Concussion / mild traumatic brain injury (mTBI) information
I've put together this page to help provide some overall information on concussions, whiplash and mild traumatic brain injury (mTBI). I should disclose that I am NOT a medical doctor or therapist and have no training in this area. The information provided below includes my observations, which may or may not be rooted in proven research. Use of this information is at your own discretion.
This site deals with mild traumatic brain injury information (mTBI). If the brain injury is more severe than mild, then the information on this page may not be relevant.
Before I delve into details, there are a few key points I want to jump to the top:
- There still are a lot of unknowns surrounding concussions. Much will be learned from the research to come in the next decades...
- "It will get better". You might not make it back to 100%, but things will improve... very very slowly.
- Post-concussion symptoms can lag on for months, and might best be described as a hangover that doesn't go away.
- Exhaustion is one of the most prominent symptoms.
- Craniosacral therapy was a beneficial treatment for me.
- The key to recover is "walking the line". Push just hard enough to almost cross the line into exhaustion and then back off.
- Setting recovery deadlines/goals is counter-productive. Take it one day at a time.
- You might experience a series of "setbacks", where you are improving, and then take a step back. Over time, recovery time from setbacks decreases.
- It's hard for those who haven't experienced a concussion to truly understand.
- Smaller social events are ideal, since loud noise and busy situations cause more harm than good. And having an easy escape or place to rest is ideal.
- If you know someone who is recovering from a concussion, the best thing you can do is stay in touch and check in on them - offer to visit or make them food.
- This is a good 5-page resource on Concussions and their consequences current diagnosis, management and prevention by Dr. Charles Tator (22-July-2013)
On a Monday night at 10 pm in late August, I collided with an outfielder while playing softball. His shoulder hit me a couple inches above & behind my right temple. I was left with a concussion (mTBI), whiplash, sprained ribs, sprained rotator cuff and sprained wrist. The scary part is that since my brain was injured, I was not able to detect that I had all these injuries and continued playing. My memories for the first 24 hours are foggy - kind of like when you've been out drinking and wake up the next day, and are only able to remember the outline of the night, but not the specific details. I don't remember if anyone asked me if I was okay, or checked on me, so for anyone out there playing sports, I hope you keep my story in mind next time someone gets hit in the head...
The next day I didn't feel well, but I still went to work. To add to my concussion, on the 2nd day, I smashed the back of my head on the desk at work. But still, it wasn't until the 48 hour mark that I started to suspect I might have a concussion. There were a handful of things tipped me off, which I wish I'd written down. The only ones I can remember are:
- Forgetting to get off the bus at my stop
- Forgetting to shampoo my hair in the shower
- Not being able to understand questions at work
Prior to this incident, I thought that the only thing associated with a concussion was a headache. I've since learned that there's much much more. It wasn't until the 3rd day that the headache & nausea kicked in. Also on that 3rd day, I (foolishly) tried playing volleyball and I remember that my coordination was awful, I got angry and I left early - which in retrospect are all symptoms of a concussion. By the 4th day, bad nausea set in, and I finally went to the doctor who confirmed I had a concussion.
It's more than a year later as I write this summary, and I'm still suffering from post-concussion symptoms. In retrospect, and with increased knowledge, I've realized that I suffered a few smaller concussions leading up to the big one, which is likely why it had such a long & lasting impact on me. The more concussions you suffer, the worse they become. I've learned a lot about concussions over the past year, and I wanted to share this information in the hopes it might help someone else...
Immediate Information / Actions
If you, or someone you know has suffered a bad blow to the head, here are some pertinent information and actions that should be taken immediately:
- Loss of consciousness doesn't dictate the severity of the concussion. i.e. if someone stays conscious, it's possible their concussion could be worse than someone who lost consciousness.
- Go to emergency and get a CT scan. Head trauma can result in a brain bleed, which could result in death within hours, or in the case of a slow bleed - months.
- Ask the doctor to write out any instructions they provide. Otherwise, you might not be able to remember them, or you might get them confused. In my case, the doctor had told me no TV, no computer, no reading, etc, but I got confused and thought the doctor said that's all I was supposed to do. After a week of watching TV, my symptoms became much worse and that's when I found out I'd gotten the doctor's instructions mixed up.
- SCAT2: Here are some quick tests/questions to help evaluate someone's cognitive & physical state (taken from SCAT2 Sport Concussion Assessment Tool 2 - also available on iTunes):
- What venue are we at today?
- Which half/inning/period is it now?
- Did we win our last game?
- What month is it?
- What is today's date?
- What is the day of the week?
- Around what time is it right now?
- Memory Test #1: Say five words and have them repeat them back (up to 3 trials):
- elbow - apple - carpet - saddle - bubble
- candle - paper - sugar - sandwich - wagon
- Concentration Test #1: Say a series of digits, and have them repeat them backwards.
