The emphasis is on persistent symptoms

It’s been a quiet week, blog-wise. It’s been a very busy week, work-wise. I am glad of that, because it indicates that I am quite functional, which a good place to be at. I haven’t had much time for anything other than working, getting a little exercise, and then coming home to make supper, watch television, and go to bed. But that’s okay.

For now.

Ideally, I’d like to have my work and the rest of my life be more balanced out. I’ve got some other things I’d like to do with myself besides complete tasks for my employer. A 40-hour work week might be nice… but I’m not sure when that’s going to happen. So, I am looking for other ways to think about my job, other than it being just a job.

Anyway, I’ve been thinking on and off about the Guidelines for Mild Traumatic Brain Injury and Persistent Symptoms, with the emphasis on *persistent*. On Page 6 of the document, they talk about

Common Symptoms of mTBI

Physical

  • Headache
  • Nausea
  • Vomiting
  • Blurred or double vision
  • Seeing stars or lights
  • Balance problems
  • Dizziness
  • Sensitivity to light or noise
  • Tinnitus

Behavioural/Emotional

  • Drowsiness
  • Fatigue/lethargy
  • Irritability
  • Depression
  • Anxiety
  • Sleeping more than usual
  • Difficulty falling asleep

Cognitive

  • Feeling “slowed down”
  • Feeling “in a fog” or “dazed”
  • Difficulty concentrating
  • Difficulty remembering

It’s a short list, compared to the “batch” of 84 ways TBI can make your life really interesting I catalogued several years ago and have used as a guideline in my own recovery. But it’s a list, nonetheless. And they can cause a whole truckload of hurt. mTBI can really mess with your head in all sorts of ways, even if medical imaging can’t pick it up. Indeed, the ONF Guidelines say:

Computed Axial Tomography (CAT) and conventional Magnetic Resonance Imaging (MRI) usually fail to detect evidence of structural brain abnormalities in mTBI. However, reviews of recent advances in the biomechanical modeling of mTBI in humans and animals conclude that mTBI leads to functional neuronal disruption, and at times structural damage

Yeah – what they said: “functional neuronal disruption, and at times structural damage”.

Now, I don’t want to go all worst-case-scenario on you and start going on about brain damage and whatnot. My point is that even if mild traumatic brain injury can’t always be recorded in medical imaging, over the long term, it can lead to problems, even structural damage.

Researchers are still learning a lot about mTBI/concussion, and they have a ways to go before they fully understand all the mechanics and impacts of it. But at least they’re starting to “get” that this is a real problem for real people, and it’s to be taken seriously. They’re making the important distinction that

In most cases, patients who experience mTBI will recover fully, typically within days to months. The concern is that, as the Centre for Disease Control (CDC) notes, “up to 15% of patients diagnosed with mTBI may have experienced persistent disabling problems” (CDC, p.3). The consequences for these individuals may include reduced functional ability, heightened emotional distress, and delayed return to work or school (MAA NSW, 2008). When symptoms persist beyond the typical recovery period of three months the term post-concussion syndrome or disorder may be applied.

So, while the majority of people do recover on their own from concussion/mild TBI within days or weeks or months, the fact remains that there are a whole lot of people who don’t. And those people who don’t can be disabled by their symptoms and the issues that surround them.

And here we come to the domain of post-concussive disorder/syndrome — that twilight zone where things get all jumbled up for no apparent reason, and a whole lot of stuff stops making sense, and you start to hear things like…

“It’s been months, even years, since your TBI — why aren’t you better yet?”

“You look fine — why are you pretending to be sick?”

“This should be easy for you — why are you having such a hard time with it?”

Everybody seems to think that recovery from concussion is a given, but sometimes it’s not. Sometimes the symptoms last for years and years, and even the people closest to you, the people who you’d expect to understand that you’re not exactly the same as you used to be, can’t seem to get their heads around the fact that you need more sleep, or you need to think things through more slowly, or you need to have more routine, than the “average” person. And they judge you for it. Sometimes they give up on you. Which is — sorry — total bullshit.

Can I tell you, the last one — “This should be easy for you — why are you having such a hard time with it?” — is probably the toughest for me — and it’s especially hard hearing it from inside my own head. I swear, there are a whole lot of things that I am certain should make a whole lot more sense to me, than they do — there are things I hear that I feel I should understand, directions I receive that I feel I should get, and there are things I’m tasked with that I should be able to complete with no problem.

