The slow return to normal – and beyond

Kind of what it feels like

So, the upheaval over the accident a week ago has begun to settle down. I truly cannot imagine a worse time for life to be disrupted. It’s been a roller coaster of tears and anger and frustration and confusion, with some pretty intense extremes.

I really don’t have time for this sh*t.

I’m not being selfish and insensitive. I really feel for my spouse and all they are going through. It was a really traumatic experience, and I totally understand the reasons for the tears and the anger and all the emotional upheaval. I truly do understand. And I’m there for them to support them as they heal. And I have to deal with my own emotional stuff, too.

The thing is, life goes on, and I have a lot going on with me, just to keep the ship sailing in the right direction. I have to keep functional at work. And I have to finish my own personal projects which are a way for me to A) earn some extra money now, and B) set me up for future income in the years to come, when I cannot do this 9-5 work thing anymore.

I’m feeling less and less capable of dealing with the workaday world, each day, and I know I need a change. I’m not happy with how my brain functions at work – I’m forgetful and distracted and I am not functioning at the level I want to be at. I feel so marginal. I think it’s a combination of brain injury stuff and motivation and the general environment. When you’re dealing with TBI, you have to put in a lot of extra effort and find the “special sauce” that keeps you actively engaged in your life. Then things can go relatively smoothly (on a good day).

But if you take away the motivation and the joy, the sense of purpose and connection, everything gets harder. A lot harder. People at work are very nice, and I’ve had worse jobs, but they’re cliquish and petty and we have very, very little in common.

It becomes more obvious to me, every day, that I cannot continue to make a living, doing what I do the way I do it now. I am wearing so thin, it’s a challenge just to keep my head in the game and show up 100% each day. I really friggin’ hate the 9-5 scene, with the cubicles, the pettiness, being stuck inside all the time, and being in an artificial environment. It also makes me nuts that the people running the show don’t seem to be interested in actually running the business for profit, so when they come up short, people get cut, and it leaves me feeling quite vulnerable and exposed.

That will never do. Someone else who can’t run their business is going to dictate how my life develops? Oh, I don’t think so. It’s really wearing thin with me, and I need to get out. I’ve started counting down to when I can leave — not sure when that is, but I’ve got this countdown going in my head.

So I’ve been putting a lot of my time and energy into developing concepts and projects that can get me out of that environment. I continue to get up each day and go through the process of living my life and building the pieces I need in place for myself in the future. I’m very clear about my ongoing direction — there’s a lot of writing and publishing and “information marketing” in the cards for me — and I’m very clear about how to get there. Plus, there are a lot of resources online to help me get where I am going. So, I’m fairly confident these ideas will take flight.

It just takes a lot of work and a lot of focus. Every extra hour I have, when I’m not eating or sleeping or trying to relax for just a few hours, gets funnelled into my Great Escape. And having this car accident intrude on my focus and having to process all the drama around this event has really been sucking the life out of my activities.

I’m not feeling like I have the wherewithal to go through this whole post-traumatic process with my spouse, and deal with it along with the rest of my life. It was traumatic for me, too, because whatever happens to my spouse, happens to me, and it was pretty intense, being at the hospital and not knowing what the hell was going on. And the car being wrecked… that’s not so great, either. Working through it all… it takes time, and time is something I just don’t have much of.

The thing is, in the back of my mind, I am absolutely certain that things are going to turn around for us. My personal projects are solid and valuable, and I know a number of businesses which have a real need for them. It’s only a matter of time, till I can break free of where I’m at.

It’s the getting there that takes so much time and energy. So, I’m just keeping steady… slowly returning to normal… sitting through the tears and anger and fear and anxiety… looking for every opportunity to change and improve, picking and choosing how I spend my time.

I’m also continuing to grow and expand and develop. Getting new ideas. Following through on them. Testing and seeing what works and what doesn’t, and just staying steady. There’s none of that old haphazard approach, where I would just throw something out there and hope for the best. I’ve got plans in place, and it makes all the difference in the world.

And so it goes. I have to keep current with my sleep, as well as my nutrition. I need to keep on with the everyday, as well as reach beyond to what’s yet to come. I’m feeling really positive about the direction I’m taking.

I just need to get through the fallout from this accident in one piece.

Onward.

Starting Again After a Brain Injury

Great first person account here:

http://www.nytimes.com/2011/10/09/opinion/sunday/brain-injury-and-building-a-new-life-afterwards.html?pagewanted=1

Losing Tiger

Here’s my blatantly opportunistic exploitation of a public figure for the sake of blog hits. But seriously folks, the whole situation does give me pause for a lot of thought.

Depending which radio station you listen to or which news source you read, Tiger Woods’ domestic dispute either involved him getting clocked with a 9-iron by a furious wife… and/or being scratched up when she lit into him… and/or driving around semi-conscious… and/or him sustaining injuries from ramming a fire hydrant with his Escalade… and/or his numb and non-communicative wife bashing out his car windows to save him… and/or him lying on the pavement snoring, when the medics arrived.

I don’t think anyone but the folks directly involved will ever know exactly what happened, but I’m not sure that matters. Enough damage has been done, to permanently erase the once saintly persona we once knew as Tiger Woods. And if his wife really did hit him in the face with a 9-iron, and he was in and out of consciousness, I have to wonder if the head trauma won’t screw with his fine motor control… and possibly bring his golfing career to a sickeningly tragic end.

I’m being harsh, you say? I think not. For years, this guy has made millions, at least in part by projecting a squeaky-clean image, having kids intone “I am Tiger Woods” mantras on moving commercials, and by hawking his wholesome image throughout the media. He has made tons of dough and enjoyed vast amounts of prestige, thanks to his image.

And what does he do, but not only tramp it up with impunity, apparently on Ambien, no less… but also be dense enough to leave tons of incriminating evidence, not to mention get intimately involved with the kinds of women who brag about bedding him. What was he thinking?!

I know the man was in pain, not least of all from losing his father. I know he’s been under vast amounts of pressure, due to his position and reputation. I know he’s been working as hard as any aging athlete to keep his edge in a field full of fresh young players just aching to take his place in the lead. I know the man was human, and I know he behaved like so many other men do in his position. I know that, being human, his mojo quota had to be in some kind of decline, which must have made him absolutely crazy at times… it’s not easy to peak relatively early in life (men do so earlier than women — some of the world’s greatest mathematicians achieved their masterpieces when they were but young pups) and then see yourself decline — however invisibly to the rest of the world. I know the temptations of all those women must have been too much to take at times. Clearly, at least some of them were.

But here’s the thing — if you know all eyes are on you… if you know your fortune depends on your ability to maintain a clean-cut image… if you have a wife and two kids at home and endorsement contracts to honor, you don’t fuck around. And you certainly don’t sext your hottie du jour hundreds upon hundreds of times and leave voicemails on her phone with your name. Geezuz, Tiger — what were you thinking, man?!

In a way, I can understand how it would come to this. I think the guy was set up by a system that makes artificially optimistic, insanely unrealistic, and eventually overwhelming demands on gifted but relatively frail human beings. Frankly, I think the powers that wrote up his contracts probably never genuinely expected him to uphold every last piece in the morality clause(s).  They probably figured they would ride the Tiger Train for as long as it would pull them along, and that eventually something would go amiss, and they’d get at least some of their money back from him, having made millions from his endorsements in the meantime. But they probably never genuinely expected him to violate his own artificial image in such a public and plainly stupid way.

When all is said and done, what I feel most about all this, is a profound sense of loss. The magical golden child of golf has fallen — sure as the golden calf was struck from its pedestal by Moses coming down from Mt. Sinai. And now he’s being ground up and served to all the masses in tiny little bits, strewn through our food and drink. The invention that we had and believed in — that innocent, honest, hard-working, Horatio Alger of a golfer — has failed to hold up under the stress tests of real life, and now we all have to eat crow and cringe whenever we think of those “I am Tiger Woods” commercials.