- Concentration Test #2: Say the months of the year in reverse order.
- Balance Test #1: Feet together. Hands on hips. Eyes closed. Maintain for 20 seconds.
- Balance Test #2: Stand on non-dominant foot. Other leg at 30 degrees. Hands on hips. Eyes closed. Maintain for 20 seconds.
- Balance Test #3: Stand heal-to-toe with dominant foot in front. Hands on hips. Eyes closed. Maintain for 20 seconds.
- Coordination Test: Finger-to-nose 5 times.
- Delayed Recall: Ask them to repeat the 5 words given to them previously.
Short-Term Information / Actions
Most incidents of mTBI clear up within a couple weeks, but some do drag on longer - like mine. Here is some useful information:
- Pain Relief: Use acetaminophen or acetaminophen/codeine for headaches. Do not use aspirin or anti inflammatory pain relievers such as ibuprofen or naproxen (NSAIDs), which may increase the risk of complications. (Side note: before I knew this, my doctor prescribed me naproxen, which I took for the first month and made things much worse - including the start of ulsers). Source; Ontario Neurotrauma Foundation
- Do not take any pain relief medication for more than 10 days, or they can actually feed the pain. "Simple analgesics (i.e. acetaminophen or NSAIDs) should be utilized no more than 15 days per month to avoid medication overuse (rebound) headache." Source; Ontario Neurotrauma Foundation
- Boredom: The key to recovery is rest. I was once told, "your goal is to be mind-numbingly bored." Until your headache starts to subside there should be no TV, no computer, no reading, no cellphone usage, and especially no sports.
- Low grade physical activity: At the 2012 NHL all-star game, new research was shared that indicated that low grade physical activity, below 150 bpm, can be beneficial in brain recovery. Activities that require minimal head movement, like the stationary bike, are ideal. For several months, I spent nearly 30 minutes a day on the stationary bike in my basement.
- March 2013 research from Buffalo University has shown that Aerobic exercise promotes post-concussion healing
If you are interested in the chemistry behind a concussion, these are a couple decent articles (although I'm sure there's lots more out there). However, there are still a lot of unknowns!
- Chemistry commands concussion comeback. "In an attempt to recover, the brain starts using up massive amounts of blood sugar and will continue to do so for as long as 30 minutes. This overuse of this glucose results in the production of lactic acid which, in excess amounts, inhibits brain function. A demand for glucose by the brain, such as when one is studying, logically causes an increase in blood flow to the brain. However for reasons not entirely clear, within two minutes of a concussion, the body decreases blood flow to the brain by up to 50 percent. This process continues unabated for 3-4 days but fully normal blood flow may not resume until an average of 10 days have passed. Consequently, at precisely the time the brain needs extra fuel to repair itself, it ends up getting less. Meanwhile, the exit of potassium allows calcium to enter the neuron. And while the exit of potassium ceases in minutes, it takes the cell 2-4 days to rid itself of the energy-inhibiting calcium. While the immediate chemical reaction of the brain to the concussion is brief and generally completed in 30 minutes, it takes days for the individual cell and the brain as a whole to restore that chemical balance which was lost so quickly. Until that balance is restored, the brain doesn't work as well and is particularly vulnerable to re-injury."
- The emotional impact of concussions. "You can shake the globe, but all the parts don't settle in the same way. A huge part (of concussions) is the psychological piece." It sheds light on why some NHL players may have committed suicide.
- The Neurometabolic Cascade of Concussion. Very technical.
Post Concussion Symptoms
The best summary of post concussion symptoms that I found was located in a new publication called “Guidelines for Mild Traumatic Brain Injury and Persistent Symptoms” was recently released on the Ontario Neurotrauma Foundation Website. It was recommended to me by the Ottawa Hospital's Acquired Brain Injury Program and it is the most useful document I've encountered so far. You can download it here: http://onf.org/system/attachments/60/original/Guidelines_for_Mild_Traumatic_Brain_Injury_and_Persistent_Symptoms.pdf
- Mild headaches - Headaches are a common problem after a mild brain injury. They can be made worse by fatigue and stress. Sleeping, resting or taking a break from activities requiring concentration or effort will usually relieve headaches. Pain relievers may help to break a cycle of headaches - use acetaminophen or acetaminophen/codeine, not aspirin or anti inflammatory pain relievers such as ibuprofen or naproxen (NSAIDs) as these may increase risk of complications. If your headache gets worse, or cannot be relieved, see your doctor.
- Me: I had bad headaches (7+ out of 10) for the first 2 months, medium headaches for another 6 months and mild headaches for another 6 months.
- Attention & Concentration - Having more trouble than usual with attention & concentration No one can concentrate well when they are tired, so it is not surprising that many people have trouble concentrating for a while after they have had a mild brain injury. Maybe you cannot even concentrate well enough to read the newspaper. If you really need to, just read for a short time, and then come back to it when you have had a break. The same thing applies to other areas where concentration is needed. Leave things that need your complete concentration until you are feeling better. If you need to concentrate on something important, do it when you are feeling fresh.
