Back in the game

Source: stephenhanafin

Okay, I’m back. It’s been a pretty rocky ride, the past several months, with the new job and my spouse going through a lot of personal stuff. Money has been a problem (it still is), and we’re living closer to the edge than we’d like. But I finally feel like I’m starting to settle in.

The business trip I was on, during the early part of this week was a positive and productive experience for me. Truly. We had a company meeting at a great hotel in a nearby city, and despite my reservations, I feel like I did extremely well.

Before going, I was really nervous about not being able to hold my own. There were people there from all over the country, whom I’d heard about, but had never met. There were people there from overseas, as well, and I was concerned about making a poor impression by not knowing the proper manners. I was especially worried about “going off the reservation” and running my mouth and saying stupid things, the way I tend to, when I’m tired and stressed and feeling on the spot.

But I only had a few instances of poor impulse control in conversations. And when I realized I was doing it, I managed to catch myself, stop myself before I went on, and really focused on paying close attention to what others were saying.

There were a couple of times where I was standing off by myself, feeling like an outsider, while everyone else who knew each other were gathered around, talking about familiar things. But fortunately, there were a number of people there who were also new, so I wasn’t the only one. And I also found people approaching me to talk about common projects at work, which was a relief.

All in all, I handled myself extremely well. I didn’t stay stuck in the insecurities that came up, but managed to shift my attention to other things — or just got moving, going for a walk or going to the fitness center, even taking a dip in the pool. I did reasonably well with the food – drank a little more coffee than I should have, and also ate more carbs than I should have. But I can always bump up my exercise to make up for it (which I did this morning).

This is good. I did really well. And what’s coming out of it is a ton of great working relationships with colleagues across the country and also overseas. This is important — so very, very important for me. I had truly believed that I was never going to be able to participate at this level. Truly.

I’m realizing now that with each TBI I’ve sustained over the years, I’ve adjusted down my expectations of what I could do, and what I was capable of doing. The auto accident in 1987, which left me unable to understand the heavy accents of some people for some time, and plunged me into a heavy round of excessive drinking, got me thinking that I have trouble with accents — which is not the case anymore. But there’s a part of me that thinks this is still true.

The accident I had in 1996 which took away my ability to read with understanding for a number of days, got me thinking that I have trouble reading and I will always have trouble reading. It’s true — when I am tired and stressed, my reading comprehension goes way down, and there are many times when I don’t realize till later that what I “read” isn’t what was on the page. But that’s not always the case, and I’m getting better.

The fall in 2004, which turned me into a raging maniac with no patience and a tendency to strike out at things (not people) around me and an almost insane drive to fake my way through everything, had me convinced that in order to succeed in life, I need to adjust down my expectations and not extend myself too much, because if I push myself too hard, bad things happen. I lose jobs. I become almost impossible to live with. I lose money. Bad things happen. And I’m not fit for human interaction.

But after the past few days, I can see clear evidence that this is just not true. When I take care of myself and I pay attention to what’s going on, and I don’t overextend myself to the point of exhaustion… and I carry myself with confidence and reach out to other people, Good Things Happen.

Which is quite exciting.

In a big way, I feel like I’m hitting a reset button in my life. My spouse is, too. They’re addressing some really long-standing issues from childhood which have been holding them back in a very big way. It’s like, we’ve both been going through a truckload of crap, that we can only go through on our own… all the while sharing space in a common house with a (somewhat) common schedule.

The good thing about this is that we can both cut each other some slack. We both “get” that we’re going through some heavy stuff, so we need to go easy at times. It doesn’t always work, and both of us tend to get wrapped up in our crap and forget about being generous and giving a damn about what goes on outside our heads. But things are working themselves out. I’m having the experiences I need to have, and they’re getting the help they need.

All in all, it’s good. And for the first time in a long time — perhaps ever — I can honestly say I feel like I’m truly getting back in the game.

Back from my business trip

And feeling good. It was the first time I’ve been off by myself overnight in a business environment since my last accident. I had a lot of reservations, as the demands were going to be pretty heavy on me, but I came through in good shape, and I have a lot more good professional connections than I had before.

I’m totally bushed, but I’m feeling really positive about it. Not only did I do well in the business interactions, but I also took pretty good care of myself.

Aside from eating more than I usually do. But then, it was on the company’s tab. And I didn’t overdo it to wild excess.

Coming home is not easy. Here, I’m still rehabbing. It was kind of nice to be in a situation where nobody knew anything about my difficulties, and everyone treated me like a regular person. Of course, it was less than 72 hours’ worth of “normalcy” — so who knows what would have happened, had it gone longer.

But the bottom line is, I did better than well, and I’m still in one piece.

Right on.

Anger, anger, more anger

Had an interesting day, yesterday — the highest of highs and the lowest of lows.

“Finished up” the whole experience with a bit of a meltdown at 3 a.m. this morning.

Life goes on, but surely there must be a better way to handle things than letting it get the best of me.

