Do you have to have a sleep during the day??
 

I was just wondering if any of you have to have a sleep during the day. For the past 5 years or so the only way I have been able to function to the max is by shutting my eyes at 11.30 am for a half hour and then by actually going to bed at 3 p.m and sleeping for an hour. If I don't keep to this routine I get that horrible foggy painful burning feeling and all the symptons become worse - headaches, dizziness - simply can't think and my memory deserts me. usuall stuff happens - forgetting what I am talking about mid sentence and words etc. I am fortunate in that I can shut my office door as I work 3 hour days and the 11.30 am snooze is at my desk - it is the only way I can last the 3 hours at work. Have wondered if I didn't work would it be any better - but if I don't work as the insurers specialists have decided I will not receive any compensation.

Good Morning
 

To Lucy, Yes I sleep during the day, 5 hours is usually the max for me. I'm usually up at 3 am till 5 am or so then up at 7 am until noon. Those 5 hours in the am are the most productive part of the day for me mentally. So I try to take care of all my people business during that time. I rest from noon until 3 pm and I take a nap at around 3 pm until 5 pm Then I'm good for another 5 hours or so. I tried to push it for 8 or 12 hour and end up not being able to do anything for the next 2 or 3 days.

I learned when I was in TBi rehab that balance is the key. So I try to push it until I'm tried and then rest, if I don't then everything shuts down and I'm unable to do anything for the next 2 or 3 days or longer.

I'm currently doing some research on chronic fatigue,chronic pain and sleep disorder as all of these factors have a negative effect on the natural healing process of the brain. I've come to the conclusion for me that since the whole body was traumatized during the accident that there is some nerve damage that needs to be healed and it is the nerve damage that is causing the fatigue. If I try to push it to hard I end up re injuring myself and the healing process starts over again.

Take Care Jeff
:)

thanks Jeff. Would you mind keeping me up to date on what you discover with your research into chronic fatigue? I have tried all sorts of things to try and over come it - including walking for miles and miles - made me lose weight and that was about it. Have tried trying to extend times between sleeps and all that does is make me play catch up for a week. Any disruption also prevents me sleeping at night and then I can end up staying awake for days on end. It does all seem to be a very very fine balance. My psychologist actually had me admit the other day (I am always in denial of all this even after 6 years!) that it takes me all my energy to simply exist at times! Oops sorry if I sound like a misery think I am having one of those days! Groan!!!

Good Morning
 

TO Lucy, Thank you for your reply. You may want to check out a post in the Chronic Pain Section on this site. There's a post there 101 Ideals to empower persons in pain. At the end of the post there are about 10 websites that deal with this issue. I've only had time to read one, but the information is very good and this might help you come up with the questions you need to ask your Dr.

I'm currently in the process of writing up my own treatment plan to:) indentify the symptoms and the causes weather it be physical mental or spiritual and then I will go find the people to help me over come or heal the causes. In my case it looks like nerve damage to the body and brain is the cause.

It is my understanding that after 3 days the body will shut down the healing processes and go into a survival mold in order to function and that this is a natural process. We shut down until we can handle the pain and release the pain in order to heal the part of the body that was injured. Since my whole body was bruised internally including the brain the body and mind shut down because I was unable to deal with the pain or the trauma at that time. I'm starting to wake up after 4 years and it does hurt.

After I write up a treatment program I will set up a new master mind group to review this plan and set up a program progess and accountability report. I usually meet with those in my master mind group once a week, in person, phone or email to get feed back, insight and direction. Is the treatment plan working yes or no and if the answer is no I need to come up with a new plan.

I hope this information helps.

I'll send you a copy of the treatment program when it is finished if you like or any other information I run across that may be helpful in overcoming TBi/PCS

Take care and be well. Jeff

Thank you Jeff.

At times I believe that my total energy goes into working - like my 3 hour per day job, which I suppose with driving to work and attempting to look presentable - like covering up the black shadows from under the eyes etc anyway - usual girly stuff- this can all take up to 4-5 hours. The remainder of the day I have to drag myself around - when I am lucky I can feel like about 30% of what I imagine my old self was. Would you consider that if I gave up my job more energy might be available for healing or would you consider it would have a reverse effect - decline in motivation? Usually I don't have any trouble with motivation and tend to over do as have a problem with leaving tasks incomplete.