- Memory - Having more trouble than usual with remembering things (memory difficulties/forgetfulness) You cannot expect your brain to be as good at remembering things as it usually is. Don't worry if you can't think of a name or a phone number that you ought to know, or if you go to get something, and then can't remember what it is. Your memory is only going to be a problem until you recover. In the meantime, get your family and friends to remind you of important dates and appointments, or write things down.
- Nausea - Feeling dizzy or sick without vomiting (nausea) Occasionally, people find that they get a sick or uncomfortable feeling if they move or change their position quickly. Usually it is only a problem for a few days. If you find that things seem to spin round if you sit up suddenly after lying down, or if you turn your head sharply, it is best to avoid such sudden movements or changes in position until it clears. If the dizziness persists for more than a week or two, see your doctor.
- Balance problems - You may find that you are a bit more clumsy than usual. Don't worry if you do find that you are a bit unsteady on your feet, or bump into furniture, or maybe drop things. Just take everything you do a little more slowly. Your brain is the control centre for your whole body. It has to make sense out of all the messages coming in from your eyes and ears and other senses, and to send the right signals to the right muscles for you to be able to do anything. So give yourself more time to do things.
- Decisions & Problem Solving - More difficulty than usual with making decisions and solving problems, getting things done or being organized You may find you are less able to plan ahead or follow through the steps that are required in carrying out an activity. These kinds of difficulties may cause particular problems during the first few days after a mild brain injury but they are usually temporary in nature. When facing situations that present problems or opportunities to plan, it may help to think things through in a more structured and objective way.
- Me: I came to recognize that I made bad decisions and could no longer trust my decision making process, which was an adjustment for me. It also resulted in some bad financial decisions, which really hurt me.
- Feeling vague, slowed or ‘foggy’ thinking - Some people who have sustained a mild brain injury find their thinking is a bit slower. This means they might have some difficulty keeping up with conversations or following directions, and things take longer to get done. Encourage others to slow down by asking questions and having them repeat what they have said. Allow yourself extra time to complete tasks and avoid situations where you are under pressure to do things quickly.
- Exhaustion - Feeling more tired than usual and lacking energy (fatigue). At first, even a little effort may make you feel very tired. Your brain has less energy to spare than it normally does. If you feel sleepy, go to bed. You will probably find that you need several hours more sleep than you usually do. Let your brain tell you when it needs to sleep, even if it is the middle of the day.
- "The accuracy and speed of the patients and the normal subjects was indistinguishable,” he says. “However, the normal subjects used a few specific regions of the brain to accomplish the task whereas the patients used multiple areas of the brain. Patients' brains were lit up like Christmas trees, reflecting hyperactivity of metabolism. This explains why patients with post-concussion syndrome look much the same as normal controls in terms of their performance on psychological tests, but when the test is over, the patient is exhausted" Buffalo U research
- Me: At the 5 month mark, I was still needing 14 hours sleep/rest per day.
- Irritability/mood swings - Losing your temper and getting annoyed easily. Some people who have had a mild brain injury find that they get annoyed easily by things that normally would not upset them. This does not last very long, but it can be difficult for you and for your family. It happens because the brain controls your emotional system as well as the rest of your body. After a mild brain injury your emotions may not be as well controlled as they usually are. There are several ways to deal with this. Some people find that going out of a room, or away from a situation as soon as it begins to get annoying is enough. Others use relaxation techniques (controlled breathing, progressive muscle relaxation) to help them get back on an even keel. You may find that you can stop the irritability from developing by doing an activity that uses up some physical energy like riding an exercise bicycle, if tiredness permits. Irritability will be worse when you are tired, so rest will also help.
- Me: I had some fits of blind rage, which were completely unlike me.
- Me: I've found that heat can increase the onset of anger.
- Brain injury linked to stroke survivors anger
- Anxiety or depression - Feeling anxious, worried, frightened, angry and low in mood are normal emotions after sustaining a mild brain injury. These feelings often pass in the weeks following the injury, as a person gradually resumes their usual activities. Recognise that emotional upset and worry is a normal part of recovery, even though you may have suffered an injury in the past and not felt like this before. Explain any difficulties that you are experiencing to your family and friends, so that they can understand the effect the injury has had on you and support you in managing your difficulties. Recognise if your worry about symptoms intensifies and a vicious circle develops. If that happens remind yourself of the point above. If symptoms nevertheless do not improve, or if you have suffered from anxiety or depression before the injury and the brain injury has intensified those feelings, visit your doctor.
