Keeping it fresh

I’m up early today, with my head spinning about so many different ideas. It’s good – but it has its drawbacks. I could have used a few more hours of sleep, but I’d rather just get up and take advantage of the time while I can. Having an extra hour at the start of the day gives me a lot more room to move and breathe.

I’m taking a break from my daily workouts, to let my body rest. I’ve had a lot of tightness in my back, shoulders, and hips, thanks to my muscles getting a good workout (and how my posture while I’m driving makes my left leg tighter than the right).  I was supposed to get a massage last night, but my appointment got moved, so I’ll need to figure out another way to loosen things up in the meantime. The pain is pretty intense, at times.

It’s important to break things up and keep things fresh, so that my system doesn’t acclimate to doing things the same way, every single day. I love my routine… but if I never break things up, eventually it doesn’t love me.

I think I’ll go out for a walk in the woods. It’s getting light earlier and earlier, and I have plenty of time for a leisurely hike before I go into the office. It will help me clear my mind and get things straightened out in my thinking. With so much going on in my head, it’s easy to lose track of what’s what. I have a list of all the stuff I need to do… but sometimes it’s easier to just back off and clear my head… then dive back in with a fresh eye.

I’ve got my MRI later today. I’m taking the afternoon off, so I have plenty of time to get there. I often take a wrong turn at the very last minute, making myself late, when I was so, so close… and I’ve given myself enough time to find my way back on track. I’ve studied the map a bunch of different ways, and I’ve calculated the time it will take me to get there.

I’m nervous, because I want it to go right. I want to make sure I don’t twitch and move, like I did on my last MRI, which screwed up one of the main images. That was really disappointing and frustrating, so I need to make sure they know I tend to do that. Ideally, they’d strap my head in place so it can’t move, but I’m not sure they can do that, so… here’s hoping it goes okay. I’ll just keep myself calm, do my deep breathing, and rest.

And all the while, keep myself fresh throughout the day, so I’m not too tired, when I get to the imaging place later this afternoon. I have a lot of miles to cover to get there, and I need to be safe.

Safe. And fresh. And incredibly grateful for this opportunity in front of me.

It’s turning out to be a lovely day. Time for a walk.

Onward.

YES. My DTI MRI is scheduled for next week

And here I thought they’d forgotten about me…

But this afternoon, I got a call from the MRI place to schedule my DTI MRI. They can see me next Wednesday afternoon, which is pretty awesome.

DTI MRI shows white matter connections in the brain — all the “cables” that communicate between the different sections, showing how everything is “talking to each other”.

Tomorrow, I have my EEG and autonomic function testing first thing in the morning. I’m not sure what I was thinking, scheduling it for 9:30 a.m. on a workday, when I have to deal with metro area traffic.

But there it is. I’ve got my appointments for tomorrow. And I’m looking forward to actually getting some data about my situation, instead of personal accounts and impressions. I need measurements. If you can’t measure it, you can’t manage it.

And after that, I have my neuropsych appointment at noon. There are only four more sessions with them, and it seems strange that after eight years, they’re going away.

But this happens all the time. And after being all torn up over it last weekend, I’m dealing.

Just get on with it.

So, that’s the news. I’m really excited to be getting all this done. It’s going to cost me some more money, but that’s what my flexible spending account is for at work. To offset this cost. So, it will.

Onward.

Some MRI contrast agents might be dangerous

What’s in YOUR MRI contrast agent?

This just in from BrainBlogger – as it turns out, my hunch about gadolinium-based contrast agents not being all that great for you, is not far wrong.

Thank you, science, for backing me up. Bold emphasis is mine below.

Some MRI contrast agents might be dangerous

With millions of patients getting MRI scans every year, the technique rapidly becomes one of the most commonly used diagnostic tools in the developed countries. However, new data published this month cast the shadow on the safety of the contrast agents used for the data acquisition – so-called linear-type gadolinium-based contrast agents.

It appears that repeated use of these agents in the MRI scans lead to accumulation of toxic heavy metal gadolinium in the patients’ brains. The safety concerns may have serious implication on the whole MRI industry and likely to result in substituting linear-type agents with safer and more stable macrocyclic gadolinium-based agents. The use of the latter does not lead to accumulation of gadolinium in the brain.

