what does it take to get a diffuse axonal injury?
 

what are rhe chances i received a diffuse axonal injury whwn i was flung violently fowrard and then back multiple times in the metro malfunction incident a few weeks ago and that is what is causing my deteriorating state?

No chance of a DAI from bouncing in the metro.

A diffuse axonal injury results from violent impacts to the head where the brain matter violently impacts the skull. Often, it is the result of a violent twist of the head. These would be more common from car crashes where the head violently twist as it hits the head rest and door frame.

Bouncing in the metro would at most just aggravate a tender neck. Unless the metro impacted another solid object and you were flung into a seat or wall, there would not be enough energy in the movement.

Stop looking for things to worry about.

Hi Ben,

You seem to be worried again about new things or events. I am sorry to see this, and I hope this will pass soon. All the things that you mentioned should be on your list of "non concussive or subconcussive impacts".

In my experience, it is perfectly possible to have a fairly long relapse after an innocuous event. In the last Fall I inadvertently hit my sternum against a table and I felt the consequences of this for several weeks. But this does not mean that we should be worried about the long-term effects. Hitting one's sternum against a table might cause a relapse, but it does not cause a concussion. I think the same applies to all the events you are worried about.

There is another thought that I would like to share with you, as it sometimes helps me to reduce my anxiety. This thought consists in imagining ourselves in 20 years talking about the important events in our life, and more specifically about the events that had some permanent effects on our health.

I think everyone on this board (including ourselves) would tell stories about really big events or injuries. No one would start her/his speech by saying "my brain has been permanently damaged because one day the hairdresser was a bit rough", or "my life has been changed permanently because one day my girlfriend kissed me a bit too hard". People would laugh at us if we made such statements, and they would be right! So, even if we feel really awful now, I think it helps to remember that our long-term self will probably have forgotten about the event entirely.

To be transparent, I am writing this in the middle of a pretty bad relapse that started yesterday after I had to brake abruptly while driving. The symptoms are real, that sucks, and that makes me somewhat anxious. But thinking that, in some time, I will have completely forgotten about this event, is a reassuring thought.

I also have a question for you: have you tried practicing the "willpower exercise" with self-talk that I suggested in a previous post? Have you found it useful or not, feasible or not, ...?

Thanks Vania, I'm sorry to hear about the incident you had yesterday and that's definitely good advice about looking at it with a wider lens perspective.

Ive been trying the self talk techniques and they help but unfortunately this past week has been the worst one symptom wise in a long time. The brain fog and blankness is much worse and the walking is becoming almost unbearable and causes me burning sensations in my head.

What symptoms do you get when you experience a "setback?

Also I have another question that would extend to mark in Idaho if he sees this.
At what point and how much should I be slowing down and cutting down my every day life (going to school, relationships, metro, cars, walking, etc) and just stop everything and rest? Like are you guys sure its safe for me to be continuing my every day routine and normal life which involves daily things like walking, bouncy metro and other unavoidable occasional bumps and jostles that can trigger symptoms?

I'm asking since ive recently learned from someone on another forum that symptoms are indicative of brain inflammation and therefore "minor" every day things that trigger symptoms woulf be damaging since symptoms means inflammation and inflammations means more brain damage if I understand correctly.

Wouldn't that mean that since I'm having trouble with basic stuff like walking I should cease all activity until the inflammation is down, no matter how long that takes? Obviously I don't want to do that but I also don't want to be causing myself constant brain damage that will eventually cause me severe disability and perhaps vegetative state or at the very least to be confined to an assisted living facility. I hoping that I'm wrong and that the doctors are right in saying that my daily routine is not damaging and at most is simply slowing my recovery somewhat but I'm not so sure and I know some people on here, especially Mark, may be more knowledgeable then even most sports med doctors.

Do what you can do, and not things make you feel worse..

Have you read anything about Somatic symptom disorder? It may be a factor ..
Somatic symptom disorder: MedlinePlus Medical Encyclopedia
Search results for: Somatic Symptom Disorder - Merck Manuals Consumer Version

Ben,

PM me with a link to the other forum. Left click on my screen name and select Private Message. I want to see what that person is meaning. Inflammation is a problem with concussions but it does not cause damage without causing other very severe symptoms. The chemical stress from your anxiety is more of a risk.

How many online forums and web sites are you following?

[Obviously I don't want to do that but I also don't want to be causing myself constant brain damage that will eventually cause me severe disability and perhaps vegetative state or at the very least to be confined to an assisted living facility.]