Those of us who demand perfection from others are as much to blame for this debacle as the parties involved. We are all complicit in this crime against human optimism. We put him up on a pedestal, and then when he stumbles, we go on a feeding frenzy, attacking our object for not validating our fondest fantasies. We need to get real. And stop needing the Tigers of the world to be our role models and paragons. We each need to aspire to and achieve heights in our own ways, not put all of our vainglory into a persona we prop up through consumer devotion and starry-eyed water-cooler talk.

Of course, in the midst of it all, some might cry “racism” and say he was set up and handled too harshly in the media — but weren’t we all set up and then disabused by our own dashed illusions? Weren’t we all just a little too trusting of the image, a little too inundated by all the media blitz, a little too incredulous that someone who flew so high could fall so far? It’s lonely at the top, and it gets hot up there, as Icarus found out.  He plunged from the great heights, too, and did not survive the fall. But he got a whole sea named after him.

As for Tiger… well, there probably won’t be any large bodies of water named after him, but you might get a good deal on a set of his golf clubs on Craigslist right about now…

Please join me in a moment of silence for our dearly departed hero.

I’ll miss him.

Quick – before the snow flies

I’ve had an increasingly pronounced sense of urgency about getting my affairs in order. Could be it’s the end-of-the-year rush, or maybe it’s this sense of immanent change, or perhaps it’s the realization that my life is changing — yet again — but this time it’s changing for the better, and I need to be more mindful of how I manage my resources and energy.

Since I began my neuropsych testing and evaluation, over a year ago, I’ve been acclimating myself to the idea that disaster is not necessarily a given in my life. I’ve realized that the head injuries I’ve experienced, the mild traumatic brain injuries I’ve incurred over the course of my life (beginning in early childhood), have played a direct role in the course of my life. I’ve also realized that with the knowledge of how my brain functions (or fails to function), I can devise strategies to offset the after-effects of MTBI, and plan alternative strategies. And with the proper amount of mindfulness, I can follow through with them in a certain what that can — and does — help me head problems off at the pass before they become the kinds of catastrophes I’ve coped with my entire life.

Yes, I now have tools to help me make my way in the world. And I need to get my act together, to match the level of my mindfulness-augmented competence.

So, I spent the weekend cleaning and moving. Saturday morning, I cleaned my study. Finally. It’s been on my to-do list for months, now. The last time I cleaned it, two years ago, the space felt truly amazing. I just loved being in my study (where before I had dreaded it). But it’s gone slowly downhill over the past few years, which I knew I needed to fix. So, I worked on that consciously on Saturday morning. And while I didn’t complete the task (which took over a week, last time I did it in in 2007), I did make a sizeable dent. And it’s a deeper sort of cleaning now, than I have ever performed in any of my study spaces.

I really focused on doing it mindfully — cleared out a whole bunch of old files, filled several grocery bags with paper to be recycled, dumped old damaged items that needed to be “liberated” a long time ago, and the proceeded to rearrange the contents of my closet. I still have a ways to go. I’m probably about 10% along the path. But the point is, I started it. (And I continued this morning, cleaning out one of my over-stuffed, disorganized filing cabinet drawers.)

Saturday afternoon, I moved leaves. Raked. Used the leaf blower/vac mulcher. Moved 7 large tarps’ worth of material off the front lawn. I may need to make another pass before the snow starts to fall, but if I don’t, at least I’ve made enough of a dent to protect the grass from the effects of acidic leaves over the winter months. I also moved summer items from outside to inside, and I also fixed the dryer duct, which had  become too clogged for the dryer to work properly.

I should have fixed the dryer duct years ago, but that was one of the things that fell off my plate, after I fell down the stairs 5 years ago. You wouldn’t think that hitting your head on a bunch of steps would completely derail your life, but after that fall, I stopped paying attention to the list of things that needed to be done. I’d had a list I was working with — we’d only been in the house two years, up to that point, and the series of things I was planning to do over the coming years was starting to become more manageable and less clogged. Then I fell, and I stopped working on the list. I’ve been working hard to get back, ever since I realized, about a year ago, how badly I’d let things fall by the wayside.

Now my life consists of a whole lot of remedial stuff. Recover stuff. Rehab stuff. Life as rehab. Each and every mindful minute of paying attention to what I’m doing — and why.

Every now and then, I also get the chance to help someone else out with their list, which is what I did on Sunday. A friend of the family is breaking up with their partner of 7 years, and they needed to move some furniture and reconfigure their living space.

My spouse and I drove out to their place and helped them get a number of large, heavy items out of their living room, as well as from upstairs to downstairs. When we got there, they were looking pretty ragged and depressed and overwhelmed. But by the time we left, they were a whole lot more relaxed and up, and they had their home office set up and connected, so they could get their act together. I’m glad we could help. And it felt great — after several months of regular exercise — to be able to lift and carry the sorts of heavy furniture we were wrangling. Recliners, with all that steel, are NOT light items to move. And trying to angle stuff through two narrow doorways was not the easiest thing. But we did it. And it was good.

This friend of ours (I’ll call them C) has been struggling with getting ahead and staying that way, for as long as we’ve known them.  They make progress, and then they make poor choices and slide back… Interestingly, back in high school and college, C played team sports — the kinds of team sports that frequently result in head injury. In fact, they told my spouse onetime that they had been hit in the head a lot, so their memory wasn’t the best. But whenever I bring up the topic if TBI  — with reference to myself, as I’ve told them about my history — they shut down and stop listening.

The other interesting (and a little tragic) piece of C’s story is that their ex-partner of 7 years was in a car accident within the last year, and they took to the bed with overwhemling fatigue, irritability, wild mood swings… and more. It sounded an awful lot like things were with me, when I had whiplash in the past. Their change in personality was eerily familiar to me.

I tried to talk to C a few times about the possibility of MTBI playing a role in the relationship’s degeneration. I said nothing about C’s athletic history, but I focused on the car accident. But C couldn’t hear it. They just blocked it all out. They refused to admit that there had been a real change, or that the change was physical and neurological, rather than psycho-spiritual. C is very much into “energy medicine” and thinks about health in terms of karma and past lives and energy. They think they can address substantive issues with affirmations and intention.

Which is a shame, because they might have been able to get some relief and/or come up with some alternative strategies, by addressing the physical and neurological after-effects of that car accident, and developed real-world coping mechanisms, rather than realinging their chakras.

Now, don’t get me wrong. I am a strong believer in chakras and energies and intention and affirmations. But I’m also a firm believer in the power of the brain’s neurology to wreak havoc with one’s life. I know the domain of the brain can be very scary for people — especially people who don’t have good insurance and/or can’t get decent medical care — but by leaving out that very important aspect of our overall health, problematic situations can escalate and become even worse, on down the line.

Unaddressed TBI issues can literally cost you your job, your home, your marriage… and more. Especially if folks avoid dealing with them up front.

TBI — even “mild” traumatic brain injury — isn’t the sort of thing you can necessarily wish away or “clear with intention”. I’m sure there are people out there who are very capable mind-over-matter practitioners, but as far as I’m concerned, it’s prudent to give the brain its due and not just brush off a brain injury as something that time alone will heal. Brain injures don’t just go away. And left unaddressed, they can cost you a lot that means the world to you.

I’ve experienced that myself… And I spent most of yesterday moving heavy things with someone who is experiencing it, as well. My aching back and joints can attest to it.

Well, at least we got things moved while the weather was still nice. And for all the hard work over the weekend, it feels great to be this functional again, after years of ennui and inertia and neglect. I feel like I’m really starting to get back in the game, in many ways. My life and my attitude and my outlook is very different than it was, before things fell apart in 2004-2005. But I feel like my life force is returning — and it’s actually good for something.

