Returning to Work
 

In the next week or two, I will be starting back at work after a 3 month absence due to PCS. Part of the reason for the return is because there isn't a lot of "proof" to vailidate PCS (even with a Doctor's assessment) and insurance companies and employers are interested more in money than an employee's full recovery. I am a little bitter about that but I am working on changing to have a positive attitude before I go back.

Back to the point...The office I work in can be a little noisy with voices carrying from one end of the building to another and lots of echo sounds. I don't think I'll be working on the computer right away so that's a good thing. I'm wondering if anyone has had any experience going back to work or school after such a long absence???

I'm a little nervous that my symptoms will be worse. I'm also worried that I'm going to give the wrong impression to people - the folks I work with are great and very friendly however I find it hard to concentrate during conversations and haven't socialized since the accident.

Any experiences you could share would be helpful :)

Hi Ski,

I haven't posted here for a while, it's 3 years since I hit my head falling backwards off my BMX.

My injury was perhaps a little different. Like you I wasn't knocked out but I did have a very frightening 10-15 minutes when I was completely confused and disorientated. I expected to be fine after that but after a couple of days I started to get acute anxiety and I gradually became more and more unwell. I experienced severe depersonalisation and had to move back with my parents or I'm sure I wouldn't have made it.

Anyway, 6 months later I felt strong enough to start volunteering at a local arts centre. They suggested I enrol on a fine art degree at the college. I really didn't think I was up to it, my concentration was pretty bad and I generally felt depressed, anxious, detached, very foggy and I was quite terrified about what my life was gonna be like long term having got myself into this state.

But I gave it a go. It was really hard, but somehow, whatever the course demanded, I was able to push myself to accomplish. I know there is a lot of talk about not over exerting yourself and not stimulating your brain too much so that it can heal but I really think as long as you're not wearing yourself into the ground then it will tell you how much it can handle. The flipside is that much of the brain's recovery rests in its neuroplastic potential and this means you need to work it in order for it to reroute itself.

So, from my experience, getting back to work, providing it is a positive place for you and you feel good about your job, is a good thing to do, but just make sure you stay in control as sometimes you may well need to step out of things and take a break.

Don't expect people to understand....they don't. People think a mild concussion is something you recover from in a day or two, they don't realise that in occasional cases it somehow becomes a much longer term affair and makes life incredibly hard in a whole new set of ways. My own family believed it was a mental breakdown I was suffering from, not a brain injury....both were true I suppose, depends whether you look at me as consisting of atoms or thoughts and feelings, and of course I'm both.....but I know what I experienced was a direct result of my injury.

So my advice is give yourself a push where you feel able and be strong enough to give yourself the breaks that you need. In my first year at college I could often be found asleep on my table in the studio!

I still have symptoms, the world doesn't look as 3 dimensional as it did, I can feel overwhelmed in noisy places and I go to bed every night with a wooshing sound in my right ear....but I'm top of my class, I ride BMX better than ever (with a helmet) and I just won 2 prizes at a major art show....so I have a life again.

Wish you the best.

Ski,

You may want to take some foam ear plugs to work. It is amazing how much you can hear with them in. The normal conversation sounds will be understood but the background sounds will be reduced. I like the yellow cylindrical foam plugs. Twist them tight then insert them.

The ear plugs will also be a reminder to yourself and others that you are still healing. If you want to get some quality plugs, you can get musicians ear plugs at most hearing aid clinics. They cost about $175 and are custom fitted.

Expect to need to take a break for some eyes closed time. Giving your brain a rest from the visual stimulation will help you through then day.

Good luck at work.

My best to you.

Thanks for your thoughts.

Benjamin, your recovery and grades are really encouraging! Problems with memory and recovering words during a conversation have decreased my confidence in my intelligence somewhat - It seems as though I haven't become less smart, my brain just needs to reroute the path to the information.

Mark, I like the ear plug idea and think that could really be helpful in the environment I will be working in. It's right about now that I wish I had my own very private office with dark blinds and thick walls!


I don't expect people will get it. I have a great, albeit small support system that includes about 5 people. The few I have been in touch with from work don't understand why the doctor can't prescribe me a medication that will cure my symptoms. It is true that the symptoms are "all in our heads" and stigmatizing that can be very hurtful. People think we're crazy and we feel like we're going crazy. It doesn't help that there isn't an x-ray to show our sensitivity to light and noise or a scan that shows a constant blurry vision and dull headache that just never goes away. UGH! Wouldn't it be nice if we lived in a world where everyone was only helpful and non-judgemental?

