The Kay in Kafka

On the Road Again

2009-09-12T18:02:00.000-07:00

So I am on the road again, headed south for whale watching, researching delfinotherapia, concentrating on writing, learning Spanish, and most importantly learning and teaching about brain injury. Finally having identified and overcome my residual post-robbery fear of writing in public I have begun filling a notebook with new blog entries which I will post as soon as possible.

As always I am energized and inspired by the thrill of discovery, learning, meeting new people, and new experiences. I look forward to sharing all of my travels and experiences and being better-able to help through them.

I will do my best to keep up the blog through this next month of travels, but wanted to keep you updated as to why I am straying from the connection series. Never fear, I will return to that in the near future....

First Contact (Meeting People is Easy part II)

2009-09-05T15:53:00.000-07:00

The ins and outs of starting a conversation, establishing a report, and basic human interaction is an art that is quickly fading into oblivion. Thankfully the ideas are ingrained in us all – we just need a few reminders. While survivors are relearning social skills is a perfect time to brush up on this as well. Survivors do however, face several additional challenges in this area as well.

In my experience, one of the biggest stumbling blocks for moving past the initial meeting and developing friendships is that of concrete thinking. It limits the brain’s ability to think “outside the box” Where to meet people, new things to do, places to go, the list is endless. I hope that previous entries have helped give a few ideas for places to meet people such as therapy or support groups.

Volunteering is another wonderful place to meet people with similar interests and outlooks, and the same can be said for any number of organized groups. Really you can meet people anywhere: at concerts or other events, I have even made fast friends on a train.

Still, it is best to start slow with groups you frequent, and branch out once you’ve found your networking “feet,” so to speak. The “where” is the easy part. The “how,” on the other hand, now that may take a little more guidance. How to start conversations, what to say when you do….

Approaching group members or people in therapy after class is a good time to do it. If something someone else said made an impression, compliment him or her on his or her insight or let him or her know what you thought about it. Another good way is to make a comment about class, "Wow, I had so much trouble understanding X, what did you think of it?"

Compliments are another great way to start a conversation. There’s no reason to approach people you don’t find interesting in some way. Don’t give empty compliments, but mention what it was that piqued your interest and if you can follow it up with a question. It can be as simple as, “those are great shoes, where did you get them?" People respond to flattery, especially when it is sincere. However you start it is always a good idea to ask their opinion, or some sort of question. Questions really get the conversation going.

While you are getting started, especially with your first few tries it may be good to take things slow. Plant the seeds - keep first contact quick and light. Talk to a few people after class, maybe exchange emails and suggest maybe getting a group together to grab coffee or lunch next time. You’re just putting feelers out, first contact. No rush, no worries….

Everybody is Lonely (Meeting People is Easy Part 1)

2009-09-01T19:11:00.001-07:00

Facebook, myspace, twitter, dating sites are a multi-million dollar industry; it seems people are constantly reaching out. We live in a culture of networking. All it takes is a quick search and you can be in instant in contact with 100 people who have similar hopes, dreams, goals, or interests. However this easy access does not ease loneliness; instead it seems to increase the isolation. Cyber-relationships and social networking sites are making us lazy and depriving us of human contact. Basic interaction is rapidly becoming a lost art.

Brain injury often destroys long-standing relationships and networks. Not only has the survivor lost social skills, and friendships, but also even those without brain injury have problems forming relationships. It seems hopeless – everybody is lonely.

This pervasive lack of human contact in society is indeed tragic. However, this gaping hole in our culture works to your advantage. There is already a need. It is up to you to fill it.

Though there are countless negatives about brain injury it can help you approach life in new ways. It does take initiative, practice, and a little effort but meeting people really is easy. You just need to follow a few simple guidelines and you will find friends in no time!

Steps (Connections recap)

2009-08-30T17:35:00.000-07:00

So we’ve covered the basics of finding friends. The building blocks of working on yourself, putting yourself first, suggestions of where to find friends, that sort of thing.

Just a quick recap:

Step 1. Work on yourself, find your balance and get comfortable with the “new you.” You are the most important thing, trying to find friends before you have a strong base will do more harm than good.

Step 2. Focus on therapy, finding the right therapy and best routine for you, and rediscovering yourself. When you have gotten into the swing of your new schedule look around. Reach out, talk to people with similar interests. This can be a great first step in finding new friends.

Step 3. Join (a) brain injury support group(s). After therapy has become routine and you feel you can take on more, join brain injury support group(s). Being around people who are going through or have overcome similar problems can provide hope, support, and help overcome fears. Support groups are another wonderful place to meet new people and make friends.

Remember: Do not push yourself to find the “right” friends. Relax, open yourself to suggestions, possibilities, and do not limit yourself.

Now it’s time to move on to the next hurdle. The how. How to prep yourself to navigate around some common pitfalls survivors have, how to successfully connect with people, and most importantly how to make and keep friends…

Onwards and Upwards (Connections V)

2009-08-10T16:10:00.000-07:00

A concerned parent of a TBI survivor wrote me that seven years after the accident he was concerned that his son was “stuck” at his injury age (19). Seven years later, at age 26, though outgoing and involved in the community his son has trouble making new friends.

The phenomena of getting “stuck” and acting younger than their age is not uncommon. Because brain injury does wipe out social skills it takes time to relearn a lifetime’s worth of social skills. Hastily relearning social etiquette immediately following the accident causes that point in the survivor’s life to be the baseline for what is appropriate.

Moving beyond that isn't something you can rush. The survivor has to be past the point of struggling to keep the deficits under control. Also, even though this may seem obvious to you it is important to talk to the survivor about your thoughts on the matter. It can be a lot easier to see these things from the outside and he may not even realize that this could be a problem. However, is equally important for the survivor to make a concerted effort himself. It is harder to read signs and pick up on nonverbal cues, but if you want to move forward it’s important to try.

I do not know the whole story, and especially in today’s day and age many 26-year-olds tend to act much younger, but there are a few things that aren’t as readily accepted. Different situations have different rules of propriety. For instance, it can be okay to curse or make off color jokes around your friends, but doing it around your boss or professor would be unheard of.

These changes in environment aren’t always so obvious and when they are subtle picking up on them can be difficult for survivors. Unfortunately they can be extremely important. It is important to always be yourself, but in this case, my recommendation is to look at how others are acting in different situations and follow their lead. At least until you have a better idea.

As far as making friends goes, I would say it is best to hang out with the people you feel most comfortable with. Age is a number. I have 21-year-old friends that act more mature than some 50-year-olds I know. The most important thing I can tell you is not to stress about meeting people or making the “right” friends. You’ll find your stride, but trying to force it won’t help anything. Just play it by ear, everybody grows at their own rate. Accept yourself for who you are, reach out to others, and good things will happen...

Light at the End of the Tunnel (Connections VI)

2009-08-07T16:51:00.000-07:00

No one can understand what I am going through. How could they? After such a huge change, and especially when family, friends, and therapists clearly don’t understand this is exactly how it can feel.

I recommend initiating conversations after therapy and reaching out to classmates in therapy. Unfortunately, when it feels like others can’t understand reaching out can seem like an almost lonelier and more isolating prospect. More people to misunderstand and remind you of the separation, and change – this prospect can be terrifying. This is another reason it is important to ease back into things.

It is vital to remember that one is not alone in feeling this way. There are millions of brain injury survivors and though every injury is different and each survivor has a unique experience, there are many similarities in all brain injuries. When you feel your therapy routine is under control try joining a brain injury support group.

Being told you are not alone is one thing, but meeting others who have gone through what you are experiencing is another thing entirely. There are groups for brain injury survivors all across the world. These communities are wonderful places to meet people, work on social skills and find guidance. Survivors can share experiences; offer suggestions for how to live with these deficits, and most importantly serve as an example that there really is life after brain injury.

Not only are they a place to find much-needed support and companionship, but going can also help you to realize that you are not alone in your struggle. Meeting others who have gone through similar things can ease the burden of solitude and offers hope for a light at the end of the tunnel….

Another piece of the puzzle (Connections III)

2009-08-05T14:47:00.000-07:00

Therapy. The word has so many negative connotations. When I got out of the hospital my parents had to drag me there. I hated being in another clinical building. I loathed cognitive therapy; I detested occupational therapy, and despised speech therapy. They kept telling me I was injured when I clearly wasn’t, or so my anosognosia*-addled brain told me.

But didn’t I just recommend focusing on therapy and working towards improvement?

Unquestionably. But though traditional therapy is important, alone it is not always as effective for brain injury survivors. I believe that using whatever means available to improve. Therapy does not have to mean traditional therapy or be held in a clinic to work well. In fact, alternative therapies have been proven to have some extraordinary results.

Every person is unique and so different survivors respond better to different types of therapy. In deciding what type of therapy to try, it is better to look at the person than the injury. Likes, dislikes, strengths, weaknesses. Enroll in types of therapy that best suit the patient. The more he enjoys what he is doing the more effective it will be. Music, riding, dance, art, horticulture, and recreation are among seemingly endless list of recognized therapies.

But not every therapy is equally effective for all patients. It is extremely important to find the right fit. Alternative therapies can help every aspect of life; many types of alternative therapy such as animal assisted therapy, hippotherapy (riding therapy), and recreational therapy encourage social interaction, cultivate empathy, and help rebuild social skills. Rebuilding these skills and relearning how to connect is the next step on the path.

Another wonderful benefit of therapy is that your classes can be a social goldmine. Not only are the people in these sessions fellow survivors, but they also share similar interests. The more you have in common with someone the easier it is to talk, start conversations, and bond with them. Start a conversation and see what happens. Chances are you will find that you have more in common you’re your classmates than you might have thought.

After a session, say hi to one of your fellow patients and see where your conversation takes you. Having a friend in therapy can motivate and inspire both of you to do your best.

*Anosognosia is a fascinating condition in which the brain cannot recognize injury or change. It occurs in over half of right hemisphere stroke victims and many brain injury survivors and can cause patients to be resistant to therapy.

A Strong Foundation (Connections II)

2009-08-03T15:55:00.000-07:00

Immediately following a brain injury it can take all of your effort just to keep your head above water – the smallest things may seem like too much to take. As the overwhelming waters of confusion begin to recede however, it is common for survivors to feel stranded, friends nowhere to be found. This is not their fault, for days, weeks, or months they have been warned against overstimulating the survivor. People cannot be expected to wait indefinitely or to instinctively know the right time to rejoin the survivor’s life.

This may lead to lonely times, but it’s important to remember not to rush into a full-blown social life. After brain injury it’s extremely easy for survivors to become overstimulated and fatigued. As time passes it happens less frequently but take care, don’t let this newfound energy lull you into thinking you are better. Take care of yourself – brain injury episodes are never far away. Not only can these destroy friendships, both old and new, but it is also terrible for your health and progress. Not to mention that overstimulation may cause an instinctual withdraw from the world to recuperate.

The best way to avoid hyper-extending or overstimulation is to make a schedule and get into a routine. Have definite activities to get you out of the house but also make sure to schedule breaks and times for rest. This will this help balance life, increase motivation, productivity, and happiness in general. This series is about making friends and connections, but the first step to building lasting relationships is taking care of yourself and getting your life in order.

Take it easy, focus on therapy, discovering the new you, improvement, and building a strong foundation. Find your feet and get comfortable in your routine always making sure not to take

on too much. When you have gotten in the swing of things and feel confident, that is the time to open yourself to opportunities for friendship. And therapy is a good place to start….

Connections I

2009-07-28T12:09:00.000-07:00

Brain injury is the loneliest thing in the world.

It’s no wonder why. The list of deficits that can push people away itself endless. But it’s more than that….

The survivor is the only one who truly can fight the brain injury battle. Though doctors and therapists may help, family and friends may support, but the real fight is up to the survivor. No one outside of the patient themselves can know what is going on. Survivors may look perfectly normal and still constantly struggle with unseen obstacles. This can lead outsiders to misunderstand, question, or even deny the problems. Fighting the deficits takes all of your energy and convincing the doubters is even harder.

Every day is a new battle. Wave after wave of obstacles, deficits, trials and challenges crashes into you. Perhaps most painful, some friends won’t be able to understand and will drop out of your life. Do not let this discourage you. You will make new friendships with people who do understand, can relate, and offer genuine support. People who will love you for you.

This is fine to say, however, because of aforementioned problems connecting with and relating to others it is unfortunately easier said than done. Overcoming trust issues and the profound sense of separation may seem like an insurmountable challenge. However it is vital that you do just that. It will take a little effort, but with guidance, suggestions, and hints it is possible.

But if brain injury is so socially debilitating and isolating how exactly does one meet new people? How does one get back in the swing of things post-injury?

