Broken body, broken mind

Source: freefoto.com

More than ever before, I’m convinced (and riding the bandwagon around the square, beating on my drum) that the body and mind are so closely intertwined, that you cannot possibly separate out the two.

You take care of the body, and the brain will benefit. The mind will benefit, too. I differentiate between the mind and the brain because I believe (like others) that the biological, physiological organ of the brain is just one part of what makes up the mind. When you take care of the body, the brain benefits. And when the brain benefits, the mind has something to work with.

Body-brain-mind connections matter. They have such a profound impact on our health — and our illness. That goes for mental health. It goes for TBI recovery. It goes for effective and lasting healing for PTSD. If you leave you body out of the equation, while trying to fix your brain, your mind may have a hell of a time getting back on track and up to speed.

Now, don’t get me wrong. I don’t advocate that everyone who’s struggling with mental health issues, TBI, and/or PTSD run out and join a gym and get ultra-ripped. I’m not saying that you have to become a competitive athlete or reduce your body mass to 5% (which might be physically unsafe, in any case – our bodies need fat). And I’m not saying that if you’re in poor physical condition, you’re going to be a vegetable.

I am saying that exercise, when done carefully and regularly, can and will benefit not only your body but also your brain and your mind. It’s not blind faith I’m falling back on — it’s scientific fact, documented research, and personal experience. It doesn’t have to be torture, it doesn’t have to involve pain. It can be as pleasant as a walk on the beach with a loved one and your dogs, or perhaps a swim in a beautiful lake. It can be as everyday as taking the stairs three flights up, instead of taking the elevator. And it can be as invigorating as a game of touch football with your friends on Thanksgiving Day.

But if it’s not at all a part of your life, and you’re dealing with the challenges of TBI and/or PTSD, I’d hazard to say that your row is going to be a bit harder to hoe.

By now there is so much documented evidence that exercise and aerobic movement aids the brain, that it’s impossible to ignore. And it would be negligent of me to not beat on my exercise! drum, if I genuinely want to help people overcome the challenges of TBI (which I do).

The fact that exercise is such a simple thing for everyone to get — even in moderate amounts — makes it one of the best-kept secrets of TBI recovery. It’s so secret, even the top experts make passing reference to it, but aren’t nearly as passionate about it as, say, the folks at the Concussion Clinic at University at Buffalo. Watch the “Sportsnet Connected” – UB’s Post Concussion Syndrome Treatment Program for some very exciting developments.

For all the talk about TBI and PTSD among veterans, nowhere do I hear anyone talking about how soldiers returning from Iraq and Afgahnistan can help themselves with exercise. The VA may not have the proper pieces in place for highly effective diagnosis and treatment, and they may be discharging soldiers with inaccurate “personality disorder” diagnoses, but the one thing I see time and time again, when I look at YouTube videos of soldiers training, is gym and exercise equipment. Even gyms built in shacks on the sides of mountains in a godforsaken country far, far from home.

This puzzles me. Why would a treatment so effective and so familiar and so self-directed not be promoted and plugged (especially for soldiers), till everyone is sick of talking about it? Maybe it’s “too easy” and people think that it’s something that’s “extra” in addition to meds and/or directed therapies. Maybe it requires “too much” consistency and people don’t know how to work up the motivation to do it regularly enough to make a difference. Maybe the VA didn’t get the memo about U@B’s success stories. Maybe veterans are waiting for someone else to initiate treatment and get them on the right path.

It’s complicated, of course. I suspect it may also have to do with the professional interests and personal makeup of the top experts. After all, if earning your bread and butter (not to mention your reputation) comes from the control of information and the dispensing of advice and assistance under strictly controlled and controllable circumstances (like your office or a rehab facility), and you feel your professional position is threatened (or you may lose clients to outside forces), you don’t necessarily have a deep-seated incentive to encourage people to do simple, common-sense activities on their own (which provide tremendous benefits without requiring insurance billing codes).

Plus, if you’re a person who’s made your mark in the world sitting at a desk or standing at a podium, and you don’t have a real focus on physical fitness in your own life, why would you even think to recommend exercise to your clients/patients? The personal element to this — i.e., non-athletic individuals (who may have gotten into science and medicine because they sucked at sports) who have an aversion to exercise — should be factored in.

Plus, the focus on the brain and psychology and “mind over matter” that pervades Western science probably hasn’t helped us appreciate the role of the body in the functioning of our brains and minds.

Personally, I don’t have those sorts of conflicts of interest or an individual bias against exercise. Quite the contrary. I love to move in coordinated and sport-like ways, and I’ve got nothing to lose by telling everyone I encounter (or who reads this blog) that exercise can help heal what’s been hurt. And the more I think about it, and the more I use regular exercise in my own recovery, the more passionate (even zealous) I become. Each and every day, this flame burns a little brighter in my belly.

To say that exercising regularly changed my life for the better would be an understatement.  Once I started working out (very lightly and low-impact) each morning before I got started with my day, my anxiety level almost immediately began to decrease. Less anxiety meant less agitation, less temper flares, less acting out, less losing it over stupid shit. It has meant that my spouse can now be in the same room with me for extended periods of time. A year ago, that wasn’t the case. It has meant that I can start out my day without two or three private melt-downs that used to deplete me daily and leave me feeling broken and wrecked even before I left the house to go to work. It has meant that my constant headaches have subsided and my aches and pains which followed me everywhere and never totally went away, did in fact calm down. They’re not gone completely 100% of the time, but they are generally much less intense, and they don’t stop me from living my life, like they used to.

To say that my life between my fall in 2004 and my starting regular exercise in 2009 was getting progressively worse would also be an understatement. All that agitation, that anxiety, and the unstoppable extremes of panic and fight-flight-freeze gushing through my system were tearing the hell out of me. It was more than “just” TBI. It was (I believe) also a sharply spiking case of PTSD that arose from the constant “micro-traumas” of my TBI-addled experience, and it was destroying my life.

My brain was broken, and my mind was, too. In no small part because my body was broken in ways that no one could see.