Can you also explain "resting" I am just wondering what others consider resting to be - sounds silly I know. Resting used to be for me reading a book or lying on the couch watching television or a combination. Now would you consider that resting is the one step before sleeping?

Thank you for your reply
 

To LUCY. You may want to read a book by Robert Mauren One Small Step Can Change Your Life. The KIAZEN WAY. I use KAIZEN in my life it is basicly breaking problem down to small incermental parts and making positive changes in your life over a period of time. 1. Ask small question 2. Think small thoughts 3. Take small actions 4. Solve small probems. This has been very useful for me in the road to recovery from TBI/PCS as my brain gets overloaded with information and I am unable to process it. It's also a good tool to use so that I don't beat myself up because I'm unable to do the thing I was able to before I was injuried.

One thing I did learn in TBi rehab it that it is very important during the healing process to be consisdent. It is also important for me to stay engaged with people I set up a master mind group for this 4 men and 1 women this help me from getting blind sided and on track. I'm in the process of setting up another master mind group for the treatment and healing. I do try to work 2-3 hours per day I think this helps me and it also keeps me engaged with the world, but I'm also realilistic in my work activities as there are many thing I am unable to do.Taking care of myself and rebuilding my brain is my number one priority.

Healing from TBI/ PCS takes along time and as a good friend would tell me baby step will get you to the bus.

Hope this helps Lucy dont give up. Jeffn:)

thank you again. You would think that after 6 years I would appreciate all that you have said. I have tried to be patient, but you get to the point that your patience is wearing very thin - you could say thread bare! There is some saying about "so little time so much to do " - something like that. The psycholgist told me the other day that those with my personality type - the picky, fussy, perfectionists can find this the hardest to cope with. I am now developing further levels of tolerance she says with a grin on her face!!!!

Good Morning
 

What's your plan Lucy ?

I was hit by a Druck Driver on my motor cycle in Sept 2003. I've had 8 near death experiences in the last 4 years. I lost my health, my career, my identity my ability to make a living and the list goes on for pages. I've spent the last 4years recovering from these injuries. When I first started out on the recovery process I could not read, write, talk or tie my own shoes.

I'm very thankful to be alive today and everyday I wake up I ask myself what one small thing can I do to improve my health today.

When I'm having a bad day I think of my friend Joe, who was also in a motor cycle accident. Joe is in a wheel chair today and it takes Joe 4 hours to get out of bed and dress himself. I go down and visit Joe when he's in the hospital. Joe well not be getting out of his wheel chair. I love to see Joe smile when you come into his hospital room he so thankful to be alive. So I really don't have it that bad.

One of the walls I hit in this recover process was I have to accept the fact that I am not the same person I was before I was injured and this took about 3.5 years to admit to my inner most self that I am disabled and the person I was before may not be coming back. So I focus my energy on the new person I'M becoming today and try to work within the limitation I have with the TBI/PCS. I simplely have to do life differently today. I have to learn new ways to solve problems and issues and I have to go ask for help when I can not solve a problem on my own.

Have you set up a support group ? Working with others who have TBI/PCS. That's what I'm trying to do now

Have you written up a plan on the mental and emotional issues your dealing with? I'm in the process of writing up a treatment plan now and for me it needs to be in black and white on paper.

Thank you for your help Lucy you've help me see some of the blind spots that I need to address. Jeffn:)

WOW!! Jeffn, your work has taken you so far! You are inspirational!

My ramblings!
 

Jeff, you have certainly done incredibly well with all that has happened to you! And you seem to be so proactive in you recovery. You are amazing. everybody that posts on here seems to be amazing in what they have researched and achieved. By comparison I feel quite in adequate. I think that in NZ there is far less in the way of resources. Most of the specialists that I have seen have been government ones. We have a compulsery system that all employees and employers pay a levy to Accident Compensation Corporation as you can not sue for personal injury. The ACC manage your recovery - so naturally the quicker you recover the sooner they can stop paying you compensation which is 80% of your previous income. When their specialists decide you can work either full or part time that is it. So if I quit my 3 hour a day job I would not have any income what so ever. Gosh I didn't intened to waffle on about that - but may as well.

In the six months following my 2 little bumps - like the neurologist said - for such trivial blows my symptons were excessive - something to that effect. In such a little country all 4 million of us -there is not a lot of choice for specialist treatment. I have seen a neuro physchiatrist privately who did explain cumulative injury - and filled me with drugs as I was that desperate I would have tried anything. And I have been to Australia and had a QEEG which finally showed my evidence of physical brain injury as the MRI and the CT I had had showed nothing.