Humans are gregarious – we’re herd animals. It isn’t emotionally, mentally, or physically healthy for us to live in isolation. In many entries I talk about the benefits of community support, a strong social network, and the importance of reaching out to others. Every word is true. Strong social networks, community support and involvement and family love and encouragement make all the difference in improvement.

Not only does social interaction help survivors to improve, having more social interaction is part of the improvement. It is our natural state to be part of a herd – it only follows that damage drives us towards isolation. Like any other damaged area of the brain relearning the ins and outs of social interaction, takes practice and time to heal. And just like any other part of rehabilitation we must start off slowly and ease back into things.

Because isolation and loneliness is such a huge problem for so many survivors I feel that it is an important issue to address. In this next series of entries I will offer suggestions for building social skills, outline a plan for building up a strong social network, and finally offer ideas on places to go to meet new friends and reconnect with the community.

Can't See the Forest for the Trees

2009-07-22T08:52:00.000-07:00

I cried on the flight down to South America.

Sliding into my seat I glanced out the window at the dark airport hanger. I had every reason in the world to be happy, excited, and expectant but as I took my seat I felt none of the standard rush freedom of embarking on an adventure. Instead, the weight of the world settled on my shoulders.

Dark thoughts wormed their tenacious little fingers into my brain. Sure I was going to get out of the country, learn about different cultures, have adventures, new experiences, and so on and so forth. Yeah, I’d extended my trip to 6 months to learn Spanish, and all that. But it was more than that…

No one was going to miss me. My friends didn’t help me move, my boyfriend didn’t even help me move. This had been the last day I was going to be in the city for 6 months and nobody even wanted to hang out with me. There probably wasn’t one single person who even cared I was going. I mean sure I had lots of acquaintances did I really have I have one real friend? They

probably wouldn’t even notice I was gone. I thought, bitterly as tears slid soundlessly down my

face.

The lack of support was my own fault. It had to be. Maybe I was just unreasonable wanting people to be there for me or care about me. Why would anyone want to be there for me anyway? I was a horrible person who couldn’t even control her emotions – I yelled at movers, threw tantrums when she didn’t get her way, and hurt people without meaning to. A seven-year-old knows better than that. No wonder no one wants to deal with me.

I could go to South America but I wouldn’t make real friends there either, I was doomed to be forever completely and utterly alone. Staring intently out the window I turned my head even further from my neighbor – hoping desperately she didn’t notice my glistening cheeks, didn’t see my face crumple at this new horror. I couldn’t distract myself with the in-flight movie, I couldn’t read a book; I was too far-gone to pull myself out of this tailspin – all I could do was to focus on the misery. No matter how long the day had been I wouldn’t be able to escape into sleep, I thought glumly.

At least I could be warm trying. Tearing the plastic wrap off of the little airline blanket I pulled my knees into my chest. I shifted this way and that attempting to situate myself in a way so that all of me fit under the miniature courtesy blanket. Well, this is about as good as it’s going to get I sighed after a few minutes and shoved the handkerchief-sized pillow between my head and the side of the plane. Within moments I was fast asleep.

When I blinked blearily awake sunlight was shining through the plane’s thick double-paned window. It was morning – the night’s dark thoughts weren’t even a distant memory – I had slept through almost the entire flight. I looked around the cabin, yawning my way back to the real world. I hadn’t realized how tired I’d been, I could still use a few hours more sleep but you never got good sleep on planes, did you. As I looked out the window that familiar thrill of excitement filled me. We were over another continent. I was exploring new lands – going on an adventure!

Fatigue is the most common complaint of survivors. For people who haven’t experienced it, fatigue can sound innocent enough; after all, it just means you wear out more easily. So you get tired, so what?

Unfortunately it is much more dangerous than that. Fatigue has many faces. It can open the way for any number of deficits; throws your judgment off, plays on insecurities, everything becomes more difficult, thoughts confused, learning impossible, the list goes on. One of the most insidious tricks fatigue will play is how quickly it comes – often a survivor won’t even realize they have pushed themselves to far until it is too late.

The morning’s brain injury episode had sucked every drop of energy out of me without my even realizing it. Because I had had so much to get done that day I shoved the incident and its emotional drain to the back of my mind. Putting on the afterburners I soldiered on through, tying up all of the last-minute loose ends.

Emotional meltdowns are the most draining thing in the world – worse than running a marathon, worse than studying neuroscience, worse than babysitting a room full of toddlers with ADD. It is as if someone opened the floodgate and let your entire reservoir of energy spill out with the emotions. Any outpouring of heightened emotions can be draining but the stressful conflict-driven brain injury episodes are the worst.

Somehow this time, fatigue had erased all positive or even rational memories. It had siphoned all happiness out of my life and thrown me into some nightmarish alternate reality. Of course I had wonderful friends who I was going to miss terribly! I’d spent half the day on the phone. If I hadn’t been running around like mad trying to get everything done I might have been able to meet up with more them than just S. But because relationships romantic and otherwise can be difficult for survivors, and because I have had problems with this in the past this is a fear of mine. Fatigue had played on this insecurity, made me forget all of the good, and managed to hide the fact that it was the culprit.

As soon as I recharged my battery with a little sleep the fatigue, irrationality, depression, and all the rest vanished into thin air. But the terrible part is that when you are in the thick of things it is all but impossible to see a way out of them. Your fears loom, obscuring the reason behind the problems, good thoughts, or any glimpse at perspective. You really can’t see the forest for the trees.

As always, prevention is the best solution. Keeping a regular schedule, getting enough sleep, keeping away from stressful situations are still the best ideas. There will of course always be moments where things don’t go according to plan. Thankfully the magic bullet for brain injury is never far or too hard to come by – Sleep. Sometimes it can just be hard to judge when you really need it.

Knowledge is power – the more you and your friends and loved ones know about how to manage your brain injury the better off you all will be. Talk to your family and friends about fatigue. Ask them if they would help out by suggesting naps or taking a little rest resting when you get irrational, or seem to be acting out of character. It isn't asking much but at moments like this getting an outside perspective in these moments can be exactly what you need. Losing one's way in the dark forest of brain injury is a nightmare, but with a little guidance it is easy to escape - all you need is someone to guide you towards the path out - sleep.

Photography by Dennis Lo

Moving Meltdown

2009-07-20T16:38:00.000-07:00

“Where’s your bathroom?”

Without waiting for an answer, the coarse Dominican mover pushed past me, clomping into the apartment.

“You’ll have to wait. Your partner’s still in there,” I said sourly, crossing my arms. Fifty minutes late, and the first thing they do is use my bathroom? They’d better not count this as moving time – if they went over an hour I’d have to pay the $350 extortion fee they charged!

My grumpiness wasn’t entirely their fault. I was on edge; it was my last day in the city. And I wasn’t just wrapping up loose ends – I still hadn’t tied half of the things that needed to be done. The list went on and on. I didn’t have one spare second before my flight that evening.

Poor planning – it creeps up on you. Suddenly, at the last minute there are a hundred things to do you haven’t even thought of. But if everything went smoothly, I’d have enough time. If…

Waiting for the movers to get to the apartment my mind churned. Blame it on inflexibility but it really irks me when people are late – it’s disrespectful, unprofessional, and downright rude. It’s kind of like saying: my time is more valuable than yours – you should run on my schedule because I have more important things going on. With a concerted effort I pulled myself up short. Be reasonable, I sternly told myself; it wasn’t the movers’ fault I planned such a tight schedule.

When the disheveled, tobacco-stained workmen arrived late I managed to bite my tongue.

When they walked in and took back-to-back bathroom breaks, I gritted my teeth – yelling at them wouldn’t speed anything up. Then they started moving my things.

“Be careful with that!” I said again and again; as I watched the movers carelessly toss my possessions into huge wheeled-containers to move into the elevator. Each time the main mover told me not to worry in his thick Dominican accent. Clearly not listening, he seemed to get increasingly careless by the minute. Cringing, I watched helplessly as his gloved hands crumpled my parchment Danish floor lamp.

As the elevator doors shut, I gave the apartment one last once-over for things to put in storage, grabbed my curtains, and raced down the stairs. We needed to get over to the storage facility as quickly as possible – I didn’t want to pay them for another hour!

I ran up to their truck. They were still packing everything into the back but the cramped cab looked as if it would barely hold the three burly men. Where was I going to sit? “When are we leaving? Where should I sit?” I asked, still worried about the time.

The shorter balding man I took to be the leader gave me an annoyed glance and replied in a surly voice. “We’re not taking you there.”

This caught me completely off guard. The storage facility had assured me the movers would take me; the moving company had backed them up. I had counted on the ride – I hadn’t even written the storage place’s address down, let alone directions there. “But … but how am I going to there? They told me you were giving me a ride…” I

“Who told you that?” the man sneered condescendingly.

“The guy from your company promised you would. How am I supposed to get there when you do? I don’t even have the address!”

“You can take a taxi or the subway to XXXX. Do whatever you want but we can’t take you,” he shrugged me off, turning back to the truck.

With that my helplessness vanished. Anger replaced it – they were taking advantage of me. “Your company promised you’d give me a ride. You’re late, rude, and now you won’t even keep your word?”

“Hey lady, I don’t know what your problem is but we aren’t a taxi service,” with that he pointedly turned back to the boxes.

Something inside me flipped. Shaking, I exploded into an unthinking ball of fury. “I can’t believe you are acting like this! F you! F you guys. You are a bunch of F-ing A-holes!!!”

“Nobody has ever talked to me like that before you little B….”

I searched for the worst thing I could possibly say. “I … I … I hope your mother dies!” With that I turned my heel and stalked toward the subway.

I had walked the route hundreds of times but with the thick smog of anger clouding my brain I took a wrong turn. Blocks out of my way enough of the rage had dissipated for me to realize my mistake. Figuring out where I was and how to get to the subway required me to use my mind and as my brain started working the towering inferno of anger was gone leaving behind a few smoldering embers. Standing waiting for the train I realized the sheer stupidity of my outburst.

The movers had all of my things in their truck. If they wanted to, they could damage or destroy any or all of my things, they could take as long as they wanted, or worse yet just never deliver my things…. I was at their whim. I had to call the storage company and tell them my side of the story.

There wasn’t much reception underground, but I figured the sooner I called the better. Halfway through telling the man on the other end the story reception cut out. Moments later my train arrived – I’d call back when I got to the moving place.

When the train pulled into the station, I had a message. It was the moving company. The manager was convinced I had hung up on him and was furious with me. When I called back he didn’t calm down. He didn’t want anything to do with me.

It took a lot of work but the manager had convinced the movers to take my things to the storage facility and drop them off at the dock. I would have to figure out how to get them up to my storage locker on the fifth floor myself.

When I tried to tell my side of the story and plead my case, the man told me I was lucky he managed to get them to take my things there and slammed the phone down.

Fighting tears back I reached the storage facility. The man at the front desk took one look at my red eyes and trembling lip, and in the most compassionate voice possible asked me what was wrong.

In the face of opposition it is easy to keep up a brave front. If there is something to struggle against or focus on then holding off the tears comes almost second nature. But warmth, caring, and understanding open the floodgates. In a mater of moments tears were streaming down my cheeks and I was trying to choke out my side of the story.

I had overreacted but they had been late and rude and unprofessional. I was upset. Now the company was leaving my things on the loading dock!

Everything would be okay the man assured me. He would take care of everything. Movers could be rude – it was unprofessional to be late. It was even worse to go back on your word. He would make sure the movers finished the job. That is what they were being paid for – it would look bad for the company if they didn’t. With that he phoned the moving company.

The movers arrived; finished the job, and I apologized for my behavior. I am extremely thankful that that wonderful man was there to smooth everything over, but I’m not sure what would have happened if he hadn’t been.

* * *

Irrational, uncontrollable fits of rage – head injury “episodes” as I refer to them – are one of the most terrifying aspects of brain injury. It feels as though you are swept away in the grip of your emotions. While they hold you in their grip you are powerless to act of your own volition. You watch yourself say terrible things that you would never think to utter of your own accord.

Heightened emotions, emotional liability with turn on a dime mood swings, inappropriate language, and problems with anger are common aspects of brain injury. Closer to the injury the survivor may not even be aware he is demonstrating this behavior, but it is important to be aware that these are merely aspects of the injury, and not the survivor. The best thing to do is to redirect the survivor’s attention, remain supportive, and above all not to take anything the survivor says in their outburst to heart.

Thankfully for me these episodes happen with less and less frequency. I have not experienced an episode of that magnitude for years but they are never good. The usual suspects – heightened stress and lack of sleep are contributing factors but the outbursts are unfortunately quite unpredictable.

