Migraine Journey

Since the brain injury, migraines are a major problem. For the first year, I suffered a constant headache, with attacks of migraines 3-4 times a week. The neurologist started me on Topomax to reduce the frequency of the migraines, after I failed the trial with the medications that lower blood pressure. Passing out at work was not a good idea. My blood pressure dropped too low. Next up: Topamax. It helped reduce migraines to 1-2 a week but at a price. I had significant neuropsychological side effects. My processing slowed, I started losing language, my hands and feet tingled. At one point, a friend was concerned I had early dementia. Let’s try something else.

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The next medication is Verapamil. I started at 120 mg without much improvement. I am now taking 180mg with moderate improvement. Last time, we added a natural supplement: Petradolex. It is butterbur root. Supposedly, it helps maintain the firmness of the blood vessels in the brain. On the third week of the trial, I went an entire week without a migraine! Woot!

The neurologist also wrote a prescription to return me to Maxalt, as he did not think the Immitrex was managing the migraine pain. I began the process of getting the VA to approve a non-formulary medication (Maxalt). Well, it’s not as easy as a letter from the neurologist. I haven’t tried Zoamig yet. So, the VA started me on a trial of Zomig.

Too early to celebrate not getting migraines. On the eight day, I was visited by ghosts of migraines past. Very angry and painful ghosts, they were. I went home, took the new migraine medicine, anti nausea medication, Aleve, and crawled into bed with a cold pack on my head and a warm cat curled in my back. Four hours later, I wake up. Dizzy, nauseous, but no pain.

I feed and medicate Tosca, then clean all the litter boxes. Kaliyah and Bobby come out to play. I laid on the couch and watched the chaos. About 9:00, I go to bed.

Tuesday, I wake up feeling disconnected, woozy, and extremely sensitive to any sensory stimulation. I go to work. Thankfully, I have a graduate intern who is assisting in one of my groups. I was so sick, I had trouble comprehending the lesson up for discussion. J led much of the discussion that day. I went home at 11:30. Took medication, and crawled into bed with a comforting kitten. I wake up at 5:00 and follow the routine of caring for the ferrets and playing with them for a few hours. I crawl back to bed at 9:00.

Today, I woke up feeling good, although a bit drained. Good! Maybe the migraine is finally gone. I do well all morning. About 1:00 pm, I get an aura. Flashing lights, gray areas in my vision. Not good. By 1:30, I was medicated, curled into bed with a cold pack and warm cat.

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So, it’s now 8:30. The ferrets have played, litters boxes cleaned, Tosca fed and medicated. No pain right now, just a feeling of absolute exhaustion.

I’m not sure the new migraine medication is working. I think this has been the same migraine, returning from the prodromal stage to cause pain.

I just hope tomorrow I am totally migraine free. This has been an exhausting three days.

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Keeping hope.

Different Meanings

I had a conversation with a non-runner today. It was obvious we were not on the same page from the start. What does “short” mean to you?

Coworker: “I saw you running with your dog yesterday. How far did you go?”

Me: “Not far. Just 3 miles.”

Coworker: “Three miles!!! That’s a long run!”

Me: “Uh. Not really.”

I was trying to figure out if he was serious or trying to make a joke. He was serious. I should have known. It is a reaction I have seen in the past. This individual was also shocked that I have a TBI and can run three miles! He made a comment that I can’t be hurt that badly. No, I just work that hard. It took a lot of sweat, blood (literally), tears, pain (migraines), and vomit to be able to run again.
But, this is a humorous post. My serious one will be later.

Marathon runners define distances differently from other mortals, even other runners. Here’s a helpful guide.

Very Short Run= Under 4 miles. Very Short Runs are done grudgingly, usually when injured. In the week following the marathon, these are known as the “victory shuffle” or “the next marathon is in 4 months, I have to train” miles.

Short Runs= 4-9 miles. Short Runs are done for recovery from Long Runs. Or when you don’t have time for a “real run.”

Moderate Runs= 10-14 miles = Cruising. On a Sunday Afternoon. What a nice distance. Love it. This is a “real run.”

Moderate Long Run= 15-18 miles This is the work distance. A long time on your legs and starting to learn about blisters, fatigue, mental chatter, hydration, and planning where to find a public toilet….. Another “real run.”

Long Run= 18-23 miles. Work, work, work! More blisters, mental chatter, and starting to question your sanity. Why do I run marathons? True dedication. Real running happens here!

