Just noticing…

… that I’m making a lot more entries here this week, but they’re mostly about anxiety and balance issues. Since I started propranolol. Maybe it’s not so good for me? Woke up today with an “upset stomach” and wondering what I ate to trigger that, and then remembering that nausea is one of my concussion symptoms. I think this one might actually be my stomach though? 

Exposure

I was just looking at my exposure therapy plans and fleshing out the details looking at the TTC website. For example, my next step says, “Take Line 1 for six stops starting and ending at a busy station,” but how to do that? How to get to a busy station, how to get home from a busy station? Which routes are currently changed (e.g. Spadina streetcars were replaced by buses for a while, is that still happening?)

Looking at the service updates page, I noticed an item on the long-awaited Eglinton Crosstown line, and looked at the map. There’s a stop at Kennedy, near the Rama Gaming House where I had my fall. RGH is definitely a place I’ve thought of as a peak-stimulus spot on the exposure hierarchy. Lights and noise and a general sense of guilt… how would I work up to going someplace like that?

And just thinking about it, I tear up.

A little panic, a little fear. Could I go there? Just to walk in the door, look around, and then skedaddle off for a saving treat? I would need someone to go with me, who would go with me? 

Just thinking about it makes me cry.

Will I ever go to Bike Rave again? Will I ever even ride a bicycle?

How is this even happening?

Sometimes it just seems insane that I was transformed in the blink of an eye from someone who was out six nights a week, biking across the city to the theatre and Midnight Madness events that end at 2am while at the same time working at a day job. Seriously, in September I’d leave home at 8, bike to work (often arriving early, first person in the office), go on a group social ride after, and then see a show at 9:30—that was a Monday.

Funny, I remember thinking during pandemic lockdown—how is this happening? And then after things were back to normal—did that really happen? Was it all just a dream? 

I hope I get back to normal again. I hope there comes a time when I look back on these dark months as a wacky anomaly—“Remember the winter that I didn’t leave the house? That was so weird!”

I really need to believe that can happen.  

Ow my brain

Just making a note to self that I have a headache coming on. Left side. Didn't get great sleep last night; kiddo came home from uni and with the train schedule it’s a quarter to eleven when they get here, and they were still yapping when I said, “I love you but I gotta go to bed,” an hour later. We went to Freshco this afternoon (note to self: I need to try exposure to a different grocery store to see how I do), and I had that “power drop” feeling I get in the summer when it’s too hot/humid. Just finished a mug of green tea so I shouldn’t be dehydrated. So tempted to doze, or try to.

Oh, and tomorrow is daylight savings, aka goodbye morning sun. Waah.

Oh and I almost forgot, I’ve been really stumbly today, too. Just staggering around and bumping into things. 

Is it me, or…

So I started a new migraine medication this week, propranolol.

Previously, I had been taking amitriptyline for migraine prevention, with mixed results (maybe it would have been worse without? But I did have that nasty incident that drove me to ER). A friend suggested I ask my doctor about Qulipta. My insurance wouldn’t approve Qulipta until I “failed” two other medications. So amitriptyline was one, and propranolol will be two—or maybe it will just work and I can stay on it?

Here’s the thing with propranolol—the side effects include lowering heartrate and blood pressure. For most people, that’s a win. As someone with low blood pressure normally, it makes me a lil nervous. I already have issues with feeling lightheaded if I stand up too quickly, and now we’re doubling down on that? Hmmm…

My first treadmill run the day after starting it went really well. It was the first day of week 5 of Couch to 5k, which feels like a bit of a jump from week 4 (week 5 feels like a bit of a jump every day). I was pleased at how manageable it seemed, and noted also that my peak heartrate wasn’t as high as it had gotten two days prior when I was finishing up week 4. Meds, maybe? 

Today, though, I just felt off. My skin felt prickly? Or almost pins-and-needles but not quite? I repeated day 1 (5 minute jog, 3 minute walk, 5 minute jog, 3 minute walk, 5 minute jog) instead of progressing to day 2 (8 minute jog, 5 minute walk, 8 minute jog) because 5 minutes of jogging felt like I was really pushing it. Afterwards, my skin was super blotchy—really flushed in some areas (face, chest), really pale in others (neck). 

Blotchy!