The adventure continues…

I finished reading a book

Here’s a blast from the past. About a year ago, I wrote this post (but forgot to publish it), absolutely giddy about having finished reading a book. Looking at where I’m at now, it’s pretty amazing the changes I’ve been through. After not having been able to get through an entire book in years (although one of my favorite pastimes was always reading), last November, I actually finished reading a book.

Here’s the post:

November, 2009

Yesterday afternoon at about 3:30 p.m., I finished reading Aging with Grace, the book about the Nun Study of those long-lived School Sisters of Notre Dame, which explores how and why some people live long and never succumb to Alzheimer’s or dementia, and why others may be more vulnerable. This book has a lot of meaning to me, because as a multiple TBI survivor, I’m statistically more vulnerable to dementia, and about the last thing I want, is to be incapacitated and demented later in life. No thanks…

I found a number of tips and clues about what you can do to avoid dementia — even if you do have some brain degeneration — and I read reports of nuns who had all the signs of advanced Alzheimer’s, but no symptoms whatsoever before they died. Sounds good to me.

I’m invigorated by this new information. I highly recommend it to anyone. And I’m even more invigorated by the fact that I actually finished the book! It took me a month to read all 219 pages, but I did it!!!

This would not be big news for most people I know. Most people I know read books as a matter of course, and when they start a book, they generally finish it (unless it’s truly awful and/or they run out of time). I, on the other hand, have not finished reading a book I started in a number of years. It’s hard for me to remember the last time I actually reached the last page of a book I started.

Let me walk around my study, looking for a book I know I’ve read cover to cover… Let’s see… I am reasonably certain I’ve read about 56 of the books in my study, which constitute maybe 10% of the total on my bookshelves. And the  most recent one I finished prior to Aging with Grace was consumed in a hurry back in 2006. I may have read something from cover to cover in 2007, but I cannot recall.

Now, mind you, I have tons of books, but most of them I’ve only read the first couple of chapters, if that. It’s a lifelong habit that goes way back to when I was a kid, and I never even really realized it was a problem, until this past year or so, when I started to take a long, hard look at my reading habits — or lack thereof — in the context of my TBIs.

It’s a complicated issue — part difficulty with the material, part difficulty with keeping focused on the material. I can be really distractable, so I often end up wandering off on cognitive tangents, when I’m reading. But part of what feeds my distractability, I think, is the fatigue that sets in after I’ve been reading for a while, as well as the discouragement I feel when I realize my eyes have been skimming pages for the last half hour, and I cannot remember what I just read. It’s complicated. And it sucks. And it never occurred to me before that I might have difficulty reading. I’m such an avid infovore – I’m usually reading something. Who would guess that reading is such a challenge for me?

It’s taken some adjusting to get used to this fact. And the adjustment has been as much of a hit to my self-image as anything else. I was always known as a bookworm. Much of my knowledge comes from books. If I’ve been reading at substandard level all these years without knowing it… and also not grasping a lot of what I was reading… what does that say about me, as a person? Does it completely invalidate many of the beliefs and assertions I’ve had about myself, for over 4 decades? It’s troubling to think so.

But now that I know reading is a problem for me, I can take steps to do something about it.  And that’s good. I literally cannot live this way, not being able to read a book from cover to cover. I am NOT going to continue in life this way. Something must be done. I need a plan. Here’s my plan — which so far has worked well, the first time through.

I need to acclimate myself to reading for longer periods of time, by reading for fun and pleasure, getting up to speed with that, and then starting to read for learning and understanding. I need to practice regularly and build up my stamina, and also develop different strategies for how to handle the material I absorb.

First, for the fun reading, I need to identify a topic that interests me which will stimulate me. I need to have some investment in the material, some payoff, some reward that comes with it. Preferably, I need to find something to read that also has “companion” material, like a movie that was made of it. I need to have the information presented in different formats, that different parts of my brain can “hook into”.

I chose The Bourne Identity, because it’s an action adventure novel that’s broken into relatively short chapters. It’s also got a movie made of it that is one of my favorites, and I have visuals of the action to prompt me as I read along

Second, I need to set aside time to read. I have to have time to do it, when I have time to rest either before or afterwards, or both.

I do this on the weekends. I take naps on the weekends to catch up with my rest. And I read during the afternoons.

Third, I need to gradually increase the amount of time I spend reading. I pay attention to how much time I’m spending, how I’m feeling, how my pace is. And I really congratulate myself, when I’ve read more than 10 pages at a sitting and understood what was being said the whole way through.

I can do this, but I also need to make sure I’m not tiring myself out. I need to make special efforts to reward and praise myself for having read as long as I have. I tend to get down on myself and think I’m stupid, when I’m not reading well, and I assume that it should be easy for me. But my reading has never been as strong as I always thought, and since my fall in 2004, it’s got even worse.