By all means try and keep on a regular schedule, get enough sleep, do what you can to lead a stress-free life, and stay away from overwhelming situations. However, I know all too well that this is not always possible. In retrospect, the majority of my episodes happen when I feel overloaded, as if I have to do everything alone – fight for myself. Having a strong support system is essential. Be it friends, family, brain injury support groups, or other organizations, having people in your life who understand, can help redirect and diffuse situations like this in your life may help prevent a potential next one…

The Call of the Open Road

2009-07-13T19:02:00.001-07:00

Maybe I should just move to Buenos Aires and stay down there for 6 months – that way I can just use their movers,” I said disgustedly. All morning I had been trying to find movers – it seemed like none of the companies could come on such short notice. I was so sick of trying to get everything organized. As the words left my lips they hung in the air, taking on a life of their own.

A looked at me, her eyes wide, “that would be amazing! You should do it.”

“Well,” I thought about it for a moment running through the concrete reasons against going. “I have a boyfriend, I mean 6 weeks is one thing but going for 6 months? No, I really should get back…” I finished weakly.

“You’re making plans around your boyfriend. The same boyfriend who can’t even be bothered to help you move? Who hasn’t even asked to stay with him while you are moving? Really?” With a laugh, she shook her head in disgust.

“Well, I guess you’re right. But I really do want to make this relationship work…”

“And you think he’s making an effort? You think he’d do the same for you? Just go, you don’t have a job right now, you don’t have kids or a family – go while you can. How many more chances will you get to do something like this?”

Her enthusiasm was infectious. I felt the seductive tug of adventure pulling at my heart, filling my ears with the call of the open road. Trying my best to ignore it I clung tenaciously to hold onto some shred of reason.

“Whether he would or not, I gave my word I would talk to him about things like this and before I make any decisions I need to talk to a few other people too. I did just write about how brain injury survivors and my advice was to run ideas past friends. It’s probably a good idea to take my own advice.”

The first person I called was my close friend S. Being one of the most adventurous, knowledgeable, worldly people in my acquaintance she really knows the ins and outs of travel. In addition to her fun spontaneous side she is extremely pragmatic, has the answer to everything, and gives excellent advice. I was pretty sure that she would think it was a good ideas and she’d certainly have helpful suggestions. If, on the other hand, she thought it was a bad idea or too dangerous then I would scrap the idea and just stick to my original trip. As much as I love adventures safety is a priority.

I told her I was thinking of extending my trip to 6 months and moving to Buenos Aires. “Do you think that this would be a good idea?”

“Why Buenos Aires?” she asked.

“Well, I have heard that it has a rich literary tradition and is a great place to write. It is also has a very European feel to it so it would be quite such a culture shock. It is also supposed to be one of the most beautiful cities in South America. I can write from anywhere. I could learn Spanish; learn about another culture, the cost of living was lo

wer…. What do you think? Do you think that is too dangerous?”

“I look at life as a series of experiences. If you were talking about somewhere in Columbia I would discourage you but from what I understand Buenos Aires is supposed to be reasonably safe. I think it sounds like a wonderful opportunity….”

I let out a private sigh of relief. One down, two to go….

As soon as we hung up I called my father. I love and respect him more than anyone in the world. Though he lives in Kansas and I don’t get to see him on a regular basis, South America is a good deal further than New York. I was all but sure he would support me but having his blessing is important to me. If he didn’t want me to go then I would put any idea of moving to South America out of my mind without question.

My instincts were not off. The instant I told him he enthusiastically gave his wholehearted support. He thought it was a wonderful idea and sounded pleased that I was going to study a new language. I hung up the phone energized and expectant. Things were moving forward so quickly it was almost as if moving to Buenos Aires had been the plan all along.

There was only one left – J. My roommate rolled her eyes, but I had promised. He was the dark horse – I really wasn’t sure what he would say. If he didn’t want me to go, then I would

respect his wishes – I had given my word. Heart in my throat I made the call.

No answer. Fantastic, more time to think, and think I did.

J and I weren’t particularly close. Though everything was wonderful when we were together that happened barely twice a month. Maybe this could be another reason to go. Missing each other could bring us closer and actually strengthen the relationship. As the saying goes – absence makes the heart grow fonder.

When J called back a few hours later I gently asked him what he would think of me extending my trip.

“Thank you for asking me,” he sounded pleased and surprised I had thought of him.

“Of course – you are my boyfriend,” I said, confused. “I promised I’d talk to you about things like this.”

“Well, if it were further in the relationship I would not like it, but it’s fine right now. You should go.”

The longer we talked the more I felt that this trip really would be good for the relationship. We would write talk all the time on skype video chat, he would come visit me - it would be great.

And with that the decision was made – I was going to South America for 6 months….

Tomorrow and tomorrow and tomorrow

2009-07-08T14:34:00.000-07:00

I hung up the phone with the storage company. $106 dollars a month for 6 months or more, the advertised “free move” was only good if you rented the space for more than 6 months. Less time than that, their movers charged $350 an hour.

$350 an hour!? Seriously? Putting stuff in a storage facility was supposed to be cheap. Their quote caught me completely off guard. I had been counting on that free move. It was supposed to be this easy no-hassle thing – they would move my stuff for free and move it for free no questions asked. Moments before I had been fine – excited about the trip, and getting everything done. One phone call and it felt as if my world was collapsing.

I stared despairingly out over the sea of half-packed boxes, overwhelmed by the weight of it all. 3 days ’til my flight left for Peru and I still had to get a P.O. box, forward all my mail there, cancel my phone, tell my credit card I was moving, the list went on and on. I could have handled it, I could have gotten everything done, but now…. Now the move was difficult – and expensive. I had to find movers on top of it all – the straw that broke the camel’s back.

I collected myself enough to text some friends and phone a few others to ask if they knew cheap movers, or if they could help with the move, but with this last-minute plea I already knew the answer. Everyone was busy, out of town, or just didn’t get back to me. A cold wave of isolation overpowered me. I was utterly, completely and totally on my own – nobody was there for me, I had to do everything all by myself. It didn’t help anything that both of my roommates were moving in with their boyfriends. Boyfriends who had been helping them pack and move the entire time. It hadn’t mattered until now

My melancholy was interrupted by a sharp knock on my door. “All packed and ready for your trip?” my roommate, A, called brightly, poking her head in the door.

“Almost, I’m trying to find movers now. What company are you using?” I told her about the morning’s surprise, the procrastination, and the rest.

“$350 an hour? That’s extortion! Doesn’t your boyfriend have a car? Where is he? Why isn’t he helping you move?

“Well, he’s been pretty busy with work and out of town a lot. He really can’t come today because he’s having a party tonight. He does have a car but even if he had the time it’s a convertible –not really the kind of car you can move things in…” I trailed off; the excuses that sounded fine coming from him rang false when I said them.

A raised a skeptical eyebrow. “But he’s not even around for moral support? That’s kind of fishy.”

“No, nothing like that. Things are great when we’re together. He just hasn’t been in many relationships. He’s really a great guy. It just kind of sucks... I put everything off ’til the last minute and now everybody’s busy. I don’t know if I can get everything done on my own....

I felt like I had a boyfriend so he should be there to help me, I know he hasn’t been in many relationships but it just sucks not feeling like I have any support. Then when I start thinking like this I feel guilty because I know it’s not his fault. If I weren’t in a relationship then I could totally do all of this by myself, but since I am it’s almost harder when I don’t have the support. What is wrong with me?” With that the tears started streaming down my cheeks.

“Oh D," she said sympathetically, "I’ll be your boyfriend tomorrow – I’ll help you move. You definitely aren’t asking too much. If my boyfriend had been like this I would have broken up with him a long time ago. He should be here and be helping you. He should have been here for you this whole time. Everything will be okay; you are going to South America in a few days. We can talk to the movers I’m using and I can help you move tomorrow.” She reassured and built me up until hiccups replaced the tears. Giving me exactly what I needed – her unwavering support.

Support is vital for everyone, but you should always rely on others to help you. Boyfriends, friends, and family have full schedules and lives of their own. It is important to be self-reliant and have a strong foundation. That way you will be able to stay steady no matter what.

Organization, attention to detail, and grasping the consequences of actions (or inactions) can be terribly difficult for me and for many brain injury survivors. Somehow I was completely oblivious to some glaringly obvious tasks I needed to get done. Until the last week before I left I had put a few things off, but I was sure that I had taken care of almost everything. When I finally realized how much was left to do I scrambled to get everything done. When one thing did not turn out how I had imagined and counted on it to be, I was overwhelmed and swept away by a tide of emotional liability. Thankfully A was there to support, distract, motivate, and help me come up with a plan of action.

Balance is the hardest thing in the world, but it is imperative for survivors. Planning, organizing, and taking care of everything in advance is the best solution, however sadly even when I do plan it seems that a ridiculous number of details tend to slip by. Asking a friend to bounce ideas off of and help with your planning is a huge help. This isn’t always possible though, and if you do get overwhelmed the best thing to do is to move forward in a calm rational manner. That way you can take care of things in a proactive, organized way and not get sidelined by stress.

Dance Your Troubles Away

2009-06-30T15:40:00.000-07:00

Cities are like people. Each one has its own personality: a mixture of industry, cultural heritage, and passion. Many great cities are motivated by one unifying factor that can be found in almost every part of the city’s identity. New Orleans for its spicy creole-influenced jazz; graceful Paris with its fashion and ballet, Barcelona for its art and architecture, just to name a few.

Dance is the life-blood of Buenos Aires, more specifically tango. From the Parisian elegance of Recoleta to the colorful streets of La Boca, tango permeates the city. Like the fading memory of a doomed love affair, ivy vines of melody wind their way through the streets. At once wistful and stirring, sensual and melancholy the haunting notes waft from the subways, drift out of the milongas, * and fill the markets, enchanting passersby drawing them into another world.

When I first arrived in Buenos Aires, though curious, I could not understand the fascination. Every traveler who came to Buenos Aires seemed to eat sleep and breathe tango. Though many “porteños” take it for granted, or claim it to be old-fashioned or touristic, this tango culture has its mark on even the most skeptical of the Buenos Aires locals. Through playing, teaching, dancing, or just listening; almost everyone I met seemed somehow involved in the tango culture.

With all the talk of dance, a faint recollection stirred in the dimly lit recesses of my mind. Just before I had left New York I had been talking to K, a woman whom I had recently met and had been telling her about Roseland and the seniors dance night. It came out that she was taking dance classes from a man who was also a dance movement therapist.

I had heard of movement therapy and things like the Feldenkrais Method, but dance as therapy? Unfortunately I was running late and didn’t have a chance to talk about it for long, but I made a mental note to research it. A note that I did not write down….

Now, months later the half-remembered conversation prompted me to google it. At once a long list of links to sites, articles, book, and organizations appeared on my screen. The further I read the more fascinating my discovery became....

Dance/Movement Therapy (DMT) has in fact been a profession since the 1940s. It is defined by the American Dance Therapy Association (ADTA) as, “the psychotherapeutic use of movement as a process which furthers the emotional, social, cognitive, and physical integration of the individual.” The ADTA also reports that there are practicing dance movement therapists in 43 states, 21 countries and 5 continents. I was appalled that I not heard of such a prolific form of therapy. How could this have happened, I wondered?

The answer hit me like a ton of bricks. I had not heard of it because I wasn’t open to it. Directly after the accident, and for many years, I was more than happy to work at compensating for my deficits, but trying to fix them directly would have been too scary. It would have been admitting what was wrong and coming face to face with what you have lost is a terrifying prospect. Dance therapy came a little too close to that.

Not only had the accident had impaired my gross motor skills, but it had devastated my visual/spatial skills, and awareness of how my body was positioned. In other words, I would not be able to see a step and repeat it – my mind/body connection was so poor someone would need to physically show me how the step would feel for it to begin to register. I couldn’t follow a class, let alone memorize choreography – dancing seemed like an insurmountable challenge.

Gross motor skill and body awareness impairments are quite common for brain injury survivors; because of this and my personal experience I had not given a moment’s thought that dance could be used as therapy. But the more I thought about it, dance therapy made perfect sense.

Dance movement therapy (DMT) is based on the principle that the mind and body are interconnected – by changing one and you will affect the other. By changing the way you move you change the way you think, feel, and behave – movement affects and reflects personality. This holistic philosophy explains w

hy brain injury can deeply affect body awareness and the way a survivor moves.

More scientifically, learning to move in new ways causes a person to use different parts of the brain. Working these areas creates new pathways which builds and strengthening the brain as a whole. This in turn helps to compensate for damage and furthers improvement in all areas. Paying attention to the way you move, breathe, and reconnecting the mind and body is paramount to improvement.

