Massed Practice vs Planned Rest Days

So a while ago I was falling asleep, when the phrase, “massed practice,” popped into my head.

It’s from the Norman Doidge book, The Brain that Changes Itself, which I was somewhat obsessed with when I read it years ago. One of the case studies was an older man who had a stroke. Conventional therapy—one hour a week—was doing nothing for him. But working at it like a job, 8 hours a day, he got all his abilities back. The concept is  “massed practice”—continually working those neurons is what builds them up. Like any kind of exercise, I guess.

And when I go full-on with my various therapies, it is a full-time job, or more. The problem is, after a day or two, I crash, hard. I get nauseated. I lurch around with that on-a-boat feeling. I get brutal headaches. I just can’t keep going.

Part of it, I think, is that I’m a bit underfed—I’m trying this anti-inflammatory diet and between being restricted from things that I love and being bored with things that are allowed, I end up in a calorie deficit a lot of the time.

But maybe I just need to be more deliberate about planning rest days?

Weekend was busy; moved kid home from uni. Monday I did a lot, in terms of all my rehab stuff. Crashed late afternoon. Tuesday (yesterday) I did not do much (mainly walking and tai chi, and my vestibular stretching). Today I feel better, back to my full regime, and went just a lil bit farther and faster on the treadmill for my sub-symptom threshold cardio. Maybe yesterday’s rest is the key to today’s success?

My current daily checklist 

A follow-up

So, I did a little treadmill run today after lunch and felt pretty great. My heartrate stayed normal! I did not want to die after a few minutes! Did a version of C25K week 5 part 2, with two 8-minute runs. Yay.

Then I came home, had an early dinner (roast trout and broccoli, easy to prepare quickly and cholesterol approved) and went to an improv class.

I had this idea a couple of days ago. I am really struggling with losing my words, especially when speaking. How do I get that back? How do I work that muscle? So I looked up improv classes, and discovered that Bad Dog Theatre has improv drop-ins every Saturday and Monday. The closest sessions were booked out, but I put myself on the waitlist and got a spot today.

Of course, as soon as I got on the bus there, I started getting a headache, and wished I had brought my new meds (there’s a daily med, and two “rescue” meds to take when you feel something starting). I don’t know if this headache was due to stress, overexertion, the fact that the last dose of the last med was wearing off, or what. But I kept my water bottle handy to keep hydrated and selectively opted out of things like spinning or bowing low. (I really appreciated that they started the session by inviting us to share accessibility needs.) And I got through it! A little nausea by the end, but it was okay. It was great to be in a room full of beginners, none of whom really knew what to expect, so I didn’t feel like “the slow one” or like I was holding anyone back. I did feel like I was getting into the swing of things like “thinking” and “speaking” by the end, and the great thing about improv is that it’s fundamentally supportive, you’re working to build a scene together, and no one is wrong. One of the exercises was even about the value of patience, waiting for your moment, waiting to have someone’s attention, and making sure that you’re connecting and they’ve understood what you’re conveying.

I feel like this could be helpful for me and wish I had thought of it sooner. Maybe there’s a two-day bootcamp I could try? That would at least work as a make-it-or-break-it type of thing? 

So wrecked.

Feeling some kind of a way but maybe it’s just because I’ve been feeling off all week. 

Part of it is stomach upset from the junk food lunch we had on the weekend. 

Part of it is the looming six-month anniversary of my tumble, coincidentally also my birthday. 

I thought I would be better by now. 

Last fall, six months was the longest I thought it could take. At the beginning of this year, 31 March was one of the dates on my LTD letter and I sort of mentally noted it as “will be better by then.” 

Now those dates are coming soon and filling me with anxiety. 

Part of me is frantically thinking, “What else can I try?” I still haven’t called the osteopath my friend recommended (I’m honestly unsure what osteopaths even do). I had the idea the other day of seeing a speech-language pathologist since it seems to be speech where my cognitive difficulties really overwhelm me. I had the idea this morning to try Improv classes to “work those muscles.” Why didn’t I think of that months ago? (Answer: I wasn’t capable of thinking months ago.)

I am typing all this from the waiting room of my doctor’s office, to follow up on some bloodwork results, anx probably get another lab req.

And wondering: 

Do I tread extra carefully now so I don’t mess up my progress as I approach the finish line?

Or do I go hard, to guarantee that I will be either 100% better or 100% obviously not when 31 March rolls around?

So this is why I feel like crap

Update from the exam room, my blood pressure is low even for me! No wonder I was feeling pooped climbing stairs on my way here from the gym. 