Fourth, I will then transfer my stamina and interest and good experiences with action/adventure fiction to my other non-fiction reading. And I must pace myself, gradually working my way up, again, and re-reading the things that I didn’t get the first time around. I need to keep an action/adventure book on hand, to keep my interest bolstered. I don’t worry so much about finishing the fiction in a timely manner. It’s more for the sake of keeping my spirits up and having a good experience while reading, so I can focus my more intent energies on the non-fiction/professional reading.

This is what I’ve been doing, on and off, with Aging With Grace over the past month. And now that I’ve done it and see that it works(!) I am ready to move on to my professional reading.

This is such important work. My survival and success depends on it. I’ve got a bunch of books I bought in the past that I need to read for work, but I haven’t been able to crack them. Now, I’ve got to do it.  Now I have a strategy and a plan, and I’ve proved (at least once) that it works. Reading really is fundamental. And the fact that I have done it with Aging With Grace has really lit a fire under me.

But before I go any further, it’s time for my Sunday afternoon nap.

Do all the concussions need to wreck us?

Source: diamondduste

I’ve been giving a bit of thought to all the reports of concussions in the news, lately. Football players, ice hockey players, soccer players… not to mention all the reports of kids heading to the ER. Conflicting as those reports may be — some say more pre-teens are being treated, some say more high-school age teens are being treated — the picture is still pretty significant. And the concern is increasingly palpable.

The message, like in a recent blog post of the Chicago Times Union, frames the issue from a concerned parent’s point of view. This isn’t an isolated case, either. Soccer/hockey moms/dads are becoming increasingly vocal about concussion risks in youth sports, and plenty of times there’s an accompanying dismay at the apparent cluelessness of the coaches regarding the risks of unsafe return to play.

Here’s the thing, from where I’m sitting — as a multiple concussion survivor and a former student athlete myself: If we funnel all our energy into fear and avoidance and attempted prevention of injuries like concussions, aren’t we possibly missing a big lesson that sports can teach us, in the first place — namely, that it’s part of human experience to get hurt… and it’s vital that we learn to pick ourselves up, dust ourselves off, and head back into the fray, facing our fears and dealing with what is.

Getting bent out of shape over concussions is understandable, but does it need to derail the very important process of learning from screwing up that often comes from childhood and youth? Since when did we start believing that all the lessons we can learn should be framed in positive terms, with no harm or danger involved? I would argue that by avoiding and trying to prevent risks, we are depriving the next generation of really critical lessons they need to learn, in order to deal effectively in the world.

If they don’t learn how to handle injury and adversity now, when they are relatively safe within the fold of their parents’ house, how will they handle it when the shit really hits the fan?

It inevitably does, you know. No parent can prevent that, hard as they  may try.

Now, I’m sure that there are plenty of parents who will take issue with this attitude. And coming from a multiple mild traumatic brain injury survivor, I realize that credibility is an issue. How can someone who’s gotten clunked on the head as often as I have be a trusted source for judgment about how to deal with sports concussions? I’ve talked about my judgment around risk being a bit impaired in the past, so why listen to me now?

Here’s the thing — it’s not that I’m advocating that we put our kids in harm’s way and not give a damn about their safety. Far from it. But at some point, the helicoptering starts to genuinely prevent the most valuable part about childhood and youth — the learning gained from trying and failing and trying again. That includes the learning gained from falling down, getting hurt, getting up and assessing the severity of your injury, letting yourself heal, and then getting back into the game when it is genuinely safe to do so.

Granted, with concussion, the threshold of safe return to play is often elusive and unpredictable.  But the opportunity — indeed, the teachable moments — that healing from an injury provides, can be invaluable in later life.

Concussions happen. They happen a lot. And I suspect they’ve been happening since the beginning of time — we just haven’t always had emergency departments at the ready to accept the steady stream of kids whose parents have good enough insurance and the level of understanding and concern to get them there.  I’m not sure there are more concussions happening today than before — we’re just more keenly aware of them. And this increased awareness means we’ve got a shining opportunity to learn all about the injury — as well as how to heal.

And learn we must. It’s not enough to wring our hands over all those mild traumatic brain injuries. It’s not enough to rush the kids to the ER and lecture the coach about their insensitivity and putting our kids in danger. It’s not enough to turn our heads away from danger and injury and/or do everything in our power to prevent it. We must learn to deal directly with this in a way that actually works, so that it doesn’t get the best of us. We need to learn to face up to the danger, the risk, the harm, the inevitable hurt, and master our skills in overcoming it.

After all, if concussions are endemic to the human experience and people have been experiencing them since the beginning of time (which I believe is accurate), and we’re all still here (more or less) and we haven’t all died off due to chronic traumatic encephalopathy and our societies haven’t completely disintegrated into a dust cloud of demented violence (or maybe we have?), isn’t that at least some evidence that concussions can and do heal — and that we can probably find a better, more effective way to heal than we’ve seen in the past 50 years or so?