Though it has been over a decade since the accident I am taking my own advice and stepping up to the challenge. With an audible gulp I am swallowing my pride and starting to learn tango – in group classes.

Photos by Lucy Usher

*places to dance tango

http://www.adta.org/

http://www.nccata.org/dance_therapy.htm

http://en.wikipedia.org/wiki/Dance_therapy

We're All In This Together (Insurance part III)

2009-06-26T14:10:00.000-07:00

Brain injury doesn’t discriminate. It is an issue that cuts across social barriers: all political, religious, and socio-economic divisions. I want to reach everyone I can, regardless of these divisions. This is why I make a concerted effort to keep issues such as politics or religion out of my writing. Not everyone will have the same opinions on a lot of issues, but liberal or conservative, republican or democrat, this is an issue that can affect any one of us.

Last week I posted a blog entry on insurance companies and how they care for brain injury survivors and how they handle rehabilitation. I wrote and rewrote the piece, struggling not to vilify the companies. This paranoia that they were "out to get me" was a figment of my imagination – it had to be. After all, our fight with them was a nightmare and I was clearly still upset. I wanted give as rational and objective a view as I could and not let anger or irrational fear cloud my judgment.

Days later the senate published a report affirming both my fears and anger.

“Health insurers have forced consumers to pay billions of dollars in medical bills that the insurers themselves should have paid, according to a report by the staff of the Senate Commerce Committee.” These companies will use any means necessary to avoid responsibility. Insurance companies aren’t simply like an organized crime ring offering money for protection – they are worse. Clients and families coping with brain injury make an easy mark, but insurers do this for any potentially costly claim. We are all in this together.

I do not want to get up on a soapbox or turn this into a political blog, but it seems to me that these committee findings indicate a much larger problem. The insurance companies treatment of initial therapy is terrible, but long-term care for survivors is as bad or worse.

I don’t have insurance. I haven’t since I graduated university. Along with 50-80% of all brain injury survivors, I am unemployed. I have not have a 9-5 job with insurance benefits in my life and it drives my mother to distraction.

With the overwhelming number of survivors who require long-term care or meds to function in society these figures are quite disturbing. Even if survivors are employed or have money to get insurance brain injury gives the companies a cornucopia of reasons to deny coverage.

The Declaration of Independence states that all men are born with the right to life, liberty, and the pursuit of happiness. Governments are there to secure these rights and protect its citizens. I believe that a right to basic health care falls into that category. Furthermore I firmly believe that the government has a duty to protect its citizens against opportunistic insurance companies.

Regardless of whether you are for or against universal health care, something needs to change. Survivors unable to get or hold jobs still need therapy, medication, and assistance. If they can get the right care then they will have greater improvements and can help society and help others. After all, we are all in this together.

As I mentioned, I am working to organize an NGO to help survivors toward fuller recoveries but I cannot do it alone. If you have ideas, suggestions, or would like to help be a part of this please contact me.

http://commerce.senate.gov/public/_files/62409UnderpaymentstoConsumersbytheHealthInsuranceIndustryReport.pdf

http://www.washingtonpost.com/wp-dyn/content/article/2009/06/24/AR2009062401636.html?hpid=sec-politics

No Excuses

2009-06-24T15:34:00.000-07:00

I love getting comments on my blogs. It is fantastic to hear your experiences, and get your feedback. Occasionally though, I feel that it is important to discuss a comment.

In my recent blog post, “building blocks,” I wrote about offhandedly telling my boyfriend J I was going to South America for 6 weeks. It hurt him terribly that I had not included him in my life and I felt dreadful that I had been so insensitive and thoughtless. I felt dreadful about hurting J’s feelings and used this as an example of how survivors can “miss” social cues or ignore rules of social etiquette obvious to others. I finished the entry discussing ways to learn from these oversights and improve.

I received this comment:

“Wow, nice cop out! I think I'm going to use it next time I have a misunderstanding with my boyfriend. Thanks!”

I feel awful that this entry was taken like this but I am happy to receive this comment. It gives me the chance to address exactly this issue.

Please don't misunderstand me to be using brain injury as a cop out or advising my readers to do so. It is extremely important never to use brain injury as a crutch or an excuse. Not only does that take away your credibility but this can hurt other survivors as well.

I do try to keep my blog on one topic and most entries discuss events in my life in terms of brain injury. I do this in an attempt to use these events to illustrate aspects of brain injury as well as to offer perspective and give advice.

Though these events are examined in terms of brain injury in my blog, I generally keep these insights to myself unless I feel the discussion would be appropriate or useful. It is good to be open about the struggles you face, but choose wisely. Even if your actions are related to the brain injury it is still important to take responsibility for them. (There are clearly exceptions to this rule dependent on the cognitive state of the survivor.)

If you believe that talking the event over will be useful to your friend, strengthen a relationship, further your improvement, or help you to move forward then don’t hesitate to talk about it. If however, it is simply to alleviate guilt, or worse still, an excuse, then it might be best to keep it to yourself. Blaming everything on the brain injury dilutes the impact of what you experience, and being accused of the girl who cried brain injury is awful. Conversely, not sharing your day-to-day struggles can have the same effect. There has to be a happy medium.

Do not use your mistakes as excuses, use them as tools – learn from them. After all, learning and improving are what life is all about!

A Stacked Deck (insurance II)

2009-06-22T11:23:00.001-07:00

There is no way to plan for it – brain injury comes out of nowhere. Without a moment’s notice brain injury changes everything. The physical, emotional, and psychological damage is irreparable. But what of the monetary strain? The US doesn’t provide universal health care coverage. What can families do at times like this?

The health insurance companies convince us to take out comprehensive coverage for exactly this reason. Saying that in case we get sick or something goes wrong then we won’t have to worry about anything but getting better. They assure us tell us they are good neighbors, who keep promises, and enrich our lives, we will be in good hands if we with them.... And like sheep to the slaughter we sign and pay. What choice do we have?

In the USA insurance is extremely useful, almost necessary. For uninsured Americans, the cost standard doctors visits, prescriptions, or vaccinations is practically unaffordable Citizens pay high premiums to help with doctors’ bills, medications, and to ensure we have the health care we need if there is an emergency.

To be fair, companies do hold up their end of the bargain on every day issues, Johnnie’s asthma inhaler or Jane’s checkups. Unfortunately companies are not the great protectors they claim, and paying a monthly fee does not insure the promised protection.

Insurance is a numbers game with the cards stacked against the client. Companies refuse to cover preexisting conditions, won’t insure individuals deemed risky, will raise premiums if there is a large claim, and deny any coverage they can. When the chips are down insurance companies do everything the can to get out of their obligations. When a client does suffer a costly injury, the insurance company will do everything in its power to deny benefits, and brain injuries plays right into their hands.

Because brain injury is “invisible,” and not as clear-cut as a broken leg, insurance companies have notoriously poor coverage for head injuries. Companies will often refuse to pay for cognitive therapy entirely claiming that it isn’t medically necessary. If a survivor looks fine then they must be fine.

At the client’s most vulnerable moment when the patient does not have the cognitive capacity to argue and her advocates frequently don’t have the energy. Instead of protecting and providing the promised insurance they do everything in their power to get out of covering costs stall, fight, or simply deny cognitive rehabilitation benefits. With all of the paperwork, hoops to jump through, and rejections, fighting with the insurance company can be almost as draining as the injury or the illness itself.

Moreover, the stress and pressure of lawsuits, arguments, and these problems is extremely harmful to the survivor’s recovery. Some of my worst brain injury-related “attacks” ranging from moments of terrible vertigo, nausea, excruciating headaches, meltdowns, and more have been brought on due to stress from battles with the insurance company. So you’re damned if you do and you’re damned if you don’t.

After my accident, though my family was covered by what was supposedly an excellent policy, the insurance company flatly refused to cover my cognitive therapy. Fortunately my parents were aware of how important it is for survivors to start therapy as soon after the accident as possible. Rather than wasting time with a long, drawn-out bureaucratic battle, my parents took matters into their own hands. Without hesitation they made the necessary sacrifices and paid out-of-pocket for as much rehabilitation as they were able. Unfortunately many families do not have the resources for this, realize how vital the days directly following the injury are to a good recovery, or have a strong support system. And that is just through the acute rehabilitation (immediately after the injury). Things don’t get better over the long-term.

It is always best to take care of problems as soon as they arise – a stitch in time saves nine. In this instance it is no different. Because of inadequate care many survivors are not able to progress as far as they could. This inevitably raises the cost of long-term care both for the family, insurance, and society. This cannot continue; something must be done … but what?

There is no easy solution to the problem. Ideally the USA would have a universal health-care system – a safety net of accessible health care available to all citizens. Though the current administration is making steps in that direction I cannot see it happening in the near future.

Happily we are making small steps forward; in 2001 the US government passed legislation mandating that insurance companies cover some rehabilitation for ABI (acquired brain injury) survivors. However the insurance companies try every loophole they can to get out of covering these costs, excluding rehabilitation as a mental health problem for example. In other words insurance companies’ care of ABI survivors is still sorely lacking.

Though all ABI issues are close to my heart this one hits particularly close to home. I am intimately acquainted with how nightmarishly ugly battles with insurance companies can get. Because of this, I realize that I am not able to look at this issue objectively, but I also am more driven to help fellow survivors in similar situations. I am currently looking for others passionate about raising awareness and helping survivors who cannot afford needed therapy. My goal is to found an NGO and raise money to help survivors get the therapy they need, find appropriate alternative therapies, and raise awareness of this issue. I ask that you please contact me if you are interested in working on a project like this….

ASHA Poll: Inadequate Insurance Coverage Hinders Public’s Recovery From Traumatic Brain Injury http://www.asha.org/about/news/tbievent/tbipressrelease.htm

Study of Health Benefit Plan Coverage for Brain Injuries Summary http://www.sunset.state.tx.us/80threports/hcbi/summary.pdf

Health Insurers Deny Coverage for Cognitive Rehabilitation http://www.neurotodayonline.com/pt/re/neurotoday/fulltext.00132985-200703060-00014.htm;jsessionid=K6wdlFQ3vjSywctQpkdGDPyLpFQCShbw2rwLqHb1HD1KRV9pplQw!-514211921!181195628!8091!-1

The Healthcare Racket (insurance part 1)

2009-06-17T12:33:00.001-07:00

“Do you have all the vaccinations you need for your trip?” S asked a few weeks before I left.

I gave her a blank stare. Vaccinations? I hadn’t even thought about needing to get shots. “How important do you think it is for me to get them? How many do you think I’d need?”

“I’m really not sure what shots you will need. It depends on where you go, if you go to the jungle you will definitely need a yellow fever shot. You should really check into it. Some countries may not allow you in without the proper vaccinations.”

I sighed, that was enough to make me go to the doctor. I’m not terribly fond of doctors’ offices, but surely there were clinics I could go in get everything taken care of. I did some research and made a few calls trying to find out what shots I needed and where to get them.

It turns out you need a license to give yellow fever immunizations and there were only a few licensed places in Manhattan. I dialed the number to a place on the Upper East Side, International Health Care Service: Immunizations.

“What immunizations do you recommend for a trip to South America?” I asked the woman on the other end of the phone. She rattled off a long list and thankfully yellow fever was the only shot I did not already have. “How much would it be to get just a yellow fever shot?” I asked tentatively.

“One hundred and seventy dollars,” came her neutral reply.

I nearly choked. Thirty, forty, even fifty dollars wouldn’t have been out of the question, but one hundred seventy? That was half the plane ticket! I thanked her and quickly hung up the phone. No way was I going to pay that much, even if I could afford it I wouldn’t pay them. If I died of yellow fever it would just be my protest against the US healthcare system’s extortion, I fumed.

I thought about the immunization on the flight to Lima. How could they charge that? Surely the drugs couldn’t cost that much. I would feel better if I had gotten that immunization though….

When I got to Lima I asked C how much one was.

“Well,” he told me, “that depends where you go. You can get one at a nice clinic for about $20, but that’s kind of expensive, or you can get…”

“Twenty dollars,” I cut him off. “Can we go? Now?” A few hours later I had my yellow fever shot.

In Peru the "expensive" yellow fever shot is $20; in Argentina immunizations are free. The United States is wonderful in many ways: there is freedom of speech, religion; education is mandatory for all children, wonderful national parks, and countless other positives. The US is also the only industrialized nation without universal health care. Though there is excellent health care for those who can afford it, forty-six million Americans aren’t insured and can’t. I am one of those 46 million....

Building Blocks

2009-06-09T14:13:00.000-07:00

"You're going to South America for six weeks?" J couldn't have looked more shocked and hurt if he'd seen me kick a puppy.

