Traumatic Brain Injuries and Homelessness

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On February 2, the groundhog declared, “There is no shadow to be cast. An early spring is in my forecast!” This is good news for homeless people, who endure long, cold days trying to keep warm, crouched in the corner of parking garages, curled up on floors of abandoned houses, or huddled together in makeshift tents. But for more than half of homeless men, they have even more to contend with than weather – traumatic brain injuries. With 600,000 homeless Americans shivering on the streets on any given night, this issue commands attention.

Studies have shown that most of the men surveyed sustained traumatic brain injuries prior to being homeless, many occurring during their early teenage years. The most common cause of traumatic brain injuries was attributed to assaults. A large percentage of homeless people studied grew up in chaotic households and experienced chronic childhood abuse, contributing to poor school performance, substance abuse, violent behavior, and arrests – as many as half of New York City teenagers who have been arrested have sustained traumatic brain injuries in the past.

What’s more disturbing is that many individuals reported that the harm they suffered as children, including the neurological outcomes, went untreated because their abusers attempted to shield their injuries from others. The statistics, however, do reveal the magnitude of the impact trauma has on the lives of individuals who have sustained such injuries.

The upside of all this research is the new knowledge we have gained, the knowledge that helps us assist the 600,000 homeless surviving on the streets – the confused, scared, lonely and lost individuals who are as human as the rest of us.

 

 

 

 

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“Failure breeds success”

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Do you ever berate yourself for failing, tell yourself that you should quite while you’re ahead? Has your writing been rejected by literary journals, magazines, and newspapers time and again ? If you’re a writer, you know what I’m talking about. Yes, we get rejected, a lot. Failure is inevitable. It’s inevitable for painters, dancers, musicians, for all creators. Writer, author, and inspirational speaker, Elizabeth Gilbert, failed – for six years she “failed at getting published.” She received rejection letters in the mail, every day.

Are you wondering where I’m going with this failure thread? Keep reading. As Elizabeth says in her Ted Talk, “Success, failure, and the drive to keep creating,” failure breeds success.”

How so? Elizabeth’s story is the answer:

Nearly a decade ago, when readers from all over devoured her memoir, Eat, Pray, Love, she became an instant success. But with that success, she says, came the hard part: “How in the world I was ever going to write a book again that would ever please anybody.”

You may not be a writer, but does this sentiment sound familiar? You’ve succeeded at something: maybe a record label has finally recognized your music. Or you’ve been accepted into an artist colony after applying countless times. Now that you’ve made it, you ask yourself, What’s next? This isn’t enough. I need to do more. I need to keep pleasing my partner, my parents, my grandparents, my children, my pet goldfish.

So, even if we succeeded, we feel like we’ve failed, because we burden ourselves with having to do better and better, all the time, which isn’t necessarily a bad thing. But if we believe we can’t keep succeeding, we may seriously consider giving up, which is what Elizabeth considered after publishing her memoir. It’s all in the mind, really. That we can all agree upon, right? We see things in black and white, good or bad. Success equals good; failure equals bad. (Whoever came up with “good” and “bad” should be … Well, I’ll leave it at that.) Of course, the unending praise bestowed on us when we succeed boosts our egos, until we realize that we need to do more, do better, that this, whatever it is, is not enough. Similarly, the lack of recognition when we fail buries our confidence. Either way, when it comes to good versus bad, Elizabeth cautions us: “There’s a real equal danger in both cases of getting lost out there in the hinterlands of the psyche.”

To stop ourselves from second-guessing ourselves, we need to find a way to forge ahead, to fire-up our inspiration. For Elizabeth, she found that inspiration from past life lessons: the constant rejections she received in the mail each day. Rather than quitting though, she found her way back: “I’m going home,” she says. Not home in the literal sense; home in the artistic sense. Writing was, is, her home. Because writing is what she loves, she returns to it again and again. She went back home after the book she wrote in follow-up to Eat, Pray, Love failed. And she keeps going home.

But how do we find our way back home? Here’s a hint from Elizabeth: “Your home is whatever in this world you love more than you love yourself.”

 

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Choosing Wisely: Health Care

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Are you concerned about how much you’re spending on health care? Are you wondering if the blood test, X-ray, or MRI your doctor recommends is absolutely necessary? Maybe you don’t make it a habit to discuss the pros and cons of testing with your doctor because, after all, he or she is your doctor and always chooses wisely what is best for you, right? I do trust my own primary doctor’s recommendations, because she listens to me, closely. And she carefully considers whether or not a test is needed, then explains to me the reasons for her recommendation. Here’s the rub: We have a conversation about evidence-based practices before making any final decisions. In other words, she engages with me, as a human being – someone with worries, fears, doubts, and needs. So why am I sharing this with you? Last fall my husband went to his primary doctor for a physical exam. A month later we received a bill from the hospital she is affiliated with; the charges for routine blood work were far greater than I had expected. Though we have health insurance, like most people, we must first fulfill a yearly deductible, which doesn’t include copays and coinsurance. When I asked a representative from the health insurance company how they arrived at the number my husband and I were responsible to pay, and who decides on the formula, he answered with what amounted to the following: hospital charge – some random number chosen by a faceless person = contracted rate – deductible – ten percent co-insurance. I had no choice but to reach for the Advil in the kitchen cabinet nearby.

