You have to realize that everyone's injuries are different even though many of us have very similar symptoms.
I think my main mistake with that snowmobiling trip was that I went from like 10-20% activity level (Only activity I did were the 20-30 min easy walks every day) to 90-100% within one day.
Another thing to keep in mind that some people might have actual injuries to other organs in the head, not just the brain. For example I was diagnosed with a fistula in my inner ear recently, and that would explain why every time I exerted myself I felt way worse for a while (fistula reopening and then slowly healing again).

I understand what you're going through right now, trying to find all the answers, I think all of us on here were in your shoes at the beginning.

The simple truth is that there isn't a set of rules for recovering from PCS, everyone's situation is different. I have friends that suffered head injuries that were way way worse than what I had and they recovered within 1-2 months.

One advice I can give you is start very easy exercises, like walking for 15 mins and see how you feel the next day. Do that for a week, and if you feel fine move to 20-25 mins walking.
Then try a stationary bike with a heart rate monitor. Try to keep your heart rate elevated for 5 mins at first, again see how it feels and slowly increase after one week.
I started with like 80 bpm for 5 mins for a week and went up from there very carefully.

There is research from the University of Buffalo (http://concussion.buffalo.edu/) that seems to show very positive results from careful cardio exercises (usually over a span of 3-4 months).

Mark,

Can I raise my tolerance for physical activity by being physically active?
And if I don't raise my tolerance and then go on a heavy physical activity, can I cause myself brain damage because of the sudden spike in physical activity? (If that can cause symptoms to return, it means it can cause brain damage, no?).

DannyT,

Skipping the Ritalin sounds like a very good idea for concussion recovery, but sadly I cannot study well enough without it. I was prescribed Ritalin last year for my ADHD, and it really helps me study. Before starting the Ritalin, I couldn't focus at all in class, had very bad grades and got myself in trouble for my hyperactivity and impulsivity (saying inappropriate things at the inappropriate times). The Ritalin helped me finally change it and become a better student. I can stop taking it, but it'll mean I'll return to be a bad student again and get bad grades, which can seriously harm me at the future.

Regarding the withdrawal - Yes, it's not very nice to go through withdrawal from Ritalin and PCS at the same time, but I'm doing it well. It's difficult, but I'm determined to improve my situation and get rid of the PCS. Also, immediately after stopping the Ritalin a few days ago I started taking extremely high dose Omega 3 every day (took it for 5 days now), and it is a great help. It's making me feel better and better every time and I'm very optimistic! I'm still extremely hungry and sleepy because of the Ritalin withdrawal, though.

I'll return to taking my Ritalin tomorrow (I go back to school), and keep taking the extremely high dose Omega 3 every day for a while to improve my situation. I hope the Ritalin won't worsen it, because it's just a medication that I have to take as I explained above.

mrsD,

I'm 16 years old and I live with my parents. They know everything about my ADHD and the Ritalin prescription and I let them know every time that I take it.

I am fully aware that Ritalin is a powerful, potent stimulant of the CNS which works similarly to Amphetamines, but I still think I should take it.

Unlike recreational drug users that get harmed from their use, I take therapeutic doses (low doses compared to recreational users) of Ritalin to treat my ADHD. The dose makes a big difference - what may cause great harm at a huge dose might not cause any long term damage at a normal/low dose.

So I don't believe that at these doses, it causes dopamine depletion in the long term (it causes a dopamine depletion, though, but my dopamine will return to normal if I just stop taking it for a week). Even if it does cause slight dopamine depletion which is not so easily reversible (I truly think it doesn't), it's still a medication I have to take to manage my life and do things correctly. I just cannot allow myself to be that bad student that makes noises and disturbs the class at many lessons, I cannot allow myself to get such bad grades even after studying well (or at least trying to study, since it's very hard without the Ritalin), I cannot allow myself to be impulsive and make the wrong decisions, and I can give many more examples of why I should take the Ritalin to treat my ADHD. I never abused it and never will - I am a responsible user of my medication.

russiarulez,

I have also heard of people that get very bad concussions and make an extremely good recovery within a few months. It just seems so awkward that sometimes, the people with the lighter and milder concussions are the ones that suffer for much longer...

And about the activity level - do you think that if you would have gradually increased your physical activity level, the snowmobiling activity wouldn't have made your symptoms returned? I mean, you said that before the snowmobiling your activity level was 10-20%, and at the snowmobiling it was 90-100%. Do you think that if you would have raised it every week (for example, 20% activity on the first week, 30% on the second week, etc,.) gradually and just a little bit every time, the snowmobiling wouldn't have caused your symptoms to return? Am I right?