By the time winter comes, this year, I might just be ready for it.

My books have arrived from the library!

I’m really stoked. I finally managed to find a library copy of George Prigatano’s Neuropsychological Rehabilitation After Brain Injury and Prigatano & Schacter’s Awareness of Deficit After Brain Injury.

I’m sure it sounds odd for me to be so excited about getting them from the library, but these are books I’ve been wanting to read for some time. I first came across George Prigatano a little over a year ago, when I was researching brain injury and wondering why in heaven’s name I had never realized there was something “up” with me. I mean, I had a lot of problems when I was a kid and throughout my adulthood. Problems with memory, problems with mood issues, problems with keeping track of stuff, problems with temper, problems with freaking out over every little thing, problems with money management… I get tired just thinking about it all.

I should have realized a long time ago, that all those problems couldn’t possibly have been due to everyone/everything else. Something had to be “up” with me. But no… my broken brain was convinced it was everybody else, not me, that had the problem(s).

Anyway, now I’ve got the books on loan for three weeks — and the past-due fees are high, so I’d better get reading. I’m sure it’s considered a little “blasphemous” and presumptuous for me to be reading up on cognitive rehabilitation and advanced topics that are supposed to be beyond this layman’s brain, but I don’t really care what other people have to say about it. I have access to the information, and even if I don’t understand everything, at least I’m going to check it out.

My wrists are doing a little better. I’ve worked almost 30 hours in the last 2 days, much of that time spent typing, so I still have more resting I need to do. But that will come. Right now, I want to celebrate.

Celebrate life. Celebrate recovery. Celebrate cognitive rehabilitation. I saw my “neuroshrink” today, and we actually had a really good session. I was talking about different events of my past, and I actually got a laugh out of them. A good, hearty, spontaneous laugh, too. In the past, they’ve been kind of reserved and distant, like they were checking me out… not sure if they were going to keep working with me. But today was a good session.

They told me, in the course of our 50 minutes, that considering everything that’s happened to me, my life is a great triumph, not a tragedy. And yes, it’s true! My life is a tremendous triumph, and I’m feeling really grateful tonight that I’ve been able to do as well as I have.

How I’ve been able to do this well — bounce back from multiple mild tbi’s, including sports concussions and falls and assaults and car accidents, and build a life that’s full of activity and love and productivity and, well, happiness… I’m still trying to figure it out.

But if I had to chalk it up to anything, I’d say it’s just stick-to-it-ive-ness. Never giving up. Being tenacious. Stubborn. Hard-headed in the right ways. Trying and trying and trying some more. And never settling for less than I want — and deserve.

Just keeping going… in some ways, that’s the best rehabilitation of all. None of the other approaches actually work that well over the long term, if you don’t have this as the foundation.

But still, tenacity aside, it’ll be good to check out these books. It’ll be good to have some input that comes from outside my own head and immediate experience.

I’m also looking forward to reading more writing from George Prigatano. I have been a huge fan of his for quite some time, and what I’ve read from him I’ve really enjoyed. It might sound odd to talk that way about a neurologist, but everybody’s partial to something. Some folks are into Japanese art, some are into road bikes, some are into Turkish ceramics, some are into Dice-K, some are into the Cavs. I’m into neuroscience. Particularly cognitive rehabilitation after brain injury, and all the fascinating aspects of life that go with it.

And I do mean “fascinating”. The brain really is the final frontier, and despite the fact that everyone has one and we all love to talk about ourselves, precious few of us — scientists and doctors, included — seem inclined to talk about our brains and the way they impact our lives. It’s as though there’s this huge curtain drawn between our white/gray matter and the rest of us… a kind of holy-of-holies veil that keeps us from approaching the Ineffable Massiveness of what sits atop our shoulders and between our ears. I can’t account for the reticence, in general. It’s like everyone is running around talking about everything except their brains… like we’re trying to keep our minds off it.

Or maybe it’s just so close to home that it makes people waaaaay too nervous to approach, and anyway, we’re taught that unless we have degrees and qualifications, who are we to discuss such weighty matters? It puzzles me. We all have brains. We all love to obsess about ourselves and our human conditions. Yet we’ll invest countless hours in dissecting the life choices of Octomom, while remaining oblivious to the Real Drama that takes place inside our skulls, each moment of every day.

I can’t account for it. But it’s getting late, I need to rest, and there will be more time tomorrow to ponder these imponderables. And read the words of  George Prigatano.

PTSD/TBI Factor #1 – Proximity to a traumatic event

This is a continuation of the discussion about PTSD from TBI – Exploring some possibilities. (Updated June 10, 2012)

When it comes to who develops post-traumatic stress disorder and who manages to recover from the trauma without post-event effects, how close you are to a traumatic event can determine the degree to which you are affected.

People who are closer to traumatic events have been shown to develop more symptoms — folks who were closer to Ground Zero after the attack on the World Trade Center in 2001 had almost three times as much PTSD symptoms (up to 20%, versus 7.5%) as folks who were in Lower Manhattan, but farther away.

Physical proximity doesn’t always play a role in the development of symptoms. Research has shown that people who watched the WTC attack on television from a great distance, many miles away, developed PTSD after the event, and in some cases, their symptoms were more extreme and persisted longer than folks who were physically closer to Ground Zero.

One of the key factors in all this is not only actual physical proximity to a threatening event — it’s the individual’s interpretation of the even as threatening… their perceived level of danger.

Now, when it comes to this aspect of PTSD, TBI can play a significant role.

But the role that TBI plays can be quite different from the role that other injury situations (like war or motor vehicle accidents) can play. In the case of those other two examples, the danger is immediate, extreme, and it can lead to deer-in-headlights freezing, which “locks” the experience in place, to be played out time and time again. In the cases of “classical” trauma, the single injuring event itself is the culprit. In TBI, while the injury itself can be a source of trauma, very often the injured party has either dim or missing recollections of the event, so like someone who’s drunk behind the wheel of a car who gets into an accident but comes out the other side without any PTSD whatsoever, in traumatic brain injury, the brunt of the trauma is felt after the injury, when cognitive functioning and decision making and perceptions are all out of whack. Not only can you end up making decisions and taking action which puts you in harm’s way over and over again, but your reactions to those situations can be heightened to make matters far more traumatic than they “should” be.

Let’s get into this a little more…

First, brain injury can impact a person’s ability to assess risk. They can end up underestimating the danger of a given situation and rush in “where angels fear to tread.” They’re not necessarily fools. They’re brain-injured.

I myself have been a walking, talking example of this. I can’t even count the number of times I’ve done really dense things that I didn’t realize were dense, till much later. One time stands out, in particular:

One day, a couple of years after my most recent head injury (but before I realized that I had been injured as much as I was) I went hiking bright and early one morning on the first day of deer hunting season. I was wearing natural earth-tone colored clothing and wandering off the beaten path, deliberately following deer tracks because I wanted to “get in touch with nature”. Seriously poor judgment. In the course of my ill-conceived hike, I happened to cross paths with a deer hunter who was watching the very area where I was hiking, gun in hand, ready to shoot.  I was in very real danger of being shot.

Now, I know better. I’m from a family filled with avid deer hunter – my dad and all my uncles and my brother go hunting regularly with almost religious fervor. I know that the first day of buck season is NOT the day to go hiking in the woods, and if you have to, you wear bright colors and you stick to the trail(s). But that morning my brain totally failed me. I literally could have been killed in one of those hunting accidents I grew up hearing about.

Believe me, I’m not proud of this genuinely impaired choice, but it’s a great example of how TBI-limited thought processing can put a person in mortal danger, without them even knowing it.