I wonder if the problems that I had after the accidents in 2001 made my situation worse, a neurologist that I had been seeing privately died of a heart attack (before she had time to do her report - but she had believed me and said that I had PCS), then my husband - who I had been married to for 22 years left me, the family home was sold, and my best friend died of cancer. All I could think is I have to go to work. I had the ACC specialists telling me that as I was scoring well in their assessments that I was ok - I was trying to tell them about headaches, tiredness and all the rest and getting no where. I kept thinking that I wasn't explaining myself very well and all the rest .... long story that I won't bore the world with. I was that tired that I literaly fell over and was ko'd again then had an episode of my BP going crazy. Was told later that it was exhaustion. However I now know if you have faith in yourself and belief in yourself you know that underneath everything you are not crazy nor are you a hypercondriac - spelling can't spell that word. That kept me looking for help and evidence that I was not crazy.

I guess I too have lost a lot. One really stupid thing that I did was with my share of the matrimonial funds I bought a cute little 3 year old house which was meant to have been maintenance free etc - well it was monolithic cladding - don't know if anybody would have heard of it over there, apparently it is some kind of shonky cladding system which develops leaks - guess what it did and then I had to mortgage it to reclad it - that is another story.

My current problem is that when I make allowances for my self I think that I am being lazy and it is hard to get your head around the fact that if you force yourself to continue with some thing it is having the reverse effect - which is so hard for me to deal with. I also keep wondering if I am a wimp.

Do I have a plan - well I have a dream that one day I will wake up and feel normal. I just seem to plod along depending on how I feel after work. I have been to the local brain injury assn - they meet when I am at work - and like I was saying if I don't work no income. Doing anything out of those hours is really hard. I have tried asking the Assn if there is anybody else "like me". the 2 peole that I have met seem to be worse.

Tomorrow I have the day off work and I am going to a PCS seminar - an all day one - I shall have my sleeps in the car in the car park. The person taking the seminar is Barry Willer a professor from Canada - he apparently is meant to be one of the best in the world. I shall let you all know and hope I don't sleep through the best bits.

Excuse my ramblings I am really tired and I think that this may have gone all over the place, Lucy (and my name is Lynlee)

Lynlee,
You are doing an amazing job with a long series of blows to your head and blows emotionally that were probably related to PCS healing phases. Too much was expected from you when your brain was not able to go that fast. My son's neurpsychologist used a great analogy when he was suffering in the throws of peaked PCS. He said it is hard to get back on the train that is going 100 miles per hour when you can now only go 50. After his injury, he attempted to do work in 5 very difficult classes, a varsity sport etc. and quickly flopped and was very symptomatic. His train needed to slow down awhile and the school supported this by his advice and reports. You did not have the priveledge of this support, likely just due to ignorance. So much is available only recently. One neurologist in a local ER, thought that my son's symptoms were because he was understimulated and needed to be pushed harder. I am a critical care nurse with alot of basic common sense, thus , completely disregarded her advise, thank god! My point here is, you are doing the best you can and should never think anything less, think about how resourceful on your own you have been. You really are getting to know yourself. Of course, you are going to get discouraged and down, you have every right to be, allow yourself that but do not look at that as a flaw. Be confident and embrace yourself for who you are and the vigilant healer and advocate for yourself that you have been. Most PCS sufferers are not entering threads here. They have difficulty being their own advocates and suffer alone. You are not only compassionate to others here, you are respecting yourself enough to learn more. That is a brillant behavior! Do not let those demons in your head put you down, you are awesome. Confidence in knowing you are doing your best will help you alot. Stay well and strong!

Good Morning NZ
 

Top of the morning Lynlee. Hope all is going well and that you learned something new at your seminar. It's amazing that I can set here and enjoy my morning coffee, look across the desert and talk with someone who is hafe way around the world that has suffered the same type of injury I have and who is trying to recover from that injury and all the side effects PCS/Chorionic fatigue. It take an incredible amount of inner strenght to recover from TBI. and to be able to shair your pain in this recovery process is part of the healing process. Sometimes it just hurts and that is part of life and I think part of the healing process. It's when we can shair our pain and talk about in a positive constructive way that we began to heal.

