Wish List Item #1: Consistent quality information about TBI

m had some extensive comments to one of my earlier posts — good stuff that bears repeating:

…. Over the past few years I have seen the quality and availability of information increase exponentially. As I mentioned brainline.org is a great resource. ABIN-Pa and BI-IFEA are two other grassroots organizations – one a local chapter that is very active and the other a web based group with many subset topics with extensive memberships and resource links. And the DCOE has tons of information, including many daily information bulletins and news updates on research, and studies.

I had heard about the BI-IFEA from Kathe Perez, but since it’s a LinkedIn group, which is part of a professional networking site, I’m reluctant to even go close to it. I’m on LinkedIn, but there is no way on earth I am going to reveal to the larger professional community that I’m a multiple TBI survivor. In these economic times, I’m not taking chances with people’s tolerance and enlightenment levels. It’s just too risky. It’s a shame I can’t get to their resource lists. I’ll have to check out the DCOE site. At first glance, it looks quite good.

The Brain Injury Association of America has a very deep site and many individual states have great BIA sites with lots of material, presentations, white papers, events, video clips etc as well as links to site specific topics – Wisconsin, NJ, New York, Pennsylvania, California, Kansas are just a few of the state groups that have extensive websites. I am also involved with a project to create a single point of access/repository for all materials produced or available through these individual brain injury organizations creating a consolidated library of information for free public use.

Thank heaven for that! You go… I’ve been thinking about how much we need something like that — a clearinghouse of all the collected information from the different BIA chapters. Having it segmented out from state to state is tremendously frustrating. From where I’m sitting, there should be a central BIA database from which all the chapters pull – not individual respositories. Have a decent data warehouse — at the very least, a DB with meta data which indexes all the collected information and links to it, for common access — and break out the individual state-specific info based on a field in the DB. Please, please, please enlist the help of a competent data architect to design the DB  — I’m assuming, perhaps erroneously, that you’re not such a person. Having a properly designed and normalized database for this can make everyone’s life a whole lot easier. I’m happy to help with the DB design (I’ve done a bit of it, myself, in my day — for large-scale enterprises with millions of customers — scale, baby, scale) so let me know if I can contribute somehow. Hmmm… now you’ve got me thinking… I’ll have to capture what’s coming to mind.

Individual hospitals that are part of the Models of Care System produce a large number of research reports and papers – available through their individual sites, the BI Models of Care site and through the COMBI site. The Dana Foundation has a lot of brain research information. And then there are special sites like Give Back Orlando etc.

And here’s yet another one of my frustrations — there’s all this great information out there, but it’s not generally available to people, unless they know what to look/ask for… or they connect with another person who has that specific knowledge about the sites. Ugh – it’s just so frustrating. Will a returning vet understand how/where to look — or their spouse? Or their significant others/family/friends, etc? And if they do find their way to the info, will they be able to get to it, to navigate it? It’s the eternal issue with the online world — figuring out what info is where, and how to use it. As much as everyone likes to come up with their own site design, it would be nice if folks could agree on a best-practices information architecture, especially with regard to TBI information. And then we have the issue of the content itself — is it scholarly, academic, accessible to everyone, written for the general population… what? Even if you are fortunate enough to find something, can you actually use it?

Is the information quality? I’d say for the most part yes, it comes from studies and current research and people in the field. Some sources are more open to ‘outside the box’ stuff such as HBOT, TCM, neurofeedback, meditation, yoga, etc etc. And some are more conservative in their approach. Generally special interests groups are NOT involved – such as the pharm industry – but of course any given research group has bias and their own perspective. It doesn’t invalidate their data but it may make it more applicable to an individual demographic or subset. How much does commercial money influence people? As much as it does with heart medicine, diabetes, etc etc. – that is to say that they give more money for certain kinds of research. But the range of studies is promising and if the results yield something positive, the money will likely follow.

Yes, quality information is key. But again, can people use it? I think there should be some sort of hierarchy established, some sort of ontology of sorts, around the type of information that’s out there.

As for ‘outside the box’ therapies, if they work and they aren’t dangerous, I think they can be an important part of recovery. Some of the more fringe treatments worry me, and I tend to be concerned about extremes of scientific/medical rigor — folks that are totally into it, can let it keep valuable treatments from the population, while folks who want to just get treatments into the hands of the needy may bypass the “quality assurance” stage. Conundrum! I think there needs to be a middle-ground somewhere.

Regarding commercial interests, I was thinking more along the lines of rehabs plugging their own flavor of TBI rehabilitation, to attract new patients. Or doctors who are proposing radical new treatments which may or may not work — I’m thinking here of  Dr. Daniel Amen and his SPECT-scan-based approach. Maybe it works, maybe it doesn’t, but “It requires the injection of a radioactive material,” which I do not find particularly appealing. I had an MRI and they gave me a contrast agent which made me ill (and I’ve read it may have a bad effect on my kidneys). However, someone who is desperate for help, might go down that route — “Shoot me up, baby! I’m suffering, and nobody gives a damn!”.

This is just one example I can think of, off-hand. Given that CAM or non-traditional healing is generally not covered by insurance, and people are prepared to pay for it anyway, it opens the door to even more questionable stuff, which people may feel is worth the risk and the expense, because they cannot get any sort of help or information anywhere else.

Personally, from what I’ve observed among friends and acquaintances, people are willing to put up with all sorts of “treatments” from alternative “healers” in no small part because the “healers” are so willing to share information, and they genuinely care for the people they’re working with. One example I can think of, was an “aesthetician” I once met (read manicurist and pedicurist and beauty salon owner) who wanted to do more for her clients, so she went to some workshops and took some classes, and started representing herself as a “cranial sacral practitioner” — just because she did laying on of hands on people’s heads and lower backs. True story. And scary.  Care is so very important — but it needs to be accompanied by intelligence, competence, integrity, and quality control.

Having good information available to people who need it in a way that’s accessible is an important first step.