How frustrating it was. I was trying like crazy to figure things out… totally fogged from my messed-up wiring, all disconnected and confabulated, and cognitively impaired by the daze of biochemical gunk that built up in my system.

It was like driving down a dark, unfamiliar road that’s full of potholes that I kept hitting, with the inside of my windshield fogged up.

Source: stoutandbitter

But then I started exercising. And you know what? Everything started to get clearer. Getting regular exercise each day was like taking a paper towel and wiping away the fog inside the glass. The road was still dark, and there were still potholes, but as long as I kept the inside of my windshield clear, I had a fighting chance. And slowly but surely, the sun started to come up.

Source: Kate Joseph

The road wasn’t particularly well-paved, and there were still potholes, but I could see them, at last, and I could adjust to my circumstances. As long as I was all jacked up on cortisol and adrenaline, I was S.O.L. and hurting from it. But when I started to clear that crap out of my system, I at last had a fighting chance to get on with my life.

My feeling about exercise are similar to feelings among my relatives about being born-again religious converts. There’s something so invigorating, so life-giving about this “new” discovery, that we feel ourselves transformed. And in a way, exercise has become a kind of spiritual practice for me. It gives me new life each and every morning, and even on those days when I’m not feeling as moved as other times, I still recognize the worth and value of this practice.

I would go so far as to say that exercise comes about as close to a “magic bullet” for TBI/concussion recovery, as anything I’ve come across. More and more experience and research is bearing that out, and plenty of TBI/PTSD survivors will agree. And the best part is, it not only strengthens the body and the brain, but it also gets you off the couch and/or out of the house and can get you into the company of other people where you’re less isolated, and you can interact with them in a structured context. TBI and PTSD can be terribly isolating. Having structured physical activity to get you up and out, and also provide a way to control your own social interactions is helpful in so many ways.

Out for a walk? You’re not only giving your veins and arteries and lungs and lymphatic system a much-needed boost, but you can also encounter people along the way with whom you can chat. Having trouble understanding what people are saying to you and following the conversation? You can excuse yourself and walk on, and no one will think anything of it. Feeling bad because you had trouble with the interaction? You can walk it off.

It’s what I do.

And the results have been amazing. (Obviously, not everyone has the same experience, and you’ll certainly have your own, but this is mine.) After hiding myself away for years, I’m back in the swing of things, taking care of what’s in front of me. Granted, I have my down days, and motivation is still a problem with me, but feeling as good as I do (aches and pains notwithstanding), I feel up to dealing with it all.

These results (and more) came after a relatively short time of doing them. Seriously. I started seeing real results after only a few weeks. Just in terms of feeling better, more centered, less foggy, more awake in the morning.

And this, after a prolonged period of sedentary isolating.

Oh, sure, I was active as a kid (and clumsy and prone to falling and hitting my head, unfortunately), and I went through periods of working out regularly and getting regular exercise as an adult, but after my last fall in 2004, the whole exercise thing went right out the window. It was bad. I went from being a regular at the gym to not even being able to set foot in the building, because I was having so much trouble understanding what people were saying to me — it totally freaked me out.

That freaking out was a problem. It was a problem at work and at home. It was a problem when I was with people or alone. My sympathetic nervous system was whacked and everything I encountered that was new or unfamiliar felt like a life-and-death threat, which had me pumped up on adrenaline all the time. I was a mess to live with. I had fallen, and I couldn’t seem to get back up.

I became intensely inactive. I stopped mowing the lawn and taking care of the plantings around the house. I stopped clearing leaves when they fell. I stopped sweeping the driveway. I stopped fixing things around the house when they were broken. I stopped going for the walks that I’d loved to go on for as long as I could remember. I stopped talking to people. I stopped talking to my spouse. I just stopped. Everything I encountered felt like a monstrous threat — one to be fought to the death or fled from in terror.

God, how miserable that was! The wild thing is, I didn’t even realize how whacked I was. All my alarm felt 100% justified. I felt absolutely positively certain that every novel situation I encountered was indeed a threat to my safety and sanity. I was going rapidly downhill, and I wasn’t going down alone. I hate to say it, but my spouse’s health declined rapidly as my own TBI issues escalated.

So, what got me out of that? Realizing, for one, that I was in danger of being put on meds for my attentional issues. My PCP had mentioned the possibility of putting me on something for my distractability, and my neuropsych had started mentioning the different medication options available. Talk about freaking me out. I had been on some heavy-duty meds for pain, back about 20 years ago, and they totally screwed me up. To the point of partly disabling me. What’s more, the thought of having someone else control my biochemistry — whether a pharma company or my neuropsych or my doctor (none of whom have to live in my body and brain, and none of whom are instantly available to me, should I get into trouble) — freaked me out enough to get me to sit up and pay attention and try to find some other way to wake myself up in the morning.

I had been trying for some time to figure out how to get exercise into my life, as I watched my weight increase and my strength decrease. I just didn’t have the intensity of focus required to figure out how.

When the docs started talking meds, I found my focus real quick.

The rest, as they say, is history. My life has done a 180-degree turn, and my mind and body and brain are doing better than ever. My neuropsych kind of looks at me oddly when I rave about how awesome exercise is, but theyr’e not living in my body and dealing with my brain, so how would they know what a qualitative difference it’s made? My PCP, thank heavens, is no longer talking about meds, and my level of functioning is on a whole new plane.

All this, I believe, because I have a solid physiological foundation. I’m exercising all my brains — in my skull, my heart, and my gut — and exercise helps them all communicate better with one another. My anxiety experience is now such that I can delay the knee-jerk reactions that plagued me for so many years. And I can stop to ask myself what’s going on, before I get carried away by my impulse to flip out.

It’s that effective and that powerful. And it’s so simple to do. Exercise. Take the stairs. Walk briskly instead of ambling along. Park at the other end of the parking lot and hot-foot it to the front door of the store — even in the rain. Get out for a walk on the weekends. And make a point of doing some light calisthenics before you get into your day. It can make a difference. It will make difference. The attention you pay to this will give back to you, over and over and over again.

As Nike says, “Just do it.” Your mind will thank your body for helping your brain.

