Thursday, January 31, 2013

Back to the machine

My neck - spine to be exact, has been crunching lately. Like yesterday during speech therapy, causing Debbie to prick up her ears.

We're working on attention and a little improvement makes her roll out the harder exercises. At one point the guy on the tape with the number fetish goes too fast for too long. I get behind and gave up. Debbie lectures that 'we don't give up'. But like, when I give up it means my brain is out of battery. Expired. It's not frustration, it's my brain being done.

A brain when it's done is totally silent. But a neck crunches.

The daily maintenance, some days more than others, is getting old. Dr. F.'s prices don't work with my current insurance and income ($0). So the management program is weekly yoga, twice-weekly TRX for making the muscles strong, and a tennis ball.

When you lie on a hardwood floor and roll a tennis ball over the muscles, nerves, and ligaments in your back and neck, it's almost like a massage.

Finally we are getting a medical opinion on the 'structural changes'. That is why at 8:20 I excuse myself from an intense dream conversation with a family member. Roll out of bed, fire up the Gaggia, flop open the street map of San Jose with the CalTrain schedule. To Danny, still in bed and functionally asleep I say "there is a train at 9:09 that would probably work. Speak now if you want me to do that".

"If it works for you, that would be one option..." he mumbles. Unfortunately I snap and he kind of wakes up and backpedals and says yes that is the wanted thing.

Last night he announced the Audi was going for an oil change in the morning. In preparation for the trip to Death Valley. I would take his car the other direction to Valley Medical. A car I almost never drive. A car that recently had a little issue in the middle of US 101. Leaving Danny stationary and helpless in the #3 lane, traffic flowing all around. For 20 minutes. Like a boulder in the middle of a wide, fast river.

This boulder and I have no future. Even after the $7000 repair that was covered because of a design flaw in the fuel system. The first rule of recovering from head injuries is Don't Get Another Head Injury.

And if there are any rules at all for surviving Valley Medical, Don't Go When Stressed has to be right up there.

This is how I come to be listening to Dr. Singh in an exam room at 10:45. Almost an hour late (I was on time). Having woken up on the 9:09 train. Having wound around the streets of San Jose to the sprawling county hospital.

The X-ray shows no broken vertebrae but unusual 'movement'. That's what happens when the ligaments get damaged, for example. Sometimes there is pressure on the spinal cord, the damage from which manifests itself down the road. Sometimes there are a few millimeters of space in there. Either way the odds of surgery fixing the pain are 50-50. He says that twice. So I need to get an MRI and come back in a couple of weeks. This is the way he talks, deliberately, with few words and none of them clinical.

Later I figure out he is talking about spinal fusion surgery. And the MRI is to see if anything is pressing on the spinal cord. If yes, they will cut. If no, I can go back to daily maintenance with yoga and TRX. For the rest of my life.

There is no way I could be dealing with this shit and holding down my job.

Tuesday, January 29, 2013

Three words

No idea how long I'll be doing speech therapy. My parking pass expires on February 20. The rehabilitation group shares the building with a YMCA and the parking situation is crazy.

At the start of the session, Debbie gives three words. About 15-20 minutes later I'm supposed to remember them. On Friday the words were illuminate, pungent, and suspect.

I remembered illuminate because she promised to tell me something later that was relevant to that word. Like a little prize. That was Lumosity, where you can play games that train your brain. The software figures out your level by your score and speed, then keeps advancing to get you to the right place.

She recommended the memory and attention games and mentioned another site as well, Happy Neuron.

There's a whole boom of these brain-training sites and there's recent controversy on whether they actually work. I asked Debbie if it was possible for me to get better using these games. She gave me a Friday afternoon kind of a look. Which doesn't give a warm fuzzy feeling, but here goes...

The first three, please. Learning new stuff does not seem to be a problem.

Sunday, January 27, 2013

At the control

A few feet down the road the front tire goes flat. I pull under a bridge to fix it. Only one tube left - wonder if I should ignore that or replenish.

Somehow I end up back at the control. I've done what I can on my own; both tubes changed out with new ones. The new tubes are perfectly seated inside the front and rear rims. Problem: no tires. Just the soft, vulnerable tubes exposed to the world.

They need inflating so I burrow further into the shop to get help. The guys are standing around absorbing, well, the ambiance of fellow guys and the bike shop. There's a spell over them and I can't get their attention. A woman is part of the crew but she's overwhelmed with emotion and helplessness. She's got enough on her plate, being pregnant. I give her a hug. Then begin diplomatic relations with the Guy Planet, trying to get the inhabitants to care about my problem.

