like they’re not telling us the whole story — like how he really is at home, what his moods are like, what his interpersonal skills are like, what his memory is like.  He’s an attractive public mainstream figure, who has received the best treatment possible and works in a field where his performance is not only scripted beforehand, but edited between the time he does it and when it is aired to the rest of the world.

I’m reluctant to say any more about him, because I am not thoroughly familiar with his work, and what I’ve seen of him has been positive. No-way, no-how do I begrudge the man his recovery or his restoration to broadcasting work. He’s covering some really important stories that I enjoy watching. But I wonder how much similarity his experience actually bears to my reality. Or to the reality of countless other tbi folks. I wonder how his irritability/anger management is, if he has constant ringing in his ears or constant headaches or other chronic pains. I wonder what truly goes on in the privacy of his own home, where no cameras are rolling and no editors are deleting the segments where he’s struggling to find the right word or remember what he was going to do when he walked into the next room. I wonder what his life is really like.

One of the things that I think may have helped him get back to work, is the fact that he works in broadcasting. Being involved in broadcasting, myself, I know how helpful it is to have a script to go by, when you’re doing your job. I often create and use “scripts” in other situations, like when I go on job interviews, or I am leading a meeting and following an agenda very closely. Having a scripted line of work (or work that follows specific guidelines, like strict meeting agendas, or has a heavily-project-managed element to it) makes getting back to work — and re-integrating into society post-injury — a lot more straightforward, in my mind.

It’s never easy, of  course, but if you know what you’re going to say and do ahead of time, and you have ample opportunity to practice, and you don’t have to be “on” for more than the length of the take/recording… and you get to edit out the parts of your performance which aren’t that flattering… well, I can see how you could present a really excellent picture of miraculously restored health after what was supposed to be a fatal accident that would — at best — leave you a vegetable.

Thinking back to the positive tbi-is-fixable article in Parade, I’m struck by the emphasis on the idea that outside therapies are capable of restoring functionality post-tbi. I don’t doubt that having someone work with you can be of tremendous help, but from what I’ve seen and experienced, what you do for yourself, with yourself, by yourself, can be a critical factor in the degree of your success.  Of course, it is important to get outside help — especially from trained professionals who have made the study and treatment of tbi their life’s work. But I also agree with the Give Back Orlando materials about outside therapy only going so far — at some point, the insurance gives out or the prescribed treatment runs is course, or therapy is no longer available or an option for you.  You then have to step in and run things for yourself, or you’re just not going to get that far. Reading about long-term efffects of TBI, what I’m struck by is that folks may improve over the first several years post-injury… but look at them 10-20 years later, and sometimes they’re really struggling. I think the critical piece in this is self-reliance and the ability to do self-therapy.

Personally, I suspect that my own self-reliance has been the secret to my repeated recoveries over the years — never having any help, and being forced to fend for myself. Not that I had any choice, mind you. My first injury was 36 years ago, and nobody had a friggin’ clue about mild tbi, back then. A year after that, when I had another more significant injury, it was worse, but not bad enough to send me to the hospital, and they probably would have just sent me home again, anyway. I’ve been hit on the head, fallen down stairs, fallen out of a tree, been hit from behind in several different cars, and I’ve had my bell rung more than once while playing contact sports, over the past 36 years. If anyone should be marginally functional and struggling in vain with basic stuff, it would be me.

But I’m not.  I do struggle terribly at times, and I do have some pretty problematic issues, but I usually manage to figure a way out of my predicament… eventually. I’m not destitute, and all my friends and family haven’t fled from me. I am not homeless, I am not out of work, I am not that terribly marginal — except to the degree I pull myself out of the mainstream frenzy to keep my balance and sanity. Best of all, I am not in jail (granted, I dodged the bullet of arrest a bunch of times, but hey – at least I dodged it, right?) Given just slightly different reactions and choices in many of my life experiences, I could easily have ended up in an institution of one kind or another. My own parents tried to get me committed due to my “inexplicable” behavior, about 20 years ago. It didn’t work, I’m happy to report.