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How I found a great neuropsychologist – and you can, too

I consider myself extremely lucky. Not everyone has the good fortune that I do — finding an experienced, highly competent neuropsychologist who is not only patient and kind and knowledgeable and insightful and observant, but who is also geared towards rehabilitation and empowerment. And who is well-connected in the neurological and psychological world.

I have truly been protected and guided by some Divine Force, in finding this individual. They have helped me in countless ways, and I’d be lost without them.

I found this individual the old-fashioned way — by picking up the phone and talking to people. I was so turned around and confused and frightened and freaked-out, about a year and a half ago, when I realized (like Paul on the road to Damascus) that things were not right in my life, and they hadn’t been for a long, long time. All the stories I’d been telling myself about how I was perfectly fine and okay, and everyone else had the problem, not me… well, they all just fell apart. I had to get help. I had no idea where to turn. I was so flipped out and frustrated and embarrassed and ashamed of myself… here, I was the Big Cheese who supposedly had it all together, and the outside shell I’d built up around me had started to crack into little tiny pieces.

I swallowed my pride and emailed the Brain Injury Association near where I live. They gave me some good info via email and told me to call anytime.

Now, you have to understand, I have a hell of a time talking to people on the phone. I get confused and turned around, and I have a hard time understanding what’s being said to me. Now I’ve learned that the mechanism of my brain that turns sounds I hear into usable information is broken and not working correctly, so I understand why I’ve always had such a hard time grasping what people were saying to me. But 18 months ago, I didn’t know that yet — all I knew was that I friggin’ hated to talk on the phone, I couldn’t understand what people were saying to me, and it sent me into a panic at times.

But then a lightbulb went on in my head — it was perfectly okay for me to call the Brain Injury Association and sound/talk like a raving lunatic (if it came to that), because they were the Brain Injury Association and they specialized in dealing with people like me. Plus, even though I had a hugely difficult time handling stuff, I was reasonably sure that they’d dealt with people who were far worse off than me. Plus, it was their job to provide information to people who are brain-injured. That’s what they were trained to do.

So, I picked up the phone.

And I got honest. When one of the volunteers answered, I did the unthinkable and gave them my name and told them I needed help. How unlike me. Seriously. In the past, I would have muttered and mumbled and beat around the bush and then just hung up. I never would have said I needed help. I never would have given someone my name. No way, no how. But this time was different.

I told them my situation and asked if they could help me. And when they said they weren’t sure, I did the unthinkable again… and followed that up with a question: Do you know who can? In the past, I would have just said, “Well, thanks for your help… have a nice day,” and hung up. And then I would have wandered off in despair, gotten confused and depressed and withdrawn. But this time, I actually followed through.

The person on the other end of the line paused for a moment, and I just hung in there. I was so petrified… it’s hard to explain that level of terror over something as basic as a phone call. It’s embarrassing for me to admit, and I hate thinking about it. But the phone and I usually don’t get along very well. I think that also, being on the phone with a stranger who knew my name and knew I had sustained multiple brain injuries… being afraid that someone would realize who I was or tell someone about me, or someone nearby might overhear my conversation… being so unsure of myself about being on the phone, to begin with… not sure if I was saying the right thing or doing it right or being clear… feeling like I was making a mess of things — again… it was pretty tough.

After a pause, they suddenly thought of someone I could call who could help me. They gave me the name and number of a long-term brain injury survivor in another part of the state, who had lots of experience with tracking down the source of their issues, years after their injury. They recommended I call them, and wished me luck. I took down the name and number and thanked them, then called this person right away. I knew if I didn’t, I’d never do it, and I had to do something.

I called the number and managed to hang in there through the initial awkwardness of repeating my name and my own story. The person on the other end of the line was really, really helpful, and they were able to spend some time talking to me about what they’d been through. They told me about requesting copies of all doctors’ notes after visits, and making sure that I didn’t get stuck with someone who was clueless, and they told me about how they’d been through the wringer with a bunch of different neuropsychs who just didn’t have a clue. And they also gave me some contact information for a neuropsych they’d gone to see, who had helped them.

They said this doctor was in private practice and they were located some distance from me, but they were the best, and they were well worth the effort of getting to. I said I didn’t care about driving — I would willingly go way out of my way to get the right help.

After I got off the phone with this person, I called the doctor and left a message. I gave them my name and told them my situation, and I left my number. Then I let it go. It was the holiday season, and I had plenty of things to keep me busy.

I also called some other neuropsychs and told them my story. They were helpful to varying degrees — in part because once they heard what insurance I had, some of them just disqualified me outright. But others told me what I needed to do, in order to get around the insurance roadblocks, which was helpful.

After about a week or so, I got a call back from the recommended doc I’d left a message with. They said they would talk to me about my situation, and we spent close to an hour discussing the issues I have. I was starting to get a little desperate, because I was going through all of this on my own, nobody else really knew all the details of my situation (I hadn’t yet worked up the nerve to tell my immediate family members), and I was running out of energy and ideas. But by the end of our discussion, I actually felt like there was hope.

Long story short, I had a really good discussion with the doc, and they suggested some alternatives for my insurance situation. But it took me another eight months before I could navigate the medical and bureaucratic red tape to actually get to see them. It felt like it took forever… and in the meantime, I had a couple of really distressing encounters with (the wrong) neurologists, some deeply disconcerting exchanges with individuals who refused to accept I was having problems, a couple of f’ed up job changes (accompanied by the smell of burning bridges), and a whole lot of trying to get my bearings in life.

But now I’ve found a great neuropsych and have had a great working relationship with them. I’m not sure how much longer we’ll be working together, but if we met for a few hours every other week for the next ten years, I wouldn’t regret it.

If you’re looking for a good neuropsychologist — or really, any medical or “caring sector” professional — and you’ve sustained a TBI or some other issue that is not well-understood, you can cut back on the BS by doing the following:

  1. Talk to people who have the same condition as you, who were successful in finding help.
  2. Talk to your local Brain Injury Association folks to find out where to look for help.
  3. Make sure you get copies of all medical records, even if the doctors and their receptionists look at you funny.
  4. Take notes on what they tell you.
  5. Don’t be afraid to seek help elsewhere. Sometimes it just doesn’t work out with a provider, so keep going.
  6. Never, ever, ever give up!

