Made Much Worse by Alcohol
 

Hi all! I hit my head in April, it was a mild concussion. I felt better after about 10 days and drank very heavily. I was living in a new city by myself so it was the only social activity I thought I could seek out. I then felt very lost, foggy, and like my brain was torn apart for maybe 3 weeks while slowly recovering. After that I thought I had almost fully recovered and I drank another beer and felt miserable again. I repeated this cycle twice more. Each time after consuming alcohol (not bingeing, I drank maybe 1-2 beers) I felt like a 1000 times worse than I did when I initially hit my head. I felt better again after about 4 weeks after this last drink of booze, and again drank maybe half a corona in mid July 2015. That was the biggest mistake of my young life.

I constantly feel like I can't construct a single thought. It feels impossible to connect with anyone. I can't look anyone in the eye, not even close friends and family because I can't mentally picture my own mind. It's absolute hell. Its been about 6 months now since the initial hit, and almost two months since the last time I drank. My symptoms haven't gotten better. I know to a large extent I brought this upon myself, but really need some hope. It's so overwhelming everyday to just think about the recovery process, and how far away I feel from the person I used to be.

I've been to two neurologists. My MRI and EKG are all normal. Both think I am fine or will be fine with time. But, this just doesn't seem to get better. I am taking unpaid leave from work and staying at my mom's house. I thought I would stay here till I felt clearer, but its been a whole month with no improvement. To be more clear, the only big problem is that the moment I try to structure a thought or think to myself I begin feeling an impossible pressure in my head that doesn't allow me to access my thinking. Maybe this is depersonalization, I'm not sure.

hermanator90,

Welcome to NeuroTalk. Many with PCS develop a severe sensitivity to alcohol. Maybe your brain needs some help detoxifying. I suggest you read the vitamins sticky at the top and get started on a brain focused vitamin regimen.

If you live near a Rehabilitation Clinic or Hospital, getting assessed there may be helpful. They could direct you to a therapist to help you with thinking struggles.

Hermanator,

I am somewhat in the same boat as you. I got a concussion in March, it was my senior year of college and struggled not being able to be social or drink until graduation. It took me about 3 months to start feeling better and that was when I had removed myself from a stressful and worrisome environment (college). I began to drink again and go full speed 100% back into my old activities and my symptoms returned. The best advice I can give is to accept that this can take a long time to recover and that stressing or worrying about it just makes it much worse. Take care of yourself and let your body heal

I don't drink, but have the exact same experience with caffeine. A literal teaspoon drop of coffee makes me completely nuts, and it usually takes a day or two to recover. I guess our brains are just so sensitive to toxins or stimulants of any sort that even small amounts of this stuff can turn life upside down for awhile. Oddly enough, there are actually a couple of supplements that I've tried that have done the exact same thing to me, including 5 HTP and St. John's Wort. Both make me feel like it's about time to check into the psycho ward. And like most people on here, before my accident I could drink up to 4 cups of coffee in the morning and more caffeine at night and feel totally fine.

Hang in there man. I'm in about the same boat as you are and was a Spring of 2015 injury. I find that actually getting out there and doing stuff in moderation is way better than being at home worrying about the symptoms and the injury. Unless I'm talking to my immediate family, most people's faces have an unreal almost one-dimensional Gustav Klimpt quality to them that is alternately terrifying, and if you let it be, rather funny.

Thanks (and some questions)
 

Thanks Mark, Nick, and Seth. I really appreciate the responses.

The one thing I did want to ask you all was that after about 2 weeks of resting back in October, I had a day of immense clarity. I could think thoughts that felt like they were fully mine. I could look people in the eye and smile. But, the moment I started up a conversation with a friend, everything became fogged up within 10 mins. It felt like my brain wasn't ready to handle the load of these pathways that I had created. Has anyone experienced that as well?

Mark, I will definitely look into the vitamins note you mentioned. I am currently taking B1, fish oil, riboflavin, magnesium, and valerean root (to sleep).

Nick - did you eventually begin to heal? Are things better now?

Seth - thanks man! Sometimes some humor really just strengthens the spirits. Appreciate it, and plan on getting out more.

hermanator90,

First, don't try to figure this out. You did not rebuild/create new pathways. Those take months with hundreds of repetitions to 'network' or program.

