Making the most of my impulsiveness

While I was riding the exercise bike this morning, I read up on impulse control problems. According to the research, impulse control is managed by the brain’s executive function, is located in the frontal lobe, so when you have an injury there, it can really do a job on your mechanisms for deciding what you will and will not do, which impulses you will and will not follow. I’ve been in a number of accidents where my head was thrown forward really hard, then back again — car accidents, falls during sports games, etc.

Coup Contrecoup brain injury

Now, the injury you have doesn’t have to be only banging the front of your head against a fixed surface. You can also hit the back of your head against something, and have your brain “bounce” off the back and then slam into the front of your skull, as well. That’s called a “coup contrecoup” (front of head, back of head) injury. It can work both ways – you can get hit on the back of your head and have the brain fly forward. Either way, you have that pudding-like substance that sits in your skull ramming up against the rough inside of the bony case surrounding it. Two injuries for the price of one, which is probably why executive function problems — including impulse control — are so common with head injury.

Anyway, I’ve struggled with impulse control for decades. My first clear recollection of serious impulse control problems was after my TBI when I was eight years old and was hit on the head with a rock. All of a sudden, I noticed myself behaving in ways that were not unlike me. Not everyone is very self-aware when they’re eight years old, but I noticed very clearly that I was behaving in ways that I did not want to. I was an older sibling, and I took my role very seriously, to be a good role model for my siblings. It was a huge focus of my life – I was a very sincere kid, you see. All I wanted, was to be a responsible older sibling, especially since my family lived in an area that was somewhat dangerous, and all of us kids had to look out for each other.

After my TBI, I found myself saying and doing things with (and to) other kids that didn’t seem like me at all. I started teasing them and taunting them, trying to provoke them, being argumentative and aggressive. It was the weirdest thing – like I was watching myself in a bad movie, and I was unable to stop. I remember thinking many times, Why am I doing this? Why am I acting this way? I need to stop… but I can’t.

It was terrible. And I became convinced that there was something terribly wrong with me, that I was a bad person, and I was not to be trusted around others.

So I withdrew. And for most of the rest of my childhood, I stayed in my shell and did my utmost to not interact with other people. After all, I couldn’t be trusted.

Ironically, the thing that got me out of my shell was something pretty bad for me: I started to party when I was in high school. My sophomore year, I got into drinking (and some drugs), and I started hanging out with kids who didn’t give a damn about my grades or my clothes or whatever — so long as I would party with them. And so I did. But I digress…

The bottom line is, my impulse control issues — also, violent temper outbursts when I was a kid (not helped by parents who were combative and liked to bait and provoke me), problems with stealing, intense distractability issues, and problems with just blurting out things that I had no business saying — have wreaked havoc with my life, and they’re still a bit of a problem with me. On any given day, I can follow impulses that take me far from where I intended to go, when I got up in the morning. And then I need to play catch-up, which is exhausting and frustrating and demoralizing.

But at least now I know about it – at least now I’m aware that impulse control is a big issue for me, and I need to take steps to address it. I’m also aware that with my history of head injuries, the chances of me NOT having impulse control issues are a bit slim. So, I try to make the most of it.

Here’s how:

First, I try to stay rested. I try to keep up with my sleep. My executive functioning (including impulse control) goes downhill when I’m fatigued, so I try to keep myself relatively rested. If I’m not well-rested (like right now – I had a long weekend, and I missed my afternoon nap yesterday) I can tell a difference in my thinking and my choices. So, I try to stay mindful of being a little bit impaired in the executive functioning area. I have to remember that my brain is tired, and it’s going to be prone to wandering around more than usual, so I have to keep an eye on it — like watching a toddler in a department store.

If I can’t stay rested, I try to stay relaxed. I don’t always keep up with my sleep, so I try to stay loose and relaxed. I make more of an effort to stretch and do my breathing exercises, to keep myself from tensing up. If I have less energy, due to fatigue, it means I need to be more judicious with energy I do have. Being tense just eats up even more of my energy and burns me out — kind of like driving down the highway in 2nd gear. It’s hard on my “vehicle” so I try to consciously relax throughout the course of the day. This helps me to not be as impulsive, because it cuts down on my agitation, which makes me more anxious and prone to just follow some impulse to do such-and-such, to relieve the pressure I’m feeling. Relaxing helps me manage my anxiety and agitation — and it gets my mind off the latest impulsive distraction I’m running off to indulge.

I try to keep things simple. I pick and choose what I’m going to work on, and I try not to overwhelm myself with too many things. When I’m tired, I tend to load up all kinds of chores and tasks on myself to do — for some reason, my brain thinks that’s a good idea to pile more stuff on the list. It’s like there’s a part of me that knows I’m liable to overlook things, so if I throw as much stuff on my plate as possible, something is bound to get done. But the exact opposite happens. When I have so much going on, it overwhelms me, and I have that much more I have to think about, which tires me out even more. Keeping things simple and focusing on one task at a time, rather than 20 of them, helps me keep my sanity.