So, I thought maybe I should look up the side effects (up till now, I’ve only known what the doc and pharmacist told me). Here we go…

From Migraine Again:

Propranolol is a beta-blocker medication developed in the 1960s to treat chest pain and high blood pressure… By blocking adrenaline, propranolol slows your heart rate, lowers your blood pressure, and reduces the dilation of peripheral blood vessels (is that where the blotchiness came from?)… Propranolol may also reduce stimulation of the trigeminal nerves in the head, which contributes to the migraine process… Common potential side effects of propranolol include:

• Dizziness or lightheadedness
• Drowsiness
• Fatigue
• Nausea (hmm, my tummy has been off lately)
• Exercise intolerance (ah, maybe that’s it)

Some readers reported intolerable side effects:

“I tried it, but it made me feel spaced out, I couldn’t concentrate, and my brain was always fuzzy—I’d rather have a migraine!”—GW (I am definitely spaced out, but I was already kinda spaced out, so…) 

“It did nothing to prevent migraine and gave me horrendous, vivid nightmares. I would not recommend it.”—MLA (not nightmares, but I have had difficulty sleeping and some vivid dreams!)

I was worried about having a “hangover” effect after last night’s struggles, but not doing too badly today (although I did almost start crying for no apparent reason on the way home from the gym). So maybe it’s helping with the anxiety too, which it is also supposed to do?

Guess just have to wait and see; often side effects go away as the body gets used to things.  

Oof

So I am just getting back from a very small social event that I went to half as a test to see how I would do. (I realised last week that while I have mastered the art of being with one person, I haven’t gotten much farther than that.) This was a Road Support social (I am volunteering for the Friends for Life Bike Rally this year instead of riding—good thing as trying to ride would have been impossible) upstairs at a pub (some of the F4LBR socials I’ve been to are at a nightclub, and even in the afternoon it’s too much with colourful lighting and crowds), and only a half dozen people came out, and the room we were in was otherwise basically empty (no voices coming from behind me). 

I did okay and when the evening entertainment was about to begin, I decided to leave on a high note and said my good byes.

At the very first corner, just steps from the pub door, I got disoriented and confused as to where I was.

I figured it out, and started walking up Church Street to Wellesley, to catch the Wellesley bus to Ossington Station.

This is where I got really confused.

I crossed to the north side of Wellesley, thinking the subway station is on the north side. Then I crossed Church to head to the station. Then I remembered that I do not want the subway, I want the bus. Then I thought, I could go to the station anyway, and catch the bus there. But what if I miss the bus because I am between stops when it goes by? 

The things about this kind of situation is that it doesn’t feel like the usual dumb indecision or being generally frazzled. it feels like a Sophie’s Choice-level of impossible dilemma (and yes I had to look that up because I have so much doubt and confusion that I don’t trust my memory about anything) that sends my anxiety spiking.

Anyway I went back to the closest stop, at Church and Wellesley, and the bus came right away. 

I got on and settled in for the ride across town. I think I can remember the Wellesley Station stop. Then the next thing I remember, they announced Jarvis. 

Now I was paying attention, if confused. Sherbourne. My westbound bus was going east! 

Again a dilemma. Do I get off, in the rain in a not great part of town with no shelter, to catch a westbound bus on the other side of the street? Would the driver let me stay on if I rode to the end of the line? I ended up doing that, just riding all the way to the other end of the line, thinking it was maybe some different route (I did that a couple of weeks ago, thinking I was on a Davenport bus and then finding out it was a Line 1 shuttle). But then I heard the announcement that it was going to Ossington Station. I asked the driver just to be sure, and went back to my seat.

Did I fall asleep, ride all the way to Ossington, forget to get off, and then all the way to Castle Frank? I don’t even know. I felt anxious the whole rest of the way home that I was going the wrong way again. Even though I know all the street names from biking on Harbord a million times, and I’d ridden that bus before, I never rode that bus before my accident, and so it all felt unfamiliar and so disorienting. I almost cried on the bus but managed to hold it together until I got home.

It’s really troubling, this inability to clearly think through what is happening and what to do about it. It’s funny, because I know some people who seem to struggle like this all the time, without even having a brain injury. I can’t imagine having to live like this with no respite. It’s really, really troubling.

My brain is also whirling trying to decode what about this made it so difficult (hence why I’m trying to type it all out here). Was it the event (which was extremely quiet and chill)? Was it the car lights at night (that contrast is something I struggle with)? Was it something else? Do I need to try again? Take a break? I have a headache now (of course), will it stick around for tomorrow? 

Just yesterday I was walking down the street and some emergency vehicles went by and I thought, “Wow, a couple of months ago, an ambulance going down the street would have sent me staggering.” Is this just the bi-weekly regression arriving on schedule? I don’t know…

The Plan

So I seem to have a pattern of feeling a bit better, overdoing it in some way, and then feeling worse. Every two weeks. I am making progress, but it’s very much two steps forward, one step back. So I’m working on pacing myself a bit better. Hopefully.

