TBI 2

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I sit here over the computer with my head in my hands. Do I want to do this again? Do I want to explain myself? Is it worth the time? Does anyone even care? Then I remember how therapeutic it was to write, refine, and finish the last article. If only for my own therapy, I decide I will, but my hope is that this helps someone at some point with what they are going through, be it a traumatic brain injury or otherwise.

TBI life continues. I say “life” because recovery has turned into a fifteen-month process so far. As frustrating as it is, I am doing my best to embrace the challenge and live my life amidst the pain that ensnares me. Looking around, it’s quite clear we each have pain and struggles we all deal with on a daily basis. Brain injury is just the one that I, personally, am dealing with.

In my previous article last October, I was progressing and began feeling better only to enter another valley of pain, symptoms, confusion, depression, and physical difficulties. I visited family over Christmas and struggled through intense migraines. Noise and light still bothered me, which was an indicator I was still dealing with concussion symptoms. Joining people in group settings or large social gatherings was challenging and more times than not, I declined. While back in Michigan, I had to ask my family to keep the lights dim and the noise to a minimum. The clanging of silverware on a plate, the sound of wrapping paper during gift opening, the sound of shovels on snow/ice, it all sent my brain into chaos and then pain/symptoms followed. I wore earplugs a lot of the time. I cried a lot. In one sense, crying was somewhat relieving, yet it hurt my head at the same time. The stress and anxiety sent my upper back, shoulders, neck and head into a tight mess. I couldn’t stay relaxed. It was great to spend time with family, get some of my mother’s love and home cooking, and pay a visit to our family cottage. Throughout this injury, I’ve realized the importance of location and how it can mean the difference in recovery and neuroplasticity - the healing of the brain.

Cottage life.  Interesting how location continues to play an important role in TBI recovery. — Cottage life. Interesting how location continues to play an important role in TBI recovery.

Upon returning to Seattle in January, I had been anticipating an appointment with a new neurologist that was recommended to me. I had already met with many others, so I admittedly went into it not expecting much. I took my seat in the waiting room half guessing what injuries the others might have sitting around me. Things are quickly put into perspective when you see people that deal with more serious medical issues and depend on others to function. It’s all part of being around hospitals. “Looman… Daniel?” the nurse called with a raised eyebrow. Into the small room I followed noticing the patient table adorned with a fresh piece of pickle paper. The feeling of sitting or lying on pickle paper is annoying, let alone the sound. “The doctor will be right in”. “Yeah, sure”, I thought. I might’ve even said it out loud. I did. In case I’m not the only one who thinks this is annoying, each time I’ve had a medical visit I’ve asked the Doc to remove the annoying paper and they obliged. I had already done my homework on this Doc and saw he was a newer neurologist and had not been at it that long.

After checking my vitals and doing a few neurological tests, the neurologist sat back in his chair and asked me what my passions were. I smiled and asked why. Speaking of things I loved which I couldn’t currently do wasn’t high on the list of things I wanted to talk about. “What activities bring you joy?” he questioned. “Snowboarding” I said with a half smile. It was the first thing that came to mind, especially since there were storms in view that would deposit a lot of fresh snow in the northwest. “I’m going to suggest you get out to enjoy some snowboarding.” The earth stood still for a moment. “Wait, what?” I asked. A million things raced through my brain at once.

The neurons were firing. He went on to explain some of what I had recently read regarding how much the brain can be affected, and in some cases even heal itself, when people experience joy doing the things they love. Doctors and neurologists had originally suggested taking at least a year off from snowboarding or any other activity where I might sustain another concussion while I was still healing. When they threw the word fatal in there, it made me listen a little more closely. This suggestion by the neurologist seemed absurd. I leaned forward and put my elbows on my knees in anticipation of what this meant. He continued, “You’re past most of the concussion symptoms and I think if you’re cautious and not out there riding the steepest runs through the trees and putting yourself in risky situations, you’ll benefit from the experience.” I’m not sure I heard anything else he said in our meeting. I’m joking. Admittedly, I judged him without knowing much about him at all. It wasn’t so much what this neurologist did, but what he said that encouraged me. He handled himself differently than previous Doc’s. He listened. I felt like a friend that he cared about, not just a number. He instilled a confidence and hope in me that was lacking for some time. He was also the first to encourage my efforts to address my brain injury and depression with what others in the medical field had thrown a pill at or laughed off. I’ve learned there is protocol that many neurologists follow. Patients have to jump through many hoops before they will consider recommending the treatment you actually need. This is how the insurance companies make their money.

