[smac]

Hi everyone,

I am experiencing PCS and have hit the 4 month mark of chronic headaches, photosensitivity, fatigue and pressure in the head upon doing anything that even slightly raises my blood pressure (stressful meeting, walking upstairs quickly, doing a single squat, etc). Prior to my concussion I was extremely active, 6-7 days per week of high intensity cardio, strength and sports. Needless to say I'm feeling quite down in the dumps with the lifestyle change. Walks are where its at for me lately, and that i have to be happy with

I have a lot of questions that my GP won't or can't answer. He refuses to refer me to a neurologist telling me they won't be able to help me any more than he can, and that the only treatment option is rest so there is no point. I didn't get a CT (nervous of radiation) and MRI will take another 6 months or so. He said if I get the MRI he will consider referring me after. I'll be 1 year post at that point.

A big question I have is around further damage. Are the headaches and symptoms I'm having now a result of the metabolic distress that I understand happens during the active concussion? or is it just residual inflammation or sensitivity and I'm not actually currently still experiencing distress. I would like to understand this better so I can feel comfortable pushing myself a bit to increase my activity. His response to this question was that I had a head injury and I shouldn't push myself...I'm really just hoping to understand what is going on and what isn't going on so I can better adjust to this new way of living.

If anyone has any input or suggestions I would really appreciate it. At this point I am keeping activity at status quo (a couple walks per day plus household activities but no other exercise) and hoping to God that my symptoms are gone at 6 months so I can cancel my MRI appointment and stop seeing my very Unhelpful doctor.

He has also made me very nervous of the MRI telling me that altho its not ionizing radiation it can still 'burn your brain'. So my safer alternative all of a sudden does not seem so innocuous.

[greenfrog]

I'm by no means an expert but my specialist (very knowledgeable, reputable and conservative when it comes to treatment recommendations) said there is no identifiable evidence that MRIs are harmful.

I'm almost at the 6-month mark post-injury and struggle with exertion as well. My symptoms are mostly pretty low-level at rest, sometimes almost negligible, but I still have issues with physical and sometimes mental exertion. My doc recommends rest and only very gradually increasing exertion, and backing off if symptoms are triggered.

He's curious about the U Buffalo exercise program, but is skeptical and thinks there isn't enough evidence yet to support it. At present, he says, all we know is that a patient's ability to exert himself or herself is an index of recovery; there isn't enough evidence to conclude that exertion is a means of facilitating recovery. Light activity or exercise is good, he says, so long as it doesn't cause symptoms to flare up. The goal should be to remain sub-threshold of symptoms.

[smac]

Thank you. That's helpful. I've read similar information regarding making sure that one listens to your symptoms and anything out of the ordinary needs your respect. So I've done the best I can - this walking routine doesn't flare symptoms. Unless I try to run for a few telephone pole lengths just to see. Then the pressure starts knocking and feels like my brain is smacking against my skull - yuck! I tried a kickboxing DVD a few weeks ago and had a headache the whole next day, even though I didn't do any of the jumping moves. Frustrating. Sounds like exertion is a very common symptom trigger. Good to know we aren't crazy and we aren't alone. Too bad that didn't make the symptoms disappear eh!?

[Mark in Idaho]

greenfrog's doctor is correct. Even Dr Micky Collins of UBMC states that the Buffalo protocol does not improve or accelerate recovery from a cognitive standpoint.

An MRI will be a waste of your time and discomfort. Unless you are rushed to the hospital with a severe head ache or numbness or loss of motor function, there is no reason to have an MRI at this late date.

Getting good rest (not just being lazy at home), good nutrition, avoiding toxins like caffeine, alcohol and glutamate (in MSG and processed soy foods) and putting out some light physical effort around the house are about all you can do.

A non-foot-pounding walk can be worthwhile. Your head aches will tell you when you have gone too far. Stop long before the head aches come.

Yes, it can be long and slow. It can also be 3 steps forward, 4 steps back if you over do it.

[smac]

Thanks for the feedback. I think maybe I'm searching for help where there is little help to be found. Lots of pressure from family and coworkers to get a CT or MRI to find out what is wrong. When I try to explain the pathology of concussion in that these likely will show nothing - especially 4 months post - I am met with eye rolls and sighs.

Time to deal with the new normal and be grateful my symptoms and injuries weren't worse I suppose

[greenfrog]

My specialist recommended an MRI, not a CT, after a month or so just to rule out any other issues. He said that MRIs are more useful than CTs after several weeks have passed (CTs being potentially more useful in the very early stages).

In most cases, MR scans will be negative (this is good), but sometimes something will show up. If a competent concussion specialist recommends getting one done, I would do it. Getting my results ("unremarkable scan...no evidence of trauma sequelae") brought me some peace of mind.

Note that some MR scanners are more up-to-date (and therefore useful) than others.

[Mark in Idaho]

The MR scanners have a limit to their resolution based on the strength of the magnetic field generated. The common 1.5 Tesla has a resolution of 1 mm or larger at best. This is fine for imaging bleeds and aneurisms but not even close for neurons or axons.

It takes a 5 or 6 Tesla scanner to start to see concussion damage finer than a bleed.

My point was that absent the symptoms of a bleed or other serious damage, the MRI is not much help except for the psychological value of ruling out such damage.

An fMRI can show areas of decreased brain function as compared to normal expected functions. There is some value to an fMRI study but only with skilled doctors setting up the protocol. fMRI is still mostly a research protocol.

There was a movement toward Diffusion Tensor Imaging and Diffusion Weighted Imaging. These techniques still need a 3 Tesla or stronger magnetic field to image the fine damage. I have not read anything lately about putting DTI or DWI into common use for concussion or such.

Some doctors use imaging, whether CT or MRI, as a liability limiting diagnostic. As greenfrog's doctor said, CT is more useful at the earlier stages, specifically, at 72 hours post injury when they will show any brain bleeds before they get absorbed. Earlier than 72 hours and the fine brain bleeds have often not become large enough to be readily recognized.

Some patients get an MRI/MRA. This is a dual MRI that by subtracting one image from the other, shows the vascular structure of the brain only. These will show the larger vascular structures but not the fine capillaries. I have a set of such images of my brain.

My neurologist suggested an MRI/MRA and SPECT (FDG PET scan) due to the severe brain dysfunctions he observed from the qEEG performed in his office. Both came back negative except for some minor out-pouching that appeared stable.

[frzrdoor2]

[B]Good to know we aren't crazy and we aren't alone.

Time to deal with the new normal and be grateful my symptoms and injuries weren't worse I suppose

Totally relate.