Maybe I’m just too stubborn and too averse to acting/living/thinking like someone who’s brain-damaged. Maybe I’m too proud to give in. Maybe I like having a regular life too danged much to let go. Whatever the reason, I’ve been self-reliant and headstrong and stubborn from the start, and I credit my tenacity and determination to just keep going, regardless of whatever the heck life throws at me, with keeping me in the game.

Now, I wouldn’t recommend following my tumultous loner’s path to anyone — tho’ a lot of us are in this “boat”. It’s lonely and confusing and confounding and can drive you half mad. It can also really piss off everyone around you and cost you jobs and friends and family, and you have to work twice as hard after the fact to fix things up again. But at the same time, a lonely, isolated path forces you to develop a self-sufficiency and skills that you might not have to, if someone else were standing by your side, walking you through everything, checking in with you regularly, and keeping you on track.

It’s kind of like that “restraint” training that some stroke survivors do — to train the hand/arm/fingers on their impaired side to function again, they tie down the arm on their able side, so they’re forced to use the impaired side. And they can progress at rates quicker than those who don’t use this technique. I’m not sure if I even have a lot of “un-hurt” parts of myself to tie down. I’ve been pretty roughed up, over the years. But I’ve forced the broken parts of me to keep going, regardless, and it’s paid off.

That being said, what I think helps me the most as a long-term multiple mild tbi survivor who is not just surviving, but thriving, is:

• keeping my spirits up,
• staying intensely interested in all of life around me,
• staying positive and solutions-oriented, and
• having plenty of access to quality information — both from the internet and neuropsychologists who are available to me.

I wish to high heaven there were head-injury-aware neurologists who were freely available to chat with the tbi survivor population — maybe I’ll check with my local BIA chapter to see if they know of any — because I’d love to be able to ask them a bunch of questions about brain function (particularly mine) without needing to clear it with my insurance company. I need information. I thrive on it. Even if I don’t understand every little bit of it, and there are pieces that get lost along the way, still… it gives me a general orientation in how to live my life. And that helps. I need information to save my life. Literally.

That’s what it really boils down to, I guess — not so much about saving my brain, as saving my life. Sure, of course, I want to save my brain, but there is much more to me than what’s between my ears. There’s what’s in my heart — and in my gut. There’s what is in my spirit, as well as the sum total of my past experiences and all the invaluable lessons that have come from that. My brain may have issues that need to be dealt with, but ultimately, there’s a whole lot more to me than just gray and white matter segmented into various lobes and cortexes (or is it “cortices?”). There’s a whole person in here, with a lot more going on than the electrical impulses and connections between synapses and neurons and dendrites and whatever else is up there (that they know about or haven’t discovered yet, which I suspect is a lot).

And I think that’s also what gets lost, a lot of times, when people deal with TBI. They are so focused on the brain, on the individual functions of the brain that need to be restored or changed or compensated for, or whatever, that they can lose sight of the rest of themselves that is so very vital in dealing with their new brain, their new personality, their new self. The old brain is gone. The old self is gone. It’s not coming back. It can be a terrible loss, and it does need to be recognized and grieved. But at some point, you’ve got to let go of the idea that things can be the way they were before. They can’t. You may be able to get back to a semblance of your former functioning, but the old ways of doing things are gone-baby-gone. It’s a tragedy. There’s no two ways around it.

But that’s not the end of the story. The good news is that for every old way that’s gone, there are lots of new ones waiting to be discovered and developed. The brain is an awfully big place (its size notwithstanding) with a wide, wide world of possibilities. The human spirit is enormous, with more capabilities than we can ever imagine. The body is also capable of incredible changes and adaptations that can compensate for plenty of problems. I’m not trying to make light of tragedy and loss, or make it out to be less serious than it is. It is serious stuff. And it is a terrible, terrible thing when it happens. But there is a whole lot more to us, than we can ever imagine.