- More sensitive to lights or sounds - You may find that your eyes are sensitive to bright light. Wearing dark glasses in strong light can help to manage this and the need for dark glasses will likely clear up within a few days. When you want to shut out something you don't want to look at, all you have to do is close your eyes. It is much harder to shut your ears. When your brain
I've experience several other symptoms that aren't mentioned above, which could be concussion related, or possibly whiplash related:
- Brain "shuts down" - This phenomenon would happen after pushing too hard and doing too much. It's hard to explain without experiencing it. When the brain "shuts down" you can't maintain conversation, can't recall details, and you just can't function. It creeps up on you, and can surprise you. It's scary. You're left feeling helpless and dumb, which can be hard to accept if you're not used to that feeling. It can also fire up primitive animal reactions of anger, rage, or depression or defensiveness. You're balance/coordination can falter. The only remedy is rest.
- Nightmares. My naturotherapist said that the deeper the brain injury, the more frequent you will have nightmares. I had a lot of nightmares for the first 6+ months.
- Multitasking. I used to thrive off of multitasking. After the concussion, trying to multitask was a quick way to give me a bad headache. I also struggled with my focus, so adding more tasks into the picture just made things worse. I've worked hard at trying to focus on one task at a time. Around the 1-year mark, I've noticed I've started being able to add in some multitasking - which makes me feel more alive - but I have to be careful because it drains me quickly.
- Heat sensitivity - During my first summer after the concussion (9 months later), I found I had very little tolerance for the heat. I often became overwhelmingly hot feeling as though I had a fever with the flu, except I never had a fever. The best relief I could find was cold showers and spending time up to my neck in cold pools, lakes & rivers, along with a little bedside fan. I've spoken to others who have had this symptoms.
- Thinking you're crazy. Everything about your life has changed, and you start to wonder if maybe you've gone off the deep end and you've become crazy. There's a lot skepticism, misinformation and lack of knowledge surrounding concussions. My athletic therapist, Karen Holland, was the first person who said "I believe you", and that I was a "textbook case of a mTBI". Up until that point, I kept having to tell myself... "And I remember calling the doctor one night in Mayo Clinic and saying now Doc this is all physiological, right? I mean, if I didn't hit my head I wouldn't be going through the emotional and the depression and the headaches. He said I'm a doctor - it's because you hit your head you're going through these things. I said Doc you're not just being nice, are you, because I feel like I'm losing my mind. He said no, it's physiological". Broken Brain has a nice little blurb on dealing with these emotions: http://brokenbrilliant.wordpress.com/tag/pat-lafontaine/
- Feelings of guilt. I was a very busy person before the concussion and afterward I was a skeleton of my former self. Being unable to take on all my usual responsibility, and being unable to work left me feeling guilty. I didn't start to see real improvement until I let go of these feelings of guilt, and accepted that I was injured and should not feel guilty.
- Standing up makes you dizzy. When you transition too quickly from lying down to standing, it can result in dizziness and/or black outs. The same side effects happens to a lesser degree when going from lying down to sitting, sitting to standing, squatting to standing, moving your head too quickly, etc. It took me a while to adapt to this symptom - I used to have to randomly just sit down on the floor, which would scare friends a little bit. It's more than a year later, and this symptom still lingers - just not nearly as bad. A friend who suffered a bad concussion said it used to take them over an hour to be able to transition from waking up in lying position to standing - without getting the spins.
- Driving is scary. I've loved driving my whole life. I drove 24K kms solo crisscrossing Canada in 2008. I was an aware and active driver, in the sense that I was always looking ahead trying to anticipate which lane will move more quickly. My first few times driving after my concussion, I was scared. I struggled to remember where cars were around me. I struggled to stay focused. I struggled to stay driving straight. I got nauseated, and my headaches got worse. I tried going on the highway once, and avoided them for months thereafter. It really put the extent of my injury into perspective.
- Panic attacks waking you from the dead of your sleep, about 4 hours after going to bed. They include skipped or extra heart beats, sweating and fluttering in the chest.* These attacks didn't start until the 4 month mark, which coincided with an increase in stress due to having my wisdom teeth removed, traveling on a plane to go home for Christmas, and having to replace my cell phone. They lasted 1.5 months and underline the importance of rest.
- Weight Loss - Research has shown that after a concussion, the brain suffers from hypermetabolism causing weight loss. "functional imaging demonstrated that all 10 of the patients with post-concussion syndrome showed a hypermetabolic state revealing altered cerebral blood flow" I lost 15 pounds in the first 2 months after my concussion, while my primary source of entertainment was eating. I continued to lose a total of 45 lbs (down to 130 total) in the year and a half after the concussion, despite consuming ample calories.
- Twitching arm. My head trauma occurred on my right side, and since then my left arm has developed a twitch. In one case, my naturotherapist found a spot on the right side of my neck that caused my arm to seize up and my whole body began twitching.