On being beyond help…

I guess I’m feeling sorry for myself today. It started this a.m., when I had a pretty intense discussion with my new shrink about what I was going to do with the information that came from my new neuro. After talking with totally outraged friends who were incensed that my present neuro didn’t tell me about the pineal cyst and were miffed about how my experiences were described in the letter to my PCP, I was seriously considering looking for a new neuro.

Until my shrink talked some sense into me.

Said they, “So, this is Neurologist Number … Three?

Said I, “Yes.”

Said they, “You can’t keep jumping from doctor to doctor…”

Said I, rather abashedly, “Uh… I know…”

We had a pretty frank discussion about how the medical profession is not having a particularly good century, thus far, and how doctors have so much pressure on them, these days, so there’s only so much I can expect from them. And there are plenty of people with much more pressing problems than mine — which are really borderline and are more exploratory than anything else, at this point. True, there are things that have been going on with me for some time, that I’ve been urged to follow up on, but it’s not like I’m in serious trouble and unable to function at all.

I’m high functioning in some ways. In others, I’m less so. It’s getting past the okay stuff to the problematic pieces that’s the major conundrum in my life.

Frankly, I’m not sure I’ll ever be able to get to the bottom of what needs fixing, so I can function as well as I can all across the board. Not really. I just can’t describe my symptoms and issues in ways that others can understand. At least, I haven’t been able to do it, yet. Maybe someday I’ll be able to, with the help of a speech therapist, but right now, I have no great hope of it. I’m just so awful at communicating what’s going on with me, when pressed for information. Just awful.

And it just pisses off the people who are trying to help me.

So, I’m beyond help.

I don’t mean to sound depressed or anything, even though I kind of am. I guess I just had higher hopes of being able to connect with medical folks, and not only failing at that, but also being told there’s no great hope of me being able to do it any better with anyone else, bums me out, too. I’m probably being a drag, right now, and I apologize for that. But for others out there who are dealing with TBI stuff, and for the sake of those who are trying to understand what people like me have to go through, I hope my words can help shed at least a little light on what problems TBI folks face in seeking health care.

I suspect this is going to be a pretty significant issue in the coming years, as our veterans return from Iraq and Afghanistan with head injuries and PTSD and lots of other issues that they need help with. What is this country going to do, when thousands of folks with communication and self-assessment problems like mine — and physical conditions that are far more severe — show up needing help? What are the doctors and nurses of this country going to do? Shrug their shoulders and say, “Oh, well…” and turn away? Or dismiss them as malingerers? Or, absent any clue about what the real problems are, pump them full of drugs that will either ease the symptoms or knock them out sufficiently to not notice them so much?

It makes my heart hurt, to think about it. It’s bad enough that I have to go through all this, when I’m relatively able-bodied and in possession of my faculties, a job, a house, a family, and a relatively stable life. But those who are far less fortunate, and who have paid an unimaginably high price for the sake of this nation… well, it just seems awful to me.

What seems even more awful is this attitude I keep coming across about how doctors have to work hard enough at their trade, without having to extend themselves for people like me. As though learning to communicate with me and figure out what’s up with me in ways that are accessible to me doesn’t matter one bit. As though any communication breakdown is totally on me. I am more than willing to do everything I can to communicate with my doctor(s), but I’ve been injured a bunch of times, and I’m a bit impaired, so I do need some help.

That’s why I seek out medical attention, to begin with. And that’s why I try like crazy to communicate in any way I can find… only to be rebuffed by docs who are irritated at my approach and don’t really have the time to get to know me well enough to tell if I’m really okay, or if I just think I am.

I really want to be positive. I really want to be hopeful. I really want to be generous and gracious and extend myself to my beleaguered doctor(s). But right now I’m too tired from being lectured about how hard doctors have it, and how I can’t expect too much from them, and how other people are much worse off than me, so I shouldn’t take up too much of their time, I’m too frustrated, too … well, everything… to see things in a rosy light.

The ironic thing is, I started out this whole quest from a place where I was totally DIY with regard to my health. I stepped into the fray, agreeing tacitly to call a truce with the establishment and give the medical field the benefit of the doubt, and keep an open mind, be compliant, try to be the best patient I can be. But now I’m being sent away again.

So, I’ll just keep looking. I’ll keep asking questions. I’ll keep recording my life. I’ll keep pressing for answers I need, even if I have to look outside the usual areas (and inside my own heart) for the answers I need. I’ll go back to doing things  the way I always have — on my own, because nobody else has the time or the energy or the willingness to help me in the places I’m the most vulnerable. And I can’t leave myself wide open to that level of dismissal and neglect.

Not anymore.

Normal MRI and EEG… or not?

One thing that has saved me from obsessing about my job situation is my neuropsychological fall-out from my TBIs. Not only did my partner finally (after more than six months) get to sit down with my neuropsych and start to ask questions from a qualified health care provider, but my copies of the MRI and EEG results/interpretations came from the hospital, and it appears that my tests were not 100% clear of all disruptions.

It’s been an exquisitely excruciating balance of good news and who-knows-what-kind-of news. And it has totally kept my mind off my job situation, which in my more vulnerable and fatigued moments just drives me ’round the bend. As much as I want to focus on my strengths and keep firm and steady, I still have a tremendous amount of insecurity around how my TBIs have affected me, work-wise, and I have deep-seated reservations about how well I’ll be able to perform, if I’ll be able to keep up, if I’ll be able to be the kind of team player I was before my fall down the stairs in 2004.

But things are moving along with regard to the neuropsychological exam, and good things are brewing there. That promise of improved coping abilities and good information made available in a way I/we can use it… as well as finding out I have a small pineal cyst, and learning that there was some rare theta slowing in one of my temporal lobes, have pretty much eclipsed my vocational concerns.

