Sunday, April 20, 2014

Diet Dilemma

A year ago I weighed in the mid-150 lbs.  At 5'9" and post-menopausal, it fit my medium-boned frame quite well.  As the year progressed, my weight and I did battle.  The weight had the upper hand.  No matter what I did, no matter what I ate, the weight clung to me as if for dear life.  I was helpless at peeling away its grasping talons.

How could this happen?  Granted the effects of concussion did put a damper on my ability to exercise -- elevate my heart rate and my head began to throb and body aches were a constant companion.   Still, I did what I could.  Even started to work with a personal trainer who helped me through the difficult days and gave me a gentle home program to keep me active.  I also consulted a nutritionist who monitored my diet and suggested tweaks to help me lose weight. 

I've always been tall and slender.  Yes, peri-menopause and then menopause itself had bumped up my weight a few pounds but nothing as drastic as what happened when I started to take the Effexor.  My weight soared to 180 lbs and I freaked out.  I had to find a solution that didn't involve starvation or developing an eating disorder.  Bulimia just isn't my cup of tea.

One of the biggest problems was that while on the Venlafaxine I never felt full.  I was always hungry.  Not just, I'm a bit peckish hungry but okay, I know I just had dinner but I really need to eat hungry.  That is a tough one.  How to regulate what I was eating when I never felt satiated?

I stayed up late one night searching the internet for potential diets.  I finally found the Holy Grail- The Serotonin Power Diet.  This diet was designed with me - and anyone else suffering from the weight gain effects of antidepressants - in mind.  The premise is to boost levels of Serotonin in the brain so the body gets the signal that it's full.  The diet is extremely simple and it works.

Today marks one week on the diet and between the diet and the change in medication, I have lost 5 pounds and trending downward.  I can literally feel my body, MY body re-emerging.  It truly is spring.

Dare I Hope??

The days from hell passed and I finally saw the neurologist.  He switched me to a new med - Pristiq.   We talked about Topamax as a headache preventative but given I am still having some cognitive issues, he said definitely not.  One of the side-effects of Topamax is a problem with word recall.  I've got enough of that already, thank you very much.  So Pristiq it is.

As the neurologist described it to me, Pristiq contains the active ingredient of Effexor without all the other stuff that was causing the horrid withdrawal symptoms.  The downside - it's still patent protected so there is no generic substitute and the stuff is horribly expensive.  What price sanity??
Pristiq is weight neutral which means it doesn't cause weight gain, and it is often used to reduce body aches (another one of the charming Effexor side-effects - is that why they call it Effex-or?  Or, what??).  What did I have to lose?

I started taking it Thursday night.  Today is Easter Sunday and I can honestly say that today is the very first day since the accident more than a year ago that I haven't woken up with a migraine.  There was almost no pressure in my head and minimal when I went for a walk.  It's nigh on to evening and I can feel I need a dose but all in all, it's been a very very good day.  It feels great to be alive!  Dare I hope.....

The Gates of Hell

Back in the early 70s, in the pre-Glastnost days when the then Soviet Union was a major mystery and, to many, public enemy number one, I had a very progressive history teacher who felt a field trip would make for far better learning than the opinions du jour.  So we went, a 747 full of wide-eyed teens and cautious chaperones.  It was the experience of a lifetime that began and ended with a stopover in HEL.

HEL in this case was Helsinki.  At the time, the SU was planning their annual May Day celebration which meant a roll out of military equipment and might at the airports - something we were not allowed to witness.  So we had to land in Helsinki and travel by land, under the cloak of darkness to our destination.  It was a great journey into the unknown and one I will never forget.  When I returned home, I joked that I'd been to hell and back and had the luggage tag to prove it.  Little did I know...

Six weeks ago I decided I'd had enough of the incessant weight gain and dragging feeling brought on by Venlafaxine (Effexor).  I'd been on the stuff for a full year and quite frankly I was feeling a bit freaked out by the potential long-tern side effects.  I wanted off and I wanted off NOW.  So I mentioned it to my neurologist who set me up to wean off.  Rather than follow his instructions which would have meant tapering from 75 mg per day to 37.5 (the smallest prescription available), I leaned heavy on my chemistry background and decided I could titrate down to zero and thus avoid the heinous withdrawal effects I'd read about.  So much for theory...

