Health

Concussion Recovery is a Series of What are my Priorities?

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Slide of graphic of man looking into his head. From Healing the Brain conference.

As I come out of the narrow, tortuous pass that is a life focused on treating brain injury and the subsequent PTSD, I’m faced with the big question: what are my priorities?

The first time I said bye to focusing on treating my injured neurons, I hunted for the supports I needed to be functional. That was my priority then.

“T1: To me “treating the whole person” is about discussing how care plans fit into the patient’s life and GOALS vs. the patient figuring that out later in a vacuum. #patientchat”
http://twitter.com/btrfly12/status/956952160234868741

As I begin writing this, I’m also scrolling through Twitter #patientchat; one person tweets that it would be nice if the physician discussed how care fits into the patient’s life and goals.

It would be!

Up until 2013, for me, my life goal was getting back to my life. Oh, I knew I was writing differently, I probably couldn’t return to computer programming, and writing was the only thing I could realistically do with my fatigue and propensity to suddenly not be able to work for long stretches. But somewhere in me, I believed I could return to “normal.” Return to working several hours a day. Return to normal socializing. Return to earning an income. Return to never having to attend another fucking health care appointment.

Then life and PTSD gave me a rude wakeup call. I had to refocus on health care appointments and also religiously treat my injured neurons at home just so that I could get through the day. That went on for years until a confluence of treatments in 2017 finally slayed the chaos in my brain. Ruminations like a hamster in a steroidal wheel slowed then almost faded away.

I resisted then finally acquiesced to the knowledge that my PTSD was not going to be treated in any curative way (some day I’ll write about why people with complex PTSD aren’t getting better and life is a daily struggle to keep functional and nights a nightly hell of tossing sleep). Then this past Christmas, I tired of treating my brain injury too.

I quit.

Yeah, okay, I’m still attending my brain biofeedback and I continue reading rehab with my neurodoc and I use my home devices just enough to keep pain of every kind at bay and my body ticking along as best it can. But I’m not doing any homework. I’m not thinking anymore about how to work on this part of my injury or that part. Any thoughts on brain injury and treatments are to keep my book blog pages updated. And I’m not working at all on treating my PTSD. It is what it is.

I want to get back to normal life, what I now define as: a day not consumed by health care.

But what do I want to do? Write novels for myself. (No one is buying them and I’m not made of money to spend on taking them to the final published book form so once I write the first draft, what’s the point of revising and editing.) Philosophy of Mind requires me to read. A lot. And really hard stuff. Well, that’s not going to happen. I didn’t get the professional help when it would have made a difference. (Health care professionals are so focused on what they do and what the average is for this function or that that they miss the rare opportunities to radically help their clients.) On the other hand I learnt of the video courses on the Great Courses Plus app, which I’m wending my way through very very slowly. I enjoy photography but can’t seem to dedicate time to it and haven’t been able to in years. I can design and create websites, though it’s on/off, sucks me dry of any energy, and oftentimes feels like there’s a thick concrete wall between me and understanding the back end of a website where all the coding takes place. I can help people with brain injury, like I did last November with NaNoWriMo and like I’m trying to do with Concussion Is Brain Injury, as long as I have energy and don’t have to do it for longer than a month at a time. There are other things I’d like to do. Cooking would also be nice; to make myself yummy nutritious meals without the energy suckage would be awesome.

I return to the question: what are my priorities? I don’t know.

Books

Back in the NaNoWriMo Noveling Saddle

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Last night at midnight, I joined my fellow Wrimos in the insane endeavour of starting writing a novel when one should be asleep!

It’s been too many years since I was ready to write, excited to write, able to join my fellow Wrimos at midnight on my computer. Since 2013, it’s been an exercise in desperation to be ready, to be able to overcome the chaos in my brain and the emotional shock of life events to throw myself into starting, never mind writing every day during NaNoWriMo. Some Novembers, I seriously wondered if I’d make it to the end of the month or get anywhere near the 50,000-word goal. Last year, the eye surgery added an additional complication because the general anesthetic temporarily screwed up my writing and the surgery improved my vision so dramatically, I was still adapting to seeing text on screens. I think I had to write on my iPad because the computer display with the way it required my eyes to track greater distances side to side than the iPad made me dizzy as heck. I have no problem now!

This year I want to get back to where I was in 2012: 30 chapters; writing every day; maybe blogging on it too. We’ll see about the latter because I need to regularly type some C++ code (from my lessons to make it easier on me) so that I can keep in the head space of my main character. I’ve set a goal of only 10 minutes per night of working in Visual Studio 2017 so that I won’t tire myself out toooo much. We’ll see.