And that field trip is very important to me, I really want to go to it and have some fun. But at the same time, as I said, I'm very worried about the jarring the my brain will receive from all the unstable footing at all the rocks on the mountains (if you were walking on mountains you know how it feels - you have to jump between the rocks and it makes your body shake VIOLENTLY). I'm very afraid it'll be bad for my brain.

So do you think that if I gradually increase my level of physical activity, I will be able to just go on this field trip without problems? I'm planning to soon start some regular physical activity and gradually raise my level of that activity, so will that help me raise my tolerance for physical activity for the field trip (so that my symptoms won't return during the trip)?

If you have any suggestions to me what to do in order that I can go on this field trip and return home without getting any setback of my PCS, please tell me. As I said, this field trip is extremely important to me so I want to know what is necessary to do so I can go to that field trip.

Thanks,
-ProAgonist

Pro..

You said "Can I raise my tolerance for physical activity by being physically active? And if I don't raise my tolerance and then go on a heavy physical activity, can I cause myself brain damage because of the sudden spike in physical activity? (If that can cause symptoms to return, it means it can cause brain damage, no?)."

You can raise you tolerance by slowly increasing your activity level. You do not want to push to a point of causing symptoms to return. At the first sign of symptoms, stop the activity. Next time, do that activity to a lower level of exertion. Causing a return of symptoms will ONLY DELAY YOUR RECOVERY. It will not cause brain damage. If it causes new symptoms and the existing symptoms to be worse than they ever were previously, then, you are pushing way to hard.

The point is to carefully learn your tolerance level so you can avoid exceeding it. If you are going to go an a hike, you need to plan for the effort to return. Hiking three miles and finding out you have reached or exceeded your tolerance still leaves you with the need to hike back. So, if you have determined that you can tolerate a 3 mile hike, turn back after hiking 1.5 miles.

There is no use taking high dose Omega 3 for a short period. If you want healing, you need to take it for months.

Regarding Ritalin. If you mess up your dopamine system, it can leave you with long term problems. Here are some good articles http://breggin.com/index.php?option=...d=30&Itemid=37

Mark,

I'll start with the Ritalin - as I said, before starting the Ritalin I was a very bad student, and honestly I think that without the Ritalin I would have dropped from high school because of my bad grades. My severe inattention problems caused my grades to be low, and they just got lower every new year when things got more demanding. My ADHD does not allow me to perform normally in life, and that could seriously harm me in the future when I will look for a job and raise a family (it's not just school - ADHD is a real disorder, unlike many think, that creates difficulties in many areas in life). So, even if I don't take the Ritalin, I would have to use another medicine to control my symptoms - and sadly, apart from stimulants, not many medications are effective for treating ADHD symptoms. I sadly often find that ADHD is being underestimated - again, it's a REAL disorder with real consequences on the people who have it.

Regarding the dopamine system - it's right that Ritalin is bad for dopamine regulation and can harm the dopamine system, but most of the time, it's temporary.

If we get into details, the active ingredient in Ritalin is Methylphenidate - a potent CNS stimulant that works by inhibiting the reuptake of dopamine into the releasing cell. That means that after dopamine is released, instead of returning to its releasing cell, it continues binding to its receptor repeatedly for a long time. The higher amounts of dopamine in the synaptic cleft are translated into an increased ability to concentrate, increased self control, decreased hunger and motivation (the ability to concentrate is the primary effect which is necessary for ADHD treatment).

In the long term, the results of repeated administration would be an upregulation of dopamine reuptake receptors (more reuptake receptors means that more dopamine can be reuptaken at the same time, leaving you with lower amounts of dopamine), and a downregulation of dopamine D2 receptors (decreased sensitivity to dopamine molecules in the synaptic cleft). These consequences happen because of homeostasis (the body's attempt to keep it's internal environment balanced), which you probably have already heard about. It's just the body trying to balance the imbalances caused by Methylphenidate (Ritalin).

On the other hand, stimulants from the Amphetamines class (such as Adderall) are neurotoxic and can lead to permanent brain damage from long term, high dose consumption. They are neurotoxic because of their mechanism of action - unlike Methylphenidate that inhibits the reuptake of dopamine, Amphetamine (Adderall) reverses the reuptake process - that means, instead of dopamine being reuptaken, it's being continously released. This creates high levels of oxidative stress inside the synaptic cleft that leads to the death of dopamine neurons (at many cases this is irreversible). Apart from the oxidative stress, the Amphetamine molecule damages the cells by itself (it is a neurotoxin). That menans that Amphetamine destroys cells just by interacting with them.