Round about 18 mg/day, the headaches became insistent.  A swooshing sound filled my head whenever I turned, nodded, tilted, moved.  It was light so I felt it okay to continue to wean.  At 10 mg/day - my head began to pound.  Imagine a medicine ball, one of those small ones with the sandbag inside.  Whenever I would turn my head it as as if my brain were the sandbag smacking into the side of the ball, my skull.  Oy.  As evening approached, my ability to drive and orient became seriously impaired.  I barely made it the 10 miles from my friends' home to mine.  Okay, I thought, I'll tough it out. That night I went to bed without taking the next lowest dose.

The next morning I could barely get out of bed.  Vertigo had set in along with the swooshing and the banging.  I felt nauseous and completely disoriented.  The couch became my very fast friend.  If I lay very very still...  A trip to the bank was sheer hell.  I got lost and couldn't seem to orient or decide - home or run another errand.  I chose home.

Monday, I was on the phone to my neurologist.  He suggested I go back on the drug.  I was reluctant but what could I do.  I started at half a dose with the intention of weaning again.  I stopped at 22 mg/day.  The headache - pressure behind my right eye and throbbing in my right temple - became constant.  I felt it safer to simply stay at this dose to see if I would adjust.  Gratefully, I had an appointment scheduled with the neurologist for the following week.

Monday, April 14, 2014

A Good Night's Sleep

Years ago I read an interview with one super model or another proclaiming that her supposedly glamorous life was little more than the quest for a good night's sleep.  It figures.  To look her best nothing beat sleep.  Same can be said for recovering from a concussion.  Except it's not just for show.  To FEEL my best, reduce the throbbing in my head and the pressure behind my eye.  To wake up feeling like my brain is engaged, and yeah, to look like I'm at least partly human, I need 9 hours of uninterrupted slumber.  How often does that happen?  Now THAT is quite another question.



Saturday, April 12, 2014

Sit Down, Shut Up, Pay Attention

Generations of moms echo that phrase, some it seems almost ceaselessly, and with good reason. Locked inside the genetic code of every child is the ability to completely ignore mom’s admonition. But.. MOM IS RIGHT! (A big shout out to mothers everywhere!) Attention is EVERYTHING when you want to do anything.
How well I know.
A year ago I suffered a concussion as the result of an auto accident. The effects are still with me as my brain slowly heals. The biggest challenge – paying attention. My poor little brain gets oh, so distracted. Yesterday, for instance, I was driving home in rush hour traffic. I sat at a light through several cycles waiting to make a left turn. Now mind you, this is a very familiar intersection, one I cross many times each week. No matter the time of day, the cycle is the same — green arrow for left turn followed by green light for all but left turn. I’ve been there, done that innumerable times. Yesterday was the same. I waited through the cycles inching closer to the intersection until I was first in line to make a left turn. The light turned green and away I went… to the collective honking of dozens of horns. For some unknown reason this cycle there was NO green left turn only arrow. I was making a left turn into oncoming traffic. Gratefully, the mayhem of SUVs and minivans and cars all askew was soon behind me and I made it safely to my door.
What got lost in the equation was my attention. I’d dropped my guard – so easy to do with a brain injury – and gone into auto pilot relying on habit instead of full attention. It was a wake up call for sure and a not so subtle reminder of that eternal mom telling me to, “Sit down, Shut up and Pay ATTENTION.”

Oh, My Aching Brain

One thing I've learned through all this is that brains heal very s-l-o-w-l-y.  I'm anxious to get on with my life but my brain more often than not stops me dead in my tracks.  It has other ideas and those are all quite self-absorbed.

Me:  Come on Brain, enough already.  I've been pampering you for a whole year.

Brain:  Ha.  You call that pampering?  If you really loved me you would have taken the year off, gone to the beach and focused on me.