A day of contrasts

Of all kinds, literal and figurative. 

I started yesterday feeling awful. Post-concussion nausea? Straight-up stomach cramps? Seemed to be the latter; I blame the “boneless wings” I had for lunch on Sunday (restaurant chosen by a relative). All day I had cramping and stabbing pains off and on, that had me looking up “spleen pain” to see if I was actually dying. 

I did force myself to go to the gym regardless; being a light cardio day I told myself I could leave early if I wanted. And this is dumb, but I knew I was due for an “award” for a 12-week attendance streak. I am like a kid with a sticker chart! Silly, but it does motivate me.

I am on fire!

Then I went home to clutch my belly for a while longer. Waah.

I had a couple of late afternoon appointments that I had been looking forward to, but worried my upset stomach would keep me from. Nevertheless, I soldiered on.

First was an orientation at the neighbourhood secret sauna.

The neighbourhood oasis 

You’d never guess from the outside, but a nondescript building in my neighbourhood is actually a gorgeous little sauna. 

I’ve long enjoyed contrast therapy, and for the past five or so years have been a semi regular at the Banya in Mississauga. I go with a friend and we spend the entire day there. I had been longing to go, but worried I wouldn’t be able to handle it. Anecdotally, I’ve heard both good and bad things about contrast therapy for people with post-concussion syndrome. I asked my doctor at the Toronto Concussion Clinic and they said, “It depends.”

Temperature regulation is a function of the autonomic system—all the stuff your brain tells your body to do without you really being aware of it. Balance is also under the autonomic system. So if you’re really pushing your autonomic system with one task—temperature regulation—it may not have the juice left for another—balance.

I reeeeally wanted to go to Banya, but I didn’t want to say to my friend, “Hey, drive me across the city to this place that costs $60 but maybe I won’t feel well and I’ll need you to drive me home after twenty minutes.” Then, I found out about a new sauna in the neighbourhood that’s more poshy-posh but I could walk there (and get home easily if need be), and we started talking about when we could go there. Then, I found out about the secret sauna, and booked the orientation.

It felt great! 

I was anxious about feeling off-balance—imagine falling into the coals?!—and whether I would be able to manage the cold plunge. I did have an experience at Banya a couple of years ago where I got the shakes and needed my friend to bring me tea and warm towels to use as a blanket while I lay on a sofa to recover. But I was okay! Got in and out without a struggle, although I barely stayed in for a moment.

I felt exhilarated after! And ready to go to my next lil appointment a brisk fifteen-minute walk away.

Part of me of course is thinking, “Wow, this is it! I have found the cure! A few more sauna trips and I’ll be fully recovered!” But another part of me remembers that I felt that way for about two days after reading Sarah Polley’s book, and apparently having a few good days and feeling inspired is not a guarantee of anything.

So far today, I feel okay (the day-after-feeling seems to be my litmus test for a lot of things). I was going to do a “practice workday” experience today (two hours of stuffing envelopes at a theatre in my neighbourhood) but just got notice that was cancelled. Maybe I’ll try the next step in TTC exposure therapy instead? 

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.  

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.  

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. 

It’s déjà vu all over again

I’m doing Couch to 5k! Yes, the same running-for-beginners program I started thirteen years ago!

I decided that I need some kind of a framework to help me stay focused and see progress, and C25K seems as good as any. It’s straightforward, easy to follow, easy to modify (other times I’ve done it, I needed to repeat weeks as I built up my fitness, and I think the first time I tried it I only got to week four).

Thankfully, the treadmill at my gym has a setting for intervals, so it’s easy to do the walk-jog-walk-jog pattern that the early weeks follow. I’m experimenting with what speeds work for me (currently doing a 3.5mph walk and 5.5mph jog), and can always add a lil incline if feeling energetic. 

I have friends cheering me on too, which is such a comfort! Some days I feel like a total ding-dong with my baby steps—I’ve run a handful of 10ks, I should be better than this!—so having people cheer my recovery means a lot.

Now I’m feeling teary and I don’t even know anymore what’s a legit emotion and what is concussion-overwhelm… 

As much as it pains me to say it...

I am trying to go gluten-free.

Anyone who knows me, knows this goes against everything I believe in, i.e. that the greatest thing since sliced bread is toast. I love gluten. But some people say gf can help with concussion recovery, so I’m giving it a shot.

So far, I've been at it since Monday lunchtime (I had rye toast for breakfast). Have I noticed a difference? No. But my understanding from the anti-gluten faction is you need to give it a solid two weeks to see results.

