I am at five months PCS and am thinking about return-to-work strategy. Essentially, what I'm wondering is, when should I start back at work?

The specialist I met with initially said "go back when you're 90% with no symptoms." Obviously, this isn't realistic for many of us, and may not be realistic for me. However, I think he has a point, which is to go back when you're basically in the clear, i.e., not at risk of exacerbating symptoms and setting yourself back. A second doc thought that I'm close to being able to return (using a stepwise eight-week return-to-work plan). However, I was having an above-average day when I met with him and probably presented well (which I tend to do generally).

I have been tracking my symptoms and keeping an overall "score" out of 10 each day (1=extremely poor, 10=my normal pre-concussion self). So far, my average scores by month have been:

- May: 5.3
- June: 6.5
- July: 6.7
- August: 6.9
- September: 7.1
- October (so far): 7.2

So, I'm improving, but only gradually. My main symptoms are: headache (mostly mild, sometimes moderate), tinnitus (mild to moderate, basically tolerable at rest), sleep issues (some insomnia, odd dreams and/or needing extra sleep), and occasional bouts of "concussion edginess" (sort of an amalgam of mild anxiety/depression, ickiness, limited mobility and feeling off).

I am increasingly having decent days with fairly low levels of symptoms - at rest, anyway. I am now walking slowly outside most days, typically once or twice a day for 15-20 mins, and intend to increase this amount if I can; I can do certain activities for moderate stretches (30-90 mins) like read, write, watch TV/movies, talk on the phone or in person, without major problems; and my girlfriend stays over 2x or 3x/week.

The setbacks are less severe, shorter-lasting, and much less frequent. But I still find that even trekking downtown for appointments and taking cab rides can make me feel worse for a day or two or more (this is getting better, but it's still an issue). Bumpy cab rides are my bane. In addition, going beyond my current daily activity limits (set out above) can cause symptoms to flare up.

I have done some freelance writing previously and am currently writing a short book review (lots of lead time, so less stress) as a means of testing the cognitive waters, so to speak. So far, so good. Being able to take rest breaks and do moderate amounts each day helps.

In one sense, I'm lucky - my work hours are pretty normal, 9-5 or so, and it is a relatively quiet office environment. However, it can be cognitively demanding and there can be deadline pressure. Plus, I would have to get there and back every day via public transit, which seems somewhat daunting, given that my daily physical limit right now isn't much more than some household chores, a couple of sets of stairs, and a slow 20-minute walk outside. In truth, my sense is that while I am gradually seeing positive signs, I'm probably not there yet.

So, my basic question is: when is it safe or advisable to start a graduated return-to-work plan? Should I try to go back soon, or wait until I'm further along (assuming I continue to make progress)? (I have asked my doctor these questions, and am awaiting his response; however, I would be interested in hearing from anyone on the site - any comments would be welcome.)

First i must say, i really do enjoy reading your posts! You are very analytical, as am I, but you have very good descriptions for everything. I also know we are at the same time frame PCS. I went back to work for 12 hour night shifts at week 3 (very stupid, lasted a week) then went back again at week 14 and lasted till just last week. So clearly, you are way smarter and patient than I am and taking your recovery very slow and extremely restful which is exactly what our docs tell us to do. Sounds like you know your body very very well and know your limits. I think its great you are doing a test draft to see how you feel afterwards. Very wise move. And your plan on returning sounds like a nice easy approach. I would definetly agree with waiting until you are close to 90% symptom free and definetly wait until you are headache free for a few weeks. I was headache free for 1 whole week before returning to work and they returned with a vengeance and now i havent had more than an hour without some type of head pain. Good luck on your plan and keep us updated as to how it goes!!!

I started back half time (on medication) after 7 months. I increased to 5 hours a day a month after that. Next appointment is on Monday.

I agree with nightnurse -- don't rush.

Can you take the public transportation in to near where you work...say at the hours you would be working. Do a little walking around..meet a friend for lunch and see how you do? Take a visit to the office possibly? Let them know you are testing the waters.

I, too, enjoy your posts as I am just as analytical!!