Me: So it's all about you?

Brain:  You're helpless without me.

Me:  And sometimes pretty helpless with you!  Cut me some slack.

Brain:  I need more sleep.

Me: I gave you 9 whole hours last night.  Talk about ungrateful.

Brain: I need 9 hours EVERY night.  You've been neglecting me.

Me:  Sigh.  What's a mother to do?  I've got work, Chicken Little and don't even mention keeping up appearances.

Brain:  I've been meaning to talk to you about that.  When exactly do you think you'll fold that pile of laundry?  Hopefully before you do more.

Me:  Now.  I'll do it now...  (grumbling to self) You want more sleep then nag me because the housework isn't done..... ungrateful... grumble grumble...

Friday, April 11, 2014

Barbie Brain or How to Become a Dumb Blonde in One Easy Lesson

Wham!  The jolt of a car slamming into the back of my minivan grabbed my attention.  After a shock of expletives, my first thoughts were of my daughter riding in her wheelchair in the back.  Looking, she seemed okay.  I phoned 911 and followed their instructions...  A trip to the emergency room the next day confirmed that my daughter was a-okay while I had suffered a mild concussion.  Mild?  I could barely keep my head up and the entire right side of my face felt as though it were melting.  An objective glance in the mirror confirmed that Salvador Dali had just added the right side of my face to his "The Persistence of Memory."  Ah, yes, memory.

In the days to come, so many givens seemed to slip through my brain.  I found that I was unable to write cursive or keep more than one numeral or letter sequenced at a time.  Filling out the accident report was a challenge and taking down a phone number became a near impossible mission.  I couldn't put names to objects, tolerate anything requiring a screen, or bring into focus anything that required a depth of visual concentration or higher processing.  In short, I found myself slipping into the realm of the dumb blonde - unfocused, absent minded, drifty, flighty, ditzy, irrational, impulsive.  Adjectives I would never have used to describe myself.  Until now.

What was that?  What WAS that?  What was THAT?  Three days later, I got my daughter off to school and commenced vomiting.  My head was a total fog.  The ghost in the machine was pressing hard against the back of my right eyeball clambering to get out.  My right temple throbbed.  I lay on the couch wondering if a short nap would revive me enough to see clients in a couple hours.  I spun the notion round and round until the phone rang.  It was my dear friend, Margaret, calling to check in, see how I was doing.  A gave her an update and agreed to cancel clients in favor of rest.  Rest didn't come.  I lay drifting - this must be what the Buddhists describe as an empty mind.  Thoughts floated through but nothing stuck.  I kinda liked it.  Not productive but I didn't feel worried or concerned.  I was observer and observed and there was no judgment.  Only awareness and observation. 

My eyes landed on a large bamboo bowl.  I wondered what it would look like if it were tea stained.  Oh, let's find out.  I was in the middle of daubing the bowl with strong black tea when Margaret called back.  She was soon at my door to escort me to the hospital.  I was checked in and after a battery of tests, said concussion was upgraded (or downgraded depending on your point of view) to moderate.  One of the consultants asked me to describe what I do for work.  I mustered my inner Mr. Rogers, "Now boys and girls..."  He was impressed.  Probably one of the simplest descriptions of the Feldenkrais Method I've ever given.  He pronounced me fine.  I could only think, "If this is fine, I'm in BIG trouble."  Ever the overachiever, super student, geek, nerd, what have you, I'd finally achieved average.  So THIS is what life is like for the rest of the world.   It gave me an appreciation for those not so quick to grasp a concept or run with an idea.  It also angered me that someone who didn't know me from Adam could say I was okay.  OKAY?!!  Okay isn't okay enough.  I wanted MY brain back.  And then I slept and slept some more.