Ref: Robert, P., Lehericy, S., Grand, S., Violas, X., Fretellier, N., Idée, J., Ballet, S., & Corot, C. (2015). T1-Weighted Hypersignal in the Deep Cerebellar Nuclei After Repeated Administrations of Gadolinium-Based Contrast Agents in Healthy Rats Investigative Radiology, 50 (8), 473-480 DOI: 10.1097/RLI.0000000000000181

Bottom line is, pick your poison. Heavy metal contrast agents aren’t particularly good for you, to begin with, but some may be lesser evils than others.

Check with your doctor/neurologist before you have your next MRI.

TBI Alert: Rehab Program Improves Memory and Mood, Even Years After Injury

Work it!

From Neurology Now

Tuesday, June 09, 2015

TBI Alert: Rehab Program Improves Memory and Mood, Even Years after Injury

BY REBECCA HISCOTT

Depression and difficulty concentrating are some of the potential long-term symptoms of a traumatic brain injury (TBI), but a specially designed cognitive training program may help improve these and other symptoms—even 10 years after the injury. That’s the finding from a new study from the University of Texas at Dallas’s Center for BrainHealth, published in the journal Neuropsychological Rehabilitation.

The researchers developed and tested an eight-week, 18-hour cognitive training program called SMART (for “Strategic Memory Advanced Reasoning Training”) in a group of TBI patients, many of whom had sustained the initial injury more than 10 years earlier.

The SMART Approach to Rehab

For the study, 31 TBI patients between the ages of 19 and 65 participated in the SMART program; 13 were veterans. All had experienced TBI more than six months earlier, with two-thirds experiencing the injury more than 10 years earlier. They all had chronic cognitive or psychological symptoms, including difficulty carrying out daily tasks, grasping complex concepts, or problem-solving, which affected their ability to work full-time or find employment.

During the program, the patients learned strategies for improving their attention, reasoning, and innovative thinking skills. For example, the researchers explained, patients with TBI have trouble multitasking, which can tax the injured brain. In order to improve concentration, investigators taught the patients to identify and block out distractions in order to better focus on a single task. In turn, honing these attention skills helped the patients read complex articles and tease out the core ideas and messages. The participants were also asked to apply these strategies in their daily lives, for instance by reading the newspaper and identifying the most important parts of a news story.

The researchers compared the effects of the SMART program to those of a brain health workshop, in which 29 people with TBI learned basic facts about brain health and brain injury, but did not learn any specific strategies for dealing with the symptoms of TBI.

SMART Improves Memory, Thinking, and Mood

After eight weeks, people in the SMART program had improved their ability to grasp abstract concepts, as measured by a reading test, by 20 percent and improved their scores on memory tests by more than 30 percent, the researchers reported. The patients also reported a 60 percent decline in symptoms of depression and stress, and a 40 percent reduction in symptoms of post-traumatic stress disorder (PTSD).

These cognitive and psychological improvements could also “have a positive impact on one’s confidence, cognitive control, sense of well-being, and self-worth,” the researchers wrote.

Brain Imaging Shows Signs of Improvement

As part of the study, the researchers also administered magnetic resonance imaging (MRI) scans to all of the participants, looking at blood flow in areas of the brain linked with stress and depressive symptoms, such as the frontal lobe, the anterior cingulate, and the precuneus. In people with TBI, blood flow to these regions is decreased, which is considered a marker of injury severity and is linked to worse performance on cognitive tests and symptoms of PTSD, the researchers explained.

Patients who participated in the SMART program had a more than 25 percent increase in blood flow to these brain regions, suggesting a healthier and less-stressed brain, which could also explain the improvements on psychological health, the researchers said.

Effects Last for Several Months

The benefits of the SMART training program persisted when the researchers administered another set of cognitive tests and MRI scans three to four months after the program ended, noted lead investigator Sandra Bond Chapman, PhD, founder and chief director of the Center for BrainHealth, in a news release.

Need for Further Study

The results are promising but preliminary, and will need to be verified in rigorous future studies, said Dr. Chapman and her colleagues. If future research confirms the results, SMART could be added to the growing arsenal of cognitive training programs that have shown promise for treating the long-term effects of TBI, the researchers said, with the ultimate goal of helping people with TBI lessen their symptoms, rejoin the workforce, and lead happier, healthier, and more productive lives.

To learn more about traumatic brain injury and how it’s treated, see and browse our archives here.

 

MRI results are back

I got a printed report in the mail, and things are looking good.

No acute intracranial abnormality.

No significant abnormality along my trigeminal or facial nerves.

Pineal cyst is stable since 2009, probably benign.

There are a few little “hyperintensities” in the right frontoparietal white matter, but of doubtful clinical significance (in every terms, who knows what that means – it’s probably nothing).