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The brain can repair itself

Source: images.wellcome.ac.uk

Behavioral Medicine Associates, Inc. say:

The brain can repair itself

In the past we thought brain damage was permanent. We now know that there is birth of new cells going on in adult brains. In fact a stroke actually has been shown recently to be a stimulus for a higher rate of cell birth in animals. These new cells grow into the regions of damage and can help restore function. What’s important is that the person get good nutrition, minimize stress . . . and place a persistent demand on the brain to perform the impaired function(s). . .  you must understand that the connections between our brain cells are extensively influenced by learning. In other words, we learn to construct the visual world as infants; we learn emotional control, strategies of attention, strategies of learning and memory itself. It is well established that these learnings cause the growth of new neuronal connections. We . . .  may, by rewarding new learning, promote the growth of new, “replacement” connections.

Education regarding what has happened, how the brain functions, the effects of various types of injury begins . . . treatment. Relaxation training is a basic part, since excessive arousal from frustration, anger at the injury, etc. will make things worse.

That being said, I’m as committed as ever to my path to recovery and whole health by learning, learning, and learning some more. Taking care of myself. Getting plenty of rest and good nutrition. Picking and choosing what I do, always with an eye towards what will help me live the best life possible.

You may wish to do the same.

What’s your mission?

Source: Aaron Escobar (the spaniard)

Disclaimer: This may turn out to be a clumsy post. I don’t want to insult anyone with any inappropriate references or seeming to make light of or diminish anyone’s career or calling or history of service. If I get clumsy with my terminology and come across sounding like an idiot, please accept my apologies. But I think what I’m about to say is important, so I’m going to take a shot.

I’ve been thinking a lot about what I’ve read about the movie Restrepo, a feature-length documentary that chronicles the deployment of a platoon of US soldiers in Afghanistans Korengal Valley. I’ve been thinking about one brief scene that someone described — a soldier being asked what he was going to do when he gets home and doesn’t have the constant adrenaline rush of war anymore.

He said, “I don’t know.”

See, this is the thing — with soldiers returning from the front, as well as TBI survivors who once lived fast-paced, action-packed lives. Logistically and qualitatively, there’s really no comparison between the constant life-and-death struggles of active-duty soldiers and, say, an acqusitions and mergers attorney. But biochemically, they’re much more similar to each other than to folk who aren’t bathed in a daily biochemical wash of super-amped-up stress hormones.

When you get bumped out of the front, thanks to TBI (or PTSD), what do you do?

We don’t know.

When it comes to addressing the issues of TBI/PTSD survivors who come from prolonged exposure to biochemical fight-flight extremes — especially when that exposure was in service to a larger-than-life, well-defined structure (in the case of m&a attorneys, the firm(s) handling the transactions and the rules of the game played… in the case of soldiers, the military culture and the rules of engagement). You have a very well-defined structure around you, you’re bound by that structure to follow certain rules, and the structure also defines for you what it is you’re supposed to do within very well-established parameters. And within those parameters, you participate in some of the most taxing and harrowing experiences the human system can endure. The structure, the order, the machine… it all makes it possible for you to do more than you ever dreamed you could — both for good and for ill.

It’s the highest of the highs. It’s the lowest of the lows. And over time, if your system is exposed to enough of those fluctuations without a chance to balance it out — the parasympathetic (rest and digest) nervous system gets out of practice, since it’s constantly pushed out of the way by the sympathetic (fight-flight-fake-it) nervous system — you get stuck in gear. Like the cable of your clutch goes on you when you’re in the fast lane hauling ass out of Los Angeles.

And then you get hurt. Or you get sent home. Or your tour ends.

And then what?

You get out of the hospital/rehab. You try to settle in at home. You look for something to fill the void left by the absence of your colleagues or comrades in arms. Everyone is telling you, “Relax… Take it easy… Calm down…” But the very things that kept you going all those months/years, the very things that made you who and what you ARE… well, they’re gone.

And how does a ghost relax? How does a shadow take it easy? How does a shell calm down?

Getting injured, getting hurt, getting fired/discharged… There’s more to it than just losing your place in the rank and file. You actually lose yourself. Who are you, if you aren’t doing the things you’ve strived to do, month after month, year after year? Who are you, if you don’t have that structure to work in, the rules to define you, the culture to tell you you’re needed?

This, to me, is the most debilitating aspect of TBI — and probably PTSD, too. It’s not just some hurt that needs to be healed or some biochemical imbalance that needs to be righted. It’s a crushing, diminishing, awful loss of the very essence of who you’ve become. And the rest of the “civilian” world — unless they’ve been in that life — cannot possibly understand how insulting it is when they tell you to relax, calm down, take it easy.

Who you are and what you are is about doing and being the exact opposite. Because that’s what you do. You don’t relax. You don’t calm down and mellow out. You don’t take it easy. Because you have a job to do. You have a mission to accomplish. And because you are who you are, you cannot and will not rest, till you finish the job.

So there.

Some of us need missions. We need a structure, a higher purpose, a job to do. We need someone to tell us This Is The Priority, so we can pitch in and do our part. We need to be part of something bigger (and badder) than ourselves, and lose ourselves in service. Some of us are not part of the cult of personality, but part of the brother-/sister-hood of service, whose very essence is refined and shaped by our selfless dedication to the Higher Good. We dedicate our lives and our whole selves to duty and to making a difference in the world — not for the sake of our own glory, but because that’s who we are.

And we need a mission.

Coming home — whether from the front or the hospital — or getting up after a fall, climbing out of a wrecked car, or waking up after being knocked out, we are not the same people as we were before the events that re-shaped our lives. But we still need direction and purpose. In the absence of the larger structures (which no longer have need of our broken selves), it’s up to us to find in ourselves where we want to serve, how we wish to contribute. I firmly believe that each and every one of us, no matter how damaged, has a role to play and a place to fill. If we haven’t got the coordination or the cognitive ability we had before, there are other ways we can pitch in and help out. If we haven’t got the old skills we once had, we have the ability to develop new ones, perhaps ones we never thought we’d have/need.

Once injured, once hurt, once damaged by the world we once participated so fully in, it can be all too easy to get lost in the shuffle.