But for some reason I can’t. It’s like my brain isn’t working. I usually end up soldiering on and just having a go at it — giving it my best shot and keeping on trying till I get it right. But I swear to GOD, it is maddening. You would think that after all this time, I would be able to get my act together.

In a way, I think I’ve kind of given up trying to get everything back in place the way I want it to be, the way it’s comfortable for me. I guess I’ve made peace with the fact that I am probably not going to get a lot of things right the first time, but I need to just keep trying. There are so, so many things that I have thought I was doing right, then I found out I was doing them all wrong… then I’d look back, six months later, and wonder why the hell it was so hard for me. It just makes no sense. But learning new things — even refining old things — takes what feels like an eternity for me, sometimes.

Still, I can’t let it get me down. If I keep my energy up and keep myself reasonably healthy and engaged in my life, I can just keep going… just keep going… till I figure things out. I just need to keep moving, keep rethinking things, keep my spirits up and keep trying. And if I treat this as an adventure and a chance to explore and learn new things about myself, it puts my experience in a very different light.

And that’s a challenge, because over the years, my anxiety has gotten to the point where a part of me HAS TO HAVE EVERYTHING COMPLETELY UNDER CONTROL, or it freaks out. A part of me craves order and predictability, it relies on routine, and being able to plan and anticipate and properly respond to my life situations. It’s that part that helps me get my routines in order, helps me keep going, helps me keep fit for work and life. But that part of me is constantly frustrated, constantly thwarted by the other parts of me that have gotten rewired and turned around over the years. So, it’s a constant source of tension for me.

A creative tension, really.

And when I think about it, it’s not all bad… there are some good parts to that tension. It spurs me on to do better, to make positive changes in my life and in the lives of others. It moves me to improve. And it moves me to explore.

The most important thing is keeping an open mind — that’s what transforms my situation from a terrible, awful burden, to an opportunity to learn and grow. It’s when I don’t cut myself slack, when I forget that the issues I’m having are because of what happened to my brain, not what my own inherent self-worth is, not what others think my problem is, and NOT because there is anything wrong with me… that’s when things start to get dicey.

In a way, acknowledging that my issues are neurological is both a blessing and a curse. A two-edged sword. But for now, for today, I’m going to focus on the blessing part.

Because I can.

 

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mTBI Guidelines and Persistent Symptoms – the scope of the work

Click the image to download the guidelines (156 pages - PDF)

I’m back to reading the PDF Guidelines for Mild Traumatic Brain Injury (MTBI) and Persistent Symptoms from the Ontario Neurotrauma Foundation, and I’m taking my time, because I want to really understand what they’re saying.

What’s jumped out at me right off the bat is that:

  1. They take mild traumatic brain injury seriously. This is really important, because in the world of brain injury, attaching the word “mild” to the injury can make it seem like it’s minor. I’ve been told that using “mild” in describing brain injury is falling out of use, however, in the medical establishment, I don’t think that’s going to change anytime soon — the degree of injury at the time of the accident/assault/event determines what sort of immediate care you receive, so that gets on your chart and your medical record for all time, and in a way that’s kind of “who you become” in the eyes of the healthcare workers who deal with you from that point on. Even so, the ultimate complications may turn out to be way more than “mild”. Hence, it’s important to start out saying “We’re talking about ‘mild’ injuries, people, and yes they are serious and can have some pretty impactful long-term effects” — at one time, they are acknowledging the relative “mildness” of the initial injury and also setting the context for future discussion. In fact, using that apparent contradiction/paradox as a basis, might actually help to get their message across even more.
  2. They emphasize the long-term effects and actually talk about them in terms of being immediately responsive and pro-active in how healthcare professionals address mild TBI. They acknowledge that there is literally no “best practice” clearly defined for treating folks who do not experience spontaneous recovery from mild TBI. And then they go on to use the sense that God gave them — they set about looking for an approach to “screen for and identify patients that are at high-risk of persistent symptoms” and also develop a management plan for the symptoms that are commonly associated with these symptoms. Pretty amazing… they actually intend to develop “clinical guidelines is to improve patient care by creating a framework that can be implemented by health professionals to effectively identify and treat individuals who manifest persistent symptoms following mTBI”.

I’m going to deliberately overlook the fact that the medical establishment has, up to this point, not felt it was important enough to actually do this before. Let’s not dwell on that maddening fact.