I use my own distractability to get things done. This is a little piece of brilliance that occurred to me about a year ago. I know I’m impulsive and prone to distraction, and I also know there are sometimes things I have to get done, no matter what. If I’m working on something in one room, I’ll often completely forget about what I need to do in another room, and I’ll be so caught up in doing what I’m doing, that some things won’t get done. So, I create distractions for myself that trigger my impulsive streak, to get me to take action on things that need to get done.

Case in point: Doing the laundry when my spouse was working yesterday. We tend to share this work between us, especially when one is working and we’ve got loads and loads of dirty clothes piling up in the hampers. My spouse will often remind me of things I need to do, so I don’t lose track. But yesterday I had a bunch of things I needed to do for work, and they were out, so I was on my own. The laundry had to get done, but I’m notorious for forgetting to start the washer, or switch the clothes to the dryer when they’re done washing. We’ve had to throw out perfectly good clothing because it soured and was ruined by sitting in a wet pile in the washer for days on end. I really didn’t want that to happen yesterday, so I created distractions for myself to catch my attention and get my action impulse going. To remind myself that I had to bring the clothes downstairs, I put a pair of shoes in the middle of the kitchen floor, where I would have to either walk around them, or put them on and go upstairs to get the clothes (I need to change out of my downstairs slippers, because our stairs are wooden –and very slippery — and the last thing I need is another fall down the stairs). I also put the laundry basket out in plain view where I would see it,  so when I went in the kitchen to get something to eat or drink, I’d notice it and then check on the clothes. I also left the light on in the laundry room (we try to keep it turned off) so I could prompt myself to check on the clothes.

Everything worked – I got two loads of laundry washed, dried, folded, and put away — all in one afternoon/evening. It might not sound like that big of a deal, but it’s not the sort of thing I take for granted.

Whenever possible, I try to harness my impulsiveness. It’s a little like engineering my own success, using one of my most glaring weaknesses. I know I’m prone to perseverate and get stuck in a certain thinking/behaving track and not be able to get myself out. I also know that I tend to be quite rigid and set in my ways about how things ‘should’ be done. S0 if I need to remember something or do something important, I create interruptions for myself that not only catch my attention, but also trigger some impulse to DO something. I do things like putting stickie notes on the sliding glass door of the kitchen. They catch my attention because they don’t “belong” there, and I definitely take action to get them out of the way. Having stickie notes on the sliding glass door makes me a little nervous, for some reason, so if I harness that nervousness and my impulsiveness, I can actually get things done, remember to do things, etc. The more important someting is, the more disruptive the interruption I create. Like putting objects where they don’t “belong” — a pair of shoes in the middle of the floor, or a stickie note on the sliding glass door, or an empty bottle of shampoo in the bathroom sink — so I remember I need to do something about them. The more nervous something makes me, the more likely I am to impulsively do something about it, so if something is very important, I’ll use a nervous-making experience to prompt me to action.

Thinking about how I do this, part of me thinks that I’m kind of copping out. I should really be training myself to have improved executive function, think through what I’m doing, be clear on the choices and consequences, and have a more “evolved” approach. But when I’m really busy, and I need to switch gears quickly — go from answering emails for work, to checking the laundry, to bringing up another bottle of water from the basement, to making myself some lunch — I need to switch gears quickly and not over-think my choices. All too often, I get stuck in over-thinking things, and then I get waylaid by the opposite of impulsiveness — a combination of perseveration and rumination and slowed processing speed.

For what it’s worth, this works for me — creating distractions to harness my impulsiveness and get things done, even keep myself on track. It can be a little messy at times, but it works for me. And that’s the important thing.

The Problem with Impulsiveness

Okay, you say, so you’re a bit impulsive at times. Who isn’t? What’s the big deal?

Here’s the big deal: With me, there’s no such thing as “a bit impulsive”. I’m REALLY impulsive. And when I go down that road, it can be a real problem coming back. The “whim” I get, to go check out Facebook for a minute turns into a two-hour time drain of reading all sorts of non-information about people I barely know anymore, clicking through to YouTube to watch videos, surfing around the web to indulge my curiosity, and generally not doing the things I originally sat down at the computer to do.

I’m burning up all my available energy, doing things that have nothing to do with my best interests. The end result is that I’ve lost two hours of my day that I’m not getting back, and if the things I was supposed to be doing were very important, now I am not only behind on things that are important to me, but I’m also more tired, so getting back to doing them is harder. I may have “taken the pressure off” by indulging my curiosity and allowing myself to follow my impulses, but I’ve now added more pressure to my life, by getting so far off track.

The other problem with impulsiveness, is that the things I tend to give into — though they may feel good at the time — don’t actually help me live my life in a productive way. Giving in to the impulse to yell at my spouse or other loved-ones has rarely produced positive results (to put it lightly). At the moment, when I’m venting at them, it feels honest and true and sincere, but it doesn’t do much for them. And I end up straining important relationships, thanks to not curbing my impulses.