- Aching teeth. My teeth ached for several months, but this could have been
- Earthquake feeling - the feeling that an earthquake is going on around you (and when you ask others if they feel it - they look at you like you're crazy). Maybe these are what tremors feel like? These lasted ~4 months.
- Painful vibrations (not ringing) in the inner ear when in a loud situation. These have decreased in their sensitivity over time, but are still present more than a year later.
- Immune System Overreaction - Some studies show that the immune system of those with post-concussion syndrome may be overreactive:
- After brain injury, cells on 'high alert' prolong immune response, affecting behavior, News Medical, 10-Dec-2013.
There are many things that can help improve your recovery.
- "It will get better". You are going to have awful days, but from everything I've read, and everyone I've talked to, they've said one common thing: "It will get better. It just takes time."
- Various: Rest. No Alcohol. Avoid computer, TV, reading, etc. Avoid over stimulating places like the shopping mall, bars or restaurants.
- Craniosacral therapy. "A Craniosacral therapy session involves the therapist placing their hands on the patient, which allows them to tune into the craniosacral rhythm". The science behind it isn't proven, and it's efficiency is debated, but the start of my treatments at the 5-month mark, also coincided with the start of my recovery. I had a few crazy "releases", where my whole body twitched, I was instantly drenched in sweat, and felt like I was spinning upside down. Recommended spots in Ottawa, are listed in another section. The key is focusing on letting all your muscles relax, which gets us into...
- Traditional Chinese Medicine. This recommendation came from several other concussion sufferers. They especially recommended Chinese acupuncture.
- Meditation. If you're like me, you had never meditated in your life before your concussion. It took me a couple months of frustration before I started meditating, and now it's a daily activity. It's simple. Focus on emptying your mind, and let all your muscles relax. Some tips: (i) Put a couple pillows under your knees. (ii) Buy a neck roll and put it under your neck. (iii) Take deep breathes in & out, and focus your breathing. (iv) Make your thoughts swirl together (v) Try not to fall asleep. (vi) Listen to relaxation music. (vii) Repeat "let go, let go, let go, relax". and on & on.
- Low grade physical activity. At the 2012 NHL all-star game, new research was shared that indicated that low grade physical activity, below 150 bpm, can be beneficial in brain recovery. Activities that require minimal head movement, like the stationary bike, are ideal. For several months, I spent nearly 30 minutes a day on the stationary bike in my basement.
- March 2013 research from Buffalo University has shown that Aerobic exercise promotes post-concussion healing
- Yoga. I thought I enjoyed yoga before this accident, but now I've come to appreciate it. Yoga should become your friend. Try and find a slower paced class (hatha or yin), and this will help you with things like balance, stretching, posture, focus, stress relief & more. When I was able to return to work, I found classes nearby that I could do at lunch to provide the break that was critical in helping me return-to-work.
- Social Interaction. It can be hard to follow conversations, and you may be irritable, and not yourself, but social interaction has been shown to improve recovery to all kinds of injuries. Counteract the Negative Effects of Stress. Social facilitation of wound healing Abstract Social facilitation of wound healing Full PDF
- Diet. Your diet can have an impact on your recovery. New research is showing that changing gut bacteria through diet affects brain function
- No Sports. You should not play any sports with the potential for a blow to the head until all your symptoms have gone away. Also, cycling is the sport that results in the most concussions. So if you plan on cycling outdoors, make sure your bike is tuned up, your helmet is secure and try to avoid heavy-traffic areas.
- Mental Games. While you are recovering, chances are that you won't be able to tolerant being in a busy & loud work environment. So while you sit at home, it's important to try and find ways to keep your mental skills engaged. I ended up signing up at www.lumosity.com, and played the games almost daily. Their scoring is a bit bogus, but that's the not point of playing the games.
- Sleep Tips. Your sleep schedule will likely be affected. As soon as you can, you will want to try to improve your sleep and schedule. There are a number of tips in the Sleep section.
- Braces / Retainer. If you have braces or wear a retainer regularly, you might want to visit your orthodontist to discuss alleviating some of the pressure on your jaw. This thought never occurred to me and when I stopped wearing my retainer every night (at the 7 month mark), my headache coincidentally started to improve more quickly. My athletic therapist mentioned that the pressure that braces put on the jaw & neck can lead to all kinds of lingering side effects. And they were of the opinion that everyone would benefit from having craniosacral therapy prior to every adjustment to the braces.
- Daily Logs. With a concussion, your memory has been damaged (hopefully temporarily). You will get details mixed up, forget details and just not thinking straight. Prior to the concussion I was detail oriented (as you can tell from this page), with a relatively sharp memory & great problem solving skills. For the first 2 months, I struggled, and finally I started keeping daily log sheets, which ended up being extremely useful in recalling events and reminding myself of symptoms & their severity. The daily log template I created is available for download in:
- Ice, not heat. Depending which specialist you talk to, they will recommend heat or ice for your neck. After months of using heat, I discovered that it actually made things worse - giving me worse headaches. Switching to ice seemed to help. Of course everyone might react differently.