I can also suggest some sunglasses. Or tinted glasses even if you get
a pair that hasn't got a prescription in them. Some colors are better
than others. Blue has been very helpful for my son with his seizure
situation.


So I would also suggest that.

Donna:grouphug:

Similar situation...
 

Hi Skiconcussion,

When I initially read your first new comer post I couldn't believe how similar
our accidents were; and now I too face the burden of returning to work.

On Feb 5th 2011 I fell backwards snowboarding down a steep slope. The outcome was some really bad whiplash, bad enough for me to be experiencing PCS symptoms. Like you, I went on with my daily routine for almost and entire month-ignoring the symptoms thinking they would just go away.

It has almost been 3 months now. I'm currently collecting employment insurance but it is running out and soon am forced to return to work.

The main symptoms I'm dealing with still are:

Marjor - Lightheadedness, dizziness, unsteadiness and concentration problems. I have a serious lack of clarity all the time!

Minor - Random headaches they do come on but not often and not for extended periods of time, tinnitus and sensitivity to sound (I work in Construction management which may pose a problem - ear plugs are a must)

I've been dealing with on/off depression. Mainly depressed about not being able to be my old social and active self...and no sex! come on...wow.

I know that if I go back to work, I can do it, but will be a nightmare and will it hinder my recovery?

Ironic how you mentioned you were excited hear about all the success stories on this site when you first joined. I felt the same way, but as I started reading and delving into the threads I actually became more discouraged about recovery than before I joined Neurotalk.

It seems that many of the senior members believe there is no full recovery...pretty discouraging for any new comer.

Anyway, thats my 2 cents for the day. I guess this is a new battle that we are all fighting together.

I live in Nelson BC Canada. If you are reading this and you have PCS and live in the area, I would love to get together and chat.

Nitro:grouphug:

Thanks for sharing Nitro! My fellow Canadian! I'm not in BC but ON which is very far but in the Great North nonetheless!

I know exactly what you mean about experiencing a lack of clarity all the time. For me, it's like I am constantly in a dream state. When I'm in a conversation, I find myself repeating what the last person said to make sure I understood them properly. Whenever I see or hear something there's a delay in processing what exactly I'm looking at or hearing.

I understand that you are feeling discouraged. I also felt that way after reading posts from people who are 3 years into PCS. I have a very compassionate doctor who reminds me all the time that this is my reality for right now and to take things one day at a time.

I have also taken this as an opportunity to listen to my body and reconnect with myself. I keep 2 journals: 1 to record my daily symptoms from which I provide my support team of my progress/changes and the other one is to record my feelings and thoughts. The hardest part is to accept that this will not go away in a week or two and there's a whole bunch of grieving that comes along with that - like you mentioned you miss being your old social, active self and sex. Getting all those feelings out in a healthy way can be helpful.

Going back to work to early can actually delay the healing process and produce setbacks so I would work closely with your doctor to set an appropriate time to return. I wish you all the best!

A return to work date has not yet been sent for me but I will post my progress once I do return.

Take Care,:hug:
SkiC

Treatment?
 

Hey,

So what exactly are your doctors telling you to do for treatment? and what to avoid? I am scheduled to see a neurologist but its not for a few months. I've read that when an NHL player is diagnosed with PCS they are told to do nothing and think about nothing until they are symptom free...is this along the lines of what your nerurologist has told you? Any info would be very helpful.

Nitro

To Nitro - My Treatment for PCS
 

The major influence on my progress includes the care of my family physician, Reiki treatments and the care of an ostepathic therapist. See details below.

I have been under the care of my family physician since the beginning and see him weekly. During this time he consulted with a concussion expert and I also was assessed by a neurologist. So the consensus is rest until you have no symptoms - rest meaning: no television, reading, computer, etc. and yes, even thinking is discouraged. This also meant not pushing myself around the house doing chores and cooking,etc. as all of these things involve thinking. I also stopped driving and cut out all exercise accept gentle stretches with help from my massage therapist. During my recovery time I rarely leave the house accept to go for appointments and much of my time is spent in a quiet, dark room.

Doing this for many weeks allowed me to slowly start to try "new" things again. In the last few weeks I have progress from feeling nauseated after reading for 5 minutes to being able to read for 30-45 minutes. I can also watch a movie, bake occasionaly and I've started doing some minor chores like laundry and dishes. Before I couldn't even bend over to pick something up without getting dizzy and losing my balance.

