Covid-19 and Brain Conditions

We keep hearing the experts talk about the dangers of Coronavirus especially involving those with preexisting conditions or “comorbidities”. But does that include a brain or neurological condition? There is so much information that’s been written that it can be difficult to sift through. We’ve compiled some good resources from trusted websites just for you. In general, the answer is no, your risk is not greater due to your condition and the current CDC guidelines should be your first steps. Following that, there are a few other things we’re suggesting to take a few additional precautions. We’ve created the graphic above which can be downloaded here. Once downloaded, each of the links are clickable so you can use it as your single page go to for lots of information.

The takeaway? 

1. MS:  Be sure to really focus on stress reduction as both a preventative of exacerbations of your condition and warding off COVID-19.  If you do get sick, treatments appear to be the same as the general public. Be sure to follow your neurologist’s recommendations and closely follow the CDC guidelines on distance, wearing a mask, and staying in due to your lowered immune system. Additionally, it’s a good idea to have 3 months of medication on hand. https://multiplesclerosisnewstoday.com/faqs/2020/03/02/faqs-about-coronavirus-and-ms
2. Parkinson’s:  Since this patient is also usually over age 60, be careful to follow all CDC guidelines and stay in.  See the following link for a letter the Parkinson’s Foundation Association recommends keeping with you:  https://www.parkinson.org/sites/default/files/Hospitalization%20During%20COVID-19%20Letter.pdf  Take a look at some other ideas at: https://www.parkinson.org/blog/tips/Coronavirus. There is also webinar and audio content available at: https://www.michaeljfox.org/news/coronavirus-and-michael-j-fox-foundation
3. Migraine:  Be very careful of your known triggers to prevent worsening.  Monitor and minimize your stress levels, practicing good self-care.  Have enough of your meds on hand for 3 months.
4. Seizures:  If you have been consistently free of seizures with medication for 6 months or more, there is no current indication of a correlation.  But do have a 3 month supply and take it as prescribed.  And, as always, manage your stress and worry to the best of your ability.
5. ABI – TBI :   Good news, there is no known higher risk for those with a brain injury. But you do need to manage all symptoms such as seizures and migraines– see above for details.  If your ABI is stroke related – keep taking the medications you were put on, following your neurologist’s advice and stay in touch especially if you are having more seizures, headaches, etc.  https://www.stroke.org/en/about-us/coronavirus-covid-19-resources  Watch diet, self-care, balance and keep up your exercises for this safely, manage stress, and have any medications on hand preferably for 3 months.  Follow all CDC guidelines for safety for COVID-19.  See https://www.biausa.org/brain-injury/community/covid-19-resources and https://news.shepherd.org/qa-coronavirus-disease-2019-covid-19/ For other information on traumatic brain injury and COVID-19. 

Links for everyone: 
To maintain this self isolating, we will all do better with managed stress, good quality and amount of sleep, and maintaining relationships with friends and loved ones using technology. For some suggestions, take a look at the links below!

1.  Down Dog – https://www.downdogapp.com/ free until May 1^st to all; free to teachers, students, and healthcare to 7/1
2.  Music to calm and relax:  https://advancedbrain.com/shop/music-to-relax/ easy download as well.
3. Headspace:  https://www.headspace.com/covid-19
4. Browse our recent blogs
5. 5 quick tips:  https://www.npr.org/sections/health-shots/2020/03/03/811656226/pandemic-panic-these-5-tips-can-help-you-regain-your-calm
6. The resources page of our website (we try to keep this updated with news, shopping tips, and some fun!)  https://www.thewholenessinstitute.com/covid-19-resources.html

 I hope you have a safe and healthy April. Please reach out if you need additional support, this is a stressful time for most. I’m here if you need me.

Take care,    Dr. Beth

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Yoga and Your Brain

Yoga. It can feel like an intimidating word for the uninitiated, can’t it? Visions of perfectly chiseled bodies in spandex holding positions that look impossibly difficult. But yoga is so much more than that. I’ll leave it to the countless experts who explain that the physical movements of yoga are only a tiny part of the whole practice (google will lead you to lots of resources if you’re interested). But the physical piece which ties into the mental component and so many other benefits is a great way to move forward and “deepen” your healing.

After an accident or an acquired brain injury the sheer volume of appointments of follow up care can feel like a full-time job. But yoga is a practice that can be added at any time in the recovery process and shows great promise at helping those who have sustained a brain injury with balance, balance confidence, range of motion, pain control, strength and mobility. Studies have shown the practice to improve balance by 36%, balance confidence by 39%, lower extremity strength by 100%, and endurance by 105%. Those statistics speak volumes for the benefits of such a gentle exercise and practice. In addition, it can be helpful to so many who suffer from anxiety related to post-traumatic stress disorder after an injury or even a car accident without injuries. One study done at two centers involving a Canadian location and Brigham and Women’s Hospital in conjunction with Harvard University found a 10% reduction in PTSD anxiety symptoms following only an 8-session program of Kundalini Yoga.  Another study through Boston University and the Trauma Center found significant reduction in PTSD symptoms after 5 weeks of yoga, and individuals held an improvement for at least another 5 weeks.  So, it seems that we should be thinking about yoga much more frequently in the field of PTSD and brain injury!