But if we step up, we can make a fresh start, with a new mission, with a new way, a new dedication. We may not have the old structures around us, but we can find and/or create new ones. This is something we can do.

For some of  us, it’s something we have to do.

What’s your mission?

concussion now i’m stupid

Someone visited this blog yesterday with the search “concussion now i’m stupid” and it seems like it’s in the air.

I had a great day Saturday — I had a very social day, and I was out and about in town, which rarely happens with me. I either don’t have the time, or I don’t make the time, or I find a hundred other things to do that are more interesting than interacting with other people in a city.

But Saturday, I took a bunch of chances, and I had a ton of interactions that were really positive and encouraging.

Sunday, on the other hand, was a huge challenge. I wasn’t able to rest as much as I had wanted/planned, and I was really feeling the effects of all the exertion on Saturday. Even if the exertion was good and positive, it was still exertion, and I didn’t remember to rest.

One of my big problems is, when I get over-tired, I often forget to self-monitor. That happened to my yesterday. So, I ran into trouble.

With a Capital T. Had a huge meltdown yesterday. As in — rage and tears and being stuck in a loop of anger and shame and frustration and resentment. I hate when that happens. I could feel it coming on, and I thought I could stop it, but I couldn’t. It was like a repeat tsunami of unwanted overwrought emotion. Waters pulling out, then washing in and wrecking everything in its path. Emotion pulling out, then rushing back in and leveling everything in its way.  It came and went for about three hours, and it totally screwed me up — and my spouse. Not pretty at all. And I’m still “hungover” from it this morning.

Ugh.

Looking back on things with a less emotional eye, one of the things that complicated my situation yesterday was that insidious little voice in the back of my head that managed to find everything I’d done “wrong” on Saturday, amplified it about a thousand times, and then commenced to tell me You’re So Brain-Damaged and Stupid. Who would ever love or care about you? You’re such an idiot – you had a concussion — no, wait, you had a bunch of concussions – and now you’re stupid. You’re so stupid you don’t even know how stupid you are.

Stupid.

Well, you get the idea. And sure enough, as always happens when that voice gets going, before long, I was at war with the world, at war with myself, at war with my spouse, at war with my job, at war with everything and everyone who came anywhere near me.

concussion now i’m stupid…

My thinking is too slow, I’m not sharp and quick like I used to be, I’m not even funny anymore (and I used to be a laugh and a half all the time), and who would want to bother with me?

Geez.

It’s bad enough that I have to contend with the physical and logistical issues, but when that voice gets going… well, the only thing to do is go to bed.

I managed to do that eventually, but not on my own steam. I had to be guided to bed and put away like a cholicky baby. I friggin’ hate when I’m reduced to that. But when I’m in the midst of that storm/tsunami, I cannot for the life of me pull myself out.

For future reference, I need to keep the image of the tsunami in my mind, when I feel it coming up. So I can get to higher ground. Tell my spouse I need to take a break, and remove myself to my bedroom or study, to simmer down. Just get myself out of the way of the wave. Maybe go out for a walk in the woods. I did that yesterday at the end of the day,  and it helped tremendously. Yes, the walk in the woods — climbing up to the top of the nearest big hill — helps me a whole lot.

I also have to have a talk with my spouse about this TBI business – it’s not okay for them to talk to me like I’m an idiot, which is what they’ve been doing more and more over the past year. Apparently, they seem to think that because my memory is a bit spotty at times, and my processing speed has slowed, I’ve lost my innate intelligence. Either that, or they have always acted this way, and I’ve just recently stopped allowing myself to be intimidated into hiding my issues from them. That’s always a possibility.

So, there are three main issues I am contending with — the wave of emotion that cannot and will not be stopped and can only be avoided until it calms down… the voice in my head that tells me I’m stupid… and the voice I live with that tells me I’m impaired. The first one, I just have to be mindful of and learn to avoid being swept away. The second one, I have to either ignore or actively argue with. The third I have to have a serious talk with — and possibly involve my neuropsych to explain to my spouse that my relative weaknesses are manageable and don’t mean I’m reduced to a simpleminded shadow of my old self. Some days it feels like that — like yesterday — but it’s not the truth of the matter.

But ultimately, the bottom line is, here’s the #1 Lesson I (re)learned over the weekend:

I have to pace myself. If I have a big day, even if it is a really good big day, I need to take the next day OFF and SLEEP. Rest. For real. Nothing else matters. No distracting entertainment is worth the price I’ll pay for exhaustion.

Growing Evidence Suggests Progesterone Should Be Considered A Treatment Option For Traumatic Brain Injuries

Found this on another blog:

Researchers at Emory University in Atlanta, GA, recommend that progesterone (PROG), a naturally occurring hormone found in both males and females that can protect damaged cells in the central and peripheral nervous systems, be considered a viable treatment option for traumatic brain injuries, according to a clinical perspective published in the January issue of the American Journal of Roentgenology. “Traumatic brain injury (TBI) is an important clinical problem in the United States and around the world,” said Donald G. Stein, PhD, lead author of the paper. “TBI has received more attention recently because of its high incidence among combat casualties in Iraq and Afghanistan. Current Department of Defense statistics indicated that as many as 30 percent of wounded soldiers seen at Walter Reed Army Hospital have suffered a TBI, a finding that has stimulated government interest in developing a safe and effective treatment for this complex disorder,” said Stein.   read more

Survey for Texans with ABI

Dear Texan(s):

The Texas Legislature directed the Texas Health and Human Services Commission (HHSC) to study the need for long-term community support and residential services for persons who have an Acquired Brain Injury (ABI) (see exact text of legislation below). Acquired Brain Injury is defined as damage to the brain that occurs after birth. Congenital disorders are not included. ABI can result from an accident or other traumatic external blow to the head as well as from a non-traumatic injury, such as a stroke, heart attack, brain tumor, infection or substance abuse.

As part of this study, HHSC’s Office of Acquired Brain Injury is conducting a survey of stakeholders that is being sent to:
• People with an acquired brain injury;
• Family members;
• Caregivers;
• Service providers;
• Advocates; and
• Other stakeholders.