Self-supporting, I had to get back to work.  I cut back my hours, juggled my schedule and rallied my energies to focus on my daughter, my clients and sleep.  Housework became a faint memory.  Bookkeeping? Taxes?  Chairing the Conference Programming Committee?  Oh, my.  I did what I could and learned the ever useful skill of delegating the rest.  Who says old dogs can't learn new tricks.  Clients wanted to talk, to find out what had happened.  I gave them a choice, "We can talk, or I can work.  I can't do both."   Somehow, my newly quiet brain - the eye within the neuronal storm - gave me greater depth in my work.  I felt more, became more deliberate in my lessons, and slowed way, waaaaaay down.  Another positive.  At least I hadn't lost my perpetual optimism.

Driving was interesting to say the least.  I dove into visual and auditory overload and became ever so easily distracted.  Oh, there's an interesting building...  "Look at the road.  Look at the road."  I had to keep reminding myself to focus on the task at hand.  I took to taking back roads with little traffic and stopped all but essential nighttime driving.  My range was greatly reduced and I felt a nagging urge to take my half down the middle.  Aaargh.  I'd become my mother!

After a month of subsistence, a client connected me with a wonderful neurologist who finally helped me to understand what was going on.  The fog that pressed in all around, the spaciness, the inability to focus were all a form of migraine.  "Most people," he told me, "think of a concussion as bruising of the brain caused by the brain hitting against the inside of the skull.  But that's not it at all."  He explained, "Think of the neurons of your brain as a bundle of wires, each with its own insulation.  As long as that insulation is in place, messages go through clearly.  But strip away the insulation and let the wires touch and the messages get scrambled.  That is what's happened to you.  The trick now is to give your brain the opportunity to heal the insulation without learning that these migraines are "normal".  Never a fan of big pharma, I was grateful for his bag of magic potions.  For the first time in more than a month, the veil seemed to lift if even for a short period. 

I was nowhere near back to normal, or my semblance of it, but I felt I was on the path.  The time between episodes of foggy brain and pounding head lengthened.  I slowly began to tolerate more than momentary glances at my computer, cell phone, etc.  I could listen to people talking and actually absorb some of what they were saying and retain some of the content.  I could once again identify a paper towel out of context, balance my checkbook and spell fruition.  I also found I was more able to take to heart the core of the Feldenkrais Method - learning to learn.  I began to challenge myself.  Could I stand on one leg?  No.  What if I stood with one foot on the floor and the tips of the toes of the other foot?  Yes.  I could do that.  Could I stand with my legs crossed.  What was that lesson?  Shift weight, heel toe, heel toe.... I began to make up mini-lessons increasing their complexity as I went along.  Backing off when my vestibular system yelled, "ENOUGH!"  I see another practitioner for lessons that help me release the physical memories of the accident - a seatbelt here, braced foot there - and replace them with greater ease and mobility.

Now a year later, I continue to heal.  I continue to play with possibilities.  Sure, I still don't multitask very well but I am far and away more adept at handling life than during the early days when I could either fix lunch or breakfast but not both at once.  I can brainstorm without setting off the internal lightening storms.  I have even re-engaged with a long standing project.  The concussion taught me very quickly that I didn't have to be super mom, super woman, super anything.  Back in the days when reading the menu at Starbucks took more energy than my short little attention span could muster, I simply let people know that I had a brain injury and would they please be patient.  Honesty in this case was the best policy and I learned the oh so valuable lesson that assistants make life so much easier.  It's meant a bit of financial juggling and developing a greater tolerance to dishes in the sink but I am coping and doing so much better.  So much better in fact that feeling more and more stable with barometric changes, I recently weaned off one of my medications.  Today, I started back on.  Incoming snowstorms gathered in my head and the pulsing in my temples said, "Easy girl.  There's no shame in taking care of yourself."  Meds are the least of my worries.  I write this through the throb of a migraine and wonder, "Will I ever be able to get on a plane again?  What does this sensitivity to pressure mean for my dreams of traveling, working at other trainings, attending seminars, visiting friends."  Gratefully, the lack of concern has stuck with me and I shrug my shoulders and think, "It's Saturday.  My daughter is with her dad.  The sun in shining.  I'm going to take a walk."  Life as a dumb blonde has its up side.  Now when do I get the dream house and that flash pink convertible..?