A million little hits

Source: photolib.noaa.go

Somebody needs to do a study on the cumulative biochemical impact of constantly finding out you screwed up. I’m serious about this – especially for new mTBI survivors. And long-term survivors, as well.

See, here’s the thing – stress impacts thinking. Cortisol mucks with your thought process. Stress hormones block out complex reasoning abilities, in favor of pure fight-flight-freeze reactions. And the long-term effects of high levels of stress hormones do have a cognitive impact.

So, after you sustain a TBI, and you’re in that initial phase of cluelessness, where you are so positive that you’re fine and everyone else is screwed up… and you keep undertaking things that seem perfectly reasonable to you, but aren’t exactly good ideas… and you keep bumping up against your new limitations (I won’t say “newfound” because it takes a while to find them)… all the while, you’re getting hit with these little “micro-blasts” of stress. The plans you make don’t work out. The relationships you depend on start to erode. Your behavior becomes not only mysteriously different, but also uncontrollable and unmanageable, and every time you turn around, something else is getting screwed up. You weren’t expecting it at all. It’s a shock — to your self and to your system.

Lots of false starts, lots of botched attempts, lots of pissed off people… and all the while, the cumulative effect of your body’s stress response to these “micro-traumas” is building up. The really messed-up thing is, that when you’re freshly injured, the experiences you have can take on vast proportions, and every little thing can seem like a monumental event. Which makes your reaction to them that much more extreme — a lot more stress hormones get released into your system that might otherwise, if you had a sense of perspective that was proportional to the actual events of your life.

But no, when you’re freshly injured, EVERYTHING can seem like a

Big Deal.

Of course, you have no reason to clear out the biochemical sludge with something like exercise or mindfulness meditation or anything like that, because either your brain is telling you that it’s much more pleasant to sit around and watch television, and/or you’re so exhausted from the stresses of daily living that making additional efforts or changes is out of the question, and/or you’ve got a lot of pain, and/or you don’t have access to the equipment or a support system or good guidance for how to start with something like that.

You’re off in your own private Idaho — no, wait, your own private hell — of watching your life fall apart for no reason that you or anyone else can discern.

After all, it was just a little bump on the head, right?

People have been puzzling for some time about the connection between TBI and PTSD, as though they are two entirely different and distinct conditions. I can tell you from personal experience that traumatic brain injury, even mild head injury, can and does result in post-traumatic stress disorder. Because even though the build-up of stress hormones is gradual and incremental, it still happens. And unless and until you figure out a way to clear out the biochemical sludge of one alarming stress response (no matter how small) after another, you’re going to have a heck of a time clearing your mind to the degree you need to clear it.

Being a mild traumatic brain injury survivor (I’m actually thriving, not just surviving), and having experienced what my neuropsych has called a “phenomenal” recovery, I can personally attest to the importance of exercise and good nutrition in helping the brain recover. I can’t even begin to tell you how “gunked up” I was, when I first showed up for my neuropsych testing. I was a wreck. Just a walking series of screw-ups waiting to happen. I bounced from job to job, just dropped out of a couple, made really bad choices about my money and my career and my home and my relationship, and to those who were watching, I was indeed teetering on the brink.

Now, I’ve been extraordinarily blessed to have connected with a neuropsych who firmly believes (after 25 years of working in TBI rehabilitation and 30 years in neuroscience) that recovery is possible, even probable, and that there is hope of some kind for even the most intractable cases. But even they weren’t expecting me to do as well as I have.

Especially in the last year, I’ve made some pretty great progress, and it coincides with my starting to exercise each morning. I don’t do a lot, most days — just get my heart rate up for 15-20 minutes, then stretch, then do some light strengthening exercises. The main thing is that I get my heart and respiration rates up, and that I jump-start my system. This is something that anyone can do — and you don’t need special equipment to do it. We all have bodies, and most of us are able to exercise them enough to get our heart rate and breathing up.