The survey asks for your opinion about the most important long-term community supports and residential services for people with ABI in Texas. A list of services is included in the survey. You may choose any three or add others. The report of survey results will discuss the services and supports that receive the most votes. Remember, these services are for long-term community and residential services and supports only.

Please complete this important survey and make your voice heard by state leaders. It will take only a few minutes of your time. Your needs and opinions are important.

All responses are anonymous. No personal information will be shared.

Please complete the survey by Wednesday, February 24, 2010, by clicking on the following link:

http://www.surveymonkey.com/s/23HWNDD

Please forward this email to anyone in Texas concerned about brain injury services and supports. The more responses we receive, the better we can represent this important issue. Thank you for your time and participation. For information about the Texas Office of Acquired Brain Injury, visit the website at:

http://www.hhsc.state.tx.us/hhsc_projects/abj/index.shtml

Sincerely,

Office of Acquired Brain Injury
TEXAS HEALTH AND HUMAN SERVICES COMMISSION
MC 1542
4900 NORTH LAMAR BLVD
AUSTIN TX 78751
phone: 512/487-3431
fax: 512/424-6991
email: oabi@hhsc.state.tx.us

Better Living Habits to Help My Brain Work Better

This just got posted as a comment at  my post about confabulating as a kid

  1. You can get away with treating your brain pretty badly and it still works okay, as long as you don’t have a head injury. That rule changes dramatically after a head injury. The brain malfunctions under any kind of unfavorable operating conditions.
  2. For example, if you skip breakfast and eat fast food for lunch, expect your brain to get sluggish. Having a healthy breakfast, including some kind of meat or other protein, is strongly recommended.
  3. You should not subject your brain to any kind of nutritional deficiency. That means drinking plenty of water, and avoiding starving yourself.
  4. There are many theories about nutritional effects on brain function that recommend avoiding sugar, white flour, or both. These are major ingredients in fast food. Although science has not reached agreement that eating a diet which is heavy in fruits and vegetables, whole grain bread, and healthy sources of protein (fish and chicken) helps your brain to work better, enough nutritionists suggest this kind of diet to make it worth considering.
  5. Lack of sleep is a major source of reduced brain ability, especially in people who have had head injuries. To the extent that you can do so, you should make sure to get enough sleep. If you have difficulty in sleeping, this topic will be discussed in an advanced chapter.
  6. If your injury makes you prone to getting tired, there are “energy management” techniques that allow you to make best use of the capacity you have.
  7. Try to do your most difficult and important work early in the day.
  8. Try to avoid working under tension as much as possible, as that burns extra energy.
  9. Try not to do one kind of activity for long periods of time. Switch off from one activity to a completely different kind. For example, after reading something difficult for half an hour, switch to doing dishes or gardening. When you do this, you stop draining the last chemicals out of the reading systems of your brain and start using other, different systems. Switching activities like this can allow you to get a great deal done without getting completely exhausted.
  10. If there are stresses where you live or spend time, work on reducing those stresses. For example, after living or hanging out in a messy room for a long time, some people find that it actually reduces stress to straighten it up. If your living area is infested with bugs, and that bothers you, take steps to get rid of them. Any reduction in stress is likely to make everything work better.
  11. Getting some physical exercise every day seems to help the brain to work better.

Doing it differently this holiday season

I did something quite unusual last night — I went Christmas shopping by myself at a much slower pace than usual. I didn’t manage to buy everything I set out to, but I got everything I could, and I got through the experience in one coherent piece — and I was able to get my nap after I got back.

Normally, this time of year is marked by team-shopping with my spouse. They contact everyone in the family and find out what people want… or we talk about what we think people want, and then they make up the list. We take the list, hop in the car, and head out to stores that look like good candidates, then we slog through the process of elimination, muddling our way through… with me getting so fried I either completely shut down and become non-communicative, or I melt down and fly off the handle over every little thing.

We usually spend several evenings like this, ’round about this time of year, and we’ve both come to dread it a little. My meltdowns had become more extreme over the past few years, and this year we were both really dreading the whole Christmas shopping business — to the point where we are going to be late(!) with presents for family members in other states. That’s never happened before. We were always good about it. But my meltdowns screwed everything up.

We both recognize that doing a lot of social things, this time of year (when work is actually getting more crazy, what with year-end and all), takes a huge toll on me. Even if it’s with friends (especially with friends), all the activity, all the interaction, all the excitement, really cuts into my available energy reserves. And then I get turned around and anxious… and I either regress to a cranky 9-year-old state, whining and bitching and slamming things around… or I melt down, start yelling, freak out over every little thing, and start picking at my spouse over things they say and do, to the point where neither of us can move without me losing it.

What a pain in the ass it is. Of all things, the uncontrollable weeping bothers me the most. The yelling bothers my spouse. It’s embarrassing for me and frightening for them, and neither of us has a very Merry Christmas, when all is said and done.

So, this year we did things differently.

We split up for the day and took care of our respective activities.

My spouse went to a holiday party that was thrown by a colleague of theirs who’s married to an attorney who deals with financial matters. I was invited, too, but we both realized that it would be pretty dumb for me to try to wade into the midst of 50+ actuaries and tax attorneys and their spouses who were invited to the shindig… and try to hold my own. Certainly, I can keep up with the best of them, but marinating in such a heady soup, especially with everyone hopped up on holiday cheer (eggnog, red wine, punch, etc.) and all animated and such, would have been a recipe for disaster.

So, I didn’t go. Instead, I took our shopping list and headed to the mall to stock up on what our families had requested. We had written down in advance all the names and the specific gifts we were going to get, and we had also written down where we were going to get them. That list was my lifeline. Especially in the rush and press of the mall, which sprawls out in all directions, with satellite stores on either end.

I’m happy to report that I actually did really well. I made a few tactical errors — like not parking in the first lot I came to and walking in. But that turned out okay, because if I had parked in the first lot, it would have been all but impossible to get down to the other end of the mall. I studied the list carefully ahead of time and used a highlighter to mark the stores where I’d be going. I also kept my focus trained on the task at hand — even if it was just sitting in traffic. I also walked a lot more this year than other years. I found one parking space and used it for two different stores. And I didn’t hassle with finding a space that was as close as I could get to the building. I took the first decent spot I could find, and then I walked to the store.