Incidentally, I have a friend who sustained a mild TBI about 10 years ago, and they have huge problems with this sort of impulse control. The main difference between me and them is, they haven’t sought any help for their injury, and their relationships have suffered as a result. They also had a few small strokes several years ago, which complicates things further. They just love to vent and yell at people, because they say it makes them feel better. Personally, I think they’re just indulging their impulses — “go with the flow, man!” they tell me all the time. They are severely underemployed (they don’t get out of bed till about noon each day, and they often don’t go to sleep till 3 a.m., because they’re busy reading emails or following some other impulse of theirs. The only thing that keeps them afloat is their spouse, who has a great job — and is usually so busy with work that they’re not around to keep them on track, which is a double-edged sword. I’ve tried to suggest other ways of living life, and they’ve said they want to do better, but so far there hasn’t been much change. Oh, well…

Impulsiveness comes in all different shapes and sizes, and left unchecked, it can really wreak havoc. In my case, not only does it pull me off course and keep me from doing what I’m supposed to be doing, but it also gets in the way of me getting back on track when I’m no longer impulsively distracted. I mentioned it above, but in more depth, the whole process of getting myself out of my impulsiveness-vortex can be a real drain on my system. Here’s how things go downhill:

  • I realize I’ve gotten pulled off what I originally sat down to do  (write an important letter to a creditor, for example).
  • I get a little startled at how much time has gone by, and I am dismayed that I’ve spent the last two hours impulsively flitting here and there, instead of just getting this letter written.
  • I start to beat myself up over having “forgotten” to do this, and I start calling myself all sorts of unpleasant things.
  • My mind is racing, my heart is pounding, I’m sweating, and I’m getting more stressed by the minute, as I imagine the terrible things that can happen to me because I got pulled off in a different direction (20 different directions, actually).
  • I spend waste a whole bunch of time being hard in myself and trying to get myself back in line. I’ve used up a lot of energy, surfing around and doing this and that, and now my brain has less energy to work with than before — just at the time when I need more energy.
  • I get frustrated and irritated, and my spouse makes the mistake of walking in the room and talking to me. By this time, I’m beside myself  with frustration, and I yell at them for bothering me. No impulse control there, either. Temper, temper…
  • We end up having a fight, and both of us end up feeling even worse than I had felt by myself when I realized I’d gotten distracted and pulled off course. Now, not only am I a slacker, I’m also a total loser and a terrible spouse. What good am I?
  • The final result is, I’m all tied up in knots, my spouse isn’t talking to me, the letter gets written, but it’s a painful, convoluted process and I don’t get all the information correct. I’m worn out and agitated, which gives me a headache and makes my whole body ache. My hearing is quite sensitive, and light bothers me. I need to go to bed early, but I’m so bent out of shape and overly fatigued, I end up sitting up late watching t.v. to get my mind off things, surfing around the channels — again, impulsively — eating snacks and drinking soda. Not good at all.

Now, I’m not laying all of this at the feet of being impulsive and getting distracted, but this is now impulsiveness can contribute to the mess my life sometimes becomes. It’s not just that I get pulled away from doing things I’m supposed to be doing. It’s that I have to work that much harder to get back to those things, once I realize what’s going on. And I have to overcome the internal chatter that’s talking all sorts of trash about me in the back of my head.

Okay, you might say, so you’re impulsive, and it’s a problem. Doesn’t everybody have this challenge now and then? I can think of a hundred different people who do this, too.

I’m sure there are plenty of people who struggle with this. But for me, TBI has a way of making everything bigger and badder than it would normally be. It intensifies my emotions, slows down my thought process, and it complicates my thinking, so that things that one would think are pretty straightforward, actually require more effort than one would expect. Plus, the after-effects are pretty severe at times. Because emotionally I get so tweaked that I blow my distraction and impulsiveness out of proportion and I can’t see the way clear, sometimes, to just get myself back on track. It’s pretty discouraging at times, to have to struggle with something that should be so easy. Other people do it – why do I have such a terrible time with it?

It’s one thing to get impulsively distracted, it’s another to get stuck there, and then have to work like crazy to dig yourself out of the hole… And get worn out and bent out of shape in the process. You wouldn’t think it’s that big of a deal, just to get back on track, but sometimes it’s a huge friggin’ struggle. Probably one of the biggest contributing factors in this is fatigue — the tiredness that sets in after using up my energy doing everything except what I started out doing. But that’s another post for another day. For now, suffice it to say that impulsiveness is a Real Issue when dealing with TBI. In some ways, for me, it’s truly Issue #1.

How I deal with this is a subject for another day. For now, I need to get back to taking care of some work I didn’t get done yesterday… ’cause I indulged an impulse to do something other than what was on my to-do list.

I suppose it never ends…

Then and Now… Issue #1: Impulsiveness

About a year ago, I put together a list of 84 ways TBI can make your life really interesting, which is a list of 84 different issues that can arise as a result of a traumatic brain injury. I pulled together the list from a number of different reputable sources — books, websites, papers — and sorted them by type, from behavioral to communication to mental to emotional, etc.

Issue #1 at the very top of the list is Impulsiveness, and it’s been a real challenge for me over the years. In fact, this morning it got in my way, as I sat down to start writing something about impulsiveness, only to find myself going over to Facebook to see what was going on, and then checking my email.