"Well yeah. I told you I was thinking of going to Peru in April, right?" I spoke slowly, trying to make sense of his reaction. What had I done wrong? I had told him I was probably taking a trip to South America.

"You did mention something about South America, but I thought you meant for a week or two. Six weeks is along time. "

“Sorry,” I said offhandedly shrugging my shoulders. He’d done told me he was going to Utah for a week a few days before he left and same when he went to Georgia. I was telling him nearly a month before the trip. What did he want?

J's pained expression didn't ease. After several moments of confusion, my brain unsuccessfully trying to understand, realization started to dawn. I actually hurt him.

“I just wish you could have talked about this with me,” he said plaintively.

With horror comprehension washed over me: communication is what relationships are all about…. I should have known. What kind of idiot doesn’t realize something so obvious!?

The more I thought the worse the thoughtlessness of my actions seemed. I had hurt someone I cared for. I fell over myself apologizing. “I’m so sorry. I didn’t do it on purpose, I didn’t even think. Can I make it up to you?”

J’s hurt expression melted away. “It’s okay. You didn’t do it on purpose. Just next time it would be nice to talk about things like this before buying the ticket.”

“I will, I’m so sorry, I only bought the ticket yesterday. I kind of decided how long I was going to be gone for while I was on the phone. It was just a cheaper that way. Next time I’ll talk to you about things when I’m thinking about them though. I promise. I am so sorry I didn’t talk to you about it this time. I won’t do it again. I am so sorry!”

“It’s okay. I know you’re sorry. You don’t have to keep apologizing. We’ll talk about things like this in the future.”

I still felt miserable, but having a plan of action and a boyfriend who could help me move forward and not dwell on social faux pas helped immensely.

Brain injury, the building blocks of social interaction - all etiquette, polish, and manners vanish. Perhaps the hardest part of being a survivor is rebuilding these lost social skills. Not only is it humiliating not being able to see things obvious to others but worse still these faux pas can hurt others terribly.

In the worst case these social missteps can dissolve friendships, partnerships, or business deals. In the best cases they can make for funny stories. The sad truth is most of these incidents rest in a painful middle ground. Realizing you missed something you should by all rights have picked up on, or worse is a painful reminder of how brain injury can affect every aspect of life.

Survivors will almost certainly have more moments of seeming insensitivity than others. More often than not they do not understand that they are being insensitive. As difficult as it may be, it is important for friends and family not to blame them for these gaffs. Survivors beat themselves up quite enough as is.

The best way to approach these situations is to express your feelings and clarify how the survivor’s actions affected you or why their action was inappropriate. Immediately, while the incident is fresh in the survivor’s mind, outline a different approach to a similar situation and a way to move forward. Not only will this keep the survivor from dwelling on an unfortunate incident, but it will also help them to move forward and do better in the future.

It is possible that they will repeat social missteps, but it is important to approach these situations in a similar manner each time. This can be frustrating, but keep in mind: with patience anything is possible….

Cool Under Fire (the Robbery Part II)

2009-06-03T15:52:00.000-07:00

The opposite of love is not hate; it is indifference.

If this is indeed the case, then it stands to reason that fear and joy are also on the same emotional spectrum. The heart racing, palms sweating – these sensations do have much in common. For ages people have known this, telling scary stories to make the heart race, participating in extreme sports for the thrill, yes fear and excitement are closely linked.

Far worse than terror is the inability to feel, and that was exactly what I experienced.

I looked down at the gun pointed at my stomach and it was as if all emotions were siphoned out of me, together with the will to act of my own accord. Time did not stretch out in eternity as can happen in terrifying moments. Instead, I could not remember a point where I felt anything but this blank passivity; a time when I had free will.

There was no sense of helplessness as I observed the gunman pulling the camera strap off of my wrist. I was not afraid, I was not upset – I felt no connection to the situation. When he reached for my purse, I let him remove it not helping not hindering. I wasn’t upset, scared, or angry – I had less emotional investment than if I had been watching a movie.

Oh the robbery was frightening, I am completely honest when I tell people that it was. I was shaken up for weeks after. However the strange empty feeling of detachment – that is what truly terrified me, and what was worse, remnants of the deadness lingered. In that moment, and for long after, I could not recall the distant tang emotions even well enough to crave them. I knew that I was supposed to be frightened, but all I could muster were the words – the emotions were slow to follow.

“Wow, I’m impressed with your cool under fire,” one friend told me.

A part of me wishes I were really that cool – able to laugh danger in the face – to look calmly down the barrel of a gun without batting an eye. In some ways it would be great if I had a firm grasp and clear head in and things like that really didn’t phase me. Unfortunately what had happened was almost the reverse. In that situation I didn’t have a choice – I wasn’t acting, I wasn’t even reacting and there is nothing cool about losing your initiative.

Could I have been in shock? Well, shock was possible, but doesn’t that usually happen after the accident? This incident didn’t seem big enough to put me in shock either, and there really hadn’t been any fear. No, as comforting and normal an explanation as that would be, that wasn’t it. The more I thought about it the more I realized that something about this sense of dispassionate detachment was familiar. The feeling's familiarity is what had really bothered me....

And then I had it. The flat affect – that was the feeling.

But why then? Why was it that I detached in a situation where adrenaline and fight or flight by all rights should have been in full effect? Why had my self-preservation instinct picked that moment to go on holiday?

Stress – that it was as if the stress and emotional overload had clogged my ability to feel or react. It worked well in that situation but had circumstances been different something like that could be terribly dangerous.

How to keep your wits about you and think quickly in high-stress environments? How to keep your head and your heart with you? How not to detach? How could I ensure my emotion and decision-making motherboard didn’t short circuit? How could I prevent this from happening again?

For many brain injury-related drawbacks there is an obvious solution. Get more sleep, avoid stress, keep a regular schedule, and so forth. I wish that I had the answer to these questions as well, but I do not. I have thought long and hard searching for solutions but have come up empty handed.

Like every puzzle there is a solution, I am sure of it. I might still be too close to see the problem. I still feel the icy breath of the flat affect and initiation deficits pulling at me. Whatever the case for the time being a resolution remains frustratingly out of reach. I only hope that relaying this will help me to shake off the last of their chill….

Any ideas or suggestions as to ways to truly remain “cool under fire,” without utter detachment or tricks to thinking on your feet would be greatly appreciated.

Playing it Safe Part 1

2009-06-01T10:28:00.000-07:00

Life is for living, I always say. I want to try everything, go everywhere, and make the most of my time. I try not to go too far, but I have been known to push the envelope.

That day I was playing it safe.

After all, it was my first day in Buenos Aires. It was a new city, I’d only gotten to Argentina a few days before; I wanted to get my bearings before doing anything too crazy. I would just walk around and explore Palermo, the eclectic, foreigner-friendly neighborhood I was staying in. Get some of the things I was out of (shampoo and that sort of thing), stop by some of the cute little shops, a museum, maybe go to one of the parks and write a bit, that sort of thing. No definite plans but to relax and enjoy the gorgeous sunny day and idyllic 75-degree weather. And I did just that.

After lunch I turned off bustling Cordoba Avenue onto a quiet street without the push of people lining the street. Besides, the beautiful neighborhood would be a wonderful place to take some pictures. I wasn’t used to taking a lot of pictures, but J had given me the perfect travel camera for my birthday a few weeks earlier. The perfect travel camera – a little point and shoot shockproof, waterproof Olympus. The perfect present for a girl setting out on an adventure. I wanted to make the most of it.

One moment I was relishing the weather, taking pictures of flowers, and wondering where the nearest park was. The next I heard a car door. A slightly-built man, an inch taller than me at most, walked toward me. Wearing a nondescript t-shirt and jeans, his lined face and streaks of grey in his wild hair made him look to be in his mid-40s. He stopped very close, partially blocking my path.

For a moment I was thoroughly confused. He’d just gotten out of a car so chances were pretty good he wasn’t a beggar. If he needed directions even if I did speak Spanish I wouldn’t be any help, just having gotten to the city. What did he want?

“Pardon, no hablo español.” Almost before I said it, he reached for my camera.

Confused, I pulled back and started to put it in my pocket. Rather than releasing the camera he glared balefully, motioned with his head. I glanced in the down in the direction he gestured just as he jabbed the sleek of silvery-grey muzzle of his gun into my stomach three times. Lifting his head chin he dared me to resist.

“That’s terrible! Were you scared?” everyone asks.

“It was really scary,” I tell them.

That’s what they want to hear. After all, what kind of person has a gun pulled on them and feels nothing? It goes against our most primordial instinct of self-preservation: fight or flight. In potentially life-threatening situations the heart races and adrenaline courses through the veins, spurring you to fight, to run – to save yourself.

I looked down at the gun and back. Sunken, glassy eyes, with desperate huger behind them this man facing me was clearly in the clutches of some heavy drugs. I made the assessment with a curiously detached sense of calm. No elevated heart rate. No butterflies. No fear. I didn’t have options; whatever happened at this point was not up to me. I had no control.

There was no sense of helplessness as I watched him pull the camera strap off of my wrist. I felt no emotional connection to the situation. Next he reached for my purse, I let the strap slide over my shoulder unresisting. Not upset, not scared, not angry; utterly numb.

He would doubtlessly throw it away when he realized what the bag contained: weeks of writing, my address book; innumerable items priceless to me but worthless to him. All items of “value” were safe back where I was staying, and cash and cards under my clothes. But I did not realize this until later. I did not even feel a sense of loss.

He pulled the purse strap from around my neck, jumped into his car and pulled away. On autopilot I noted the license plate and try my best to remember it. Pens and paper gone, all I could do was repeat the plate numbers in an endless litany. I waved getting the attention of a boy across the street and motioned for him to come over.

Not confident I could remember the license plate number, and try to speak Spanish I repeated it over and over until I got the boy to write it down. Only then did I discover that not only did he speak English, but he was actually from Chicago. Kindly he helped me call the police, accompanied me to the station, and translated, helping me file the report.

Thankfully I was not injured but losing weeks worth of writing, that hurt. Rather than risk having something like that happen again, I took it as a sign. I scratched my original plan of written on the road and step away from writing until I was settled. Of course I took notes, but I no longer spent hours a day scribbling in my notebooks or in front of a computer.

This way I could concentrate on the experience, focus on meeting people, and learning. This way I wouldn't have to stretch myself too thin. I would gain a better understanding of myself, the world, and brain injury and therapy.

But this is only part one of the story, there are still many loose ends....

Never Count Your Blog Entries Before They are Published

2009-05-26T22:15:00.000-07:00

My last entry was in Lima, thousands of miles and almost two months ago. So much has happened; so many stories, so many insights, and a plethora of knowledge. All you have to do is start. All you have to do is type and the rest will follow. One word down on the page and the rest will flow. But where to begin?

I set out for South America intent on updating this blog if not daily, at least at regular intervals. After all, brain injury does not take a hiatus; with the added stress of travel I would certainly have more than enough to write about. On this, at least, I was not wrong.

Oh at first I couldn't scribble my thoughts down fast enough in my little spiral notebook. I spent hour after hour writing in the parks of Santiago, Chile, Mendoza, Argentina, on bus and plane rides. I would distil my thoughts and notes to a computer and polish them into blogs when I was a bit more settled, I told myself. I was more productive here than I had been in the states. It was wonderful!

But sometimes life does not go exactly as you plan. Never count your chickens before they hatch, and never consider a blog entry written before it is published. You never know what the future may hold….

First day in Lima

2009-03-27T10:00:00.001-07:00

I don't have a whole lot of time to update. As much as I love to travel it wears you out. Thankfully my host, C, has been wonderful and has been giving me the opportunity to work naps into my days and has let me sleep a LOT in my first few days in South America.

My flight left at 11:30 pm on the 24th. After a 7-hour flight, my plane landed in Lima at 6:30 a.m.. The taxi arrived at C's flat in Miraflores at 7:30 and I ended up sleeping until 10:30. I woke up, enjoyed the lovely ocean view (which I am enjoying at this very moment), and took a shower.

Refreshed and rejuvenated we went out for a fantastic lunch of ceviche, a delicious

Peruvian seafood dish and Pisco sours, the Peruvian national drink.

After lunch we went to the pre-Incan ruins of Huaca Pucllana and went on the tour. I had never

even heard of the Lima people and was fascinated to learn about this ancient people and the extraordinary earthquake-resistant design of their structures.

On the tour I met two of the most unusual looking animals I had ever seen - Peruvian hairless dogs. Reputed to cure asthma, arthritis, and rheumatism these dogs obviously made up for what they

lacked in looks with their health benefits - I wondered if they would have miraculous powers assisting recovery from brain injury.