Let’s focus instead on the fact that someone is doing it now, and they are off to a good start, from what I can tell from the first 10 pages of the PDF. And they are coming from a medical standpoint, so the general practitioners of the world who are seeing all these folks who had a car accident or sports concussion six months ago and still aren’t getting any better, won’t be left out in the cold wondering WTF?!, when it comes to these types of patients.

That said, now it’s on to the next paragraph — on page 5, the Scope of the work. (I’m adding my own emphasis below)

The present guidelines are appropriate for use with adults (≥ 18 years) who have experienced mTBI. The present guideline is not appropriate for use with patients who have incurred penetrating brain injuries, birth injuries, brain damage from stroke or other cerebrovascular accidents, shaken baby syndrome, or moderate to severe closed head injuries. The guideline addresses early management to only a limited extent because the purpose of this document is to provide guidance on the assessment and treatment of persistent symptoms. Nonetheless, because early management can influence the development and maintenance of persistent symptoms, the most critical issues regarding early management have been incorporated. For more comprehensive guidance on prehospital and acute care, readers are directed to the Motor Accidents Authority of NSW ‘Guidelines for Mild Traumatic Brain Injury following a Closed Head Injury’ (MAA NSW, 2008,
http://www.maa.nsw.gov.au/default.aspx?MenuID=148). The present document targets healthcare professionals providing service to individuals who have experienced mTBI, including health care providers, neurologists, physiatrists, psychiatrists, psychologists, counselors, physiotherapists, occupational therapists, and nurses. (p5 “Scope”)

More good stuff. They’re clear about who this is for. It’s for adults who are least 18 years of age or older, who have experienced mild traumatic brain injury. This is an important distinction because the more we find out about mTBI and concussion, the more we realize that kids are affected differently than adults — small children are affected differently from teens and adults, and teens are affected differently from small children and full developed adults. I wonder if the 18-year cutoff might be a little controversial, since I’ve read/heard that the brains of males are not fully mature until age 24 or so. I’ve heard that all young adults have still-developing brains. So, I wonder if there might be a gray area around the ≥ 18 years qualifier. And I wonder if this isn’t going to spur more research and similar guidelines for teens and small children.

Anyway, the main point is that it’s a start at differentiating between adults and non-adults, and yes, that piece of information is important, too, because too many people — doctors and other healthcare folks included — aren’t fully up to speed on the differences. It’s also significant to me because in the world of mild traumatic brain injury/concussion, when adults are impacted and cannot get adequate care, everyone is affected — their spouses/partners, their kids, their own parents, their employers, their co-workers, everyone they interact with in the adult world. Their difficulties affect our whole system — our economics, our politics, the social fabric of our culture — in ways that kids’ issues simply can’t. So, coming up with guidelines for treating adults can have far-reaching benefits and consequences throughout the whole of society.

The next important distinction is that this “guideline is not appropriate for use with patients who have incurred penetrating brain injuries, birth injuries, brain damage from stroke or other cerebrovascular accidents, shaken baby syndrome, or moderate to severe closed head injuries.” This is an important distinction because mild TBI has its own set of “exciting” complications that don’t necessarily translate to other sorts of acquired or traumatic brain injuries. mTBI is in a class of its own — and yet, it can have confusing and frustrating overlaps and similarities with other brain conditions, such as stroke or birth injuries or penetrating brain injuries like gunshots or Phineas Gage’s much-studied case.

Mild Traumatic Brain Injury is in a class of its own, as so many of us can attest. And its initial complications can mutate into a whole host of other problems on down the road. Not taking it seriously, or trying to apply treatment/coping mechanisms to it that are really developed for other kinds of brain injury can be terribly frustrating and counter-productive. It’s important to acknowledge that this is a condition that stands on its own and needs to be considered and treated as a distinct condition.

And now we come to the proposed management strategy — They say they’re going to talk about early management only a bit, because they’re really talking about long-term issues that don’t resolve. It’s a good place to come from — being clear like that. At the same time, they do say they’re going to talk about early management, because it “can influence the development and maintenance of persistent symptoms, the most critical issues regarding early management have been incorporated.” So, I could see this document serving two uses:

  1. To teach healthcare folks how to understand, treat, and manage long-term mTBI issues, to teach them to take it seriously — and also give them tools and information they can use to improve their medical practice.
  2. To heighten awareness about all the crap that can go wrong, if you don’t manage the injury properly at the start — a kind of wake-up call for the healthcare folks who dismiss concussion and mild TBI as something that “takes care of itself”. 10-15% of mild traumatic brain injury survivors don’t spontaneously recover — and I wonder how much that might change, if the injury were properly managed from the get-go.