- Neck Pillow. A neck pillow will help a lot with traveling in vehicles.
- Timer. An interval timer, such as a sports watch, may be handy if you have trouble remembering to take breaks, especially if you do computer work. Set it for every 15-20 minutes. Staying focused for shorter periods, and taking frequent breaks can result in a more productive day. And helps avoid setbacks.
- Noise Reduction. Noise is distracting and hard to avoid at work, and in social situations. Ear plugs might be worth trying. I found they were too painful in my ear. Otherwise, a good pair of noise reduction or noise eliminating headphones may help. I recommend over the ear style (versus on the ear), so that there is less pressure on your ears. I also recommend stress release or sleep themed music albums. The headphones can reduce, but not always eliminate noise. Pair it with stress release music while at work, and it can help drown out the sea of voices. I bought my pair of refurbished headphones at Factory Direct for $50.
- Stretches for whiplash. I hope at some point to put up a video of stretches to help with neck/head pain that I accumulated from my physiotherapist, massage therapist, athletic therapist, naturotherapist and personal trainer.
- Uplifting Music. Uplifting music can boost mental capacity, research finds
- Integrative Medicine. This looks at the whole picture, for more complicated situations. Treatment is by medical doctors using non-medical or more traditional forms of treatment.
- Light therapy. Light therapy may improve sleep & cognition after brain injury. I used a SAD day lamp and wake up alarm lamp, after the concussion, both of which I've found to be beneficial. Especially with improving sleep patterns.
- CBD Oil / Medical Marijuana - https://www.andysshave.com/health-blog/
Treatment in Ottawa
The following have been recommended at some point in time. Use of their services is at your own discretion.
- The Sports Medicine Centre. Athletic therapy. It was opened by Daniel Alfredsson & the Ottawa Senators trainer Gerry Townend. Located in Kanata.
- Dr Taryn Taylor at Carleton University
- Dr David Mai at the University of Ottawa
- The Sports Medicine Centre. Athletic therapy. It was opened by Daniel Alfredsson & the Ottawa Senators trainer Gerry Townend. Located in Kanata.
- Simply Healing. Naturopathy. Located at Main & Hazel. 613.237.1754. Ask for Abigail.
- Ortho-Sport Physiotherapy. NOT CURRENTLY TAKING NEW PATIENTS Physiotherapy. Located at 1 Raymond (@ Bronson). 613-729-9079. Ask to be treated by Norm.
- Blaine Hoshizaki, University of Ottawa, Associate Professor & Concussion Researcher. Neuro Trauma Impact Lab
- Michael Vassilyadi, CHEO, Director, Concussion Research Project Clinic
- iPhone Speech: If you have an iPhone you can go to your general settings-> Accessibility and turn on a feature to select text like you would to copy it, but it will now have a "speech" capability. Adjustable options include voice (female vs male) and speed.
- Smartphone App --> Dragon dictation by Nuance (iPhone/Android/Blackberry) - Turns your speech to text for text, and emails. There are character limits, but it allows you to copy all the text with a button click and you can keep pasting it into an email for a more verbose email and make minor edits yourself. The versions for Android & Blackberry have fewer features.
- Smartphone App --> Voice Brief (iPhone) - Great for reading emails, Facebook, CBC, BBC news etc.
- Smartphone App --> Web Reader (iPhone/Android) - Reads web pages without selecting a bunch of text, and you can configure it to read you PDF documents.
- Smartphone Apps --> 27 Life-Changing iPhone and iPad Apps for People with Brain Injury
- PC --> Dragon Nuance NaturallySpeaking - "Dragon speech recognition software makes it easier for anyone to use a computer. You talk, and it types. Use your voice to create and edit documents or emails, launch applications, open files, control your mouse, and more. Quickly and easily capture your thoughts and ideas while Dragon helps you get more done faster." It comes with a mic headset.
- PC --> Adobe X - Provides a read out loud feature that is pretty choppy but works for short documents.
- PC --> f.lux - Adjusts your computer monitor's lighting to reflect the time of day. Brighter in the morning. Warm at night.
- Gunnars computer glasses help reduce eye strain, headaches and fatigue. To quote a friend, "If you have a computer job, it's the best $70 you will ever spend - even if it's just for the placebo effect."
The contrast of black text on a white background is hard on the eyes. If you want to change the background of all your applications:
- Windows 7 > Control Panel > Appearance and Personalization > Personalization > Window Color > Advanced Appearance Settings > Window Text (in the Active Window) > Color 1 > Other : Select your colour
- For example, tan is easy on the eyes (Red:210, Green:180, Blue:140; or D2 B4 8C)
How to help someone with a concussion
Here are some tips to help you help someone with a concussion:
- The best thing you can do is stay in touch and check in on them - offer to visit or make them food. They might not be in the mental state to express their appreciation, but it will make a big difference.