And this week, again, has had ups and downs. But I want to go from ups to upper-ups.

My up this week: going to the theatre for the first time in months. Went to see Company, my all-time favourite musical. And I was okay! What I think helped: I was well-fed beforehand (salade niçoise with a massive fresh yellowfin steak), and my friend drove and hovered around me in the lobby beforehand, we got seated early, and I avoided the lobby altogether at intermission.

My down this week: tried—failed!—to go to Mandarin for lunch on Saturday. It was kiddo’s birthday, so I made the effort, despite my concerns (crowds, chaos). What I think hindered: I was already a bit tired and headachey (theatre meant I was late getting home, and chatting with kiddo kept me up further past my bedtime), the TTC was its usual failure of a self, with cancelled and rescheduled buses, and subsequent punctuality anxiety. Also, the paving at Eglinton station is just off. Instead of regular rectangles, it’s irregular diamond-shapes that made it feel like things were sliding off to the side even if the ground may have been level. Bad lighting in the station, feeling disoriented when we reached the street, and then a huge crush of people at the heavily-ornamented restaurant. Nope. I didn’t even make it as far as the table before I said, “I’m sorry, I can’t do this.”

My next challenge: Friday I have tickets for Rachmaninoff at TSO. What I hope will help: being well-rested to start with, getting downtown early and having an early dinner so I’m relaxed and well-fed when I get to Roy Thomson Hall. I have a gift certificate for Earl’s, not normally my kinda restaurant, but being a chain it’s easy to suss out the gluten free options, so I can keep up the gf thing and still eat some good food (the gf dessert option is white chocolate crème brûlée!), and it’s a short stroll to the symphony from there. Do I dare to wear heels, which I have not since October? I guess the weather will decide that one.

30 grams of protein and no gluten 

Run Towards the Danger

So I finally finished the book Run Towards the Danger this morning and it has me thinking all kinds of things, but more importantly, feeling hopeful.

I’ve been going to the gym pretty steadily for the past week and a half, doing the sub-symptom threshold cardio and trying to keep my heartrate between 80 and 90 (around 50% MHR for me). My heartrate usually tends to be on the high side, I work on regulating it through slowing down, breathing exercises, etc. (I’ve found gazing at the potted plants helps). It’s pretty boring, but I do my best.

I will also admit I have slacked off on the shoulder physio, because doing that consistently for a couple of days will give me a day of headache, so I have to rest to recover.

In the book, the expert Sarah Polley sees insists, just like the title, she needs to “Run towards the danger.” Do the stuff that makes her brain hurt. And when the symptoms come, instead of resting, exercising (she has a routine of fast-paced vestibular exercises to do).

I sadly do not have thousands of dollars to go to Pittsburgh to visit this clinic, but I want to try my own little experiment. In a low-risk way (not in a way where I risk falling and hitting my head again).

Amping up my cardio (while staying on the stationary bike, no chance of falling). And doing cardio when I feel symptoms coming on, and also talking myself through my symptoms.

One thing that happens to me when I’m experiencing cognitive stress or visual stress is that I feel a wave of heat wash over me. I’ve taken that as a signal to stop what I’m doing—finish my session with my SAD therapy lamp for example. Today I felt that rush of heat on the bike at the gym, but instead of stopping or slowing down, I just said, “This is a normal response,” and kept going. It went away.

After getting home, when I sat down to write this, I felt a headache starting. Instead of, “Oh no, a headache,” I said, “That’s just my brain fixing itself,” and the pain dissipated. Placebo effect? Maybe? Probably? Who cares, I don’t have a headache.

One of the things she mentions in the book is she started saying yes to all of the social events she had been avoiding. Man, I would very much like to get back to socialising. But I want to be mindful about how I do all this stuff, and not just knock myself out and set myself up for regression. I do have a number of things planned for January—things I planned before my accident, mostly, and a few I planned figuring, “Surely, I’ll be better by then”—so my goal for now is not to plan more, but to not need to cancel anything. 

Part of me wants to set a crazy goal, like running a marathon this fall (literally running towards to the danger). I don’t know about that. But maybe. We talked about getting a team going to fundraise for the theatre I’m on the board of, so maybe?? Is that nuts? 

I guess the first step is to see how I do tomorrow.

For now, I’m going to try going to the grocery store—an overstimulating place I’ve avoided—since my kid is here with me to support if I need it. Tomorrow he goes back to university, and I am intending to take the train with him. Last time I did a day trip to Waterloo, it knocked me out and I needed to rest a few days to recover. What if this time, instead of resting to recover, I stick to my cardio routine? We shall see…