Second, Just because you are having a good day does not mean you can tackle business as usual. It can be surprising how taxing a simple conversation can be, especially if it is stimulating. Having a conversation with other voices in the background can be the worst. If you try to pay attention (tough with PCS), you may notice some signs before you hit your limit. The foggy brain usually tries to warn you that it starting to fatigue.

Try to link a week or two of good days before you start trying to stretch your limits. The best recovery happens during these extended good periods. Consistency is a better achievement that peak performance.

Oh yeah. All the time. I know exactly what you are talking about. It's like you are talking to them and in a couple of minutes it feels a bit like you are in a fever dream. I find that the faces reduce in their 3-dimensionality, also, if that makes sense? And that can go on all day. You are not alone in this warped world.

Thanks Mark! I agree that I won't be figuring this out and I suppose it is foolish to try to imagine what's exactly going on.

In terms of tangible experience - I am definitely realizing that consistency would be huge, especially putting together any stretch of good days. After my first five days of rest in August I felt perfectly fine one morning so I returned to work. Within an hour, I felt exhausted and back in "brain chaos" (I call this recovery phase where I can't seem to close my eyes and even think or structure a thought that feels like my own as "brain chaos.")

After than it wasn't till September 16th that it felt like I had a similar clear-ish day. Starting in September, I had been taking leave from work so this was following some rest. Speaking to one friend for 20 mins completely seemed to evaporate this clarity. Again returned to "brain chaos" where I stayed till October 1st when I woke up and felt clear. At this point I knew I had to trap this and not push it, but even smiling at folks and making eye contact seemed to exhaust and eventually deplete this reserve. Since then I have returned to this brain chaos phase and am recovering through that now. Just wondering if this patter of peaks in recovery getting smaller and harder to maintain is consistent. Does this recovery process seem familiar with things you might have experienced or heard about from others. I am just resting at home. I text friends and talk to close ones in this stage but it's very difficult to communicate because my sense of concentration and ability to structure a thought seems lost.

I don't mean to keep whining about myself because seems like many people are going through much worse. But, this has turned my life completely upside down at 24. This forum seems to be the first place I am getting real support.

Nick,

Thanks for the note! Hope you are doing better now. I have a couple questions for you -

1. Did you experience day to day recovery after your symptoms returned? Because I used to experience day to day improvement before that last drink in July. Now things just seem stagnant, and that is what is really scary. They've been stagnant for the last two weeks.

2. When you were recovering from symptoms did you have a lot of setbacks? When I was initially getting better I would slowly get better but not slip back from a recovery standpoint barring additional stimulus (usually a long day of work or alcohol). About two weeks ago I felt clearer than I had felt in a long time but the moment I had a conversation with someone I felt myself slip out and exhaust into chaos again.

hermanator90,

It is problematic to try to compare recovery processes and outcomes. There is a saying. If you have seen one brain injury, you have seen ONE brain injury.

It helps to try what others have tried but try without expecting the same result. It is more important to figure out how your brain is responding to various activities. If face to face talk is a struggle, email can be helpful at maintaining those connections.

It will help to find an activity you brain will tolerate. You need to stimulate good brain blood flow with causing brain chaos. Manual activities are often good. The struggling brain can usually handle manual activities because the hands can not work faster than the struggling brain can process. Craft projects, learning to do card tricks, playing solitaire with a real deck of cards, working in the yard/garden, etc. can give you a sense of moving forward and keep you from going boredom crazy.

Recovery is almost always a roller coaster ride. Some times, one can identify the triggers of the down cycles. Sometimes, they just happen. Sleep can make a big difference. Keeping good sleep hygiene with no excessive napping during the day that interrupts proper long sleep at night is good.

But, if an activity causes you to feel sleepy, a short nap can be helpful. I spent a lot of time in a recliner where I could nod off if I felt sleepy. I use a laptop and do online jigsaw puzzles and things like that. If my eyes feel tired, I just put my head back and doze off. My wife says she can tell when i am getting a good nap. After 20 minutes, I spontaneously wake and am back at it. I get some of my best sleep in my recliner because the sleep is demand oriented. By that I mean, I sleep when my brain says to sleep.