Sweet.

The thing is, I don’t have anything annotated on my disk, so I can’t see precisely  what the radiologist is talking about. I have a pretty good idea that the three little dots in the frontoparietal region on the T2 Flair image are what he’s talking about. I’ll just have request an annotated copy, I guess.  Maybe that will have something.

As Mr. Spock would say, “Fascinating…”

MRI is done

Not me – but similar

Yesterday was a long friggin’ day. I had my MRI at 7:30 a.m., to get it out of the way. It was fine. It was in one of those mobile units, which I suppose are wonders of modern science, but was still basically an MRI lab in a truck. It was fine. Not exemplary, just fine. The technician doing the work was in a mood, and they were just cranking out patients at a brisk clip. They had a bit of a problem with getting the IV in me, which wasn’t my favorite thing. The other weird thing was, I couldn’t feel the saline they put in, or the contrast agent when it went in. The first time I had it done in 2009, I felt everything. But yesterday I couldn’t feel any of it, past the iv going in.

Odd.

Those kinds of things are exhausting for me, because I have to work really hard to keep still. I tend to twitch and tic involuntarily at times, so I have to really focus on keeping relaxed and still. By the end of the hour, I was beat, and I had some difficulty getting on my feet and walking away. It was a pretty involved brain MRI, and the equipment wasn’t exactly top-notch.

The good thing is, I got a copy of it all right afterwards. How cool is that?! It gives me a chance to study my brain before I go to the doctor. Of course, if I find anything amiss, it could throw me for a loop, but I’d rather be thrown for a loop in the comfort and privacy of my own home, than in a doctor’s office.

Anyway, the MRI hadn’t been read and annotated by someone who knows what they’re looking at, so I didn’t really have any points of comparison to go by.

I did pop the CD in my computer last night and take a look. I found one image that looked like I had a bunch of microbleeds going on. There were all these little clear dark spots speckled throughout my brain. I Googled them and found similar pictures of MRIs of people who had microbleeds. That concerned me a bit. But when I looked at the other images, there was no sign of those same dots, so I’m probably not reading it right.   Also, someone told me back in 2009 that those are actually blood vessels, which makes it good to see them.

It’s always nice to know you’re getting blood to your brain.

So, I have the disk, and I have my 2009 disk. I pulled them up side-by-side yesterday to compare how my brain looks. The problem is, different software is used to view the imagery from different years, so I don’t have a simple point of comparison. Also, the way the files are organized doesn’t make sense in the new one.

Although… I could try copying the files into BOTH software, and look at both years in the same program. I’m not sure that would work, because they appear to be different formats. But that could be confusion on my part.

I hope that works, because I really want to be able to see what’s what.

Just from an initial cursory look, it appears that

A) My pineal cyst looks bigger than last time. I’ll have to wait till the MRI gets read and annotated (and then I’ll request another copy with the radiologist’s notes in it).

B) My brain looks a little smaller than last time. There seems to be more space between my brain tissue and the inside of my skull, and my brain isn’t smushed up against my skull like in 2009. There’s more clearance, and there’s also more definition between the different folds (I think they’re called sulci). I don’t know what that means. I’ve seen pictures of people whose brains have shrunken — a lot — and it’s a little freaky.  On the other hand, if I’m losing certain white matter or grey matter, there may be a way to beef them back up. I know that regular meditation increases gray matter — it’s been documented. So, that’s fairly straightforward, I think. Also, certain types of things will actually shrink your brain — depression and stress, for instance.

Anyway, it’s impossible to say what the deal is with me. I’m not an MD or a radiologist, and who knows what the deal is.

The neuro is supposed to call me with the results, so we’ll see. I have no idea when that will be. I guess no news is good news.

In the meantime, I’ll get my systems together, I’ll spend some time this weekend looking at my MRIs, and I’ll see what I can find about fixing whatever I can.

Oh, as a side note, I am not all that impressed by the quality of the imaging taken in the back of the truck. Maybe it’s the type of MRI I got, but the images are not as clear, they don’t have the same level of detail as the 2009 ones, and some of them look “smudged”. It could be because I may have moved, but there is absolutely no smudging in the 2009 MRI, and I was in worse shape then, than I am now.

At least, I think I was…

Anyway, if I ever get that done again, I’m going to a proper hospital — preferably the one I went to before — to get this done. If I’m going to have heavy metals put into me intravenously, I’d better get some damned good imaging out of it in return.

More to come.