Rest alone won’t always do it.  Concussion and TBI experts tend to agree that resting (and doing nothing else) doesn’t always fix the problems that come from post-concussive syndrome. Exercise, on the other hand, has been shown to clear issues with people with remarkable success — as SUNY’s University at Buffalo Concussion Clinic has found. Even professional ice hockey players are turning to them for help, and it appears to be helping. After decades of partial solutions, we’re getting to a point where we’re learning new ways of dealing with the somewhat staggering numbers of head injuries, and we should use them.

Let’s use them. Let’s deal with the issues around concussion — both the prevention of needless injury, and the healing from the hurt. Short-term recovery should be actively evolved and pursued and talked about in every public forum, from youth/amateur sports to professional circles. And long-term recovery should be addressed as well. Nobody who’s sustained a concussion (or more) should have to live under the dark cloud of the depression, the mood disorders, the behavioral issues, and the cognitive problems… not to mention the public stigma that comes from being considered “brain damaged”.

Concussions happen. But they shouldn’t have the last word.

At least, that’s what I think.

Addressing the trauma in traumatic brain injury

Source: Scott Butner

As I’ve been exploring the landscape of my head injuries over the past few years, one aspect of my life experience has consistently come to the fore — trauma… and its long-term effects on lives of both survivors and the ones they love and live/work with on a daily basis.

It’s almost a total fluke that trauma should even have this on my radar. But over the years, I’ve befriended — and been befriended by — a number of psychotherapists and counselors, most of whom specialize in trauma. In retrospect, I suspect that many of them have assumed that my difficulties were due to past traumatic episodes — rough childhood, misspent youth, etc. In fact, one of them has flatly denied that my issues could be due to TBI, and they became more and more insistent about me getting a therapist, which was probably the worst thing I’ve ever done, in retrospect. (This friend’s denial is a topic for another post — it’s quite interesting, “clinically” speaking.)

Now, I have to say that after more than 10 years of being around these friends of mine, I get a little tired of every ill known to humanity being ascribed to after-effects of trauma. When I talk about experiences I’ve had and people I’ve encountered who have annoyed me or done some seriously sick stuff, I’ve often heard the refrain, “Oh, they’re a trauma survivor, so they’re dissociating/being triggered/experiencing kindling/re-enacting their past traumas.”

There’s not much room for just being an asshole. For some of my friends, it’s all about the trauma. And in an attempt to better understand what it is they’re talking about, I’ve attended some trauma workshops, as well as read some books. I’ve got Peter Levine on my bookshelf, along with Belleruth Naparstek. And now I’m reading Robert Scaer, M.D.’s  book The Body Bears the Burden, which explains (from a neurologist’s point of view) the effects of trauma on both the body and mind of someone who’s gone through awful experiences — and those whose experiences don’t seem that terrible, compared to, say, Pakistan’s flooding or suicide bombings in Kabul.

The DSM-IV defines a “traumatic stressor” as:

[an stressor] involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate

The part that interests me is the “direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity”. The other parts are just as significant, but I’m not going to speak to them at this time.

When it comes to mild traumatic brain injury, I think sometimes the severity of the experience tends to get downplayed. After all, the injury is mild, right? Well, interestingly, mTBI survivors apparently can show more disruptive symptoms of traumatization after the fact, than survivors of more severe injuries. And these long-term effects  can wreak havoc in the lives of survivors, as well as their immediate circle.

Problems such as fatigue, emotional volatility (emotional lability), rage, agitation, irritability, insomnia, sleep deprivation, anger, temper flares, temper tantrum, anxiety, fear, panic, risk-taking, danger-seeking, not to mention all the crisis and drama that can accompany hormonal spikes during times of stress, certainly don’t make things any easier. If anything, they complicate recovery by flooding the system with stress hormones which interfere with your ability to learn from your experiences. So, at the time when you’re having to get a new grip on your newly changed life with its “new normal,” the biochemical processes going on behind the scenes may be getting in the way.

How maddening is that? At just the time when you need your brain to be able to recover, it’s busy cranking out all sorts of interesting concoctions that specifically get in the way of your recovery.

Because (I believe) there is unresolved and un-dealt-with trauma wreaking havoc behind the scenes.

Trauma in mild traumatic brain injuries is particularly tricky. After all, the injury itself may not have been that dramatic — something gets dropped on your head, or you get in a fender-bender, or you slip and fall down and clunk your head on something. You get up again, walk away from the scene… maybe pay a visit to the emergency dept of your local hospital, get scanned, and you get a “clean” bill of health (and maybe a few pointers on what to watch out for to make sure you don’t have more serious issues later on). Then you’re expected to get on with your life.

But inside your skull, something else is happening. Some of the fragile connections in your brain have been sheared or severed or frayed, and your brain isn’t able to communicate with itself like it used to. On a fundamental, profound level, your very existence has been threatened — only nobody can see it. Even you can’t see it very well, because your brain is either still bathed in the stress hormones designed to keep you from feeling a bunch of pain (and thus preventing you from fleeing an immediate threat), or it’s just not making the connections it “should” in order to give you — the resident owner — a clear picture of what’s going on. Or it could be both things going on.