One of the issues with people with TBI is that it takes so much energy to function in our society / community that we have to cover up whats really going on inside. We are basically in a survival mold and we have to be in order to survive and function because people do not understand that you a dealing with a brain injury and that you are healing and that takes time.

We also have to deal with our inner selfs and know that that old person is no longer functioning and the new person is running a we bit slow. Hard to accept when you are an over achiever and you want it done right now.

One thing I have learned is the PCS/CHRONIC FATIGUE is these are the symptoms not the cause. The cause is the TBI and that is what needs to be healed. The pain is the nerve damage in the brain and body and those nerves need to be healed.

Keeping life simple.I've been working on that for the last seven years getting closer.

It sounds like your starting to heal , because you are able to talk about what's going on and this is good.

This is a good forum because the people here are trying to recover from there injuries and illness and it is a good place to learn and share. Sharing is part of the healing process.

Keep on Dreaming Lynlee. Our dreams turn into visions our visions into resolve and our resolve turns into power and our power turns into inner strenght and our inner strenght into our character and then we realize that we are here to help other people and when we set our minds on helping others we in turn help ourselves.

It is what I think and what I believe that produce the power to over come this TBI.

Still working on my treatment plan have about 10 items that need to be addressed and once this is in written form I'll go find the people to help me over come these issues.

Life is good.:)

Jeff

thanks
 

thank you so much Nancy and Jeff - was being a bit of a misery! I will tell all re the seminar soon/later as lots to tell, very tired today, am at work (in my physical presence - not much of a mental presence is happening though - lucky to have such a tolerant employer). Just sneaked a minute on the internet - am supposed to be having my morning snooze. Suggest that you google Barry Willer and have a read up on his ideas in the meantime. Lynlee

I am interested to hear what Barry Willer said in the seminar. He has written some good articles on this subject.

http://www.ubortho.buffalo.edu/concussion/research.html
Management of Concussion and Post Concussion Syndrome
&
Regulatory and Autoregulatory Physiological Dysfunction as a Primary Characteristic of Post Concussion Syndrome: Implications for Treatment

sorry
 

HI.............I haven't done my report back on Barry Willer yet, my computer at home is having some problem - something to do with the wireless router ???? I am certainly not an expert so hopefully things will be back right for the weekend for me to do this. Am at work at present. I had a nasty time with the psychologist yesterday and will tell about that as well. Have a great weekend everybody - did you know we are in the middle of our spring time and all the blossoms are out on the trees - makes you feel good just looking at them!!!
Lynlee Good grief just tried to edit the tilte - it was meant to say sorry - now I do sound like a nit wit!! Groan

Hi Lynlee, thanks for the info about Barry Willer. I'm looking forward to your report of what your learned. I read about the program at the university in Buffalo and wish it were available in my area. I live in the "Show Me" state (Missouri) and the leaves are turning to beautiful orange and red tones. It's been sunny all week and I walked to the mighty Mississippi, about 1 1/2 miles from my house, a few days ago. My legs are still sore, but it's the good kind of soreness, ha. I hope you are able to enjoy your spring, maybe it will give you some renewed energy.

Hi Sissy, Jeff and Nancy - finally wrote about the Barry Willer seminar. I was so disappointed, as I didn't mention - actually forgot to mention that he believes that there is no cure for me - people like me at present. That was on Tuesday and then on Thursday I saw my psychologist and that was even worse, left in tears as she believes it is a waste of my energy hoping - some times I wonder if I actually know what I am doing or should be doing anymore. It appears that I try and hope too hard - kind of like a reverse bad attitude. All I want is to be able to stay awake all day - I don't care about the other stuff. I don't think I am being selfish and greedy wanting to stay awake!!!! I guess compared to many people I am lucky - I can still go out for a walk, work 3 hours a day (and sometimes I wonder if that is charity by my employer of 10 years) drive and I even taught myself how to do sudoku - the novice one. And Jeff there is your friend Joe - so I should shut up and put up!!! I am going to bed now - it is coming up 10 o'clock and I am over tired and grotty - good night from Lynlee

Top of the morning
 

Lnynee, I'm impressed with your report and feed back on Berry Willer alot of positive imformation Thankyou. I printed off a copy of your report, hope you don't mind so I can use this information in regards to creating a treatment plan still working on the outline. The information will be very helpful when I set down and talk to my PCP, Who is a real Dr. and cares about my well being, my healing and my quality of life I live. Your report has given me some insight into some issues in regards to TBI, that I could not put my finger on.I'll need to think about this for a few days.