But however this month goes, it feels good to be back to where I was in 2012 before events threw me off the track of my life. (To read the details of that, see my book Concussion Is Brain Injury: Treating the Neurons and Me.)

Brain Power

Sixteen Years Since my Brain Injury 

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So. My 16th anniversary of the car crash that scattered my life into ashes is now. That crash didn’t only give me a brain injury, it also led to events that gave me PTSD.

From my experience, PTSD is a monster that feeds on the worst of human thoughts and beliefs and lifts up a magnifying glass to aim those thoughts and beliefs at the person who has the least power: children, women, the injured, the sick, the marginalized.

Fear partners with PTSD.

Fear incubates itself in the powerful, the doctors, the therapists, the healthy family members, friends, church congregations, who know the injured one, and wraps its tentacles around their hearts, whispering if you deny, if you leave, you will be safe from that person, you can believe nothing bad happened to them, it’s only depression and their refusal to take drugs that makes them so unwell. And the PTSD screams in delight when the people who say words like we’re there for you, we support you, we won’t quit on you then criticize, judge, deny, refuse to take phone calls or emails or texts.

And leave.

Or make you quit.

By driving you, the person with the PTSD, to quit proves to all that you’re the unwell one. It allows the “healthy” ones gripped by hidden fear to feel comfortable in their pity and sympathy for you, safe from having to repent — change their minds — to upheave their assumptions so as to give you a rock to stand on and heal from.
I mean, who wants to be a secure rock for a greatly suffering person, anyway?

Hidden fear influencing their thoughts, their beliefs, driving the person with PTSD to quit, to be alone, puts all responsibility for your pain and maybe self-destruction on you, the outwardly suffering one.

Destruction of human relationships, whether it’s familial, friends, strangers, or health care professionals is PTSD’s incubator and baby.

I tweeted out my feelings but not too much.

I was unwilling to reveal how my relationships have gone since my brain injury, and the toll on me has been horrible. I have been minimized, betrayed, abandoned, judged, criticized, derided, dismissed, disrespected, unhelped. It is no wonder I have PTSD.

The wonder is I’m still alive.
In spite of all that has happened to me, I am still here. But I can only remain here if I vomit out the toxic brew I’ve been living in and with since 2000. When I very recently began to leak out the remnants of my broken heart like putrid streams of bile, my physical heart rate began to stabilize at 100 — although two weeks at 100 is not really stabilization. But it will not continue to improve unless I write.

Back in 2012, I wrote a book on brain injury but left out the crucial social and relationships aspect of it. Yet the broken links between us and all the people whose lives we used to be in, is what destroys those of us with brain injury. How health care professionals ultimately don’t allow us to express our grief and our worst thoughts and how they don’t actively treat brain injury like they would cancer or heart attacks, is what slowly decimates us over the decades. New friends come and go; those who stay cannot fully understand the depth of our grief, having not known us before brain injury. Yet that very fact is what makes them much better friends than our old ones who abandon us to our daily lives. New friends accept us; old ones, with the occasional, mature, loving exception, do not. 

The same hidden fears in 2001 that grew my PTSD, perpetuates into today like a perpetual-motion hamster wheel, despite my neurodoc’s heroic but futile efforts — futile because he will not use 21st century methods to keep on top of my complicated case and allow me to fully vomit the poison driven into me in the only way I can fully — private email and texting — because seemingly his 20th century methods have served him well. And, like my family, he doesn’t seem to want to change, in his case, his belief set as to what constitutes medicine.

And why should he?

He’s a rare breed; few specialists of his type are in practice. Patients have no choice who to see — if they can get in. He does. Patients have no choice in how much care they receive. A little is better than none, right? He does have a choice how much to give. And so he has all the control.

But at least he initially did better than the string of failures by other health care professionals. He began to succeed partially, but backtracked on his promises, breaking my trust. Then in this atmosphere of trust blowing away like sand, critical forces rose back up to deny the reality of my physical limitations and crushed the one kind person’s optimistic and realistic perception and attitude toward my brain injury and its effects on me. That person is backtracking on their backtracking.

I have metaphysical whiplash from all this backtracking by people purportedly there for me.