The doctor first gave me Relpax (for migraines) which somtimes worked and sometimes not so much. Recently he prescribed nortriptyline (10mg) to help with the migraines. I have felt some difference in the strength and frequency of my headaches and they are now manageable with an occasional ibuprofin (Advil).

I have also had success with Reiki treatment (energy) on a weekly basis which has decreased the strength of my headaches & nausea immediately after the treatment and have made me feel more alert at times rather than dazed.

A therapist using osteopathy techniques treats me almost weekly. I can't quite describe it like the therapist does but the goal is first find the areas that trigger the symptoms and also to get things moving in the areas where I hit my head. I have to tell you the treatment is very cool - I've experienced a panicky feeling when he gets close to the area that was hit and if I'm very relaxed and aware, I can feel the movement in my head and my entire body. My nausea and dizziness have decreased because of this treatment as it calms the nervous system.

On my own, I have discovered that small and frequent sessions of meditation and rest are best. It also helps to practice positive affirmative thought patterns i.e. "I now allow myself to heal", "I trust the process of healing", etc.

Something that may be helpful is to keep a daily record of your symptoms i.e. what they are, when they appear and the duration. Both the osteopathic therapist and my physician has said this is helpful for them. It also allows me to see the progress eventhough it's slow, it prevents me from thinking that things will never get better.

I hope that helps :)

One thing I would like to suggest when it comes to going back to work.

If there are things you can start to do at home. Or even if you can
go out say to a store and do some things that would be close to
being in the office again. I would practice this for say 15 minutes
at a time to get ready.

I have a job were computer is necessary. Working on a laptop is something
that is easier for me. Being in a lower lite atmosphere helps me.

But if I have to be with a group I make sure I can do quieter things.
Then I also make sure I can take small breaks as time goes on.

I am a parent advocate, so its not unusual to find me with a group
of 10 people in a room. If it gets to loud, I've warned my parent
ahead of time. I might call a break for me. As much as her.

Donna:grouphug:

Thanks Donna for your suggestion and for sharing your practices at work. This will help me as I start to put together a plan to go back. I think that's a good idea to try going to a store or somewhere where there is a lot of stimulation for a small amount of time. I remember about a month or two ago I tried to go to the supermarket with my husband and I hardly lasted 5 minutes before I had to go to the car. Now I think it might be time to try that again.

It seems like a big part of returning will be educating the folks I work with on what I need - like you said, taking breaks and having quiet time, working in lower lit areas etc.

Did you find that your symptoms increased when you first started working again?

Ski and Nitro,

One way to help others understand what your needs are and what you are going through is to explain how your brain is malfunctioning.

The simplest issue is the over-stimulation or over-attending as the medical term goes. The brain receives a vast amount of information but needs to process very little of it. It has to filter out the excess information/stimuli and direct the needed information to the proper part of the brain. This is where PCS causes a problem.

The brain's filtering mechanism is the most commonly injured part of the brain, especially in a concussion. It is like a traffic cop at a busy intersection with impatient drivers honking their horns. As it tries to filter or direct (gate) the information traffic, it fails and lets too much information through without giving it a direction to go. The result is the individual part of the brain that wants just a bit of information gets too much information and some of it is information that should have been directed to a different part of the brain.

Crash, the information collides as it tries to get processed. This is the overwhelmed feeling. It causes a cascade of other malfunctions, especially in the epinephrine/nor-epinephrine system causing a flight or fight response. Now the brain is told to speed up by the flight or fight response. Problem is, it only has first gear. It can't handle any faster speed.

The goal is to let the brain work with only first gear until it can handle second gear. The epinephrine/nor-epinephrine system also regulates blood pressure and pulse. Raising blood pressure and pulse increases head aches, etc.

This is far too much to try to tell co-workers but it can be simplified. I just tell people that my brain's filter that filters out excessive stimulation is injured and it lets too much information through, causing an overload. They usually understand this simple explanation.

I also have a visual and auditory memory problem. I explain that my immediate and short term memory is severely injured, making it difficult to follow quickly changing visual images or verbal instructions. btw, This is likely due to the gating system not processing the information correctly.

The additional problem is called diffuse axonal injury. Each brain cell (neuron) has up to 10,000 wires (axons) connecting it to other brain cells (somewhere between 10 to 100 billion brain cells). The wires become stretched, broken and tangled. This causes information to not flow consistently. Neurons heal slowly but only during REM sleep.

There is some research that indicates that the neurons can replicate over time. The problem is axons heal very slowly and you need thousands of them for each brain cell to connect to the other brain cells. It took 20 years for the brain to accomplish most of its maturing and connecting the neurons with axons. Repairing this broken mass of axons will not happen over-night.