The second way TBI can contribute to the proximity of danger is by heightening the intensity of one’s response to situations.

For example, a head-injured person can quickly lose their temper in a confrontation with someone bigger and badder and meaner than them. That has happened to me many times, and I’ve been injured in the process. I know from personal experience that an impaired brain can make you think you can take on that opponent — and win — only to have your body find out that’s not the case. And if you piss someone off who carries a grudge, you can find yourself looking over your shoulder at every turn… becoming increasingly paranoid and jumpy… which eventually can add up to a hefty dose of PTSD.

Now, one of the things that Belleruth Naparstek mentions in her book Invisible Heroes (this discussion is based on info from Chapter 4 therein), is that another factor is internal perception of danger/trauma. If someone doesn’t know they’re in danger, they may not be impacted by even a serious event. People who are involved in accidents when they’re drunk have been shown to develop less PTSD than might be expected. That’s not to say everyone should run around intoxicated, only that having your perceptions impaired or dulled or distracted somehow can keep PTSD at bay.

But if you believe you’re in danger — even in the case of a near miss — you can really find yourself on the PTSD ride of your life. It’s your perception of danger that sets off the reaction… which can build and recur, build and recur, build and recur, till you don’t know whether you’re coming or going and you feel like you’re losing your mind. Even if you escape a traumatic situation relatively unscathed, you can end up with some nasty symptoms.

The third way TBI can contribute to PTSD is by slowing information processing and reaction times, so it can be hard to get out of a worsening situation before it turns really ugly.

Remember, slowed processing time is one of the most common hallmarks of mild traumatic brain injury. And fatigue is not only a common after-effect of TBI, but it’s also a factor in diminshed attentional abilities and cognitive functioning. When you’re in a potentially dangerous situation, the last thing you need is to be thinking and reacting more slowly than you could/should/otherwise would. But with TBI and its after-effects, that’s precisely what can happen.

As an example, say you’re driving down a deserted country road after dark one winter evening. It’s late and you’re worn out from a long day, and you just want to get home and fall into bed. Out of the corner of your eye you see a shape standing on the grassy shoulder beside the road. A huge six-point buck comes into view in your headlights. Something tells you to slow down, but tou’re not thinking clearly, you’re tired and foggy and slower than usual, and it takes you a few seconds longer to hit the brake than you normally would.

Suddenly, the buck turns and starts across the road right in front of you. Before you can react, you hit the deer head-on, crumpling the front of your car and inflating the airbags in your vehicle. Your head bounces off the airbags, breaking your glasses, and slams against the headrest. Dazed and confused, you sit stunned for a few moments. Then you climb out of the car and go see what just happened.  As you approach the deer, you feel something sticky and warm on your face. Your broken glasses cut into your scalp, and the cut — like many scalp wounds — is bleeding profusely. Clamping one hand to your head, you you try to drag the deer off the side of the road so you can drive on, but it’s too heavy — the carcass won’t budge.

You head back to the car to find your cell phone, but you’re so confused you can’t find it anywhere. It’s dark, and it’s cold, and your car looks like it’s totaled. Your scalp is bleeding, you’re disoriented and confused, and it’s been over an hour since you passed an inhabited area. It’s too cold to get out and walk anywhere. You’re cut off. Alone. You spend the night keeping your car running, so you can stay warm, afraid you’re going to bleed to death, uncertain if and when you’re going to get help, having countless scenarios of impending doom running through your mind.

In the morning, a local deliveryman finds you and your car and the dead deer and radios for help. A tow truck comes and delivers you to the nearest town, which is just a quarter of a mile away, up the road, ’round the bend you couldn’t see in the dark the night before. You find your cell phone in your car’s glove compartment and you call a family member to come pick you up. Then you get on with the business of dealing with your totaled car, getting back to work, getting on with your life. You seem okay physically, with just the cut (that stopped bleeding) and a nasty headache. But you can’t get that vision of the deer out of your head, and you keep waking up in a cold sweat, your heart pounding, feeling like there’s something sticky on the side of your face.

Now, this is not to say that someone without a TBI wouldn’t have the same experience. But having thought processing slowed can contribute to slower reaction times, poor judgment calls, and impaired coping techniques… which can contribute to and complicate bad conditions, making them worse than need be — and making them seem worse, too. And that can happen not only with someone who has a TBI going into a tight spot, but someone who experiences a TBI and then has to deal with challenging situations with an injured brain. A double whammy.

The forth way TBI can contribute to PTSD is by making everything seem a whole lot worse than it is.

With TBI, impaired risk assessment can go both ways, I believe. It can not only be impaired, but it can be hyperactivated. TBI can make you think things are lot more hazardous than they are, that you’re in more dire peril than you are, and that you need to respond more intensely than you necessarily need to. PTSD alone can do this, but when your brain isn’t firing with all pistons, your impaired judgment just feeds the PTSD fire.

So, even if you don’t end up in that car accident, or you really aren’t in danger of getting your ass kicked by that Very Large And Angry Person, or you walk away unharmed from a fall that was broken by soft snow, your (impaired) perception of “immediate danger” can trigger a bunch of biochemical reactivity that puts you very much on edge and eventually adds up to full-blown PTSD.

Warning, Will Robinson!

Danger! Danger!

You may not be in danger at all. But your injured brain tells you that you are/were. And your impaired judgment, thinking it’s protecting you from a perceived threat, gets the gears going and sets off a potent chain reaction that — while bothersome at first — can lead to serious trouble, on down the line.

So, there are several distinct aspects to how TBI affects the proximity factor of PTSD (including, but not limited to):

• It can create conditions of actual physical proximity to danger by impairing someone’s ability to detect (and avoid) risk/danger.
• It can make a person’s responses more intense and/or more precipitous, so they overreact to situations and put themself (unintentionally) in danger.
• It can keep someone from getting themself out of trouble in a timely manner and keep them from adequately dealing with an existing tricky situation.
• It can heighten the perception of physical proximity to danger.

All of these (and I could think of a bunch of other examples, but I won’t take up the time here), not only do a number on your head, but also on your body. PTSD is very much about physical reactions… and they tie in with mental processes. So, if your brain is impaired by an injury, and you’re backed into a corner (or think you are), you can end up with a more potent mix of trauma experience that heightens the post-traumatic stress impact.

And that’s no friggin’ fun.

2D/3D Medical Animation: TBI – Traumatic Brain Injury Part 2

I’m feeling a bit low today… tired and overwhelmed and feeling down about how much of my life has been derailed by my invisible neurological challenges. I actually had a productive day at work, but now I’m really tired, and it’s starting to show.

I do want to post something tonight, tho’… I have a full day tomorrow and may not be able to post much, but I wanted to share this with you:

2D/3D Medical Animation: TBI – Traumatic Brain Injury Part 2 on YouTube.

Somehow, it makes me feel better to know that my invisible issues are well-documented as being very real.

Still, I am tired, so I think I’ll hit the hay early.

G’night, all

TBI and Fibromyalgia

I just found this blog talking about Fibromyalgia and TBI — Fibromyalgia Haven. This is of real interest to me, as this may be an issue for me, as well. I’ve been dealing with a lot of stuff over the years, including debilitating, chronic pain, but I never seriously dug into the fibromyalgia piece of it. I was provisionally diagnosed with an autoimmune disorder, back in 1987, after I started having a skin rash and intense joint pain, confusion, and various problems. It was also after a car accident that scrambled my thinking (I couldn’t understand what people were saying to me — I was intensely confused), and I ended up quitting my job so I could devote myself to drinking full-time.