Not so successful at that.

The control/bicycle shop has huge windows facing the street. One of these windows perfectly frames the action as a girl with light blonde hair crashes her bike and falls onto the cobblestones. She rolls over silently. Her eyes are milky white.

Friday, January 25, 2013

Groundhog day

Turns out memory and attention are different. And related. A lot of things that seem like short-term memory issues are actually deficits in attention.
Part of "Frequency and Volume" by Rafael Lozano-Hemmer
For example, leaving a jacket in the coat check at a museum. It starts with an innocent detour to the gift shop. There, any jacket thoughts completely go away and you take a straight line to the exit. Outside, it is not cold. You might be thinking about where to buy a stamp and whether you'll make the 4:09 express train home.

The speech therapist wants me to think of a technique, one that could possibly have enabled remembering the jacket.

Then we did another test, this one for "divided attention". That's what they call processing when there's multiple things going on. Multitasking. It was a tape of a man talking, with a low-level narration in the background, as if the radio were on. You listen for certain patterns in what he says. On the first round I missed a couple. During a break she explained which ones.

On the second round I missed exactly the same ones. Welcome to my world.

It feels like I am always fixing things. Under that, it feels like being punished for escaping, for losing myself in the art at MOMA. On the other hand fixing this requires another trip to the museum, more art. So that might swing things to the plus side.

"Bring the claim check", said the security guy. It's around here somewhere...

Art therapy

Took yesterday off. Went to SF MOMA. Blown away by the Jay DeFeo show. Never heard of her before. Loved Jasper Johns too.

Recovery is plenty stressful. Often in the real world when I'm on the spot the right words or actions do not come. On the tip sheet from speech therapy is 'some form of meditation or prayer'. The therapist says she takes mini-breaks, by gazing at a beautiful, calming nature scene. I'm supposed to do whatever works for me.
With the news about the King of Clubs and another neuropsych exam, more stress. The skin on my face and scalp is peeling off, leaving uneven red patches. Looks like an allergic reaction.

What would counteract the physical stress? How many deep-tissue massages? Trips to hot springs. TCHO-a-day. Rides to Pescadero. Bike tours with Meetup. Solar panels on the roof. Sliding shelves in the pantry.

Get a dog (or two). Root out friends who have gone dormant. Help dad with The Book project. Buy a used RV, drive north and park somewhere (like Clam Beach). For a few months.

Whatever it takes to right the sailboat when it leans too far over. The most basic project, the foundation of all projects. The ability to notice when you're upset and soothe your own emotions, one of the key skills of Emotional Intelligence (EQ).

Don't worry, I'm not going to preach from Daniel Goleman's book. It has a journalistic, sociological perspective that is helpful for judging the behavior of others. For righting your own sailboat I recommend Come to Your Senses.

Insurance companies know how to upset us and they count on us not knowing how to respond.
There's probably a timeline somewhere on a white board. With a hash mark at 15 months. 'By this point' they say, 'most people have either made a mistake or given up'.

There are other options, like communing with fellow hipster rebels in San Francisco. The ones who make kick-ass Blue Bottle Coffee. Sell medical marijuana. Decorate bikes with stickers and a sumo wrestler horn and a sign (probably) saying "Bicycling Against Oil Wars".

Life as art. Yeah.

Wednesday, January 23, 2013

Steps, and steps

The steps are sinister - Bella is (usually) not
Monday I stepped out and down toward the yard from the front porch-- missing a step. There are only three...

Landed on the good ankle! Doing something right.

Slowly it's becoming clear that steps are a problem. A couple of near misses in the stairwell at work. A slip and hard landing on my way out to the back yard. A few visits to Dr. F for the lopsided hip.

For me it's perception of space along with (in)attention and balance. I don't notice the gap until it's too late. It's not the flying that's a problem, it's the landing.

Today was the first speech language therapy appointment. Had to fill out paperwork. How medical people love the paperwork! It asked about falls. Had to check the box.

The speech therapist was really really nice. Gave me a cognitive exam that's a fair bit easier than the ones neuropsychologists use. Still flunked a few, not many. They mostly treat stroke at El Camino, not TBI. But it's a lot closer than Valley Medical, they're respectful, they have appointments. This is the price of having those things.

Even when the person giving the test wants to help, it's still a workout. And just have to say this...it was totally the right thing to do, plunging back into work after the accident, pushing myself. Riding all those miles. More pushing at the gym with yoga, Spinning, TRX. Reading and writing every day. I can almost pass for  "normal" with tracking, simple memory tasks, simple language tasks. Not quite, but almost.