- Trust them. Even if you don't believe it's possible for them to still be suffering from symptoms after such a long time, try to put that aside, and believe in their concussion.
- The concussed person's life has changed, and many of the symptoms leave them more isolated and limited in their ability to be social - at a time when they need social support the most. Try and organize events for the person that they can attend. e.g. A quick in-and-out pot luck at the person's house is amazing - where you take care of all the organizing. They get to see friends, can lie down at any time, and they don't have to make their own meal.
- Encourage them to take care of themselves, and not worry about you. (e.g. encourage them to go lie down in the middle of chatting if they need to)
- Be there for them.
- Asking them "how can I help" can feel like more of a burden to someone with a concussion than a help. Someone with a concussion struggles to put together plans and organize. Instead listen to them, and try to propose a plan of how you want to help.
- Offer to do research for them. Remember their mind doesn't work the same way it used.
- Ask about their finances, and provide advice if you can. I made costly mistakes - I wish I'd had someone helping.
- Traumatic Brain Injury and Intimate Relationships - What You Need to Know. This includes a good section on communication tips:
- Ask open-ended questions
- Allow time for word finding
- Be clear and concise
- Have a sense of humor
- Keep your conversations brief
- Make sure you have the listener’s attention
- Reduce distractions
- Remain patient and calm
- Speak slowly and simply
- Stick to the K.I.S.S. method (Keep It Simple, Straightforward)
Fun Activities while recovering
- Listen to Audiobook (or have your ebook reader read to you). Audiobooks can be downloaded for free from a lot of public library websites.
- Play with animals
- Talk with friends
- Go for walks
- Go to the beach/picnic/Fishing
- Sort through old boxes of stuff / Clean clutter / reorganize
- Catch up on household projects/jobs (not that fun)
The Recovery - Challenges
- "Hangover" - If you haven't had a concussion, then the best way for you to relate to post concussion symptoms is to think of the last time you drank too much alcohol and had a hangover. Post concussion symptoms feel similar to having a hangover that stays around for months. It's awful. My "hangover" lasted about 8 months.
- Lack of oversight.
- Within a few months of my injury, I had seen quite a few different professionals: physician, neurologist, physiotherapist, massage therapist, naturotherapist, athletic therapist, neuro-psychologist, brain injury rehabilitation doctor, work health consultant, and more.
- Each of them acted separately, which left me as the person responsible for putting all the pieces together, initiating things and trying to draw some of the conclusions.
- It was really quite ironic because I was probably the last person who should be trying to figure it out, since after all, my brain was injured.
- For the specialists, it could be a month or more between appointments, so it was important that I take a couple days to prepare because my mind could "shut down" at any moment or my memory could go blank and would be another month before I would have the chance to ask questions, mention symptoms, etc.
- I definitely made some poorly thought out decisions because my brain just can’t put the pieces together.
- In addition, I often only had 15 minutes to an hour with a professional, which would barely skim the surface of the background, history, factors for consideration, symptoms, treatments & more.
- I often felt the result was snap/gut opinions/decisions by most professionals with the resulting advice being that which followed the typical template. Much of it was insightful, but some of it I felt was not correct with my situation.
- It must be tough for professionals to make conclusions when they never met you before the brain injury, and have no basis for comparison.
- Lack of research/knowledge - The brain still isn't very well understood. Concussion research is in it's infancy. So it can be challenging to find someone with the expertise, knowledge & experience to be able to understand and treat you.
- Mental Goals - I have always welcomed adversity, and worked hard at accomplishing any goal I've set out. I had an A+ GPA through 2 university degrees; won an East Coast Music Award & spearheaded publicity campaigns for 2 Juno nominees, among many accomplishments, but recovering from this concussion is definitely the biggest challenge I've ever faced! Why? Because the instinctive approach to work hard is counterproductive when it comes to a concussion. It results in missed goals, feelings of guilt, added stress, and an unaccustomed feeling of worthlessness - which only delays recovery. It's a vicious cycle that I struggled with for the first 6 months. It's important to shift your goals to be in one day compartments - do all the exercises you can each day to get better, and accept that you'll be better when you're better. Don't worry about letting anyone else down. You need to take care of yourself.
- Type A vs Type B personality - At the 8-month mark, I had my first appointment with the Ottawa Hospital's Acquired Brain Injury Program. Dr. Shawn Marshall told me that there are 2 types of personalities: Type A - who are go-go-go, and always busy; and Type B who have no problem being lazy. In all his years of work, Dr. Marshall has never once seen a Type B person with a mTBI injury. He only sees Type A personalities, because they don't have the coping mechanism required to recover - the ability to shut off their brain, and lie around and do nothing. I mentioned this to my athletic therapist who countered that Type B's just might not care about their loss of brain function, so it's hard to say. Regardless, as a Type A personality, I've had to completely re-wire the way my body works in order to recover.