Early in my recovery, I would be able to do 10 to 20 minute activities. I had a rotation of things to do. If I was at my desk and started to struggle to read a line of text on the computer screen, I would stop and go downstairs to my recliner and watch some Discovery Channel. I'd might take the dogs for a walk and start the rotation over again.

So, try to find small tasks and activities to occupy your time with. The mild stimulation is good.

Mark,

All of that makes sense. I just want to thank you for being so proactive and thorough in responding. For someone like myself who has spent the last few months just looking for someone to speak to who would understand what I'm going through, this forum is very very helpful.

Thanks!

Hey,

I agree with Mark its tough to compare other people's recoveries to your own considering all of my friends and teammates (I played college soccer) would get concussions and then feel fine a few weeks later. Nothing about my recovery has ever been day to day. I find it useless to stress over why I am feeling good one day and why I am not feeling good another day. I have had good days where I had a stressful day at work and I got through it just fine and came home from work with plenty of energy and in a good mood. I have had other days where I got a lot of sleep didn't do anything stressful all day and felt pretty bad. So I have given up trying to fuss and analyze every last symptom or feeling that i have and figuring out where it came from or why its not going away. The key for me is just acceptance, keeping stress to a minimum, patience, and knowing that things will eventually get better!

Things have been stagnant for a while now since my setback and I am trying to be patient and take care of myself as best I can because thats all that is really in my control.

Hope that helps somehow.

I am sorry to keep belaboring about myself, but been resting for about 40 days now without any improvement at all. It's very difficult because I am completely unable to connect with people. Not just strangers, even friends and family.

Just to quell my anxiety, I am wondering if anyone in the past couple weeks has come across anything that might explain why I have been feeling this way. To reiterate, my concussion was made much much worse by repeated alcohol use. I literally felt all the clarity and improvement disappear the moment I completed my last alcoholic drink back in July now. And things just have not gotten better.

I began a vitamin regimen in early October, but other than that just taking a lot of rest. Would love to know any additional information on effect of alcohol on a brain recovering from concussion that might explain why the last few months have been so stagnant.

Thanks a lot!

It is a losing game to try to point to a reason for prolonged concussion symptoms. Every concussion is different. Every response to alcohol is different. Prior alcohol binges can create a brain that is very sensitive to alcohol.

It might help to engage in some low stress activities that encourage good brain blood flow. Light exercise that does not cause symptoms may help.

Thanks Mark. I guess I am most worried about the permanence of this. You said you haven't come across anything where alcohol use caused permanent damage after a concussion, correct?

I apologize for kinda having a panic attack all over this thread. It just gets overwhelming to be like this.

One thing I've noticed is that there are different phases or stages of healing. Some happen quickly and some take a lot longer to get through. Thats why to some it may be described as moving through a plateau stage of healing and not seeing any improvement. Healing does not happen overnight and in day to day increments. One thing I can say for certain is that all of this worry and stress is not only going to make your symptoms worse but they will be magnified psychologically because of how strongly you are focusing and worrying about them. It's a hard thing to accept that recovery may take a long time for sure. Try writing a concussion journal. You can keep track of your headache score, screen usage, how you slept, and write down all of your frustrations and worries. The act of doing this can actually clarify things for you and sort out stresses and worries.

Otherwise all you can do is take care of yourself. Avoid the obvious activities, make sure you're getting enough sleep, vitamins/supplements, low stress, and hydrate hydrate hydrate. Otherwise you could maybe look into seeing a cranial sacral therapist. That's one thing that has helped me.

Alcohol can and does cause permanent damage. I just have not seen anything that says alcohol makes concussion damage permanent. I was told by my neuro at 16 years old to stay away from alcohol because its effect would be much worse with a concussion injury. Alcohol is a neurotoxin. It will likely delay your recovery.

I've heard it stated that getting blotto drunk has a similar effect on your brain as getting a concussion.

But, what ever you did, you cannot change it. You can only effect your future behavior. Learn from your mistakes and move forward with your life. Anxiety will only make you symptoms worse.

Thanks a lot Nick and Mark. Really really appreciate your responses.