Back on Friday. Testing multitasking, or divided attention. That should be a mudfest! And learning strategies. Move on from the Best Memory That Ever Was to one that would be considered decent after a stroke.

Tuesday, January 22, 2013

The football fix

No jaw, no mouthpiece, no brain.
Football fever is here, with the San Francisco 49ers headed for the Super Bowl. People are dressing themselves and buildings and whatever else in red.

The other day kids were throwing footballs across the street, over passing cars. We used to do that. Little known fact: I can throw a spiral pass, because my older brother wanted a younger brother and instead got me.

The NFL is taking a tobacco-industry tack to defend itself against the brain injury stories. It says the latest developments mean we need to do more research on CTE. To show their sincerity they donated $30 million last year to CTE research. You can almost feel the strategy sessions that must be taking place.

This is foot-dragging because it could not be more clear there's a problem. When brain autopsies of 33 out of 34 former players show signs of CTE, pull the emergency brake. Don't just call for more research. It's a moral crisis, people.

Meanwhile, big progress elsewhere:
  • Alzheimer's diagnostic techniques can now be used to find CTE in living brains. A radioactive substance is injected, then a SPECT scan looks for tau proteins.
  • Stanford University, in love with football AND academics, has come up with a way to objectively measure the force on a player's brain from a hit. The players wear special mouthpieces with sensors that record the force of a hit. So far the data is startling.
These two basically unfunded efforts could blow the NFL's strategy to smithereens. If every college and pro player gets a diagnostic scan, how many new cases of CTE are they going to find? My bet, not a small number.

As more players use the new mouthpieces with sensors, lots more data will suddenly be available. I'm looking forward to what the data will show. Do we think it will support the NFL view that football is mostly safe?

Then consider the possibilities for non-players. Maybe the crash test dummy will get a brain and a jaw. (These are the actual heads you can order for your crash test dummy today.) Then NHTSA could measure the forces on the brain when linear acceleration changes to angular acceleration. As it does in a real car accident. As it probably did in my case.

Future Headforms

As dummies are pushed further toward measuring non-contact, closed head injuries there may be development in the area of simulating the soft tissue in the head. This will require the application of clinical research and tissue characterization to the development of the heads.
With more data on car accidents will insurance companies still get away with delaying and denying the effects of brain injury? Over a million cases of mild TBI, every year in this country. Mmm mmm mmm mmm, expensive.

This Super Bowl Sunday I'll be doing what I always do: riding a bike, tending my brain.

Wednesday, January 16, 2013

It's like a muscle...

A few people were surprised when I kept riding after Route 66. Kept blogging too!


This is why. It only takes 3 weeks on the couch to lose the brain benefits of exercise. The brain is just like a muscle.

Tuesday, January 15, 2013

The good doctor

Yesterday's ride was a good idea. My brain is basking in bliss-making chemicals.

Time for the follow-up visit at Valley Medical. The first visit was epic, spawning a few posts:
It is way WAY easier to talk about the things that don't go well. There are so many of them. They make easy targets. Like bona fide professionals who bully and lie for insurance companies. Like your chances of getting reasonably accommodated. Like the labyrinth if you want treatment.

This morning fifteen minutes in line gets you to a gatekeeper. They make you say your name, address, date of birth, insurance, phone, everything. Every patient, every time. Traffic jam.

The doctor I saw the first time isn't here any more. He was on rotation from Stanford Med School. Could she check on who I AM supposed to see? She assumes I've got my patient ID memorized, or at least close at hand. Hey I'm just not that into you folks. Then she interrupts in the middle of my date of birth. There's a protest 'I'm just trying to help you' (spelled 'show who's boss'). Then a sigh with eye roll.

The front office folks don't really get trained on dealing with patients who say things like "Oh, not the passive-aggressive tricks. I don't really need THAT this morning".

Or "My appointment was 10 minutes ago. Do you think we could get on with it?"

Maybe that's why it works, breaking the spell so she can go off script. Relate to me as a human being.

The nurse who comes to get me says "we have your vest, you left it last time". Thank you! Was pretty sure they had donated it to Goodwill by now.

Dr. G. shows up. The head of Neurosciences, he's the doctor who came recommended. The first time I tried to see him but was switched to 2 other doctors instead. Dr. T. needed someone to practice on.