This is a ridiculous idea. If you would visit a brain injury support group and see some people who had to relearn to walk and talk.

I know plenty who would give you a serious talking to for that statement.

One friend took 2 years to learn to walk, a year to relearn to talk. He lives on his own and travels to participate in para-athlete competitions.

Another friend was throw from a car his senior year of high school. He was in a coma for a few weeks. He recovered enough to go to college. It took him 10 years to get a bachelors degree then a masters in counseling. He is a licensed professional counselor. He has a passion to help people with brain injuries but has a full spectrum practice. He has to work extra hard because of his struggles but he is married with a wonderful wife and 2 kids.

What all of these people have in common is quite simple. They refuse top look at the negatives. They are constantly moving forward.

Thanks I'm trying to balance not giving up on my life and school and still letting myself rest but it's been very hard recently.

I am very familiar with somatisation, it's what my parents and certain doctors thing I have and they question if I'm even dealing with pcs at all.

Thanks when I get the chance I will pm you the website.

I was first told about inflammation by talking with with a guy on this website called reddit who is having very similar symptoms to me with the sensitivity. We were sharing experiences and concerns and I asked what he thought the cause of the sensitivity was and if it was harmful. He said that all symptoms are caused by inflammation so anything that triggers symptoms is triggering inflammation.

He said inflammation damages the brain since there is only so much space available in the skull so therefore the small things were harmful regardless of if they were concussions and they should be limited. He said the sensitivity had caused him to cease all activities and now he can't leave the house or do anything really. He also said he had a very similar incident to my metro malfunction incident (except for him it only happened once as opposed to 4 times for me). He said this incident triggered him so bad he had to go to the er. He also said he had a lot of problems with the same subway I take(the one in Montreal).

All this has seriously made me question what I have been doing in the past several months were I've been attempting to live a regular life and routine expect for making certain changes(reduced course load, no more contact sports). It made me rethink everything I've been doing and the harm Ive caused myself and if maybe I should be like him and stop everything to focus on rest. Especially since the sensitivity has been a lot worse recently, walking has been very difficult and the fact that I've had several mildly traumatic and out of the ordinary incidents with the 8" drop, metro incidents, haircut etc.

Not saying his opinion is necessarily correct only stating that it made me reconsider everything, especially with my recent rough patch and brain fog/burning.

I will get back to you with the website

Hi Ben, I am sorry to hear how you are feeling this week. My symptoms are quite similar to yours (headaches, brain fog, fatigue, some memory impairment and concentration difficulties).

I am sorry but I am unable to give an educated answer to your question, as Mark will surely do. Have you thought about giving yourself some quiet rest to see if that helps? I would certainly not quit all activities for an extended period of time, but a few days of rest to go through the relapse would perhaps be useful. I sometimes do it (for 24-48 hours) when my symptoms are too strong.

Have you invested in good shoes? I personally find hiking shoes to be the best, but there are also some comfortable sneakers or running shoes, as I already told you. Walking shouldn't be a problem with these.

To reduce the inflammation, have you started an anti-inflammatory diet? I think I mentioned that to you already. Many people on these boards have had good results with it, in particular for the sensitivity that many suffer from. It takes some discipline and patience, but it is probably worth trying. You can see these threads for instance:
https://www.neurotalk.org/traumatic-...-diet-pcs.html
https://www.neurotalk.org/traumatic-...-injury-2.html

There are many people on these boards who recovered well even after a prolonged period of post-concussion syndrome; perhaps you could try thinking more about these cases than about the nightmare scenarios that seem to obsess you?

Thanks for the response, yes I've dug out some old basketball shoes and will try and wear those for a change since the have more cushion than skateboard shoes or boots. I've also bought some insoles but I don't find them to provide much relief. I went out last night and had to do a lot of walking and it was hell.

Ive been eating as healthy as I can but it's almost impossible for me to never eat any 'inflammatory' foods.

Your right, the thought that I'm causing myself constant damage with every step or bump in the road/train does consume me at times but if only I could get that idea out of my head it would be much better.

My mom had an interesting idea, she said that perhaps the walking sensitivity and sensations in my head started out mild but now that i look for it and focus on it whenever I'm walking and I essentially move around on eggshells with my whole back tense and now that has made it much worse. Not because of physiological reasons but because I've built up so much in my head.