One thing I did learn from My neropsycologist when I was first tested, 6 mouths after the trauma was that I have an invisual disability and 2. That that treatment programs are set up for failure. This information help me from getting blind sided by the professionals who where setting me up to fail.

I did try to return to work, full time at the 2 year mark and ended up back in the hospital for several days and spent the next 3 mouths walking around in a daze. Not Cool, this has happen several times in this recovery process.

It has been taught to me that success and failure are never final, and that neither count for very much in the final assessment of any man who has done his best. [ writen by and Irishman ]

Have I done my best today? Kaizen

It's time for me to start thinking outside the box.

Enjoy your weekend. Jeff

PS: Ran across Joe yesterday. He was in the Parking lot doing wheelies in his wheel chair pushing the envelope to see how fast he could go, big smile on his face, maybe he was pretending he was back on his bike doing 100 and catching some wind in his hair. miss that rush.

Ok back to work I have a mountain to clime. This TBI is just a bump in the road.:)

Hi Jeff - n. What exactly is an invisual disability?

And what happenned when you worked full time and ended up in hospital? At about 3 years when my hours at work were pushed up to 6 hours per day I ended up in hospital twice - the first time was when my blood pressure went crazy resulting in a c/t scan thinking stroke - turns out it was exhaustion - as the ACC (insurers had been pushing me to increase my hours - give me a challenge and away I go) and the second time was very tired and literally fell over - knocked myself out and cut my face on an umbrella urn. After a day in hospital discharged myself as I could see that nothing was going to change and I couldn't stand the noise. Was a zombie for a while after both. After that took myself off to a private neuropsychiatrist who instantly said 3 hours a day - didn't do any other tests than balance (just like Barry Willer said!) I have kind of managed since, but doesn't take much to derail me - any kind of stress or pressure and I don't cope very well. On the good days I tend to race around like a lunatic thinking the miracle has occurred - make hay while the sun shines - of course I then pay for it. But there is nothing like the power of positive thinking!!!

Like the Irish saying I have been thinking about all those that are posting - there does seem to be one thing that is in common - besides the headaches etc - everybody seems to be reasonably intelligent - is that why there is such a severe extent of symptons - just food for thought!!

Lynlee

Top of the morning lynlee
 

TO , Lynlee*Opps a typo invisible: can not be seen. I can walk and talk and crew bubble gum all at the same time therefore I am not disabled.

*I was hit by a Drunk Driver on my bike, witch is a crime in the US. The lady blew a 2.59 alcohol level at the scene after running a Red light and having a head on collision with the car stop at the light across the street. I T boned her truck in the intersection. Very fortunate that I did not get caught between the two cars, as I would have lost my legs at best and most likely my life.

**All my internal organs where bruised from the impact, so I looked OK on the outside but my insides where black an blue. My lungs where bruised in the accident and I developed Asthma. I've had several asthma attacks in the last 4 years and these attacks put me in the Hospital. You can not breath when your having one of these attacks and anything can set them off. The Asthma is managed by medication, but I have to be careful about being around dust and mildews and several other enviromental elements as they well put me back in the Hospital and that's not a fun place to go. I had an Asthma attack when tring to return to full time work.

*Since my neuropsychologist gave me a heads up at the 6 mouth mark I knew I was going to being set up for failure in regards to rehabilitation and re turning to work full time. I worked union jobs for years and there is no such thing as light duty work in the type of work I did before I was injured. You can either do the work or go home in the real world.

*This is part of the mis information you are told at the rehabilitation clinic. I was given some basic tools to manage the TBI and I use those tools today and they are very useful tools to have, but these basic tools do not make me the competent equipment operator that I was before I was injured.

**Barry Willer is correct in saying the insurance companies, in my case Crime Victims does not want to pay for the rehabilition process for people who have suffered from TBI/PCS as this is a very time consuming process and could take years as we all know or the rest of a persons adult life.

*It's been my experience that the insurance company will give you half of what you need to recover or a lest become functional and then stop before the job is finished, thus setting you up for failure and that's not a nice thing to do to someone who suffers from TBI/PCS, as most of us have enough on our plate just to make it through the day.