I’m being obtuse. That’s because I really don’t want to talk about it, yet I knew that my book on concussion was missing a critical component, one that is the main reason people with brain injury end up not reaching their potential but remain sidelined outside of society, trapped in a perpetual loop of seeming to recover yet not really. We all want to think things are better than they are. We all want to turn our eyes away from suffering and tragedy. But human beings are social animals who need other human beings to heal, succeed, thrive. When we turn away from the person with a brain injury, we not only tell them they’re value-less, we also deny them the opportunity to truly recover and to rejoin society.

When we demand they be normal and refuse to accommodate their real needs, labelling them as selfish and complaining and faking and a disappointment, we deny ourselves their contributions to our lives.

I can’t endure it anymore. I have snapped; I have started spewing words all over the place. The private becomes very, very public.

My book will be updated. I have nothing left to lose. The important people in my real life seem to not want to change their beliefs. So I will. To save my life, I am throwing it out. I am changing my belief that some things should remain private. 

My iron self-control has crumbled under the onslaught of abandonment, judgement, criticism, and emotional turmoil.

My neurodoc is trying to keep me from doing a Toller Cranston move. But I can see why Cranston chucked his entire life out the window and left it.

Navigating everyone’s hidden fears, assumptions, determinations to not change the way they do things, is wearing.

Trying to accommodate and be constantly OK with whatever is said or done to me so that I won’t be left or discharged is joyless.

No wonder fatigue is my constant, unrelenting companion.

Brain Biofeedback

A Crisis, A Call, A Camera

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My health care team is not really a team: it’s three parts linked through me, the one with the injured brain, the healing brain, the brain that has suddenly sent them into crisis mode while freaking me out. I have tried for years to get the disparate parts of my team to talk together. I’ve only succeeded once or twice with two parts like COTA and CCAC people meeting with me around my kitchen table (homecare is literally at-home care, and OMG, what a wonderful non-draining way to get care, that allows you to do more in a day than just attend an appointment, but I digress). Or when I got my neurodoc and Dr. Lynda Thompson of the ADD Centre to talk on the phone about me over a year ago.

Every now and then, I try to get my neurodoc to speak to the other members of the team, maybe CCAC or maybe the ADD Centre. The idea of all three entities holding a conference call would be utopia. Anyway, my efforts usually fail. The usual reason is no time, too busy, schedules don’t mesh or zero communication happens — missed calls — and then they forget to retry. So I struggle along.

Then one day I was informed of something, which I can’t write about yet because I’m still trying to negotiate a reversal. Suddenly: flurries of calls were made between my neurodoc and some members of my team.

Then I was scheduled for a full-cap assessment in a few weeks, and so I began the Herculean task of arranging a post-assessment call between my neurodoc and the ADD Centre to co-ordinate my reading program based on that assessment. O.M.G. I wanted to kill myself. Just to get a tentative date, I had to use email with the ADD Centre and a combination of voice mail and in-person methods with my neurodoc (and email copies that he kind of, sort of read because he doesn’t do emails you know) to be the go-between.

That became moot last week because my brain decided to get real plastic and do what-to-me is bizarre stuff after the ADD Centre changed the biofeedback protocol back to CZ. The bizarre stuff has happened last year but went away, or so I foolishly, wishfully thought. And I’ve done CZ training before and SMR training. Not my favourite place because of memories of the emotional tsunami that hit me back in 2005 (it was rectified immediately).

But this was different.

Suddenly, my neurodoc got on the horn and called the ADD Centre. The usual missed connections ensued. But there was no forgetting to retry this time. (CCAC should have been in on this action too. But, well, they have other issues on their mind.) Thank God! Because what is happening is WEIRD.

Why does it take a crisis to get health care professionals to speak with each other? Why can’t they do that as part of their regular practice to co-ordinate care, to keep in regular or at least annual touch to ensure they are staying on the same page, and to ensure no-one is missing out on major problems?

A client presents differently to different health care providers. Co-ordinated care with the GP at the centre and the patient kept fully engaged is essential when treating complex and/or multiple problems. As for trying to keep my GP in the loop . . . Well, I don’t know what to do about that systemic health care problem.

I have, in the past, kept my GP informed, but with all the emotional and PTSD difficulties, I haven’t since last year. It’s too bad that when you drop out of being an engaged patient, not even your GP will intervene, take the initiative, and call you, that is, boss you around so that you’ll get the things necessary for your health done. I miss my old CCAC person. She was good at bossing me while ensuring I didn’t get overwhelmed. Sigh.

