The brain needs rest to even start to heal. Stress and over-stimulation are counter to this needed rest. Rest between periods of high stress or over-stimulation is not effective. It is important to moderate stress to avoid the peaks. The peaks are most likely to delay recovery.

You said, "I also read that there is evidence Topamax may help repair damage after a TBI." Where did you read this ? If it is true, it should be headlines.

Phentermine is the weight loss drug. It is a psychostimulant. Stimulants are not advisable for recovery. It could be causing problems.

Topamax is an anticonvulsive often prescribed for migraines.

In my experience, Christian pop music is too stimulating. I can not listen to it. I can listen to instrumental music with more 'impact.' I can also listen to quality vocals with quality instrumental accompaniment. I also struggle with music where the vocals are buried in the music so you have to strain to follow the lyrics. The brain wants to understand the vocals. If it can't, it overloads trying.

I have mostly recovered from a nasty bout of PCS that started over 3.5 years ago. Life is now humming along (in fact it is better than before my injury), but getting to this point was by no means easy.

Here are the things that I believe helped me the most:

Rest
Time
Keeping stress low (as best possible)
Good nutrition w/ varied diet including sufficient protein
High-quality fish oil supplement, vitamin D3, good-quality multivitamin
Being disciplined about limiting cognitive and physical activity (not overdoing it) and shutting it down and resting when necessary
Very gradually increasing activity (as slow as necessary - over months/years if necessary)
Support from loved ones who get it (these may be few in number)
Learning relaxation techniques (might be a slow walk in natural/quiet surroundings, a breathing/relaxation tape, classical music, hot bath, etc.)
Understanding that recovery can take a long time
Perhaps most important: no further head impacts! Daily reminders/mental cues can help with this
Apart from learning from others' experiences, don't compare yourself with them - each head injury is different
Acceptance that you've had a serious, life-changing injury

For most people, it does get better, but recovery can take quite a while. Be good to yourself. Recovery is a marathon, not a sprint - it's a cliche, but one that is profoundly true.

My best to you (as Mark likes to say).

Thanks, greenfrog! I live and die by the hourly bill and have typically worked 55-70 hour week in addition to whatever other community service I try to get in.

What you said about supportive family... I have an awesome wife who has already said if need be she is willing to "downsize" and "simplify" our life... I am thinking the first step is to get the Neuro's recommendation and the eval and then see what I can do about adjusting my work.

Speaking of community service, I had also read that PCS tends to cause one to become self-absorbed and to focus on helping others instead. I noticed you and Mark spend a lot of time commenting and helping other here...

Do you find any relief/recovery in anything like that--does that help, to refocus your attention to other people?

Chronic use of Topamax can lead to glaucoma and kidney stones.

About 30% of patients have lowered bicarb levels, and this can occur at any dose at any time during use. (not just in the beginning).

http://www.fda.gov/downloads/Drugs/G.../ucm054728.pdf

So regular visits to the eye doctor is recommended, and also tests for serum electrolytes including bicarbonate.

Just FYI

Here is the link to the article mentioned by Lawyer1732 above...

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3707352/

Ther Adv Neurol Disord. Jul 2013; 6(4): 211–227.
doi: 10.1177/1756285613481257
PMCID: PMC3707352

Topiramate: Effects on cognition in patients with epilepsy, migraine headache and obesity

Barbara R. Sommer,corresponding author Erica L. Mitchell, and Tonita E. Wroolie

Mark,

Here is a quote from the Natl Inst of Health paper that discusses the various studies on Topamax. You can see why it took me all day to get through it all... And it appears as if there hasn't been enough research w one study showing negative results:

"This evidence that administration of TPM [Topamax] confers protection against neuronal damage and cell death following cerebral injury may have implications for learning and memory following cerebral injury. This has been shown in rat models of cerebral injury, induced through hypoxia, induced seizure, middle cerebral artery lesion (to induce ischemia), and TBI. ...

"The studies used rat models to investigate the effect of TPM administration on learning and memory following cerebral injury. Hoover and colleagues found that while there was a beneficial effect on preservation of motor function, learning performance was impaired in brain-injured rats administered TPM 1 month post-injury [Hoover et al. 2004]. Other studies found that rats given TPM had preservation of some cognitive abilities following brain injury compared with brain-injured rats not administered TPM. Amelioration of deficits in learning and memory however, were inconsistent between doses and tests used for assessment making generalization difficult."

Also, Mark, Phentermine and Topamax are now being prescribed in combination for weight loss, typically in one pill form called something liked "Qysmia." The combination is very effective. But that uses Topamax at about 46-50mg/day.

But those studies I was looking at showed that when taken at levels exceeding 300-600mg/day then Topamax can cause mental confusion. This happens at rates of like 5-6% of study participants and the higher the dose the worse the side effects. At the weight loss dose, no cognitive side effects were ever reported.

But even if there was a relationship that doesn't explain hypersensitivity to sound and anxiety and many of the other symptoms of PCS either.

(Oh, and by the way, I was sharing that article w my wife last night and came across another part I highlighted that said another study showed promise for Use of Topamax to treat social anxiety disorder too... Interesting)