And until we put our minds to it, we can never begin to find out just how much is in there.

So, while I do often wonder if brains can be saved, I’m ultimately much more interested in how lives can be saved. It’s not always about what’s in our heads that counts in life — it’s what’s in our hearts.

Can Brains Be Saved?

A great positive-spin tbi piece in Parade Magazine by Lee Woodruff. It’s about a year old, but it’s still a good thought-provoking read…

September 6, 2008, was a clear-blue Indian summer day in Nebraska. Jennifer Ruth sat in the stands and watched her 12-year-old son, Derek, run with the football. She was unconcerned when he was tackled in a routine play. But as he fumbled the ball, she remembers seeing his right arm drop oddly, almost in slow motion. “He never does that” flickered through her mind. The coach noticed a glazed look on Derek’s face in the team huddle. He pulled him aside and asked him for the date, score, and his brothers’ names. Derek answered correctly. Then, minutes later, he screamed, “My head,” pulled off his helmet, and collapsed.

Derek was taken to a trauma center and went into surgery. After several weeks in the ICU and months of therapy, he is regaining his physical and cognitive abilities. At first, he could only give a thumbs-up or thumbs-down response to questions; now he reads at a sixth-grade level and tackles algebra problems.

A decade ago, Derek’s prognosis might not have been hopeful. But thanks to advances in the treatment of traumatic brain injury (TBI), the outlook for patients has dramatically improved. “ Research points to the amazing regenerative powers locked in our brains,” says Dr. Col. Rocco Armonda, senior Army neurosurgeon at Walter Reed Army Medical Center in Washington and at Bethesda Naval Hospital in Maryland. “The proper therapies can help with the unlocking.”

Read more >>

An attitude of gratitude

I’m feeling incredibly grateful today. And it is good.

To all appearances, I shouldn’t be quite this happy. The weather has turned ugly again, and it’s looking a lot more like November than July, right now. I have had to really work at keeping up with my workload, lately, and I have this sneaking suspicion that I’m falling behind on something… though I’m not sure what that is. My schedule has  been kind of up in the air, with different appointments coming up that need to be dealt with, a fender-bender that has been followed by messed-up paperwork… and my regular life still needs to be tended to, as usual. Laundry has to be done. The lawn needs to be mowed. On any one given regular day, I can do some if not most of it, but lately – with all the excitement – I’ve been doing less than I feel I should. And I’ve been feeling like I’m falling behind.

Still, today I’m feeling great and very hopeful. It’s like something has taken a turn for the better, and I have yet to find out what that is. There’s a whole world of possibility out there waiting for me, and I can’t see why I shouldn’t be able to enjoy myself while I’m finding out what that is.

The feeling started yesterday, as I was driving around running an errand. I was thinking about all the crap stuff I have to do, trying to figure out how I was going to do it and get a nap in (I never got the nap). I was feeling pretty hassled and harried and I wasn’t having fun. But in the midst of my dissatisfied reverie, I was interrupted by the thought,

“Nobody is making you feel bad. Nobody is making you feel any way. Yes, you’ve got plenty of logistical concerns and things aren’t easy right now, but it’s your choice how you feel about it all. You can either get your knickers in a bunch over what’s wrong, or you can be grateful that your life is complete enough and you are functional enough that you can have these “problems.” A lot of people aren’t. And you didn’t used to be. If you weren’t doing this well, you wouldn’t get to experience this level of complication and irritation. And frankly, it’s a very good sign that you do.”

That snapped me out of it. Got me right off the proverbial pity-pot. Three years ago, I wasn’t able to deal with all the wrinkles in days like I have now. I wasn’t able to hold down a full-time job that places extra demands on my time management skills with its telecommuting aspects. I wasn’t able to hold down a job, period. I wasn’t able to hold a civil conversation with someone for longer than 15 minutes, and I wasn’t able to manage my money effectively. I wasn’t able to communicate with my spouse or take good care of my house and my yard. I was “functional” only because I had worked so hard over the years before to build up a lot of supports that were able to prop me up when I was in a bad place. They propped me up, but they also wore out and went away. The money. The job. The friends. The peace and stability in my home.