Luckily, the Toronto Pan American 2015 Games began, and they have been a welcome distraction. I took my camera out for a spin at the free sailing races off of Sugar Beach and began checking out the cultural venues. I took photos.

Watching the Races

Brain Biofeedback

Back to SMR Training at CZ to Continue Brain Injury Treatment

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I am having a full cap reassessment later this summer. But in the meantime, I had a mini one at CZ and PZ a couple of weeks ago (that’s top centre of head and middle at back-top of head where I’ve been getting gamma enhancement biofeedback). This week, I began a new protocol based on that mini assessment.

Basically, because of all the emotional shit I’m going through, the area at the top of the brain that’s involved in emotions and connects through neuro networks to the thalamus and thus to the hypothalamus and so on to the pituitary, is a mite too active in the bad worry and tired zones. They want to create calm alertness so that I can think more clearly in spite of the new sources of stress and emotional tsunamis roaring through my life and mind and in spite of the fact that my current situation does not provide as much emotional and organizational support as I had even two years ago. Clearer thinking, better focus may restore some of my functionality that I’ve lost in the last year or so. As a side note: my neurodoc told CCAC recently I’m prone to regression. Yeah, understatement. As my GP once said: healing is not a constant upward trajectory. Sigh.

Still, my brain has apparently healed enough at CZ that I’ve graduated to an ADD protocol: enhance SMR brainwaves (12-15Hz), inhibit delta, theta, alpha but NOT high alpha brainwaves (2-10Hz), and inhibit busy brain aka ruminations aka hamster on steroid wheel brainwaves (22-35Hz).

We’re not inhibiting high alpha, that is, 10-11Hz brainwaves because they’re involved in creativity. One thing we don’t want to do is reduce that in me!

I noticed right away my perceptual area was closed in. I hadn’t realized how much gamma brainwave enhancement training near my occipital lobe had opened up my perception until we began training SMR at CZ this week.

Also, my anger in no way dropped like it usually does. This may not be good. My neurodoc had told me this week to lower my expectations of myself, for I may manifest anger unexpectedly or certain people may fuel my triggers (I gather because of my emotions waking up and making me re-experience my memories, now with emotions, and with my PTSD being so active). Without the de-stressing effect of gamma enhancement his words may become a bit too prophetic.

And of course with starting a new protocol, I was dead tired. My eyes felt like fat pigs after being forced to run a marathon and my brain a sloth who’s had to walk a 10k. Dark chocolate with coffee time!

—–

Click on one or all of the titles for definitions used in this post:

Brain Health

Vampire Clinic Time

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I’m not in the mood for writing. I finally trundled over to the vampire clinic, starving from over 14 hours of fasting (I kind of miscalculated the time To stop eating). This was a triumph. It took only six *cough* months and a few reminders from my neurodoc to get meself to the blood lab so that my GP can monitor my glucose, lipids, and Vitamin D.

But you know what it’s like. First, winter. Who wants to schlep through the cold and snow to shed layers so that your elbow can be jabbed. And then there’s the whole cold and flu thing. Then, well, I’m off on vacation. No way getting pricked before and after. Gotta save up my energy. Then there’s the whole I-hate-needles thing and the pain . . . Ouch! Although I must admit that never stopped me going before 2013. I just complained, dragged my mother along, and went. Finally, I just forgot.

But eventually, my neurodoc got me emotionally stable enough for me to endure the test because at the end of the day, the real reason I wasn’t going was I have too many things on my plate, too many emotions waking up and swirling like tornadoes in my head, too many memories of going to too many medical appointments alone having to advocate for myself alone, that I couldn’t tolerate one more thing. And overcoming my brain-injury-induced initiation deficit was beyond me even for the cause of better health, the one driver normally stronger than my deficit. 

I guess this is living with PTSD, where even a simple battery of tubes sucking your blood out is too much.

But the advocacy never ends. I had to get my Vitamin D tested. It was too high last time. My father had told me OHIP will cover the test in that case. Oh. You mean, I don’t have to pay $50 for an important, preventative-medicine test under our free medicare system? Nope. You just need the code.

I asked my GP’s office. They thought it was free. Um, no. My GP didn’t know the code. My neurodoc didn’t know it offhand. Since I’d run out of time and knew if I didn’t go on the early morning I’d decided on — and of course I made all these calls last minute — it’d be months before I tried again.

So in I went to the blood lab and asked about this free Vitamin D test. They looked at my lab requisition form and said, well, first off this requisition has expired. Yes, folks, I had stalled too long. Oops.