She said maybe if I could convince myself that there was no way waking could actually harm my brain, I would not think about it and it would go away.

I'm not sure I agree but it's plausible, regardless I just want to be able to walk comfortably again, without thinking about it and without it causing me problems, it is truly all I care about and it not being able to do so makes my day to day life a living hell.

I'm also considering moving in with my grandma who lives much closer to my school than I do. This would diminish the travel I would have to do and would reduce the time I have to spend on the awful metro every day.

Ive been taking it easy, as much as I could this week but I still had to leave the house to go to appointments and a few events. I had a bad setback on the metro earlier this week also.

Ben,

The Reddit guy does not know what he is talking about. The two of you together are a mutual anxiety club of over-reactors to minor issues.

As I said before, for inflammation to cause brain damage, the symptoms would be far worse than foggy brain or such. A damaging headache from inflammation would be so intense, you could not do anything. You would be losing motor control such that you would struggle to walk or stay balanced upright. You would appear to be severely drunk or more.

Inflammation is you body telling you to take care of an injury. Are you taking any anti-inflammatory meds or doing anything to reduce inflammation?

It would be interesting to see your daily schedule. You sound like you live a high stress life. You could list all activities at home and school, transportation, meals, vitamin supplements, hobby activities, etc. How much time do you spend on a smart phone? What web sites do you visit regularly?

How well do you handle classes that require complex intelligent thinking? Does it take serious effort or do new concepts come easy to you? Has it always been this way?

Thanks for the response, I appreciate you putting inflammation into perspective.

I take curcumin supplements and omega 3 fish oil since I've read it reduces inflammation. However, I do not take any anti inflammatory medication. Is this something I should consider and ask my doctor about?

My lifestyle definitely feels high stress to me but the cause for 95% of my anxiety and stress revolves around my health and worrying about my brain and concussion issues. When I wake up I an anxious since I know I will have to walk and take the metro, when I am out with friends or studying I worry about the contact I will have to make(hugs, kisses, hard handshakes, slaps on the back) and keep my head on a swivel to make sure I do not receive any serious impacts.

When I am at home resting or when I'm supposed to be studying I am instead on websites like these or analyzing and listing all the events from my day/the last several months and trying to calm myself down by ruminating over the incidents that happened and convincing myself that they are in 'non damaging' list we made in a previous thread and that I will one day be ok. Before I go to bed however I meditate, watch shows, or read other things in order to go to sleep with something other than thinking about my symptoms and worries.

My daily routine would not be high stress if I did not have symptoms and did not worry about my health. To put things in perspective, this day last year I was a two sport star athlete, getting good grades in my last year of high school, was a founding member and salesman for a product company, had an active social life and just met my now longterm gf, worked out and ran almost every day, was on the student council and all this while most likely suffering from unresolved concussions(I was wholy uneducated about the dangers of pushing through them).

Now my routine on an average day is this:
-Walk to the metro
-take metro 4 stops (the first three are fine and not that bad but the last stop I have to switch lines to the green line and that last stop can get really bouncy/shaky and cause problems, that 90 second ride is the worst part of my day)

-arrive at school and go to class
-after class I do one of the following three things depending on the day
1.walk 20 minutes to my grandmas house and eat/rest for 3 hours before walking back to school and waiting for my next class

2.go directly to my next class(gym class where I do some light cardio, light weight training and stretching)

3.take the metro and walk back home because it was my only class of the day. When I get home I usually have lunch and rest for a bit before starting to research/worry about concussions and analyzing the harmful potential of that days/past months events until I reach a state of semi-satisfaction and I can focus on something else until I go to bed.

Sometimes after school, instead of going home I will take the metro and go to my gf house to rest, hang out, have 'intimate' time and have dinner and then take the metro home later at night.

On Thursday I have cbt, on Saturday I have oestheo and some other time in the week I'll generally have physio or some medical appointment. All these require me to travel by bumpy car or bouncy metro. Also sometimes during the weekend I will spend time with friends(going to ones house for a social gathering, go to cinema, restaurant, etc). All these require me to either walk, take the metro or drive. Generally though I try and take it pretty easy on the weekends.

Also sometimes but rarely I will have an event I can't miss that will require me to travel further like when I had to go on a 45 minute drive on terrible roads to attend an important event with my gf's friends and family.

Then of course there is the bumps and jostles that inevitably happen in day to day life but I have posted about these at length in the past months. I also often play basketball by myself or with a friend in the backyard(although obviously not now since its winter).