On an up note, my partner and I had a great session with my neuropsychologist last week. From the mouth of a professional, descriptions of my situation and my “challenges” sound a whole lot less scary, and my neuropsych had straightforward answers and suggestions, where I generally get turned around and agitated and even sometimes a bit combative when pressed for information. My partner got to ask the questions that have been burning in their mind for months and months, and they got total access to the doctor sitting across the desk from them. They got to see that my folder about my testing is 4-5 inches thick, and there are tons of tests I took, all of which rendered pertinent results. They got a real sense for how complex my situation is, and how good my doc is — how they really take their time and make sure they’re thorough and cover all the bases, which is a good thing.

I think it was a total relief for my partner, who was starting to think — I believe — that my neuropsych was lolly-gagging and taking their sweet old time. One other thing that was very beneficial was that the doctor had to take a call and talk someone through the steps of tracking down a loved one who was impaired, and keeping them from being a danger to themself. I’ve had appointments canceled and rescheduled with this doc numerous times, due to things like this, and my partner was thinking I was just being brushed off. When the phone call came in, they got to see the doctor in action and just having that experience really did a lot for their confidence in them.

I think my partner and I both have more good info to work with now, in regards to our marriage, and they can see that the problems I’m having are not necessarily due to my being deliberately stubborn and trying to yank their chain and ignore them. Yes, I can be difficult, but I’m a lot less deliberately problematic than my partner believes. I’ve been catching crap for years about being too inattentive, too oblivious, too lax, too lazy, too unmotivated, too absent-minded, too flighty… and now, at long last, I’m somewhat vindicated. They were told explicitly by the doc that I have trouble understanding spoken language in the moment, and it takes me longer to process information when someone is talking to me. All those times that I’ve gotten raked over the coals for not being responsive enough quickly enough can now be put behind us. We don’t have to do that anymore. And we can slow down. Something about having a doctor communicate the information I’ve been trying to convey over the past year is helping. I’m not going to question that. I’ll take it — it’s a gift.

On the other hand, my other doctor — the neurologist I saw in January and February — seems to have mucked things up a bit. I got a copy of the MRI and EEG analyses, and while they may read as “normal”, they are not without event. My MRI shows a small pineal cyst, and my EEG shows some theta slowing in one of my temporal lobes. In both cases, the anomalies are not great enough to warrant all-out alarm, but they are both something to keep an eye on.

In addition, the neuro wrote up notes from my visit and sent them to my PCP, and their description is not 100% accurate. They focused a great deal on the “rage” issues I’ve been having. I wouldn’t necessarily call them “rage” — just abrupt swings in emotion, in all directions. And they also mis-characterized my family history, making one of my relatives (who has had a lifetime of symptoms and experiences similar to my own, in some respects) look and sound like a rage-a-holic.

Oh        my        God…

Now I have to back-pedal and compose a letter to both my neuro and my PCP correcting the record. It sorta kinda freaks me out a bit. I’ve had so many unproductive relationships with doctors, I can’t even begin to say. Now, I finally managed to find someone I can work with and with whom I have established a decent rapport… only to have this neuro mis-characterize me and potentially undermine that relationship.  It’s bad enough that the neuro misunderstood me and is working off bad information. But now they’ve dragged my PCP into it, too. Ack.

So, my next steps are to communicate my situation in writing. I am going to:

  1. Work through this with my new therapist, who is a neuropsychologist themself, and who knows about TBI and can help me think through my response. I need to correct the record very thoroughly in writing and compose a letter to that effect.
  2. Send the letter to this neuro and my PCP.
  3. Follow up with my PCP about what to do with all this new information. I may need to do damage control. I want to keep the lines of communication open with them and make sure I’m not digging myself yet another hole.
  4. Probably find a new neuro. I really liked dealing with this one, for once, but they clearly were not present and were not dealing with what was in front of them. I’m not sure where they were, at the time we were talking… But no matter. They are so fired, and I’m off to find another neuro.
  5. Check in with my new therapist a lot through the whole process, to make sure I’m not making things worse for myself. That would be all too easy to do, and I want to do things different this time.

What this experience has really taught me — and there are some vital, valuable lessons here — is that I really need to approach my health care with my TBIs in mind. The biggest problems I’ve been having with health care, throughout my life, have revolved around communication. I have never had an easy time of describing my symptoms to doctors, nor have I done a very good job at collecting and analyzing information from them. I can see now that I’ve had a truly terrible time understanding what doctors are saying to me, parsing through it all, and then retaining it to act on it later.

And because I’ve had such a terrible time — all the while looking (to the untrained eye) like I should be more “with it,” so what the hell was I being such a freaking space-case about?and I’ve got a history of various trauma with plenty of PTSD to go along with it, I would get all revved and anxious and become either overly withdrawn or combative in this exaggerated fight-or-flight dynamic that probably every TBI/PTSD person knows all too intimately. And I would either come across as hostile and aggressive, or I would retreat into my shell and not speak up about what was going on with me.

Which never made for very good doctor-patient relations, I can tell you.

Now I need to take a different approach. Put the facts of my situation into writing. Take it slowly and deliberately and seek out help. Because at least that’s a way I can communicate with my doctors with 100% accuracy. And the next time I deal with any doctor, I’m going to summarize in writing my issues and give them to them — along with a note from my neuropsychologist that explains that no matter how bright I may look on the outside, no matter how extensive my vocabulary may be, no matter how conceptually “with it” I may be, my speed of processing is slower than one would expect, my ability to process spoken language in the moment is impaired, and my short-term memory is for shit. And I don’t mean to come across as hostile and argumentative — I just have a hard time dealing with my “asymmetrical” challenges.

The next thing I do  — after I correct the neuro’s info and send it to them and my PCP — is get a brief summary letter from my neuropsych explaining both the strengths I have and the limitations. I cannot see any more doctors until I have that in hand and I can give it to them in advance, so they can understand I am not malingering, I am not deliberately being difficult, I am not trying to make their lives more complicated, I’m not a malpractice risk, I just need help when it comes to communicating, and I’d appreciate it if they wouldn’t jump to conclusions about me, just ’cause I fell down and got hit on the head a lot over the course of my eventful life.