And then they give us a link to more comprehensive guidance on prehospital and acute care which is great – I checked it out and there is a lot of information there. Too much for me to get through right now. Since I’m working on my focus and not getting distracted, I’ll focus on the ONF pdf before I go wandering off to other things 😉

So, whom do they intend to educate with this document?

  • healthcare professionals providing service to individuals who have experienced mTBI, including health care providers
  • neurologists
  • physiatrists
  • psychiatrists
  • psychologists
  • counselors
  • physiotherapists
  • occupational therapists
  • and nurses

That’s a pretty comprehensive list, and I have my own individual hopes for how this document can shape the perceptions and approach of each. Here’s my wish list:

  • For healthcare professionals providing service to individuals who have experienced mTBI, including health care providers — I hope that they gain a heightened awareness of the issues that mTBI survivors can deal with on a daily basis, and that they stop writing us off as malingerers and fakers, and start taking our issues seriously.
  • For neurologists — I hope that they can find a common nomenclature, a common conceptual framework within which to place mild TBI. I also hope that they will stop dismissing us because our injuries were “mild” and that they’ll gain a greater long-term view of the consequences of their actions at the start of the injury management. Mild TBI is not an injury that always “just clears up” — when it doesn’t, the choices made and actions taken at the start, can have dire long-term consequences, which result in untold, needless, and often avoidable suffering.
  • For physiatrists, physiotherapists and occupational therapists— I hope that, like neurologists, they gain a greater appreciation of the impacts that mTBI can have on a person, and connect the dots between the different aspects of the injury – physical, mental, emotional, and yes, spiritual. Being in rehab, it’s also so important for them to not fall into cookie-cutter responses to mTBI survivors, because our symptoms and issues can shift and change over time. Plus, at times, our issues can seem to be improving, when they’re really not — we may be able to better manage the pain and confusion and sensitivities, but they are still very much there and very much a part of our experience. So, please don’t dismiss them because we seem to be doing so much better.
  • For psychiatrists, psychologists and counselors — I hope that they come to see that there can — and will — be physiological reasons for and connections with mental health issues that some of their clients have. I truly hope that they can somehow learn to see the physical aspects of mental health, and to acknowledge the neurological basis for many issues. Rather than trying to address certain problems at a psycho/spiritual level, it can be a whole lot more effective to address them at their physiological roots and foster better mental health by encouraging things like getting good sleep, exercising, and eating right. Acknowledging the neurological and physiological basis for some mental health issues is not caving in to the competition or losing ground to the “hard sciences” — it’s identifying concrete things that can be addressed through behavior modifications and support and focused intention — and in solving issues at the root level, you can get out of the business of constantly talking people back from the ledge, and helping them to live truly full and amazing lives. I honestly can’t imagine why a counselor wouldn’t want to get out of the “mental health maintenance” business and take on more of the work of true life transformation. Seriously — wouldn’t it be amazing if you went to work everyday and saw your clients doing amazing things with their lives, instead of just trying to stop them from screwing up, time and time again?
  • And for nurses — I hope that this document helps raise awareness — just as it could for doctors and neurologists — only on a much more thorough-going basis. I had a relative, years ago, who was in a terrible car accident and sustained a brain injury in the process. But the nurses on staff treated her like she was being uncooperative on purpose. She literally could not speak properly anymore or lift/move her hands and body, but the nursing staff treated her like she was a cranky old lady who was coming off long-time Valium use — they treated her like a junkie going through withdrawal, when she had really been brain injured and was not receiving proper rehabilitative care. It wasn’t until a trauma doctor happened up on her and told everyone that she was in fact brain injured, that she started to get proper help. I don’t fault the nurses — they had every reason to believe it was antidepressant withdrawal that was causing the problems. But it wasn’t — it was a brain injury. And I spent every Tuesday and Thursday nights (after work) and most of the day Saturday for the next six months or so, sitting and working with and helping her to restore her ability to interact and relax and think and express herself, watching her improve each week. I really believe in the work that nurses do, and I really believe that if they were given the right information and properly trained about mild TBI, they could play a hugely important role in diagnosing and treating brain injury. I also believe they might be able to mitigate some of the conditions that exacerbate the effects of TBI. Just a higher awareness and also a genuine caring about what mild TBI can do to a person’s body, mind, heart, and sense of self, might make a real difference in the world.