Unsurprisingly, I acted on the advice of this neurologist rather quickly. That same week, the storm delivered between fifteen and twenty inches of snow to Mount Baker. My buddy Chad and I ventured to take advantage of all the powder. The morning weather report showed the sun might make an appearance, but anyone that lives in the Pacific Northwest knows, you can’t believe weather reports. Baker was all that and then some. It was one of those days where you can feel the energy in the air while everyone around you is gearing up in the parking lot and the sound of huge bombs exploding around the mountain as ski-patrol does avalanche control. The anticipation was building. As we rode up the lift, the sun came out and untracked fields of goodness lay before us. The emotions ran high. I started crying. I didn’t think this moment was going to come for a long time and here it was; a chance to strap in and slide sideways through some pow and take a step forward in recovery. I can’t explain what this did for my confidence, let alone the joy I felt in the moment and in the days that followed. My head hurt with increased heart rate, but calmed down again as the heart rate did. My body felt weak. I had lost a lot of weight and my muscles had atrophied. Yet, I had a new found hope that I was going to be okay.

The views around Baker aren't bad either.

My friend Chad sliding through some Baker powder.

I continued studying Neuroplasticity. Neuroplasticity is “the ability of the brain to form and reorganize synaptic connections, especially in response to learning or experience or following injury.” By reading about neuroplasticity, I began to understand a lot more about the importance of brain recovery and what things I could be doing to help the recovery process.

Here’s an excerpt taken from a book I read:

“Most of the interventions make use of energy – including light, sound, vibration, electricity, and motion. These forms of energy provide natural, noninvasive avenues into the brain that pass through our senses and our bodies to awaken the brain’s own healing capacities. Each of the senses translates one of the many forms of energy around us into the electrical signals that the brain uses to operate.” The book goes on to “show how it is possible to use these different forms of energy to modify the patterns of the brain’s electrical signals and then its structure. The doctor/author shares a few examples that are incredible: sounds played into the ear to treat autism successfully; vibration to the back of the head, to cure attention deficit disorder; gentle electrical stimulators tingling on the tongue to reverse symptoms of multiple sclerosis and heal stroke; light shone onto the back of the neck to treat brain injury, into the nose to help sleep, and the slow, soft movements of the human hand over the body to cure a girl, born missing a huge section of her brain, of cognitive problems and near paralysis. All of this had me excited to try some new things with my TBI recovery.

I began using a Ten’s unit: Transcutaneous Electrical Nerve Stimulation. It does exactly what the name says; give electrical stimulation to the nerves. Think about those comics that have people’s fingers in an electric socket with their eyes popping out of their face and their hair gone afro. Well, maybe not that strong, but TENS pack a punch! This small device has not only helped relax my nerves, but the muscles as well. TENS help stimulate neurons and studies have shown they can reduce chronic and acute pain.

I changed the food that I was consuming. I added more brain foods; omega-3 rich items such as avocado’s, nuts and seeds, wild salmon, blueberries, and beans. Research shows that the omega-3 fatty acids reduce inflammation and lower risk of chronic diseases. Omega-3’s are highly concentrated in the brain and are important for cognitive and behavioral function. I all but gave up gluten and most dairy. For those of you that have completely given up gluten, I’m happy for you, but let’s not get carried away. You know a BLT or a pizza with extra gluten sounds good every once in a while.