- Intelligence - They say the brighter/smarter you are, the longer it takes to recover.
- "Setbacks" - Setbacks occur when you push too hard & do too much, and your symptoms become worse. You take a step back. If you have an active mind, like myself, you'll likely struggle to get the hang of "walking the line," which will result in setbacks. My first "setback" was at the 1-month mark, and lasted about 2 weeks. The next was at the 2.5 month mark, and lasted about 2 weeks. By the 6 month mark, a setback was only lasting 3 days, and now at the 1-year mark, a "setback" can last only a few hours. This can be one of the most frustrating aspects for anyone who is a hard work, and intrinsically pushes hard toward achieving a goal.
- Walking the line - The key to recovery is walking the line. Push & back off. You want to push & do as much as you can, without crossing the line and having a "setback". This line slowly moves forward, allowing you to do more & more. Picture the times you've been so exhausted that your body aches, you can't think straight, headache, nausea, irritable & feel like you're getting the flu... That's the point I've aimed to almost reach everyday for the past year, slowly, but surely pushing the breaking point further, allowing me to do more. I took for granted how easy life used to be.
- Insurance - If you're unable to work, and have disability insurance coverage, expect to be bombarded by confusing forms and letters. They know you have a brain injury and won't hesitate to insist on phoning you, talking a lot, leading to confusion. Write them a letter requesting that all correspondence by via email, to allow for time to process what they are saying.
- Expect to have your claim rejected, and make sure you appeal.
- Here is a good article: When should I sign off on my claim or settlement?
Here are some things that I found would make headaches worse:
- Not resting as soon as a wave of exhaustion hits (2-3 times per day)
- Loud voices or noise
- Poor night's sleep
- TV / Music
- Difficult decisions
- Driving, especially on bumpy roads
- Wearing a retainer
- Doing strenuous mental tasks.
Stories of Professional Athletes
- David Ross, Boston Red Sox (July 2013) - Ross back with team, expects to play this season.
- "My vestibular system is the part that's messed up, so it reacts with my eyes," he said. "headaches, a lot of upset stomachs, an unsettled stomach, like seasickness, kind of. Real irritability. I think my wife is glad I'm out of the house now."
- Sidney Crosby (MacLean's Nov 2011) - Rebuilding Sidney Crosby’s brain - A little-known treatment by a Canadian-born chiropractor to the stars may be the key to his comeback
- Eric Lindros & others (MacLean's May 2011) - Concussions: The untold story - Eric Lindros and other pro hockey players on their depression, anxiety and suicidal thoughts
- Pat Lafontaine (brainline.org) - NHL Hockey Hall of Famer Pat LaFontaine Shares His Story - PDF or video
- 1-2 Nov 2012 - Concussion in Sport 4th International Consensus Conference
- 18 May 2012 - Sports Related Conference on Concussion & Spine Injury
- 27-29 Sept 2012 - The Brain Injury Association of Canada
If you can recommend any good literature on concussions, please let me know.
Here are some that have been recommended, but I haven't yet read:
- Concussion Recovery: Rebuilding the Injured Brain by Colleen Butler. Check out her website here: http://www.brainnavigators.com
- Ultramind Solution by Dr. Hyman - This was recommended by Celiac Brain
- The Anatomy of a Concussion (Psychology Today), 8 July 2013
- Brainstorming: What is the aftermath of a brain injury? by Colleen Butler, Multibriefs, 19 Nov 2013]
- How even a small bump on the head can cause hidden brain damage, By Diana Pilkington, UK Daily Mail, 11 Nov 2013
- Is a concussion the same as a mild traumatic brain injury (TBI)? by David Holllingsworth, Ottawa Injury, 19 Oct 2013
- Long-term effects of concussions misunderstood: Toronto doctor. David Kerr's story. Toronto Star, 22 July 2013.
- Living with a 'borrowed brain' by Lindsay Corley, CNN, 9 Mar 2013
- Voyages in Concussion Land: the homeless, Sidney Crosby and me, by Tabatha Southey, Globe & Mail, 6 Oct 2012
- Concussions can ruin quality of life for young athletes, CHEO research finds By Andrew Duffy, Ottawa Citizen, 26 Sept 2012
Proof the brain can repair itself with hard work & proper rehabilitation.
- Rewiring Trevor Greene's brain: The former soldier survived an axe attack in Afghanistan, now he’s defying the limits of science in his recovery by Ken MacQueen, MacLean's, 7 Jan 2013
Interesting Video Stories
- Peter Mansbridge sits down with hockey superstar Sidney Crosby to discuss how it feels to live with concussion symptoms and also the the not-so-conventional, CBC News, The National, 6 Sept 2013