In some cases, from what I’ve read in Dr. Scaer’s book, the onset of problems can be delayed by hours, even days. So, right after the accident/event, you’re walking around looking fine, seeming to be fine… maybe you’re a little shaken up, but that’s to be expected.  But then you start to slip away… decline… feel the effects of what was supposed to be a mild event that had no serious immediate effects you. In your system, hidden from view, the process of gradual (and possibly debilitating) problems has begun.

This process is utterly maddening. Everyone around you, who was worried for your safety, just wants to be relieved that you’re okay. But all of a sudden, you’re acting strangely, you don’t seem like yourself, and you’re complaining all the time. The complaints don’t get better over time, either. They get worse. And for no apparent reason. People think you’re looking for attention, that you’re trying to “milk” your accident for all it’s worth. They just want you to get back to being your old self. But you’re doing the exact opposite.

And the pressure to return to normal builds, even as your system is being eroded by the biochemical havoc of trauma that was introduced to your system which has not been cleared — it hasn’t even been recognized. How can you clear away what you can’t see/hear/detect?

Indeed, the most insidious and problematic manifestations of trauma take root when the person having the experience is taken by surprise. Studies have shown that bracing for impact limits the impact, but being blindsided makes it worse. And it makes the experience as a whole worse. The body detects this threat to its safety and existence — all of a sudden out of nowhere — and it unleashes myriad biochemical substances for us to deal with it — including endogenous opioids designed to numb the pain of injury. Animals in the wild which are being chased by predators, when there is no way to escape, will often fall down as though dead, their bodies full of chemical substances that will both numb the pain of being devoured and turn them into “dead” prey which might discourage a predator from actually killing them.

The same biochemical process is in place with human beings. After all, once upon a time, we were hunted as prey by animals larger than us. Indeed, we still are, in some cases — the predators happen to be other people, more often than not. In times of combat and assault, when all escape routes have been blocked off and we believe (on some level) that we’re done for, our brains and bodies do their natural thing — they bathe us in substances to protect us from feeling that knife going through our lung or feeling that bullet smash through muscle and bone.

Our brains and bodies are doing their utmost to protect us as best we can. But our minds tend to interpret the experience differently.

In the case of animals who freeze and then survive the assault, they shake themselves, go through a series of shuddering/jerking motions, do heavy, deep breathing, and then pick themselves up and get on with their lives. In the case of humans who freeze and then survive the assault, we tell ourselves we were wusses for freezing the way we did, and we plunge into cycles of self-doubt and conflict, feeling like we failed — when we were simply being the biological creatures we are designed to be.

And the self-perpetuating downward spiral of the PTSD loop starts. Where it stops, is anybody’s guess.

Therapies which have been successful in freeing people from that negative feedback loop are those which engage the body to discharge the sudden burst of biochemical self-protection, and get the autonomic nervous system back into balance. In the completion of the fight-flight-freeze cycle, the body is allowed to return to its most effective ways of working. And we can get on with our lives.

Here’s where the problem starts with mTBI. (Note, I’m not a doctor or certified health professional — this is just my belief system about how our systems interact with the world around us.) If the injury is “mild” then what’s the big deal? Why should we even need to complete the fight-flight-freeze cycle? Wasn’t the injury itself mild? We just got clunked on the head. Big deal, right?

Hardly. I think with mild traumatic brain injury, there may be another aspect of it that comes into play. With “mild” injuries (not that any brain injury is ever mild, mind you), the brain itself perceives the threat on a basic, biological level. It knows something’s wrong, and it kicks into overdrive, trying to right what’s wrong.

I suspect this is why people who have sustained concussions or mTBIs are so prone to denying that there’s anything wrong. Our brains are so busy trying to right their internal systems, that they fail to communicate with the rest of the world — that includes our conscious mind.

Based on what’s happened to me, what I’ve observed, and what I’ve read, here’s the cycle that I believe gets set up:

  1. An individual experiences a sudden, unexpected impact or injury, which injures their brain. This can be a fender-bender, a tackle or collision in a sports game, getting cold-cocked by an attacker, or having something fall on/hit their head.
  2. Fragile connections in their brain are frayed, sheared, or destroyed completely… or all three.  On the surface, they seem to be fine. The injury doesn’t look like that big of a deal. It’s just a bump on the head or a hard hit or a bit of soreness or being dazed after the fact.
  3. The body interprets the impact as a threat to the system, and it unleashes a biochemical cascade of hormones and other neurochemicals which narrow the focus, numb the system to pain, and shunt energy away from “extraneous” body functions.
  4. The injured person’s brain senses something is amiss, and it works like crazy trying to sort out what just happened. The whole body-brain connection needs to be tested to make sure everything is still online, so the system can correct itself as need be. Any outside talk or input is dismissed and rejected — “Are you alright?” isn’t a sign of concern, it’s an intrusion into the vital process of the brain checking through the bodily system for problems. And the brain is so focused on its internal process, that it “forgets” to tell the rest of the world what’s going on. There is no full communication loop with the brain — it’s in damage assessment mode, and it blocks out any input as well as refuses to provide output.
  5. The impacted individual wanders around in a bit of a daze, then they appear to recover, and they get on with the rest of their activities. They drive on in the car, they get up off the bench and go back in the game, they pick themself up off the pavement, or they go back to work.
  6. In the course of going about their business — both immediately and over the course of the coming days and weeks — their brain is having trouble figuring out how to do the things it used to do so effortlessly. The old connections have been disrupted, as though a massive storm had torn through a region, torn up trees, unleashed flash floods, and made many of the old roadways either treacherous or impassable.
  7. The brain senses something is amiss — the inability to do things it used to do before is intensely distressing, and it doesn’t understand why things aren’t working. This confusion represents a “threat to one’s physical integrity” and the body reacts as though its very existence were being threatened. The cascade of stress hormones and fight-flight-freeze substances wash through, and the sympathetic nervous system is activated.
  8. Unfortunately, the incidents of confusion and disorientation and disrupted functioning aren’t intermittent. They can be regularly occurring — as well as unexpected. Time after time, the brain is surprised by its sudden (and unexplained) inability to do what it’s always done. Surprise sharpens the experience, making it both more intense and more indelible in the body and brain.
  9. The brain/mind interprets these inabilities as a problem with the self, and a chain reaction of personal recrimination starts up, which assigns more meaning to the events, which triggers further releases of adrenaline and cortisol into the system when the amygdala is tweaked by this interpretation.
  10. When cortisol and adrenaline are released, higher reasoning is impaired, and lessons which might be learned from trial-and-error are not retained. One misstep after another occurs… one screw-up after another… confusion compounding confusion… anxiety heightening anxiety. What was originally “just a bump on the head” elaborates into a full-scale debilitating condition which becomes more and more entrenched over the ensuing months, even years.
  11. Social pressure doesn’t help at all. Impairments to speech understanding (that happened to me) aren’t interpreted as symptoms of brain injury, rather as laziness or stupidity. Sensitivity to light or sound, which foster distractability and make holding a conversation difficult are not perceived, but the results — wandering attention and apparent oblivion to what others are saying — are obvious (and not at all appreciated).  Social pressure leads to increased stress, which in turn triggers the release of more chemicals that prevent the injured person from effectively learning new patterns and building new pathways in their brain.
  12. The brain is still trying to sort out what’s going on, and it’s not very communicative, either with others or with the “resident” in this body. It gets wrapped up in the drama of flawed interpretations of what’s going on, the crisis of stories it’s invented about what’s going on around it, and the increasing struggle to make sense of anything.
  13. Time passes, and things just seem to get worse. Self-esteem plunges, and resilience declines. Self-recrimination builds, and difficulties at work and at home erode the ecosystem of the impacted individual. Jobs are lost, relationships fail, and money seems to fly away for no apparent reason.
  14. If they’re lucky, the impacted individual can find help from a competent neuropsychologist, counselor, or neurologist — or even friends who are up to the task of helping them get back from the brink. If they’re like all too many traumatic brain injury survivors, they cannot get the help they need, and they end up becoming permanently unemployed (or sporadically employed), with no savings or source of income, no social support network, and no justification for going on disability or collecting insurance payouts.
  15. Muddling through, maybe they make it, maybe they don’t. Ultimately, many end up on the streets, in jail for behavior problems, or on medication for psychological disorders that mimic brain injury after-effects and carry lasting side-effects. And unfortunately, a number eventually commit suicide, hastening the process that an oblivious, uneducated society and tough-it-out culture sets in motion.

As you can see — assuming this progression is at least somewhat accurate (and I believe it is) — the impact of a head injury need not be severe, in order to lead to severe consequences.

To fully understand the pervasive effects of mild traumatic brain injury, you need to look at multiple systems — from the brain’s inner workings, to the autonomic nervous system, to the demands of adult living or childhood development, to the expectations of one’s surrounding social milieu. With mild TBI, it’s never just one issue that sends you down the dark road — it’s a million little, subtle, interrelated issues that combine to create a recipe for disaster that, like bread dough sitting near a hot wood stove, will inevitably begin to rise and expand.

Trauma and the body’s internal responses to perceived threat and our interpretation of those threats, is like yeast added to a sugar-water-flour mix of our injury. With enough heat and time, it’s going to double, triple, even quadruple (and more) the issues that initially come with mild traumatic brain injury. Unfortunately, it appears that our systems are designed to work that way, and unless we can figure out alternative ways to address the issues, we’re in for a rough ride… till we can find help, sort things out, or end up incarcerated or dead.

What strategies and approaches we can hope to employ in this trickiest of situations — which might actually work — is a topic for another post.

Finding balance

Source: Jason Dunn

I’ve been reading the DOD’s new Mild Traumatic Brain Injury Pocket Guide, and really appreciating it.