So yah that's pretty much my life at the moment, of course there's more stuff that I'm missing like a couple months ago I went on a family trip to Boston and had to drive on some bad roads to get to and from the airports and around Boston as well as walking in Boston and obviously taking the plane.

As far as the brain capacity question it's hard for me to say. I could argue both ways.

On one side, I DEFINITELY feel impacted, I have awful fog and blankness and get very self conscious and struggle in conversations with new people, feel like I sound slow and 'punch drunk' when I speak, feel like I have trouble following in movies, feel like my brain gets tired easily, sometimes feel nauseaus when working or researching concussions or writing these long posts.

All in all the best way I can describe it is feeling as if my brain is working at 30% and my brain which was once filled with creativity, inspiration, passion, desire and constant thought and activity is now a desolate wasteland plagued by the toxic fumes of worry, panic, dread and inflammation. Sometimes my mind just feels blank and this is unbelievably terrifying. It feels as if my brain is deteriorating and my brain cells are being slowly killed off by the daily things I stress over (walking, metro, etc)

On the other hand however, a few months ago I was evaluated by a top neurologist who said I had no noticeable deficits. A few days ago I spoke with a top psychiatrist who said I sounded very intelligent and articulate and should consider becoming a psychologist for my career. My parents and gf say they have not noticed any drop off in my intellect and my friends have not mentioned anything about me acting differently besides that I am now more quiet. (even though for me I feel severely brain damaged when I have conversations with them)

Ive also gotten above class average in the exams in school that I have taken so far even though I was foggy and symptomatic while taking them and I hardly studied. I definitely feel pretty brain damaged in school sometimes though, it can be hard for me to read and understand things, remember, etc and like I said I can get nauseous doing these things sometimes.

So yah I hope I answered all your questions. Please tell me if my worries that I am slowly deteriorating my brain with these activities or if it's ok for me to continue. Also if you think certain things like the metro or the walking could be problematic or really any comments you have would be greatly appreciated.

I should also mention I've been recently diagnosed with mild ocd so that is why I constantly reiterate the same concepts and questions on here. I'm also hopeful that much of my fogginess and blankness is due more with the effects anxiety, worry, panic attacks, lack of proper sleep than it is the effects of concussions and continued brain deterioration from the events I've mentioned.

I guess time will tell with the gains from cbt and possibly eventual medications use if it comes to that

Why can't you eat an anti-inflammatory diet? I agree that it requires some organization, but given the potential benefits don't you think you could try to stick to it religiously for a few months?

Try different types of shoes. I was bothered by some running shoes (the ones with air, especially when walking on very hard surfaces) but not by others. I finally found a great relief with good hiking shoes. Not overthinking it will definitely help, but you also want to put yourself in the best possible conditions to minimize symptoms.

Your right I'll do my best to stick to the diet. Sometimes though it's hard since I'm a broke college student so I kinda tend to eat what's given to me but you make a good point.

Also though I'm very skinny so I fear I will lose too much weight on it

Why do I have to minimize symptoms, is this because it will make my recovery faster?

Ben, I hope that is OK for me to offer you some CBT.

You wrote "continued brain deterioration". and "I feel severely brain damaged"

You also wrote "I was evaluated by a top neurologist who said I had no noticeable deficits. A few days ago I spoke with a top psychiatrist who said I sounded very intelligent and articulate and should consider becoming a psychologist for my career. My parents and gf say they have not noticed any drop off in my intellect and my friends have not mentioned anything about me acting differently besides that I am now more quiet."

In CBT jargon the first quotes are forms of a Negative Automatic Thought (NAT) called Catastrophising.

The key to CBT is to challenge a NAT, asking if there is any evidence for it.

The second quote shows that there is not a scrap of evidence that your NAT has any basis in reality.

Thanks, that is something I've seen in cbt. I actually have a whole form on that exact concept. I really wish I could just stop thinking about all this though and I guess I was just worried since the neuro appointment was about 5 months ago and I know that alot can happen in 5 months.

Thanks for reminding me my training though, it helps

Ben, We all agree that inflammation is a big contributor to concussion symptoms. It is not the only cause. The web article you pointed to just says that but does not offer treatment suggestions.

As you said, you spend a lot of time focused on your concussion symptoms and concussion issues like worry about a passionate kiss or hug or bumps on the metro. If the bumpy part of the metro is only 90 seconds, stand up with your knees flexed and let your body absorb those bumps.