Before I knew it, I was impulsively writing something about an issue that was related to what I was going to start doing — but WASN’T what I originally intended to write. This keeps happening to me, each weekend. I start out planning to do a handful of important things, then I impulsively get caught up in other activities, and before I know it, it’s Sunday night, and I’ve gotten nothing done that I intended, and I’m pissed off and grousing at my spouse because I’m upset with myself.

Impulsiveness can be such a pain, and it can be so hard to deal with. Especially when I’m tired. I impulsively do a million different things that have nothing to do with what I should be doing, and that series of distractions keeps me from being effective and living up to my promises to myself.

At the time, of course, it feels like I’m doing the right thing. It just feels so good, to “let myself off the leash” for a little while, and just give in to the temptation to surf the web, read Facebook, chat with people, and watch YouTube videos for hours at a time. All this, when I could be doing something useful — like doing chores or catching up on my sleep. But no, it’s much more interesting to “go with the flow” and let impulse rule my day.

As I said, it’s particularly hard to deal with when I’m tired. When I’m fatigued, I don’t think quite as well as when I’m rested, so the extra effort of keeping focused wears me out to the point where I “need a break” — from everyday life. It’s a vicious, self-perpetuating cycle, especially when my impulses and distractions are very energetic, which puts an even bigger strain on my energy resources.

I had been hoping to share something about how I have overcome Impulsiveness, but now that I think about it, it’s an ongoing struggle. Right now, in fact, I’m battling it. I guess the difference between now and then, is that now I’m aware of it, and I’m much less likely to stay stuck in that mire of impulsive distraction.

Like now, for example — I’m really going to get dressed and run my errands. The day won’t wait, and I’ve lost enough time to distraction this morning.

Then and Now – TBI Issue Management

Almost year ago, I published a list of 84 ways TBI can make your life really interesting, which is a list of 84 different issues that can arise as a result of a traumatic brain injury. I pulled together the list from a number of different reputable sources — books, websites, papers — and sorted them by type, from behavioral to communication to mental to emotional, etc.

The list itself actually dates back to about 2008, when I put together a list of all the issues I’d been having that I needed to manage. I’ve been using this list for several years, now, to monitor and track the things that make my life more challenging, and it’s really helped a lot — sometimes, mainly because it just reminds me that I have these issues and I need to be mindful of them.

It’s tough to manage things that you can’t see, after all…

But with things in plain view, I was able to manage. At first, it was tough, but eventually I learned. It took a lot of work and a willingness to be honest about what was going on with me — like any self-improvement work, I suppose. Except in my case, instead of it being “all in my head/heart”, I had some underlying neurological issues that played into the whole picture.

In a way, having the underlying neurological issues was a relief. I had felt for the longest time (30+ years) like there was something wrong with ME, for how I behaved and the ways I handled the world around me. I thought I wasn’t trying hard enough. Or I was being lazy. Or stupid. Or I was deliberately sabotaging myself. As it turns out, I was dealing with neurological issues which in and of themselves weren’t terribly severe, but which combined to exacerbate each other to the point where I was practically disabled in some ways.

I had plenty of talent and plenty of smarts, but contrary to all appearances, I couldn’t seem to get my act together. I had told myself for years that I was “choosing” to not employ my talents fully, when in fact I was constantly undermined by distractability, fatigue, anxiety, constant restlessness, agitation, chronic pain, and sensory sensitivities (to light and sound) that derailed me in times when I needed to be at my best. I was on a constant roller coaster of up and down emotions, taking two steps forward, two steps sidewards, two steps back, three steps forward, and getting all turned around in the process. Anxiety, not intention, determined my life’s direction, and I can tell you, I was going nowhere fast.

Even in those times when I was feeling like I was getting somewhere, I sometimes got hurt again, and then I had the setback of yet another tbi to deal with.

All the while, there I was, thinking there was something wrong with ME… I was a loser, I was a waste of space, I was a charter member of underachiever’s anonymous. And that sense was probably just as debilitating as any of my neurological/physical issues.

I wasn’t doing myself any favors by being so down on myself.

But when I started learning about TBI and started tracking my issues in light of my neurological situation and background, things started to really come together. I was also amazingly fortunate to connect with a neuropsychologist who believed (as I did) that the problems I had were “fixable” and they’ve been working with me to help me think differently about myself and my abilities, and see my whole life, not only my tbi’s, as an opportunity to learn and grow.

Once I quit blaming myself and being ashamed of my issues, a lot of my troubles started to clear.

But it wasn’t until I took a close look at what was going on with me and got honest about the havoc it was wreaking in my life, that I was able to DO anything about it.

I could have gone on indefinitely, telling myself — and the world — that “That’s just the way I am – you got a problem with that?!” Being constantly defensive about my limitations and difficulties and pulling out all the stops to justify them and defend my “right” to be a screw-up. It’s how I’d been living for close to 40 years, so why stop now?

Well, watching everything you hold dear go to shit, and realizing that you’ve got no foundation (financial, professional, interpersonal) to support your life has a way of forcing you to get honest. That’s why I stopped all the B.S. in my head. Plus, I was really tired of feeling like crap all the time, constantly wondering why nothing ever worked out the way I wanted/expected it to.

