Originally Posted by Mark in Idaho

You are quite a perfectionist. How about trying some reality? I did not say you will be more prone to stress. Stress is stress. Some just tolerate it less. I said that stress will likely affect you more. We need sleep to recover from daily stress. Good brain nutrition helps the brain tolerate it better. You will still be able to spend time at altitude but if you were to take an ImPACT or other neuropsycholgical test at altitude, your results will show a deficit compared to others who have not suffered a concussion. Your decision making skills will be lessened. Nobody can predict if that deficit will be problematic.

You may have virtually undetectable residual factors but they will be there. Yes, it is great to have a goal of 100% recovery. We all need to have something to shoot for. Please keep in mind that any rehabilitation uses measurable factors to determine levels of healing. My knee that I tore the medial meniscus on in 1972 healed so I could resume my running. But, that minor tear became a major tear years later. My shoulders have healed to useable conditions but my bursitis has never healed to near before injury standards. My broken tib/fib healed but is prone to arthritis at the ankle joint. In all of these injuries, I regained full range of motion with the exception of my shoulders. If I push for full range of motion, then I risk inflaming the bursa.

Do a little research into cartilage. It does not heal very well at all. Especially the meniscus because its only nourishment is the synovial fluid. The synovial fluid contains lubricin (The body's lubricant) that is lost during any knee surgery. The body does not replace it properly or fully so the lubricity of the synovial fluid is forever reduced unless it is artificially supplemented. That loss of lubricity causes the cartilage to deteriorate faster.

Look at nerve fibers. They can grow at 2 to 3 mm per month. But, they will not grow unless there is a myelin sheath in place. The myelin sheath grows extremely slowly if at all.

Look at capillaries. They do not heal well at all. HBOT is often used to assist/encourage capillary repair/growth. But, in the brain, those capillaries are covered with glymph cells that do not heal well, if at all leaving the brain's waste removal system in a weak state.

The axonal damage common to concussions is also problematic. This axonal wiring does not have a road map. They reconnect by happenstance. They keep trying to connect to dendrites but get rejected until the correct dendrite is found. The neurons have as much struggle to repair. There are over 4000 different 'classes' of neurons. Even when there is a regeneration of the proper class of neuron, they still need to be programmed to be functional.

The fact that you are having head aches suggests that your concussion was not as mild as you think. Plus, research shows that there is no direct correlation between intensity of trauma or immediate symptoms and long term results. The only valid stats say that 85% of concussions recover spontaneously in the first few weeks. By recovery, they mean that primarily, those patients stop complaining to their doctors. Those of us with long term concussion symptoms rarely even meet the threshold of being symptomatic by mTBI standards.

There have been multiple recent studies that can show a difference between those who have suffered a concussion and those who have not, even after what appear to be a full recovery. They can see a difference with qEEG/AEP/VEP, high resolution MRI, and some other diagnostic procedures that my damaged mind can't remember. Older research showing this dates back to the 70's.

I suggest that those 100% recoveries, even from the rotator cuff tear you mentioned actually recovered to much less than 100%. That rotator cuff will tear again with less force. A return to full range of motion does not mean 100%. A return to full strength tests do not mean 100%.

My father suffered an almost complete non-displaced fracture of the humeral head. It took 6 weeks of immobilization before he could start rehabbing. He regained better range of motion and better than before strength but developed arthritis.

Check out neuroplasticity. There are many claims about the brain doing some miraculous things. When one looks into the specifics, neuroplasticity is not nearly as miraculous as first presented. The brain has many ways to adapt to injuries. It re-allocates less used resources to greater needs.

There is good research that shows many 'full recoveries' from brain injuries of all levels are really subjects who have learned how to make accommodations and learn work-arounds to the limits of their injuries. I have learned memory tricks to make up for much of my memory limitations.

So, here's to your positive attitude about pursuing a full recovery. You will very likely experience what appears to be a full recovery.

btw, That PA was wrong in saying you may have not suffered a concussion at all. You said you had a head ache and were a little hazy. That is a concussion even if you did not exhibit any symptoms when she examined you. Unfortunately, medical schools are way behind the times.

My best to you.

Originally Posted by Mark in Idaho

john,

First, don't waste your breath asking your neuro. As I said, he does not know the answer. Plus, what symptoms are you seeing the neuro for ? I thought your only symptom was occasional head aches. You said "Not just the single simple question "is 100% recovery possible" as I do know that, yes, doctors will usually say yes based on the patient's usual layman understanding." I don't think the patient's usual layman understanding has anything to do with how a neuro will answer your question. Even your doc with special training in concussions will say Yes. They do not know any different.

But, I expect you will keep asking this question so you can get a number of answers that agree with your opinion.