He asks me what I want to accomplish today. Then listens very, very carefully. He's concerned that I fell off the steps Saturday. Gives me another neurological test. I flunk the balance and memory portions and after a slow start, ace the math.

He takes the test results and listens to what happened with Valley Medical speech therapy. Tells me to go elsewhere. Just get to a speech therapist.

His main message is, get good sleep. Every night. At all costs. OK.

Sends a written to-do list back with the nurse. It says:
  1. Sleep hygiene
    • Take Advil for pain
    • Use melatonin
  2. Avoid alcohol
  3. Referral to Speech Therapy for cognitive services
  4. See you in clinic
  5. Follow through with your Neurosurgery appointment for neck pain
Notice anything?

It's all about me. Making things better for moi. Not, look at me I'm Doctor Fancy Pants doing my job.

Oh yeah, he's the real deal.

Expert Poker

Let's play poker!
The first neuropsychologist. Hard-nosed, clear-headed, low on empathy. The first exam was too short because (Aetna) insurance refused to pay for the full version. It was inconclusive but felt like she was trying to teach me a lesson (she'll beat you if she's able).

The full exam, a marathon, was more successful for diagnosis. That night I slept for 14 hours.

The second neuropsychologist gave a second opinion. Bold, unconventional, helpful, possibly the most helpful of the lot. Depends how he's used.

Time for the third neuropsychologist. Today through the lawyer Prudential requested an Independent Medical Examination. They'll pay this guy to do a third exam. It's an offer we can't refuse. An all-day affair, designed to exhaust the brain.

Their goal is to trump the Queen and Joker to win the game. The King of Clubs has to prove I can still do my job. Or pin those pesky memory, attention, and  mental speed issues on something other than a brain injury.

Normally I'd say good luck with that, Big Guy. But y'know, neuropsychology is more art than science. It's like psychology + physical brain research. It's a pseudoscience, my dad would say. Neuropsychologists view themselves as hard scientists where the rest of the world views them more as artists. Very dangerous territory.

So odds are extremely good the King of Clubs will make something up and substantiate it. He can't help himself. He has nothing to lose.

I don't want my gut to be churning but it is.



Playing card designs from Zarrukan Productions

Monday, January 14, 2013

Elaine-Brain

It's my brain...
In college I was lucky to have a raucous, irreverent circle of friends. Laura Manning, writer of short stories, created a moniker for me: Elaine-Brain. As I recall, Laura had a penchant for discussing bodily functions at meals. That was pretty much the only line that needed policing though. She would find it hilarious, my brain on the Internet.

Today I would give plenty to sit with them again at the round table in a corner of the dining hall. Just to hear the latest, come together for an hour then head out in the world again. We used to laugh so loud. That's what I miss, the stories and laughter.

When I went to see this neuropsychologist, I said 'they took a couple of MRIs and didn't see anything'. His response was 'Nothing? Are you sure?'

;-)

Well, just my brain which they called 'unremarkable'.
Normal MRI examination of brain without IV contrast. No evidence of intra or extra-axial hemorrhage, cerebral contusion, or other trauma related abnormality.
No lesions. Unfortunately that doesn't mean I can multitask and remember stuff. It just means insurance companies can put me through hell.

Thinking of donating my brain to science so it can have adventures of its own without the rest of me.

Run away home

Tomorrow, the follow-up at Valley Medical. Gird for battle.

Last time the young doctor, Dr. T., asked for:
  • the latest neuropsychological exam
  • the results of a hearing test after the accident
  • four blood tests
  • the images and report from the latest brain MRI
Even if he did treat me like a lab rat I figure it's in my best interest to provide information. More information = more science (hopefully) and less art.

The last one still needs gathering. Originally the plan was to take the train to and from San Francisco, where the MRI lives.
Sunny and cold, it's a beautiful winter morning. On impulse I get into (wool) bike clothes and pull the Waterford out of the garage. It helps with stress management. Front-loading the stress management seems like a good idea.

The main route is simple: the Loop, Sawyer Camp Trail, San Andreas Trail, Highway 35. The part in the city is not straightforward and I'm wishing for a smart phone, with Google Maps close at hand. Since the accident I've made a fair number of 'where am I?' calls to Danny from my not-so-smart phone. The goal is to minimize those.

Pushing away from the house, there's a sense of freedom.

When I got back from Las Vegas the first couple of days were stressful. Fraught with baggage (literally). Bags from the Christmas Trip and NMX lurk in the living room, waiting to be unpacked.