Imagine that — in past years, I was possessed with finding parking as close as possible, and I would move the car between stores, even if they were only 500 yards apart.  This year, I just walked the distance. Even though it was cold, for some reason the cold didn’t bother me, and it actually felt good to be out and moving.

I think that my 5 months  of daily exercise has paid off, in this respect. I think part of the reason I was always consumed with driving everywhere was that I just wasn’t physically hardy. I was kind of a wimpy weakling, in fact — though more in thought than in body, but a wimply weakling, all the same. But having a good physical foundation — even just from doing an hour (total) of cycling, stretching, and light lifting each morning — has made a significant difference in my willingness and ability to walk between stores.

It might not seem like much, but the walking (instead of driving) between stores part of the trip actually made a huge difference in my overall experience. Walking between stores — stopping at the car on the way to stash my presents — helped me break up the activity and clear my head. It got me out of that in-store madness, the crush and the rush, and it got me moving, so I felt less backed-up and agitated. And that let me start fresh at the next store.

That was good, because the first store was a friggin’ nightmare. It was one of those big-box electronics places, that supposedly has “everything” but really didn’t. It was exhausting, combing through the stacks of movies and music, only to find everything except what I needed. The lighting was awful — extremely bright and fluorescent and glaring. People kept bumping into me, or walking so close I thought they would run me down. But the worst thing was the acoustics. Everything surface was hard and echo-y and the place was overwhelmingly loud, and every single sound was at least partially distinguishable, which drove me nuts. I’ve noticed that acoustics have a lot more impact on me than light, when I’m out shopping. The store was one big cauldron of loud, indiscriminate noise, and my brain kept trying to follow every sound to see if it mattered. I couldn’t function there. Not with the place full of people — and very agitated, anxious, aggressive people, at that.

I eventually went with a gift card and got the hell out of there. I doubt I’ll ever go back when it’s that full. When the place is low-key and all but empty, I can handle it much better. But at this time of year? Not so much.

Walking back to my car chilled me out. Sweet relief.

At the second store — a bookstore — I started to feel pretty overwhelmed. They had long lines, and the place was packed — which is good for the retailer, but not so great for me. I spent the longest amount of time there, in part because I could feel I was getting overloaded, and I stopped a number of times to catch up with myself and remind myself what I was there to buy. My list was getting a little ragged, at that point, what with me writing notes in the margins and taking it out/putting it back in my pocket. So, eventually I just pulled it out and held onto it for dear life. I must have looked a little simple-minded, but I don’t care. Everyone else was so caught up in their own stuff, anyway. My main challenge there, was not getting trampled by Women On A Mission — many of them carrying large bags and shopping baskets that doubled as ramrods to get through the crowds.

One cool thing happened, though, when I was taking a break — I had a little exchange I had with two teenage boys who were talking about some book they’d heard about. I was just standing there, pretending to look at a shelf of books, just trying to get my bearings, when I hear this one young guy tell his buddy, “I heard about this book I should get — I think it’s called the ‘Kama Sutra’ and it’s, like, about sex, and it’s got these pictures… and it’s really old… like, from India or something.”

Well, I perked up at that, and suddenly very alert, I looked over at them and said, “Oh, yeah — the Kama Sutra, man… You should definitely check it out.”

They kind of looked at me like deer in headlights, and they got flushed and flustered and stammered something about not knowing how to find it. It was about sex, and they didn’t know how to ask someone to help them. I so felt their pain…

I confidently (and confidentially) pointed them to the book-finder computer kiosk, where they could type in the title and it would tell them where to find it in the store.

“Dude, you should totally look into it. It’s got lots of information — and pictures — and it’s been highly recommended… for hundreds of years.”

They got really excited and headed for the book-finder kiosk. Here’s hoping they — and their girlfriends — have a very Merry Christmas.

That little exchange got me back in the game, so I took another look at my list and managed to find the handful of books and music and calendars I wanted to get. I headed for the line and just chilled/zoned out. I didn’t get all tweaked about how long it was taking; I listened in on a conversation for a while, till I realized it was mostly about death and health problems people were having.

Oh – and another thing that helped me keep my act together, was the 4:15 p.m. alarm that I have set on my mobile phone. 4:15 is usually when I need to start wrapping up my day at work. I need to do a checkpoint on the work I’m doing, start to wind down, and begin keeping an eye on the clock, so I don’t get stuck in town past 6:00, which is what happens to me when I don’t watch my time after 3:30 or so. I have this alarm set to go off each day, and it went off while I was in the store, which was a blessing. I had completely lost track of time and I was starting to drift, the way I do, when I’m fatigued and overloaded and disoriented.

It startled me out of my fog, and I knew I still had a bunch of things on my list to get, so I refocused and started thinking about what I would get at the next store, so I could just march in and do my shopping without too much confusion and disorientation. After I paid for my books and music and calendar, I debated whether to have my presents wrapped for free, which might have saved me time in the long run. But I couldn’t bear the thought of having to interact with the folks who were doing the wrapping. They looked really friendly and gregarious — Danger Will Robinson! Warning! Warning! Even a friendly conversation was beyond me at that point.

I realized I just wasn’t up to that, and I must have looked like an idiot, standing there in the middle of the foyer, staring at the gift-wrappers for about 10 minutes, but who cares? Everyone was so caught up in their own stuff, they probably didn’t notice me. And if the gift-wrappers were uncomfortable with my staring, they didn’t show it… too much 😉

Anyway, after I managed to extricate myself from that store, I headed for my last destination. Again, I didn’t sweat the traffic getting out of the lot, and when I got to the final store, I parked at a distance from the front doors and walked in through the icy cold, which was good — it cleared my head.

Inside, I consulted my list again and headed directly for the section that had what I needed. Halfway there, I remembered that I’d meant to buy a very important present at the first store, but I’d totally blanked on it. I started to freak out and got caught up in trying to figure out how to get back to that first store and not lose my mind in the process.  Then, I slowed down and stopped catastrophizing, and in my calming mind, it occurred to me that — Oh, yeah — they probably carried that item at this store, so I went and checked, and sure enough, there it was – score! I didn’t have to back to big-box hell. At least, not that day.