I began listening to classical music. Studies have shown it can lower blood pressure, induce relaxation, and reduce anxiety. I’ve never been a fan of any classical music. I never understood how anyone could listen to that garbage. I can remember days back to high school when I would pick up my buddy Ian and a Metallica tape was purposely stuck in the tape player blaring through twin six-by-nine speakers of my old 1978 Honda Civic. I think my frustrations in high school were released in the Honda listening to Metallica and other similar music. Fast-forward to current day and Chopins piano rifts fill the air at my place with sounds that feel, dare I say, healing. My high school Humanities teacher, the late great, Mr. Rybarczyk, would be stoked to learn of me finally figuring it out and appreciating classical music. It just took my brain being slammed to figure it out.

Aromatherapy. Quoting University of Maryland medical center, “The smell receptors in your nose communicate with parts of your brain (the amygdala and hippocampus) that serve as storehouses for emotions and memories. When you breathe in essential oil and molecules, some researchers believe they stimulate these parts of your brain and influence physical, emotional, and mental health.” Lets be real, anytime you can stimulate your amygdala and your hippocampus, I think you’re in for good times. My friend Kylie brought over some frankincense oil one day and I began using it in a diffuser. I honestly don’t know for sure if it works, but it seems to have calming, relaxing properties and I don’t mind the smell. I figure if one of the wisemen brought some to the manger scene as a gift when Jesus was born, it has to be good for something, right?

Capturing a thought. A struggle throughout this injury is trying not to think about the pain and the downward spiral of thoughts and emotions that follow. During a visit with one of the shrinks I met, he challenged me to try something. He shared, “each time you have a negative or depressive thought, address it, acknowledge it and move on.” He emphasized not dwelling on it. I laughed when he told me, because it seemed like common sense, but then tried putting it into practice. It worked. It allowed my brain to quickly move on to something else that kept me out of the downward spiral of thoughts and emotions. I also began countering those thoughts with gratitude; thanking God for anything and everything I could think of. You can imagine how that would change your perspective even to the point of smiling and being joyful for what you have, where you’ve been and the journey you’re currently on. This leads to the next thing that has helped me tremendously; humor.

I found that keeping humor and laughter included in my daily life lightened my attitude, thoughts, and mood. I have a longtime friend named Paul from my high school days that sent me Far Side cartoons to keep me laughing, specifically through the more depressing, mentally challenging, tough spots in my TBI journey. At random times during the week, I received a text and these jokes would pop up on my phone and invoke a smile that had me laughing almost immediately. If you know Gary Larson, the creator of The Far Side jokes, you know he’s a good one. There are others that try, but personally, I don’t think anyone can touch his stuff. It’s like Seinfeld to comedy TV. People still try and make comedy TV shows, but Seinfeld is the measuring stick that all other shows are compared with. A few of my favorite episodes are Kramers adopt a highway, Vandelay industries and Shrinkage. “When you smile, you throw a feel good party in your brain. It activates neural messaging that benefits your health and happiness. The feel good neurotransmitters dopamine, endorphins, and serotonin are all released when a smile flashes across your face. This not only relaxes the body, but it can lower your heart rate and blood pressure.”

I’m going to try to throw a feel good party in your brain now.

Jokes:

A young boy enters a barber shop and the barber whispers to his customer. ‘This is the dumbest kid in the world. Watch while I prove it you.’ The barber puts a dollar bill in one hand and two quarters in the other, then calls the boy over and asks, ‘Which do you want, son?’ The boy takes the quarters and leaves. ‘What did I tell you?’ said the barber. ‘That kid never learns!’ Later, when the customer leaves, he sees the same young boy coming out of the ice cream store. ‘Hey, son! May I ask you a question? Why did you take the quarters instead of the dollar bill?’ The boy licked his cone and replied, ‘Because the day I take the dollar, the game is over!’

You know how catholics get holy water? They just take tap water and boil the hell out of it.

What do you call a dog with no legs? It doesn’t matter, it’s not going to come.

Two hunters are out in the woods when one of them collapses. He doesn't seem to be breathing and his eyes are glazed. The other guy whips out his phone and calls the emergency services. He gasps, "My friend is dead! What can I do?" The operator says "Calm down. I can help. First, let's make sure he's dead." There is a silence, then a shot is heard. Back on the phone, the guy says "OK, now what?"

