update and insight
 

The elavil took almost two weeks to kick in and really show me what it can do. With it, i'm about 75% well. I can run short errands, have short client meetings, work a full day, and care for things around the house just fine. I cannot run, swim, or bike yet... or simply go out for a walk.

I went to see a doctor who is one of the leading doctors in the nation for concussion. he's a prominent doctor for an NFL team.

He helped me to understand my next steps. He gave me a graduated exercise plan, meaning an exercise plan that starts small and provides for small increments over time.

I am symptom free at rest. I am to do something like swim or walk for 5 minutes at a target heart rate of under 100 beats per minute. I am to do that, for example, on a monday, then take tuesday without exercise to analyze how I feel and if the exercise brought on any symptoms. Then if okay, proceed to exercise on Wednesday, and take Thursday off to again analyze symptoms, etc. Exercise again on Friday and again, analyze symptoms the following day. Do this for a week and if no symptoms increase, increase my duration of exercise to 10 minutes. Increasing by 5 minutes each week. Continue with this until I reach 30 minutes at under 100 beats per minute.

Then at that point I can increase intensity little by little and keep the exercise duration at 30 minutes, until I get up to my max heart rate.

At that point I should have the hang of it and figure out how to keep progressing onto a regular exercise routine like I used to do which was up to 2 hours at a pretty nice heart rate and fluctuating heart rate as I go.

He thinks it should take a few months to get back to running a few miles. It may take some time (no idea) to get back to my 6 days per week for an hour or two schedule. But I don't care! As long as I can feel normal again.

No doctor could yet tell me if/or how long this headache issue will continue. HOwever, he seemed to think that by one year I should be back to 100%. He did comment that the headache could be the one symptom that persists for some time.

So... Who is this leading concussion expert?

freezerdoor : What is your Elavil dosage? What major symptoms did it help with? I have been on 10 mg on and off for 2 years and didn't help me with the major symptoms - dizziness, facial pain, low headaches and fatigue. Wondering I need to increase my dosage.

You concussion specialist exercise plan seems like a lot better than going on the medicines route.

I don't really want to say since I wasn't really supposed to be accepted as a patient. I just knew someone who knew someone. I don't want to cause any problems. This site is very well SEO ranked.

I'm taking 10mg a day and it's knocked out fatigue, headache, and low tolerance for mental stimulation. My headache is constant and sharp in one spot. Doesn't move, and never lessens.

I think everyone is different though. Just my story. Elavil may not help everyone of course.

My neurologist gave me 25mg prescription but I didn't need it and made a decision to start small (1/4 of a pill) and keep taking more until I felt better. 10mg was the sweet spot for me. 25 would make me incredibly drowsy to the point of ridiculous. But I weigh only 108 lbs.

Thanks freezerdoor. I do have all the symptoms you have but 10 mg didn't help. My headache is in between eyes, top of my head and around my eyes. Wondering I need more dosage? When I took 25 mg in the beginning it sure knocked me out and made me groggy and sluggish so I cut down to 10 mg. May be time to go up a little bit? I weigh 155 lbs.

Unfortunately, I don't know the answer but under a doctors supervision, it's worth a try. Also, there are other drugs to try. My doctor said if this didn't work, there were about 4 others to try, topomax, etc. I got lucky with the first one. May be try another. I am very anti-drugs but in this case I've come to believe it was the right thing for me.

I used to be anti-drug and not any more as long it helps. I may try Topomax next before going up on Elavil. In my case doctor's supervison seems to be a joke. I have to make my own decision in many cases. I will be seeing a new Neurologist in next few weeks. I expect nothing from him other than writing prescription for the meds I ask for.

Thanks
 

Thanks for sharing this information freezerdoor, very helpful + an encouraging prognosis. Good for you for taking the initiative to meet with the specialist.

One of the benefits of Elavil is it can help with insomnia. Getting good sleep can greatly reduce all of the symptoms freezerdoor mentions. But, to get good sleep, the insomnia and other sleep disturbances must not be caused by sleep apnea. If the subject has sleep apnea, no amount of Elavil will help.