I am so done with dealing with doctors who don’t have all the information and can’t use their heads to observe what’s right in front of them. Maybe that’s not how medical professionals do things, but God gave them two eyes,  two ears, a nose, and a mouth, and it seems to have worked well for millennia, so why not avail oneself of one’s native abilities?

I’m also fed up with not being able to “read” what they are trying to communicate, and being held back by my broken brain’s penchant for meaningless detail. I’m tired of struggling with something I “shouldn’t” have problems with, getting lost… and not realizing I’m lost till several hours after I leave the doctor’s office.

I’m sick and tired of this whole hidden disability trip, all the ignorance, all the half-assed information, all the bias, all the cluelessness… and how the lowest common denominators seem to drive the situation. I’m tired of having to navigate the seas of truly debilitating difficulties, without anyone else realizing they’re a problem for me — and giving me shit because they are.

I am also fed up with doctors who don’t take time with me. I need to figure something out. I had considered double-booking appointments with my doctor — reserving twice as much time with them, so I don’t feel as rushed and I can ask all the questions I need to ask at a speed I can actually sustain. Either that, or I’ll get an “interpreter” to go with me and help me understand what the doctor is saying to me — and who can help me get them to slow down and stop rushing me. I think that having another person in the room with me to help me sort things out may be the way to go.

Honestly, does my health need to suffer, just ’cause someone doesn’t want to slow down? The rest of the world may think so, but I don’t. I’m just not going there. Something’s broken. And I’ve got to fix it.

Nap a little now… Sleep a lot later

I finally was able to get a bunch of sleep over the past 12 hours. I got home from work yesterday, and I was utterly exhausted. I could barely stop at a gas station to top off the air in my car’s left rear tire (which has been low for some weeks, but didn’t fully catch my attention till I really took a close look at it yesterday). Once home, I took a long, hot shower to take the edge off the pain I’ve been in and help me relax, then I debated whether to stay up and spend time with my partner and hit the hay early, or just take a little nap to take the edge off my fatigue.

Not feeling particularly … “viable”… I opted for the nap. I would have been lousy company had I stayed up, anyway, and why do that to someone who’s also had a really long day? I crawled into my “cave” — the quiet guest bedroom that’s at the back of the house that is my own little retreat at home — and lay down around 6:30 last night. I planned to get up in an hour or so, when supper was ready, but when my partner came to rouse me, I couldn’t budge. I couldn’t even fully wake up. This was probably around 8:30 or so… My beloved decided to let me sleep, as I’ve been so edgy and antsy, and it was abundantly clear to them that I needed to rest.

‘Round about 10:30, I woke up a bit — had to use the bathroom — and I joined the rest of my household for a little warmed-up dinner. I generally try to eat supper before 8 p.m. (which I know is probably too late — should probably be before 7) but last night was different. I was a little concerned that I might not be able to get back to sleep, if I stayed up and had “dinner” and watched a little television, but I gave it a whirl.

And wonder of wonders, I was actually tired — yawning — the rest of the evening. I headed back to bed in my cave around midnight (I have a long day ahead of me today, and I need uninterrupted sleep all by my lonesome in my cave when I’m having trouble with insomnia). I did write a little in my journal about some PTSD stuff that’s been coming up for me, lately, but when I lay down and relaxed, I went right to sleep, which is nothing short of a miracle.

I did wake up earlier than I wanted to, this a.m. — I had hoped to sleep till 7:30, but I was up before 6:00, as usual. Oh, well. At least it was closer to 6:00 a.m. than 5 a.m. Maybe my body is preparing for Daylight Savings Time, which begins this weekend. And this way, I have time to post some info before my day starts. Not a bad thing. At least I got another 5-1/2 hours of sleep between my nap last night and right now.

One thing I noticed when I woke up this morning, was that I was extremely tense. My body felt like it was spring-loaded and ready to spring into action. This is not new for me. I usually feel this way when I’m waking up, and try as I might, I cannot seem to release the tension, first thing in the a.m. I think that’s what’s been waking me up — being really tense and tight, first thing in the morning. It’s almost like my body is gearing up for the day, in advance. Like it knows I’m going to be waking up soon, and it’s getting all charged up in advance.

I have a hard time, sometimes, getting out of bed. Literally and figuratively. Not only do I have to muster the courage to get out of a warm bed into the cold air, but I tend to not be very coordinated, first thing in the a.m. Especially when my vestibular system/balance is off, I can be very wobbly and sick-on-my-stomach, when I get out of bed. I am sometimes not very coordinated about it — I hit the floor a lot harder than I intend, and I wake up my partner, which is a PITA for both of us. So, I tend to tense up and gather myself physically — and mentally — before rolling out of bed.

You wouldn’t think getting out of bed would be such a challenge, but some days it’s just the first of a long series of difficult things I’ll have to do.

Another thing that I noticed this a.m., when I was waking up very tense, was that when I relaxed, my body started to ache and throb. My joints have been giving me a lot of trouble, lately, as has my lower back. It’s not really muscular — it’s along the areas where my muscles connect with my bone, like along the top of my pelvis in my lower back — the iliac crest, I think it’s called. My shoulders and neck and hips and back just ache and throb and burn. And it gets worse when I relax.

About 20 years ago, after a car accident that didn’t seem like that big of a deal (but sent me spiraling downward — I couldn’t understand what people were saying to me when they talked, and I couldn’t keep my job and I started drinking pretty heavily). I started having terrible, awful problems with debilitating pain. It started in early 1988 and persisted for about five years — eventually the pain got to the point where I couldn’t hold down a permanent job, and I literally couldn’t get out of bed in the morning. At the time, fibromyalgia (as well as chronic fatigue syndrome) was not widely recognized or well-understood, so even though I had a lot of the symptoms of it, then, I was never diagnosed. Comparing notes with others with FMS (or “fibro”), I see an awful lot of similarities, so I’m “lumping” my experience under the FMS banner, sans official diagnosis. I’m not sure I’ll be able to work up the nerve to see a doctor about these symptoms — my ordeal 20 years ago was pretty gruelling and debilitating in and of itself, and nothing the doctors told me or subscribed for me really helped. Ultimately, I made some lifestyle changes — stopped smoking, started taking better care of myself, quit pushing myself so hard all the time, changed my shoes from hard-soled boots to soft-soled loafers, and I started eating right — and the pain dissipated considerably. I’ve been in pain, off and on, over the years, and I tend to use it as a barometer for how well I’m taking care of myself. I must not be doing a very good job of that, lately, ‘cuz I’m in terrible pain, these days.