Mark, to your point I did mean if alcohol makes concussion damage permanent. So thanks for the clarification.

Nick, I plan on beginning a journal. Definitely think that's solid advice.

Nick- What symptoms did the cranial sacral therapist help with? How did you go about finding one.

And, it's strange literally my only symptom is the inability to think and interact like my usual self. It absolutely occurred immediately after drinking repeatedly while concussed. Everything else is just as before i.e. no additional light/sound sensitivity, nausea etc. Should I still try to avoid using the screen for a long time?? I don't feel any fatigue from using the screen or watching tv.

(That's why I am curious because this almost seems different than a lot of other people's injuries. Its as if what made me myself, that thinking, it is shredded and blocked. Every time I try to think I just feel like the head blocks it off and I am in a dreamy fog and unable to concentrate enough to think.)

Most cranial sacral therapy is done by an osteopath or Doctor of Osteopathy. Some massage therapists say they practice CST.

But, CST has two parts. Cranial therapy and spinal therapy. Spinal manipulation/therapy by a CST can be useful. CST's claim to be able to read and adjust/move the cranial plates. But, there is no evidence that cranial work has any medical basis. When studied with multiple patients diagnosed by multiple CST's, there was no common diagnosis. Some on NT have tried it and ended up with headaches.

Thanks Mark. I am still just very confused about what I am dealing with. I hit my head one time very lightly, and every other setback was triggered by alcohol (5 times). While I understand your point that it is imperative to look forward, I don't think the right treatment could be assigned without knowing what exactly is the issue.

I am wondering if the tearing feeling I got after drinking was a result of axonal damage or the fact that I don't feel like myself at all (being blocked off from that thinking) is a result of damage to the white matter.

Correct me if I'm wrong, but if I don't know what the problem is (I'm only aware of the symptom I am experiencing) how could I possibly start trying out solutions, and expecting them to work.

So, wondering what tests I should get done to understand where the damage is. I have currently only gotten done an MRI, and EEG. Both were negative.

Would a DTI test make sense? Anything else you could think of?
- It's clear that connections that after my first few times drinking after the concussion would repair in time, are now no longer repairing OR taking a very long time to repair.

Please stop trying to diagnose a physiological injury, axonal tearing, white matter, etc. This is just anxiety. No specialist can tell you the answer you are looking for. The standard is to treat the symptoms. There is no way to define the damage to treat the damage.

A DTI MRI will not tell you what was damaged. It will just tell you that your brain is struggling in a specific area. A DTI will only image symptoms of an injury, not the specific injury.

40 days of rest is a very short time as brain trauma is concerned. Rest alone is not a treatment. You need proper stimulation to encourage good brain blood flow. You also need to deal with anxiety as it causes a cascade of bad chemistry through the brain.

You could be simply suffering from depression. Have you seen a mental health specialist/psychiatrist ? Depression can cause severe brain fog. Believe me. I was in a severe fog from depression 32 years ago that lasted for over 6 months. That is why I was told to start the vitamin and supplement regimen. B-12 was a big part of my recovery. It took 8 weeks to see a difference. Not everybody responds the same as I did. If anxiety is a factor, other therapies may be needed to overcome the learned anxious thoughts.

Stop doing internet research. Axonal damage, white matter, etc. are all just terms you can use to increase your anxiety. The more you find terms like that, the more likely you will struggle with anxiety.

So, please seek a professional diagnosis.

My best to you.

Mark

Mark, thanks again. I am seeing a psychiatrist and a neurologist. They also recommended taking B12 and Folic so starting that right away.

I just don't know how to keep moving forward when I feel nothing like myself, and can't connect and communicate with a single person out there. I'm 24, all my friends are dispersed all over the country, and none live near me. When I talk to them on the phone, I feel like I'm a stranger that I don't even recognize. I am alone all day, and constantly fighting depression, you're right.

I am worried about starting depression medication because that might mess with my thinking even if it begins to clear. I took depression medication 6 years ago when my father passed away, and felt like they just confused me. My doctor mentioned anxiety medication, but my heart racing/ panic moments are very rare (less than once every 4 days). When I feel anxiety building up, I try to engage in some activity and that pretty much stops the panic because I'm also very aware that anxiety is counter-productive regardless of if I'll ever get better.