So, those are my hopes for the audience of this document.

Now, how to get it into the hands of those who are best served by it?

That, my friends, is the question.

But I digress. I’ve written a whole lot about this matter, and it’s time for me to get on with my day. I’ll be reading more and writing more — rest assured, as this is really great stuff to “chew on”.

Happy reading…

Change it up

How easy it is, to fall into a rut.

Day in and day out, I have pretty much the same routine, and part of me likes it. I get up, I exercise, I have my breakfast, I go to work, I come home, make supper, watch some television or read or do some work, and then I go to bed. In between, I may stretch or take a walk or do some sort of additional exercise. I’ll also check my email periodically and have a cup of coffee and a snack in the afternoon to keep me going.

Each day, it’s pretty much the same. Even on the weekends, my routine doesn’t change much. It’s great for keeping myself on track with a consistent, reliable schedule. And it makes me quite reliable, as well. I often have so much going on in my life, I don’t have a lot of leeway to stray from my path. That makes me a valuable employee, a responsible spouse, and a solid community member.

It also represents a bit of a change from how I used to live my life, when each day was a new form of improvisation, and I really didn’t have much routine at all. When I was much younger, I drifted from job to job, relationship to relationship, state to state, country to country, residence to residence, a bohemian vagabond who was more interested in the experience of living, than actually accomplishing anything.

Then I got all respectable and what-not. I got a real job. I settled down with a partner. I had responsibilities. And I changed how I did things, becoming responsible to a fault — rigid and regimented and not very flexible at all.

I went from one extreme to another. It wasn’t all bad. It made a lot possible for me that had eluded me for years — a steady income, a (somewhat) predictable career path, respect from people around me, a higher standard of living.

But I’m starting to feel antsy again. Sometimes it’s nice to change things up a little bit, and I’m beginning to feel the pull of change. I guess working in technology for the past 20 years, I’ve sort of become dependent on constant change — I expect it, I’ve acclimated to it, as things are never static for long in the technology field.

The trick now is to introduce some change into my life that doesn’t derail everything I’ve accomplished. My job history is dotted with relatively brief (12-18 months) positions that focused on one thing, then I “traded up’ to something else. I’m not sure I want to do that. I need a change. I crave a change. But I need to find somewhere to have healthy change — not destructive change.

In the past, I’ve been all too quick to just cut and run, when things got too familiar, or too comfortable, or downright easy. I need things to be challenging, and it’s always been tough to find regular challenge that can last. Especially when I’m working in environments that are geared towards standardizing everything and making things as predictable and as “safe” as possible.

I suck at safe. It’s just not me. But being a danger-seeking adventurer doesn’t go over that well in the corporate world.

I need change, and I need it on a regular basis. But I’m also realistic. Looking at my life, I don’t really want to get rid of my routine — it makes my daily life possible in ways that a hectic, constantly changing and shifting series of distractions can never do. But I do want to change some things about my routine. Like the exercise I do, first thing. For about a year, I did the same exercises — lifting free weights in the same kinds of sets, in the same sequence — and I never deviated from that.

Which is fine. If that’s all I wanted to do. But I found that it had all become quite rote and, well, boring. And it wasn’t waking me up quite the way it used to. I guess I’d gotten too acclimated, and I didn’t actually need to work at it anymore — which is the whole point of my exercises, first thing — to work out and wake myself up in the process.

So, I switched up the weights I was using and went heavier. I also changed the number of repetitions in each set.

I also moved away from doing ONLY weights, and I started doing more full-range movement, to strengthen and stretch more of me, not just isolated muscle groups. I started doing a bit of yoga, following along with some videos I found.

The overall results have been good, I’m happy to report.I feel more awake and more “with it,” thanks to this shift in how I’m starting my day. I feel more energized, actually, with these small alterations in my routine. I still have the structure of the routine to get me into my day, but I have some leeway in the midst of it all to perk things up a bit. I can have the best of both worlds – a regular routine that gets me into the day, along with some variety to keep me interested and engaged.

The same thing holds true for my work at my day job. I’ve pretty much “got it down,” after nearly a year of some pretty arduous efforts. Now I need to keep with it and build on what I’ve got, rather than running off to find some other way to keep my attention trained on what it is I’m doing. I need to watch my energy, that’s for sure, and not wear myself out. But I also need to keep active and not let myself fall into the trap of getting bored… and then getting in trouble.

