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. 

Back at it

I was not allowed to exercise for a week after a lil procedure I had done last Saturday (well, 5 days + discombobulation due to ophthalmology eyedrops) so it was nice to get back to the gym today. Especially because I’m feeling a bit like a blob (logging in here and seeing “It’s Sausage Week” might be another clue as to why that is).

I’m at the “pants feel tight” stage, which is when I usually put a lil effort into diet and exercise and get back on track, but not sure how that will work in light of my post-concussion brain. I need nutrition and specifically carbs (brains run on glucose!) to get better. The trick I guess is to get those needs met without going overboard in other areas.

Like fat. Pretty much every day I log my nutrition in Cronometer, and pretty much every day it tells me I’m way over budget on fat. Oops! The problem is, fat is yummy.

It’s funny how no one ever puts it that way. 

Like, I saw an infographic the other day about women’s clothing sizes and how they don’t match up (super annoying) and how they also don’t match up to actual women. Or should I say, actual American women. I mean yeah, I have definitely noticed that Japanese brands, for example, run way small compared to American brands. Last fall, when I had to buy a bunch of sweat pants and spaghetti strap cami tops—i.e. clothing I could easily step into and pull up with one hand—I had fun surprises when the same letter size was too small in one brand and too big in another. Simons and H&M had small smalls. Old Navy had huge smalls. Interesting to note, too, that the infographic left off most of the big American brands like Gap. Could it be that American brands cater to American markets, and European and Asian brands cater to European and Asian markets? If you look at a label from H&M, it lists about six different sizes—US, UK, Euro, China, Mexico, and Australia. They all have totally different systems. Why is is such a surprise that items designed and manufactured in different countries would use their own sizing instead of American sizing? US defaultism at its worst.

This at the same time as people are losing their minds over GLP-1 drugs. Are they going to save the world? Or destroy it? Is it “fair” that some people might get to be thin without “doing the work”? There was an editorial about this a few weeks ago marvelling about these things, most amusingly that the per capita cost of obesity in the US—roughly $200/month—is roughly the same as a prescription for these drugs. Give them to everyone! It’s gonna be great!

Which makes me inwardly groan at the thought of all the other wonder drugs that were expected to be panaceas and turned out to cause a whole host of unexpected problems. The marketing of these new drugs, and how easy it is for people to get prescriptions without even a real medical appointment, seems like a set up for disaster.

And shouldn’t the real question be, what caused this shift? Why are this many people in the US suddenly so overweight? At no time in history has there been such a massive shift in such a short period of time. And it’s pretty well confined to the US, although some countries are working to catch up. Why not figure out the root causes and work on those? Maybe stop adding corn syrup and soy to everything, maybe stop eating convenience foods in cars, maybe drive less and walk or bike more!

Anyway I’ve complained about this stuff enough elsewhere on this blog, so I’ll drop the subject for now, because I’m about to go to dinner with friends. A proper meal, sitting down and socialising with people as we break bread, not a solo drive-through dinner.

 

It’s sausage week

I feel like I’m on a meat-themed version of Great British Bake-Off every time I enter the kitchen, imagining Sue Perkins announcing “It’s sausage week.”

Actually I’m just eating a lot of sausages.

Back in November, I attended a charcuterie event with mixed results. It was a lovely evening, but I struggled with various things—the noise and light, even though it was a relatively quiet event with gentle lighting; and various shoulder-related struggles.

The same crew recently hosted a sausage-making class, which I had wanted to attend for ages and quietly campaigned for, so when it was announced in January I had to get a ticket. I anticipated with a mixture of excitement—because surely I’d be better by late February, right?—and dread that it would be overwhelming and lead to more regression.

Happy to say I got through it! No candles this time, hooray. And no loud clappers. And no sling for me to contend with! We worked in groups of two, and most people were very focused on kneading their meat and filling their casings, so not too much “hubbub.”

And, I came home with sausages! Guess what I’ve been eating every day this week (paired with various Odd Bunch veg).

Maple-5-spice sausage with enoki mushrooms and sesame-miso dressing

Bratwurst with rutabaga “fries”

Chorizo with guacamole, roasted tomato salsa, and corn chips

Toulouse sausage with green salad

The rutabaga fries were not bad! It’s definitely one of those what-do-I-do-with-this vegetables, but other than being annoying to peel, pretty easy to prepare this way.

Rutabaga Oven “Fries”

Ingredients:

1 rutabaga
1 tbs olive oil
1 tsp salt
1 tsp paprika

Directions:

Cut the rutabaga in half. This is the hardest part! To say this thing is sturdy would be an understatement. 

Once you have two halves that will sit flat and not roll around, it gets easier. Cut each half into slices, about ⅜” to ½” thick. Peel each of these using a paring knife (It’s much easier to peel the individual slices than the whole thing, and you’ll need a proper knife, not a peeler). 

Once peeled, cut each slice into sticks about ⅜” to ½” wide.

Toss with oil to coat. Season with salt and paprika and toss again to coat evenly.

Arrange in a single, well-spaced layer on a baking sheet (I did a half-recipe to start, and needed a full-sized sheet). 

Bake at 425° f for 35 minutes. Just enough time to make a bit of salad and cook a sausage!

Just realised it’s been a while...

... and I left on a bit of a cliffhanger.

My CT-scan was all clear, no funny business showing up in my brain.

I had a follow up appointment the next day (why do hospitals do this—discharge in the wee hours, and ask you to come back the next morning, maybe six hours later) with the hospital ophthalmologist, who did some additional testing, said everything seems fine, but I should consider following up with a more thorough exam. I mentioned that I was due for an ophthalmology appointment—my optometrist had referred me to the Kensington Eye Institute back on Hallowe’en when I got my eye exam for new glasses, and told me I should expect to hear from them in January or February, and to call them if I hadn’t heard anything by then, so this was my trigger to call. The hospital ophthalmologist said that was great news, everyone at Kensington is great, so I gave them a call.

They said they had no record of a referral. 

We had a brief conversation where they basically told me to call my eye doc and have them re-send the referral, but it would probably be months before I got an appointment. I called my eye doc, told them about the missing referral and my subconjunctival haemorrhage, and they said they’d call me back.

A couple of days later, Kensington called with my appointment—at the end of this month! I don’t know what they said, but it worked. That appointment is Friday.

Meanwhile, I asked the hospital ophthalmologist about the recurring subconjunctival haemorrhages (this is the third time it’s happened) considering I don’t have any of the obvious risk factors, like high blood pressure. They said, maybe it’s because I have such low blood pressure? That a BP reading that most would take as “normal” would be enough of a spike that my eyeballs, used to very low BP, just go kaboing? I will definitely be asking about that in Friday’s appointment.