Then again, it could be the weather, too. All I know is, I’m in a lot of pain, these days, and it’s keeping me from sleeping. And relaxing. I think in some ways, the relaxing problems bother me even more than the sleeping ones.

How much does that suck… I mean, it’s bad enough that I haven’t slept, and that my days have been crazy-busy, and I’m having trouble with figuring out how to deal with my work. But when even the simple pleasure of relaxing is off-limits to me, and it actually increases my pain and discomfort, well, then I start to feel like the Universe is really out to get me.

I hate to be a whiner, so I’ll stop right now. But let the record show that I’m not really happy about not being able to relax without pain. I’ll have to work on that. Use my acupressure points, drink more water, exercise more… maybe work some exercise into my morning routine to release some of the tension before my day starts. And quit eating so much sugar!

Well, the day is waiting. I would prefer to not be in pain and to be able to get through the day without exhaustion and tension, but you can’t have everything. At least I’m able to get through the day on my own steam, and I have plenty of activities to distract me from my discomfort.

Life, on the whole, is not bad at all. Onward…

Diving Into My MRI

I spent time yesterday studying my MRI, comparing my brain with pictures of normal MRI’s I found online at Google images. What a treasure trove Google is! Just being able to find pictures of what “normal” looks like has been a great boon to me.

Looking at MRIs can be very trippy, and looking at my own brain is kind of spooky. From looking at it, the untrained eye could easily become very disoriented and alarmed. But knowing what other normal MRIs look like is very helpful. How else would I know that I’m not a freak of nature? The brain is just so fascinating!

It’s so great to find descriptions of the normal brain MRIs, since it can be hard to figure out what you’re looking at. I’ve got a used textbook on neuroscience I picked up, as well as a copy of Netter’s Atlas of Human Anatomy, which is a hefty tome of highly detailed drawings (done by Dr. Netter) of virtually every part of the human body, which also have every little piece clearly marked and labelled. I look at my MRI, then I consult my Netter’s book, then I Google the part of my brain that I think I’m looking at and read about it, and then consult my neuroscience textbook, to read more in-depth information that’s at a student level. Fascinating.

But I’m surprised to be having such a hard time finding information on reading MRIs. Maybe I’m not looking in the right places. Maybe that type of information is too advanced to be safe to release into the public, lest we all fire our radiologists, start reading our own MRIs, and jump to conclusions about ourselves. I’ve already had people look askance at me, when I told them I was going to be studying my MRI. They clearly seemed to think that I’m not qualified to do it, but I figure, why let that stop me? I’m not getting paid by anyone to ply that trade, and I’m only interested in my own situation, and it’s really just for my own gratification, so I’m not letting their skepticism stop me. It’s my body. I’ll study it to my heart’s content.

I know there’s no substitute for a qualified neurologist or radiologist, but I really need to understand what’s going on with me, and nobody seems to have the time to spend with me to make sure I’m clear on what’s going on. It’s very discouraging to have this level of testing done, only to not be able to find someone to help me understand it. The neuro I saw a week ago wouldn’t give me any more information, other than that my tests read as normal. I asked if they could show me the film, but they brushed me off. Maybe they thought I’d be looking for something that doesn’t exist… malingering and all that. I’m not malingering. I’m curious! And honestly, I don’t want to milk this and make myself out to be sicker than I am. I just want to know why my life experience is so different from what I hear everyone else describing. I want to know why I have the many, many issues I’ve got. I want to know what makes my brain unique — and treat that uniqueness as a strength, not a weakness. And having MRI images to help me gain just a little more insight into my situation seems like a great opportunity to learn more… even/especially if what I learn is that my variations on experience are “within normal range” and not the sort of thing I need to be concerned about.

I did find some pictures of my brain that I have questions about. Places where there are asymmetries and/or dark/light spots that might be old injuries or some abnormality. The part of me that’s been on high alert — or hovering around there — is eager to run off to a neuro to get the spots and dots and bright places explained… to explain how the asymmetries in my brain might translate to some irregularities in how my mind works. I know I need to calm down, get some rest, let it all sink in. There’s no tremendous hurry, now that I know that I’m not in imminent danger from a brain tumor or MS or some other terrible neurological condition. I can relax, now. And I need to make more of an effort at doing that.

In the meantime, while I recover from my over-excitabilities, I’ll think about my next steps. Study normal MRIs online, look around, just do the whole visual image thing, getting my eyes used to the sight of MRIs, so when I do get a chance to talk to a neuro about my results, I can sound at least moderately intelligent. I’m thinking about contacting that last neuro I went to see — the one who treated me like I was looking for drugs, who has since apparently recanted their attitude towards me and offered to help me “in any way” they can. I may give them another chance — but next time, take someone I trust with me, and ask the neuro to just walk me through the high-level points of my MRI. There are some things that are grabbing my attention, and I would like a little bit of an explanation.

I really need someone to read it who knows how to interpret the orientation of the images. I think MRIs may give you a mirror image of a body part, so the left side of the picture is actually the right side. At least, that’s the impression I get from reading descriptions of MRIs that show clear anomalies on the left side… but the text talks about right-side issues. It gets confusing. One side of my brain is shaped a little differently than the other, and I’m not sure if my right side is lop-sided, or if it’s my left. I think it makes a difference, too, which side is varied from the “norm” — left and right sides have different functionality, or so I understand, and if I’ve got developmental issues with one side of my brain, then knowing about them might help me better understand and manage my own issues.