Anyway, I guess the bottom line is, you can’t fix something if you don’t know it’s broken. And getting past the idea that it was ME that was broken, rather than how my brain was working, was an important part of restoring my daily and long-term functionality.

Speaking of functionality, I’ve got errands to run. Have a good day, everyone. Stay strong.

 

Where Have All My Issues Gone?

I’ve been thinking a little bit lately about all my TBI-related issues which I was really struggling with over the years before I figured out what was going on with me and got some help. The last three years have been a pretty amazing process, and at my neuropsych appointment this past week, I was struck by the contrast between the conversations I used to have with my neuropsych and the conversations I’m having now.

Now, our conversations are much more about how I’m handling things in my life in a productive way, or how I might handle them differently to achieve the results I want. It used to be about all sorts of abstract noodling about my life, theories, research, and all manner of exploring the ins and outs of what was going on in my head.

Now things are much more concrete. Much more “mundane” but at the same time, much more productive and, well, powerful. Not powerful in the sense of overpowering others, but in taking control of my own life.

It really is remarkable, and it’s pretty gratifying. I seem to have made astounding progress, just in the past three years. I have to say, too, that things started to turn around for me in some pretty big ways, when I started exercising regularly, almost every day. Amazingly, a lot of my anxiety was reduced, and the edginess and snap decision making that often ended badly, had a markedly less pronounced place in my life.

I have to say, I haven’t been as derailed by my issues — headaches, memory problems, mood swings, impulsiveness, distractability, temper outbursts, light and sound sensitivities, balance problems, pain, fatigue, and insomnia — half as much as I was, only three years ago. So much has changed.

Or has it?

I took another look at the list of issues that can cause a person problems after brain injury, and as I looked down the list, reading the behavioral, emotional, mental, and physical issues, I realized that to some extent, I still had a lot of those issues. I still have headaches, and I still have anger (and other emotions) come up and then disappear abruptly. I still have light and sound sensitivity, and sometimes the tactile sensitivity is pretty intense, to where I can’t be touched — especially when I’m tired. I haven’t been sleeping well, the past few weeks, and I’ve been pretty fatigued and foggy.

In all, were I to go down my list of issues and tick them all off, and also write something about them, it would be a pretty exhaustive list. I have a headache now. And I’m not nearly as sharp as I’d like to be. I’m also behind the 8-ball on a couple of important projects, which is stressing me out. That’s just the tip of the iceberg.

But it’s different now, than it was three years ago. Three years ago, I would get so worked up over all these issues, get stuck in thinking that there was something WRONG with me, and get panicked about not being able to fix everything at once. I also didn’t have good strategies for fixing the things that needed to be addressed. I had a lot of false starts and flops. I was in pretty constant crisis.

Now, though, I have a completely different perspective, thanks to my coping strategies. I have managed — with the help of my neuropsych — to develop thoughtful responses to things that come up with me, and I’ve learned how to manage my time and energy and thought process. I’ve learned so very, very much, to the point where I still have all these issues, but they are not taking over my life.

I think that’s the thing — everybody has issues. TBI or not, concussion or no, everybody has their own problems. Some people have emotional problems, some people have physical challenges, some people have attentional issues. Some people have no family or friends. Some people have no job or no home. Some people seem to have “everything” but they feel dead inside. Everybody’s got something going on that is like an albatross around their neck.

The thing that makes people different and sets them apart, is how they handle their issues. How they cope with them. The difference between my frame of mind now, when I am working actively with being mindful and thoughtful about many, many aspects of my life… and my frame of mind three years ago, when I was driven by this constant anxiety and agitation… it’s like day and night, respectively. Words cannot describe.

What’s made the biggest difference, I think, has been the way I’ve learned to approach my issues and turn them from life-threatening hurdles to factors I need to work with on a daily basis. I’ve learned coping skills and I’ve worked on being mindful, so that I’m not in a constant state of alarm and frenzy. The alarm and frenzy cuts into my clarity and clouds my mind with emotion — intense emotion I cannot always control, and which comes up like a wildfire to burn everything in its path. Alarm floods my system with all those stress chemicals, which make it all but impossible for me to think clearly. I cannot have complex thought and take the many, many factors of life into consideration, if I am perpetually stressed and frazzled. I also cannot rest, which makes me even more fuzzy. The experience of constantly being driven by this anxious frenzy exacerbated my symptoms even more, turning them from somewhat irritating, distracting issues, into — literally — life-threatening challenges that constantly threatened to derail me and any progress I was making in my life.

My issues are still here — it’s how I handle them that’s changed. And this is a biggie for me.

It’s so big, in fact, that I’d like to devote some time over the coming months to talking about all these issues and explaining how they’ve changed with me — and why. It’s a fantastic before-and-after story, and it’s worth telling, I think.

In the midst of all the talk about the long-term tragedies of sports-related head injuries, I’d like to offer some hope to people who are seriously scared about their prospects after traumatic brain injury/acquired brain injury/concussion. There are ways to address the issues in a constructive way, so they don’t completely take over your life. I’ve found some, and I’d like to pass them along.