**I think knowing that you are going to be setup for failure, before you even start this process is helpful in that you don't feel so disappointed or discouraged when you get blind sided by the people you ask for help. TBI/PCS IS AN INVISABLE DISABILITY.

*You are correct Lynlee the people who post here are very intelligence and they're looking for solutions and answers to over come the the symptom and the causes of TBI/PCS and how that effects the quality of their life.

*Ask small questions. KaizenOnce again Thank you for your post on Berry Willer food for thought still processing that information.

Take care and enjoy your spring.:) Jeffn

PS Back to waking up at 3 am I don't fight it as this has been going off and on for the last 4 years

Hi Lynlee, please don't give up hope and don't believe that nothing can be done for you. I don't see why you could not benefit from some kind of exercise program to regain some energy, maybe something very gently like water exercises or some mild strength training. I am certainly going to look into this and see if I can find someone in my city to work with me. Do you have any access to a health club? I hope this week will be better for you.

Exercise
 

HI - in the first year I walked and walked and walked - every day at 7 p.m. I walked miles - some days I walked for 2hours. It was the only thing that kept me sane. Then 2 years ago ACC sent me to their gym. I had a personal trainer and went for 3 months. The problem was with that was that because of where the gym was I had to go straight after work at 1.30pm, literally gallop around the gym and get myself home on the motorway before sleep took over. I couldn't go home and sleep and then go back because of the traffice - I simply can't cope with rush hour traffic any more. I did ask if they would let me go to a gym closer to home - but no. I am not keen to go to just any old gym because of balance problems and can't put my head down either. The funny thing about the personal trainer was - she kept saying to me " you shouldn't be able to do this" and I would have to tell her it is my brain - the rest of my body is ok - like the muscles still work - I used to be a bit of a sports freek gosh how do you spell freek? They (ACC insurers) would only fund the short time - I felt fitter but it did not really help the PCS - guess it didn't have time to. I have decided that I am going to make more of an effort and get out walking again - after my visit to the psychologist last week I went out walking again - more like stomping around the neighbourhood - neighbours must have thought that I had really lost the plot! And - after my going on about the lovely spring weather we are back down to 11c. Lynlee

Kaizen
 

Jeff-n I have looked up the Kaizen method - and shown it to my employer - he was most interested I am working for a sole practioner - he was knocked off his bike about 14 years ago - was basically scalped but not ko. Was in hospital for about a month I believe. I didn't know him then. At times he behaves like a head injured person - at other times ok. We have strange conversations - like we will be discussing a file and next minute talking about the lack of rain in Ethiopia - anybody listening would probably think it is a comedy act!!!!! Lynlee I still can't control these jolly icons - I wanted to put the grin at the end!!

Lynlee,
I really cannot stress enough, that health care professionals opinions whether neurologists or not cannot be taken as the ultimate truth. The really good ones will simply say they do not know. There is so little known in this area. It is very lightly touched on in medical school. If you are motivated you can improve. How about increasing the mental stamina problem, in a similar way that a person increases physical stamina, very gradually. Has anyone tried just working 5 to 10 minutes longer each day etc and seeing if this helps. The impression I get is most patients seem to be their same old intelligent self at times but it may be just for 5 minutes. They tire out quicker with too much cognitive thought. The simple idea of trying to condition mental stamina gradually, takes alot of patience but I wonder if it would help. Just keep firing those neuron pathways but everything in moderation so you do not have it backfire. There is always new pathways to create in the brain if old ones are broken. You guys are in control, not the health professionals, their experience can be helpful but never let it affect your precious motivation. Hope all you healers are well. We are doing well, my son is finishing up cross country season and keeping grades up, no emotional breckdowns and he is avoiding drugs and alcohol for now. I enjoy all your threads and am learning from them.

Thanks Nancy! I guess my neuro was right when he told me to look on the internet as I have learned so much from all of you on this forum and nothing from him.

After several days of bad headaches, and tense neck and shoulder muscles, I went to my local fitness & rehab center to see if they could help me and I was given a flyer for Myofascial Release Therapy. So I went to my PCP and he gave me a referral. I'm hoping they will be able to work with me to set up a graduated exercise program like Barry Willer talks about. My first appointment is next Tuesday, so I will report back how it went.

P.S. I tried the Topamax for two days, but had a feeling that it wasn't the way to go.