Stress is the worst thing for this brain environment when it needs to heal. Stress increases cortisol and epinephrine and nor-epinephrine. This is like trying to put a fire hose's volume of water through a garden hose. The excessive pressure and volume will just fatigue and break the garden hose. There go a trillion axons, stretched and fatigued. Back to square one and more need for rest.

I am surprised your doctor sees you weekly. A bi-weekly visit would be more frequent than the brain can heal. I have had brain overload crashes that took longer than a week to recover from. Often, up to two weeks.

The value of a journal IMO is to observe and report trends, not daily events. It also allows extreme events to be remembered and related to the doctor, like going out and overloading when a siren or alarm went off.

I have gauged change over months time, not days or even weeks. Often, I will realize after accomplishing a task that I had not done that task successfully in months or even a year or so.

I notice the doctors prescribed "no thinking." For me, that was not possible. Instead, I moderated my thinking. Music works well to fill my mind but not stimulate thoughts or reactions. Amusement TV also works. By amusement, I mean TV that allows passive watching, not active and reactive watching.

I believe there is a rhythm that the brain relaxes to. Music with a consistent tempo and a melody that is fluid rather than chaotic is very easy to relax to. It may require trying some music genres that you consider boring. Boring is what the mind needs right now. Lyrics with gentle meanings allow you to cognitively understand and agree with can be beneficial.

My wife can tell when my mind is at rest. I will have a sense of peace on my face. If my mind is not at rest, I will have a grimace on my face. When I wake up, I will not feel refreshed.

Instrumental music may be all that the mind can handle at first. Lyrics later as the brain can handle the extra information. Foreign language lyrics work for me. I imaging the thoughts of the lyrics rather than the actual literal meaning, like "Time to Say Good Bye" (Con te partiro) sung in Italian by Andrea Bocelli and Sarah Brightman. The English translations are available online to get the gist of the lyrics.

I hope this helps you understand what is happening in your brains. Once you understand the flow of information in the brain, it is much easier to explain to others and to not feel like you are going crazy.

My best to you.

Mark thank you -- that explains me exactly yesterday at drs office. I was in the waiting room and I had earplugs in...I heard every noise and just couldn't stand it. The phone was ringing in the background, several different conversations...all of which I couldn't ignore even with my eyes shut. It was strange....overwhelming.

Does it take the brain a long time to be able to accept more and more? Is it a matter of training the brain to do that?

If I had a speech problem, then I would be in for speech therapy...right? So, why can't there be a rehab for overload??

Thank you SOOOO much for your post regarding people not understanding. It's nice to realize I'm not alone in feeling like an outcast because people don't understand how life altering PCS can be, and that there isn't a pill to fix it or a test to prove it!

Pcs
 

I have PCS and it has been 8 months since my accident. I never thought it could take so long to recover. I wanted to come on line to see how long it takes. My neuro Dr. told me it can take a year. My symptoms have changed some. Im not in the bad fog I was in. My thinking is clearer, but I catch myself zoning out all the time. I have trouble finding the right words to say and my spelling is horrible which is not a good thing because I am a writer. I have never had to google words for spelling. I seem to have long term memory but not so good at short term. My close up vision is good, my distant vision is blurry. so it keeps me from driving. I have headaches on one side of my head everyday. Some times I just do not make it out of bed. Im really trying to get better. I guess we all just want our lives back. I was hoping someone could tell me they just get better and better and back to how they were.

Your doctor is somewhat right about it taking a year. Nobody can say how long it will take. Some studies say that the symptoms that last after a year are often going to be long term or even permanent.

Most of the recovery from such symptoms is by way of learning work-arounds and other accommodations. There are many ways to work with the short term memory problems.

Have you had your eyes checked. Sometimes, visual therapy can be helpful.

I have serious immediate and short term memory dysfunctions but am able to function at a high level. I do have those bad days, but my good days can be quite good. Using the work-around skills I have learned, I can be very functional.

Do you have any history of prior concussions or even minor head bumps or impacts?

Head traumas are cumulative. Prior traumas can combine with your latest trauma and cause long lasting symptoms.

I have done extensive writing by using multiple displays. I use one for the work in progress and the other(s) for notes and research. Some computers come equipped for multiple screens. Others need a display adapter for the second screen.

It is well worth the expense. I am constantly correcting spelling. Spell check is a big help along with google.

Tell us about your biggest struggles. There are decades of PCS experience here.