Mostly it's life wreckage though. Like a shadow in front of the sun. So I broke the rules and had a glass of wine 2 nights in a row. That wasn't a good idea. After giving up alcohol (mostly) it could not be more clear, the impact on my brain. Makes me irrational. Moody. Depressed. Stupid.

Now I'm free. At some point in Portola Valley I realize it's possible to ride to Daly City, then take BART the last few miles into San Francisco. Never done that before. Always good to try something new.

Also, my ankle is kinda done. Saturday I fell backward off the front steps and heard something rip. It's a sprain. There's been swelling, bruising, ice, and Advil. Today is the first day back in the saddle.

I phone Danny, who is looking at Google Maps in his office. He confirms how to do the BART thing. Go 2 miles past the dreaded Hwy 35/1 interchange, John Daly Blvd. The new plan!

The trail winds around Crystal Springs Reservoir, which stores drinking water from Hetch Hetchy. There is something peaceful and relaxing about staring at the blue surface.

Under the reservoir runs the San Andreas. The last photo looks southward along the fault. Try to see a line running from the right foreground to that little speck of blue reservoir near the center. Beyond that point the fault curves left and goes into the Santa Cruz Mountains. Making good, hilly roads to ride.

It's considerably less peaceful during rush hour on John Daly Boulevard, crossing 280. I run the gauntlet, giving drivers meaningful looks (don't kill me, man). BART whooshes right into the heart of the Mission District, about a mile from the hospital. The staff are bubbly and helpful, burning a CD with the MRI images on the spot, printing out the report. It's stupefying, their persistent cheer in a place where people find out what their cancer or broken hip looks like and where people like me can't get out fast enough.

On a packed commuter train, suddenly I'm part of the working world again. Everyone has a laptop or smart phone. Two interesting neighbors. On my left is a engineer at Pinterest who presented at South by Southwest and was a blogger before there was such a thing. Opposite sits a mechanical engineer with a degree from Davis who says it's too dangerous to bike in the city. All her arguments are fear-based and familiar but she gets a demo of my Solas blinkie anyway. For the first time today my toes are warm. The CD and MRI report are stashed in my bike bag.

Fifty miles, mission accomplished. Trains, like an old friend, enabling my escape. And bringing me back to face tomorrow.

Junior Seau had CTE

The last day of the Christmas Trip we turned at the ocean, keeping it on the right. To celebrate a calm sunny morning we stopped and took photos against the calm blue of the Pacific. Then we headed for San Diego, right past the house of Junior Seau.
  
View Larger Map

It's where the NFL player and native of Oceanside committed suicide eight months ago on the last day of the Route 66 trip. 

The results of the brain study were just published this week. They found CTE from 20 years in the NFL, taking hits to the head. He was 43 and if he had lived longer, dementia would have been his reward.

So far after studying 34 brains of former NFL players they've found CTE in 33 of them. 

The house has a new owner now.

Sunday, January 13, 2013

Every day we do something

At Marco & Heather's place, look to the left at the kitchen sink. This poem might catch your eye. I've seen it before it but standing here on the raw boundary of an old wrecked life and the bare desert of a new one, it's still satisfying.

Manifesto: The Mad Farmer Liberation Front
by Wendell Berry

Love the quick profit, the annual raise,
vacation with pay. Want more
of everything ready-made. Be afraid
to know your neighbors and to die.
And you will have a window in your head.
Not even your future will be a mystery
any more. Your mind will be punched in a card
and shut away in a little drawer.
When they want you to buy something
they will call you. When they want you
to die for profit they will let you know.

So, friends, every day do something
that won’t compute. Love the Lord.
Love the world. Work for nothing.
Take all that you have and be poor.
Love someone who does not deserve it.
Denounce the government and embrace
the flag. Hope to live in that free
republic for which it stands.
Give your approval to all you cannot
understand. Praise ignorance, for what man
has not encountered he has not destroyed.

Ask the questions that have no answers.
Invest in the millenium. Plant sequoias.
Say that your main crop is the forest
that you did not plant,
that you will not live to harvest.
Say that the leaves are harvested
when they have rotted into the mold.
Call that profit. Prophesy such returns.

Put your faith in the two inches of humus
that will build under the trees
every thousand years.
Listen to carrion - put your ear
close, and hear the faint chattering
of the songs that are to come.
Expect the end of the world. Laugh.
Laughter is immeasurable. Be joyful
though you have considered all the facts.
So long as women do not go cheap
for power, please women more than men.
Ask yourself: Will this satisfy
a woman satisfied to bear a child?
Will this disturb the sleep
of a woman near to giving birth?