It’s taken a lot of hard work to get back to a place where I have at least some of those things back. It’s taken a lot of hard work to get to a place where I am once again able to maintain the life that I desire. It hasn’t been easy, but it’s been possible. And it is good.

And for that, I am very, very grateful.

In praise of shape and color

I’ve been experimenting with better ways to keep myself organized throughout my days and weeks. I have always had problems with losing track of what I was working on, forgetting what I was supposed to do next, whether it was from hour to hour or from day to day. When I was a kid, it brought me all sorts of grief because people thought I was just lazy or not trying hard enough. When I grew up, it continued to be a problem, only on a much larger scale.

Forgetting to finish cleaning the bathroom sink during Saturday morning chores, or forgetting to finish sweeping the neighbor’s driveway when they’ve hired you to do the job is bad enough. But forgetting what you’re working on, from day to day, at a full-time job, and losing track of projects you’re responsible for… well, that’s an issue of a much higher order.

I have hassled and struggled with this for many years. When I was younger and just starting out in the working world, I found myself essentially unable to hold down a “real job” for longer than a year or so. I could keep up for a while — maybe six months or so — then I would start to forget things, start to misplace things, start to get turned around, and the downward slide would start.

I’d begin to withdraw from the people around me, confused about what the nature of my issues was, unsure about how to deal with them… thinking I was losing my mind or something like that. I’d get increasingly uncomfortable around other people and I’d start to say things that were unkind or impolitic, and slowly but surely alienate even my closest allies. Eventually, the situation would deteriorate (in my mind, as well as in reality) to the point where I just couldn’t stay anymore, and I’d start looking for another job.

Ultimately, I figured that I was much better off just temping, taking on enough short-term assignments to fill my week and pay my bills. So, I signed up with a bunch of different agencies who had enough work to keep me busy (I was living in a big city at the time), and I managed to not only keep my head above water, but pay for a really nice place to live in a really good neighborhood.

Eventually, I did have to branch out and find permanent work. I needed the benefits, and I got tired of being a vagabond. I’ve done really well for myself, and people who know my history are amazed at my ability to get by as well as I have.

One thing that’s constantly dogged me, though — and that I’ve constantly struggled with — is this memory business. Losing track of what I’m supposed to be working on, and keeping on schedule for getting it done. Early in my high tech career, when I was just starting out, keeping to the project plan wasn’t a problem — someone else was in charge of making sure I was keeping on track, namely the project managers. But now that I’m at a more advanced stage of my professional life, and now that the industry has changed (to move away from having distinct project managers on every project), I find myself tasked more and more with the responsibility of tracking my own projects, setting my own priorities, and keeping myself on schedule.

I’ve really been struggling with this aspect of my work for some time, and over the past six months, the problem has been even more pronounced, as my new job is a whole lot more stressful and high-demand than my previous one.

In my previous job, nobody was paying particularly close attention to what was going on, there was no great sense of urgency, and the general attitude about tasks was, “Oh, whenever you can get to it, that will be great.” Now, things are completely different. There’s very high demand, high expectations, and there are no excuses allowed.

Talk about sweating bullets. I’ve tried a bunch of different techniques over the years to keep myself on track – list-keeping of many kinds, whether in spiral-bound notebooks or on stickie notes in my daily minder…  specially designed forms for lists of things I need to do, all broken out by category and time of day I need to do them… recording everything in my Outlook calendar at work… putting reminders in my personal online calendar (which doesn’t work so great, anymore, as I can’t access my personal email/calendar from the office)… leaving notes in prominent places so I won’t forget them… keeping journal entries about what I have done, haven’t gotten done, and what is keeping me from finishing what I started. But lately, my systems have broken down — they’re just too clunky and for some reason, they just don’t work with me, anymore.