Over the years, I have coped with the pain in various ways, primarily through what I call “analgesic stress,” and it’s been more or less effective. I just tend to block out the pain, now, after never getting any substantive help from doctors for my problems. I know folks with “fibro” but I never really considered it might be a factor with me — until I recently came across info about skin rashes coming with fibro. That rash that wouldn’t respond to ointments was what led doctors to diagnose me with that other condition — which was never substantiated by any of the many (and I mean many) blood tests I took over the years.

I don’t have time to go into this now, but I did want to link to the blog, for your reading enjoyment.

More attention for the invisible disability – TBI

Over at New York Brain Injury Lawyers, there’s a great post, Brain Injury The Invisible Disability

I’ve copied and pasted a fair amount of the post here (their content is indented), and I’m going to add my editorial commentary to it, as well.

Brain injuries can affect people’s compulsive nature and decision-making skills. It is a very sensitive area of personal injury law and quite rightly so. Brain injury varies greatly from person to person because each person’s injury allows for differing affects due to the location of the damage.

I love it that they start out on this note. It’s interesting how, of all the people who talk about brain injury, the people who seem to be the most sensitive to the issues and complexities are attorneys. Lawyers tend to get a bad rap, but in the big wide world of brain injury blogging and generally available information, I’ve found their sites/blogs to be some of the most helpful. Indeed, some of the most reliable and insightful and encompassing (as in, approaching the complexities of the situation without succumbing to the temptation to oversimplify) pieces of truly useful information (at least, for me) have come from lawyers. So, my hats are off to them — the ones who use their powers for good instead of evil, of course 😉

A traumatic brain injury is potentially one the most devastating disabilities. It not only affects the person suffering from the injury but can turn whole families upside down.

Amen to that. TBI does turn families upside down. It sneaks into the most secret and obscure places of one’s life, and it not only causes the affected brain to do and say things it wouldn’t normally say, but it often masks its effects by blinding the TBI survivor to the true nature of their words and deeds. I cannot stress this enough. We live in a society that lusts after self-determination and stigmatizes anyone who “can’t help themself” from doing or saying bad/inappropriate/embarrassing things. Our society is founded upon the idea that everyone has the ability to make themself and their world over in exactly the fashion they please. But though this may hold largely true, sometimes other factors come into play that are beyond our control. And that includes brain injury.

The range and severity of problems arising from a brain injury will vary significantly from person to person because every person’s brain injury varies in the extent and location of the damage. Some of the affects of a brain injury are not immediately obvious and only become apparent as time progresses.

Again, good information. It is so true that the range and severity can and will vary from person to person. No two bodies are alike, and no two brains are alike. It’s just impossible for them to be identical, as they are shaped by events and circumstances and body chemistry in unique and individual ways. So, the range of our injuries will vary… and the severity of our problems will, too. After all, the severity of our issues depend on not only the scope and nature of our injury, but also upon our own personality makeup — how we respond to different circumstances — as well as environmental factors. Things like jobs that allow us little flexibility in our daily schedule, financial difficulties that add stress to our experience, living environments that are intolerant of our shortcomings, and any number of other factors like the food we eat and the amount of sleep we get, can and will affect the degree to which we are impacted.

What’s more, some affects are not immediately obvious… subtle changes in mood, shifts in attentional ability, our cognitive capacity, our processing speed… these things aren’t always immediately detectable to the outside observer. What’s more, changes can take place over the course of one’s life, due to hormonal fluctuations and body chemistry changes.  The brain changes with age, just as the body does, and events like puberty and menopause (male and female), which alter the body’s hormonal makeup, can cause brain changes, as well, which can cause issues to arise that weren’t there before. If the part of the brain that is affected by a certain hormone was injured, and a scar develops, but that hormone remains relatively stable in the body over the course of one’s adult life… then it starts to fluctuate later in life, it could trigger some unexpected activities.

The following are pointers to look out for in a persons make-up if you feel they may be suffering from a brain injury after a nasty knock or have suffered a serious injury.

Note from BB: Keep in mind that even a “mild” brain injury, such as a hard bump or sudden impact or “whiplash” from a car accident (or even head-banging at a rock concert) can cause shearing of the connectors in the brain/brainstem, which can have the following affects. One of the biggest misconceptions about traumatic brain injury, is that it would have to be an open wound or something really dramatic, like losing concsciousness for hours or going into a coma, to cause problems. Trust me, you don’t have to teeter on the brink of destruction to be severely impacted by brain injury.

Cognitive changes
A brain injury can cause cognitive changes which affect the individual’s ability to learn new things, to work and to be able to interact socially.

So true! Some examples of this, from my own experience, are:

• I have a hard time learning new things from books, because my short-term working memory has been compromised. If I’m reading something that’s new, and I divert my attention from it for even as short as a few seconds, I can completely lose the new information — and have to go back and start from scratch again.
• I also have difficulty with sustained attention — I just can’t study the way I used to. I used to be able to study for hours and hours, and at the end of a long weekend of non-stop reading, I would have a new treasure trove of information to work with. Now, I’m lucky if I can last an hour with my reading.
• I have difficulties at work, because I get so tired and I tend to space out when I’m fatigued. I find myself, sometimes, just sitting in front of my computer, staring at nothing in particular, or surfing around just for the sake of relieving my over-taxed brain. It’s not productive, but it’s unconscious, and I’m usually not aware I’m doing it, till I’ve done it for a while.
• Social interaction is a tough one for me, because I have difficulties following people’s conversations at times, and I feel really self-conscious. I also get tired, being around people, and I find I cannot go into places I used to go fairly freely before 2004 — crowds have always distressed me somewhat, but since my fall in 2004, I’m even less tolerant of the noise and hubbub. Also, I have found myself isolating a lot more, over the past few years, and I’ve had trouble managing my emotions and words in social situations, which makes me even less inclined to venture forth.

Lack of insight
Individuals with a brain injury can have great difficulty seeing and accepting changes to their thinking and behaviour. The individual may deny the effects of the injury and have unreasonable expectations about what they are able to do.

I’ll say. Immediately after my 2004 fall, when my job had fallen apart, and I was in the process of quickly depleting my $250,000+ nest egg, I decided I was going to become a financial planner. Talk about a lack of insight! Not only did I not see that I was having an impossible time completing the self-paced work-at-home coursework — in 18 months, I managed to complete only 1-1/2 of the 6 courses, and I got a C on the one I did complete, which is totally out of character for me! But I also was oblivious to the fact that I was mismanaging my own funds so badly that I was quickly running out of money, when I could/should have been making money on it (after I prematurely cashed out of my shares — I walked away with $143,000 instead of the $700,000 I could have had, if I’d just managed to hang in with that job another 18 months — 18 months!!! — I put the money in my checking account that earned no interest and was open-season for my spending). I was doing a piss-poor job of managing my own money and planning what to do with it. What in the world made me think I could be a financial advisor/planner for anyone else? That’s easy — classic p0st-TBI lack of insight. Sheesh!

Memory problems
There may be problems in remembering people’s names, passing on messages, or recalling details read in a book or a newspaper. They may forget what they are doing from one session to the next. Memory problems may cause the individual great difficulties in learning new things.

Oh, please, don’t even get me started on this. If I don’t write down something in the moment, I might as well wave good-bye to it. I am, this very morning, trying to catch up with things I forgot to do over the past three days. If I lived alone or I was with someone who was less interactive and invested in keeping me on track, I would be lost. And quite possibly homeless and jobless, as well.

Poor concentration
A very common outcome is an inability to concentrate and to become easily distracted from what they are doing. This is usually because they are having difficulty concentrating.

Yes, yes, yes. My concentration comes in fits and starts. I found, right after my fall down the stairs in 2004, that I couldn’t concentrate to save my life. I was just flitting from one thing to the next, and I was utterly unable to learn the new skills I needed, in order to keep my job. Of course, I had no idea that I had been brain injured at the time, so I told myself — and everyone else — that I had chosen not to learn the things I needed to learn. I didn’t want to/couldn’t admit (or even see) that it wasn’t that I’d chosen to dig my heels in… I literally couldn’t. Because my concentration was totally shot.