This is key. I can’t say it enough — to help clear out the buildup of stress hormones in the body which can impair thinking and make the aftermath of an mTBI even more challenging than it is already, exercise helps like nothing else.

What’s more, it oxygenates the brain and it stimulates the parts of the brain that learn and heal. How amazing is that? Very, very cool. Even after a long period of difficulty, as the folks at the Concussion  Clinic at the University at Buffalo have found, regular exercise can clear away “stuck” difficulties of post-concussive syndrome. One of their study participants even got back to a way of being that was better than he was before his six concussions or so — according to his mother.

Why does this work? How does it work? There are lots of possible explanations, but at the core — for me — it’s about giving your body the ability to deal with the constant onslaught of surprise and alarm and reaction to situations which emerge (often blindsiding you) in situations where you thought you were fine. For me, it’s very much about giving your body the ability to return to balance, to homeostasis, so it can just get on with living life. It’s about clearing out the cortisol, the adrenaline, the noradrenaline, and the handful of other biochemical substances that our brains normally secrete in order to help us deal with emergencies. Humans don’t have the same ability as animals, to clear this stuff out. Rabbits and antelope will shiver violently and shake and run around to clear out their biochemical “load”, but humans just end up hanging onto it, for better or for worse.

But, you may say, having things turn out differently than you expected isn’t such a big deal. Why would that be so stressful?

Trust me, when you’ve sunk a whole lot of time and effort into something and your self-image and survival (i.e., job) depend on things going the way you planned… and then things turn out to be screwed up in a way you hadn’t anticipated, and everyone is all worked up and pissed off and gunning for you ’cause you wrecked things (again), it does produce an extreme reaction. Especially in someone who has to contend with the extreme emotions and volatility, uncontrollable anger, rage, inexplicable confusion, and all that crazy anxiety and agitation that go hand-in-hand with traumatic brain injury. Even folks with “mild” injuries have these kinds of issues, and it can exacerbate and compound matters to no end.

Ultimately, if it builds up enough (and let’s not forget the embarrassment and shame and confusion that can be socially isolating), it can all become utterly debilitating. Disabling. And all because our  bodies haven’t had a chance to recover adequately from all these little incremental alarms, shocks, and other reasons to get pumped full of adrenaline and cortisol.

So, it’s important to not gloss over the effect of those million little hits. Inside our bodies and inside our minds, they do add up. And as our bodies accumulate the sludge of fight-flight-freeze, our minds are affected. Fortunately, there is a way to deal with it — exercise. Vigorous to a degree that gets your heart and respiration rate up.

Don’t have access to a gym? So what? Take the stairs instead of the elevator. Don’t have a set of weights? Big deal. Carry around some heavy stuff in your home. Don’t have an exercise bike? Do some knee bends, jumping jacks, and run in place. Swing your arms around. Stretch and move. Just get going — enough to get your heart rate up and create a noticeable difference in your body.

Now, I’m not saying it can fix things overnight. It’s taken me a year of consistent effort and commitment to get to this point, and when I started out, it was about the last thing I wanted to “have” to do each morning. But I wasn’t making the kind of headway I wanted to in my recovery, and the doctors were starting to talk about putting me on meds for my attention and mood issues. Given the choice between pharmacopia and 15 minutes of exercise each morning, I went with the latter. I’ve done the drug thing before, and it just made my life that much worse. I can’t go back there again. I just can’t.

So, I started getting my butt out of bed, and am I ever glad I did. I’ve read about biochemical stresses and PTSD in the past, and I’ve read about how animals can clear out the “soup” but humans can’t. But until I started exercising and got clearer as a result, the full impact of what I’d read didn’t sink in.

Now it’s sunk in, and it makes total sense. TBI can very much lead to PTSD — by right of the constant barrage of surprise and alarm and shock (not to mention our tendency to over-react to the unexpected or unfortunate events in our lives) which bombards us with stress hormones that don’t automatically clear themselves out of our sensitive systems. Given that TBI survivors’ systems tend to be even more sensitive after our injuries, it’s all the more reason to get up and get moving.