After experimenting with this for years, and I was about to give up and just surrender to the fact that I’m going to be behind the eight-ball for the rest of my born days, always scrambling and playing catch-up. But then, on a whim, I tried something different the other day. I started using colored images in my daily planner to prompt me about priorities and my status.

I went online and found some images of red and green and yellow arrows and x’es and other little colorful symbols that meant something to me, and I started inserting them in my to-d0 list for the day. As the day progressed, I kept updating my list as I went, replacing the yellow arrow (for “in progress”) with green check marks or red x’es for “success” or “failure”. I also started color-coding my priorites — red bold for HIGH/Mandatory, green for Medium/Important, and blue for Low/Optional.

And it worked! Lo and behold, by the end of the day, I had tracked 17 different necessary tasks (for my job — I have a lot of responsibility), out which 11 were successfully completed, 2 were incomplete, 1 was delayed, and 3 were failures that I needed to try again the next day to do. The beauty part was, I printed out my list and took it with me at the end of the day, and when the next morning rolled around, I had an easy-to-read list of things I had not gotten done the day before that I absolutely positively needed to get done.

Resuming tasks I neglected to finish has been an ongoing struggle with me.  I’m usually at my cognitive and motivational peak, starting at 3:30 p.m., which leaves practically a whole day of ennui, disaffection, and relative cluelessness to contend with, while tasks like on the to-do pile, mouldering away. Many times, I’ve only started to recall that I needed to resume a certain task towards the end of the day, not first thing… when the window of opportunity is that much smaller and that much harder to fit into.

Of all the issues I’ve had with time and energy management, this has probably been the biggest one, and I’ve never been able to figure out how to assist myself and my easily distracted attention.

Until now.

Now, I wake up and can glance quickly at my list to see what I didn’t get done the day before. I can see what the priorities are, and how they match up with the status of my tasks. Is there something that was urgent yesterday that didn’t get done? If so, I put it at the top of my list for the day… and then I track my success with getting it done. The system is simple, easy to read, it’s complete (as I keep important notes), and it’s not just a sheet of words lulling me into a trance as my eyes drift from line to line to line.

This is huge. This is good. What a relief, to have found something that really works… for once.

Getting beyond the broken to find the brilliant

I’ve been pondering a lot of stuff, lately… Going through the motions of my days, trying to see where things are working well, and how they’re working well… Doing inventories of my strengths along with my challenges, so that I can “map” my strengths to my issues and so find solutions to long-standing problems.

I’m working with my diagnostic neuropsych to identify the issues that were called out in my testing — in particular, issues with compromised attention, my difficulties understanding what’s going on at a given point in time (and which parts of that action really matter), as well as communication skills. It’s been pretty humbling, to sit there and find out that all is not as well with me, as I thought for so long.

Now, I have traditionally thought of myself as a fluent speaker and writer, but the more closely I look at my style of writing and speaking — especially when under pressure — the more I can see places where I could really use an overhaul of my skills. When I’m just chatting with someone or I’m blogging away, I do just fine and dandy. But in professional situations, or in situations which call for deliberate focus and economy, well, I’m kinda lost. I tend to ramble, throw out odd details, get sidetracked on tangents, and generally take a very winding, circuitous route to where I’m going… if I get there at all. I often get lost in the course of a conversation, and then I just let it drop. Like a rock. It’s a bit uncomfortable for people I’m talking to, I have observed, but I haven’t really known what — if anything — I could do about it. I didn’t understand the nature of my problems, and I certainly couldn’t figure out how to fix them.

It’s so strange to realize this now. Nobody ever really called me on my communication issues before. Maybe nobody noticed, so long as I was fun to talk to and my writing was entertaining. Or they didn’t want to put me on the spot and make me feel nervous or self-conscious. But now I have regular appointments with a trained professional whose judgment I trust, who’s calling out specific instances where my situation assessment and communication skills are a whole lot less intact that I’d like to think they are. And I can start to address them… and allow myself to feel nervous and self-conscious with someone who doesn’t judge or think less of me… until I figure out a better way to do things.

