March End of Month Review

Forced out of the house due to running out of aspirin. The irony is that on return, the pain appeared to have subsided. It may be possible to avoid a further dose. Started to document this fact in a post and realized it is time for the March End of Month Review.

Walk Therapy

Only recorded 64.67 miles this month for a 2016 cumulative total of 365.47 miles. This a positive outcome compared to March 2015 during which only 4 miles were recorded. In the first 3 months of 2015 the cumulative total was 36 miles.

Shoulder Pain

There has been a recurrence of the stabbing shoulder pain. The last full blown episode of this was experienced in February and March of 2015. This year, after a month of reduced walk effort, there is a resumption of the same pain. The link between walk effort and onset of shoulder pain is coincidental, and does not indicate causation. This is something to be discussed with Dr. H on the next visit.

TAQ Submission

One of the reasons for the reduced walk effort is that I have returned to asking if the activity I propose to undertake advances the TAQ Submission process. If the answer is YES, then I perform the activity. If the answer is NO, then I continue the search for an alternate task in which the answer is yes.

During the February period of high TAQ productivity, I would work in the morning, then encounter the onset of fatigue and attempt to “beat the fatigue” by taking a walk. This appeared to defer the full onset of fatigue but did not completely eliminate it. The problem experienced in March is one of significant psychological resistance to the TAQ summary project. This I need to discuss with Dr. D.

I have been able to complete some incidental TAQ exhibits. These are relatively short, one or two page documents introducing a specific medical finding or other element of evidence. The summary represents an overall synthesis of the past five years and it has been much more difficult to write. In trying to understand the reason for this I have arrived at the following:

Intellectual Puzzle vs Information Synthesis

The prior work focused on gaining an understanding of the injury. My research activity had the quality of an intellectual paper chase. Each new morsel of information prompted a new search. Each new search resulted in a fight to read, interpret, and understand, the newly discovered scientific paper. The cumulative effect of this understanding led to an increased awareness. I now have a much better understanding of mTBI injury than I had one year ago. In the period prior to 2015, I lacked the ability to perform this research activity.

The present TAQ activity is not a paper chase. It is an attempt to synthesize the details of the past five years, to frame this in legal terms, and place a coherent description on paper. It is a very different mode of activity, both more challenging, and more difficult, than digging up a relevant morsel of scientific knowledge.

Awareness Originating From Mode of Injury

The psychological roadblock commenced when drafting the series of posts which commence here. The most critical of these drafts was this one. Working on the incomplete draft gave me an understanding of the nature of the injury, the fact axonal lesions, and the process of synaptic trimming, result in permanent incapacity. I deem it extremely unlikely I will achieve a return to my prior level of competence or function. Not in this lifetime.

Age Related Criticality

My understanding was deepened by the situation described in a series of two posts of which this is the last and most meaningful. One cannot cram 64 years of learning into a 12 month period.

Impaired Sense of Self

There is a much older post I have not yet been able to locate (Found it!). It references research which addresses the need of mTBI victims to reconstruct their prior sense of self.

When I first read this research it made some sense but I do not think I fully grasped its meaning until recently (see the last paragraph of this post) and the full text of this one. Everyone is familiar with the notion of reconstruction after an accident. Typically this refers to physical form, or impairment. If you lose an arm, or an eye, the impairment is evident. The need to relearn specific task performance to accommodate the injury is an obvious element of rehabilitation.

The problem with brain injury lies in its invisible nature. The injury is not obvious to anyone encountering your physical form. There are no immediate physical clues to the nature and extent of the injury (I experienced this when I first attended a brain injury peer support group. None of the other attendees appeared to have any form of injury at all. It was only as I began to interact with each of them as individuals that I began to learn more and understand the specifics of their individual impairments).

What may be missed is that the impairment may not be fully understood by the mTBI victim. One develops a self-image over an extended period of lived experience. One learns, and comes to know, what is possible, what action lies within the realm of personal capacity. Post injury, the mTBI victim retains this prior, deeply embedded, self-image. This preserved self-image is likely incongruent with the individual’s post-injury capabilities. One consequence is that the victim overestimates their capacities and underestimates the difficulty of performing tasks once known to be effortless. The world falls apart and all that is solid melts into air.

Contact with Prior Self

The present TAQ endeavour forces me into the review of texts written three or four years ago. I am struck by my naivety, by my lack of understanding, by my ignorant belief, by my unfounded confidence in my “bulldozer” methods (see here and here). I can now “see” the variance between then and now, the degree of clouded, or magical thinking, or the cognitive error present in the early years after the accident.

Contrast Between Then and Now

This contrast between then and now also contains the seed of depression. If it has taken me five years to achieve my present outcome it implies a very slow rate of improvement. By the date of my 126 birthday, I should achieve a full recovery.


Links to Prior Review Pages

Initial Task Review
October EOM Review
November EOM Review
December EOM Review
January EOM Review
February EOM Review


Links to Similar Header Images:

January 2016
February 2016
April 2016