24. The Trouble with my Ears and Eyes

HEY...It's been a few months since I posted on here.  Luckily I finally got around to writing my last few posts, which I will share over the coming weeks!  Diving back into it below:

Next Steps

The progress I made after undergoing treatment at MyoWorx was incredible. I saw more improvement in my symptoms within two weeks than I had the last two plus years since suffering my concussion. 

And my progress has only continued.    

The intensity of my headaches steadily lessened, and the pain in my legs, feet, shoulders and arms became less pronounced.  The involuntary twitching, muscle spasms, numbness and swelling also began to subside even as I continued to increase my physical activity.  

The two areas that didn’t seem to be progressing quite as quickly were my ears and my eyes. 

The ringing in my ears was still present and the unbearable noise sensitivity kept me wearing earplugs 24/7.  I still struggled to read due to fuzzy vision and the intense strain behind my eyes continued to make me feel like I was permanently crossed-eyed. 

On my second trip to MyoWorx in March, Terry decided to solicit some of his colleagues to get their perspective on my lingering issues.  The two doctors he reached out to are part of a team of specialists that call themselves The Sandbox.  The Sandbox is a self-proclaimed name; they are a group of five doctors that work together to treat concussions and Post Concussion Syndrome (PCS).  I am a huge fan of the team-based approach for treating concussions and PCS, and this crew might have the best team name I’ve ever come across.  It includes Terry – the neck specialist, an audiologist, a neuro-optomitrist, a dentist to evaluate TMJ issues and a cognitive behavioral therapist for psychiatry needs.

The plan was for me to meet with the audiologist to evaluate my ears and neuro-optomitrist to check out my vision.  Terry called in the favors and I was able to see both of them the next day. 

Why I hate all noises

The audiologist is Dr. Brenda Berge from the Berge Hearing Clinic in Guelph. She is a graduate from Dartmouth Medical School and immediately chirped me for being a “Yale-er”, despite my insistence that a Yale-er isn’t a thing.  This witty banter continued as Dr. Berge evaluated my ears and concluded that my ears were not, in fact, damaged.  She went over everything in detail, beginning with the correct understanding of tinnitus. 

She explained that tinnitus is a phantom auditory perception.  It persists through an abnormal neurological feedback loop that keeps your limbic (emotional response center of brain) and autonomic nervous systems hyperactive.

This feedback loop is the reason I have persistent noise sensitivity too.  Dr. Berge referenced a condition called misophonia, in which negative thoughts, emotions and physical reactions are triggered in response to sounds.  She asked if I get upset when I hear noises without my ear plugs in.

Yes, I’d get extremely upset.

Dr. Berge cued in on this negative reaction and referred back to the feedback loop.   Repeatedly getting upset when I heard loud noises, or when my ears were ringing incessantly, kept my limbic and autonomic nervous system in a hyper-active state.  In other words, as long as I continued to get angry about my ear issues, my body would remain in a constant fight or flight state. As a result, my ears would remain hypersensitive.

Her treatment approach was simple:

This is Wilson. That is all. 

1.    Stop reacting to loud noises

When my dogs start barking at the neighbor’s dog trotting along the road in front of my house, I have to completely ignore my impulse to throw my hands over my ears and freak out.  Instead, I am to convert the thought process into something positive, like how cute my dogs are – cue photo to the right. 

This continues to be the most difficult therapy for me, but the logic behind it makes sense.  If I continue to get upset every time I hear a loud noise, or even a normal pitched sound for that matter, I will continue to signal to my brain that noises are a threat.

Yes, I have acquired a wide array of earplugs.

2. Stop wearing the earplugs  

My ears need to regain the ability to tolerate different frequencies of sound, which will never happen if I constantly wear earplugs.  The earplugs themselves are only perpetuating the issue.  Dr. Berge called them my crutch, and it was time to start walking normally again (AKA, hearing). 

As excruciating as it was to remove my obnoxious neon pink plugs and listen to my dogs uncontrollably howl, I understood not only that I had to do it, but why I had to do it. 