So when talking about long-term permanent effects, the real danger here is with Amphetamine (and also all drugs from the Amphetamines class). Methylphenidate, unlike Amphetamine, is not neurotoxic (unless given in mega high doses). Research shows that rats and monkeys recover from long term Methylphenidate administration eventually (although some recover in a few weeks and some take months), but not all rats and monkeys recover 100% from repeated Amphetamine administration.

Also, in the website you posted I can see studies about Ritalin causing psychotic episodes and depression, but I couldn't find an article that concludes that these effects are permanent (if they're not permanent, it's not a problem because the medication can be stopped the moment they start appearing, and the person will recover).

And about the physical activity tolerance - if I push too hard and my symptoms return, isn't that a sign of new brain damage that I caused to myself? And even if I, by accident, push hard enough to cause my symptoms to return, it'll only delay my recovery, but not cause any further brain damage? I'm worried that it won't only delay my recovery, but also cause more brain damage (the field trip that involves physical activity and hiking). And if it doesn't cause new brain damage, what is the reason to the return of the symptoms after heavy physical activity? The delayed recovery sounds like it carries more risks with it (I hope not).

Thanks,
-ProAgonist

Thanks for your answer. Then we understand each other that you include your parents on all decisions about drugs and supplements you discuss here, before making any change at all?

Pro,

"And about the physical activity tolerance - if I push too hard and my symptoms return, isn't that a sign of new brain damage that I caused to myself? And even if I, by accident, push hard enough to cause my symptoms to return, it'll only delay my recovery, but not cause any further brain damage? I'm worried that it won't only delay my recovery, but also cause more brain damage (the field trip that involves physical activity and hiking). And if it doesn't cause new brain damage, what is the reason to the return of the symptoms after heavy physical activity? The delayed recovery sounds like it carries more risks with it (I hope not)."

Physical activity that causes a return of symptoms means your brain is still recovering. Your brain can be in an extended 'still recovering' condition even if you are symptoms free during low stress times. The injured brain will forever be sensitive to stress. The more and better it heals, the more it will be able to tolerate stress.

The brain needs to re-establish its mechanism for self-regulation. Without self-regulation, symptoms will manifest. You need to slowly work on helping your brain re-establish its ability to self regulate. If you choose not to try to help it re-establish this ability to self-regulate, you should not go on this trip. A return of symptoms can result in loss of skills/functions that keep you safe. A lack of balance, motor control, etc. could increase the risk of you falling and further injuring yourself.

Since it is apparent that you do not listen well and take an extreme effort to convince, your ability to make wise decisions while on this trip is questionable.

mrsD,

Yes, my parents know about all supplements and medicines I'm taking.

Mark,

Sorry if I sounded like I tried to convince you with what I wrote. I just wanted to understand what exactly causes the return of the symptoms, and you now explained it perfectly, and thank you for that.

Right now, I'll most likely won't go on that trip (according to what you have said, if I understand correctly, it is safer not to go on that trip). I'll let my brain more time to heal before I go to do such activities. You are totally right about that, especially about the part that the return of my symptoms will increase the possibility of getting injured during the trip.

I do listen to you and take your advice, Mark. It is important to me because I know you understand a lot about concussions, and I'm sorry if it sounded like I'm not responsible or trying too hard to convince you. I'm usually a responsible person that thinks twice about all most every decision I make, so I'm sorry if I made it sound like I don't listen and don't take your advice.

And if you were talking about the Ritalin in the convincing attempts, I'll explain it shortly - I know it's not very good for my brain right now, but without it I'll drop out of high school. If I could treat my ADHD without Ritalin I'd happily do that, but I can't allow myself to stop taking Ritalin because I will drop out of high school and that will ruin my life (this is very serious). I'm sorry if I made you think I'm not listening about this issue, but it's not like I have too many choices here. Also, my parents would probably disagree with me about stopping the Ritalin and wouldn't allow me to do that.

I'm not trying to convince you to stop Ritalin. I am just cautioning you. Ritalin is like throwing a monkey wrench into your recovery. You will likely have quite a roller coaster ride as you go on and off the Ritalin. The Ritalin may be contributing to your anxiety issues. I can't say. Just wondering.