Thanking the gods I have an iPhone and don’t have to hunt for a payphone or beg to use a phone anymore, I prayed my GP’s office was open. It was. His very sleepy-sounding secretary answered, and she, the wonderful woman that she is, faxed a new form to the lab with the magic words on it — “Vitamin D insured.”

Insured.

That’s the code to getting this important test covered by OHIP. Now my docs will know. And I await my test results . . . well, assuming I hurdle my next internal barrier, seeing my GP to hear what my blood has to tell.

Brain Health

The Centreboard Life of Brain Injury

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When we first came to Canada, my father’s colleague introduced us to the frightening delight of sailing in a tippy boat on a lake with capricious winds in Ontario. Pretty soon, my Dad had his own centreboard sailboat, one that was a little more stable than his colleague’s Albacore.

Back then, only rich fat white guys could afford keelboats. The rest of us had centreboards: cheaper but more likely to dunk you in the water. A keelboat has a permanent “fin” that dives deep into the water, giving the boat stability, making it more likely to stay mast up. A centreboard has a smaller board in the centre of the boat that you winch down as you sail out from shallow waters into deeper ones.

Winches or ropes can get stuck. The wind can grab your sails before you get the blasted board all the way lowered, then off you go skimming over the water at the mercy of the wind like some freaked out cat.

So growing up, our sailing days would begin with us standing on the calm of the land, shoving battens into the sails, pushing the boat into the water, threading the sails onto the mast and boom, before raging at the tiny motor to sputter to life and putt-putt us out of the sheltered area of the yacht club’s water through the gap and into Lake Ontario.

While we stood serenely on the land, the wind invigorated our senses and we yearned to be out for a thrilling afternoon of sailing on the waves flinging white froth.

But once on those heaving waves, our hair streaming in the wind, our hands working frantically to shouts of get the blasted centreboard down, pull hard on the main sail, get the jib up quick quick, we were not so sure this was quite what we had yearned for. But before we could think more on that, the main sail snapped to attention and more shouts commenced — “coming about!” — eek! — we ducked just in time from being whacked and thrown overboard by the boom. For hours, we battled to tame in our sails the unrelenting wind hurling the waters up and down into bigger and bigger swells.

Down into the troughs we’d sink, sky and water our only view, up into the swell we’d rise, an amazing view of Hanlan’s Point appearing briefly before we’d plunge back down into the trough, all the while sails and wind driving us away from the calm land towards the deep, treacherous waters of the open lake beyond the protection of the Toronto Islands.

From land it looked exciting, like we had it all under control. In our tight sailboat, our hands and bodies were in non-stop action keeping our boat upright and us in the boat. We needed an endless supply of energy.

Having brain injury is like being in that boat alone, handling main sail, jib, and rudder all at once. Without energy.

Everyone else — family, friends, neighbours, health care professionals, acquaintances — stand on the comfortable shore watching, perhaps shouting encouragement across the waves to us but rarely offering to hop into a zodiac and zip over to join us in our tippy sailboat and take over the jib or the main sail and rudder for awhile.

This week’s session:

Neurodoc: You don’t get a vacation too often?

Me: I just went to . . .

Neurodoc: I don’t mean that kind. I mean the kind where someone comes over, fixes breakfast, lunch, and dinner, takes care of things for you for a day or so.

Me: *blink*

Neurodoc: *raises brows questioningly*

Me: Bwahahahahaha! Um, no. I had a friend come over once years ago at 10:00pm to cook me dinner.

Brain Power

Post Brain Injury and PTSD: What Happens If Re-Traumatized?

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What happens if one is re-traumatized? If one witnesses something similar to one’s own trauma, especially after acquiring PTSD and/or a brain injury?

Like anyone who watches a human bounce off a windshield and fly through the air, you gasp, your heart pounds, you freeze or rush to help. But I did something different in addition: I covered my face, whipped away, and crouched until it was over while everyone stared in horror. Then I became confused trying to futilely call 911 (I’ve never had trouble dialling 911 when I witnessed collisions before), but luckily there were a bazillion witnesses who rushed to help and call the ambulance, which got there so quickly, I swear it must’ve been waiting a block away.

Seeing him sit up and so many around him and the paramedic there, I called for my own help and returned to the ADD Centre. There was no way I would reach my neurodoc then so I didn’t bother to try; but I knew I would have to see him soon. When one has PTSD, one has to process events like this as quickly as possible so that they don’t add to one’s own load.