I have also never given much extended thought to my difficulties assessing the salient points of a passage I read in a book, or a scene I watch in a movie, or interpersonal dynamics taking place near or around me. I freely admit that when it comes to social interaction, I’m often in the dark and I take my cues and clues off others. And when I watch movies, I don’t always follow what’s going on (that’s why I always watch with other people — so I can pick up from them what is supposedly happening). And when I read a passage in a book and discuss it with someone, I often find that I don’t understand it the same way others do. Or I’ll go back to it later and realize I didn’t pick up some of the important points, the first time through.

All these things were just stuff I took in stride, over the years. I never gave much thought to them — perhaps because getting into it would have been upsetting and distressing for me… perhaps because almost nobody else ever made an issue of it, and when they did (some of my teachers over the years), I frankly wasn’t following what they were saying, so I ignored them.

It’s quite easy to ignore people you distrust and cannot understand — like most of of the authority figures I’ve known in my life.

So, I went about my business largely untroubled by criticisms from outside my head… tho’ inside my head, I had more than enough, thank you very much.

Anyway, now I’m looking at my real issues with someone who has a clue about them — what they are, what they’re about, and what (if anything) to do about them. And this person is also keenly focused on helping people be the best they can be, regardless of their history and limitations. We’re on the same wavelength, I do believe — both of us are convinced that people are capable of much more than they think they are. And I have this person’s help in addressing my broken parts, to get to the brilliance.

People tell me, “Don’t pay too much attention to what’s wrong… You might get depressed.”

Possibly. But it’s a whole lot more depressing to have all these issues — and never fully realize the nature of them. Or to muddle through life, wading through sludge, when you don’t even realize that you’re up to your thighs in muck.

Personally, I’d rather know what’s “wrong” — that way I can do something about it. You can’t fix something if you don’t know it’s broken. And if you never make an attempt to fix it, you may never find out just who you are and what you’re made of.

Being broken can’t keep you from being brilliant. It just makes the expression of that brilliance a little more … indirect. A lot more challenging. But ultimately, perhaps, a lot more rewarding, than if it all came quite easily to you.

Onward

Harnessing the force of habit

I’ve been giving a lot of thought, lately, to how I’ve managed to make my way in the world and do such a damned good job of it (if I say so myself). Despite a bunch of MTBI’s (some of which have nearly wrecked me) I’ve somehow figured out how to get on with my life and rebound after the fact. I know that people do recover from TBI, but so much of the literature I’ve read talks about how they just never get back to where they were before. I hear people talking about it, too, and to be honest, it can be a real downer at times. My heart just goes out to folks who get lost along the way and don’t have any help finding their way back.

I can definitely tell that I haven’t gotten back to where I was before my last accident in 2004. My thought process has slowed considerably, and my memory leaves a lot to be desired. My moods are more intense and precipitous, and my tendency to lash out verbally has amped up a lot more than I like.

Yet, it hasn’t totally devastated me. It’s come close, a couple of times, but I’ve managed to pretty much maintain my standard of living and not lose so much of what I worked hard to build up. Okay, I’ve parted with hundreds of thousands of dollars in record time — and after I worked my ass off to earn every penny(!) — but I haven’t lost my house, I haven’t been put out on the street, my cars haven’t been repossessed, and despite having a 5-3 ARM on my house, I am managing to keep up with my house payments. (It helps that  I made sure I had a 2% cap on the amount my mortgage could increase with each adjustment period, and I made damned sure my bank holds the note for the life of the loan, so they can’t sell it out from under me to a mortgage company that’s going to jack up my rate without warning.)

Despite my injuries, I’m actually doing better than a whole lot of people who haven’t been brain-injured, and that feels pretty good.

And I’m doing well at work, I’m doing better than ever at home, my temperament is levelling out, my memory is getting stronger slowly but surely, and I’m improving in so many different ways.

