My Concussion Story
My Concussion Story.
This is a long blog post. But I encourage you to read it, or at least skim. Because some day it might be you that hit your head, or someone you know, care about or even love. And the early days can make a significant difference. Of course, if you don’t want to commit to this entire read, feel free to skip to the end, where I will summarize in point form. To be clear, I suffered a moderate concussion, was unconscious briefly, but no brain bleed.
How It Happened.
It was a sunny Sunday afternoon like many in August. Sunday is date ride day in our household, but I was feeling a little off. Not terrible, just a bit of stomach angst. I’d have an amazing ride with friends the day before, one of those rides where you just really feel connected to your bike. But a few of my riding mates were complaining of stomach aches, and I had written it off to over indulgence the night before on their parts.
But Sunday I woke with a flippy stomach of my own, and osculated back and forth as to whether I would actually ride that day. Arthur (my significant other) and I went for coffee first, and I decided I would join him on the climb and see how I felt. If the nausea didn’t subside, I’d call it. If it did, I would continue.
As my heart rate elevated, I started to feel better and committed to staying on my bike. We rode up to a trail I’ve ridden dozens of times, the new darling of Seymour Mountain, John Deere. There’s a “feature” on that trail I had been contemplating dropping rather than rolling. I asked Arthur to demo, and made a decision that I wasn’t feeling it that day. So I proceeded to roll the step down ramp, as I’d done many times before. It’s a move that doesn’t take anything for me to do. A really simple roll down, with a hard packed run out. But something happened that day in the run out – I got a little squirrely with my front end, enough so that it sent me over the bars at speed. I’ll never know what happened, because I don’t remember the crash.
What I do remember after the ramp, is not being able to see. When I slowly regained my vision, it was split in half. I blinked over and over trying to rectify, but it didn’t respond. It was split by a wavy line that kept changing shape – like watching a heart rate on a monitor in the hospital. Okay, I can’t see. I start to check in with my body - what else? My head hurts, a lot. The worst headache I’ve ever had. And there’s something up with my arm, shoulder…not sure. Arthur is sitting beside me talking to me, telling me he thinks I separated my shoulder. I tell him my shoulder isn’t the problem at the moment, but my vision is. And it’s official – I have a concussion.
My first lucid thought after the realization that I had just sustained my first brain injury, was that I couldn’t be one of those statistics – one of the many I know that can’t recover from concussion symptoms. I’ve got two kids, a mortgage to pay, and I just opened a new gym. No “post-concussive syndrome for me”. I was going to have to figure this out fast.
After sitting for 15 minutes, my vision corrected itself and I could see straight again and we started the process of getting me out. We called a good friend to meet us with his car at the closest spot to where we were. Every step was excruciating, and made my head pound even more. I started to feel unstable with my footing, and had to move slowly to not trip. Every footstep was calculated, and I hung onto Arthur for support.
Once I got into the car, I ran my hand along my collarbone, and realized that it was indeed broken. Okay, broken collarbone + concussion; things just got a little more complicated.
Off to the hospital we went. As soon as I was admitted and placed on a bed, the vertigo began to kick in. I felt incredibly nauseous, and whenever the doctors moved me up, down and around, the room spun. CT scans and X-rays showed that my collarbone was broken in three places, but my neck was intact. Off came the neck brace.
At this point, I wasn’t doing well. They gave me lots of drugs, trying to control the headache, nausea and vertigo. I was asked repeatedly, what hurts more? Your collarbone or your head? My head won – hands down.
I wanted to go home desperately, especially now that I realized I didn’t have a brain bleed, and a decision on repairing my collarbone could wait until I talked to the surgeon. I pleaded with the doctor, and she made me a deal. “If you can make it (with help) to the bathroom and back, I’ll consider it. But I’d rather you stay here for the night.”
Well, I made it to the bathroom just in time to start vomiting in the garbage can. Great, now I can’t walk without vomiting. And this vertigo is really messing with me.
I stayed overnight with regular four-hour visits from nurses bringing me more meds to keep my pain under control. Getting out of bed with vertigo and a broken collarbone is a challenging feat.
The next morning I was discharged, and the so kind ER doctor told me that because my concussion symptoms were significant, I would likely “feel very bad for a long time”. I smiled. I feel sorry for all the rest who get sent home believing him. I wish they had taught him the phrase “nocebo effect” in med school.