If you’re still sitting down while reading this, please get up off your butt and move. Your brain — and your life — will thank you for it.

Author: brokenbrilliant

I am a long-term multiple (mild) Traumatic Brain Injury (mTBI or TBI) survivor who experienced assaults, falls, car accidents, sports-related injuries in the 1960s, '70s, '80s, and '90s. My last mild TBI was in 2004, but it was definitely the worst of the lot. I never received medical treatment for my injuries, some of which were sports injuries (and you have to get back in the game!), but I have been living very successfully with cognitive/behavioral (social, emotional, functional) symptoms and complications since I was a young kid. I’ve done it so well, in fact, that virtually nobody knows that I sustained those injuries… and the folks who do know, haven’t fully realized just how it’s impacted my life. It has impacted my life, however. In serious and debilitating ways. I’m coming out from behind the shields I’ve put up, in hopes of successfully addressing my own (invisible) challenges and helping others to see that sustaining a TBI is not the end of the world, and they can, in fact, live happy, fulfilled, productive lives in spite of it all.

11 thoughts on “A million little hits”

  1. So glad you decided to continue to post. I don’t suffer from traumatic brain injury, but still learn a lot from your blog and am inspired by your progress. Thank you for sharing your journey. I’d comment more often, but usually don’t have the time or brain power to gather my thoughts. Just want you to know you’re not speaking into a void.

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  2. BB, this post reminds me of why I find your blog interesting, despite never having had a TBI…your struggles remind me quite a bit of my own with PTSD. It’s my brain just not giving the right info – over-reacting, being overly emotional, forgetting things…There’s a lot of similarity.

    I’m also pretty vigilant about getting some light exercise every day to keep things moving and stress ratcheted down. In my case, heavy exercise sets off my symptoms, so I keep it light. But I keep at it. Cheers

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  3. Oh how you hit the nail on the head for me each and every time I read your words! I’m learning so much from you. PLEASE don’t ever stop this blog! (ok…you can keep threatening…but PLEASE don’t ever stop!) : ) I’ve printed this out for others in my family to read. This blog doesn’t just help me. It’s helps me to help those in my family to understand what I am trying to tell them. This “silent” injury, while it IS in my head, is NOT in my head. I really am a happy camper in here! : )

    Now, I’m off to ride a bike! : )

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  4. Hi Ellen –

    Thanks for writing. It’s interesting about the exercise setting you off. I find that happens with a lot of folks, which is why I think a lot of people don’t exercise. It just triggers symptoms that are enough of a challenge to deal with under sedentary conditions. I find that if I work out enough to make my muscles sore, it affects my mood. It’s something I need to monitor, so it doesn’t wreak havoc with my life. But I do need the strenuous exercise, on a semi-regular basis.

    But even a little light exercise really does wonders.

    Thanks again for writing

    Cheers
    BB

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  5. Hey Kelly –

    So glad you’re finding this helpful. I hope it helps your family, as well.

    Be careful on your bike — make sure you wear your helmet 🙂

    Thanks for writing. I can’t promise that I’ll never stop blogging, but I can promise to do the best I can with what I’ve got.

    Cheers

    BB

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  6. Ah…the bike…..it’s stationary! : ) (thank goodness for that!) I’m not up to 2 wheels on a road with balance yet…and it’s been a long time. I may not ever be up to that again. Maybe a tandem. Right? THEN the helmets!

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  7. Thanks for this. In 2001 I had an intraventrucular subarachnoid brain hemmorhage. Since blood is caustic outside blood vessels I continue to find “difficiencies” 9 years later. No one has told me that I have PTSD but it feels like I do. I have dealt with pain since then and that is stressful because when it is bad enough it affects my breathing and walking. Narcotics make balance worse so I concurr with helmet comments. After 2 falls I went to stationary. I have seen a range of neurologists from UT Southwestern to Froedert in Wisconsin to noted pain management neurologist. The best I can say is I am still standing. I have 4 kids under 14 and they need a father and an income stream.