It sounds odd to hear myself saying this. At my age, one would think I have more sense and more stability than to be debating this, but it’s a lifelong habit of cutting and running that I have to overcome. It’s taken me three years of regular rehab — talking with someone who understands my cognitive issues within the context of my history of TBIs — but I’m finally at the point where I realize that I don’t have to completely trash my life, in order to stay engaged.

Actually, on a deeper level there’s something important going on — I’m finally at the point where I (at long last) realize that I’ve been trashing my life to stay engaged, all along. I never realized that, till I learned about how TBI and neurology affect attention and distraction and resistance to interference, that seeking out drama and “refreshed” situations (read, new jobs, new friends, new homes, new… everything) was my way of keeping myself alive and involved in my life.

It’s not that I deliberately want to sabotage myself, or that I don’t think I deserve to have success in the long term. People have told me that story about myself for as long as I can remember. They’ve told me the following:

  • You’re a quitter.
  • You don’t have what it takes to get the job done.
  • You’re not up to the task – it’s too hard for you.
  • You’re trying to sabotage yourself/the group/the job for some deep-seated psychological reason.
  • You don’t think you deserve success.
  • You just can’t.

In fact, the exact opposite was true in many cases.

  • I wasn’t a quitter – I had a really hard time holding my attention on tasks that were easy, and I didn’t know I had that problem, so I could never address it.
  • I did have what it takes to get the job done – in fact, I had more than enough, but the easier the task got, the harder it was for me to concentrate.
  • I was up to the task – it was actually too easy for me.
  • I wasn’t trying to sabotage yourself/the group/the job for some deep-seated psychological reason – it was a neurological and physiological combination of compromised attention, susceptibility to distraction, and anxiety that set in when things started to go wrong.
  • I didn’t start out thinking I didn’t deserve success – but after so many failures and aborted attempts, I started to believe it.
  • I could — I just couldn’t see what my issues were, so I couldn’t deal with them.

As a matter of fact, many of the “decisions” I have made to either “give up” or “start fresh” were not conscious decisions at all. They were impulses driven by a serious need for alertness and attention — which was physiologically compromised by my neurology, and which I could only get back through changing up things, when they got familiar and comfortable and I was approaching mastery.

The easier things got for me, the less I paid attention, and then things started to fall apart. When things started to fall apart, I would get anxious, wondering why the hell things were starting to go south — and that anxiety and worry would further encroach on my already limited attentional capacity. I would start making choices that stressed me out, and because I thrive on a moderate dose of stress hormones, I would keep that up, gradually exhausting myself and burning myself out and endangering my working relationships.

The downward cycle would commence. And keep going. Until I was out looking for another job.

I would go looking for something else that wasn’t familiar — I’d wander off in search of more excitement that didn’t involve the situation I was fleeing. I told myself I wanted another adventure. It wasn’t that I needed to trash my life — I just couldn’t think as well as I wanted to, anymore, in those old familiar surroundings. I couldn’t function as well as I desired, and that made me very anxious and complicated everything all the more.

In a way, the easier things got for me, the harder it was for me to stay.

So, I didn’t.

Now, here I am at a job I really like, with people I really like, in an industry that’s actually stable and growing. I’ve got it really good. They like me, too. There’s absolutely no reason I should leave. So, I need to find ways to keep myself alert and engaged and attentive. Focused. Intact.

My TBIs have trashed my life often enough in the past. Time to change things up. For the better.

When getting hurt feels good

Hurt doesn't always hurt

I’m back from vacation, and I’m already starting to feel over-taxed. Time to get out in front of what I’m doing and take command of my days, my time, my energy. Most important of all,  I need to not get down on myself, thinking there’s something wrong with me, because I can’t “keep up” with everything going on. I have more stringent definitions of what “keeping up” is all about, anyway, so I need to give myself a break and be a bit easier on myself.

I’m doing great. I really am. I’ve been getting great reviews at work, and I have a really good feeling about this year. We’re already through the first quarter, and we’re moving on. Just gotta keep moving on…

One thing I noticed – again – is that I tend to push myself harder than I should. It’s partly because I have high standards, it’s partly because I have this perpetual sense that I’m falling behind, and it’s partly because I really dig the feeling of pushing myself really hard — even to the point where I’m hurting myself. I’ll stay up too late, take on too many tasks, drive myself onward-onward and feel the effects of it, day in and day out, till I crash. But I won’t stop.