The Post-Concussion Downward Cycle

Here’s a break-out of a scenario I’ve seen happen with concussion, both in my own life and in the lives of others. (Note: Click the graphic below to take a closer graphical look.)

Post-Concussion Downward Cycle

Post-Concussion Downward Cycle

Here’s how I’ve witnessed concussion sideline perfectly capable individuals, particularly in the world of student athletics. It’s a rough synopsis, and I’m sure there are many other versions that could be created, but this hits on the major points:

1. The athlete experiences a concussive hit / fall. The “lights go dim”, which makes them nervous. They’re disoriented, confused. They’re also dis-coordinated, which they find embarrassing. They feel tremendous pressure to perform. TRY HARDER! is all they can think.

2. So, they jump back up and get back in the game

3. The result: Diminished performance. After all, they’re disoriented and confused. But pressure to perform pushes them – TRY HARDER! And they do. But they’re dis-coordinated, which is embarrassing. Still the pressure to perform — TRY HARDER!

4. During play, they’re hit again, and they just can’t seem to perform – they are benched by a frustrated coach. Pressure to perform is still there – including peer pressure from teammates who don’t understand what’s going on. The athlete is confused and embarrassed.

5. Post-Concussive Syndrome (PCS) sets in, including:

  • Headaches, which are invisible to others. “You’re milking it!” is what the other jocks say.
  • Volatile moods set in, which just looks like attitude problem. “You’re not trying hard enough” is what teachers and parents say.
  • Temper outbursts come up, which seem like behavior problems. “You’re being a jerk” is what people think.
  • Concentration problems happen. Distractability rules. It seems like willpower problem to people. “You’re not trying hard enough”.
  • Memory problems happen. Things just don’t seem to “stick” and forgetfulness rules. Again, it seems like willpower problem to people. “You’re still not trying hard enough”.
  • Sleeping problems come up – either too little or too much. Others can’t see the problem. “You’re milking it!” is what they say.
  • The concussed athlete is always tired, but nobody can see what it’s like inside. “You’re milking it!” is what people say and think.
  • Light and sound sensitivities come up — always at the worst times. Again, nobody can see what it’s like inside. “You’re milking it!”

6. The athlete is sidelined in life. They can’t do all the things they used to do, and they’re pretty much alone. On top of it, there is teasing, ridicule, ostracism. Peers don’t get it, which means they lose their support system and the peer group they turned to for their identity. They become depressed. “Who am I?” they wonder.

In school, they are underperforming. Grades suffer. Teachers don’t understand.

There are problems at home — moods and memory and temper outbursts. Parents are concerned, but nobody knows what to expect. Nobody knows what to do.

7. The only “SOLUTION” the athlete has is to Get Back In The Game, no matter what the cost. They’ve lost their peer group, their sense of belonging, their most prized activities, so what more could happen?

8. They return to play, pretending their symptoms are all gone. But things like diminished coordination — making them more prone to fall and not be able to avoid injury… diminished conditioning — making them less strong, less fast, less able to avoid/recover from hits/falls… and diminished risk assessment, which causes them to put themself in harm’s way without knowing it… it all combines for:

9. Re-injury

10. Either ‘shake it off’ and keep playing restart the cycle at 1.
OR be permanently sidelined
OR find a better way to respond to the concussion.

And there we have 10 steps to concussive issues. As I said above, there are probably many other ways to describe this scenario, but I believe that understanding the different “ingredients” that go into the recipe for concussive re-injury can help us do root-cause analysis of the situation and craft some intelligent, well-thought-out approaches for not only preventing concussion, but responding to it when it happens (and it will happen).

Education and objective analysis and the commitment to take concrete steps to address this epidemic will go much farther than fear and intimidation and punishment, in addressing these serious issues which can have long-lasting effects on this and future generations.

Together, we can break this cycle.

Down and up again

It’s been a pretty interesting week. I’ve gotten too little sleep, but I’ve been doing more than usual. Maybe that goes hand in hand — the times when I am more tired are the times when I am more inclined to push myself. And vice versa. I’ve been having some conversations with my neuropsych about this, and they are a strong believer in the ability of the trained mind to overcome impulses like not taking care of yourself or not being mindful and deliberate about things.

I suppose I agree with them to a certain extent. I do believe that the mind can overcome a lot of hurdles and obstacles. But I also know there is something else that drives me, other than my trained mind. There’s something else pushes me to take action in ways that I wouldn’t, if I were NOT stressed and tired — and if I were NOT so drawn to stress and fatigue. It’s like there’s a part of me that actually craves those things, and that part of me has a way of putting the kaibosh on some of my best-laid plans.

Logically, I know that being overly stressed and worn out is not the best way to get things done. I know I have a lot to do, and I know I need to take special care of myself so that I have the energy and the attention span and the calmness to get things done. I am well aware that I need to take care of myself, and yet I don’t. I know, logically, that if I stay up later than I should, I’ll be too tired in the morning to be 100% effective. I know, logically, that if I push myself too hard, I can become irritable and aggressive and start missing important details about my work and life. I know from plenty of experience that it’s no good for me to disregard my health and welfare.