How do I do it? I have to ask myself, because it frankly doesn’t make logical sense to me that I should have such a crazy history of concussions and falls and accidents and assaults, and still be tooling around like nothing’s wrong. There is plenty wrong with me — on the inside of my head, that much is clear to me on most days, even if it’s not apparent to others. How do I manage to present as though I’m perfectly normal, not to mention have a normal life?

After mulling this over… and over… and over, for days, now, I have reached the conclusion that sheer force of habit has a whole lot to do with my track record. Just deciding what I want to do, and practicing it over and over and over again… going through the motions, from a slow pace, to a faster pace, to an even faster pace… till it’s second-nature to me, and it feels very natural to be doing what I do… that’s what does the trick. Starting out really basic, taking notes, keeping track of my performance on a daily basis, and being constantly vigilant about how I’m doing and how I can improve.

For example — I was having a hell of a time remembering to go through certain steps with my cat, who needs several different types of meds in the morning, and again in the evening. I was missing doses, which was throwing off their appetite and weight and mood… and this cat is almost 20 years old (but doing amazingly well, when the meds are properly administered), so we don’t have a lot of wiggle room. This poor cat… they were just all over the map, because I couldn’t seem to remember to give them all their meds in the a.m… and then I was missing things in the evening, too. Some people would say, “Just put the poor thing down — why make ‘em suffer?” but dangit, I didn’t want to just give up.

So, I made a very explicit AM and PM task list for myself and forced myself to follow it to the “T” every day. I wrote down the meds schedule on the calendar in the kitchen, and I consulted it religiously. I made myself take time, each morning, to tend to the cat before I did anything else, and I just walked through the utterly annoying and boring and mind-numbing steps of setting up the meds and treatments each day… until it started to come naturally to me, and I could manage to do everything each day before I consulted my notes. I still keep my list around, but it’s for the purpose of double-checking on my task list, rather than telling me ahead of time what I need to do.

I can tell you, I felt like a total idiot and goof, having to write down such basic stuff on a list and slowly, deliberately walk through the steps, one by one, each and every morning and night. But gradually, it started to come much more easily to me, and now it’s just second nature. I used that force of habit — I forced myself to develop the habit. And my cat looks great, has been gaining weight, and their coat is full and sleek and healthy. This animal looks better than a lot of cats half their age.

It’s boring and annoying, but active habit-forming has got to be done. And I have myself to thank for all my hard work after the fact.

It’s funny… I look around at personal effectiveness folks who talk about how to achieve peak performance, and a lot of my approaches are similar to what they talk about — visualization, believing in possibilities, constantly watching for opportunities, and constantly challenging my beliefs and assumptions. I have a lot in common with them.

The one big difference that I can see between my approach and that of lots of personal performance gurus, is that my “practice” is a lot more nitty-gritty, a lot more basic, a lot less glamorous, than the approaches I hear the personal performance folks espousing. It’s less about “attracting” positive experiences than it is about doing the slog work, the grunt work, the boring-ass drudgery of creating habits of effectiveness and excellence that will stand the test of time and extend my all-too-short attention span. My approach feels a whole lot more compulsory and less optional than what I hear folks in the personal performance line of work talking about. Less about living my dreams and more about just doing what needs to be done, in order to get where I’m going.

But hey, it works for me. It’s a lot less glamorous, in the short term, but the long-term payoff is huge. And if I can just figure out the basic stuff, I actually have a chance to live my dreams.

Customizing my workdays

I’ve been out and about for the past few days, not doing much extroverted type of activity like blogging or talking to people. I’ve been spending more time watching my daily habits pretty closely, seeing how I’m doing with my life in general, and finding areas where I have real problems — and devising solutions for those problems. I’ve been working with the ideas from Give Back Orlando, which prove more useful to me every day.

