Basic Concussion Care

2. Let go of needing to know when you will get better

If you are anything like I was, you might be overwhelmed with an intense desire to know when you will get better. Here’s the thing. No one knows how your concussion journey will unfold. No two concussions are alike. Symptoms vary. Intensity of symptoms varies. The lengths of time symptoms are present vary.

It doesn’t seem to matter how concussions are caused or what the initial symptoms are, there is no way to determine the long-term prognosis from the start. I am among a small percentage of people who continue to have symptoms years after the fact, but most people, even with more intense symptoms than mine, fully recover within months.

I wasted too much time fretting about when I would fully recover. Things changed for the better once I was able to (mostly!) let that go. I used to say that I ‘accepted’ my situation but a better word is ‘acknowledge.’ Acceptance comes with a connotation of ‘being OK with it’ which can be a lot to ask. Start with just recognizing, acknowledging what is true right now. It is still frustrating, disappointing and hard, but it’s no use fighting it.

3. Let Your symptoms Be Your Guide

An essential aspect of mindful concussion care is to learn to attune to our body – to listen to the messages our body is giving us and then actually do what our body is asking us to do. This is not easy! It is hard to make decisions and take actions based on how you actually feel rather than how you wish you feel or because you think you should be feeling better by now.

Most of the time when we confront ailments we do everything we can to ignore or mask our symptoms. Mindful concussion care asks us to do the opposite. The key to letting your symptoms be your guide is to pay deep attention to what is actually happening:

1. Recognize what your symptoms are
2. Recognize what brings your symptoms on
3. Recognize what keeps your symptoms at bay

It’s up to you to listen to your own body so you can figure these things out for yourself, because what works for me may not work for you; your concussion care journey is your own Grand Experiment, and the laboratory is your own body.

4. Don’t go back to work too soon (and limit your activities to what you can actually handle)

For many of us our instinct is to ‘dust ourselves off’ and ‘get back on the horse.’ We feel an invisible compulsion to get back to work – as though it is just so important that we do so. Somehow this intense feeling overrides common sense which indicates that in fact what we need is more rest and self-care.

You cannot do mindful concussion care on the side of your desk. You must give yourself the time you need for self-care. Of course sometimes people can’t afford not to work. I get that. But as best you can, try to decide what you really have to do and let the rest fall away. Be discerning in what you keep on your plate. I still battle my want-to-do-more-than-I-can demons, but as best I can I forgive myself when I take on too much.

What might you be able to give up right now so that you can properly care for yourself?

5. Pace yourself

The mantra is: Do. Rest. Do. Repeat.

As best you can, avoid always being up against the edge of your capacity – The sweet spot is behind the edge of what you can manage, not just over the edge where so many of us tend to live. It’s not worth it to keep pushing and feeling crappy! Accept (or at least acknowledge!) your limitations.

As best you can (because it is bloody difficult!) try to:

• space things out over a day, over a week
• prioritize what needs to be done and let the rest go
• do the hardest things early in the day
• try to rest the body and mind BEFORE you get exhausted
• try to avoid the DO TOO MUCH/CRASH cycle
• just SAY NO (resist the urge to push through when you need to rest)
• be realistic about what you can get done and don’t berate yourself if it is less than you had hoped
• SLOW DOWN (it’s ok to do less)

6. Resource yourself if you are feeling overwhelmed

It’s normal for us concussion survivors to get overwhelmed. We either go UP into hyper-arousal and into anxiety, fear or anger, or DOWN into hypo-arousal and into numbness, foggy-ness. Notice when this happens. Recognize that this dysregulation is normal for an injured brain and traumatized body; our nervous systems don’t work normally and it is harder for us to regulate our emotions.

When symptoms come on (noise and light sensitivity, headaches, cognitive and physical fatigue, dizziness, memory loss, strong stress reactions etcetera), be kind to yourself. In these moments you can resource yourself:

• leave a loud room
• put in ear-plugs
• wear sunglasses
• put on a hat to block bright lights
• ask to have the music turned down
• take a walk
• take three deep breaths
• look outside the window at the calming trees
• enjoy a cup of tea
• take a bath
• talk to a friend and seek out a hug
• take a nap
• put your hand on your heart and say ‘this is hard’
• just lie down in the bloody dark room again!

7. Don’t let yourself get hungry or thirsty

For the first few months after my accident I couldn’t let my blood sugars drop or I would start to feel weak and shaky. Even today I have to be watchful. No one told me this, but somehow my body figured out that what it needed was a lot of protein and fat. I ended up eating a rather frightening amount of eggs and cashews; these calmed the shakes quickly. What does your body ask for if you get the shakes?

Also, make sure you drink plenty of water to keep that brain of yours well hydrated! Why is this still so super challenging for me?!