The only reason I don't think what I am experiencing is just depression is because of actual physical headaches I feel all day when trying to think. Also, as mentioned earlier, the two days since July when things did begin to clear up, I felt extreme mental exhaustion and pain as I tried to communicate.

I hear you. I'll stop trying to diagnose. I just wonder if the same treatments you are suggesting (mild stimulation, rest, good brain blood flow) would work for me considering I have none of the other symptoms commonly experienced by multiple concussion patients. Realizing here, like you said that no two brain injuries are the same.

Why are you not taking the whole vitamin regimen as recommended in the Vitamins sticky at the top ? B-12 and folic acid are a very minimal effort. You also need a B-50 Complex (it has folic acid) to get all the B's for proper balance. D-3, too. Your brain suffered a toxic event. You need good brain nutrition to help it heal from that.

Mild stimulation, enough physical effort for good blood flow is good for any neuro condition. None are quick fixes. It take weeks of discipline to see improvements.

Hi everyone,

Just wanted to update on this thread in case someone else with a similar situation has been following. I spoke with Dr. Allen from Cognitive FX and they think I'd be a great candidate for the treatment. I am definitely skeptical but debating whether I should just go in for the treatment anyway. If anyone else is considering it or has received treatment at Cognitive FX would love to hear how it went.

For now, since October 1st I have had absolutely no improvement and still am unable to think, with persistent pressure headaches on my temple. I have been successful with my anxiety to a high degree, and that has been a great help with coping.

Of course you are a candidate. They claim to be able to treat just about any neurological condition. The qualifier is a willingness to pay. Be very careful as you decide about such a large financial expense.

Personally, I'd be doing intensive nutritional/vitamin/supplement therapy for a few months before spending $7000 to $10,000. No amount of cognitive and such therapy will overcome a toxic condition.

I definitely agree with that. I am planning on continuing this vitamin regimen for another month before making a decision. if there's absolutely no discernable improvement after 2 months, I am pretty sure I'd be happy to pay the $500 deposit for treatment to get even a semblance of my self back.

The doctor mentioned it was a brain cell energy issue, and those issues can be reversed by therapy by targeting therapy that trigger the right areas in the brain. Since I have had clarity since the last time I drank alcohol, I would like to think the initial alcohol toxicity is no longer the problem, but the overall energy is. What do I know.

$500 deposit is just a small part of the fee. Don't let them force you into a financial corner. Medical expenses are the leading cause of bankruptcies in the US.

I definitely understand that Mark. They are booked up for two months, and the $500 fee is to hold a spot for the eventual treatment that will cost $7900. If i do go forward with the treatment, the $500 fee can be used as part of the $7900 total cost. If two months later I were to realize that I am actually improving and don't need the treatment I would lose that $500.

I definitely understand the high cost of this. I am going to wait and try to see if there is any improvement doing this by myself.

Since October 1st like I said earlier I have had absolutely zero improvement. I am going to wait till November to see if I even want to place that $500 deposit for a treatment. I feel if after two months there is no improvement (while in the past in my recovery there had been improvements and relapses at least every month), then I have to try other treatments.

Wow, they have a two month waiting list but still charge a $500 non-refundable fee to get on the list. I bet they keep a lot of those $500 fees.

Personally, I'd would be very hesitant to do business with a company with a fee structure like that. I'm sure they fill every spot that becomes available when a client cancels so they do not lose any revenue.

What symptoms are you still struggling with ?

Have you sought help from a NeuroPsychologist ? They can assess your thinking skills. They are often covered by insurance so the financial risk is much less that Cog RX.

Did most of your symptoms start to manifest just as school finished ? Your timeline sounds like that may be the case.

The only symptom I continue to struggle with is my inability to connect with people. My emotional connection with people is completely lost, as is my ability to generate emotionally connected thoughts.

The best way I can explain this is my inability to maintain or make genuine eye contact with anyone, not just strangers, even my mom, my sister, my best friend. I feel intense pressure in my head and headaches if I try to think and use the normal thinking I would have used in the past to connect. In essence, when I sitting alone, I still cannot think and therefore make eye contact with myself in the mirror.