It could be that I’m on some wild goose chase, and that all the differences in my brain are in fact quite normal. But looking at my pictures and comparing them with other MRIs, my head is kind of lop-sided, and one side of my brain has a noticeably different angle than the other side — between the lower frontal/parietal lobes and the temporal lobe that sits beneath it. I’ve got some asymmetrical bulges, and in some places, one part of my brain looks like it’s been crowded by another part that is not shaped the same way as others’ normal pix. It is considerably wider and looks bigger than I’ve seen elsewhere, so that just makes me wonder.

I don’t think it’s a bad thing, having parts of my brain differently arranged than the norm. If anything, it’s probably an advantage. Even if my brain developed differently over the course of my life, it hasn’t completely stopped me from living my life, and no one would probably ever guess that it’s developmentally different. I’ve been far too successful in my life, far too resilient, far too capable, far too adaptable, far too effective, all across the board, for any sort of developmental differences to be a liability. If anything, my differences are a strength. And I’d never part with them. Not at all.

Looking at all these “normal MRI” pix, I have to wonder… What is normal, anyway? If you think about it, the chances of anyone turning out the same way as other people are just so slim. The human body is an amazingly intricate and sensitive system that can be impacted by unseen, invisible forces that we don’t recognize for a long time, if we recognize them at all. We’ve got billions and billions of cells constantly growing and changing and multiplying, we’ve got tons of distinct body parts, we’ve got so many different bodily functions, many of them invisible to us. And we’ve got not only our internal world but our external world to deal with and factor in. Some days, I’m amazed that the human race — or, for that matter, any living creature — makes it through a single day.

Lots can go wrong. Lots can change us. Lots can affect us and our development. But variations are what keep the human race viable. The healthiest living systems have a lot of variety in them, and I would expect that variations in brain development are critical for a healthy system, as well. Even if those variations appear to be “disabilities” or some other sort of rare deviation. The human brain is an amazing organ, and not only can it do things we cannot even begin to imagine possible, but it can also accommodate a whole lot of additional variations and bounce back from injuries, with neuroplasticity and remapping functions and other mechanisms we haven’t even begun to name. (I haven’t done a plug for The Brain That Changes Itself by Norman Doidge, in a few months, so I’ll mention it here — if you have doubts about the ability of the brain to adapt, then you should definitely check it out.)

So, even if my brain is developmentally anomalous, and even if it got broken along the way with those hits and falls and accidents, and even if it gets tired and overwhelmed and doesn’t know where it is, sometimes, it’s still mine. It’s what I have to work with. And so far, injuries and accidents notwithstanding, it’s still going strong.

Got a copy of my MRI on CD

Hallelujah! At last I have pictures of my brain.

And now it’s time to explore it.

I got the images on CD yesterday, but I had company last evening, and this is the first I’ve been able to take a look at the images. My computer keeps locking up on me, tho’, so I have to reboot every now and then. The GE program that displays the MRI slices apparently requires more power than my laptop has. Oh, well. At least I have the images and I can look at them.

Already, I’m seeing interesting things that might explain a thing or two with me. In addition to the TBI-caused difficulties (which aren’t immediately visible on the pictures, at least to me), it appears that my brain is not entirely symmetrical in every way.

Interesting…

I’ll write more later, when I have been able to digest this a bit more.

Add Your Name to the Open Letter to the President

I just found this over at the Sgt. Sam Nichols TBI recovery blog:

Over the past year and a half, my daughter Erin has spent 8 to 14 hours a day in various military hospitals at the bedside of her husband Sam, a US Marine severely injured in Iraq by a roadside bomb.  It has become Erin’s dream to go back to school to become a speech therapist so that she can help Sam and other wounded veterans of the Iraq and Afghanistan wars learn to speak again.  She hopes to one day work in a veterans hospital.  One of the provisions of the new GI Bill is the option to allow servicemembers to transfer their GI Bill education funding to a spouse or dependent.  But—the military has been dragging its feet on getting the regulations in place, so servicemembers are still waiting for that benefit.  The Obama Administration can and must get the bureaucracy moving and make this benefit a reality.

In the coming months, President Obama has a unique opportunity to make a series of critical decisions impacting Iraq and Afghanistan veterans. Sign the open letter urging him to enact these four critical policies in his first 100 days:

    · Ensure that veterans don’t have to fight for funding for hospitals and clinics.

    · Prioritize veterans in the economic stimulus package. (Note: It may be a little late for this, but it’s still a good idea.)

    · Implement GI Bill transferability.

    · Aggressively address troops’ mental health injuries.

Add your name to the open letter here.

I just did

I may need to find another job…

This is really bumming me out. It just sucks. In another few weeks, I may be looking for another job, uprooting myself from the place I’ve been at for the past eight months, and transitioning into another company, position, and whole new group of people to figure out.

It doesn’t make me happy. And I hate being in this situation, but I have to do what I have to do.

Basically, the place where I’m working now wants me to go to full-time permanent, and my boss say’s they’re under pressure to convert people from contractors to perm. Either that, or get rid of the contractors (which would include me). Now, I have to take that with a grain of salt, because my boss has been known to “shade” the truth to push forward their own agenda(s), so who knows exactly what they’re being told. Bottom line is, they’re pushing to get me to convert to permanent, and it’s really uncomfortable for me. It’s terrible on a number of different levels.

First off, they’re trying to low-ball me. They converted other folks in my group to perm, and those folks are actually very weak and easy to push around, so they agreed to take less money than they could reasonably demand. Part of the problem with these folks is that they’re not the most dedicated workers, they spend a fair amount of time hanging out and doing things other than working, and they are also easily bullied — perhaps in part because they know they’re slacking and they don’t want to rock the boat.

I, on the other hand, am a workaholic, and it is rare that I’m ever not working. I was working on my stuff till 10:00 last night — in part because I love what I do, in part because I need to pace myself over the course of my day and break up my work into smaller, more manageable pieces.

But my boss doesn’t see it that way. All they see are dollar signs, so when my two slacker co-workers took less money, they set a precedent that I’m stuck with — and the bitch of it is, one of the slackers is higher up than me, organizationally, so my boss has to offer me less, which is just awful.