There’s more. Health insurance company administrators treat people not as human beings but as fixed codes that should fit snuggly into pre-printed, micro-millimeter boxes. So, since my husband’s doctor advised him to take Vitamin D supplements, because his lab work showed it to be low, we received another bill charging us a nominal fee for what our health insurance called a “consult.” (That single blood test alone cost us a chunk of $125.29.) It didn’t matter that the “consult” took place during his physical – it didn’t fit into the insurance company’s pre-fab, coded square for “preventative care.” But isn’t that why we have physicals, not only to be examined, but also to discuss what measures we can take to improve our overall health? That sounds a lot like the dictionary definition of “preventative”: the branch of medicine concerned with prolonging life and preventing disease.” If my husband’s doctor didn’t speak with him about his Vitamin D level, how else would he have known that he needed supplements? Health care has become much like an a la carte menu.

Here’s the good news: A friend and author at Strategy Health Care, Dr. Gene Lindsey, led me to a handy resource when I reached out to him with my concern about health care costs. That resource is Choosing Wisely. Launched, in 2012 by Advancing Medical Professionalism to Improve Health Care (ABIM), the goal of Choosing Wisely is to encourage dialogue between providers and patients in an effort to prevent unnecessary medical tests, treatments, and procedures. A practitioner of cardiology for nearly four decades, and President and CEO Emeritus of Atrius Health and Harvard Vanguard Medical Associates, I trusted Dr. Lindsey’s recommendation, as much as I trust my own primary doctor.

Choosing Wisely offers lists of health-related topics created by medical specialty societies, and represents evidence-based recommendations providers and patients should discuss. Topics range from plantar fasciitis to cancer drugs. Each topic includes information about when tests and procedures are deemed appropriate. The recommendations should not be relied upon to decide health care coverage, but to provoke conversation about whether or not particular treatments are necessary.

While reading through the list on Vitamin D testing and supplementation, this is what I learned: Testing doesn’t improve treatment. Most of us have low Vitamin D levels, but not “seriously low levels.” It’s recommended that we get a little more sun, eat foods rich in Vitamin D, and if we don’t get a lot of sun or eat enough D-rich foods, we should talk to our doctor about supplements. According to Choosing Wisely, “Getting tests that you don’t need often leads to treatments you don’t need, or treatments that can even be harmful. For example, if you take too much vitamin D, it can damage your kidneys and other organs.” And “doctors are ordering tests six times as often as in 2008.” Of course, there are conditions that warrant Vitamin D supplementation, like osteoporosis, and any disease that damages the body’s ability to absorb the vitamin.

Take a look at Choosing Wisely, and look out for yourself, your body, your health, because it’s you that matters.

 

 

 

 

 

 

 

 

 

 

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What Not to Say to Someone with a Brain Injury

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At the Vermont Brain Injury Conference last fall, a TBI survivor, who sustained his injury years ago, spoke to an audience of nearly four hundred people. He didn’t have any visible scars, difficulty with speech, or an obvious limp to his gait. He spoke clearly and eloquently, and, in fact, was back in school pursuing a college degree. Because he appears healthy and strong, he explained how those without a TBI often don’t know what to say to him when they learn that he sustained a TBI. I recall him saying to the audience something like, “I’m me.” In other words, he was affirming his TBI, not from the perspective of a victim, but from the perspective of an individual who has accepted his disability, who has learned to cope with the challenges he faces each day, and who wants others to know that, though he looks “normal,” he cannot do everything others can do.

He left me thinking, thinking a lot, about how confusing a TBI is for those who do not have one, especially if they cannot see or hear it – the scars, the limp, the slowed speech. We all mean well (or I like to think so), and when we meet someone with a TBI, or any kind of disability, it’s natural to want to offer an opinion or suggestion, even if it’s unsolicited. I’ve done it myself, and I have a TBI. A few months ago, when walking on the treadmill in the gym where I live, a middle-aged woman with a cane shuffled in, one foot dragging along the carpet. The arm on the same side of the dragging foot hung limp. Her speech was slurred when she said hello. I assumed she had had a stroke. I smiled at her and introduced myself. I watched her struggle to lift herself up onto the seat of the stationary bike, and suggested that she might want to try the recumbent bike. She responded with a soft voice, saying that she had trouble adjusting the seat of the recumbent bike. I offered to help her, but she said she could manage herself. “Are you sure?” I asked. “Yeah, I’ll figure it out.” She did. Though I was being helpful, I wasn’t. She needed to figure out, on her own, how to adjust the seat. If she needed my help, she would have asked me.

While we may mean well when interacting with someone who has an invisible TBI, or any invisible disability, there are an untold number of statements we may find ourselves saying (some of them people have said to me), that are not helpful, but hurtful. It can be said that such statements are not only meant as an attempt to be helpful, but also as a diversion from facing our own morbidity, and mortality. For instance, it’s easier to say to someone with a TBI, “But you look great,” than to say nothing at all, which would leave too much space in your mind for thoughts of your own vulnerability.

To learn what not to say to people with a TBI, go to Brainline. This same site offers other communication strategies when interacting with TBI survivors, including those with post-traumatic stress disorder. But please know that by sharing this list, my intention is not to be prescriptive or didactic. Dare I say it … it’s my way of making a suggestion. (Maybe I’m not being very helpful, but I can only hope so.)

Thanks for considering these tips!

 

 

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