All or nothing – for real

I have been looking at my notes from the past days, seeing what I’ve gotten accomplished, and what I haven’t.

There is a whole hell of a lot I have not gotten accomplished, that I have been promising myself I would. Some of the things I have not done are serious. They are job-related. Survival-related. Pay-related.

I cannot NOT do them. But that’s what I’ve been doing.

Not.

I’ve also been thinking about how long it took me to realize that my fall in 2004 had affected me the way it had. Some call it “denial.” Some call it a “cognitive blind spot.” I call it “not sinking in because I have so many other things to think about.” Things like stray distractions that come across my path that for some strange reason I cannot resist following. Like a mynah bird. Magpie me.

The really freaky thing is, I ‘got’ that my concussions as a kid had affected me tremendously, when I was young. The discipline problems. The meltdowns. The outbursts. The getting kicked out of class because I was too much of a handful and nobody knew what else to do with me. I also ‘got’ that the concussions of my childhood had affected my development and made it difficult for me to really function as a regular adult throughout most of my life. Certainly, I did a great impression on the surface, keeping a job (well, a series of jobs) and getting married and settling down and doing important things.

But nobody on the outside ever saw what went on inside. And very few people ever knew what living with me was really like.

The fact that my spouse has stood by me all these years is nothing short of a miracle.

Anyway, the reason I bring up my cluelessness about the impact of my fall in 2004, is that it’s the same kind of obliviousness that I now sense, around my work and the things I have let slide. It’s like I’ve been in this haze, this wandering-about fog, where my brain is busy thinking about everything except what it’s supposed to think about. And that happily distracted piece of me is quite content to not give much thought to my work.

But I must change this. Because focused attention is what helps restore my everyday function, one task at a time. I hate that I have to approach just about everything I do like some rehabilitation exercise, but I do. I just do. I have to make extra effort to get things started, and I have to make extra effort to stay on track, and I have to make extra effort to finish what I start.

I don’t like it. I hate it, in fact. But that’s how it is. That’s how it is with me.

So, I’ll make the extra effort.

And yes, I’ve decided to drop my shrink, once and for all, because they keep encouraging me to not work so hard, not be so hard on myself, not expect too much of myself.

That’s no way to recover. I need to recover, and not give up. I need to treat each and every day like a chance to recover some part of me I’ve lost — or am in danger of losing, if I don’t pay extra attention. I just can’t end up like the football players and other professional athletes who end up demented and/or dead long before their time, because they had no idea what they were doing to their brains, and they never found out what they could do to fix them — or probably ever realized that they needed to fix anything.

Enough of the blind spots. Enough of the denial. Enough of letting things slide and acting like that’s okay. I have to keep sharp. I don’t want to fade away. I don’t want to end up demented and dazed, because I was too dazed and/or lazy to put in the extra effort to keep my brain healthy and engaged.

I need to be healthy. I need to be engaged. Like the nuns in the Nun Study in “Aging With Grace” I need to keep disciplined and focused and not give in to my lazy streak… the streak in me and my broken brain that loves to wander around and follow whatever little distraction comes along. My brilliant mind knows better than to do that all the live-long day.

I must do better. Each and every day is an occupational therapy opportunity. I need to get back what I’ve lost – and make sure I don’t lose what I’ve worked so hard to get.

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Is playing safe? Is it safe to return to play?

Recently, someone posted about the Maher mouth guard being effective protection against TBI in sports. I don’t know enough about it to speak with any authority, but on the other side, there’s the impact of low-level hits to consider. I believe I’ve posted about this before, but it bears repeating:

When we think about football, we worry about the dangers posed by the heat and the fury of competition. Yet the HITS data suggest that practice—the routine part of the sport—can be as dangerous as the games themselves. We also tend to focus on the dramatic helmet-to-helmet hits that signal an aggressive and reckless style of play. Those kinds of hits can be policed. But what sidelined the U.N.C. player, the first time around, was an accidental and seemingly innocuous elbow, and none of the blows he suffered that day would have been flagged by a referee as illegal. Most important, though, is what Guskiewicz found when he reviewed all the data for the lineman on that first day in training camp. He didn’t just suffer those four big blows. He was hit in the head thirty-one times that day. What seems to have caused his concussion, in other words, was his cumulative exposure. And why was the second concussion—in the game at Utah—so much more serious than the first? It’s not because that hit to the side of the head was especially dramatic; it was that it came after the 76-g blow in warmup, which, in turn, followed the concussion in August, which was itself the consequence of the thirty prior hits that day, and the hits the day before that, and the day before that, and on and on, perhaps back to his high-school playing days.

