neuropsychologist

The Home Stretch

aforrest Leave a comment

I had the intuition that I should title my blog post “The Home Stretch” while I was meditating.

Because my brain is still a little more groggy from all that I have been through the last 2 and 1/2 months, I had to think a little more about what the term sporting event the “Home Stretch” came from.  At first I thought it was a baseball analogy about the run from Third to Home Base.

As I reflected on it, I realized that I have heard it used that way by the announcer at baseball games.  And then I realized that the idiom comes from a horse race.  In fact, when I looked it up in Merriam Webster, I found that the first definition is “the part of a racecourse between the last turn and the winning post” and the second definition is “the final stage”.

This week, upon much reflection, I realize that I have turned the corner on the last turn and I am in the home stretch of getting back to my baseline before my dental appointment.

As I thought about what goes on in a horse race between the last turn and the winning post, I realized that there is a lot of strategy that goes on in that final distance.  I have seen many races (on television) where the horse that wins the race is not the horse that is ahead at the turn, although sometimes the horse that is ahead at the turn wins.  In a horse race, it is speed that wins, but it is also strategy.

What reflecting on what happens in a horse race means to me now is that I have to be careful and conscious about my home stretch.   And I have to use all my strategies to get from where I am now (roughly 80% of my previous baseline) to where I want to go (back to the 100%) in order to get to the finish line (where I want to go).  And in my case, I don’t want to leave all my energy on the field, like the horses and riders do.  I want to be able to keep going and building after I get to back to where I was before all this happened. In my case, its not how fast I cover this distance to 100%!  Its about doing the things that will get me there and which I can maintain after I get there.

In addition, I want to get back to 100% of where I was, and possibly a bit better than 100%.  (I talk about better than 100% of my baseline in my blog post called Focusing and Refocusing). And, I want to be able to keep going once I get back to where my old “new normal” was.   I want to keep my new new normal evolving, in other words the benefits of neuroplasticity.

Now, what I have learned from my experience about setbacks is that, if I try to get down the home stretch as fast as possible, I may never get back to 100% (of my baseline)!  

And I won’t be able to sustain that 100% once I get there.  

And, I won’t get to more than 100% which would be the best outcome and what I am hoping for.

When I say I have learned that going as fast as I can on the homestretch does not work from experience, I mean that the temptation is to try to race there as fast as I can! I am tired of having to compensate around my brain not working as well as it did.  I am tired of telling others that my brain is still not working well as well as it did.  My husband can see it, and my close friends who listen carefully can either see it or hear it.   But lets face it, most others who don’t know brain injury cannot.   And even if they could, I am tired of having to work further around my work arounds!  I am tired of taking cognitive rest.   I am tired of telling people I haven’t been able to do much this summer and thus have not gotten to all the things that I thought I would get to this summer including things I may have told them I would get done for them.  I am just plain tired of all this. And as an over achiever prior to my brain injury, I learned to push hard in the home stretch.  I learned it so well it became habit.

You see, I have learned over and over that my habit of pushing hard before my brain injury does not work.   So pushing harder in the home stretch, which was my pre-injury habit, also won’t work.

I have seen many others, not just myself, push hard to get through a concussion.  It doesn’t work. I have to consciously unlearn all my habits of wanting to be done with this last stretch.

So what is my strategy for this particular home stretch going to be?

The first step to changing this strategy is to identify the habitual problem of wanting to race through it.

I have done that.

The second step is to figure out how to be conscious about it.

I have begun to become more conscious about it by writing about it.  

That is one thing I love about writing my blog. Writing forces me to reflect and think about what is going on for me and how I am handling it this time.  

And that reflection sometimes leads me to different answers than I had when I started writing.

And in reflecting and writing, I have become more conscious that I have been at this (or a similar) juncture before, many times in fact in my recovery.

As I write, I am beginning to remember that I have even discussed this very issue before.   I now remember a conversation that I had with Dr Lebedun, years ago.   Dr Lebedun is a very bright and intuitive Neuropyschologist that I found when I lived in Northern Virginia.   I now recall that “holding back my inner over achiever” should be a part of my strategy now.

But its not all of my strategy.