By the time the tour was over I was exhausted. Kindly C let me go back to the apartment for a disco nap before going out that night.

Head injury or not, I love to travel, learn, and experience life to its fullest. Survivors are capable of all of this. However we must be absolutely sure to remember how exhausting travel can be and to get enough rest. If we do not we will not be able to learn or enjoy these experiences no matter how wonderful they may be.

I Walk a Thin Line

2009-03-23T14:35:00.000-07:00

At times like this, when I have so much to get done and so little time to do it I walk a thin line. I am scrambling to get everything accomplished before I leave the country tomorrow. At times like this poor planning skills and lack of foresight are a terrible drawback.

I will do my best to keep up the blog during my travels however these weeks I am a bit pressed to respond to all questions, posts and emails. Like a tightrope walker teetering between productivity and a plummet to my death while trying to stay on the good side of productivity, I pray to keep my balance. My deepest apologies if I get behind or take longer to respond. I will answer all questions and comments when I am able. Thank you for your understanding.

Warmest wishes,

Dorothy k

By the Seat of My Pants

2009-03-20T10:14:00.000-07:00

My ceiling collapsed....

I’m going to South America.

Oh it’s not quite as dramatic as all that. It was my roommate’s ceiling, and not quite the whole thing at that, but that was the last straw.

In many ways it’s a great apartment. It’s in a beautiful pre-war building; marble fireplace in the entrance hall, spacious rooms, 10-foot ceilings…. It would have been the ideal apartment if it had been well-maintained.

Unfortunately it was quite literally falling down around our ears. The shower clogs, the ceiling collapses, the radiator leaks and our landlord doesn’t seem to care. After endless requests he eventually fixes things – but it’s never more than a perfunctory patch job and a few months later the problems come back, and worse than before.

I didn’t want to leave the apartment but after the other roommate (whose ceiling did not ostentatiously collapse) telling us that this was the third time there had been ceiling problems in 4 years, I realized it wasn’t even safe to stay. With the uncertainty, my stress level skyrocketed. I needed to find a new place! ASAP!

A few hours of frantically combing Craigslist I started to think. So I didn’t have an apartment, maybe this wasn’t such a bad thing. I hadn’t been out of the country in a while – I’m writing – I can write from anywhere. Besides, I was getting the urge to travel; I had almost booked a trip to Peru a month earlier. This could work out perfectly – flights were cheap, I wouldn’t have to pay rent and I wouldn’t even have to find anyone to sublet the apartment… I could put my stuff in storage and just go!

I booked my flight – 6 weeks in South America – everything was set. I was getting out – away conflict from landlords yelling at me, roommates fighting, apartments held together with duct tape and twine, waking up in saunas at 3 a.m., dumping leaky radiator’s water out the window throughout the night. I was free! Adventure, exploration, discovery … the promise of adventure sent a chill running through me.

Think, want, do; that is how it happened. I didn’t think the trip through. I didn’t think where I would stay when I got back or where I would stay while I was there. I didn’t think of the fact that my limited vocabulary in Spanish from American Sesame street episodes as a child (uno, dos, tres…) might be a problem. It didn’t cross my mind that my decision might have repercussions – or affect anyone else. I didn’t think.

My ceiling collapsed. I’ll buy a ticket to South America. I doubt many people would think like that, fewer people would actually do it. I am not most people – I have a brain injury.

Impulsivity, and poor planning and decision-making skills are huge problems for brain injury survivors. I can honestly say that have made more than my fair share of poor, un-thought-out decisions. Thankfully by the grace of God, and by the grace of my ability to scramble and hold my life together with twine and duct tape, I have made it through, and had some great adventures. I have also had some miserable, high-stress moments where I barely scraped through. When things do go wrong they can go catastrophically wrong. I would not recommend living like this.

This is not to imply that I am not still phenomenally excited about my trip. I am thrilled to be getting out of the country and for this opportunity to learn, experience new cultures, and share every moment with you, my dear reader. I will be extremely careful and be writing from my travels so you needn’t fret.

Though spontaneity can be a rush, and snap decisions or judgments can seem thrilling or even necessary, my strong recommendation is that to talk all major decisions over with your family and friends before acting. You don’t have to be a stick in the mud or anything. Fly by the seat of your pants – just make sure to bounce your ideas off a few people and see what they say. If you don’t, you could hurt yourself, others, irreparably damage relationships or worse….

Practice Makes Perfect

2009-03-18T13:18:00.000-07:00

If practice makes perfect, then what’s stopping us? Why do we stick with our strengths and hide our weaknesses rather than working to better ourselves in all respects?

Last month my friend T took me to the New York City Ballet’s “XXI Century Movement” performance for my birthday.

I always enjoy the ballet, but I rarely go. In fact, believe the last one I saw was Swan Lake, over four years ago in Slovakia. Though I did take ballet lessons as a child, unlike music, dance was not a large part of my childhood. My father had season tickets to the opera, would regularly attend performances of classical music performances, but dance was simply not a priority in our household. So though I do have a great appreciation for all the arts, going to the ballet just never come to mind. So when T invited me I was surprised and delighted and was thoroughly looking forward to the evening.

The day of the performance, however, it was a different story. Having quarreled with my parents, I was in a terrible mood, and was considering telling T to take another friend. The ticket would be wasted on me. If she took another friend then I wouldn’t ruin her evening and her friend could have a lovely time. Seconds from calling I thought better of it – I’d made impulsive decisions like that before and lived to regret them. Besides, it was a birthday present. T had put time and effort into getting it for me, canceling on her would probably be in poor taste. With prodigious effort, I sucked it up, and headed to Lincoln Center.

The first act went about how I expected it would. Lost in my agitated thoughts I barely noticed the dancers and for all their skill it was wasted on me. During intermission T adroitly steered my attention away from my brooding thoughts and towards the world of dance.

Gradually, through the second act my attention turned outward and to the stage. The grace and skill the ballerinas moved with was breathtaking. Soon all thoughts of the day’s confrontation were forgotten. I was drawn in, mesmerized by the dancers’ precise movements, lost in the world of dance.

After the performance, standing in the line to the washroom, a middle-aged woman asked me if I were a dancer. Laughing with astonishment, (I am built nothing like a dancer and am almost certainly about 50lbs heavier than any of the girls on stage.) I said that I was not and warmly thanked her for her compliment.

“Well, it must be in your blood,” she smiled and disappeared into the washroom.

Though flattering, the exchange left me feeling slightly melancholy. I would love to learn to dance. I am passionate about music, I have an amazing time volunteering at Roseland assisted living community “dancing” with the residents, and every time I try to dance I have amazing time. It would certainly be good for me to build these new pathways and gain a new skill.

J and I have talked about taking dance classes, and in theory that would be wonderful. In practice, on the other hand, I am terrified that trying to learn in a class setting would be all but impossible for me.

Neuroplasticity is a wonderful thing. I can learn. All survivors can, but it takes longer for us than for people without brain injury. Whether it’s learning or relearning, retaining information, building the pathways, getting the steps down, all takes longer for survivors. To complicate things, ballet lessons ages 4-6 not withstanding, I don’t have a background in dance. Learning will be covering uncharted territory and learning new things, building pathways where no pathways exist, takes longer still. If that weren’t enough, there is the problem of my motor skill deficits.

This is why I say that learning in a class would be impossible for me. I can teach my body to move in new ways. I am capable of picking up steps; I just wouldn’t be able to keep up with a class. I can’t learn at the same speed.

I don’t want to make the class wait for me to pick up the steps. I don’t want to embarrass J and making him wait for me as I go through painstaking process of endlessly repeating a step until it is locked in my brain. Unfortunately if I want to learn that is the only way I can do it.

Even after so many years it still embarrasses me when I don’t pick things up as quickly as people around me. It reminds me of my deficits – what if I simply can’t? That what if shakes me to my very core. I guess it’s that way for most of us. But embarrassment and fear of failure are poor excuses. I may not be able to pick things up as quickly, and I won’t always be able to do them as well, but practice does make perfect. Working on things we may not excel at exercises and strengthens weak areas of the brain and whatever level we are at, we can always improve ourselves.

No, I am not going to take a group dance class – at least not at first, but I am going to face my fear. I am going to try. Not dissuaded by numerous warnings, my kind and patient friend L has agreed to teach me. Hopefully at some point I'll get to the point I can keep up with the class.

The Road to Hell

2009-03-16T15:32:00.000-07:00

I wasn’t on my deathbed. Not even close.

Sure, I lost my voice, did a fair amount of coughing, and managed to sleep several days away, but all in all it was a minor case of the sniffles.

I made it to my computer on Wednesday with the best of intentions. I had writing to do – I would make up the time I had lost! The ideas were there, just putting them onto paper; somehow the words just wouldn’t flow. No, that wasn't quite it. The words were there; it was the motivation to write that remained conspicuously absent.

Day after he entire week vanished before my eyes. I marvel at how one little illness can be enough to overload me. It is as if I jumped off life’s merry-go-round to catch my breath, but the work didn’t stop when I did. Now I’m ready to get back on, but all I can do is watch as the horses whiz past faster and faster a little faster with each new addition on my to do list.

All my grandiose plans to jump back in, do 3 make-up blogs in one day, catch up on my emails and reading, clean my apartment, and so on and so forth had caused my brain to short circuit. Even after all the advice I’ve given on not taking on too much and not holding oneself to such high standards I didn’t listen.

As they say, the road to hell is paved with good intentions, and that’s all my plans will be if I try to jump in too fast. Picking up where I left off isn’t an option. It takes time for me to get from zero to sixty. I have to ease my way back into up to speed.

Improvement is always possible. Survivors can learn, progress, and take astonishing steps forward. However, it is important to remember, and have others remind us, to take things slowly – gradually increase the amount of things you are involved in. If you push yourself too hard, get sick, or stretch your resources too far, you will need to let yourself ease back to the point you were before.

It can be difficult, but stick with this method of slow progression, but it is well worth it. Take more on when you are certain that you are ready, but be sure to pay close attention to what your body tells you after each new addition to your schedule. In the end, you will be able to take on and accomplish more than you ever thought possible….

If You Only Listened

2009-03-10T16:41:00.000-07:00

I knew it was happening. All the warning signs were there, but did I listen? Of course I didn’t.

I said that one way of getting out of the vicious cycle of poor sleep and stressing yourself out too much was taking a break. Not taking it easy, but a real honest to goodness rejuvenate, recharge and replenish rest for your body. This is completely true. Unfortunately if you don’t catch it in time your body will make you.

I mentioned that I’ve been under stress, not sleeping well, and that sort of thing. When I started to feel the first hints Tuesday – wearing out more quickly than usual, an errant tickle in the back of my throat, and the like – I just figured I could take it a little easier and it would go away. I went to bed a little earlier than normal and hoped that would do the trick.

Wednesday I woke up in a good mood and had all but forgotten the previous night’s warning signs. But over the course of the day things started to go downhill. Everything was getting under my skin. That afternoon, J and I were discussing some minor point. It shouldn’t have mattered, but somehow, this what shouldn’t have bothered me seemed awful. I took a reactionary stance – I didn’t want to be around anybody who didn’t have my opinion.

Taken aback by such inflexible, rigid thinking, coming from a normally open minded girl, J made a comment on how judgmental I was acting. After a few minutes of explaining that I wasn’t judging. It was fine if they had their opinion, I merely didn’t want to be around people who didn’t agree with me. I plead my case, confident that I had a logical and rational argument. By the time we finished our conversation I was confident that I had proven my point. Twenty minutes later the full weight of the fatigue hit me.

Stepping back and writing about this episode I see frightening parallels between last week’s exchange and the anosognosia, I experienced immediately after the accident. Though no longer a total eclipse of my reason, I was still incapable of recognizing that there was anything wrong.

What I should have done was skipped the meeting, taken the next day off and just slept. But no, I had told J I would be at the meeting, so I took hour train ride home, slept for fifteen minutes, and rode the hour back rushing to get to the meeting on time. I got a nap in there – I was taking it easy – shouldn’t that be enough?

I took it easy for a few days, but I refused to cancel all of my plans. By the end of the networking potluck on Sunday I had made connections and lost my voice. I managed to get home but no further. My body had utterly given out. I spent the next two days in bed with a fever, barely able to make it to the kitchen for tea. Try and take it easy, or try and push through, the results are the same – I get sick if I don't give myself a real break.

If this always happens, then why haven’t I learned? Like so many other survivors, I forgot the consequences, thought it would be different this time, and failed to learn from my past mistakes. I have gotten better. Now I do take it easy when I feel like I have pushed myself too far, but I still try and limp on at half speed for a while before my body utterly gives out on me.