So, as others have said, your mileage can vary.

I believe that Mark! I never in my life have had sleep issues and do not now with PCS, but Man, I think I'm sleeping more soundly with Elavil than what is humanly normal. : ) It's definitely sleep like a baby.

i never had sleep issues before head injury and I always sleep soundly.

Now I take Elavil 10 mg and I sleep for about 10 hours and only some nights I wake up once to use the bathroom and go back to sleep immediately.

When I was at the hospital for 3 days probably they measured my O2 levels too constantly. They didn't say there was any issues with that except my heart rate goes very low during night may be in 30's. My heart rate always low even before the injury. Now I am confused even increasing Elavil dosage can help.

I guess may be getting Oximeter like Mark mentioned may be one way to find out.

The home oximeter or pulse-oximeter will track your heart rate too. A low pulse with good O2 may be a concern. In the hospital, you were likely sleeping in a reclined bed. This can help with breathing as it causes a better neck posture.

Just some ideas for consideration.

btw, I had a bad bout with low blood pressure and pulse after a ride back from California. I had fallen asleep in the truck with my head falling forward. I know that this position is very problematic for me. I was just learning this issue at the time. I spent the next week with BP of 70-80/40-50 with pulse rate in the 40's. I could barely get out of a chair.

Mark : You are right, I was at slightly reclining position. Now I started to sleep with kind of reclining position with lots of pillows.

My blood pressure is between 120 -132/70 -85 most of the time.

I believe I have low pulse rate with good O2. Why is that a concern you think?

My neurologist put me on Elavil for insomnia/headaches for PCS. It did not knock out the headache until he combined it with gabapentin. After being on Elavil for about 4 or 5 months, I wanted off because it gave me such a short fuse. It made me grumpy all the time. The gabapentin helped with my headaches (600mg) for about 2 weeks, and then they came back.

I've been reading about people's neurologists as well - I think I got lucky with mine, although I had some issues on top of the PCS after my head injury. I'm glad he didn't write me off - especially because my headaches and the tingling in my face that I experienced after my head injury turned into a textbook case of trigeminal neuralgia about a month ago - my original head injury headaches were also a form of neuralgia (shooting pain down the scalp of my head).

I'm also that idiot that never rested afterwards and didn't give my CNS a chance to fully heal. They aren't sure how it happened - it could be a vein/artery compressed between my left TMJ and nerve root (the TMJ dislocated on the right side and put a lot of pressure on the left, etc) or just from displacement of the veins/arteries in my head. Hahha, I remember the first time I was blowdrying my hair after my head injury and had my head flipped down and I looked in the mirror - I nearly screamed, holy cow where did that vein come from and why is it so big?! It was the strangest thing to me.. suddenly the veins in my head being in different positions.. and seemingly bigger?

But anyways, you never know what your noggin is doing or what that headache could turn into (head injuries can develop into primary stabbing headaches OR migraines) so it's a good idea to have a neurologist that will continue to treat your headaches (as well as YOU) until you are symptom free (hopefully).

Those of you with longer hair might consider some changes in your hair routine. The motion to flip your hair either to the front or to the back again can be enough of a motion to your brain that it can cause symptoms to persist or relapse.

I sort of cringe when I see women flip their head from side to side to get hair out of their face. This same motion would stop me in my tracks.

Remember the term Sub-Concussive impact. Those are the motions that cause subtle traumas to the brain that do not cause immediate symptoms but combine to cause much more serious symptoms.

On a scale from 1 to 10, you may have suffered a 6 or 7 concussion and needed to recover. Later, you can suffer multiple 1 or 2 sub-concussive impacts that combine to cause symptoms much worse than the 7 concussion. That hair flip may only be a 1 or 2 but can cause havoc over the long run. There is sound science to back up this claim.

I wonder if that's why I'm in this situation. I felt fine a week and a half after my hit and then after I attempted a mile and a half run I've been struggling ever since.