It seems unbelievable, but today marks the eighth week since the surgery. What an odyssey. Well, to mark this auspicious occasion I started a specialized round of Physical Therapy today known as "Vestibular Rehabilitation Therapy". In normal people speak that means that I am embarking on nudging the educational process of my brain along in processing where exactly Terra Firma is supposed to be.
I have noted in earlier writings that this experience has taught me that the brain is one heck of a machine. I am continuing to find it more and more fascinating how the brain processes and delivers information, but as importantly, how it learns to compensate for deficit performance when something goes awry.
What I have principally learned about this part of my recovery I owe to the Acoustic Neuroma Association, a fabulous advocacy and educational organization established for the purpose of providing ongoing information to the acoustic neuroma pre and post operative community. Their website is 'http:www.ANAUSA.org'. They have produced a series of pamphlets on all aspects of AN treatment for those who may be reading the blog and are seeking additional information.
Under normal balance conditions, we process information for balance through three separate systems: the Vestibular System, Vision, and Proprioception (there's a new one for you crossword puzzle folks). I am really going to try to keep this as simple as possible -really - no, really.
When all is hunky dory with the vestibular system, information about where up is and where down is processed by the vestibular nerves. The nerves, sending the data to the brain, in turn sends signals to the hydraulic system in both inner ears. This information is like the way the flaps (ailerons to you aeronautic techies out there) work on a plane. For an airplane to turn right, the right flaps go down, the left flaps go up and off you go. Now imagine that the hydraulic lines are not functioning on one side and you try to turn the plane. Oops - it just is not going to happen (don't you just hate when that happens?). Well the same thing happens when the vestibular nerve function no longer operates in the human head. You literally wind up with the room spinning because there is information only being transmitted on one side and the brain has no idea which end is up. Additionally, it is the direct connection from the Vestibular Nerve to your eyes (sending your eyes in the opposite direction from the head at the exact same speed)that aids the brain in processing of things appearing stable. What does begin to happen is that other tools, normally considered by the brain to be secondary tools, begin to kick in.
That takes us to the other two systems. Vision normally reinforces what the vestibular system has told the brain. If the vestibular system is not working, your vision begins to kick in as part of the primary information source to the brain. And if you are not good at processing information such as the horizon moving towards you, for example when you are moving quickly, or if you spend too much time looking out the side window of a fast moving train or car, you will develop motion sickness because your brain is just not getting a fix on where the level horizon is. Vision however, is of little obvious use in the dark or where there are no fixed straight objects to fix a focus on. Which is why should you get out of bed in the middle of the night you will initially have difficulty with your balance until you can fix your adjusted sight on an object in the room.
I have noted in earlier writings that this experience has taught me that the brain is one heck of a machine. I am continuing to find it more and more fascinating how the brain processes and delivers information, but as importantly, how it learns to compensate for deficit performance when something goes awry.
What I have principally learned about this part of my recovery I owe to the Acoustic Neuroma Association, a fabulous advocacy and educational organization established for the purpose of providing ongoing information to the acoustic neuroma pre and post operative community. Their website is 'http:www.ANAUSA.org'. They have produced a series of pamphlets on all aspects of AN treatment for those who may be reading the blog and are seeking additional information.
Under normal balance conditions, we process information for balance through three separate systems: the Vestibular System, Vision, and Proprioception (there's a new one for you crossword puzzle folks). I am really going to try to keep this as simple as possible -really - no, really.
When all is hunky dory with the vestibular system, information about where up is and where down is processed by the vestibular nerves. The nerves, sending the data to the brain, in turn sends signals to the hydraulic system in both inner ears. This information is like the way the flaps (ailerons to you aeronautic techies out there) work on a plane. For an airplane to turn right, the right flaps go down, the left flaps go up and off you go. Now imagine that the hydraulic lines are not functioning on one side and you try to turn the plane. Oops - it just is not going to happen (don't you just hate when that happens?). Well the same thing happens when the vestibular nerve function no longer operates in the human head. You literally wind up with the room spinning because there is information only being transmitted on one side and the brain has no idea which end is up. Additionally, it is the direct connection from the Vestibular Nerve to your eyes (sending your eyes in the opposite direction from the head at the exact same speed)that aids the brain in processing of things appearing stable. What does begin to happen is that other tools, normally considered by the brain to be secondary tools, begin to kick in.