Slowed responses
An individual with a brain injury may now be slower to answer questions or to perform tasks and may have difficulty in keeping up in conversations. Their capacity to respond quickly in an emergency may also be diminished.

Yeah, this is a problem. And it can be pretty scary, too, when you’re in an emergency situation. This has impacted me a number of times.  A couple of  times over the past ten years, in fact, I have had to help friends who were having strokes, but both times, I couldn’t seem to put two and two together. I couldn’t seem to figure out what was going on, and it’s lucky for them that there was someone else there, in both instances, who could see what was happening and come up with an appropriate response. The feeling of being turned around and not being able to respond quickly in such a life-threatening situation is scary enough at the time, but afterwards, it can really haunt you. It’s certainly haunted me. In fact, my inability to respond to a number of emergency situations — some of them life-threatening — was one of the things that “raised a red flag” with me and told me something was just not right with how my brain was working.

Responding to questions and keeping up with conversations is very important when you’re dealing with authority figures and law enforcement, I have found. One of my recurring issues with regard to my TBI is run-ins with the police that nearly went sour, just because I wasn’t following what the officer was saying to me. You have to understand, I’m a very law-abiding citizen. I believe the law is what makes our society livable, and I make every effort to obey it. So when I mess up, go faster than I should, miss a stop sign, or take a left turn too closely, and I get pulled over, I am genuinely confused, because I certainly did not intend to screw up. And my confusion makes it harder for me to focus on the situation, as well as follow the officer’s directions. I have nearly gotten into physical confrontations with cops because of my confusion and frustration and short fuse. I knew better, but my brain failed me at the time when I needed it most. This is probably one of the suckiest things about having a brain injury (or, in my case, several) — it keeps me from being the kind of person I desperately want to be, and from living the kind of life I am determined to live.

On the less dramatic side, with regard to being slower to respond to questions and finish tasks, it can take me forever to get my head around things I’m being asked. That drives my family nuts, and I have a tendency to try to cover up my cluelessness and slowness, so I don’t piss them off. But when I really want to get something, I’ll make them slow down. I also have to be ready to remind them that I am a bit slower than they expect, and they need to not get so upset with me about not following as quickly. Sometimes, they yell at me because I’m “being difficult” when I’m just a lot slower than I’d like to be.

I also often have trouble keeping up with conversations. I can’t tell you how many times people have started talking to me, and I haven’t had a clue what they were saying… for about a minute into the conversation. I tend to have to replay conversations later on, to see if I got what just happened. Socially, I’m fortunate that I have a lot of really gregarious friends who do most of the talking. I just sit back and let them do most of the “work” — and they’re fine with that. Either that, or when I’m in a conversation with someone that I’m just not following, I’ll actually just echo back what they’re saying without fully understanding what they’re talking about. I will appear to agree with them (which they like), but I’m actually just rephrasing what they’re saying. This makes me very popular (people like to be mirrored and they love it when other people agree with them!) but it doesn’t do much for my own sense of self.

Problem-solving
Individuals with a brain injury might have difficulty solving problems and planning and organising things they have to do. They may encounter trouble with open-ended decision-making and complex tasks need to be broken down into a step-by-step fashion.

Oh yes… breaking things down. Can I tell you, my life is filled with detailed step-by-step instructions about how to do the simplest things. When I need to organize my busy day, I fill my planner with the different things I’ll need to do, in the order that they need to be done, and I walk through them in precisely that order. I cannot tolerate changes in routine — it makes me nuts and freaks me out. I desperately need predictability and routine, because backing up and re-configuring my day is a recipe for disaster.

Irritability
Individuals may also have a very low tolerance for frustration and can become easily agitated and may lose their temper quickly.

Yes, yes , yes. Never forget that fatigue factor. Being tired not only makes it harder to think, but it makes it harder to manage emotions and modulate your expression. The thing with me is, too, that my TBIs have made me look more impassive and stoic on the outside than I feel on the inside. So, I may be seething with frustration on the inside, but I look perfectly fine on the outside, so people around me cannot judge my level of frustration — until I blow up.

Another thing that ‘stokes my fires’ is the pain that I’m often in. I have a lot of pain in my body that isn’t helped by drugs or much of anything other than rest. When I’m fatigued, I’m often in extreme pain, which just adds to my irritation level.

Irritation is a huge problem — for me as well as others, because I never, ever want to hurt the people I love, but my irritability gets the better of me all too often. And I have to live with myself afterwards.

Socially inappropriate behaviour
People with a brain injury may no longer know how to act or behave in in social situations. This can be incredibly difficult for families to understand and cope with, particularly as they may no longer recognise their loved ones and not understand their behaviour.

I have screwed up social situations so often, that now I just tend to keep to myself and I don’t respond unless others address me first. Some of the many things I’ve done that have landed me in hot water are:

• Talking too loud about sensitive issues
• Forgetting that I promised to keep a secret, and telling the world — in front of the person to whom I promised I wouldn’t tell
• Behaving in ways that women felt were too familiar or encroaching or sexually intimidating
• Behaving in ways that men (including security guards and police officers) considered threatening, and triggered an aggressive response from them
• Coming across like I was making fun of or deliberately embarrassing family members

I really, really hate this aspect of TBI, especially, and it makes it easier for me to just keep to myself. It’s tough, because I want to be social — who doesn’t? But I do it so poorly, at times, that I feel it’s my responsibility to shield others from my ineptitude.

Communication
A wide range of social skills may be affected by an a traumatic brain injury including the ability to have conversations, to interpret and respond to social cues, to show interest in others, to use humour appropriately, and to regulate the volume and tone of voice.

Uh, yah. See above for how my TBI affects communication issues. I generally don’t initiate conversations, and I’m terrible at sustaining them. Good thing I live with very social people who can run interference for me. I usually don’t stray far from them, as I tend to get into trouble with people, when I try to initiate and sustain conversations. At times, I just don’t know what to say. I’m like a little lump of clay that isn’t able to create impressions on others, but can be impressed upon by others. I generally stick with just responding to people’s cues, but even then, I’m often totally lost, and I simply don’t follow. I also am often strangely devoid of interest in other people. Oh, certainly, on a grand cosmic scale, I do care a great deal about what others experience/think/feel, but personally, in my injured brain, part of me just doesn’t care. I want to care (I think), but I just don’t. I’m sorry, world. I just don’t.

I also don’t always use humor appropriately. I usually think I do, but then I find out from others that I don’t. Heaven help me — and everyone around me, who has to put up with my sense of humor when I’m tired.

Regulating my tone of voice is a constant challenge, which is another reason I keep quiet so much. I often use the exact wrong tone – I’m too loud in quiet situations, or too quiet when I’m talking about important things… I sound angry when I’m just riled up… I sound deadpan/stoic when I’m really worked up. In some cases, people I live with have been very afraid of me because my tone was a lot more intense and sounded “hateful” and aggressive, when I was just having a lot of trouble articulating, and I was scared half to death over something. I’m hoping that my family members will learn that my tone doesn’t always match my inner reality, and cut me some slack.

Depression
Depression in an individual with brain injury is a very common emotional consequence that usually comes some time after the injury. Signs of depression include lack of motivation, loss of sexual drive, sleep disturbance and tearfulness.

Okay, here’s one of my pet peeves — interpreting neurological processes with emotional ones. Lack of motivation is not necessarily depression-related, nor is loss of sexual drive, sleep disturbance, or tearfulness. There are a host of neurological reasons why all these can occur, and the fact that they’re commonly lumped together under “depression” tells me that there are probably a lot of people walking around with neurological issues that could be possibly addressed with occupational therapy or other coping mechanisms, but they’re being medicated, instead.