It is important to listen to what your body tells you. However, it is equally important to let your loved ones know that survivors don’t always learn from mistakes and can show poor judgment. Ask your friends and family to give you a little “heads up” when they feel like you are acting a little off, see if you’re feeling tired, or let you know if they feel like you’re taking on too much. What you don’t see may be obvious to everyone around you and fatigue isn't something you want to mess around with.

Your body will get the rest it needs. Just try to give it a break before takes one....

Sleepless Nights

2009-03-04T10:31:00.001-08:00

Patting blindly along the floor my hand finally found its way to the soft lump of the throw pillow I had tossed out of bed. Another futile attempt to find that illusive position which would magically allow me to drift peacefully off into dreamland. I was reconsidering - maybe hugging the pillow was more comfortable. Anything was worth a shot. I’d lie on my back, on my stomach, pulled the covers over my head, then kicked them off. I had curled up around a pillow on my right side, on my left side, with the sleep mask, without the sleep mask – no use. All this tossing and turning was practically getting a workout.

Drawing the pillow to me, I rolled into my standard position – curled up on my right side, facing the wall and tried to relax my mind. It felt weird, it was too hot – I didn’t want the thing near me! I threw the covers off, hurled the pillow away in disgust. Wracking my brain for ideas, I finally remembered my eye-pillow. I had gotten the small lavender-scented buckwheat pillow as a Christmas present years earlier. I didn’t use it terribly often, but its cool weight generally had a soporific effect and relaxed me into unconsciousness. Hopefully, I draped the eye-pillow across my face and waited … and waited … and waited … all to no avail. I couldn’t get comfortable – nothing helped.

It had been hours since I’d woken up. What time was it, anyway? 4:47, the telephone glowed. I’d gone to bed around 11, like normal, but somehow I kept waking up around 3. Third time this week. All this waking up in the middle of the night was killing me. I’d get seven or eight hours of alertness before exhaustion would hit again. It was like living sleep-paycheck to sleep-paycheck. What was the matter with me?

I blamed it on steam heat, stress, having too many things on my mind … and I truly believed it. If I were just relaxed things would be fine, I told myself; if my room weren’t a sauna I would sleep like a baby. Rationalization after rationalization for why I couldn’t sleep a whole night through….

A week or so later I was having coffee with B, a fellow TBI survivor. She told me that she participated in some studies Mount Sinai was doing on traumatic brain injury to make a little extra money. “I think they’re starting one on sleep disorders in TBI survivors next month. Do you have problems sleeping? I think they are looking for more survivors to participate.”

As so often happens, my mind erased the problems I’d been having, and I was quick to decline. “Thanks, but I usually sleep fine. I’ve been having some issues, but that’s just because of the steam heat. It isn’t brain injury-related.”

A few nights later, as I lay awake at some ungodly hour, it all came flooding back. There are close ties between brain injury and sleep disorders. Almost all survivors have problems sleeping. Disturbances in sleep is even one of the signs you have had a concussion! The fitful nights, the fatigued days, the irritability – it all fit – my problems sleeping were related to the brain injury. How could such an obvious connection have escaped me?

Easy – I wasn’t expecting it. I hadn’t had problems sleeping for years. So long, in fact, I had forgotten it was even a symptom of brain injury. I was used to looking out for certain problems – fatigue, spatial deficits, fine motor problems, and that sort of thing – and had all but forgotten about others. This kind of carelessness and inflexible thinking (refusing to consider brain injury even a possibility) is awful, because sleep disturbances can be one of the more dangerous problems facing survivors.

One would assume a group of people so prone to fatigue, would have no problems at all falling asleep. Sadly this is far from the case. When I am fatigued there is a window of time where I do fall asleep easily – I can sleep pretty much anywhere. However, if I push myself past this point, then I may lie awake bone-tired, but unable to fall asleep. Or more often, I will be able to go to sleep, but I will wake up a few hours later, my battery still low. This can turn into a vicious cycle, sleep disturbance leads to fatigue, which opens the door for all of the other deficits.

So how can one break out of this cycle? How can you avoid getting sucked into it?

To get out of the cycle, I find if I become trapped in this type of nightmare, the only way out is to “hit reset.” I take a relaxing weekend and allow myself to sleep in. If possible I highly recommend going to the country. Being around nature is extremely therapeutic and recharges my batteries. If you can, being around horses is wonderful as well.

It is important to remember is that sleep medications are not the answer. Though doctors will often misdiagnose survivors as suffering from insomnia and prescribe them, this will not help normalize sleep cycle patterns.

To avoid getting sucked in is easier than one might imagine. Some simple ways are:

- Keep a Regular Sleep Cycle

- Get into a Daily Exercise Routine (avoid working out at night)

- Eat a Balanced Diet

- Sleep in a Dark, Quiet Area

- Avoid Caffeine Around Bedtime

As far as suggestions for better sleep habits, there will be some you can follow, but others that are out of your hands. For instance, I live in New York, so blocking out the noise and light isn’t really an option. But you don’t need to live your life by a book – do what’s right for you! My best advice is to start slow. Work the easiest ones into your life first – stop drinking caffeine around bedtime, for instance. If that doesn’t help, add another one.

Sleep is the most important thing for brain injury survivors. A well-rested survivor can take on the world. We may need to be a little more careful, but it is definitely possible to get our sleep cycles back on track. Don’t let fatigue get the upper hand.

I would love to hear any ideas or suggestions for a better night’s sleep. Let’s all try and stay well rested so that we can be at our best…

http://www.healthcentral.com/sleep-disorders/news-36163-31.html

http://www.tbiguide.com/sleepdisorders.html

http://www.bestsyndication.com/?q=010808_sleep_disorders.htm

http://ezinearticles.com/?Sleep-Disorders-From-Traumatic-Brain-Injury&id=1404406

A Stitch in Time Saves Nine

2009-03-03T13:27:00.001-08:00

Happy Brain Injury Awareness Month!

Sports and Concussions is The Brain Injury Association of America’s theme for this year’s Brain Injury Awareness month, more specifically youth sports. This is particularly relevant right now. Recent studies have that shown that when the repeated concussions often incurred in sports are not given time to heal it can lead to “Chronic Traumatic Encephalophy” (CTE). This degenerative disease is the only preventable cause of dementia and is similar to early onset Alzheimer’s.

The Center for Disease Control and Prevention (CDC) estimates 1.6-2.8 million sports-related concussions occur each year. This statistic becomes even more alarming when paired with a recent study in the Clinical Journal of Sport Medicine, which reports that barely half of student athletes reported their concussions. In a chilling example, the autopsy of an 18-year-old high school athlete revealed the student to already have CTE – the youngest recorded case.

We cannot allow this gruesome warning to go unheeded. We must take action. It is imperative that we educate students and parents.

Concussion can be caused by any blow to the head, regardless of loss of consciousness. Some signs may include:

- Confusion

- Blurred Vision

- Light Sensitivity

- Dizziness

- Nausea or Vomiting

- Forgetfulness or memory loss

- Perseveration (endless repetition of a thought or question)

- Ringing in the ears

- Slurred Speech

- Mood or cognitive disturbances

- Sleep Disturbances

- Fatigue (wearing out easily)

- Irritability

- Impaired Balance

The Mayo Clinic, one of the top ten rehabilitation hospitals in the country, advises that it is extremely important to seek immediate medical attention if you or your loved one experiences:

- Prolonged Dizziness

- Disturbances in Vision

- Nausea or Vomiting

- Impaired Balance

- Prolonged Memory Loss

- Ringing in the Ears

- Loss of Smell or Taste

Let’s use this month to do everything we can to prevent more people from going through this ordeal. Visit the Brain Injury Association of America’s website:

http://www.biausa.org/biam.htm. Spread the word – tell your friends with children. Parents, talk to your kids, reach out to your local PTA about getting your children’s school to hold brain injury awareness assemblies. Just as the saying goes: stitch in time saves nine – a little effort now may save you the enormous hardship of rehabilitation, or worse... Let’s all use this month to raise awareness and reduce the number brain injuries. We can do it.

The Brain Injury Association of Americahttp://www.biausa.org/biam.htm

Tackling Brain Injuries http://www.boston.com/bostonglobe/editorial_opinion/editorials/articles/2009/02/01/tackling_brain_injuries/

Teen Football Players Still Dying, Experts Say Better Safety Measures Needed http://www.foxnews.com/story/0,2933,485744,00.html

Experts Tackle Head Injury Problem http://www.metrowestdailynews.com/news/x1118758239/Experts-tackle-head-injury-problem

Devastating impact

http://www.recordnet.com/apps/pbcs.dll/article?AID=/20090112/A_SPORTS09/901120317/-1/A_SPORTS

Mayo Clinic: Symptoms of Concussion http://www.mayoclinic.com/health/concussion/DS00320/DSECTION=symptoms

Mayo Clinic: Concussion: When to Seek Medical Advice

http://www.mayoclinic.com/health/concussion/DS00320/DSECTION=when%2Dto%2Dseek%2Dmedical%2Dadvice

Center for the Study of Traumatic Encephalopathy Announces New Findings http://www.eurekalert.org/pub_releases/2009-01/bu-cft012709.php

My Funny Valentine

2009-02-27T12:25:00.000-08:00

It isn’t often that I find myself waxing poetic on the joys of Valentine’s Day, quite the reverse. Though the candy-coated hype can be sickening, on the whole, I am indifferent to its dubious charms. As I wrote earlier this year in response to a blog comment championing the holiday:

I don't place that much importance on it. I'd much rather have a relationship where you surprise and appreciate one another throughout the year than have a humdrum relationship with an ostentatious show on the days you're "supposed to" be romantic.

This year was different.

I didn’t have high expectations. I never do for Valentine’s day – I’ve been disappointed far too many times. I did have a boyfriend, but that didn’t matter – my worst Valentine’s days have been the ones I’ve been in relationships. The previous night P and had had a long discussion about the dreadful holiday. It was the same for her, but a thousand times worse – the poor girl had been with someone for years and never gotten a single flower! Some of the horror stories she told made me want to swear off Valentine’s altogether.

But this year participation was mandatory, I already had plans. J was picking me up at 5. Whatever. Just another Saturday, I tried to tell myself. I went for a run, talked to a few of my depressed girl friends, and just went about my day.

Around 3 my phone beeped at me, “Did you get anything from me this morning?” said J’s text message.

The building's super, Castro, wasn’t holding a package for me, no notes on the door … nope, no package.

I shrugged my shoulders and got ready. A few hours later J picked me up at 5 carrying 2 dozen deep pink roses. “They are beautiful!” I exclaimed, after a moment.

“They aren’t as nice as what I was supposed to come,” he said as he opened the car door for me. “I bought you a miniature rose bush in a beautiful pot I picked out especially for you. Long stem roses only last a few weeks, but you can keep the rose bush forever.”

When we got to his apartment, he cut off the bottoms of the stems and crammed them into an elegant vase, clearly designed to hold a dozen roses. Flowers squished firmly into the vase, like little pink anchovies in a sea of green, he reached into a bag on the nearby countertop. Extracting a small glass bottle he presented me with a present – rose salt he’d gotten in Georgia. “I saw it and thought of you.” he told me. I thanked him and looked at the curious gift. It was nice that he’d thought of me on his holiday, I do like salt, and rose salt for Valentine’s day was a really sweet and thoughtful present, but I was still skeptical. Having over an hour before our dinner reservation, so he fixed us each a drink and we adjourned to the sofa to talk.

The only time we’d hung out in a month was for his father’s birthday celebration – I was concerned. Sure he’d been out of town for part of the time, but he’d had time to hang out with friends. We never saw each other - this wasn't how it was supposed to be, was it? I had been thinking about it for weeks. He didn't want to see me - I just knew it. What had I done wrong this time?

Even when he gave me the roses J had seemed stiff, like he was doing it because he was supposed to – like he couldn’t break up with me on Valentine’s day but he was only there because he felt obligated. Had another relationship somehow self-destructed without my knowledge? I took a deep breath and steeled myself for the worst. If he wanted out that was fine, I just didn’t want to drag things out if he didn’t even want to be around me.

Somehow it didn’t work out like that. In the midst of my paralyzing fear, when we actually sat down on the sofa, and he put his arms around me, the tension started to slip away. We talked – about everything; my fears, and problems, his concerns, obligations, our relationship, and how we would make things better in the future. With anyone else it would probably have been a nightmare, but it just seemed to strengthen the relationship. It felt so nice – like I could tell him anything. We talked for over an hour. By the time we had to leave for our dinner reservation, all my fears allayed, I was happier than I could remember being with a relationship.