First thing is making sure I have light cardio days instead of C25K on the treadmill every day (these would be light days for most normal people, but I am not most normal people). So, using one of the other machines—stationary bicycle or elliptical—and keeping my heartrate in the 110-116 range.

Second thing is building an exposure hierarchy to get gradually used to more.

For example, I have been able to manage a meal at a restaurant and going to the theatre with one other person who can be my point of focus and “sherpa” to get through hubbub and generally keep an eye on me (the incident where I ended up in hospital last month, I had no one person to focus on or look out for me, it was conversations in all directions). On Saturday, I had an early dinner with two friends. Later this month I was invited to a group dinner at a restaurant, which sounds kind of like a nightmare. But maybe book club would be a way to work up to that? There is hubbub, but usually people speak one at a time during the club meeting proper.

Another thing I struggle with is public transit. Streetcars are best. I can handle a bus if I have the right seat and it’s not a crazy route. Subways are the real sticking point. I have managed a Line 1 subway without problems a few times (never at rush hour though obviously) and am working on building my tolerance to Line 2, which is somehow wobblier (I guess due to older trains)? The main thing is avoiding St George station, where too much is going on due to the number of people transferring, and if on the Line 2 platform, I get overwhelmed by the thundering of Line 1 trains overhead on top of the screeching of the wheels on the tracks.

So my transit exposure hierarchy might look something like:

1. Take Line 1 for three stops starting and ending at quiet stations in off-peak hours (e.g. Dupont to Museum)
2. Take Line 1 for six stops starting at a quiet station and ending at a busy station in off-peak hours (e.g. Dupont to Osgoode)
3. Take Line 2 for three stops starting and ending at quiet stations in off-peak hours
4. Take Line 2 for six stops starting at a quiet station and ending at a busy station in off-peak hours
5. Take Line 1 for six stops starting and ending at a busy station in off-peak hours
6. Take Line 2 for six stops starting and ending at a busy station in off-peak hours
7. Transfer at Spadina station in off-peak hours
8. Transfer at Bloor/Yonge station in off-peak hours
9. Transfer at St George station in off-peak hours (Line 2 to Line 1)
10. Transfer at St George station in off-peak hours (Line 1 to Line 2)

And then repeat the whole thing but at rush hour.

That’s the exposure part of exposure therapy. The therapy part might look like having “rescue” options for managing stress during the exposure, like grounding exercises, techniques like havening, noise-cancelling headphones with soothing music, or bringing a journal to write out impressions during the ride; and honouring that this is hard work by rewarding with self-care treats (my go-to being hot chocolate and an almond croissant). 

I should look through my old therapy notes to see what else I can add here.

Anyway today’s exposure adventure is my first volunteer usher gig since the start of October (five months ago)! It’s at a theatre that is very close to home (a five-minute direct bus ride, I could walk there if I want), and has a straightforward set-up (unlike, say, Crow’s, where the layout changes with every production and there’s a lot of traffic management). Thinking I’ll make myself some hot chocolate to bring. I can feel my anxiety rising just thinking about it! But hopefully it will be an easy enough test to my system that I will pass with flying colours. 

And then, a few days’ rest, and on to the next! 

Trying something new!

So I’ve made a little plan for myself for the month of March, alternating between C25K and lighter cardio days. Trying to build gradually instead of overdoing it (again) and crashing out (again). More “jog towards the danger” than “run towards the danger” if you will.

Today, I tried using the elliptical machine for the first time.

The Elliptical

It took me a minute to get going (that is, to figure out how to get it going). But I’m excited to try something that uses my arms as well, and also is just a different “feel” to get used to.

The weirdest bit (to me) is that it doesn’t have the cross-body motion I was expecting—like when you’re walking, or a baby starts crawling—with left arm moving with right leg, and right arm with left leg. After all of the struggles I’ve had working on that, both at the start when I thought I’d use an umbrella as a walking stick on a rainy day and more recently when I started using Nordic poles, this is just the opposite!

Eventually I got used to the rhythm though, and managed to maintain a respectable (for me) pace.

The main thing is it’s another way to get my arms working. My left arm is still very much a noodle after all that time in a sling, and I obviously can’t think about lifting anything until I get my balance issues sorted out. Friday I couldn’t walk a straight line for hours after getting eye drops, yet another reminder to not get cocky! But I still think I can see the shadow of a bruise on my left arm sometimes. Today it seemed very visible when I was on the Elliptical—maybe because of the lighting, maybe I was just seeing it from different angles due to the different motion?

Is that a faint bruise, still?

Note to self: make sure to do a thorough stretch tonight, as different muscles were getting some use today.