Another relatively small group of only 17 items. Once again we begin with a table:

 

Section 4	Persistent Physiological Impairments
	2012	2013
Unscored	0	0
Scored 0	10	8	Not Present
Scored 1	0	1	Present, no interference
Scored 2	2	0	Mild, not disabling
Scored 3	5	8	Moderate, greatly interferes
Scored 4	0	0	Extremely disabling
Items N/A	0	0
n=17

Section 4	Improvements	2012	2013
	No Improvements

Not much to say here. But I should take a future look at exactly what aspects demonstrated an improvement. In Section 6 there were improvements in neurological effects. Here there have been no observed changes in physiological effects.

Section 4	No Change
Item 4.7	Easily fatigued	Score 3
Item 4.12	Lessened ability to perform physically	Score 3
Item 4.15	Trouble falling asleep	Score 3
Item 4.16	Awakening during the night	Score 3
Item 4.17	Sleep that is restless or disturbed	Score 3

I become fatigued after four to six hours of work. This time varies depending on the complexity of the task. With a more complex task I will fatigue much more quickly. I also appear to fatigue more quickly when presented with new situations and unfamiliar people. Last year I would experience fatigue and headache after a one hour session with one of my Doctors. This is no longer the case.

When I attempted my recent bike ride, I noted that my left arm was very weak to the point that after about 45 minutes it was painful to support my body weight on the handle bars. I have also been doing housecleaning and notice the same impairment. I am not sure of the cause of this. I know I did not experience this prior to the accident.

Trouble falling asleep verges on being scored as a “4.” I have a lot of problems with sleep hygiene and it completely disrupts all other aspects of my life. I have undertaken walks of 5 to 8 miles to create conditions conducive to sleep. I typically fall asleep but then wake two to three hours later and will be unable to return to sleep.

There is a noticeable difference between regular “night sleep” and sleep due to fatigue. With fatigue I will lay my head on the pillow and drift off almost instantly. I then wake spontaneously about an hour later. The quality of this sleep experience reminds me of falling asleep as a child.

Awakening during the night also verges on a “4.” In 2012 I would regularly wake around 0300 to 0400, and then get on the Internet to start job hunting. I viewed this as a positive response to being out of work. I now see this waking pattern as a disruption that causes negative lifestyle impacts. I worry that if I did have a job, my erratic sleep schedule would create performance problems for me. I did not have this sort of problem prior to the accident.

Item 4.17 is another item that verges on a score of “4.”  In the past year, I have woken up from extremely vivid dreams such that I was confused over the difference between dream and reality on waking. I cannot remember a recent occurrence so perhaps this is getting better.

 

Section 4	Increases
Item 4.1	Heart pounding or racing	From 0 to 1
Item 4.3	Headaches or head pains	From 2 to 3
Item 4.6	Ringing in ears	From 2 to 3
Item 4.9	Weakness or loss of strength	From 0 to 3

I noticed my heart racing the other day. This is unusual for me and I want to ask Dr H about it at our next meeting.

The nature of my headaches has changed. Up until recently my headaches have been dull sensations of pressure, or discomfort, in the region above my left ear toward the crown of my head. These headaches typically coincide with the onset of fatigue. Dr H has advised that the headaches are a sign  I am overextending myself and that I need to stop and take a nap.

When I was preparing the last submission to the insurance company, I experienced a new headache. This was also on the left side (everything I experience is on the left side. This is very sinister) and instead of being above the left ear it was behind the left ear on the middle of a line extending from behind the ear toward the back of the head.

There were a number of strange characteristics associated with this headache. First, it was sharper and more direct than the above the ear headache but still less powerful than a sinus headache. Taking a nap did not eliminate it. It persisted after both long and short naps. I had to meet a submission deadline so I could not stop working. Once the submission was in the mail, I ceased all computer related work. But the headache persisted for two days after that. I found this very worrying and am not sure what this means but will discuss this with Dr H when we meet next week.

The ringing only takes place in my right ear. There is no ringing in my left. The ringing is constant and sounds vaguely like a night time field full of crickets. I can hear them now. The volume appears to change with exercise; during a walk the normal chirping crickets will become very loud operatic crickets.

I shouldn’t joke. This week I took the car in for gas and I couldn’t get the pump to operate. The cashier was trying to tell me something via a speaker in the pump but I could not hear her over the sound of the crickets. This is the first time I have noted this. I think it had something to do with the very poor sound quality of the outdoor speakers.

Item 4.9 “Weakness or loss of strength” almost duplicates Item 4.12 which was addressed previously. I have suffered a loss of strength on my left side. This is noted on riding a bike, on doing household chores, and on carrying objects. Recently I have also noted some form of weakness in my left thigh, or hip. This too appears to be weak. I have also noticed a pain when I depress the clutch in the car. This too is on the left side of my body. And again, these pains and weaknesses were not experienced prior to the accident.

 

Section 4	Not Observed
Item 4.2	Rapid pulse
Item 4.4	Increased blood pressure
Item 4.5	Increased sensitivity to touch
Item 4.8	Numbness or tingling in parts of your body
Item 4.10	Feeling tense or keyed up
Item 4.11	Restlessness, unable to sit still
Item 4.13	Decreased tolerance for alcohol and drugs
Item 4.14	Appetite disturbances

I have started taking my pulse on a regular basis. The resting rate varies between 49 and 55 beats per minute. It will be higher following a day of exercise with the highest recorded value around 60 bpm.

Dr H took my blood pressure a while ago. I have the figures somewhere. It was a normal reading for a person of my age.

I have not noted any increased sensitivity to touch.

I did experience a numbness in my legs in the period immediately after the accident. It was as if they went to sleep and were now awakening. This has not been experienced since that time. I have recently felt a tingling, or a sort of “flutter” in the area of my face subject to atrophy. This is relatively new and was first reported to Dr H several months ago.

I have no feelings of being tense or keyed up. My experience is the exact opposite. Taking an objective look at my situation I think I should be completely anxious but I have no feelings of anxiety whatsoever. This lack of anxiety was one of the three factors that first lead me to consult a physician.

Item 4.11 does not appear to apply to me. I have the opposite situation. I will find myself sitting completely still with no thoughts, no sense of interaction. My preference is for some type of activity such as performing this analysis.

I do not use either alcohol or drugs so this item does not apply.

My appetite has been normal and my diet is straightforward and regular. I do not eat any “factory food” and cook all of my meals from scratch. I believe I tend to over eat in response to depression and despair but I have since recognized this problem and am now taking off the weight that I gained over the last month.