Luckily my biofeedback trainer answered my call for help and told me to come immediately. She put on the breathing belt and heart rate monitor and hooked me up to the computer. We then did two HRV screens until my heart rate settled down close to what it had been during my biofeedback. We talked a little bit too since talking it out helps, since the physical presence and emotional support of another human being helps. And she ran the CardioPro program to see how stressed I was. No surprise really the results.

I was feeling calmer, but my SDANN told us the feeling was a mirage that needed to be turned into reality. My SDANN was about half of what it had been when I’d begun my regular biofeedback session this week, and that had already been in the basement because of a variety of stressors.

So I left knowing I’d have to tell my neurodoc.

Because the memory, the sound of it, the visuals of it, was intruding, he did EMDR on me as soon as he could. The sooner the trauma was dealt with, the likelier it would not become part of my PTSD, he said. Only time will tell if successful.
In a country where police don’t take traffic injuries and deaths seriously, in a province where the governments more and more believe insurers about needing to cut auto insurance benefits to our health’s detriment, on a planet where brain injuries are barely treated and those that come with concurrent PTSD hardly recognized, it is amazing that those of us injured in preventable crashes are not re-traumatized every day.

If governments and insurers really wanted to reduce health care costs, the most obvious solution is to crack down on bad driving and cycling, to create policing and policies that will shape sober drivers into safe drivers and will keep drivers intoxicated by any substance out of the driver’s seat. Until then and/or till driverless cars become ubiquitous, we survivors have to do whatever we can to protect ourselves and grab help immediately after re-traumatization. 

Brain Health

Growing Social Media Divide Leads to Bad Advice

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I’m not often told it might be good to avoid Twitter or to give it a break, but when I am — and when others with brain injury are — it’s by people not on Twitter or who have a lurking-only account. And who don’t know or understand how I use it.

They’re unhelpful.

They’re unhelpful because they don’t understand how Twitter works. And so they advise the blunt instrument of total avoidance instead of helping me or anyone with brain injury avoid the “negative” while allowing us to still play in the fun social sandbox.

One reason us people with brain injury are told to stop is because of “oversharing.” This is part of a larger discussion about our cultural shift to emoting more in public, to creating closer ties even with people we’ve never met in real life, to the trolls among us and how to protect ourselves from them. But the oversharing I’ve seen people with brain injury are criticized for is nothing compared to what some non-brain injury people do. I think the advice to us in this case smacks a bit of the patronizing attitude so systemic towards people with brain injury. Talking out consequences but leaving it up to the individual to decide if they can handle it is way more respectful than telling them stupid stuff like, “what will your daughter think?” Maybe their child will realize their parent is a suffering human and learn some compassion.

Another reason given to avoid it is when we’re bothered by tweets from a certain individual. In that case mute block report that individual is the better option, and I’ve written about that before.

Another reason can be overload. This is a valid concern. We people with brain injury are prone to sensory and informational overload. Couple that with impaired ability to stop, and you have massive energy drain. Years and years ago, I began to turn off the computer and go offline Saturday night and not turn anything back on until sometime on Monday (very occasionally Tuesday). That broke any addictive cycle that had been building up over the week. It also gave me the rest I needed.

The iPhone has complicated things for me because it has apps on it that I find restful or distracting. It is a computer but not a computer. It’s my second brain; it helps me function and relax. But the iPhone has the ability to connect to the online world through its data connection, and with the phone plan I have, I don’t worry about data costs. Deadly!

Worse, brain injury tends to kibosh self-control and habits are hard to keep.

But I’ve held this habit for so long that I don’t forget it, like all my other ones. And if I do sneak online, this habit keeps me from not participating. One complicating factor is I do need a data connection to message people — messaging is the new phone calling and, frankly, a lot easier to keep in touch with others no matter one’s schedule. But I’m not exactly a social butterfly anyway.

And sometimes no matter who you are, just like we all need a vacation from work or from family, having an annual or every-four-months week-or-two-week-long vacation from Twitter or Facebook is a good way to recharge the social batteries.

But for day to day, instead of wholesale avoidance, the health care provider should be suggesting:

  • Focus on your Twitter list of close friends.
  • Just look at your hobby list.
  • Muffle the political tweets that are sending you ballistic until you’re ready to get back into the game.
  • Follow your favourite Twitter chat and then turn Twitter off till the morning.

But they cannot unless they use social media. Just another reason why the divide is growing and causing friction between the patients on social media and the health care providers and friends and family members who are not — to the detriment of the patient’s social and emotional health.