Unraveling neurological issues from psychological ones is in the Top Ten Things I Hope to Promote in This Blog. Calling our neurological, TBI-related issues “psychological” ones and addressing them with drugs just empowers the pharmaceutical companies, not the people who have to live their lives. Don’t get me wrong — I have nothing against a quality pharmaceutical solution. But too often pills are pushed as a solution, when they just add to a problem — like Prozac making certain people suicidal.

Mis-diagnosing neurologica/TBI-related issues as psychological ones and inappropriately medicating patients actually works against the pharma companies, as well. It makes them suspect, when the real culprits are lazy/mis-informed/biased/idiotic psychiatrists/therapists/doctors and it prevents good science and good medicine and good psychotherapy. I want good pharmaceuticals as much as the next one — but I want their power used properly and for good, instead of lazy-assed evil.

Headaches
There are multiple sources of head and neck pain, both inside and outside the head. Headaches arising from a brain injury can be caused by a number of reasons.

When don’t I have a headache? Rarely. Of course, one of the neuros I’ve seen over the last year tells me they’re stress related, and if I just relax and exercise more, they’ll go away. Hasn’t worked so far… Hasn’t ever worked.

Visual problems
Vision and visual functioning is often adversely affected by brain injury. Some of the more common visual systems problems include double vision, rapid eye movement and near-sightedness.

Can’t speak to this much, aside from rapid eye movements I sometimes get when I’m overtired.

Hearing problems
Hearing problems can occur for a number of reasons, particularly when the inner ear and/or temporal lobes have been damaged.

And let’s not forget tinnitis — that constant ringing in the ears. True, it can be more neurological than auditory, but it’s hearing-related. For the record, I have — and always have had — constant ringing in my ears. Sometimes it’s louder than others, but it’s always friggin’ there.  It used to drive me nuts when I was a teenager, but I have since acclimated to it. Now I use it as a barometer of my physical condition — louder means I’m having issues of some kind — stress or fatigue or what-not. It’s actually a useful gauge of my physical well-being. Provided I can tolerate the constant high-pitched whine.

A traumatic brain injury is often called the invisible disability. As there are frequently no outward physical signs of a disability, effects such as fatigue, lack of initiation, anger, mood swings and egocentricity may be seen simply as bad personality traits by others. It is easy to see why a traumatic brain injury can be such a devastating disability, especially when the disability is not obvious to others.

Indeed. In fact TBI is often a double-hidden disability, as it’s so often hidden from the survivor, themself. It’s a real conundrum, let me tell you. Society has so many biases against behaviors and problems that can come with TBI, it can be all but impossible to get people to consider you injured, rather than bad. The real challenge, from where I’m sitting, is learning to detect and live with my own disabilities, find my strengths, and ultimately, finding peace in myself, no matter what the rest of the world has to say.

And if I can get through the day without doing any harm, so much the better.

TBI can be a devastating experience, both during and after — in the short and long-term. But if you can get past the trauma of it and learn to deal with it substantively, it doesn’t have to ruin your life. And the pieces that have been broken, can sometimes be put back together again. Ultimately, the brain is a fascinating phenomenon. We all have one. And the challenge — for us all, at this time — seems to be learning how to use it properly.

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Better today… of pain and ptsd

Well, I got to bed by 10:00 last night, and I was able to sleep through till 6:30 or so, which is an improvement over what I’d been able to do over the last weeks.

I’ve been kept up by anxiety over what my neuropsych evaluation is going to reveal — that’s coming up this week — me being terribly afraid that I had given wrong information or I just couldn’t think my way through certain things… I’ve been second-guessing myself for days and days, wondering if I answered as accurately as possible… of if maybe I’m more crazy than head-injured… or that my head injuries have led to some sort of mental illness that’s invisible to me because of my anosognosia… or maybe I’m just on this wild goose-chase that will end up being all for nothing.

I try to be level-headed and logical about this and remind myself that my neurpsych has been doing this for many years, and they have certainly seen worse cases than me. But still, not being able to be a full participant in the process and being a subject of examination and enquiry… well, that makes me uncomfortable, and even if I do trust the doctor. I just don’t know what to expect, and I cannot manage my wild rang of emotions, if I don’t know what I’m managing for.

Fortunately, I do feel better this a.m. — not so much pain, not so much tenderness. I got a bit of a massage yesterday p.m., and it really, really helped. Even if it was painful at times — I don’t care. Short-term pain for long-term benefits. I’ll take the pain in the short-term, if it will help me feel this much better in the a.m.

I still have discomfort when I move – especially in my hips and lower back. And my elbows are still sore. And my thighs are still tender. But I can push up my sleeves, so they’re not chafing my wrists, and my body isn’t screaming so loud I can’t hear myself think.

I tried the Arnica yesterday. i can’t say I noticed an immediate effect, but I’m going to keep trying it — 4 tablets dissolved under my tongue 4 times a day, for a few days. I’m going to take it again after I finish my cup of coffee. (I’ve heard that you have to be careful taking homeopathic remedies when you’re eating or drinking. It’s my understanding that the remedy needs to be the only think you can taste… or I could be wrong.) I’m not off caffeine entirely — that would be too much. But I am cutting back. I only had one cup yesterday, which I think helped me sleep.

This arnica experiment is definitely going to be totally screwed up by my other changes I’m making. In a “real” test, the only thing I would change would be taking the arnica, not getting more sleep or changing my diet or getting more exercise. But dude, I’m in pain, and I need it to stop, so I can get on with my life.

Thinking about the role that pain has played in my life, I think there’s a definite trauma aspect to it. I have friends who specialize in treating trauma, both in medical and psychological environments, and they talk a lot about it. They also love to tell me I’m a “trauma survivor” — having had a whole bunch of accidents that left me progressively more impaired, as the years went on, along with the social, interpersonal, and physical after-effects of my impairments that haven’t helped me get by in the world.

And since I have a history of trauma — physical, as well as psychological — I have to admit I do show signs of PTSD.

Over at Wikipedia — http://en.wikipedia.org/wiki/Posttraumatic_stress_disorder — I found this (note: my comments are in italics):

The diagnostic criteria for PTSD, per the Diagnostic and Statistical Manual of Mental Disorders IV (Text Revision) (DSM-IV-TR), may be summarized as:[1]

A. Exposure to a traumatic event – multiple head injuries over the years, along with other accidents and fights/clashes with people that threatened my safety
B. Persistent reexperience (e.g. flashbacks, nightmares) – I’ve had lots of them over the years… where do I begin?
C. Persistent avoidance of stimuli associated with the trauma (e.g. inability to talk about things even related to the experience, avoidance of things and discussions that trigger flashbacks and reexperiencing symptoms fear of losing control) – some things I just will not talk about… you can pump me for details till the cows come home, but I’m not talking about certain things that have happened to me, unless I can know that it’s not going to ruin my life, if I do
D. Persistent symptoms of increased arousal (e.g. difficulty falling or staying asleep, anger and hypervigilance) – well, yuh, I’ve had more restless nights and being jolted awake at 3 a.m. with my heart racing and my body soaked in sweat… than I care to think about
E. Duration of symptoms more than 1 month – try months and months… sometimes years later, after the initial event is over
F. Significant impairment in social, occupational, or other important areas of functioning (e.g. problems with work and relationships.) – just ask my friends, family, and co-workers… just ask my 17 former employers

Notably, criterion A (the “stressor”) consists of two parts, both of which must apply for a diagnosis of PTSD. The first (A1) requires that “the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.” The second (A2) requires that “the person’s response involved intense fear, helplessness, or horror.” The DSM-IV-TR criterion differs substantially from the previous DSM-III-R stressor criterion, which specified the traumatic event should be of a type that would cause “significant symptoms of distress in almost anyone,” and that the event was “outside the range of usual human experience.” Since the introduction of DSM-IV, the number of possible PTSD traumas has increased and one study suggests that the increase is around 50%.[48] Various scales exist to measure the severity and frequency of PTSD symptoms.[49][50]

Now, this is all pretty thick stuff for me to get into. Personally, I don’t feel like I can take on much more to process, other than just dealing with my own pain… but I have to say, the pain is worse, when I’m feeling the after-effects of some past trauma. When I’m dealing with people who have really physically hurt me in the past — like adults who used to really knock me around — or I’m interacting with people whom I have hurt in the past because of my bad behavior and poor social integration.

