I hope this topic isn't too silly.

I've been doing well, I guess. Been taking a vitamin regiment and being easy. Today during Easter though we were over at my family's and my girlfriend wanted a tour of the woods. I didn't think much of it at the time. We went on the golfcart and drove around the trails for fifteen minutes.

About a half an hour after (around 2:30) until now (9:00) I've been dizzy and nauseous ever sense. Am I going to trigger a concussion or am I now just, thanks to PCS, more susceptible to motion sickness?

Eddy,

Both, the bumpy ride may have just been too much motion for a PCS brain. Or you may have caused a decompensation (relapse). I cannot handle bumpy roads at all. A trick I use when I know the road will be bumpy is to sit forward so that my back is not against the seat back. Then, there is an amazing amount of bump energy absorption by the body when the back is able to flex and move. I do this same thing on shaky roller coasters, you know, the old wooden ones.

I have a problem with motion sickness that I never had before. After my 11th concussion, I started getting miserably sea sick when I went deep sea fishing. I had never had this problem before. We call if "barking at the seals."

I have never heard any physiological explanation for this sudden motion sickness symptom but is is not uncommon.

This will likely be one of the problems that you will have to learn to strive to avoid.

Early in my last concussion, I went for a ride in the country with my wife driving. My head was on a swivel as I looked back and forth at the wild life and other scenery. My decomp was so severe it took me almost a week to get back to normal. The symptoms were not very apparent during the drive. They got worse after the drive.

Live and learn. That is how we go on.

Great question, EddysHead! Remind me how far out are you from your original injury?

I'm trying to understand the difference between creating a new concussion through some previously harmless activity (i.e. riding golf cart) and decompensation.

Is a decompensation a temporary return of symptoms? Or are you actually causing the brain more injury (a new concussion)?

My daughter has experienced this at least twice (recently hit her head getting in a car, exercising too hard in the early stages). Do these events get added to her total number of concussions?

Also, is there a timeframe where the majority of people stop having decompensations?

Is there a way to know beforehand if some activity might cause one (i.e. rollercoaster rides or boat rides)?

PCS,

A decompensation would be when she exercise to hard or otherwise stresses her brain and symptoms return. When she bumps her head getting in the car, I would consider this to be an new concussion, albeit, a concussion due to her brain being very sensitive to even mild trauma. A term that is beginning to be used is sub-concussive impact or event.

The time frame for an end to decompensations would be entirely personal. It would be very difficult to put a time to it due to the individual nature of concussions.

In your daughter's case, the primary focus should be reducing the risk of a subsequent concussion or decompensation.

She should be lead toward an understanding of some lifestyle changes to minimize the risk of multiple impacts and stresses than cause a decompensation. It will be hard for her to project into the future, but if she looks back, she will begin to notice the cause and effect of stress.

For example, she may notice that intense study and taking an exam may leave her struggling for a while afterward. Attending a loud music concert may leave her with after effects. She may need help with the observations of her struggles. She will likely go on ignoring the symptoms of a decompensation. As her mom, you may notice the subtle changes in behavior, lack of attention, a change in her eyes, etc.

Decompensations can be self fulfilling. The more one has, the more frequent they become. The efforts to reduce the stresses that cause them will be very worthwhile in the long run.

It takes some very truthful introspection to catalog the stresses that cause decompensations. I would categorize a roller coaster ride that causes symptoms to be a concussion. The sea sickness would just be a decomp. A loud rock concert would be a decomp. Dancing hard at a rock concert would likely be a concussion.

These risks can be moderated without having to shut down her life. Some activities can be replaced with others, like replacing loud music with other styles that are less problematic. There will be choices she will have to make, at least eventually. The youth culture promotes a lot of activities and behaviors that are not beneficial to a stable life, whether one has PCS or not. For example, she could replace some of the more aggressive activities with dance or ballet. Ballet is a lot more challenging that it appears.

I hope this helps.

My best to you,

I'm interested with subsequent concussions, do these cause even further brain damage? Do these new concussions take an even longer time to heal?

A concussion as I understand it refers to impact that causes brain injury and subsequent conussive symptoms. But for a PCS brain, a mild bump to the head that presumably wouldn't cause any considerable physical damage, may result in a return or worsening of symptoms due to the brain's sensitivity. Does this indicate significant new damage, or more that a very small amount of damage added to the original damage that caused the PCS in the first place results in a worsening of symptoms.

And how does this differ from other triggers that don't involve jolting movements, such as light excercise causing diziness? Is this causing damage?

We need to understand that trauma to the head is relative.

<But for a PCS brain, a mild bump to the head that presumably wouldn't cause any considerable physical damage, may result in a return or worsening of symptoms due to the brain's sensitivity.>

If the trauma is intense enough to cause damage to a very sensitive brain, this relative rate of intensity to sensitivity can be considered a concussion or even a sub-concussive impact. The issue of 'considerable physical damage' is the important point.

<Does this indicate significant new damage, or more that a very small amount of damage added to the original damage that caused the PCS in the first place results in a worsening of symptoms.>

"More than a very small amount of damage" is a relative term. If there is damage, whether intense or very small in nature, this is still damage. It may only cause a chemical reaction. But, that chemical reaction may cause the physical damage.

The brain reacts to insults with a cascade of events. These may include a 'self destruct' instruction to the damaged cells and those nearby that have been stressed.