That takes us to the other two systems. Vision normally reinforces what the vestibular system has told the brain. If the vestibular system is not working, your vision begins to kick in as part of the primary information source to the brain. And if you are not good at processing information such as the horizon moving towards you, for example when you are moving quickly, or if you spend too much time looking out the side window of a fast moving train or car, you will develop motion sickness because your brain is just not getting a fix on where the level horizon is. Vision however, is of little obvious use in the dark or where there are no fixed straight objects to fix a focus on. Which is why should you get out of bed in the middle of the night you will initially have difficulty with your balance until you can fix your adjusted sight on an object in the room.
Proprioception refers to the sensor function provided by the joints in our ankles, knees, hips and spine and the information send back to the brain regarding the alignment of the bones of any or all of those joints. There are also sensors in the balls and heels of our feet that help in sending information as to which direction our body is leaning. This will be impacted on whether the surface is firm or soft - hard floor or plush carpeting, for example. For people who have poor vision issues, getting information from their spine or derriere if they are sitting or laying down will give them a sense of stability.
On a priority basis, the vestibular system will always be correct. That information will be backed up by the other systems. The fly in the ointment is when the vestibular system is not working properly and the brain becomes truly confused in attempting to calculate where the horizon should be. Here is what is so fascinating. When the vestibular function in one ear stops functioning, initially the brain continues to accept the data sent by the good ear only to interpret the information as the whole world spinning (going back to our airplane flap analogy, think one set of flaps working, one not, and the plane spiralling). Generally speaking, this is not a good sensation and tends to limit an individual's mobility. But the brain (being the clever machine that it is) does something very interesting at this point. It will at some point shut down the vestibular function on the working side, enabling the vision and the proprioception systems to provide the primary data.
And that brings us to where I am at this point in the recovery process. As I mentioned at the outset of this posting, the physical therapy process that I have begun is designed to train my brain to accept the primary information for balance from the so-called secondary systems, so that eventually, the vestibular function in my good ear will be turned back on and will work in coordination with the other systems.
If you think it takes a lot to understand all of this, you should try living with it. I am finding that the more activity I can find for myself that forces the use of my vision and proprioceptive systems to keep me vertical is a good thing. Whipping my head back and forth is still not a good thing to do so I think I will be staying clear of attempting to cross Broadway at Times Square for a while yet. I got to hit some golf balls today at the local driving range and while the follow through with my swing had a bit of an impact on my stability (that's carefully worded "is that guy over there drunk or what?") I did squarely hit the ball and was not totally dissatisfied with the results. Frankly, the most difficult part was the follow through and bringing my right leg into position which in essence leaves more weight on the left leg and had some curious impact on staying steady. But I will go back in a few days and do it again just to keep working at it. In the meantime, please refrain from commentary on the form - give a guy a break - I mean I did not fall over once.
There is still some fatigue plaguing me. It is manageable and I am practiced on how to pace myself. Napping is not a considered option as I do not want to mess with the yet fragility of my nighttime sleeping cycle. Headaches still arrive occasionally - Monday's first PT session brought on a dusey upon awakening on Tuesday morning. There is still an occasional twinge of pain that comes from the incision site every so often - I have written that off to nerves and tissue mending and getting reconnected. Admittedly it's a little weird but no one told me this was going to be quite the same thing as recovering from a splinter removal.
Hearing is at this point is what it is. I am yet investigating the BAHA device and gathering some additional information to make an informed decision. As it stands now, larger groups are troublesome and larger venues are plain annoying and for me worth avoiding at this point. The tinnitus is now with me for over a year. I wonder if it stops would I miss it? I think not, but at this point it keeps me amused when I am alone. In a group setting it is a true annoyance. I think that getting back to the office is going to present its own challenges with the activity that goes on in our practice throughout the day. Granted this is a realistic concern, but not one that is insurmountable. I do think being medically designated an 'SSD' - 'Single Sided Deaf' person on the cusp of my 59Th birthday has been a little bit of a smack on the side of the head, but we will get used to how to work around this and get a good handle on how to work with it.
At this point I believe it is fair to state that Phillipe Petite anf the flying Wilendas need not worry about any potential competition from me in challenging the high wire accomplishments for which they hold records. I am going to keep on staying stable while working on step ladders and changing light bulbs in high hat fixtures around the house for now and see where that takes me.
Oh - no one has asked, but I have passed the half way point in Middlemarch by George Eliot. I am loving it and only wished that I understood all of the 19Th century references to the subtleties of British upper middle class life in the English countryside. The current goal is to complete it before I return to work. I wonder if the insurance company would alloy that as part of the evaluation of my progress?? Hmmm.
See you around the campus....
No comments:
Post a Comment