I’ve noticed that I’ve been getting into the office later and later, over the past weeks. I had started out arriving at the office around 8:00 each day, sometimes even earlier. Then I started getting in at 8:30… then 9:00… 9:30… and lately I’ve been getting in around 10:00, sometimes later.

I was starting to get down on myself about this, thinking that I was just being a slacker and I wasn’t doing my job. But the fact of the matter is, I have been spending time in the a.m. at home, studying and learning and practicing my skills in the privacy and quiet of my own home office.

The office at work is loud and distracting. There is always someone talking loudly — on the phone or to other people — and I cannot get away from the noise. I can put my headphones on and listen to music, but that’s still sound. And I have to turn it up, so I don’t hear everyone around me, which makes it loud, even if it is enjoyable.

So, doing work at home which requires focused concentration makes sense. In the privacy and quiet of my own controlled environment, I can focus fully on the material I need to master, I can read without being interrupted, I can code without being accosted by someone who would rather talk about movies and their kids’ eating habits than work, and I can get a whole lot more done than I would at the office. Some people’s jobs depend on them being on the phone all day, every day. I’m not one of those people, although everyone around me is. And I don’t see why I should have everyone else’s conversations included in every moment of my workday.

Anyway, a part of me still feels a bit insecure about doing work at home in the a.m. (as well as sometimes in the p.m. when I get home). I just have to track what I’m doing and show (to myself) that I’m actually getting work done. Which I am.

It’s funny… my brain is so dependent on tangible results, if I’m spending my time planning or scoping or thinking through an engineering solution, it doesn’t think I’m actually working, because I don’t yet have something to show for it. But, as my therapist has been telling me, that’s work, too. Just because it’s not hands-on and concrete, doesn’t mean it’s not work.

So, I have to trust it. And track my progress, so I have something to show for my work.

Going in later in the day is still giving me some problems. I had a conversation with someone last week about how they always get into the office around 6 a.m. They say they can’t sleep, and they like to get an early start on the day. They also like to miss the traffic and find a parking spot, first thing in the a.m.

I can see their point, and part of me would love to be able to do that, too. I can’t really sleep well, either.  But try as I might, I’m not that kind of a morning person… the part of me that functions well in the morning does not do well when driving in. With my fatigue issues, I have relatively small windows of opportunity to use the good energy and clarity I have, so spending a chunk of that time behind the wheel of a car is not my idea of good resource stewardship. Even if there is less traffic and I can get a parking space.

I have a job that lets me work from home, and I do the type of work that is often best suited to relative isolation. I can also do it from just about anywhere. So, shifting my hours so that I’m at home during the times when I am thinking clearly but still need quiet (and cannot deal well with a lot of activity around me) makes sense.

I’ve also been doing some work around the timing of my tasks. I have reached the conclusion that early afternoons are pretty much of a lost cause for me. That’s the time when my brain goes into a downswing, and I can’t think or do much of anything from 1:00 till about 3:30. Ironically, that’s when a lot of people around me are up and at ‘em, and the after-lunch flurry is noticeable. But my upswing happens around 3:30, when I start to really wake up and am ready to hit the ground running. Some days, I get more done between 3:30 and 6:30, than I do all day up to that point.

I was really getting down on myself for not being able to focus or concentrate in the early part of the afternoons. But looking at the different things I need to do everyday, I can see how I can fit the really boring crap that I hate to do anyway into that time slot. Things like administrative tasks… scheduling… compiling lists of things that need to be done at some point in time…. testing my code step-by-step in a mind-numbingly systematic way… updating project plans… Things that don’t require a lot of cognitive “firepower” but still need to be done — and which are a terrible waste of exuberance and energy, if I do them when I’m at my peak. I’d rather use the times when I’m at my sharpest to do the work that excites and invigorates me — and that needs to be done right.

So, that being said, I’m feeling better about how I am managing my time and tasks. I’m looking at the big picture, trying to see how things can fit together better, and how I can match my tasks with my energy/interest levels. If I’m going to do my best with resources that can be limited and inconsistent, I need to have a plan — that makes sense.