Fartlek: Despite the funny sounding name, this does not happen in the Port-a- Potty. This is a particularly noxious twist to a run, where a crazed individual runs sets of distance at accelerated pace during the run. For example, the runner might run at training pace for 2 minutes, then accelerate for thirty seconds. They repeat this throughout the workout.

Intervals: Running like someone with an axe is chasing you, usually on a track. This is done using a stopwatch, so you know how long you’ve suffered. It is a form of speed work to improve you’re aerobic conditioning.

Tempo Run: Running with headphones while listening to Leonard Bernstein conducting the New York Philharmonic. Or running at steady pace at 70%-80% of your max aeorbic conditioning, to build up your lactate threshold.

That’s how to understand your marathon runner.

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A Long Absence

I haven’t been blogging recently.  I went through a time where I withdrew inside.  Acceptance is a process.  Recently, I have been struggling with accepting the outcomes of my brain injury.  I keep improving, but so slowly.  Meanwhile, it seems like life is moving by at warp speed while I struggle along on impulse power.  “Captain, she’s nae firin’ on all thrusters!”    I think that really describes how it feels in my head sometimes.  Things come at me so fast that I struggle to keep up and comprehend what I need to do.

This weekend marks a step forward.   Although I struggled with pain, fatigue, and nausea, I continued my training for a half marathon.   The Missoula Half Marathon on Sunday marks the first race post-injury.  Really, I expect to walk a fair amount of the race.   The longest run I managed to complete was 8.5 miles.  That is a respectable distance.  I paid a high price in migraine and nausea.    However, it strikes a huge change in my previous running experience.  Two weeks before the accident, I completed the Yakima Valley Marathon, setting a personal record on the course.  I miss being able to lay down those long training runs and races.   They are a challenge, mentally and physically.   Completing the training cycle and race marks significant dedication to the sport.  It doesn’t matter how fast (or not) you run, if you complete a marathon, that’s an accomplishment!  For some reason, the longer runs trigger my symptoms.  I think it has to do with fatigue and repetitive motion.  Running is a physically difficult sport.  It involves all the senses and I often find myself struggling with sensory overload issues as I run longer.  It is encouraging that I can run around 5 miles on a good day fairly comfortably.   The first 2-4 are usually easy miles.  Maybe, over time, I’ll recover enough to marathon again.

So, this Sunday is a halfer (13.1 miles).   I ran the Missoula Marathon the first year they held the event.  I went the whole 26.2.  The course is beautiful.  There’s a few hills to make it challenging but there’s good course support.   The half course doesn’t have the toughest hill of the full.  Yet, there’s still some good scenic areas.   It will be good to put myself out there and try to run a half.   I wish I had the shirts.  I tried to design a shirt for the race about TBI Awareness.  I didn’t like any of the designs I came up with and ran out of time.  I plan to keep trying to come up with an idea.  I want to make shirts to sell to friends, with the profits going to Brain Injury Association of America.

Wish me luck for the weekend!  Race report to follow!

 

Day Two

Today was a new day in brain injury recovery.  I was not scheduled to work today.  It was a “chore” and therapy day.

To start, I woke up at 8:30, to my favorite ring tone, “Lazy Day.”   I drove out to Bennington Lake and went for a  run.  The morning was beautiful.  The sun was shining, a light breeze blowing, and the day smelled of early spring.  It was a nippy 43 degrees.   The farmers were out, preparing for spring planting.  Birds sang their love songs and flew to and fro, gathering nesting material, and preparing for mates.  The run went pretty well.  I still struggle with pace and stamina.  Prior to the injury, I ran between 8:00-8:30 minutes/ mile on this route.  Now, I plug along at 9:30-10:00 minutes/mile.  It’s no longer an easy run.  I rate it as the hardest route that I can finish right now.  After the run, I rested in my car, drinking water.  Then I drove home and took a quick nap.  Running is part of my physical recovery assigned by my doctors.  It works on my balance, physical stamina, and vestibular issues.  It also helps keep me sane.  Running was a major part of my life, before injury.  I would not do as well if I wasn’t running again.

After I woke up, I went to the gym and worked with my trainer/ physical therapist.  Mainly, the workout was upper body strength, core, and balance issues.  Weight lifting was part of my fitness plan before injury.  It, too, was added to my therapy as soon as it was safe.  The gym also works on sensory stimulation issues.  I wear a hat and sunglasses to help reduce some of the stimuli.  However, there are days the sensory issues are the hardest part of the workout.   I was exhausted at the end of the session.