This is a crucial point. Much of the attention in the football world, in the past few years, has been on concussions—on diagnosing, managing, and preventing them—and on figuring out how many concussions a player can have before he should call it quits. But a football player’s real issue isn’t simply with repetitive concussive trauma. It is, as the concussion specialist Robert Cantu argues, with repetitive subconcussive trauma. It’s not just the handful of big hits that matter. It’s lots of little hits, too.

That’s why, Cantu says, so many of the ex-players who have been given a diagnosis of C.T.E. were linemen: line play lends itself to lots of little hits. The HITS data suggest that, in an average football season, a lineman could get struck in the head a thousand times, which means that a ten-year N.F.L. veteran, when you bring in his college and high-school playing days, could well have been hit in the head eighteen thousand times: that’s thousands of jarring blows that shake the brain from front to back and side to side, stretching and weakening and tearing the connections among nerve cells, and making the brain increasingly vulnerable to long-term damage. People with C.T.E., Cantu says, “aren’t necessarily people with a high, recognized concussion history. But they are individuals who collided heads on every play—repetitively doing this, year after year, under levels that were tolerable for them to continue to play.”

Speaking from experience, I don’t see how it’s possible to discourage kids who live, breathe, eat, sleep contact sports to give them up — even if it means they add years to their lives and they avoid the dementia and cognitive problems that can appear over the long term.

I, myself, have apparently had enough concussions in my life to make my brain increasingly vulnerable to damage. The fall I had in 2004 almost cost me everything, and it was totally a fluke — or divine intervention — that spared me and my family from complete ruin.

Parents and coaches and spectators alike should give the impact of repeated subconcussive impacts a good deal of thought, and weigh the immediate benefits versus the potential long-term costs to the next generation.

Just my two cents… on top of Malcom Gladwell’s amazing piece.

One concussion, two concussions, three concussions, four…

I had a meeting with my neuropsych last week, when we talked about my concussive history. I had read the article by Malcom Gladwell in the New Yorker called Offensive Play, and I had some questions about how my past might have made me more susceptible to tbi, later in life.

I was wondering aloud if my rough-and-tumble childhood (when falling and hitting my head and getting up and getting back in the game ASAP were regular parts of play), might have brought me lots of subconcussive events, like so many impacts on the football field. I checked in with my neuropsych, and they had me recap from the top, all the head injuries I could recall. My recollection and understanding of them was considerably better than it was, just six months ago. What came out of it was the determination that I’d had enough genuine concussions to do a fair amount of damage to myself. Forget about subconcussive events; the concussive events sufficed to cause plenty of problems, on their own.

It kind of threw me off for a day or two, and I got pretty stressed out and ended up pushing myself too hard, and then melted down in the evening. Not good. It’s hard, to hear that you’re brain damaged. It’s not much fun, realizing — yet again — that you haven’t had “just” one concussion, but a slew of them. And considering that I’m in this new job where I have to perform at my best, it really got under my skin. It’s taken me a few days to catch up on my sleep and settle myself down, after the fact. But I’m getting there. My past hasn’t changed, nor has my history. I’m just reminded of it all over again…

All told, I’ve sustained about eight concussions (or concussive events) that I can remember. Possible signs of concussion (per the Mayo Clinic website) are:

  • Confusion
  • Amnesia
  • Headache
  • Dizziness
  • Ringing in the ears
  • Nausea or vomiting
  • Slurred speech
  • Fatigue

Some symptoms of concussions are not apparent until hours or days later. They include:

  • Memory or concentration problems
  • Sensitivity to light and noise
  • Sleep disturbances
  • Irritability
  • Depression

I experienced most of these (except for nausea and vomiting, and not so much slurred speech, that I can remember) during my childhood and teen years. Not surprising, considering that I had a number of falls and accidents and sports injuries over the course of my childhood.