Of course walking out of the ER into daylight was disturbing. I was sensitive to everything – light, sound and noise. My eyes trying to track movement, like cars driving by, would bring on vertigo. I felt like I was constantly on the verge of vomiting and my headache was still excruciating.
Fast forward four weeks exactly. I’m cleaning out the vegetable drawers in my fridge, and I start crying. I’m crying because I’m back to normal. I have no concussion symptoms. None. And they were horrible. And maybe I’m crying a little bit because no one in my house thought to clean out the vegetable drawers while I’m injured, but mostly, they are tears of happiness.
So why am I, four weeks later, so much better off than others I know? It seems everyone knows someone first hand who is suffering from concussion related symptoms they can’t resolve. Am I just lucky? I don’t think so.
What I Did.
I’m going to lay out exactly what I did. If I can help one person by writing this blog, it’s worth what I suffered.
A concussion is invisible, and so unique for everyone. I ran into my neighbor while my symptoms were acute, who saw my arm in a sling. He asked what happened, then said “at least you didn’t hit your head”. I didn’t bother to correct. Yes I did hit my head, breaking my helmet in the process, and standing here talking to you is extremely difficult for so many reasons. I feel like I’m in a bubble. The volume of your voice hurts me. Standing outside makes my eyes burn. I’m dizzy all the time. I want to vomit. I can’t focus on what you’re saying. Concussion truly is an invisible injury.
A few weeks before I hit my own head, I posted this article on Facebook, and intuitively it made complete sense to me:
Right after my accident, I reached out to a smart physiotherapist acquaintance who reminded me that the medical community is about 30 years behind in concussion science. He advised that I don’t want to completely avoid my symptoms, but do the reverse – expose myself a little bit daily to everything that brings on symptoms. Not to the point where the symptoms are strong and incapacitating, but enough to keep my nervous system from becoming sensitized to them. And as soon as I can, get some aerobic exercise. I've seen firsthand what happens when people shut everything out that stimulates their symptoms, even to a small degree. The brain is very plastic, and quickly neurons find new ways of firing, even faulty ones. So don't lock yourself in a quiet, dark room all day, unless you want to guarantee yourself a later diagnosis of “post-concussive syndrome”.
So I started to formulate a plan. I’d read a lot previously about fish oil in high doses for traumatic brain injury in the early stages, so I began taking 5 grams twice daily from day one. Initially, I couldn’t be responsible for my own supplements, because I couldn’t remember three seconds after if I had taken them or not. I watched TV, and it didn’t bring on any symptoms. Reading was okay for a bit, but would bring on a strong headache if I read too much, so I would stop before it got there. Reading on my phone or IPad didn’t agree with me, but I could do a small amount of texting with friends with the light turned way down. I was light sensitive, so wore sunglasses (rose colored) most of the time, until the sun went down. The problem is when your brain is getting intel that everything is really bright all the time, especially in the evening, it shuts down melatonin production, which is why most people then can't sleep.
For the first five days, I couldn’t walk unassisted. I had to hold onto a wall, or someone else. I had no balance. Bending my head over to brush my teeth would give me vertigo. I was pretty high maintenance for all around me. I was tired for sure, and needed a nap every afternoon to make it through the day. Eating was close to impossible as I could only have a few bites at a time.
Around day five, we started walking, about 15 minutes at a time. It was hard and I had to hold onto Arthur. We walked up to the coffee shop in our neighborhood. I felt terrible always, but I knew it was important to move, and Arthur made sure I did.
By day eight, I could walk unassisted. Sometimes I found myself reverting to holding the walls, but I would remind myself that I didn’t need them anymore.
By day ten, the lights outside at night stopped “jumping”. That was my check in with how my brain was doing. I was very relieved to see this settle.
By the two-week mark, my vertigo had become predictable, and would happen when I'd try to lay my head down, or on my right side, and whenever I would stand up from lying down. Once I started researching vertigo, I discovered that often a head hit can dislodge calcium crystals and dump them into your inner ear canal, which is supposed to be only full of liquid, not solid. It's called benign paroxysmal positional vertigo. I did a series of very simple exercises to dislodge them every night before bed (the Epley maneuver), then slept upright, and within 5 days was vertigo free. I still experienced dizziness, and decided to increase my Magnesium supplements. There’s some studies that suggest it dives with traumatic brain injury, and dizziness is a sign of deficiency, so I figured there would be no harm (most endurance athletes are already deficient). I take it daily already, so simply increased my dose from 500 mg to 1000 mg. I had nothing to lose.