But I still do it.

I get over-tired, I get turned around, I end up having my weekends fried, because I’m too tired to A) do all the things I want to do, or B) enjoy myself… or both. I make poor choices about what to eat, how to handle my time, how to interact with people. I end up impaired — for no good reason at all.

And it really puzzles me. This, to me, is one of the biggest challenges of my life, I and I’m convinced it’s directly tied to my TBIs/concussions/head injuries. There’s something about my thought process, over the years, that’s gotten pretty messed up, but it’s not a purely logical thing. It’s not even a cognitive thing, I think. I really believe it has more to do with the physical effects of my traumatic brain injuries – the metabolic changes that took place. The way my physical body handles energy and keeps things going, has been changed a little bit by each successive concussion/mtbi, and that physical alteration has reached into many parts of my life, including cognitive and behavioral ones.

Here’s how I understand it breaking down (and I apologize if I’ve gone on about this before and it’s all old news to you) — mild traumatic brain injury often results in a constant restlessness and agitation, which is either related to (or is a cause/result of) fatigue. Fatigue causes the brain to work less well — fogginess and slowness and a general feeling of “not quite being all there” results. This is a really shitty way to feel (sorry for the language), and I friggin’ hate feeling that way. I feel like crap when I’m “low” and I’d do just about anything to overcome it. So, I do — I push myself in ways that trigger an adrenaline rush and get my system all hopped up on stress hormones. I sleep less and take on more things to do. I procrastinate and don’t actively manage the things I’m doing. I do things that will sharpen my attention — or at least makes me feel like my attention is sharpened — and those things are often detrimental or edgy or risky.

It’s my version of extreme living — my everyday version of extreme sports. I push the envelope. Push myself harder. Set tougher deadlines. Take on more projects. Get completely overwhelmed, and love it — until I get in a jam and find myself behind the 8-ball and just barely able to pull myself out from behind it.

And I know I’m not alone in this. Now, I’m not saying that everyone who procrastinates and pushes the envelope and willingly becomes sleep-deprived is neurologically “impacted”. But I do believe that my own difficulties with staying on track with my sleep and activities can be mapped directly to my TBIs. And I’m sure I’m not the only one out there.

Which leads me to think about all the people out there — including student athletes — who are concussed or brain injured and have difficulty staying on track with recovery and/or activities and behaviors that are healthy and geared towards their recovery. It leads me to think about all the athletes who have gotten dinged and aren’t feeling quite with it, but throw themselves back in the game with an even more intense fervor. Recently, I read a blog post by a former football player over at The Concussion Blog, who returned to play right away after his first concussion, and then ended up in the hospital when he was concussed again — and again. He attributed his determination to get back in the game to pride, which I agree with — in part. There’s something more basic, almost primal, at work, too, that plays a role. The other part of it is an internal engine that gets fired up after you’re concussed… that propels you forward and amps up whatever you’re feeling 2000%, till it becomes this irresistable force that neither you nor anyone without sufficient power and influence (and the proper education) can resist. It intensifies your emotion, it consumes you with the drive to use that emotion, and it does not relent on its own. Somebody has to stop it — preferably a coach or a trainer, rather than an EMT.

Personally, I think this young man was fortunate to have not been more seriously injured by his second and third concussions. Second Impact Syndrome can kill. But the bottom line is, plenty of damage was done. His football career was at an end, even before it got a chance to really get started. Who knows what might have happened, had he stayed healthy throughout high school and gone on to play in college?

We’ll never know. Just as I’ll never know what might have become of me, had I not sustained all those concussions/TBIs over the course of my life and been driven by a sort of madness to let my wandering emotions direct my life. I told myself I was an explorer, an adventurer. I told myself I was living my life. But I was really bouncing from one distraction to another, one heady experience to another. Job changes. Friendships won and lost. Moving from apartment to apartment, back and forth across the country, and overseas as well. Getting in and out of trouble. Pushing the envelope, having run-ins with police and other authority figures. There was something that told me that this was all part of life, that it was all part of me being “more alive” — but it was the same kind of impulse that had me picking myself up off the ground, after falling hard and being a little woozy and wobbly afterwards, and hurling myself back in the game, throughout many a sports competition in my youth.

It was pride – absolutely. It was a desire to compete – totally. It was a burning need to be part of a team, part of what was going on, part of life. But the volume of my pride and desire and need was pumped up so loud by my neurological situation, that it deafened me to everything else — including common sense and a sense of perspective.

Now, granted, that drive and desire has served me well over the years. My eagerness to be part of a team, to contribute, to be a part of what was going on, has helped me be quite successful in my own way, and it’s brought me a good living. The problem was, I had a lot less modulation than I needed. My control panel had a bunch of On-Off switches — I was either ON or I was OFF — and there weren’t a lot of volume controls. The lack of modulation sent me to extremes countless times, and that’s cost me a lot, in terms of long-term employment prospects and just my ability to advance in a career.