I found some more of the presents on my list, and although I didn’t get everything I needed, I made a decent dent. My partner can come with me and help me sort out the other items either today or tomorrow. Or possibly when we get to our family — they usually have some last-minute shopping to do, and they can cart us around with them. And I won’t have to drive.

By the time I got home, I was bushed. My spouse wasn’t home yet, so I called them — they were on their way home and were stopping to pickup some supper. I said I was lying down for a nap, and they didn’t have to wake me when they got home. Then I took a hot shower to get the public germs off me, laid down, and listened to Belleruth Naparstek’s Stress Hardiness Optimization CD. I had a bit of trouble relaxing and getting down, but I did manage to get half an hour’s sleep in, before I woke up in time for dinner.

My partner had a pretty good time at the party, but they said it probably would have been a disaster for me — so many people, so much energy, so many strangers, and unfamiliar surroundings. I concurred, and I showed them what I’d bought that afternoon.

We’d both done well. We both missed each other terribly, but we did get through the afternoon without one of those terrible holiday incidents that has dogged us for many, many years. Like Thanksgiving, which went so well, this Christmas shopping trip actually felt normal. It didn’t have that old edginess that I always associate with holiday shopping. It didn’t have the constant adrenaline rush. In some respects, it feels strange and unfamiliar, but you know what? If strange and unfamiliar means level-headed and low-key and plain old sane, and it means I can keep my energy up and pace myself with proper planning… well, I can get used to that.

Yes, I’ve done things differently this year. And it’s good.

Dangerously dizzy… but life won’t wait

I’ve been increasingly dizzy, the past few days. My left ear is squishy and has been making its presence felt. Pressure in my head, and fatigue… I haven’t had good sleep hygiene, for the past few weeks, and it’s catching up with me.

It’s a scary thing, because it’s so disruptive for my daily life. I have things to do and stuff to accomplish, but if I stand up too quickly or move too suddenly, the whole world starts to rush and spin and I get very sick on my stomach. It also makes me extremely irritable, so I snap out at every little thing, which makes me very difficult to deal with at times.

The only thing that really saves me, is being totally focused on what I’m doing, and not moving much while I’m doing it. Working at the computer is a perfect solution for me, because I have to sit up straight and stay focused on the screen in front of me.

The only problem is, it’s Saturday… a few days before I take off on my marathon trip to see family… and I have a whole lot to get done. Dizziness puts me in more danger of falling or having an accident. If I’m not careful, I can get in a lot of trouble. The last thing I need this holiday season is another concussion — most of my adulthood injuries have coincided with holidays, when I was running around like a chicken with my head cut off and wasn’t paying proper attention. I was fatigued and disoriented… and I fell or had a car accident. Not good.

Yes,  I need to be very, very careful, in everything I do.

I think a big part of the problem I’m having right now is the impending holiday rush. The prospect of driving through several states to see multiple families, over the course of nearly a week is making me a little nervous, and that’s setting off my schedule and my focus.

I have been doing really well with keeping to my daily exercise, which helps.  I just finished my morning workout, in fact, and I feel noticeably better than I did before it. I worked up a sweat and got my heart pumping, which in turn moved the lymph through my system to clear out the grunge. I love lymph. So basic, so essential, so useful. Without it, I’d be in a heap of trouble, and I count my blessings that I don’t have lymph drainag problems, like folks with edema do.

Anyway, I’m feeling better, and I have a full day ahead of me. But I’m pacing myself. And I’ve blocked off time this afternoon to sleep. I haven’t had a good afternoon nap in weeks, and it’s taking its toll. If I don’t nap at least once over the weekend, it catches up with me — and that’s what’s been happening.

And now I’m really dizzy, with a lot of stuff to do, and I regret doing chores last Sunday, instead of taking my nap. I had three solid hours to myself, to use as I pleased, and I frittered away the time on futzing around and doing little chores that took longer than I expected.

Ah, well,  so it goes. At least I’m aware of my dizziness, so I can accommodate it and work with it. When I’m really, really dizzy, I find that keeping my posture ramrod straight and moving very slowly and deliberately helps tremendously. Also, if I sleep a lot and drink plenty of fluids and avoid sugar, that helps, too. I’ve taken medicine for vertigo, but it didn’t help a bit. Anyway, it turns out the medicine is really just for nausea that results from vertigo, not the vertigo itself — at least that’s what the PCP I had at the time told me. Come to think of it, they could have been wrong. They were a bit of an idiot, by average standards. (And it was a scary six months in my life, when they were my primary doctor.)

But now I’ve got a pretty good PCP, and I trust them a whole lot more than the last several I went to. Trusting your doctor is good. It simplifies a lot of things, in many ways, not least of which is the office visit experience.

But more on that later. Right now, I need to stay focused on my dizziness.

Tracking back over the past week, as it’s gotten steadily worse, I have been looking for what I’ve been doing differently that has contributed to this. The one thing that I’ve been doing regularly, that is very different from before, is that I’ve been eating pieces of chocolate to keep myself going. Not just chocolate, mind you, but those little Dove chocolates with peanut butter in the middle. I thought that the peanut butter would give them more staying power, but what I’ve noticed over the past week is how much sugar is in those little puppies.

Zoinks! Who eats this stuff regularly?! They’re dangerous! Sure, they give me a little pick-me-up when I need it — like driving home late from work when it’s very dark, I’m very tired, and I’m having a hard time seeing. But I’m finding that when I eat one, I crave another one about 10 minutes later — like I spike, and then I crash and am worse off than before, so I need another “little” piece of candy to keep me going… and my system gets totally fried by all the sudden, extreme ups and downs.

Which contributes to my fatigue… and apparently my dizziness.

Not good.

So, while I’m doing my errands today, I’m going to remove the chocolates from my car — just throw them out — drink more water, eat more fruit, and be very, very careful when I’m out and about.

The last thing I need is another accident or fall.