There are studios throughout the country which offer yoga classes geared toward those with brain injury through the Love Your Brain Foundation and rehab centers. You can find some resources online at https://www.loveyourbrain.com/yoga though if you do a search right now you’ll find that in AZ, classes are not yet available (check back soon as a provider training is happening in April and is already full—so we should see some offerings coming!) The other place to check is the outpatient rehabilitation program through your local TBI hospital. In the Phoenix area, Barrow has some yoga classes with details found here. Although they have no specific yoga offerings at this time, Ability 360 is also a great resource for those with brain injuries and changes. A recent search of google for trauma and yoga in Phoenix brought up several studios with classes specifically for traumatic stress or PTSD. So, there appear to be some options, but take caution with these studios, doing homework to ensure their credentials are what you’re looking for and are the best choice for you.

These in-person classes are a great resource and whenever possible, I do recommend that people attend with an instructor present. That hands on advice and adjustment to a position can be very beneficial, but if it can be intimidating to try something new, can’t it? A big barrier to entry for an untried activity is the lack of understanding what the cultural norms are, what’s to be expected, and not wanting to look foolish doing something for the first time. Rest assured, the classes that are geared towards beginners, and specifically for those with brain injury, are not going to include the difficult poses that you see highlighted in yoga articles or images. Everyone in the class will enter with about the same level of expertise, that’s why there are classes for a variety of different audiences. Also, there are modifications that can be made to make this gentle stretching available to anyone, in any condition. If you’d like to see what a class may include, or would like to try something at home without an audience, there are some videos of classes for brain injury you can try at your own risk (check with your physician first to be sure you’re ready for these). Love Your Brain says it best, and I agree with their statement, “I cannot assume responsibility for any exercise and/or subsequent injury you may incur, “Yoga is for everyone. However, when online, it is up to you to assess whether you are ready for the class you have chosen. The techniques and suggestions presented here are not intended to substitute for medical advice. LoveYourBrain assumes no responsibility for injuries experienced while practicing these techniques.” And we cannot assume any responsibility for injuries experienced either through their program or others. That’s why it’s best to check with your doctor or physical therapist first. Classes online are an option for you to try if you cannot find anything available near you and once cleared by your medical health provider. Take a look at https://www.loveyourbrain.com/yoga-videos for some classes geared toward healing from a brain injury.

As we move through 2020 and we continue to explore our word for the year, deepening, I hope you’ll give some of the ideas I propose a try or use these suggestions to look for ways to incorporate new ideas into your life. I will be offering a workshop for you and your partner or spouse in April that will discuss the changes brain injury has on your work and home life. For more information, click here, and together let’s incorporate strategies to help you heal to be the very best you can be.

Why? Why Not?

In a week like this one, with the deaths and massive injuries in Las Vegas, I hear “why” even more than usual.  But I often hear “why” with those I have the privilege to serve who have and are suffering the impact of severe accidents, those who are so bright and have such positive futures ahead of them and now have head injuries and the recovery is stalled.  I speak with those who have cancer, or whose loved ones have it and are dying.  I speak with people who simply wonder why they haven’t been able to change something they have wanted to so badly.  And truth be told, I also ask myself this at times.

And yet, the truth is, why not me?  What do I think is so special about me, that bad life experiences should not happen?  I remember hearing someone share this very sentiment a few years ago, and wish I could find the source for it.  But I do remember as a younger woman voicing a question of why and someone saying why not you, and I was angered.  It felt like an attack.  I do not mean it in that way at all, and likely that person did not either.  But I do think we need to ask it in the way Eric Church did this week in his sharing and new song “Why Not Me”.  Take the time to listen to him, please, at https://www.youtube.com/watch?v=sqCYKFXfRb0 .

As individuals we each need to struggle with this internally and in conversation when the most difficult life events occur around us.  The times we are called upon to rally all of our support and face that most difficult experience in life that we are uncertain we can handle, i.e.:  loss of a loved one, rejection by a spouse or significant other, life threatening illness, end of life, traumatic head injury, life changing event that requires we reconstruct our lives thoroughly, or even an internal life-time struggle that seems impossible to change, each call for specific actions and resources.