    Thanks for you blog it tells me that although I may be brain damaged I am not stupid. I have asked these questions and have been told there is no connection to PTSD but that always rang false.

    How did you find a good neuropsych? I only saw 1 and he taught and had a practise and was on some military PSTD study. So when he told me there is no connection I just stopped looking for a neuropsych because I did not need to hear there is “nothing” wrong with me despite my bad balance,pain (180 10/350 vicodin per month), blindness in one eye, central sleep apnea when pain is not managed, damaged pituitary gland which has stopped intructing the body to produce testosterone etc. I just don’t need to hear I should be thankful to be alive. I am but that does not stop my desire to have a good life and be a better husband and father because I feel horrible all the time. How many times can you a pologize for reacting angrily? Anyone can find a “how” to live if they have a “why” to live. My why are my children. When the youngest (8) is in college, I can finally let go.

    Anyway thanks for your blog. I found it after a Chris Nowinski NPR interview. Of you can provide any tips on finding a good neuropsych it would be appreciated.

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  8. Hi Xorapoan –

    Congratulations for staying in the game. Hang in there. It’s worth hanging in there, so don’t let it get the best of you. You can do this — it just takes longer and it can be a lot harder and more complicated than you ever expected. Still, it’s worth hanging in there, to get to see your kids grow up, maybe have grandkids, and enjoy and experience all that life has to offer.

    I consider myself extremely lucky to have gotten connected with the people I have. I have truly been blessed, and I’ve also be extremely persistent in getting the help and the answers I need. It took me about a year to find a competent neuropsych who isn’t going to tell me I should just be happy to have what I have, and don’t worry about the pain and the things I’ve lost along the way. They have 25+ years experience in neuropsych rehab, and they have seen great things happen. They also don’t tell me I’m worse off than I am — they don’t sugar coat my situation, but they also work with me to find solutions and coping strategies and compensatory techniques.

    Unfortunately, there are very few neuropsychs like that out there. The place I started, was with my local Brain Injury Association — check biausa.org for your local chapter, and give them a call. My local chapter sent me a list of doctors and neuropsychs who others had found helpful. I went through that list and called the ones who looked like they were good candidates. The problem was that a lot of the doctors I talked to were not much help at all… I guess I was “too functional” for them, of they were the kinds of docs who think that once you’re brain damaged, that’s it for all time. I had a lot of problems with insurance — I had to actually find a neurologist who would recommend neuropsych help for me, but I couldn’t find anyone who actually believed that I had issues. I’ve been so accustomed to just dealing with all the crap that comes my way, that I conceal my difficulties very well, which worked against me.

    Then, when that didn’t work out, I talked to someone. I called the BIA chapter and told them about my problems, and they put me in touch with someone with the organization who had been in the same boat as me — they gave me some incredible pointers, from the point of view of someone like me, and they put me in touch with a neuropsych who could help me – the one I’ve been working with for the last 3 years.

    It was a pretty grueling year or so till I found help, and during that time I was able to change insurance, which was critical. So, I didn’t have to have a neurologist refer me to the neuropsych – I could just go to them.

    As for the PTSD, I don’t even raise the issue with my neuropsych, because they don’t seem to believe there’s a connection, either. I’m not going to fight that battle with them. They’re helpful in other areas, so I leave that discussion for this blog. I am also blessed to have a number of friends who are therapists who specialize in helping trauma victims. Some of them were at Ground Zero during the 9/11 attacks, working with first responders and survivors there. From what they tell me and what I’ve read in books they have recommended, I can see a very clear connection between TBI and PTSD. Each can feed into each other, and they are complimentary in many ways. Nobody can tell me that the repeated experience of one emergency after another, brought about by TBI issues DOESN’T eventually build up to post-traumatic stress. Someone would have to argue pretty well to convince me otherwise. It makes no sense that there would NOT be a connection.