In the moments that I have felt clarity since my initial injury, this pressure and blockage in my head would completely disappear, while I would continue to feel fatigued. All my symptoms came about when I drank alcohol. I am 24, was still working when I last drank, which was Friday July 17, 2015.

The next week when I returned to work, I couldn't interact with colleagues I had become close friends with over the last 5 months.

My other cognitive skills like analytical thinking, visual processing are not hurt. I do think memory is poor because I am forgetting names a lot. But, that I am not as sure of.

What you are describing sounds like 'flat affect.' I think a Neuro Psych Assessment would be worthwhile. It will be able to differentiate cognitive symptoms from emotional/psychological symptoms. I still think you have a high likelihood of depression. You sound like me when I had my depressive episode 32 years ago. I felt like a zombie trying to connect with others.

I had an appointment with a neuropsychiatrist today. The doc does not think this is depression, and referred me to Dr. Cantu's concussion program at Boston University. I will be looking to see if I can get treatment there.

I am a 100% certain this is not depression or anxiety. The excruciating headaches I experience when trying to unsuccessfully think are proof of that. Furthermore, the doctor also had an explanation for the feeling of fogginess I felt that sets in on the very few days that I do feel clear. I explained how speaking and thinking was exhausting on those days even though I felt capable of it, and he noted that it's because I need the blood to flow through the brain faster than it is capable of. I will have to listen to my brain and body and not over-exert on those days. But, since such a recovery day hasn't appeared since October 1st, I need to get looked at professionally.

I will keep people posted on updates here. Thanks again for your help so far everyone, and especially Mark.

I have great respect for Dr Robert Cantu. He has been speaking about concussion for 30 years with nobody listening until 10 years ago. I have his book on my shelf. His office in Concord only take sports concussion patients from the last I heard. Hopefully, the Boston University clinic is open to others.

How much activity are you taking on each day ? What kind of work are you doing ?

What are you trying to do when you 'unsuccessfully think' ?

Hi Mark,

Currently I am not doing any work. I was working till September 13th but took leave from work because I felt extremely awkward interacting with colleagues. Friends and co-workers who had known me for months tell me they don't see me when they look into my eyes.

I think this leads well into the question of what I am doing when I am trying to unsuccessfully think. The best way I can explain is that when healthy we have say x% of social awareness of your self and how to relate to people. The higher your ability to connect with different types of people, the larger that x%. Of course that grows based on experience and your ability to learn as well. But, at any given time, you have a given amount of that understanding.

When I am unsuccessfully trying to think, I essentially mean that this bank of awareness that I can normally easily tap into seems blocked off. It literally feels blocked from access. The harder I try to reach and think, the more my head hurts but I am just unable to access it. In the days that I have felt that clarity that I described, I feel this thinking is no longer blocked. That is all.

So currently in this chaos when I look into someone's eyes, I don't understand and can't maintain the eye contact because within myself I can't think or relate that way. I am not talking about making eye contact with strangers. I am talking about people I have known all my life - my sister, my mom, my best friend, the girl I was dating before I got hurt (Alas!).

I definitely could use more activity. That is the primary focus in the coming days. I had been resting because as I understood from my neurologist exercise after a concussion is detrimental because your brain needs energy to heal. I suppose light exercise is important to get the blood flowing as you explained. So, will definitely plan to get started on that right away by taking long walks everyday.

You have lost me about the unsuccessful thinking issue. I know what it means to struggle to think. Accessing memory. word finding. calculating, processing thought, understanding spoken words, spacial relationships, math, imagining, imaging, recognizing facial expressions, etc. None of this sounds like what you describe.

What kind of work did you do ?

You sound like you have a psychology background, at least to me.

Your explanation of interactions sure sound like what I went through back in 1982-3. The depression that was diagnosed was not the morbid, I feel worthless, suicidal, etc. classic definition of depression.

He diagnosed me as having a depressed state of functioning. I had extreme flat affect. I struggled to communicate. I would struggle to finish a sentence/thought. I had a scattered presentation. It was like I was not there in my body. I looked gaunt. I lost weight. He explained it as a chemical overload of my brain cells due to stress and over-attending. It had been years since my last minor concussion. I was just under stress due to being ripped off for hundreds of thousands of dollars.