I returned home for a shower and another nap.  Brigid was happy.  Two cuddle-naps in one day!  Heavenly!  Each time I awake, I receive purr therapy.  Ah.  That makes my day.

After the nap, I realized that I had not eaten since my Cliff Bar before the run.  It was now almost 1:00 pm.  I rolled out of bed and decided I wanted a good omlete at Smith’s.  Lobster omelet with tomatoes, cheese, and chili sauce, fresh fruit, and some hash browns.  I was quite hungry and almost managed to clear my plate.

Now, it was time for my “homework” from cognitive therapy.  I played several rounds of timed puzzle games on my computer.  I can’t finish the first levels yet.  But, when I turn off the timer, I can.  I also worked on written word finding exercises.  Now, it’s time to work again on my peripheral vision and eye exercises.  Mainly, I move my eyes between to points, track a moving target, and work on moving my head and eyes more as I walk.   A hard variation is to work on head turning and eye movements while running on a track.  When running on the road, I have to be very careful at crossing roads.  I can manage to turn my head a couple of times without too much problems.  But, if I turn it too many times or too fast, I get dizzy and/or nauseated.  With peripheral vision, I work to “notice” more things to my sides.  One exercise is tracking a cat teaser moving across my field of vision while keeping my head straight.  The idea is to notice it sooner on the sides.

Brain work is physically tiring.  After my afternoon homework sessions, I meditated.   As I was mentally tired, I used deep breathing and body awareness meditation.  Imagery was difficult for me before the accident.  Now, I can only visualize very simple things, for a short time period.  For example, I can visualize a colored number for about 20 seconds before I lose it.  I work on visualization skills as well.  It makes a good concentration exercise.

After meditation, I chilled out and watched some afternoon TV.  I napped briefly on the couch.  Yes, nap number three.  It was only a half-hour.  Then, I remember that I needed to get some things from the store.  I grabbed my smart phone, which has my list on it, then off I went.  Shopping was stimulating. There was a lot of noise and light today.   I ended up getting what I needed immediately and left off the other stuff for later.  I returned home.

My friend stopped by after work to help clip Brigid’s toenails.  She was not a happy kitty.  We both got “told off.”  She is a very expressive kitty when she so chooses.  My friend had to hold her in a scruff and immobilize her front paws.  We got the deed done.  Unfortunately, kitty also needed a bath.  Her comes kitty Cuisnart.  And one throughly wet and ticked off cat.  The bath complete, we left a wet, disgusted kitty grooming herself dry, and went to eat.

My life revolves around recovery activity.  The brain injury impacted my life in ways I still don’t fully comprehend sometimes.  Yet, I see improvement every month.  Recovery isn’t a sprint, it’s a marathon.  Slow and long.  But, recovery happens.

Today was a good day in terms of headaches and activity.  I rested often.  However, I did not get a migraine.  Migraines are a frequent occurrence in my recovery.  Currently, I get around 2-6 a week.  Unfortunately, prevention medication lowers my blood pressure too far.  So, I have to work on trigger elimination and treating the migraine as soon as I recognize the symptoms.  I think the frequent rests helped.

This is one person’s day in recovery.  Every brain injury is different.  Every brain injured person has different symptoms, different problems, and different strengths.  I am ahead in my physical recovery.  But, my cognitive and vestibular issues continue.  Others don’t have the same physical recovery I experienced.  Please find out more about brain injury.  It may make a difference in your life, the life of a friend, or the life of someone you love.

Rooks Park.  The trail around Bennington Lake is on the

right hand side.

Brain Injury Awareness

Anytime, anywhere, anyone.  Brain injuries don’t discriminate.  Every year, 1.7 million people suffer brain injuries.  Yet, it is a mostly silent epidemic.   Often, the injury and ongoing symptoms remain unrecognized.

The severity of brain injury is described in three categories: mild, moderate, and severe.  The assessment of severity is made at the time of injury, using physical exam and the Glasgow Coma Score (GCS).  The GCS measures the response in three areas; eye-opening, verbal response, and motor response.  The total score possible is 15.  In a mild TBI, the GCS is 13-15; moderate 9-12; and severe 8 and below.  The severity of the injury does not necessarily indicate the level of symptoms and ongoing disability a person can experience.  Even in a mild TBI, it is possible for someone to have ongoing difficulties in function.  However, usually the person recovers full function.