    Plus, considering how much pain so many of us are in, and considering that prolonged pain affects the emotional brain, that’s another connection. Even without the constant SURPRISE!!!! of TBI mis-steps and mis-calculations, there’s still ample fuel for the PTSD engine.

    The hormonal changes are pretty difficult. I myself have experienced some real changes in my hormone levels — I believe because of my TBI history. People don’t realize how important hormones are to just getting us through our lives. It’s a part of who we are, and when that changes, who we are changes too. That can be extremely difficult to take, at times.

    I would encourage you to actively work on the anger management. It’s totally understandable and very human, to react angrily. Being mindful of your moods and making an extra effort to not react angrily can pay off in a big way. But keep on apologizing. And keep working at turning things around. Constant pain is a real bitch, and blindness, and all the complications that come with all that doesn’t help. Just keep trying. For your kids. For your life. Every bit of effort you put into it helps. It might not feel like there’s any “why” to living, but as you keep at it, you may just find more “whys” than you realized are there.

    Best of luck to you and hang in there.

    BB

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  9. Heads up on a relatively new article regarding endocrine deficiencies after TBI or subarachnoid brain hemorhages. The synopsis is:

    “These results are preliminary, but they confirm the high risk for pituitary disorders after moderate to severe neurologic events, including traumatic brain injury and subarachnoid hemorrhage,” Dr. Raverot said in an interview. Action Points  
    Explain to patients that this study documented a high prevalence of pituitary disorders following moderate to severe head trauma and subarachnoid hemorrhage.

    Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
    “The results support a recommendation for evaluation of pituitary function in patients with subarachnoid hemorrhage or moderate to severe traumatic brain injury.”

    the link is. http://Www..medpagetoday.com/Neurology/HeadTrauma/14747

    basically it corroborates some of the hormonal issues I have talked about before and ties them to brain injury. I thought I would share them here in case it helps people. As a new development I had 2 broken teeth this month and a crown that snapped off. I had almost no vitamin D and therefore no calcium in my body hence the weaker teeth. In case people were not aware you can buy 50,000 units of vitamin D without a prescrition and use once per week. Hopefully this wll help reverse my body reserves and strengthen my teeth and bones.

    Last time you mentioned being too functional. I concur since I got no help I developed my own coping skills.

    For example I stand in front of the mirror every day and say “hair, face, teeth and pits”. Since I developed that system I have not “forgotten” to do any of those things before work or school. it is very embarrasing to find yourself surprised to get comments of your new look when you just forgot somethin basic. I alway try to count to 10 before acting because what I call impulse control is harder. There was a pregnant woman at work an I met with her the day her water broke and she started her maternity. I have a wife and 4 children so have some experience but when I saw her I was struck by her pregnant beauty. Her very full breasts because her milk had already come in and the radiant glow of her healthiness. When I saw her I had an impulse to stroke her breast and comment on it. Can you imagine the consequences? Besides losing my job I would probably frightened the poor woman stealing a day that should have been about joy. Can you imagine her husband? I would want to beat someone if thy frightened my wife that way. How could I explain that? If I said I had claimed it was not “sexual” because I had no testosterone withou supplementation who would believe me and even if they did she would still be traumatized.

    Anyway, keep fighting the good fight and I hope you enjoy the article.

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  10. Xorapoan –

    Thanks for the heads up on the article. I had heard about endocrine issues after tbi, but not the specifics on the pituitary gland. I sometimes wonder if my childhood tbi’s maybe affected my growth when I was young. I was small for my age, but I did not start out in the world that way. It wasn’t till I hit puberty that I started to grow normally. All of a sudden I was the same size as my peers.

    Impulse control… that is a big one, esapecially when tired. I need to remember that, too – thanks for the reminder. It’s a good thing you held yourself back with that woman. Or you might habe ended up with more broken teeth. Vitamin D is so critical, especially for immune function. I’ve been warned against taking more than 400 iu at a time however. I think too much can be dangerous – like too little.

    Hang in there and good luck with all the logistics.

    Cheers
    BB

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