Therapeutically we would suggest a person sit with the feelings, see what is really in front and within, and breathe through the feelings.  Journal, draw what is within, in some way allow oneself to face it.  In doing so, we increase awareness rather than run; allow movement of the pain or shame or fear rather that avoid it; and, in the end we are in a new place and not pushed to addiction – money, food, alcohol, work, or drugs; but rather, we regain center.  The same concept is suggested by Pema Chodron in the “no more struggle” meditation.  However, she sticks with breathing and returning, breathing and returning, until the strong feelings are reduced and one is able to face what is going on outside oneself or within and allow it without judgment.  Only then, she says, can the issue or feeling be resolved.  From a Christian perspective, Fr. Thomas Keating would say it is called prayer or centering or contemplative prayer, all with a focus of resting in God.

After we have done this, only after, can we move forward and know how to pick up our feet and keep moving.  Taking the next step ahead in life, but taking it as we move into life, not retreat from it.  A young man mentioned to me something I had hear others say – that a friend instead wanted to retreat and not go out and keep living after the Las Vegas shootings.  After this week his friend had decided to go to no more concerts, events, etc.  His friend, and others I’ve heard say similar things, are not moving through to keep living.  They are stuck in the fear and anger; and have no way to move through into life.  Action is important – freezing and being stuck is not healthy and builds walls, not bridges.

Bridges are very important in life and in moving forward when a huge life event hits us and makes us ask why, or why not, me.  I had never read the poem “The Bridge” by Robert Wadsworth Longfellow until pondering this topic.  I came across it and it is so very rich with metaphor and meaning, but I’m going to take a few stanzas out to focus on in this article.  He says after many years of nights when he went to the bridge when life seemed so difficult and he watched the tide go in and out:

How often, O, how often,

In the days that had gone by,

I had stood on that bridge at midnight

And gazed on that wave and sky!

For my heart was hot and restless,

And my life was full of care,

And the burden laid upon me

Seemed greater than I could bear.

But now it has fallen from me,

It is buried in the sea.

As I read this I thought how often we do have experiences in life that give us pause to think.  We may walk our neighborhoods, much like Mr. Longfellow did when he went to ponder near a bridged waterway.  And if we walk, meditate, ponder, pray, stay with our feelings and thoughts we cross a bridge as we put down our cares.  We no longer carry the feelings of pain, terror, shame, or anxiety.  And so we can move forward into life.  We can move forward despite the fact bad things still happen to good people, life does fall apart at times, cancer ravages bodies, brain injuries can significantly change one’s life direction.  And yet, as author and speaker Jonathan Lockwood Huie says, “The darkest night is often the bridge to the brightest tomorrow”.  Don’t miss your bridge – go seek it out as Mr. Longfellow did, as the young man in my office did, as Eric Church, Pema Chodron, and Fr. Keating have all done.  Calm, serenity, release, God, hope for a new tomorrow are all there once you do.

 

 

What Brain Injury Looks like in Every Day Life

Allow me to introduce you to some people I’ve met in the past. First, please meet my 76-year old friend, Mimi. At 74, she was active in her church, minister of communion to those at home, running to meetings and luncheons, heading out to her exercise class followed by coffee and talk with the ladies. Now, she sits in her chair most days, can’t concentrate long enough to read, so she pages through magazines occasionally and frequently tells the same story over and over—or forgets things completely.

I’d also like you to meet Jackie. A professional woman who used to run her own business, hire and fire, as well as take care of a family and participate in many recreational activities. Today she struggles to organize her day, has mood swings and sleeping problems that tire her out, and rather than the 20 hour day with 4 hours of sleep it is 4 hours activity and 20 hours of rest.

Finally, let me introduce you to James, who 3 years ago, was top salesman in his region. Running, going, stretching to meet those demands as well as be dad and hubby. Then, suddenly, the phone was terrifying and the thought of leaving the house too much.

What happened? And, what’s the big deal, right? I’ve just described plain old, ordinary garden-variety Alzheimer’s and Depression right? It’s not as easy as that.

We are learning so much more about the brain. When I began in this field over 20 years ago we would have treated these from the paradigm of mental illness and taken it no further. Today, research has shown us that the brain, that gelatin-like mass under our skull, does so much more, and much more precisely than we’d ever imagined. Thus the condition of the brain itself, the way it sends messages, how blood and oxygen flow through it, and the way in which it may have been jolted in the past and impacted the present, all are considerations in the condition of someone, all extremely important.

Have you ever worked on a computer that is DOS based, not Microsoft Windows, or Apple iOS based? If you have and attempted to run a program that is Windows based on it you’ll know that you must have the right software for the program running your computer. If it’s on a Windows platform you must have Windows software, etc. Or have you tried to load a program for which your computer doesn’t have enough space? Or even better, attempted to retrieve information from a corrupted disc? Brought back your worst nightmare at the computer, huh? Well, this is like our brain.