The decompensation event is usually a result of non-impact stresses. Excessive mental effort, mental fatigue, mental shock as in a adrenaline reaction to a high intensity event, high fever, chemical insult as in alcohol, drugs, food toxins or environmental toxins, etc. can stress the brain from a neuro-chemical direction.

Eddy, subsequent concussions lead to Multiple Impact Syndrome. Each successive concussion of the same intensity does more damage by increasing factors. For example, if your first concussion was an impact energy level of 5 (a random value) and caused damage at a level of 5, a successive concussion of impact energy level of 5 could easily cause damage at a level of 10. A third impact of level 5 could result in damage at a level of 20. Or, a third impact of level 2 could result in damage at a level of 10.

There is no medical/scientific formula for this increasing progression of damage. It is just know that each successive impact causes more damage. The brain ability to recover declines as the number of concussions increases. There comes a point where the brain is struggling with damage to a point that it is less able to heal or recover because it is using all of its capabilities to just endure the injury.

Think of trying to move into a strong wind. At first, one can move into the wind. As the wind increases or continues, the body tires and forward movement become more difficult. At time may come where forward progress is no longer possible. At this point, any increase in wind strength will actually push the person back.

I have Multiple Impact syndrome. I have had 13 concussions over 45 years. I can now get a concussion shaking my head 'NO.' There are others on this forum with the same sensitive brains. Some have tried to say that these head shake moments are not concussions.

My most common concussion symptom is a taste of metal, like I am chewing aluminum foil. I also get a feeling like I got punched in the nose. I may feel dizzy but more likely feel foggy in my thinking. I may feel nauseous.

A decompensation will not have these symptoms. I will just feel mentally tired and easily overwhelmed with sensory input (sound and visual). I can decomp from being in an intense discussion with a single person, or in a room full of people talking.

I can be in a group of people and finally need to walk away and find a quieter spot. My mind goes sort of blank and I retreat to a safe place.

I have had times when it took up to two weeks to recover from a decompensation. This happened after my Work Comp hearing with the administrative law judge.

The important point is to learn how to recognize these different events, discover the trigger, whether it was a head shake or too much stimulation, and develop behavioral habits to avoid them in the future. It is believed by some researchers and physicians that even decompensations are cumulative in nature. At best, they can delay recovery. At worst, they can cause worsening of symptoms.

There is an old saying; Live and learn. The PCS person has to endeavor to do both.

After reading the above posts, I feel I am in a constant state of decompression. I know what certain triggers are (bike riding, running, exercising too hard), but these are things that I love to do and besides the headaches that follow I feel better about myself and that helps with my mood.

It's the things that are not controllable (bumps in the road, going through round-abouts in our town, looking from side to side too fast, etc.) that I have a hard time with.

Mark, just the thought of going on a roller coaster makes me want to vomit! The movement of my brain from side to side would kill me.

After 15 months, I cannot stand bright lights, am very sensitive to sound (work next to a loud lady), can't stand being in a huge group of people. Sometimes when I get home at night I am just wiped from the day and it is not a physical thing, it is definitely a mental thing.

I have constant headaches ranging from dull to full blown migraines. Prior to the accident, I probably had one migraine once a year. In the last 3 weeks, I have had three. My neuro told me that people who are prone to migraines have a longer recovery time. I have tried a few medications. The first was nortriptyline which had side effects that I didn't like. The last was propranolol which helped with the headaches, but lowered my blood pressure so much that I was winded just walking up a flight of stairs. So, now I am not taking anything. Sometimes ibuprofen helps and sometimes it doesn't.

I am trying to make gradual changes as to changing the things that trigger decompensation, but it is not easy.

Sheds: Our neuro also said that people prone to migraines take longer to recover. I've seen people recommend blue-tinted glasses and foam ear plugs for an office environment. Might be worth a try? All my best to you-

Now I am wondering how one would tell the difference between decompensation and "routine" brain injury recovery.

For example, is it possible that Sheds' "constant state of decompensation" is not a decompensation, but still part of the recovery phase?

In my daughter's case, she was nauseated for four straight months. Now a headache, even minor, tends to make her nauseated. These seem more like physical hyper-reactions rather than new injuries. Similar to how an asthmatic will get "twitchy" lungs and over-react to stimulus.

Has anyone asked their neuro about decompensation vs. new concussions? I don't see much research out on the web about this. Just curious.

I'm now at a state where minor bumps on my head seem to be causing concussions. Actually, since February it's been happening once a week. I keep putting myself in a safer and safer routine but it keeps occurring: I moved in my sleep and tap my head on a wall (even when the bed is a foot away from it), I tapped my head on a shower head, my girlfriend moved in the sleep once and accidentally smacked me in the head. She also was climbing up something while I was behind her and she kicked me square in the head. These are minor to the point where I think "This wouldn't even cause a bruise on someone" but then I get the symptoms: Weird taste in my mouth (bitter almonds), the roof of my mouth taste colder, instant insomnia, my thought starts rushing. Pain in my head stops after a day or two, then in a week either my symptoms return or grow. New symptoms after these series are sound intolerance, and now light sort of "flickers" around my view. These symptoms don't last too long, actually, and seem to disappear within a week.

Still though, I'm getting really aggravated at my current state of affairs and I'm starting to feel like the only way I'll ever "recover" is if I become a hermit or stick myself in a bed for several months.