A letter requesting nutrition advice

The following letter was sent to a nutritional consultant requesting feedback on my diet. My aim was to get ideas on how to improve my diet within my unique constraints. It took a long time for her to get back to me, and when she did, she wasn’t sure how she could help. The primary difficulty being we lived too far apart and in-person consults (at quite a high fee) would be required to sort things out..

* * * * *

Hello,

Thank you for considering me as a patient for nutritional consulting. Here are my notes related to struggling with brain injury and fatigue that you requested. I hope they help. Let me know if you need more information.

The trauma-induced fatigue is still being discussed. All of this didn’t exist before my injury and became an issue post-trauma about April 2017 when I became very tired, and has gotten worse but the medication trials I’m on for chronic fatigue syndrome have given me a little bit of energy lately.

I hope this is enough information about trauma induced fatigue. I’ll talk about mental fatigue separately..

You didn’t request this but I thought it might be helpful as an example of challenges I have with feeding myself by sharing my established meal plan:

Bag salad with dressing, seeds and dried cranberries. (I know!)
With boiled sweet potatoes. With steamed broccoli. With a roasted meat, usually from the green butcher.

(I have been strict with this until recently with new medication. Now, I have a lot more GI problems which add to food confusion, whether I’m too sick to eat, and then becoming so ravenous and in such an overwhelming brain imbalance that I’ll eat just about anything. It’s so confusing.

Example of confusion: I have plain natural full fat 3.5% yogurt but I can’t eat just blueberries (thawed) on it (not sure why), so both are abandoned in fridge. I was adding banana but I forget about the banana. Now I think I’ve been completely ignoring breakfast as it is too confusing. Maybe if I remember and I’m sure it’s going to help my gut and thinking, then I could do it every day and later add a modification.

My head injury is now considered a minor traumatic brain injury (mTBI), with post-traumatic headache. I’m taking psychotropic medications for depression and nerve pain. Doses are always being tweaked.

In December 2016 (over a year ago), I fell at my sister in law’s front walkway outside her house and hit my head (left temporal) on a flower pot.

CT scan clear, did not lose consciousness. Out of sorts in first days and very anxious. Massive headache mounted over 2 weeks. Since the then struggling…

Headache currently ranges from 4/10 to 7/10 on pain scale where 10 is high pain. Head pain triggered by:

• concentrating or thinking
• stimulation, sound, light, confusion
• strong smells
• other body pain
• GI or stomach issues

Memory issues:

• can’t remember a few hours ago
• some information is lost
• spend time finding thoughts
• word finding in speech
• short-term moderately impacted
• get very distracted, lose track
• seek to focus on one thing
• quite slow, paced, aware
• a lot of brain effort to do things
• long term memory is different
• more obscure past memories
• some lost recent past memories, some greatly enhanced

Mental fatigue caused by:

• mental exhaustion, trying to function, using my brain
• coping with continuous high grade headache
• emotional resilience, dealing with stressful situations
• problem-solving, especially under pressure, immediate fatigue

Impact of mental fatigue:

• extreme headache
• physical exhaustion
• cannot make a decision
• word finding
• cannot listen, read or take in any new information
• usually go to bed, until there’s a break in how I feel — sometimes 1/2 hour recently, more commonly for the rest of the day or until next appointment
• if in bed and not needing complete silence, sometimes able to watch at least one rerun of a show (gardening, or old sitcom, etc.)

Improvements lately:

• if feeling slightly better and it’s a good time at night to lounge and listen to something healthy, I do listen to a Mindful podcast. I’m on #5. It’s really good.
• I’m also recently able to watch shows on Netflix about once a week, whereas I haven’t been able for almost a year
• since December, I’ve been cooking at home. I’m able to manage buying exactly the same things and making the same few things over and over and over. I can’t do different meal plans every week. I have to do the same meal plan every day. Later I might be able to add minor variations, and then build from there.

Thank you so much for considering me.

* * * * *

In the end, I called “811” and spoke to a one of the very kind community nurse triage who had a nurse dietitian call me back. This was an excellent decision. The nurse dietitian spent a lot of time with me on the phone. She understood my dilemma and suggested adding cottage cheese to increase protein, which worked really well. She called me back the next week to see how it was going.

❤️