My advice from Neurologist who specializes in concussions
 

Hi all,

I recently traveled interstate to see a Neurologist who specializes in sports-related injuries including concussions.

I indicated that I feel my symptoms almost all the time (even at rest now) and that they are aggravated by physical and cognitive activity. It appears that my symptoms are more easily triggered than they used to be.

To cut the long story short, the neurologist indicated that I should still be able to undertake cognitive activity and that doing so would 'not' inhibit my recovery. I questioned him on this but he assured me that he was correct. What does everyone here think?

He recommended that I start an exercise program where I train to a heart rate that does not worsen my symptoms, then slowly increase over time. I have heard of this before. However, I feel my symptoms constantly and they are just worsened further by exertion. So, is the theory that I start exercising, even with symptoms present, and hope my body just becomes acclimatized to it? I'm not sure about this logic.

The Neurologist also referred me for vestibular testing and neuropsychological assessment which I am currently progressing with.

For those who do not know, I am a 27 year old male with PCS for over 18 months and without improvement. Symptoms have worsened and are more easily aggravated.

Any advice would be appreciated.

Thanks

I went to see a specialist just like yours and she said basically the exact same thing. The discomfort you are feeling when you do stuff is NOT causing any actual damage. Normally your body gives you pain signals when you are being harmed so you stop. This is not the case here and its ok and beneficial to keep going.

She said that any worsening of symptoms in later months is due to psychological issues increasing like depression or from deconditioning. She advised me to start getting out of the house more and to start doing yoga or other exercising outside the house and not on my recumbent bike or treadmill at home.

She didn't say I should start jogging 3 miles or even go back to work but she did say I should take an interest course so that both sides of my brain would get exercise.

So yes what she's saying has been said before and kind of makes sense. As you start to push a little you realise you're able to do more than you thought. Everything starts to get a little easier as you build back up your stamina and you're retraining your brain that these activities are not harmful and no need to act up.

I think its really important to start with things you enjoy because she said there should be no stress like tests or deadlines.

I'm already noticing I can do things I thought would cause longer lasting problems and I didn't think I was depressed but I'm enjoying getting out a little more.

Hope that helps. Good luck and start small. You will have fatigue because its been so long.

CC

Recovery
 

I've gotten really far along in my recovery, so it's interesting to read that, as I was not told that. In my experience, I have to be careful about pushing myself too hard, and I think anyone trying to tell me differently is wrong. I've had several setbacks by doing too much. I find I can do things that are taxing but I have to rest afterward. I say, sure, take her advice to some degree, but if you start feeling worse, take a break. Listen to what your body is trying to tell you. If I start getting a headache or getting really dizzy, I don't keep at something. I take a break and then continue what I was doing when I'm feeling a bit better. That's just my two cents!

I find this advice confusing. Then again I am certainly no expert at four months post concussion.

My gut tells me that so much of this "medical" advice isn't medically based at all, but rather opinion based. I don't think that there's enough knowledge out there (regardless of titles) by concussion "specialists" to really know if what they are advising is beneficial. From what I understand, the ramifications of concussion are just barely unearthed, let alone understood.

Just my gut feeling about the truth and doctors... Rarely in the same room at the same time.

I'll be watching this thread though. We're all at the mercy of what we're told to believe.

Halfnelson,

It sounds like you have some kind of an undiagnosed and unresolved injury other than your brain. Your brain should at least be stable after 18 months. I still have head aches 18 months after my most recent head impact but they do not stop me from activity very often.

What symptoms are still chronic ?

Do you have tenderness at the part of your skull behind your ears ?

btw, The work out to the level of a return of symptoms is similar to the Buffalo protocol except the Buffalo Protocol suggests reducing the exercise level to 10% below the level that causes a return of symptoms.

Cognitive rest does not mean no cognitive effort. It means moderated cognitive effort.

Hi Mark,

Chronic symptoms include; light & noise sensitivity, tinnitus, dizziness and balance problems, tingling and pressure in head/behind left eye near impact site, language difficulties and slurred speech (probably just slowed processing).

I do not have any tenderness behind my ears but have lots of 'pressure' behind the left eye.

It is possible that I have an undiagnosed injury other than the concussion which accounts for some of the above symptoms. MRI and CT scan reveal nothing. The Neurologist suggested a few things;

1. Vestibular damage - light & noise sensitivity, tinnitus, balance & coordination. I am half way through the assessments.
2. Occular nerve damage - pressure behind left eye and tingling in head. This may be determined at a later stage.
3. Depression/anxiety - aggravating all of the symptoms. I don't doubt I am a little depressed and anxious but feel these symptoms are secondary to some form of injury.

Any other suggestions?

He also recommended I get a neuropsychological assessment to determine any damage to areas of the brain controlling language and short term memory etc. I am awaiting my appointment in a week.

The exercise regiment is very reminiscent of the Buffalo Protocol but now I'm a little confused if I should proceed. I suppose it can't make me any worse after 18 months though.

Any advice would be appreciated.

Thanks

I still have a lot of the symptoms you have (not all) and have a very limited public life as it is too much for my brain to be in a noisy, stimulating, demanding environment. I guess for some people the brain injury takes longer to heal (hopefully it does!).

There was more research published this week on the importance of controlled exercise and brain healing. Dr Leddy.
A good book I am trying to read on exercise and the brain.....'Spark'. Highly recommended...or try to find a podcast by the author (whose name escapes me at the moment).

Hang in there.

Pcs
 

Hello
Just checking your progress with dizziness and other symptoms? Having similar issues. Need help!
ekhfs

ekhfs,

Welcome to NeuroTalk. ** You will find more people will respond to your question in the main forum threads. **

Please feel free to start your own thread by using the New Thread button at the top left. You can introduce yourself and tell us about yourself.

We'd love to help you. What symptoms are you struggling with ? It appears dizziness may be one

What care and diagnostics have you received so far?

btw, Halfnelson has not posted in over a year.

Hi HalfNelson,

Great post. This issue between exercise, symptoms, and impact on the individual is something that's been broached a few times over the past month. I've never assumed that the headaches that result from over stimulation/activity generate more damage, but it's logical that they result in some fundamental physiological change that leads to short-term issues.

At 22 months, my intolerance to exercise and mental engagement is very similar to what you describe. I've also had Neurologists and Psychiatrists point the finger directly at depression, and state that exercise is the solution.

I wish there was more consensus on this issue, particularly for concussions that do not fit the "physiologic" description that Dr. Leddy primarily developed the Buffalo protocol for. Regardless, it's hard to argue that exercise isn't a positive thing... I just wish I could do it!

Hopefully some others continue to chime in... this is great stuff to read.