I did this when I was younger, too. When I played sports, I would just push myself and push myself and push myself, playing through many injuries, including head injuries. It didn’t help that I had pre-existing concussions by the time I got to high school and started playing organized sports. I think, in fact, it contributed to my willingness/eagerness to play through injuries. Definitely, having the prior concussions contributed to the impact of the ones I sustained in high school. They made the actual injuries worse, and they made my responses to them less intelligent and more stubborn and non-compliant.

Why?

Am I innately self-destructive? No, I’m not.

Do I want to hurt myself? Did I have a deathwish, back when I was younger? No, that’s not it.

Do I disrespect myself and think poorly of myself, so I have to be punished for some terrible thing I think I”ve done? Sometimes I feel that way, but not all the time.

So, why do I do it? Why do I push myself hard (and crash hard, too) when I know it has a negative effect on me and my world.

Because as much as I intellectually know it bodes ill for the rest of my life, the simple fact is, it feels really good to push through, to play through, to keep going.

This comes back, yet again to the energy/focus/analgesic stress idea that’s been on my mind a lot, over the past years. It has to do with the calming effects of stress hormones, the way they help block out all extraneous details and simplify things for me. It has to do with the pain-deadening effects of the biochemical cascade that comes online when you’re in high-pressure, dangerous, high-stress situations. It has to do with the rush and the chill that comes from extreme living.

It has to do with pain and trouble introducing a relief of some kind, and how I instinctively seek that out.

It’s not that I want to harm myself with stress and pain. I actually want to help myself. Because the pain and fatigue and confusion of so many stimuli coming up — when I’m fatigued, I become even more sensitive, and my hearing, sense of smell and touch, and eyesight all become amplified, picking up every little thing. It’s painful and confusing, and I just want it to stop.

So, I push myself. I push myself through the work I’m doing. I push myself to get up earlier, to stay up later, to take on more tasks, and I overwhelm myself.

On purpose.

Not because I want to hurt myself, but because I want to help myself. And the stress hormones do just that. The adrenaline I get pumping, the intense focus I bring, the ability to shut everything out, just to focus on one individual task or experience at a time… it gives me a huge amount of relief. Relief from the aches and pains and sore tightness in my joints and muscles. Relief from the fog that sets in from having so many responsibilities going on that I lose track of. Relief from my insecurities about being able to get anything done at all.

Just relief.

And that’s a problem. It’s always been a problem, for as long as I can remember. As far as I’m concerned, this need — real, physical, logistical (NOT psychological) need — to plunge into stressful situations — has been at the root of many of my issues over the years. I can very easily see how it has fed my behavior issues, my distractability, my inability to complete things, my restlessness and inability to stay the course over so many years before I got started with rehab. Contrary to what many psychologists will say, I’m convinced (from my own personal experience) that it’s NOT a psychological choice to “sabotage” myself — that’s not it at all. It’s a real physical, logistical need that’s borne of neurological conditions, not psychological ones.

And to think that for so many years, I was convinced that there was something wrong with my psychology, that I was suffering from low self-esteem, that I was self-destructive, that I was somehow psychologically impaired, when all along, there were fundamental underlying neurological and biochemical reasons for my behavior and choices.

It makes me a little nuts, to think of all the years I spent feeling psychologically impaired because of misunderstood neurological conditions. But at least I’m aware of the true nature of my issues now. And that’s half the battle, right there.

If I can get some rest, step back, take another look at how I’m living my life, and make some choices that I want to make about how I want to live my life, rather than having them be made for me by reflex or reaction, drive by others’ agendas, that will be good. I’m doing that now. I’m looking at my pain levels, my sleeping issues (I’ve started lying down on the couch earlier in the evening and just going to sleep for a while when I’m tired, so I’m less exhausted when I actually go to bed – and I can actually GET to bed), my daily routine… I’m looking at it all.

Vacation was good, but it didn’t solve everything. But at least it gave me a little more rest and some distance to contemplate what it is I’m doing with myself and why/how I want to do it all.

Which is good.

Getting hurt isn’t the only thing that feels good. Sometimes getting things right feels pretty awesome, too.

I just need to make a point of focusing on that.

And find yet more replacements for the kinds of activities that give me that huge rush — the rush I don’t just crave, but can’t live without.