Why it’s so hard for me to read

Luckily, I soon gained more understanding about my vision during an appointment with Dr Quiad at Guelph Vision Therapy.  Neuro-optomitry is a field of vision care that combines neurology and optometry to assess how the brain processes information being sent from the eyes. 

Dr. Quiad met with me on his day off, which happened to be St. Patrick’s Day.  After introducing himself with a thick Irish accent, I knew that my appointment was the result of an incredibly kind favor.  An Irishman was evaluating my eyes on St. Patrick’s Day – what luck.  I felt even luckier once I began to realize that this guy was smart.  He evaluated my vision and discovered the root of my problems.  I recorded his detailed explanation (a habit I got into when I found a doctor I liked).  

It turned out, however, that I didn’t have to record it because within a week his office had sent me a detailed eight-page report of my results.  I had been evaluated by over ten eye doctors before Dr. Quaid, and not only did none of them know what was wrong with my vision, but none issued a detailed, professional report like this one either. 

This is a wall in my room with some of my vision therapy exercises. 

According to Dr. Quaid, one of my biggest issues is “Accommodative Infacility”.  This means that my eyes are unable to focus properly.  They are constantly going in and out of focus, which produces the fuzziness or “low definition vision” I described in a previous post.  It’s why my eyes can’t handle looking at things with fine detail such as tiles on the floor, stripes, or small print.

The report listed other issues as well, and it also included a comprehensive vision therapy plan that I was to do regularly at home along with my neck therapy.

More Therapy, More Progress

The Ears

Once home I continued with all three of my therapies and felt confident I would make more progress.

As for my ears, the first few weeks were the hardest.  It has been a huge mental challenge to force myself to hear noises that make my ears feel like they have hot molten lava pouring out of them while simultaneously pretending like it doesn’t bother me that my ears feel like they have hot lava pouring out of them. 

Yes, it literally feels like that – as if my ears are on fire, bleeding, exploding, and generally disdaining any noise that they come into contact with, even my own voice.  In fact, my voice was one of the hardest noises to adjust to because it projected so close to my ears.  I’d talk to people and try my hardest not to think about how much discomfort I was in. 

After going long periods without wearing my plugs, I’d reward myself by wearing them for a few minutes. It was heaven.  I’d let my ears rejuvenate before exposing them to another round of excruciating noises.  Along with this, I kept up with a particular neck exercise Terry taught me.  It stretched the area of my neck right below my ear, which helped relieve compression on the auditory nerve.

I kept up this routine, hoping that soon my ears would begin to build up a tolerance.

Slowly but surely, it did.

Nowadays, I still carry my earplug case everywhere I go, but I don’t have to put my plugs in quite as often.  Using them in loud environments – restaurants, hockey rinks, bars – is always a must, but I am usually ok with everyday activities and conversations, which is a big win in my book. 

The Eyes

My vision has improved, too.  Understanding the connection between my neck and my vision was extremely useful.  My neck and eye therapies complimented each other well, and I was able to identify which combination of exercises benefited me most. 

For example, I found that my eye-strain significantly decreased when I did a neck stretch to release the sternocleidomastoid muscle on the upper right side of my neck followed by an eye exercise to improve my convergence.  The neck stretch released the actual strain and the vision exercises re-trained my eyes to move properly together.  This, along with exercises to retrain my eyes to focus properly, have led to steady improvements.  

Thanks, Sandbox

None of my symptoms are perfect just yet, and there are two more things that I haven’t talked about that have made a huge difference in my recovery (stay tuned). 

But it all started because I worked with doctors that could answer the ‘why’ question when it came to my symptoms.

When you understand what’s wrong with you and how you can treat it, things become a lot more manageable and a lot less stressful.  It’s why I feel so incredibly grateful for the Sandbox Team.  They are smart enough to answer my questions, and they have the empathy and compassion to spend time laying it all out for me.  

They also understand the value of working as a team; that patients can benefit from other treatments outside of their own.  This is the same model implored by the Sports Neurology Clinic, another team of smart, progressive doctors that helped me make strides in my recovery last year.  The team based approach, I hope, is the future of concussion treatment, and I feel incredibly fortunate to have been under the care two groups implementing this strategy.

So, this one is for The Sandbox – thanks for being great doctors and great humans!