Were you seen by a NeuroPsychiatrist (rare) or NeuroPsychologist ? What kind of diagnostic testing was done ?

I hope the concussion clinic can help you.

It actually does sound like your flat affect. I can overall see when I am being interesting or not to someone. But, I am completely unable to engage in the way I used to before. I can still tell from eye contact when someone has lost interest in what I am saying etc. I am just completely unable to smile in my mind and that doesn't allow me to connect with people.

I was a business consultant in NYC. I have a business background but have always thought heavily about depression, suicidal instincts, interaction stemming from my dad's heart attack and death when I was 12.

But, that said, my personality is of an extreme extrovert. I was going out every couple of days, meeting new people connecting before I got hurt. That obviously feels so far away right now.

The doctor I saw was a Neuropsychiatrist. He is based in Pittsburgh (referred to from a work connection as an expert in PCS) so we had a Skype meeting. I visited his website, he has published several articles on post concussion symptoms, apathy following post concussion, and has been practicing neuropsychiatry for over 25 years.

In terms of testing, he was more interested in just hearing how I interpreted my shortcomings. Since I continued to work for months following my last setback in July, doing a very high quality of work (such that my manager found it hard to believe anything could be wrong other than me just acting "like a weirdo" at work), it seems very unlikely that cognition, analytics are impaired. I can still break down issues and understand problems the same as before, so not as worried about that. I do have trouble finding the right word and accessing memory to some extent, but on days of that blockage removal that didn't feel like a problem at all, so not necessarily my focus right now.

Mark, how did you go about treating that flat affect? Are there certain foods or vitamins more important than others?

Thanks for your answers and concern once again. Since I joined this forum to now, while my "thinking blockage" symptoms themselves have not waned, my anxiety is completely under control which has made life somewhat livable again, and I thank you and everyone here for that.

I still struggle with mild flat affect. Back in '82, I recovered mostly. Not back to 100% but much better. I could relate to my wife. Be there in a supportive way for the birth of our second child. etc.

My injury in 2001 left me with a relapse of flat affect. I have had to learn to cognitively respond as if I am emotionally responding. The emotional response does not come naturally. It is like learning to be polite and courteous. Of all the aspects of emotional response, I am clueless to most but use those that function to almost exaggerate a response to the others. I have to choose to express gratitude based on cognitive observations. Same goes for empathy, etc.

I think some of it comes from a failure or struggle in the part of the brain that recognizes facial expressions.

Oddly enough, I can get weepy eyed in response to some situations but that appears to be an emotional lability issue/ PBA like symptom. (PseudoBulbarAffect) Very light triggers can cause an emotional response in some cases.

SSRI's and such can make some of these issues worse.

Back in '82, I received weekly B-12 shots plus the vitamin regimen.

It is a struggle to understand.

Did you get a consult with Dr. Bernstein ? Or the people at UPMC sports concussion program ?

Are you still in NYC ? Boston will be a trip to see the concussion clinic.....

My best to you.

Mark it definitely does sound somewhat similar. I'm following on the vitamin plan and hoping that creates a difference.

Wondering with some flat affect now do you feel capable of holding engaging conversations for the most part? Like if you were stuck in a room forced to talk to a stranger would you be able to talk and connect without being/feeling awkward, or losing their interest. Cuz I currently wouldn't, and I guess need to learn coping strategies to get there.

There is a saying about topics of discussion.

There are those who talk about people.
Others who talk about things.
And a few who talk about ideas.

I struggle to hold any interest in talking about people.
I spend more time talking about things.
But, I gravitate toward talking about ideas.

Unfortunately, most conversations I witness are about people.

If I was alone with a single person, it that person was interest in 2 or 3 above, I'd be OK. I'd fail at 1.

I am not good at idle conversation, mainly because I do not see much purpose to it.

But, if the conversation is task or activity focused, I'd probably be OK.

But, I don't see flat affect impacting conversation that much. But, that can just be me because I have never been one to talk about feelings. I also do not get a sense of self from my ability to hold a conversation.