Symptoms of TBI

Mild:   headache, fatigue, sleep disturbance, irritability, sensitivity to light and/or sound, balance problems, decreased attention span and/or concentration, decreased speed of thinking, memory problems, depression and/or anxiety, and emotional mood swings.  Loss of consciousness is not necessary.  People with mild TBI generally recover fully.

Moderate:   The symptoms of mild TBI are present in moderate injury.  A moderate TBI occurs when there is a loss of consciousness that lasts over 30 minutes.   Confusion lasts from days to weeks.  Physical, cognitive, and/or behavioral impairments last for months or are permanent. People with moderate TBI generally can make a good recovery with treatment and successfully learn to compensate for their deficits.  Some may make full recovery.

Severe:  In severe TBI, there can be a loss of consciousness for days, weeks, or months.  Severe TBI is broken into subgroups, depending on the symptoms.

Head injuries can either be open (fracture or displacement of the skull) or closed (no fracture or displacement).   There are six types of skull fractures associated with head injuries.  Each type of fracture can cause additional medical issues.  With closed head injuries, the swelling in the brain can press against the skull or into the sinuses.  This also causes an increase in intracranial pressure, the pressure within the skull.  Swelling and pressure within the brain can be life threatening.

Causes of TBI

According to the Centers of Disease Control and Injury Prevention Center, the leading causes of TBI are: falls (35.2%), motor vehicle accidents (17.3%), struck by or against (16.5%), assault (10%), and unknown/ other (21%).   The hallmark injury of the wars in Iraq and Afghanistan is Traumatic Brain Injury.  The most frequent cause is explosions, either IEDs or mortar fire.

Outcomes of TBI

Brain injury can result in a number of different outcomes.  Every year, 52,000 people die,  275,000 are hospitalized, and 1,365,000 are treated and released from Emergency Rooms.   I was treated and released.  However, I later went on to develop more serious symptoms.  If it weren’t for the intervention of my friends and co-workers, my recovery would have been greatly complicated.  At one point, I had let water boil on the stove until it was mostly evaporated.  Any brain injury needs to be taken seriously.  The injured person needs a watchful support network to help improve recovery and safety.

The long-term outcome of TBI varies by individual.  It ranges from complete recovery, to severe disability, to death.  Often, individuals will be fully functional but may have some continuing symptoms.   Even in mild TBI, ongoing symptoms may be present.  The most improvement of the injury occurs within the first 18 months post injury.  It is vital to protect the individual from additional head injuries during this time.

Repeated head injuries

Repeated mild TBI can result in significant  long-term neurological and functional deficits.  The majority of the research conducted in this area has been in athletes in football, boxing, and soccer.  Numerous studies of boxers and football players have uncovered a form of dementia caused by repeated mild head trauma.  In addition, lower responses in neuropsychological function and slower healing from progressive head injuries have been noted.  Difficulties in the visual cortex and balance have also been noted.  Healing from progressive head injuries may leave permanent change in function.

Impact of head injuries

Head injury not only affects the injured individual but also the families, friends, and communities.  Depending on the level of disability, the individual may require continued speciality care.  The victim may never recover independent function.  Families, friends, and the individual must grieve the losses and discover a new way to live.  Even in mild TBI, the individual may have permanent mood, mental, or emotional changes.   The individual must adjust to the “new normal” of life post-injury.

Brain injury is unpredictable.  Each brain injury is different and the impact on the person varies.  Our brains impact who we are, how we act, how we feel, how we think.  Injury can change everything.  In one second, my life changed.  The long-term outcome is still unknown.   The unknown is the most difficult part.

Take time to learn more about Traumatic Brain Injury during March.  The information may change your life or the life of someone you love.

Resources:

The information in this blog was taken primarily from the Brain Injury Association of America website, available here: http://www.biasua.org   The BIAA website contains a wealth of information and links. 

The information about repetitive brain injury was taken from MedScape: Repetitive Brain Injury Syndrome by David Cifu.  Available here: http://emedicine.medscape.com/article/92189-overview

Other useful resources:

Mayo Clinic: http://www.bing.com/health/article/mayo-MADS00552/Traumatic-brain-injury?q=brain+injury&qpvt=brain+injury

Centers of Disease Control and Prevention: http://www.cdc.gov/TraumaticBrainInjury/

Defense and Veterans Brain Injury Association: http://www.dvbic.org/