I don't think you should be doing weight training. It may seem safe but it causes neck muscle tension that can be a problem.

An issue you have failed to understand is quite simple. Your recovery is not based on the amount of time you spend resting. It is more impacted by the most stressful things you do. Just as you say that only 90 seconds of the metro ride are a problem, spending a small part of your day wrapped up in anxiety will prevent the rest from having any value. It is like you keep picking a scab off just as a wound starts to heal.

You have not developed brain damage since the neuro appointment 5 months ago. Also, top neuro or top psychiatrist is completely meaningless unless they have expertise with your condition (most top neuros don't) or you are willing to believe them.

Perhaps, but primarily because minimizing symptoms is an objective per se. Isn't it what we are all trying to do?

Also, one tip for the subway. I have a bumpy bus ride everyday to go to work. It used to set me back frequently but now that I stand on my tiptoes (instead of sitting) it is much less of a problem. Of course you have to hold yourself to something to avoid falling.

Alright, i appreciate it Mark. So you believe that my routine is safe and worth contiunuing as is so long as i make certain adjustments such as reducing weight training and making serious efforts to reduce stress at all costs?

Im assuming you believe my great fears and concerns over harm of small things such as the transportation dilemma, walking, others, is unjustified?

Yah i agree with you about the doctors, i was only stating it for me to properly answer your question in an objective manner.

Also, small i thought i would mention this small anecdote: a couple months ago, while on the previously mentioned family trip to Boston, i had an interesting experience. I had been taking a mild dosage (5mg) of the ssrri lexapro over the last 4 days. On the 4th day of taking it i had a 3-4 hour period during which i felt much better. Its as if some of the fog was lifting and i was beginning to feel like myself again. The difference was definitely noticeable and what surprised me was that is came following the period of last few days which were FILLED with some extremely bumpy and long car and plain rides. I was certain i had just ruined myself but then out of nowhere that experience happened.

It was short lived, i soon went back to normal and the next day i got cold feet and discontinued the medication but that 4 hour window gave me a glimmer of hope. Now i know it doesnt mean much but its meaningful to me since its the onlyntime over the past several months were ive kinda felt like my old self.

Also do you think all the very bumpy driving/travel around boston/plane ride could have been potentially harmful?

Ben, it was good to read that you noticed some improvement after taking Lexapro for a short time.

Please remember that Lexapro, like all SSRIs, typically take a while (weeks - months) to become fully effective.

You could consider taking it for a longer time to see if you notice a sustained improvement.

No, the bumpy plane and car ride was not harmful unless you were in the back of a truck laying on the floor with your head bouncing on a hard object/floor. This is the last time I will respond to these illogical concerns about getting brain damage from a plane ride or hug or such.

As Kiwi said, Lexapro and others like it take a couple weeks to take effect. One can never look at them with an hour to hour analysis. There is still a potential of a mild up and down in symptoms with SSRIs. They smooth out the highs and lows to a more tolerable level.

It sounds like the Lexapro is worth a second try. It can help you get control of your thoughts and anxieties, at least to a level where you start using the CBT skills.

Regarding the comment about pursuing psychology, I do not think it is a good idea for you. Get a book by Ralph Mattson and Arthur Miller called, "Finding a Job You Can Love." Finding a Job You Can Love by R. T. Mattson & A. F. Miller I met Ralph and Arthur 40 years ago. They have amazing insight into finding a career direction.

Ok thanks, sorry for asking the same things so much.

So you agree I should continue my every day routine as is? Simply asking since you've suggested in the past that people slow down.

The plan is to stick with the therapy for another month or so, see what benefits I can get and then go on to a ssri if I'm not satisfied with the progress. And then ofc combine the two.

I'll check it out thanks, and yah I agree I don't particularly want to go into psychology, I'm more interested in business and economics. I just hope my brain will be able to handle the math classes lol.

I think your mom is correct .....moving might be worth a try, and might help you break the cycle of thinking in your head..

Thanks I'll think about it. What I really want thoug is if someone could sign off on the daily routine and activities I am currently doing by listening to my issues and what I've said and just giving an opinion on if it's ok. I don't like feeling like I could be making my condition worse every day but I don't really know what else to do.

Ben, I would be happy to look at your posts from a CBT perspective.

I could comment on what seem to me to be NATs, with an explanation.

It will be up to you to do a "CBT challenge" of those NATs though.