Massage and accupuncture. This meant more awkward waiting room interactions in addition to all the other appointments I continued to struggle through. I remember being a few minutes early to a massage one day only to be graced with a conversation between Gertie and Hattie. I was somehow sandwiched between the two and it was clear they hadn’t adjusted their hearing aids and didn’t mind talking over, or, through me as it felt. My brain went to mush. It was barely the waking hour for most people and Gertie must’ve polished off a can of red bull for breakfast. “How did I get here?” I thought to myself. “Ah, that’s right, I’m here for a tuina massage.” Tuina is a chinese manipulative therapy using hands on body treatment including brushing, kneading, rolling, pressing and rubbing affected muscles. The practicioner used a variety of motion, traction and stimulating the acupuncture points. My brain injury caused constricting of my jaw, neck and back muscles. As soon as the masseuse put hands on my back she commented she had seen tension before, but this is another level. “Yeah”, I said “I’m hoping your hands can remedy some of that; lets get to it”. Initially there was only temporary relief, maybe a day or two, max. But, after a number of visits I began feeling progress. The clinic where I was getting massages done was in an oriental medicine graduate school where massage students were practicing along with an instructor next to them to help them hone their skills. There were three patients matched with three massage grad students and one Instructor. Each patient was separated by rice paper wall partitions, so the instructor could jump around and advise. During one visit as I sat in the waiting room, there was a guy in what looked to be his mid-twenties. I could tell by looking at him he wasn’t feeling at home in this setting. One of the female grad students opened the door and with a cute smile called his name, much to his delight. She introduced herself as Genevieve. As he stood, he blurted out “I really like your bangs”. “Dude, what?!” I thought to myself. If he had convinced anyone before hand that he had been to a masseuse before, he had just blown his cover. Even the guy scheduling appointments behind the counter looked up with his eyes, wrinkled his forehead, and cracked a smile while shaking his head side to side. Only a couple minutes later I was in the same room getting worked on. You could tell he had quickly developed feelings for her. The ohhh’s and ahhh’s he began oozing out as she massaged him were comical. At first I thought he was joking, but it didn’t take long to figure out he wasn’t. We could all hear it and it was obvious he wanted us to. Another masseuse jokingly commented, “hey, what’s going on over there?”, which was met by a few chuckles. Moments later, my masseuse had me sitting up and unbeknownst to the weird guy, we overheard him telling Genevieve, “I’m not sure about you, but I’m feeling a connection here I’ve never felt before”. I wanted to say, “dude, where are you feeling that?”, but I kept my mouth shut. I was cracking up and my masseuse was too. To her credit, Genevieve handled it professionally and shrugged off the comment. His massage was cut short and I overheard the instructor inform him he wouldn’t be welcome at their clinic anymore. Haha. The visits to the clinic loosened up my muscles and released tension and tightness that bothered me. I enjoyed each visit and the humor was a bonus.

The acupuncture was something entirely new to me. I had dry needling done for a back problem years ago, but never a proper acupuncture session. Initially, I didn’t notice any change, but after three or four visits combined with the massage work I was having done, plus some minor stretching, progress was evident. Being treated like a pincushion was interesting. I had needles in my toes, ankles, lower/mid/upper back, neck, and head. It was relaxing and it helped the tension throughout my body. Studies have shown acupuncture can help musculoskeletal problems, nausea, migraines, anxiety, depression, insomnia and infertility.