I’ve decided not to fire my therapist… yet

Note: I unpublished this post from 2009, for some reason. But reading it again today, it still seems very important to mention. So, I’ve published it again.

I’ve been agonizing a bit over my therapist, lately. And it’s kept me up at night, which is not good. I had intended to come back from Thanksgiving and fire them, since I have not felt like they are totally supportive of my recovery, and in some ways, the innuendos that they toss my way.

They’ve said things like, “You may have to settle for making less money because of your issues,” when I was talking about my job challenges and how frustrated I am with the high tech industry and my future prospects. I was frustrated with my own difficulties, yes, but my frustration was also due to the changing industry and the flood of young guns who are showing up (not necessarily knowing what they’re doing) and snapping up jobs for lower rates, which is a problem for seasoned pros like myself.

I was telling them about trying to repair a relationship I have with someone who is 15 years older than me, and this therapist said “Well, they are getting older, so you can only expect so much of them.” As though this friend of mine were impaired, simply due to their age. And they weren’t going to get any better over time, which meant (in their mind), I had to just accept the flaws in the relationship and take what little I could get, not have high hopes, not have high expectations, not have high… anything.

Truly, that makes me crazy. I am 100% committed to my recovery, and restoring myself to the highest level of functioning that is humanly (even inhumanly) possible. I know the human species is built for amazing things. I’ve watched Cirque de Soleil, and once you see — really see — them, you realize that more is possible than you ever dreamed. I’ve hauled my ass out of some pretty tight spots in my life, some of which looked hopelessly dire.  I’ve had my ass spared from some pretty shocking fates, through total flukes, coincidence, apparent divine intervention, and the kindness of strangers. I’ve been homeless, and I’ve been in the top 10% of the world’s wealthy. I’ve  been bullied and feted. I’ve won blue ribbons, and I’ve defaulted and fouled out. I’ve experienced a fairly wide gamut of human experiences, and since I’m only in my 40s, I don’t expect to stop doing that anytime soon.

For this therapist to tell me what is and is not possible, what I should or should not expect from life, is not only out of line, but flat out wrong.

Yes, it drives me crazy. The problem is, it drives me crazy in retrospect. ‘Cause I’m having trouble keeping up. The conversations we have tend to take on a life of their own and really speed up, to where I’m flying by the seat of my pants, trying to at least appear like I know what I’m talking about. I have been quite nervous with this shrink from the start. I’m not sure exactly why. Maybe it’s that they have these multiple degrees, and they carry themself like God’s gift. Maybe it’s that they’re very well-connected and I’m intimidated by their influence and power. Whatever the reason, when I’m in session, I get nervous. And I think they do, too, because they know I work for a very big and powerful company that is an imposing monolith in the region where we live. Yes, I suspect they’re quite nervous with me, too, and we both set each other off, so the conversations we have tend to jump around and pick up speed, and things get said that I can’t react to in the moment, ’cause I’m back on the last thought, trying to sort out what they meant when they said “_____”

Keeping up has always been a challenge for me, but all those successive challenges have been building up to critical mass. They’ve said a lot of things to me, and I’ve just nodded and uh-huh‘ed my way through the conversation, and then later realized what they said and what I really thought about it. And then, time after time, I’ve gotten upset and tweaked, because I haven’t been able to stand up for myself and set the record straight.

It drives me crazy, not being able to speak up at the instant something is not quite right. And it’s something I need to deal with.

Which is why I’m not firing them… right away.

What I really need to do, is get some practice standing up for myself and working with conversations in a common-sense way. My processing speed is slower than one would expect. That’s been well-established with testing. I also have difficulties understanding what I’m hearing. That also showed up on my neuropsych evaluation. And I have a long history of holding back and not engaging in conversations with people, because I’m trying to figure out in my head what just happened… but my head is not cooperating.

What I really need to do, is develop my skill at having these kinds of conversations, and mastering them in the moment, when they are causing me problems. Not run away right away, but stick with it, and see if I can sort things out — be very, very honest about what I’m thinking, ask for clarification, stop the action periodically to see if I’m following correctly, and not let this therapist make me feel less-than, because I’ve sustained a bunch of concussions over the course of my life.

This is very important practice. Handling conversation is a skill I must learn – even at this “late” date. Because this sort of muck-up doesn’t just happen with them, and it doesn’t just mess me up in therapy. It has messed me up at home, in the past, but I’ve been doing a lot better with it, since my spouse and I have been approaching our discussions and exchanges with my post-concussive state in the backs of our minds. It sometimes messes me up at work, too — the saving grace with work is that I interact with people on a daily basis, and I can check in with people again after the fact, and get clarification. And use email to get it in writing. And check with others to make sure I’ve got things straight in my head.

But not every exchange I have with people manageable with email and foll0w-ups and a deep understanding of my neurological issues. I have the whole outside world I have to deal with, and I need to deal with it well and effectively.

So, I will not be firing my therapist right away. I need to learn to deal with them more directly, to have conversations with them that are not one-sided, but are full conversations — (putting the “con-” which means “with” in “conversation”). I need to get with the conversations we’re having and participate. Even if it means slowing things down and feeling dense in the process. If I can get away from feeling stupid about not following at lightning speed… if I can figure out a different way of thinking about my processing speed being slowed down… if I can find another way of framing my interactive needs… that would be helpful.

Because the way I’m framing it now:

“You’re stupid to be this slow, so you’d better keep up, even if it’s at the cost of not following exactly. And by all means, never let them see that you’re struggling. You have your pride, after all.”

Well, that’s just not working.

Truly, I really don’t have the time to waste on relationships that undermine me. But this pattern with this therapist is part of a larger pattern I need to address. I need to practice having conversations with people that involve me, as well as them. And I need to slow down the pace, so I can have a fully involved exchange, not some mad dash to the finish line. What I really crave is quality of life. To be involved in my own life. To not just put on a good appearance, but also have a full experience — good, bad, or otherwise.

It’s all very well and good, if I look like I’m fine. But if I’m not fully present in the moment, when I’m looking the part, then the life I’m leading is not fully mine. It’s everybody else’s but mine.