Go with your love to the fields.
Lie down in the shade. Rest your head
in her lap. Swear allegiance
to what is nighest your thoughts.
As soon as the generals and the politicos
can predict the motions of your mind,
lose it. Leave it as a sign
to mark the false trail, the way
you didn’t go. Be like the fox
who makes more tracks than necessary,
some in the wrong direction.
Practice resurrection.

Friday, January 11, 2013

End of a road



Sad this morning. And last night. Waves of sadness.

Just before Christmas an email came saying I was no longer an employee of the company. With instructions for returning my laptop. Take it to any UPS Store, the company would pay.

I loved my job. The people on my team, helping them accomplish stuff. The feeling that I had something of value to contribute. The paycheck.

I like the way it gave the day structure. Like most tech jobs in Silicon Valley it was all-consuming. It was a daily struggle to hold onto a shred of humanity. For 18 years, a job and a bicycle. That was it.

Health benefits went away more than a year ago; this represents the final step in the separation process. It might be the final loss in the cascade that began with the accident. I am unemployed.

Sometimes it feels like I can't breathe the air, can't allow myself, forgot how. As the youngest of five work was helpful for showing my parents and older siblings how I could make it on my own. Able, in the full sense of the word. Where they saw a younger, poorer, smaller, dependent, worth-less version of themselves, the world saw a person of value.

People at BlogWorld were very nice. Sometimes after the words "brain injury" their body language would change, stiffen. Their eyes would scan for external signs. As Lon Nungesser says in Axioms for Survivors:
Much of the initial impact of any diagnosis will be due to the stigma attached to the illness.
OK, so I wonder what work looks like now. Going forward.

People tend at this point to nudge toward the good stuff. A future that is undefined, opening up ahead of me. Turning the bad into something positive. This blog is already there, letting people know what it's like from the inside to have a brain injury. Sharing the experience, the stories, the recovery process.

But sometimes as Dr. H says, it's just sad.

After all Vegas has always been a place of big highs and lows.

Friday, January 4, 2013

35 psi


Wrote an email to a friend today. An excerpt:
If you ever are tempted to take a folding bike in a suitcase to Las Vegas, then ride from the airport 9 miles to the house where you're staying, let me know - I'll talk you out of it!
Somehow we made it, me and the Bike Friday and the trailer. Found the way out of McCarran International (hint: go through the parking garage). The little trailer wheels with their 35 psi cheerfully rolled through glass and sand and road anomalies. They bear more than a passing resemblance to the wheels on the landing gear of a passenger jet. Tough.

Sometimes we retreated to the sidewalk. There just isn't much bike infrastructure here. Every bit of road belongs to cars.

It IS flat in Vegas. 20 years from now I envision all manner of bike lanes, like Stockholm.

An older man waiting at a bus stop watched me trundle past, nodding. "I LIKE your alternate mode of transport!" he said. Complete with safety triangle it might as well be an Amish buggy. I gave him a thumbs up.

Route 66, a journey is at BlogWorld (New Media Expo) for the next few days. Staying with Marco and Heather. Learning how to be a blogger! Thanks for sticking with me during the first year.

Tuesday, January 1, 2013

Double jeopardy

Back from the Christmas Trip. Happy New Year!
Lawyer email? Check.

The insurance company wants the raw data from my neuropsychological tests. Neuropsych tests are considered the gold standard for proof of mTBI.

It's a good thing, right? They want to see the proof. 16 months after leaving work, I have not seen a dime from them. Could you last 16 months without money coming in? They're betting no.

The insurance company is wholly unconcerned with the truth. They'll take the data and get one of their experts to say it's not mTBI, it's something else. Just like they looked at my medical records and pretended it's possible to see a brain injury on an MRI scan.

Neuropsych tests are considered so private, providers won't even post them online like other medical tests. Neuropsychologists don't want to hand over your own results because they're often upsetting. And now Prudential wants them.

So I'm opening myself up again. More humiliation, more violation of boundaries. The lawyer says we just have to go through it. If we don't cooperate they'll deny the claim outright. Of course, if we do they'll deny it based on some version of reality they cook up.

Caveat emptor. For invisible injuries like mTBI, you do not have private disability insurance. You pay them, your employer pays them, they do not pay. I am kicking myself for giving Prudential additional money every month, to receive a greater percentage of my salary if I was ever disabled. They used that money to do this.

Riding is an honest activity. It's just you and the bike and the weather and the contours of the earth. At no point is it a sham.