Over numerous points in this journey, I had my blood drawn to check for anything that might be of concern. One specific time I was asked to sit in a chair with a custom armrest specifically built for the purpose of taking blood. Impressive, I thought. I had seen the heavier set fellow in his official lab coat with his back to me when I was brought over to sit in the blood giving chair right around the corner from him. Knowing the medical field a little, I bet they shorten blood giving chair to BGC. “Send over this patient to the BGC and prepare them for a BSN (blood sucking needle).” Anyway, back to the fat guy. He had one other nurse in there with him as well. Since they hadn’t seen me led to the BGC, they didn’t know I could hear their conversation. He was asking her if she wanted to try the BSN on me. Albeit affirmative, I heard hesitancy in her answer. As he came around the corner and saw me in the chair, he started into some super convincing campaign about having me give permission to his nurse-in-training to draw my blood. Before he could go any further, I interrupted him and said, “what you’re saying is, you want me to give permission to this young nurse, who doesn’t exemplify any confidence or experience, to stick a needle in me and poke around until she finds a good vein? Nah, I think I’ll pass.” He laughed a short breath and replied, “I understand” and asked the nurse to watch him do it once more. I could tell by her deep interest in his procedure that sticking needles in people wasn’t her A-game. As he wrapped the rubber band around my arm, I slapped the inside of my elbow and made a fist once or twice. “No, no, no, Mr. Looman, we don’t need you to do that.” It was something I have seen in movies that invoked my actions, but I guess it wasn’t necessary. He sucked a couple needle’s worth out of me, put that cheap piece of cotton into my elbow crease and folded my arm to keep it there. “You can do the next one”, he said as he looked over at the nurse next to me. “Yeah, if they only knew what was coming from Nurse Pokerama”, I thought to myself.

Biofeedback.

Through a facebook page for people struggling with TBI, I met Carolyn. She found and read my first TBI article and was kind enough to reach out and encourage me. She also offered some insight on what had and hadn’t worked for the TBI recovery of her 13 year old son, Spencer. Spencer had been experiencing similar symptoms, headaches and frustrations. Struggling with the lack of help and knowledge the doctors were giving her, she had stumbled on Biofeedback. Biofeedback is a process whereby electronic monitoring of a normally automatic bodily function is used to train someone to acquire voluntary control of that function. In my case, this therapy was used to treat conditions, including migraines, tension, and chronic pain. Once approved and into the first therapy visit, it was apparent the muscles in my head, neck, and back needed to be trained to relax again. My therapist, a skinny Dutch guy with an accent and pleated dockers pants, helped me regain control of my brain and the connection to the muscles that were tightening without me even realizing it. With wires hooked up by small suction cups all over my back, we could monitor what muscles were firing involuntarily and address it with breathing, mindful relaxation, and exercises I could do at home between therapy visits. With time, the combination of biofeedback, massage/acupuncture, and breathing/stretching began to work and in turn the number of migraines I was having decreased.

Next up was a headache specialist that I had waited month’s to see. She began with various neurological tests; tapping my elbows and knees, rubbing her fingers together next to my ears, having me follow her moving finger with my eyes, etc. After passing most tests, she proposed an injection into the back of my head to try and localize where the headaches and pressure were coming from. If I experienced a change in the pain level, there was hope that treatment would be minor. The injection felt like a wasp was pissed at me. Unfortunately the painkiller she injected didn’t change the pain level, so she knew I needed to be sent on to a Physiatrist. “He gives the deep injections into the nerves along the back of your head.” “Great”, I thought. Just what I want is someone giving me an injection needing the guidance of an MRI machine to help steer the needle. If it meant relief of some sort, it didn’t matter. I was ready for anything. We waited for insurance to approve and I was scheduled to have an Occipital Nerve Injection.

The consult visit with the physiatrist, his protégé and a nurse was interesting. They probed the back of my head with their fingers to localize the pain. “This procedure has a pretty high success rate for your symptoms”, the doc said so fast I could hardly understand or respond. I then responded by asking why this wasn’t considered before now. The nurse dropped her chin a little and responded truthfully. “Look, I’m sorry you’ve had to jump through a lot of hoops. You’re not the only one. Insurance and western-medicine both require that you try a number of other things before you’re considered for this procedure. It’s sad really.” She understood my frustration and had obviously seen it in others that came through their office. After explaining the details of the procedure, she asked if I had any other questions. “Yeah, can I have a friend or one of your team photo document the procedure?”, I asked, not sure if I should grin or not. She grinned and hesitated. “I’ll have to ask and get back to you on that one.” I already knew the answer was no, but thought it would make a nice addition to this article. A week later, the procedure was approved by insurance and I was scheduled within days. Funny, nothing seems to happen within days unless they’re getting paid big bucks by you or the insurance company.