I need to be conscious about figuring out my strategy and using what I have learned prreviously.

I need to make a “plan for success” about how I will approach it.  By the way, I attribute the concept of making a “plan for success” for some work I have been reading by Dr Larry Schutz. (More on his work later but here are the resources http://givebackorlando.com/hepusef/hepindex.html)

How do you approach the home stretch — whether it be back to your baseline before a concussion or back to a “new normal” baseline with persistent symptoms following a concussion.

Have you approached a home stretch in a way that you wouldn’t try again?

What happened?

What are your best strategies for the homestretch?

What has happened for you when you used them?

Who taught you or how did you learn your best strategies for the homestretch?

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Comprehensive Management of mild TBI

aforrest Leave a comment

Two weeks ago, I wrote about my new friend who is trying to get medical help in understanding her symptoms that she suspects are related to multiple falls and the empathy I felt for her after my own difficult search to find the help I needed to recover after my symptoms following a car accident in which my head went from side to side and back to forward.

I want to post some information that I heard on Webinar sponsored by the Brain Injury Association of America.   The Webinair was on Comprehensive Management of Mild TBI by Dr Kevin Crutchfield, MD and Dr Jessica McWhorter, PhD.  Dr Crutchfield is the Director of the Comprehensive Concussion Program and Director of the Noninvasive Vascular Laboratories at Mt Sinai Hospital of Baltimore and Dr McWhorter is a Rehabilitation Neuropsychologist at Berman Brain and Spine Institute also in Baltimore I believe.

Before I post more, I want to say that I am a big fan of Dr Crutchfield.  I attended a seminar that he was also a participant in, and I introduced myself to him because I was so impressed with his questions for the speakers.   Later, when I had another concussion (after the concussion that changed my life and livelihood), I traveled up to Baltimore from Northern Virginia to see him for a second opinion when I my new symptoms were not resolving.   He validated the need for a new sleep test and had several other suggestions.  His referrals helped my life enormously.   And he has helped a number of people that I have sent up to Baltimore, for a second opinion, in life changing ways.

I also want to say that he is by no means the only doctor that does comprehensive care for mild traumatic brain injury.   I am posting because his webinair had slides that said what comprehensive care is.  Since I had so much trouble getting to comprehensive care, and since I meet so many people who do not get comprehensive care initially–or who, like me, do not even know what comprehensive care after mTBI is– I wanted to post what it is.

This morning I heard the statistic from Dr Cheryle Sullivan that roughly 80% of people with TBI don’t get to treatment at all.   Much less comprehensive care.   And many people that I meet, thought that they were getting comprehensive care when they went to their doctor, because surely their doctor knew about concussion.   Later they found out, when they are not getting better, that they may not have gotten all the care that they needed.

One of the many objectives of the Webinair was to identify the essential elements of a comprehensive approach to mTBI.

I want to include information from the medical part of the discussion in this post.   I wish that I had had a comprehensive evaluation when I first had my injury in 1997.   Brain injury treatment has advanced tremendously since that time.   When I think about what I wanted to know it was what comprehensive treatment for mTBI was.

So here in 2014, I want to know that I have stated what I believe is good information about what to look for in treatment.   I struggled many years with symptoms that I believe I would not have had to struggle with had I gotten to comprehensive treatment early on.   I believe I am correct about making that statement because when I finally got to most of the treatments discussed, they helped me.   Earlier treatment is thought to be more cost-effective and faster than later treatment according to researchers.

I also want to say that many of the people that I meet through my public speaking and through my advocacy have not been evaluated comprehensively and are grateful for knowledge of what kinds of diagnoses have been helpful to my recovery and others, and what kinds of treatments are available so that they can recover further and move their lives forward as best as possible.

In the Webinair, Dr Crutchfield, a neurologist by training,  presented and discussed the following information:

Diagnostic evaluation should include:

-concussion scale

-neuro-ophthalmology (which includes vision therapy (added from my notes by ASF))

-referral to a mTBI program

-sleep test and referral

–physical therapy

–speech therapy

–cognitive therapy

–EEG

–Imaging

Source: Comprehensive Management of Mild TBI, slide number 22.   Dr Crutchfield, Life Bridge Health and Mt Sinai.