8. Get enough sleep

The silver lining about having a concussion is that we have tremendous incentive to do all the self-care we know we should be doing anyway. Other folks can push through on little sleep to meet a deadline, but we can’t. We feel the pull to go to bed on time much more intensely; go with it and get the sleep you need.

Brain injuries can conjure up an awful lot of worry. This fretting about how we will manage can lead to insomnia. There will be no sleep as long as I lie there worrying about the fact that I am not sleeping! I try to notice when rumination (negative thought-loops) begin, and as quickly as possible I try to change the channel.

I have learned that the best thing to do is to simply accept that I may get less sleep, but that’s OK, I will manage. Maybe I’ll catch a cat-nap the next day. This letting go of worrying about the consequences of not sleeping is hugely relieving.

So, I (try to remember!) to do one of two things:

a/ I take some long slow deep breaths, inviting my body to relax (and somewhere along the line I fall asleep).

Or

b/ I get up and watch a TV show (not computer work as that blue screen light kills the sleep impulse). This tends to flip my ruminating mind off, so when I go back to bed I can sink into some meditation or slip into sleep.

9. Take up gentle exercise

Introduce gentle exercise but don’t push it if it brings on symptoms; let your symptoms be your guide! Try some slow walks to start, and pick up the frequency, duration and intensity over time based on what you can handle without bringing on more symptoms. No skating, skiing, or horse-back riding people! The last thing we need is a concussion on top of our concussion!

10. Reduce brain-taxing activities

The key here is to simplify and avoid stress. Here are ten suggestions:

1. Keep things neat
I cannot tell you how much it helps to de-clutter. It may sound unimportant given all that is going on, but it calms my mind when the house is tidy. It may sound odd, but even just making sure all cupboard and closet doors are closed feels settling. It’s worth taking the time to clean up. Give it a try and see how it feels….

2. Make lists
I have found it hugely helpful to keep track of things via To Do Lists. You may be used to tucking tasks into the back of your mind, but it’s exhausting trying to remember everything. Just write it all down right away.

I have three lists:

1. a running list of all things I need to do
2. a shorter list of priority items
3. an even shorter list (for everyday or every few days) of time-sensitive items

3. Leave the house early
I have found it is best if I always leave the house early so that I avoid being stressed for the whole transit ride to where I am going, hoping I’ll make it on time. I just leave with plenty of time so it’s a relaxing experience on the way. No worries if I show up a bit early.

4. There is no need to rush
I remember so clearly when a monk at Birken Forest Monastery gave me this advice: Kids move quickly without rushing. Emulate that energy. Instead of stressing when there is a time crunch, just move quickly. You won’t get things done any faster by adding that ‘rushy’ feeling!

5. Try not to cram too much in
A good example of this is that now when I am reading on transit, I don’t start a new chapter if my stop is coming up. I just close my book and take a look around. Take a few breaths. Ahhh…..

6. Avoid people who cause you stress
How wonderful to finally have a good excuse to avoid the people who cause us stress! OK, this may sound facicius, but truthfully after my concussion there were some people I could no longer handle; my reduced capacity to manage stress made the stress they caused me so much more apparent. It gave me the strength to set boundaries where I so needed them.

7. Avoid alcohol and drugs
OK, I know you won’t like this one! But still, in the acute post-concussion phase, alcohol and drugs don’t help! This can be difficult if you tend to rely on these when times get tough. It’s an opportunity to explore other (healthier) stress reduction tactics. Abstention need not last forever, but it is important in the short-term.

8. Get a handle on your screen-time addiction
Screen-time is not good for brain injuries – she says as she writes a blog for you to view online! It is all about moderation and pacing. So stop reading this website once your brain starts to get tired – come back to it when you are re-charged…..

Notice when you feel the pull to check your phone. Recognize that often this has less to do with an actual need to attend to an issue than it has to do with your desire for connection. Is it possible to seek out real connections, instead of hoping for one more like on Facebook?

9. Let natural breaks in life be a blessing not a curse
I try to take advantage of ‘down-time’ moments like when I am waiting for the elevator, or the light to change, or when I am in a line. I try to use this time to take a few breaths, connect to my body (feel my feet on the floor for example), or just take a look around and enjoy people watching. This is much better than getting lost in frustration about having to wait. I like to think of these moments as gifts instead.

10. Take the time to recalibrate to the present throughout the day
Throughout the day we get thrown off balance. By queueing ourselves to presence, we set our compass back to our Calm Centre. Many times a day we can say to ourselves: what can I see, hear, smell, touch or taste right now to pop me back into the present? This constant recalibration, and settling into presence helps us weather the storms of our lives as concussion and trauma survivors.