Friday, March 27, 2009

First day in Lima


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.  

Monday, March 23, 2009

I Walk a Thin Line


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

Friday, March 20, 2009

By the Seat of My Pants


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.  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….  

Wednesday, March 18, 2009

Practice Makes Perfect


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.  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.  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.

Monday, March 16, 2009

The Road to Hell


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….

Tuesday, March 10, 2009

If You Only Listened

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.  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....



Wednesday, March 4, 2009

Sleepless Nights

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. 


Tuesday, March 3, 2009

A Stitch in Time Saves Nine



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