It’s pretty wild, really, how those experiences of my childhood contributed to my difficulties in adulthood — especially around TBI. I’ve been in accidents with other people who had the same experience I did, but didn’t have nearly the after-effects that I suffered. For them, the incident was a minor annoyance. For me, it was a life-changing concussion. A head injury. TBI. Brain damage. Geeze…

Thinking back on the course of my life, beyond my experiences with the accidents that didn’t phaze others but totally knocked me for a loop, I can see how the after-effects like fatigue and sensitivity to light and noise, really contributed to my difficulties in life. It’s hard to be social and develop socially, when you can’t stand being around noisy peers (and who is as noisy as a gaggle of teens?). It’s hard to learn to forge friendships with girls — who always seemed so LOUD to me(!) — or hang with the guys — who were always making loud noises, like blowing things up and breaking stuff — when you can’t tolerate loudness.

And when you don’t have the stamina to stay out all night… It’s a wonder I did as well as I did, as a kid. Of course, I was always up for trying to keep up – I was always game. And I wanted so very, very badly to participate, to not get left behind, to be part of something… That kept me going. I was just lucky to have people around me who were kind-hearted and intelligent and tolerant of my faults and limitations.

Anyway, I did survive, and I did make it through the concussions of my childhood. I have even made it through the concussions of my adulthood.  And I’m still standing. I didn’t get any medical treatment for any of these events, and the most help I ever got was being pulled from the games where I was obviously worse off after my fall or the hard tackle, than I’d been before.

But one thing still bugs me, and it’s been on my mind. During my high school sports “career, ” I was a varsity letter-winning athlete who started winning awards my freshman year. I was a kick-ass runner, and I won lots of trophies. I also threw javelin in track, and by senior year, I was good enough to place first and win a blue ribbon in the Junior Olympics. Which is great! I still have the blue ribbon to prove it, complete with my distance and the date. But I have no recollection of actually being awarded the ribbon, and I barely remember the throw. I’m not even sure I can remember the event or the throw. It’s just not there. It’s gone. And it’s not coming back. Because it was probably never firmly etched in my memory to ever be retreivable.

I’ve never thought of myself as an amnesiac, but when it comes to my illustrious high school sports career, when I was a team captain and I led my teams to win after win, I have all these ribbons and medals and trophies, but almost no memory of having earned them.

Which really bums me out. What a loss that is. When I hear Bruce Springsteen’s song “Glory Days” I feel a tinge of jealousy that the guy he’s singing about can actually recall his glory days. I can’t. And that’s a loss I deeply feel, mourn… and resent. Seriously. It sucks.

This could seriously mess with my head. And sometimes it does. But on the “up” side, it might also possibly explain why I’ve been such a solid performer over the years, in so many areas, yet I can’t seem to get it into my head that I am a solid performer. My memory of having done the things I did, in the way I did them, is piecemeal at best, and utterly lacking at worst. So, even if I did do  well, how would I know it, months and years on down the line? How would I manage to form a concept of myself as successful and good and productive and inventive and trustworthy, if I have little or no recollection of having been that way in the past?

It’s a conundrum.

But I think I have an answer — keeping a journal. Keeping a record of my days, as they happen, and really getting into reliving my experiences, while they are still fresh in my mind. If I can sit down with myself at the end of a day or a week, and recap not only the events of the past hours and days, but also re-experience the successes and challenges I encountered, then I might be able to forge memories that will stay with me over time. If nothing else, at least I’ll be making a record for myself that I can look back to later. And I need to use colors to call out the good and the not-so-good, so I can easily refer back to the date and see where I had successes and failures along the way.

Most important, is my recording of successes. I’m so quick to second-guess myself and assume that I don’t know what the hell I’m doing. And when I think back to the times when I overcame significant difficulties, I often lose track of the memory before I get to the end of the sequence I followed to succeed.

But I cannot let that situation persist. I need a strategy and a practice to reclaim my life from the after-effects of way too many concussions. I’m sure there are others in life who have had it far worse than me, but some of my  most valuable and possibly most treasured experiences are lost to me for all time, because I have no recollection of them.

No wonder my parents often start a conversation with me with the sentence, “Do you remember ________?”