Onward.

Gearing up for my MRI tomorrow morning

At 7:30 tomorrow morning, I’m getting another MRI of my brain. Should be interesting. The last time I got one, I was having seizure-like episodes, and I was being evaluated for possible epilepsy.

Didn’t happen. That is, the tests produced nothing out of the ordinary, and in fact, other than a pineal cyst (which is very common), my brain is perfectly fine and normal and un-interesting (in a good way).

I’m trying to make a copy of my MRI files on CD. The first two tries didn’t work – the computer wasn’t recognizing the blank CD, or it wasn’t realizing it was even there. So, I’m trying it on my laptop, which is a long shot, because it’s been on the fritz.

Worst case, I give them either a thumb drive with all the files on it, or I give them the original CD I got, and I request another from the hospital.

Either way.

As long as I get a copy of the new one, too. I am pretty stoked about getting more images of my brain to look at. It’s a real thrill for me to actually be able to look at my brain. Awesome.

Anyway, the timing is actually pretty good for all this, because after a day of feeling increasingly better after my miserable migraine on Sunday, the headache is back. I had a bit of a venting meltdown at work — nothing terrible, I was in a “safe space” as they say, and my rant was actually very entertaining for those privy to my unbridled frankness. But as a result, I got a pretty mean headache. So, the migraine is back.

It will be interesting to see if anything shows up in imaging. Considering the way I’ve been feeling, if nothing shows up and my brain looks good, so much the better. I figure that means at my best, it looks great.

We’ll see.

Now to bed.

On-ward.

 

 

 

The road will be long – and surprising things will happen

So, I had a good appointment with my new neuro.

Headaches = migraines. Confirmed.

MRI coming up… partly to check on that pineal cyst that was discovered back in 2009. Everyone has assured me it’s no biggie. Tons of people have them. MRI with contrast. Get ready. Last time, I got a little sick from it. So long as I know ahead of time, I can prepare.

Thought everything was going well. Then got a call from the dr.’s office. Apparently, my insurance company told them that my coverage was terminated on March 1 – two months ago.

Surprise.

And not at all true. Premiums have been deducted from my account like clockwork, and I have coverage till the end of November.

Paperwork.

Huh.

So, after a few harried phone calls, I got people back on track. Not at all true. I do have coverage.

So there.

Onward.

“On” day today

Time to hit the “on” button again

Yesterday was a quiet day for me. I rested a lot, did a lot of reading and studying the parts of the brain, and also looked more closely at my MRI. I might be due for another one, because it’s been five years since my last one that revealed the pineal cyst.

The cyst is actually about three times the size of a “shouldn’t be a problem” cyst. It is 1.6 cm and .5 cm is a usual size that shows up. Looking around online at other people’s experiences with pineal cysts, they are experiencing a lot of disruptive symptoms with ones that are about the same size as mine.

I honestly don’t know what to think of this, because on the one hand, all the headaches I’ve been having, along with the vertigo and numbness and tingling in my face and hands *might* be related. On the other hand, I don’t want to start digging around for issues that will raise flags with medical folks and send me down a path of super-invasive procedures, when the symptoms I’m having are actually tolerable.

The headaches don’t make me happy, but they also don’t stop me from living my life. I just recognize that my head hurts, I do what I can to relieve the pain a bit, and I get on with my life.

Anyway, after spending a quiet day yesterday, getting some good rest and taking it easy, I’m ready for a whole new day – out and about. I’ve got a handful of things to take care of — nothing really intense or overwhelming, just stuff. And running those errands will take me into a town with a library that has some books I’ve been wanting to check out, so that’s good.

This seems to be about the right pace for me — not too fast, not too slow, just very steady. I have some intervals of excitement, here and there, but I have also interspersed it with some naps and rest, which is a real step in the right direction.

It’s been great to slow down, but it hasn’t been without its challenges. Stopping moving makes me realize just how much pain I’m in, and the stretching and exercises I’ve been doing have revealed some stuff that I need to work through. The tenseness, the tightness, the limited range of motion, and also my poor posture. I really have poor posture, which is screwing up my back. Not until I stopped going 100mph and slowed down to notice what’s going on with me, did I realize it. But now I realize it. So, ouch. There’s the good pain that comes from sore muscles after exercise. There’s the bad pain that comes from limited range of motion and under-use. Ouch. But I’m working through it.