The day of the procedure I was calm. The nurse walked me back to a waiting room where there were three chairs for patients set against a wall. Ron, a stout and weathered looking man in his 50’s was getting an IV. The room had that sterilized smell. Even though I had declined the sedation, I was given an IV by the nurse “in case there were complications with the procedure”. I adorned that really cool hospital top, answered fifty medical questions and signed my name a few times. It became clear they were doing a series of injections one after another, starting with Ron, the guy sitting next to me. Turns out Ron has had back surgeries and horrible pain ever since. He was to receive an injection in his lower spine. About the time he and I began exchanging small talk, Harriet was wheeled into the room to join us. Harriet’s gray hair gave away her age. She spoke loud and had some sarcasm to her game. When handed the hospital top, she responded quickly to the nurse, “now you don’t want to see me without a bra, I’m telling you that much!” Ron and I shared a quiet laugh trying not to add a visual with the commentary. Harriet went through all the same questions they asked Ron and I, including the list of meds she was currently taking. As she began listing all of them off a phone started ringing with the most annoying ringtone and at an audible level that seemed someone had paid extra for. “Oh, is that mine?”, Harriet questioned, only seven rings into the call. Again Ron and I chuckled. The nurse leaned into me, smiled, and said, “this, is what you have to look forward to”. It was Ron’s turn and they walked him back to be sedated and begin the procedure. It seemed like only a couple minutes later and it was my turn. I went facedown on the table with my head nestled into the padded opening so I could breathe. Just like the masseuse, I thought. If only this was going to feel as good. The doc walked in and tried to make small talk by commenting on my tattoo. I could hear him stretching on some new rubber gloves. “Alright, so you’ve opted out of having the sedation, huh Daniel?” “That’s right. Anything to keep from having more meds pumped into me and feeling like shit for days”, I responded. The injection was deep and it did hurt, but I’ve experienced worse pain. The steroid they were injecting took a couple minutes. I could feel him moving around the needle and as he did, one of the nurses stroked my arm attempting to distract me. It worked. When the needle was removed, I could feel a large spill off the side of my neck, which was quickly toweled up by one of the nurses. They wheeled me into the next room where Ron was having his vitals checked. I couldn’t feel a difference in pain in the back of my head, but half of my head was numb. Weird. A fair-skinned, freckled nurse named Shannon checked my vitals and we somehow got on the topic of traveling. I think it was a good distraction on her part to get my mind off from what just happened. It makes sense. Anyway, Shannon’s family is from Ireland, but she doesn’t like Guinness. “Wait, what?” I excused her. She quickly interjected “But, I do like Harp beer”. “Alright, I’ll let it slide then” I responded with a smile. She offered me some graham crackers and cranberry juice, which sounded like steak and wine after not having eaten all day. She checked my vitals and released me within thirty minutes. It’s been a few weeks now since the procedure and I have noticed some improvement. I still experience pain, throbbing and some migraines, but not near as intense or as many. It’s as if the pain has been “muted”.

I’ve been back to the Physiatrist for a check up and was made aware that I can receive more Occipital nerve injections every three months if needed. For now, I continue with all the things that have helped me recover thus far and am slowly reintroducing the physical activities I enjoy so much, albeit with some pain.

I am grateful and indebted to friends that have prayed, brought over meals and books, and insisted on helping. If I am honest, I can say you learn quickly who your real friends are and the ones who disappear when you need them most.

I encourage everyone to fight, believe for good, and be vulnerable with those around you. A lot of times, it’s more about the journey than getting right to the destination. It’s in the journey that we sometimes experience pain and suffering, but they can develop into much more beautiful things if we let them. There’s a quote in a really good book I like that says “We should be stoked in our trials and suffering, knowing that suffering produces endurance, and endurance produces character, and character produces hope, and hope does not put us to shame, because we know God loves us”. Am I thankful that I have to go through all this? No. But, I am grateful for the ways I am changed; physically, mentally, emotionally, physiologically and my faith that has been strengthened as a result. My injury pails in comparison to what others deal with on a daily basis and my respect, appreciation and compassion are increased to encourage, love and pray more for those same people.