You should seriously consider the vitamins and supplements regimen as a long term/life time issue. You need to learn how to manage your brain safely.

It's hard to tell what really caused the severe comeback of my symptoms after that trip. It might've been the physical exertion (I had to pull the snowmobile out of snow several times), or it was due to the jarring/vibration (I rode fairly fast on a bumpy trail all day), or probably the combination of everything.

At that time I didn't consider a trip like that to be very demanding, I thought that I was taking it easy by staying on the trail, avoiding deep snow, not dropping off cliffs in the mountains. etc... I took frequent breaks and told my riding partners that I need to take it easy when they tried to talk me into doing more challenging riding.

Nobody here on the forum or in your life (that includes doctors) can tell you for sure that if you do x number of weeks of increased physical activity, you will be fine to do the field trip.

Again, you have to understand that your injury is unique to you. And your recovery will be unique as well. Just because we have similar symptoms, it doesn't mean that what worked/did not work for me will work/not work for you.
I understand that you're looking for answers, but other than "be careful and see how it goes" there's really no other answers.

A note about drugs and doctors saying things. I was prescribed Xanax for my constant anxiety after the concussion. I took it a couple of times, but then read all the nasty stuff about it on the internet and decided I'd rather suffer anxiety. After my snowmobiling trip it all came crashing down again so I decided to listen to doctors and take Xanax. At first it did wonders for me, I felt almost a 100% better, but after a week or so the effect started to be short lived and not as good. I was taking a very low dose (two to three times less than what I was prescribed). Doctor didn't really explain anything to me other than "take as needed up to three times a day". So eventually by the third week I realized that I'm getting addicted to it. I called my doc, he said it's impossible to be addicted to it on such a low dose and such a short period of time so it would be ok to stop taking it if I wanted. So I did....
Let me tell you, what followed was downright hellish experience for about 3 days. From what I could gather online, I was going through the classic benzo withdrawal.
Later I talked to a neurologist about this experience and she said that an injured brain can be very sensitive to any drugs (especially the ones that mess with it), and although in most cases they don't see any adverse effects of Xanax at the time/doses I was taking it, it is possible that in my particular case I developed an addiction.

The other side of it is that Xanax was masking symptoms, and when I should've been feeling like crap and forced to rest, I was working full time and living a normal life, so in the end it was way worse after I stopped taking Xanax.

I had severe anxiety this summer with full on panic attacks, and I still refused to take Xanax again. I would much rather suffer anxiety/panic than deal with benzo hell again.

I'm not saying that you should stop taking Ritalin, but be cautious about it, do your own research. Like Mark said it might be causing or contributing to some of your symptoms. And I believe he's right, I do remember reading about long term damage from it.

I grew up without taking any drugs, even things like Advil. Now after this concussion I had to take a bunch of different ones and it screwed up my stomach last year in a really bad way. Now I have reaffirmed my belief that drugs only make it worse. They have their place, but most of the time they're not the answer.

Do some research into ADHD, for example problems with eyes can lead to issues with concentration. For example here's some info - www.alaskavisiontherapycenter.com

My son has ADHD.... he was able to stop Ritalin in high school, based on using essential fatty acids and magnesium and Bcomplex to rebuild his neurotransmitter system and receptors.

I know all about Ritalin, as he took it for 5 years. He was able to stop in 10th grade.

I am a professional who knows drugs for a living.

Here is my EFA thread:
http://neurotalk.psychcentral.com/thread6092.html

The average ratio in most modern humans today is 20+ Omega-6 : Omega-3. In order to normalize the brain and nervous system it should be 1:1 up to 1:5 (omega3 to 6's)

Studies have been done specifically on ADHD kids, showing they have dramatically low Omega-3's.

So your use of Omega -3 fish oil will undoubtedly help your ADHD.

In the meantime you might want to read this newer article on long term methylphenidate use and its safety:
http://www.medicaldaily.com/long-ter...fficacy-245927

http://www.thefix.com/content/resear...m-brain-injury

Unfortunately, the newer research is refuting the older.
I am most concerned for your anxiety and depression postings here. Some or all of that could be due to your medication alone.

While this new study only found improvements in ADD inattentive, it is still worth reading:
http://psychcentral.com/news/2014/12...ype/78113.html

My son was diagnosed during a two day lengthy testing intake at a Children's teaching hospital here. His diagnosis was ADHD with anxiety as a secondary diagnosis.