One of the other things that keeps happening to me is that I keep getting very emotional — tears are coming up, which I hate, because crying gives me a splitting headache and I feel like crap for days afterwards. I have been tearing up while driving, and also while sitting around my house. I guess stopping all the forward motion is causing the emotional stuff that I usually “use” for fuel and motivation to show itself for what it really is. I haven’t stressed about much of anything all week, which is a big change. And not stressing and not needing to keep everything under wraps seems to be making me more emotional.

Times like this past week, when I am not constantly focused on what needs to be done, I get re-acquainted with my TBI issues in a much closer way. The memory problems — I went to the hardware store and bought $75 worth of supplies, but I couldn’t remember what they were, a day later… the fatigue problems — never feeling like I have enough sleep and always been a bit wiped out… the coordination problems, headaches, ringing in my ears, and the difficulty I have getting started on things… Slowing down makes me more aware of these things, and having time to think about my life, also doesn’t really help that much, because I just get depressed, thinking about all the things I was able to do before, but now cannot seem to get my head around.

Well, whatever. I’ve had a few down-time days, which has been good. And now I’m ready to be “on” again. I’ve got my list. I’ve got my plans. I’ve got things pretty much mapped out, and that’s good. I can’t sit around anymore and feel bad about my situation. That’s just no good.

Now, onward – the day is waiting.

Diving into my brain

Check out what’s in there…

Time to break out the old MRI again. About five years ago, I had a series of weird experiences that other people assured me were seizures. I honestly didn’t know what to think — my eyes would start jumping rhythmically back and forth, I couldn’t keep them focused on any one thing at a time, and I had these extreme and overwhelming floods of emotion that really leveled me. I even went blind for a few minutes, one afternoon while I was spending time with family.

After talking to a bunch of folks, including epilepsy doctors, I had an MRI and an EEG, and nothing came back definitive, other than a pineal cyst — which is common in the general population. About 40% of autopsies uncover a pineal cyst, but it doesn’t seem to make a ton of difference in quality of life, other than headaches and other issues in extreme cases. My pineal cyst was fairly small, so the doctor just told me to keep an eye on it and get re-scanned every couple of years to make sure it’s not getting worse.

I haven’t been back since, as I’m not having any symptoms or issues that seem worth the trouble. Also, the contrast agent they pump into you to make things light up made me sick, and there have been lots of reports of bad side-effects, so no thanks.

Anyway, reading about dopamine and how it’s produced in the body and the parts of the brain that are involved, I’ve dug up the old MRI files to look at, and it’s as fascinating as ever. The thing is, my brain doesn’t look like the textbook images — I must have lay on my back a lot as a baby, because the back of my head is flattened and the cerebellum is pushed forward and up. I have found other images on Google that look like me – and we certainly don’t look like what’s in the Netter’s anatomy book I have.

Fascinating. Not that this means there is anything wrong – it’s just different.

So, anyway, I’m looking at the physical structure of the brain, trying to see where all the action takes place. There’s a ton of stuff going on in there – it’s hard to distinguish between the different pieces, based on my limited knowledge, but I guess the most important thing is that everything is intact — and I have the capacity to explore and question and discover for myself.

That, in itself, gives me a rush, which is exactly what I need.

I need a rush that is for something meaningful and useful. For years, I devoted hours and hours of my time to activities that just took the pressure off and distracted me from what was really going on — writing for hours and hours in journals which never served any useful purpose, other than providing a rhythmic, solitary activity that would soothe my jangled nerves… studying history and obscure facts in order to better understand life around me (had limited success with that)… and drifting from one project to the next, each time convinced that I was going to hit the big time and make a fortune, then dropping each undertaking in due course because I got bored or it didn’t pan out the way I expected. I was really quite aimless — in large part because I only wanted to take the pressure off my head and my heart… not actually do anything with my life.

I suppose it was good for something. The interests and the discipline I developed over the years have stood me in good stead, with researching my TBI issues and figuring out how to address them. So, it wasn’t all for naught. But I spend a whole lot of time doing a whole lot of nothing — mainly because I just needed to take the edge off my anxiety and depression and low energy levels.

Now I’m able to focus that attention and activity in a productive direction. And getting the hang of tweaking my dopamine levels and increasing my general feelings of well-being, is just the ticket. It’s fascinating to me, and that can’t hurt.

So, the day is waiting. The brain is an enormous domain that’s full of all manner of fascinating areas and abilities. Looking at the anatomy can be overwhelming, but when I think about the dynamics of it — just how it works, and how I can better use it — a lot of it makes more sense.

Time to dive back in and get fascinated again.

Onward.