My layman’s understanding of a diagnostic evaluation is that the Doctor should consider all these possibilities and should pursue evaluation if the symptoms presented warrant it.   For example, an EEG might be done is seizure is a possibility but not done if seizure is not a possibility.

Since I am translating this information for the non-medically trained I want to present a second slide about what is treatable.

The slide is:

What can we Treat?

When rest alone provides no relief.

–sleep disturbance

–headaches

–visual disturbance

–mood alterations

–behavioral alterations

–vertigo

–imbalance

Source: Comprehensive Management of Mild TBI, slide number 28.   Dr Crutchfield, Life Bridge Health and Mt Sinai.

I will reach out to BIAA to find out is the Webinair is available for viewing and how one views it.   I reached out to Drs Crutchfield and McWhorter about their webinair last week and I hope to hear back from them.  I have questions for them and I will report back.   And in my next posts, I will post more about the concrete ways that comprehensive management would have helped me.  I also want to discuss that comprehensive management of mTBI by doctors and health professionals is also a goal of the Ontario Neurotrauma guidelines that I have posted earlier.   www.onf.org.

 

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The importance of cognitive rest

aforrest Leave a comment

I have learned alot about cognitive rest and its importance in re-finding balance, and re-building after my injury.    I was reminded of it last week when I noticed that I was getting more and more out of balance in my life.  I realized I needed to change direction and get my life going towards re-finding balance.

There are many names for good rest — brain rest, cognitive rest, power naps, downtime, REM sleep.  My friend has coined the terms “aggressive rest therapy” and “emergency nap”.

The role of cognitive rest is so critical.

Several years after my accident, I benefited from the guidance of a neuropsychologist who taught me my compensatory strategies so I wouldn’t get too tired–or what my friend and I call, “too tired to sleep”.    The neuropsychologist  taught me to do daily life activities then rest, then do daily life activities then rest, and she thought I needed 3 rests a day.   She called this ” pulsing”.  I learned that I could actually get much more done in my day if I rested my brain frequently.

My vision therapy Doctor  taught me to stop doing or limit the things that were fatiguing to my eye-brain connection.   I had to learn what these activities that caused the fatigue were.  They were often things that I could have easily done before my injury like walking more than 20 minutes.   So, it took me years to learn when I was (unintentionally) over-tiring myself and to stop doing them.

Later, a speech therapist gave me rules like “no computer after 7 pm at night”.  ( This was helpful when I was finally able to be back on the computer with the help of assistive technology).   She also taught me to limit my time on the computer for only 20 minutes a time.

And my speech therapist taught me to stop all activities BEFORE my symptoms (irritability, intense fatigue, feeling overwhelmed and increased confusion) began.   It was more efficient to stop ahead of time then to wait til the onset or overdoing it came.  Because the onset was often delayed, this self-awareness about when to stop was really hard to  to master and took me years.

But I have gotten ahead of myself.

Last week, when I realized I was out of balance, I was able to use the cue to begin the process of putting into place my compensatory strategies to help me.   Thursday afternoon, I thought I would take one last look at my blog before I published it.    Turns out our cable service went down.    So I couldn’t publish the blog post from my computer.   Rather than being frustrated, I realized the best thing for me was to seize the moment and let myself take a “cognitive rest”  for the entire time that my sitter was here.

Boy, did that help me!   Sometimes, it feels like too much luxury to stop to get brain rest.  Or, like Thursday, that I don’t have time to get cognitive rest.

What I have learned through practice  is that when my internal voices are telling me that I don’t have time, is usually when I need downtime the most!    As an overachiever, learning to “hold back my inner over-achiever” has been one of the hardest things about my recovery.   I have learned for my own recovery, I  need to err on the side of more rest rather than erring on the side of less rest.

And, as it turned out, getting downtime Thursday was indeed the best thing I could have done for myself.   It  helped me to be alittle more calm and it helped me regain more balance.  I find cognitive rest helps me make my life tolerable and allows me to keep going.   My cognition is always better afterwards.

Do you use cognitive rest to help you regain balance and help in your recovery and rewiring?   How does it work for you?

 

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