For years, I spent an awful lot of time bouncing from job to job, all the while telling myself that I had good reason. But the simple fact was, I didn’t have the wherewithall to stick with it. Because the volatility got to be too much, and I just couldn’t tolerate the build-up of pressure (not to mention keeping track of all the crap I’d overcommitted to).

Had I not been so volatile, so prone to racing off on flights of fancy that gripped me again and again, I might have become a doctor. Or a lawyer. Or an esteemed researcher with tons of degrees and distinctions to my name (which is what I wanted to do, when I was younger). I might have become a fantastically wealthy serial entrepreneur who ends up funding much-needed health research. Who can say? All I know is, the decision-making process that tends to take over my mind and derail common sense, has definitely been altered, thanks to a series of mild traumatic brain injuries.

Now, I’m not one to sit around and boo-hoo my sad fate. I believe that we make our own fates, and we have a lot more power to change the way our world is, than we often guess. But it is good for me to step back and look at what I’ve had to contend with over the years, to keep it green, keep it real with me. I can’t afford to dismiss this undercurrent of agitation and restlessness that steadily undermines my health and well-being and thought process. I can’t afford to ignore it, as it washes out the foundation of my life.

It’s a problem. It needs to be dealt with.

Speaking of problems, the wind of the past few days has apparently taken out my phone line. I thought for sure it was going to go out two days ago, but it wasn’t till last night that it went down. I need to go check the box on the outside of the house to see if it’s a house-related problem or a network-related problem. I called the telephone company and got the steps I need to take. I’ve had my breakfast, now I need a shower, then I’ll suit up and go out into the cold to see if I can get a dial tone.

This is not the sort of thing I need to put off. I have to return some calls from yesterday, and some of my relatives have been trying to contact me about an upcoming wedding I’m supposed to attend in June. So, I’ll gather my supplies — a screwdriver and a phone with a cord attached and the instructions — and head out to see what the deal is.

This is one of those projects that’s easy for me to stay on track with. It’s a relatively short process, going out and checking the box. And the steps for how to do it were laid out very clearly by the telephone company. I have been involved in multiple phone calls around this, in the past 24 hours, so there’s a feedback mechanism to keep me on track. And it’s important I have a phone line open, because there are important things going on. The project is limited in scope, has a feedback loop, and it’s a priority. So, I stay on track.

Not so, with so many other undertakings I pursue. Not only am I susceptible to distraction, but my brain infuses those distractions with such fervor tha I’m convinced they are necessities, instead of distractions. Just over the past few days, when I’ve been working on these other projects of mine, I’ve gotten swept up in a handful of other distractions that are huge projects in and of themselves, and will demand a lot of time to follow through with them. They’re NOT the sorts of things I can add to my plate right now, but sure enough, as I was writing down the steps for the three new projects I have in the works, they came roaring to the forefront, as though they couldn’t wait. More distraction. But infused with a passion and a drive that made them seem like The Real Deal.

That, to me, is the biggest drawback/danger of TBI — the infusion of passion into distractions and poor choices, that makes them look like viable activities. True, it’s not necessarily life-endangering, but it has kept me from following through on the things that meant most to me, at times, effectively arresting my development in ways that – ultimately – have endangered parts of my life. It’s been a constant battle, to keep things in perspective and push back the rising tide of supposed “necessity” so that I can just get things done. I’m sure that distractability is not unique to TBI, but the compulsion to fixate on it and get pulled off in a completely Wrong direction (thinking that it’s Right) adds a whole new dimension to the distractability and thought process.

TBI adds a whole new dimension to basic human shortcomings. Things like:

  • Intense emotion.
  • Compulsion.
  • Obsession.
  • Fixation.
  • Rumination.
  • Rigid, literal thinking.
  • Diminished risk assessment.
  • Combativeness.
  • And more.

The trick, for me, is remembering this. At the times when I am most susceptible — when I’m tired or stressed or agitated or turned around or all of the above — those are the times when I’m most likely to get waylaid by this stuff. If I don’t, I run the risk of getting swept up in something far bigger and badder than myself. I run the risk of running myself down… then having to drag myself back up, all over again.

Remember…?

I just got back from a great session with my neuropsych. We talked a lot about how I tend to lose sight of the great progress I’ve made. I tend to get so caught up in the moment, feeling like I’m missing something, that I forget how much I actually “get”.

It was a good reminder. A little depressing, that I forget so easily the things I get right. But still good to jog my memory.

Maybe writing it down here will help me remember it later ;)

One can only hope.

Miles to stretch before I sleep

So, I have been stretching before I go to bed each night, and am I glad I have.  The pain is much less than it has been, and it’s easier for me to relax and get to sleep. It’s also easier for me to relax during the day, if I stretch periodically.

This relaxing thing is becoming increasingly critical to me. One of the ways TBI can wreak havoc with you is by making you more agitated and restless. And that  feeds — and feeds off — fatigue, which makes everything worse, including cognition.

By consciously relaxing throughout the day and tracking the times when I get knotted up, I can just kind of let go and allow my mind and body to relax a bit. Which in turn frees up more energy for me to use in productive activities. Like getting some work done.

Such a little thing — stretching — which makes such a big difference.