Second of all, no matter how well prepared and how skilled I am, the fact remains that change freaks me out. Completely. I can’t even begin to say, just how stressful it is for me. When I was younger, and before I had sustained all these head injuries (I’ve had at least three over the course of my working life, on top of the 4+ I had when I was a kid, and my ability to handle change has decreased with each one), I could shift between different tasks and different jobs and not worry about it. But now I’m having a really hard time with even the idea of change. It’s making me very, very nervous, very, very uncomfortable… it’s keeping me up at night, and waking me up early… it’s agitating me and putting me into a cycle of fatigue-driven poor decision-making patterns that are worrying me. I want to believe I can handle this, and part of me believes that I can. But the rest of me is extremely uncomfortable with uprooting myself from my routine and hauling myself off to another gig with another bunch of people, another whole opportunity to make an ass of myself, and yet more chances to alienate and irritate people who don’t really know me without meaning to.

Third, my resume has some spotty stuff on it that makes me suspect, so it undermines my confidence and ‘smooth’ presentation at interviews. Over the past 2-3 years, since I was ejected from my Good Job with that Big Company, I’ve had a bunch of different jobs, some of which went south because I couldn’t keep it together. The stress of the jobs, my poor decision-making (which was largely a result of my stress-induced analgesia/soothing-seeking cycle, where I would semi-intentionally put myself  into a highly stressed state, day after day and week after week and month after month, just to feel normal and functional), and the cumulative effects of stress on my system took their toll, and I crashed and burned and didn’t handle my exits very well. I can still smell the bridges burning, in fact, and it’s tough to think about how badly I screwed up those  jobs, not only in terms of leaving, but in terms of having taken them in the first place. They weren’t good fits for me from the start, but did I listen to myself? Oh, no! I was much too hungry for the stress and strain of bad decisions. So, now I have to explain myself to folks, if I go back out into the world. And God forbid, if they contact those people…

Fourth, if I go, then my insurance is probably going to have to change. That means I have to wrap up all my testing pronto and I have to make sure my insurance company is properly billed and all that, before I go.  It puts tremendous pressure on me to finish up something that I don’t want to rush. And it also screws up my partner’s health situation, because they have ongoing health insurance needs that are covered by insurance I have through my present agency, which is telling me there are no jobs out there — which I know for certain is not the case, because the job boards are full to bursting with work I can do. This whole insurance thing is a real problem. It’s not something that the federal government may be able to fix — a whole lot of money would go a long way towards solving it for me, but who knows if/how/when that’s going to happen?

And last but not least, I just don’t want to go looking for another job! After eight months, I’m just now getting settled into my current job, and now they have to go and churn things up by trying to convert me — for less money than I deserve, or can reasonably expect to earn, even in today’s market. I want to settle in and take care of myself, do my TBI rehabilitation, let down my guard for just one minute, and focus on restoring the parts of me that are broken. I need a serious break. And I mean a serious break. I’ve been going and pushing and striving for so long, I’ve forgotten there is anything else in the world, and I was just starting to realize there’s more to life than constantly pushing, constantly going, constantly trying to make up for lost time, lost chances, lost hopes. I want to just have my daily routine, get up and go to work, come home and contemplate my life, be with my beloved, have a nice dinner, spend my weekends hiking in the woods and reading good books and getting together with friends. I don’t want to be — yet again — plunged into the chaos of adjusting to a new place, new people, new routines, new rules. It’s so confusing and stressful for me, and then it sets me off in a downward spiral of problems, problems, and more problems. It’s just so hard, and I don’t want to have to do it!

But if I have to, I will. It won’t be the first time I’ve had to really drive myself to do the right thing, when the right thing was the last thing I wanted to do.

EEG and MRI are both normal!

Woo hoo!

I had a visit with my new neuro on Monday, and they tell me that my EEG and MRI both read as NORMAL.

There is no sign of a brain tumor.

There is no sign of MS.

There is no sign of degenerative disease.

I’m way symmetrical and looking good.

At last, I’ve got some actual testing and numbers to show for all this. Enough of the guesswork — I’ve got plenty of notes and detailed observations about my life, but no doctor apparently has the time or inclination to sort through them all.

Plus, with my over-the-top attention to detail and fixation on things that are experientially important (but probably medically insignificant), who knows if anything I’ve recorded is even any use to them at all?

God, I love minutiae. But it doesn’t love me 😉

Anyway, I’m trying really hard to stay positive through all this. I think that part of me would have liked to see at least a little bit of “variation” on my test results, so I have concrete proof that something unusual is “up” with me.

But this is actually one of the things that makes TBI such a conundrum for folks — both medical doctors and people who experience it. Your test results can come back looking great, your CAT scan, your MRI, and your EEG can all come back normal. But there are real issues hidden under the surface that emerge over time and with varying degrees of difficulty.

And those issues can look like seizures or mental illness or ADD or OCD or some of the other “alphabet” conditions that are swimming around out there.

Or, worst of all, they can be interpreted as a lack of will, being a “bad seed”, being “sinful”, or old-fashioned “character defects” that have little or nothing to do with character and have everything to do with the brain not behaving as it should.

And it can make you crazy. Personally, I wouldn’t be surprised to learn that mental illness can emerge as a result of the stress and strain of dealing with TBI… with or without knowing it.

Well, I would love to write more… and I really want to. But I’ve got to get ready for work and stop at the bank to close the business bank account I opened back before I realized that I wasn’t nearly as capable as I thought I was, and my MBTI was propelling me forward in life, fueled by anxiety, drive, aggression, and a deep-seated need to prove to myself and the world that I was really doing very well… when in fact, I wasn’t.

I know now that the complicated tasks involved with running a business are well beyond my broken brain. I may be able to get back some of my functionality with some speech/occupational therapy, but that’s a ways off in the futur. Right now, it’s time for me to let go of that unrealistic drive and work with the limitations I have. In a way, it’s a huge relief. There are plenty of other ways I can prove my self-worth to myself and the world that don’t involve adminstrative paperwork and filing quarterly taxes 😉

Note: This was cross-posted at Daily Strength