It talks about definitions of mTBI and common symptoms, and it talks about different approaches to take to treat them. What a breath of fresh air — which is probably not the sort of thing that often gets said about the U.S. Department of Defense.

Included in the topics are:

  • Management of Concussion/Mild TBI
  • Management of Headaches
  • Management of Other Symptoms
  • Management of Dizziness and Disequilibrium
  • Management of Fatigue and Sleep Symptoms
  • Management of Vision, Hearing and Olfactory Symptoms
  • Management of Irritability
  • Management of Appetite Changes and Nausea
  • Cognitive Rehabilitation for Mild TBI Consensus Conference: Summary of Clinical Recommendations
  • Driving Following TBI Conference: Summary of Clinical Recommendations

It’s really great to see these pieces of information collected in one place, in a pocket-size format (although on my computer, I look at it full-screen, so it’s not in pocket form for me right now).

I’m particularly interested in reading what they have to say about dizziness and disequilibrium, because that’s been such a big issue for me for so long. Being dizzy has wreaked havoc with my health and mental state more than I can say — I used to have such a hard time staying upright, I’d flip out over every little thing, and I couldn’t talk to anyone, first thing in the morning, while I was trying to get ready for work. I had to focus so intently on what was in front of me, and not falling over, that if anyone spoke to me while I was getting dressed or making my breakfast, I would lose it.

Seriously, I was a friggin’ bear to deal with, first thing in the morning. For years. I feel  sorry for all the folks who have had to deal with me, when my vertigo was at its worst.

Being dizzy and losing my balance didn’t help, back in 2004, when I was standing at the top of some stairs and my spouse called for me to come get something. I had no business standing at the top of those stairs in stocking feet, but I was… and in the space of a minute, I was lying at the bottom of those stairs in a foggy daze, not quite sure how I got there, but remembering quite clearly the BAM-BAM-BAM of my head on the steps as I went down.

Shit.

Anyway, enough dwelling on the past. I’m getting back to balance, I must remind myself.

It never actually occurred to me that it was abnormal to be so dizzy all the time, till I started talking to folks about my recurring intense vertigo a few years back. I had told one of my past doctors about being super-dizzy when it was particularly bad, some time back. They just put me on meclizine, which did absolutely nothing for me at all. It didn’t even take care of the nausea.

Looking at the Pocket Guide, I see that pharmacologic treatment has not been shown to be effective in chronic dizziness after mild TBI. A ha! There it is — a possible explanation for why meclizine works for friends of mine who have vertigo, but it does nothing other than make me even more numb and whacked than I already am.

Of course, at the time I was seeing that doctor (I have since moved on – they were a bit too pill-happy for my likes), I didn’t know about my mTBI issues, so I was just another medical mystery that they shrugged their shoulders over and sent away with some comment about how I’d just have to wait it out.

Interestingly, I’ve never been examined specifically for dizziness and disequilibrium. With me, it tends to come and go — it’s worse when I’m tired or I’m fighting off a cold or I eat something with dairy ingredients in it. And of course, I’m often just peachy keen in the dizziness department when I go see my doctor.

So, I’m kind of on my own in this. But reading further, it looks like I’ve been doing the right things for this. They recommend:

  • Perform neck stretches — I do this, especially in the shower in the morning, when I can get really hot water on my neck and shoulders. That makes stretching easier. I also stretch before going to bed, which helps me relax and get to sleep.

  • Modify activity and change positions slowly — I’ve had to do this by default. I learned the hard way a bunch of times… moving too quickly and changing positions quickly when I’m dizzy is a recipe for extensive bruising, not to mention panic.  Both are less than optimal.

  • Change sleep position — I started sleeping on my back a lot more,  a few years back, and it seems to help. But there’s nothing like just rolling over and going to sleep.
  • Perform vestibular rehabilitation exercises — I do my morning workouts, and I’ve been adding more balance work to the mix. I have been doing this crazy-hard move (sometimes holding onto something while I do it) — I stand on one foot, and raise the other leg up, with my knee bent. Then I bend over and touch my left hand to my right toe, and vice versa with my right hand and my left toe. Not only does it really work my legs, but it’s also incredibly difficult for me to do. I’ve gotten to the point where I can do it without hanging onto something, but it’s still hard. I may be fooling myself, but I seem to be able to tell a difference in my balance, since I started doing this.

I’d like to add to this:

  • Keep yourself from getting sick and congested (my ears really do a number on my balance, when I’m congested)
  • Avoid dairy (or other foods you may be alergic to). When I cut out dairy, it cut my balance issues by 2/3. No kidding.

I still have issues, now and then, but they’re not constant, so I notice them immediately and I do modify my behavior. I avoid standing at the tops of stairs for too long. I also pay extra attention when I’m going down stairs or doing other balancing type activities. I also don’t go running around out-of-doors, climbing on rocks and jetties like I used to. (What a loss that is — I used to love to climb and jump and hop from rock to rock, but my better sense has prevailed in that — somehow, not getting hurt again is worth the cost.)