As I have mentioned in earlier entries, as for many brain injury survivors, developing and maintaining romantic relationships is far from being one of my strengths. Understanding and living with brain injury can be difficult in and of itself, but adding the heightened emotions of relationship to the mix and you have a recipe for volatile behavior. Add to that the additional fatigue from heightened emotions, more fatigue from learning social behaviors, fear from past bad experiences, and so on and so forth. Relationships can be terribly hard.

I think that the most important qualities for a survivor’s partner are patience, compassion, and strength. For survivors, I believe that openness, perseverance, and an earnest desire to work at the relationship are integral. Survivors can make wonderful partners, one may have to put in a little extra effort, but it will be repaid tenfold.

I feel extremely lucky to be with someone who is patient with me and does put the effort out. I can only hope that the friendship and relationship continue to develop and that our friendship and partnership grows stronger over time. There are patient, caring, loving people out there. It is just as important for this as for all other aspects of improvement - never give up hope. There is even an online support community for people with disabilities and their partners. http://www.able2beme.com/

Strengthen Your Body, Strengthen Your Mind

2009-02-25T13:27:00.000-08:00

It was 60 outside. It had been gorgeous outside for days. At another time, or in another place I would have embraced these balmy weather. But spring hadn’t arrived – this was New York, it was the middle of February. It would last just long enough for me to let my guard down. That way the bitter cold would be twice as bad. Global warming? More like Global weather mood disorder.

By Friday I was starting to second-guess myself – maybe spring had come early. If that’s the case then I need start getting back in shape. With the apartment too hot to work out in, and the weather too cold to run in, I hadn’t worked out all winter, and I was starting to feel like a disgusting lump. Yeah, now’s as good as time as any. I resolved to start the next morning with my first run of the season.

The alarm went off too early for a Saturday. Maybe I could sleep for a while longer … maybe…..

No. No, you’re not going to be lazy today, I told myself. It’s time to get up. Taking a deep breath, I lurched up out of bed. Pushing away, I scrambled to get ready before the inviting bed lured me back. Pulling my hair unceremoniously into a ponytail, I climbed into some work out clothes, and shoved on my running shoes as quickly as I could.

Focused on getting out the door before the last remnants of that initial momentum dissipated, I barely remembered to grab my hoodie and ipod (metrocard inside) before dashing out the door.

Pleased I’d made it out of the apartment, I energetically jogged into the brisk morning air. Half a block later I zipped up the hoodie, another block and my hands found their way deep into my

pockets. Breath visible, I fervently wished I’d brought gloves. Google had said it was getting up to 50s! Didn’t I just see ice

there on the sidewalk? Stubbornly I ran on despite the weather. Surely I could make it to jog a little in Riverside Park. 2 miles -I could run that in my sleep. I wasn’t in good enough shape to make it all the way back – I’d just take the subway at the Columbia stop at 116th street.

A mile and a half later, my breath started to come harshly, soon daggers pierced my lungs. Blocks later my stomach started to cramp. “Just to the end of the bridge, just to the end of the bridge,” I chanted the words like a mantra.

I made it – barely – and jerked to an abrupt halt. I couldn’t have made it a step further. Hands on my knees, stomach threatening to unburden itself of my nonexistent breakfast, I sat down on some nearby stone steps. A moment later, when my stomach had calmed down, I dragged

myself to the nearest subway and shamefacedly gasped and wheezed my way home.

Unbelievable how out of shape I’d gotten in just a few months. I was a wreck! It was ages before my lungs stopped feeling like someone had turned them wrong-side out. Finally when I felt a little less like a puddle of gelatinous goo, I took a long hot shower, stretched, and fixed

myself a nice hot cup of earl grey.

Sipping my tea I told myself (for the thousandth time) I would work out on a regular basis year round. I'd be sore tomorrow.

I need to work out. It isn’t just so I can fit into my jeans, looking nice is important, and a motivator, but it's not the reason.

My physical health is important, but it’s not just that either. For myself and other brain injury survivors, working out is imperative for cognitive and mental health, as well as physical well being.

For brain injury survivors, exercise has been shown to:

v Increase neuroplasticity (helping the brain repair and learn)

v Increase proteins involved with learning and memory

v Reduce depression (in more pronounced ways than for those without brain injuries

v Reduce the number of physical, emotional and cognitive complaints and symptoms (including sleep disorders, agitation, organizational skills, and so forth)

v Improve memory

v Improve speed and thought processes

When I began writing this entry, I realized that exercise was good for recovery but I was surprised to learn the extent to which it can help. We have every reason in the world to exercise. Now there's no excuse. Let’s strengthen our bodies to strengthen our minds.

Onwards and upwards, let's move forward with our improvements….

http://query.nytimes.com/gst/fullpage.html?res=9C04E2DE1130F936A35752C1A961958260

http://www.ncbi.nlm.nih.gov/pubmed/15051152

http://cat.inist.fr/?aModele=afficheN&cpsidt=1785254

issue#2 http://www.mssm.edu/tbicentral/resources/publications/tbi_consumer_reports.shtmlhttp://www.colemaninstitute.org/Conferences/Coleman-2002/Boulder-material/posters/Kreber.pdf

Brain Injury Awareness Month - Faces of Brain Injury

2009-02-23T13:20:00.000-08:00

Did you know March is TBI Awareness Month?

If you already knew then you're one step ahead of me - I didn't have a clue until last week when my contact at the Northeast Center asked me if I had seen their Brain Injury Awareness site.

http://brain-aware.northeastcenter.com/

The Northeast Center takes their 2009, "Faces of Brain Injury," theme very seriously. Through 12 downloadable Brain Injury Awareness Month Posters, they seek to humanize this condition and show that the faces of injury are as varied as the injuries themselves. Brain Injury awareness not only celebrates survivors, but also spouses, parents, siblings, doctors, therapists, advocates, and every member of this diverse group of individuals from an array of other backgrounds making this community.

Put a poster up in your office or at school, let a friend know a little more about how you are related to TBI, talk to someone you meet this month. It doesn't have to be a big deal, but if all of the members of this community work just a little harder to help put a face to brain injury, then think what we can do towards raising awareness. This month, let's make strides towards making the invisible injury visible...

Hindsight is 20/20

2009-02-20T14:22:00.000-08:00

“I wonder why you sometimes don't do what you know would help-you've given us several examples: not crying on J's shoulder, not getting enough sleep, not eating enough.”

Often outsiders wonder precisely this about brain injury survivors' actions as this insightful blog reader. So many problems could just be avoided if survivors would simply listen to what doctors’ advice. In my case it’s even stranger – I know the right thing to do – why don’t I just take my own advice?

To ease your mind dear reader, though I do struggle with TBI, and the deficits remain, at this point they are shadows of their former intensity. For the purposes of this blog however, I am focusing on this aspect of my life to better illustrate these entries in order to help educate, inspire, and offer guidance. However, because of this I give examples of what I am doing wrong, and point out how to do it right in hopes others can learn from my mistakes. Even though it may sound like my life is a constant battle, I simply don’t write about the good days because they aren’t informative, interesting, and don’t have much to do with brain injury. In other words, though I had a delightful Valentine’s day with J, writing about the beautiful roses he gave me, our phenomenal dinner, or any other part of the perfect evening, simply did not seem pertinent. However had this been the sole reason I would not have found it necessary to devote an entire blog entry in response to this comment.…

The other, more complex reason, is a hallmark characteristic of brain injury - poor judgment. Distracted by excitement, caught up in the moment, or locked in a single-minded “need” to get things done, one can push through, oblivious to the warning signs. To make things worse, the more fatigued, agitated, or focused a survivor becomes, the harder it is to step back and listen to what your body is telling you until it is too late….

My stubborn nature and drive to always push myself further, beat the odds, and prove my self-sufficiency has served me well in many ways. I believe it has given me the strength to come as far as I have, and has made me who I am today. However, there is a time to push forward, and there is a time to listen to what your body is telling you.

Unfortunately I have not yet mastered the art of recognizing when to say when. I can and do overextend myself, refuse support (not wanting to be a burden), stay out too late, and generally ignore what my body is telling me. Curiously, the more I take on, the more energized and invincible I feel. When I get to this euphoric state and push past the brief “nap threshold,” as I refer to the point when exhaustion washes in, whether it is an emotional meltdown, a TBI episode, or me just getting sick, the outcome is never good.

After the fact I realize exactly what I should have done, and generally kick myself for it. “Hindsight is 20/20” could practically be my slogan. However, in the heat of the moment on the other hand, stopping isn’t even an option, and unfortunately, a common problem.

Fortunately it is not an insurmountable one. Brain injury is a desperately lonely thing. This is, however, a time where you need your friends, family, and support the most. It is extremely important to be open with your family and friends about challenges you face. An outsider’s perspective and a little common sense go a long way in diffusing the situation before it goes too far.

It isn’t difficult, all it takes are a few gentle prompting words to guide the survivor towards thinking about the consequences of their actions. This may take the form of suggesting a nap, recommending you cut down your course load (or not taking on so much) in order to do better at a few things (and giving some examples of what could potentially happen), reminding the survivor they have to get an early start. This is merely another way suggestibility can be used to guide survivors towards wiser decisions. So many crises truly are avoidable if the situations are correctly handled. Calmer days are just around the corner….

No Problems Come Without Gifts

2009-02-18T16:51:00.000-08:00

There are links between brain injury and depression.

This statement seems painfully obvious. Of course there are links between brain injury and depression. It is one of the most widespread challenges facing brain injury survivors. Up to 77% of survivors are intimately acquainted with the crushing despair, the feeling all happiness has been sucked from the world as their lackluster days drag on endlessly. Is it any wonder?

Brain injury capriciously robs survivors of intellect, social skills, physical abilities, and so much more, haphazardly taking a bit of this, a bit of that. Every ‘given’ is thrown into question, always and forever loses all meaning. Lifelong relationships crumble, your emotions are no longer your own – you’re not you anymore. Every survivor I’ve ever met has struggled with depression. We're mourning the loss of ourselves - how could we not?

There are links between brain injury and depression – tell me something I don't know already!

Brain injury can cure depression.

I did a double take when I read it, but it's true. Studying Vietnam vets and other TBI survivors, Neuroscientist Michael Koenigs and his colleagues have discovered that when the part of the brain right behind the eyes (the ventromedial prefrontal cortex – VMPC) is damaged or destroyed it actually “cures” depression!

In one extreme example mentioned in the study discusses a woman who had cured herself with a gunshot to the head. Through some miracle, her attempt at suicide not only failed, but also managed to neatly destroy her VMPC, after which all depression vanished. According to her neropsychologist, “she never shows distress, worry, or anger.”

At first glance this blissful state of perpetual calm, sounds quite nice. After all, brain injury damaged a part of my brain proven to cause depression, I must admit, I felt a bit like I’d gotten the short end of the brain injury stick. Until I read the fine print….

That’s right, there’s always a hidden cost. Don’t go signing yourself up for a 1950s-style lobotomy too quickly. Though taking out the VMPC does help depression, there are serious social and cognitive deficits. Survivors frequently will lack empathy, compassion can’t interpret nonverbal cues, see connections, and the list just keeps going.

This is not to say that one type of injury is better or worse than another - all deficits are hard – brain injury is not for the weak of heart. Over the years I have become accustomed to, learned to regulate, and even come to see some positives in these challenges. Trade mine for a new set? No thanks.

Heightened emotions may have their drawbacks, and I am sure there are those who would be happy to waive empathy and insight goodbye along with depression, but not me. I was, thankfully able to balance my brain chemistry out, and bid the days of clinical depression farewell years ago. Though I have moments I am grateful that I’m able to experience the entire range of human emotions – the joy wouldn’t be so sweet if I didn’t know the salty taste of tears…

It is true, everything comes at a cost, but no problem comes without bearing gifts. It is our duty to uncover them….

The Links Between Brain Injury and Depression http://insciences.org/article.php?article_id=2359

Neuroskeptic: No Ventral Prefrontal Cortex? No Problem! http://neuroskeptic.blogspot.com/2008/12/no-ventral-prefrontal-cortex-no-problem.html

Traumatic Brain Injury and Depression http://74.125.47.132/search?q=cache:n04aY9dA_28J:www.freddhaas.com/CM/Articles/

Deficits in Social Knowledge Following Damage to Ventromedical Prefrontal Cortex http://neuro.psychiatryonline.org/cgi/content/full/17/1/66

CNS Spectrums: Depression, Anhedonia, and Psychomotor Symptoms: The Role of Dopaminergic Neurcircuitry

http://www.cnsspectrums.com/aspx/ArticleDetail.aspx?ArticleID=1613