At two weeks post crash, I decided to have my collarbone repaired. The surgeon I initially was referred to encouraged me to let it heal on it’s own, even though it was broken in three places and 100% displaced. After surgery, the surgeon told me it was “a lot more broken than it looked on X-ray”, apparently in 6-7 places. I can’t see how that would have sorted itself out without surgery, so I’m sure glad I insisted.
My nausea came down a level once the vertigo left, but was still present. At this point, my regular therapist Paul Sherman (a trained physiotherapist and osteopath who practices the amazing therapy techniques of Dr. Guy Voyer) was back and we started to tackle all the symptoms that were remaining. There was no question that I had whiplash in my neck; I could barely rotate my head and the right side was painful all the time. Paul uses osteo-articular joint pumping, and this felt amazing. Over the course of three sessions, Paul got my neck moving, corrected my pelvis, and eliminated my nausea by improving the mobility of my thoracic spine and releasing a very tight diaphragm. All of these symptoms were not concussion related. Related to my crash, yes, but my brain, no.
Now that my collarbone was in one piece again, I started spinning on the trainer. I hooked up a harness type arrangement to a pull-up bar, and could sit there without putting any load into my left arm, and also not worry that I might fall off the trainer during a bought of dizziness. I began with 30 minute intervals at a very low intensity (Dr. Voyer says that low intensity training normalizes dural tension). I felt so much better after the first day, and even better after the second.
At this point, everything started to fast track. I felt more normal with every day. All the weird, fuzzy sensations kept lessening. After three weeks, I returned to work part-time. It still felt too early, so I kept the hours minimal.
By the fourth week, I was back to work and felt like I had just spent time in a very bad dream. I had no headaches, no dizziness, no vertigo, no nausea and no light sensitivity. Food tasted like it used to and I started to enjoy my morning cup of coffee. My kids started talking back to me again and I no longer struggled to remember the most minute details.
One item I haven’t mentioned yet was cranial pumping as taught by Dr. Guy Voyer. This is different from the classic cranial/sacral model. Arthur had attended a course in New York last year focused on treatment of the cranial diaphragm and concussions. He learned the pumping technique there, and performed this on me daily from day one. I had questioned Dr. Voyer on concussions during a course in April of this year in the UK, and he emphasized the importance of cranial pumping, which is simply enhancing the flow of cerebral fluid using a specific technique that is in tune with the PRM (primary respiratory movement). Western medical says there is no science that the PRM even exists, but I have no issue feeling mine.
There it is. Everything I did to get myself from a complete mess post TBI to functional in four weeks. A few other things I had going for me were my nutrition habits (no wheat or dairy, lots of vegetables and lean proteins), and my focus on balancing my hormones and nutrients over the past year with the help of my functional medicine doctor (you get what you pay for these days when it comes to health).
The last thing I’ll touch on is mindset. If I didn’t know what I know, I likely would have been terrified by my symptoms, and would have lacked the confidence to push my symptoms and move my body. The brain is very powerful, and detrimental to some – it will believe whatever you tell it. I view the body as a machine that is not nearly as complicated as we believe, and I love a good challenge. The body has an amazing ability to heal itself, so avoid the “rest, reassure….and eventually medicate” tactics of our current medical system. Trust that the brain will heal in 7-10 days, and after that, you and a very good manual therapist have some detective work to do to resolve your symptoms, which at this point are peripheral and no longer related to your brain. And get on this in the acute phase. Seriously. I was in for treatment in the first week. The sooner you get treatment, the sooner those symptoms will leave.
I hope this helps.
- Believe that you will heal, and that you are your own best therapist
- Take fish oil and magnesium
- DO NOT sit in a dark room, and avoid all symptoms. Expose yourself to your symptoms on a daily basis, but not to the point of incapacitation. Don’t fear them, and don’t assume that because you feel them, you are somehow doing damage. They are bi-products of your TBI, and will resolve with your TBI. Be around noise, light, people. Rest when you need to.
- Get aerobic exercise, low intensity, on a daily basis. Start with walking, and do it as soon as you can. No, it won’t feel good. Do it anyway. It can be 5 minutes to start.
- Get manual therapy as soon as possible. Concussions in cyclists often result from an extension and rotation of the neck – WHIPLASH. Treat it. Find a therapist who really understands the spine. Many of my symptoms were caused by my cervical and thoracic spine, and resolved with treatment. I had treatment twice weekly.