When I think back on being a kid, I remember a lot of pain, both from internal sources and from without. My pain issues date back to fairly early childhood – I was not a very limber kid, and I had a lot of difficulty doing things that other kids could just do, like touching toes and climbing and jumping and doing cartwheels and such. I had a lot of trouble with my balance, and I couldn’t do a somersault until I was about 5 or 6. I can’t remember exactly how old I was, but I do remember the day I did my first “real” somersault — I didn’t fall off to the side, but was actually able to just roll right over and keep my balance. When I tried to stretch and extend, like other kids could, it was very painful for me. But I kept trying, and I just forced myself to stretch and extend… until the pain was too much, and I had to stop… which was usually far short of where I wanted to be.

I wanted so much to participate, to take part, to be a part of what was going on. I hated being on the outside, not able to do what other kids could as easily as they could, so I pushed myself — very hard. There was a lot of pain, but that was just the price I paid for being able to be a part of what was going on.

The other source of pain was from the outside. I was raised by parents who didn’t know how to relate to me. I tended to get over-stressed and over-extended with all the stimuli going on around me (including the pain), and they tended to discipline me. Grab me. Jerk me around. Take hold of my arms and pull me to where I was supposed to be. It was excruciating, and it was shocking. My memories of childhood are full of instances where my mom would grab me out of the blue — I wasn’t following what was going on, and I didn’t understand what she wanted me to do, so she would yell and/or grab me and pull/push me to where I was supposed to be. With my sensitivities, it was like just being pounded out of the blue, time and time again. I could never prepare for it, I could never brace for it. And I didn’t really “get” why it was happening, a lot of the time.

I wasn’t able to explain my “bad” behavior to them, and they didn’t seem much interested in finding out if I was having problems, or if I was just a bad kid who needed discipline. I think, because of their religious orientation and the role that my very religious grandparents had in our lives, they “went with” the religious explanation that I was a “sinner” and that “sin” or the “devil” had taken hold in my life, so I needed to be disciplined to stop my acting out.

So, they did. I got called a lot of names, when I was little, because I couldn’t keep up cognitively or physically — spaz, space cadet, bugger, doofus, spastic… that was my dad. My mom preferred to call me pathetic or disgusting or asinine (asinine was her favorite). I was actually shielded from their wrath a lot, because I didn’t understand till I was 7 or 8 or 9 (?) that they were actually talking to/about me. I thought they were just saying what they were saying into the blue. It didn’t occur to me, till I had been in school for a few years, and other kids were calling me names, that my mom and dad were calling me names, too.

Actually, come to think of it, it didn’t occur to me that my mom was calling me names, till a few years ago. Somehow, being mistreated by my mother is a lot harder to take than being mistreated by my dad.

Even when they showed affection, my family’s hugs and touches were extremely painful. My family — for whatever reason — loves to give big, hard hugs, and it hurts like crazy when they do! I don’t know what it is that makes them think it’s okay to just throw their arms around someone and squeeze so hard… or maybe they can’t really feel it, themselves, so they have to have hard hugs and forceful contact, to even tell someone is there. My grandparents were hard huggers, and my mom was/is, too. She loves to reach out and grab people as a sign of affection, which is a double-whammy — I don’t want to shut her out, but I cannot take the force of her contact. Just over Thanksgiving, she was walking by me, and she reached out and grabbed my arm as a sign of affection. And when I was getting ready to drive home, with the weather being as rainy as it was, she got scared for my safety and she just threw herself at me and hugged me really hard, which really hurt.

I still haven’t figured out how to tell people that when they touch me, sometimes it feels like they’re pounding on me. It’s embarrassing, it’s troubling, and I dread people knowing just how much pain they’ve caused me. Being in pain is bad enough, but then “spreading it around” by telling others about it — and telling them there’s nothing they can really do, but keep their distance — is just awful. I’ve done it before, and it’s awful. Awful to be pushed out to the margins. Awful to be forced to push people away. Awful to have to hold them at arm’s length and never let them close, without pain.

Thinking about growing up in constant pain, raised by people who repeatedly hurt me terribly, is definitely not easy to take. I have to tell myself my parents weren’t fully aware of the effect that their behavior was having on me, and that if they’d known what it was like for me when they grabbed me or hugged me, they would not have done it. I have to tell myself that they had no idea, that they were innocent. Believing that my parents would intentionally harm me, is more than I can process right now.

But it’s probably worsening my pain, to hold back from that belief. Now that I’ve been away from them for a whole day, I’m starting to relax, and I’m starting to be able to adddress my pain. I think when I was in the midst of it all, I was so shut down that even if I’d been in terrible pain — which I may have been — I wasn’t aware of it. I was up in my head. I was too busy talking. I was too busy trying to stay out of arm’s reach of both my parents.

I rarely notice until days after the fact, but when I am in the midst of family at holiday/Thanksgiving time, I hold as still as possible for long periods of time — both as an attempt to not draw attention to myself, and to keep myself from acting out when I get stressed. When I’m stressed, my brain stops working really fluidly, and I end up needing to take more time to explain myself. But when things are all wild and woolly, like at my parents’ place at Thanksgiving, I don’t have the time to fully explain myself, and I end up hurting people’s feelings from a poorly told joke, or an attempt to josh around with others, and then I start flashing back to all the other times I said/did things that people took the wrong way.

Yes, I hold very, very still during the holidays… both for my own protection and that of others.

And it probably doesn’t help my pain — because of my rigidity and my disconnection from my body.

And it doesn’t help my PTSD. Because I go back to that place where I’m on auto-pilot, where I’m just keeping my head down and keeping moving, where I’m just doing what’s in front of me, and not aware of whether or not I’m hungry or tired or anxious or stressed. And when I’m not aware, when I’m just soldiering through (as I do so well!), I tend to push myself even harder — do more stuff, take on more tasks, be more manic, be more forceful, be harder on myself and add more things to my to-do list — and that cuts in on my sleep, it cuts in on my rest, it cuts in on my physical well-being.

And I have pain. Lots of it. Tearing, ripping, screaming, shooting, chafing, burning, crazy-making pain.

So, in a way, the pain is like my barometer for how I’m doing, stress-wise. It tells me if old stuff is coming up that’s making me do things and make choices that aren’t healthy. It tells me if I’m falling back on old patterns, letting my fears and anxieties and old hurts stop me from living my life. It tells me if I’m tired — and it tells me that I’ve let myself get over-fatigued and ill-nourished.

It’s an objective measurement of how I’m doing psychologically and physically. And it gives me a great “excuse” (in my mind, when a simple reason won’t suffice) to step back and cut out all the shit I’ve got on my plate… focus in, take care of basics, talk over my issues with my therapist, and make sure I get plenty of rest. It tells me, loud and clear and in no uncertain terms, that I’m totally f’ed up, and I need to stop doing what I’ve been doing, and just take a break. Take care of myself. Have a long, hot shower. Take care of myself. Now.

Unless I do, I’m going to stay in pain. That’s just the way it is. And it’s my choice.

In a way, pain is my friend — but only because it’s my mortal enemy.