Yeah, taking steps to avoid problems has become a more regular part of my life over the past couple of years. Maybe I have a better appreciation of the risks I run. That’s certainly true. And I’ve also gotten in the habit of doing things that will help prevent future injuries, not just avoid them. Like working out. And working on my strength and flexibility.

Balance for me seems to be as much about muscle strength, coordination, and mindfulness as what’s going on in my wiring/inner ear. The stronger I get, thanks to my workouts, the more balanced I feel. I’ve notice myself becoming more coordinated than I was before. I’m sure it’s a combination of things, not just my brain/wiring. But I have been noticing an improvement.

Of course, there’s always the occasional flare-up — sometimes out of nowhere, for no reason that I can tell. But as long as I keep an eye out and I pay attention, I have a chance of staying upright — and doing things that will keep me that way… or at the very least, keep me from falling over.

mTBI Pocket Guide

This just in:

In collaboration with the Defense and Veterans Brain Injury Center (DVBIC), DCoE distributed a Mild TBI Pocket Guide for providers at the DVBIC 4th Annual TBI Military Training Conference on August 30-31, disseminating the tool to over 900 attendees. The Mild TBI Pocket Guide is a quick reference, all-encompassing resource for primary care and other TBI healthcare providers on the assessment, treatment and management of patients with mild TBI and related symptoms in the continental United States.

Concussion stampede

Source: t3rmin4t0r

Football season is picking up, and with it comes a spate of stories about professional players suffering concussions… then we have stories about student athletes suffering concussions… head injuries on the rise… mild traumatic brain injuries increasing… trips to the ER… stories from individuals talking about either their own or their kids’ head injuries…

You’d think all the world were sustaining traumatic brain injuries.

Then again, maybe we are. I mean, look at the stats:

  • 5.3 Million Americans are currently disabled by a traumatic brain injury
  • 1.5 Million Americans suffer a traumatic brain injury each year
  • 80,000 Americans sustain long-term disability from TBI each year
  • Every 21 Seconds, someone in the U.S. suffers a traumatic brain injury

Source: Neurology Now, Sept/Oct 2006

That’s an awful lot of traumatic brain injuries (which include concussions — don’t let the semantics confuse you). And that was back in 2006 — who knows where we stand now.

That’s an awful lot of people — and only in this country, we’re not talking the rest of the world — getting “dinged”, or worse, and suffering long-term because of it. Crazy. When will this madness stop?

Or will it? I’m not sure it ever will — as far as I’m concerned, head injury is about as endemic to the human condition as promiscuous sex and violent crime. As damaging (and as interrelated) as they may be, and as much as we may try to reduce the incidence, the fact remains that they continue to happen.

It is so very hard to have a healthy perspective on this head injury situation. On the one hand, you don’t want to overreact, but on the other hand, you don’t want to under-state the significance of head injury. It’s serious business. People get badly hurt — even when they don’t look like they’re injured. And they suffer for a long, long time. Some people never rebound. They get lost in the crowd, fall between the cracks, and fade away into their own private hell.

And our culture just keeps churning them out — especially in the sports arena. Between professional football and student sports and cage matches and mixed-martial-arts fighting and extreme sports and the heavy-duty ‘roids folks are on (including student athletes) and the popular fascination with hard hits and rough pastimes… it’s just one big head injury circus waiting to entertain all the folks sitting home on the couch with a cold beer, waiting for the blood to start flowing.

I’m a bit punchy tonight, I’ll admit. But buried deep inside this thought process, there’s a rhyme and a reason. More and more awareness is coming out about brain injuries and the long-term effects of head trauma. More and more players are agreeing to donate their brains to research. More and more air time is given to concussion and who’s on the disabled list this week, thanks to post-concussive syndrome symptoms. More and more stories of chronic traumatic encephalitis are coming out, and more and more tales of soldiers getting hammered by IEDs and other blasts are making the news.

But still we parade on like it’s all good fun — or at least the kind of thing that we should take in stride. You get hit, you go down, you wobble around when you get up, and nobody thinks anything of it, should you keep yourself in play. You get dinged, you drop to the ground, you get up dimmer and slower than you were before, and the game goes on. You get blindsided on the ice, you land hard and have to be carted off on a backboard, and when you’re not back playing in two weeks, the world starts to forget about you. If you do manage to come back (before all the symptoms have really cleared), you’re lauded as a brave soul.

And we think it’s fine.

Why even bother with all the pres and all the stories? Our culture loves its hard hits and its blindside tackles. We love to watch people get the crap pummeled out of them every Monday night. We love to watch our heroes go down, and get up and continue to play, no matter what. We get all hopped up on adrenaline and drama, get high off our bodies’ stress response hormones, and we worship the ground the most risk-taking, danger-seeking players walk on. We love our heroes, and we expect everything of them — except basic human vulnerability, and simple biological susceptibility.

It’s football season, and student athletics are swinging into high gear.

Concussion anyone?

Oh, take two — they’re small.