The hardware is the structure of the brain and the protective skull that covers it. The software consists of all the electrical impulses, the neurotransmitters, the thousands of ways in which the brain communicates to allow us to move our right hand when we want to, or know which is left, or figure out a puzzle, or allows us to be appropriately angry or sad without feeling out of control. There is nothing that we do, literally nothing, that doesn’t come in some way from the functioning of our brain.

So that’s new? Haven’t we always known this? Well, not so much. We used to think it took a massive head injury that resulted in surgery and/or coma to cause difficulties later. Thus after an accident when taken to the emergency room if you could walk, your eyes reacted to light, and you sounded like you knew who you were then you were sent home deemed “shaken up but fine”. No one paid attention or related the fact that another woman I know couldn’t organize her work space, was teary for months and months, became very depressed, couldn’t remember things, and had become extremely irritable after an auto accident. Well guess what? When she was rear-ended by a semi-truck going 55 miles an hour and walked away from a totaled vehicle–she wasn’t fine. Her brain had been jolted and, think of a Jell-O mold here, had sloshed back and forth against her skull, causing trauma to the structure of the brain that can’t be seen on X-rays, CT, or sometimes even MRI. But can be seen in neuropsychological testing that allowed her to finally realize she isn’t crazy, she’s lost function in her frontal lobe that controls her organization as well as to her temporal region that controls memory. And what is more important is that all the psychotherapy in the world will not correct this. She needs specific tools to overcome the deficits and make life easier. She also needs time for her brain to heal. And the understanding that it isn’t her fault, it isn’t a moral defect, it is an injury. Thankfully, in her case, after 2 years she regained most of her abilities but still deals with difficulty in organizing and planning and has to work much harder at it than she ever did.

So, let’s go back to the individuals you met earlier. First, back to Mimi, our 76-year old with “Alzheimer’s”. The doctors for a year and a half said it was just “aging” when she complained of not remembering everything. Possibly true. And then there was a surgery with aftercare mismanaged by the surgeon and a cardiologist, a physician, and mental health provider who all deemed her depressed. Eventually, 6 months later she was diagnosed and treated for the pulmonary embolisms that were impacting her ability to breathe and eventually her heart so that very little oxygen was getting through her body. Now, we have a woman who has had mood problems in the past, but her memory, moodiness, ability to initiate and concentration are all poor. Why? The brain needs oxygen which it didn’t get it and these damaged pieces can never be regained. So, Alzheimer’s? Likely not from the brain scans and MRI’s already done. Oxygen deprivation to her brain, highly likely. Reversible? No. In her case she’s not gotten worse, fortunately with oxygen flow restored, her symptoms stabilized and with help from her family she is able to live with her husband well.

Remember Jackie? The previously successful “superwoman”? She had hit her head numerous times throughout life in sports injuries and domestic violence. She did okay, had some problems, but managed. But then came a sports injury that left her significantly impaired for a few days and gradually her overall functioning reduced and she needed more and more support from staff. Eventually the coping became too much, her mood took a huge dive, and her ability to work became compromised. Just depression? No. Just a personality disorder? No. Significant damage to temporal and frontal lobes, some parietal dysfunction, and both her hardware and software have been impaired.

Finally, James, no major head injury. But he has a genetic background of bipolar and major depression. The software is corrupted, and the stress of managing on a corrupted software program became too much. Much as your computer starts freezing when a patch or some other fix is needed, he also froze. And it’s been a long way back to speed with medication and life management changes and dealing with pain in his emotional past. Not just depression, but bipolar disorder.

We can’t be too careful when it comes to evaluating ourselves, our loved ones, and our clients in terms of hardware and software deficiencies. The 76-year old woman had family members who kept asking questions, and asking for new doctors, and pushing hospital staff to reconsider what they found to be obvious. Eventually the answer was found, but not before the damage was relatively severe. We must be proactive in evaluating people and not just settle for the easiest, the quickest, and the least difficult explanation when the “fixes” for these diagnoses are not helpful. We must demand our health providers keep looking and search for the answers. And you deserve to understand your brain and your loved one’s brains. It may never happen to you or a loved one, but we don’t know what we’ll be given to deal with, do we? As Mrs. Gump said, “Life is like a box of chocolates…You never know what you’re gonna get”. If you are interested in learning more, any of the following books are great references and fairly easy reads on the basics of the brain. Then you too, can advocate for someone — or perhaps for yourself.

The Brain that Changes Itself by Norman Doidge

The Whole Brain Child by Daniel Siegel and Tina Bryson

Change Your Brain, Change Your Life (Revised) by Dr. Daniel Amen

CDC Website for Sports and Children – Heads Up Program at http://www.cdc.gov/headsup/youthsports/index.html