I take great exception to you terming my comments as only my opinion. I have been seriously reading the research for over 15 years. The research from the 70's was repeated in the 90's with the same result. As I said, even newer research with the latest and greatest diagnostic tools have confirmed the older research. The research is conclusive. There is no way newer technologies can disprove what has already be demonstrated. Newer technologies will not show the changes in qEEG/AEP/VEP to be erroneous. High Tesla MRI's can image the damage long after an perceived appearance of recovery. I am not adding the comment that the brain does not heal 100% as my observation. The studies make this statement in their scientific conclusions. It a study were to say less than such an affirmative statement, I would only repeat it as studies suggest, not studies state or studies show. And, scientific studies routinely make that distinction. Often, when they make a 'the study suggests' comment, they also comment about the need to study the issue further using a more refined study protocol.

Some of the long term symptoms of brain injury are in thought processes. A common one is called rigidity of thought. It is a thought process where it becomes difficult to over-rule existing thought processes. It can be compared to OCD like issues. Anxiety or a focus on a single issue is also a common symptom. In MY perspective, it APPEARS that you have not been able to accept comments I have made nor take those comments and apply them in a logical way to come to a conclusion. Now, you have taken that same comment and made it into an accusation versus an observation from my perspective.

Regarding nicotine, the fact that it is vasoconstrictive HIGHLY suggests that it can effect recovery that requires good blood perfusion. Research shows great value to getting good blood perfusion in the brain to recover from brain injuries. One of the key struggles the injured brain has is clearing toxins from injury and metabolic wastes. Only the capillaries supply blood to the individual cells. Larger vasculature is only for blood distribution. There are plenty of concussion issues needing research that make any research about nicotine out of the question.

HBOT imaging research is often used to promote HBOT for concussions based solely on the observation that HBOT causes capillary regeneration. They can image this capillary regeneration. They tie this capillary regeneration as important for concussion recovery based on the known need for good capillary perfusion. Logic would suggest that anything that reduces capillary perfusion as counter to optimal healing.

Regarding your other history. Your demand that I ignore that when answering your question is like the patient who asks his doctor if he will be able to dance after his leg heals. When the doctor answers "Yes," the patient responds, "Great, I never could before."

I am not making a judgement about your past. The fact that you overcame that period is a giant feather in your cap in my view.

btw, I do understand these issues. I lost an uncle and great uncle to alcohol. I have also read the research about how alcohol affects the brain long term. It is most damaging to the brain when abused before the age of 25, the younger, the greater the risk to the brain.

Doctors take medical histories because those histories matter. I am sure you have been taught the importance of getting accurate medical histories.

The reason I brought it up this last time was to emphasize how the brain changes how it functions based on things as simple as nicotine and alcohol. The neurotransmitters and multitude of chemical receptors in the brain can quickly become accustom to the presence of things like nicotine, alcohol, drugs (legal and illegal), sex hormones and related pleasure chemicals, and such. It is often extremely difficult to change how the brain responds to these issues.

It is known that PTSD causes physiological changes to the brain. They believe these changes to be permanent.

You still have not explained why this question is so important if your only symptom is head aches. What symptoms do you still need recovery from ?

Originally Posted by Mark in Idaho

John,

I have only two points.

First, You refuse to accept that my comment of "In my PERSPECTIVE, it APPEARS" as what is says. I describe rigidity of thought for your information, not as an accusation.

Second, Rehabilitation specialists have found that accepting the current state of recovery as real is a starting point toward maximizing recovery. This is important because anxiety is the worst thing for recovery. The toxic brain chemistry caused by anxiety is counter to recovery. Plus, the lack of quiet rest where the brain relaxes and lets go of stressful thought allows the brain to apply its resources to recovery.

And, Yes, you are right. The research is not complete enough nor long enough to prove that over a lifespan, 100% recovery is not possible. It has looked at 10 and 20 year spans between known injuries and continuing evidence of the prior injury. But, as you say, it does not cover all persons so some may have recovered 100% without ever being examined. Unfortunately, the research to prove that 100% recovery is impossible. There are just too many variables to make such a study scientific.

Google "long term effect of concussions" and you will find lots of information. Most is related to those symptoms that are still noticeable. Some relate to dysfunctions that show even though there are no noticeable symptoms. You need to find the studies that have a broader cohort to find the most applicable information. You also need to find the studies where they found these abnormalities in what was thought to be a control (no concussion group) but in hind sight, the individual subject could point to a time where he may have suffered a concussion even though it was not a diagnosed concussion. I have hundreds of links to information.

Dorothy Gronwall did much of the pioneering research in the 1970's. Her work is not available online since her books are still being sold in print only. She died in 2001 due to a brain aneurism. You might find some excerpts online.

There is a phrase used by those in the know. "When you have seen one brain injury, you have seen ONE brain injury." There is strong evidence that shows one can not compare concussions. A 'mild' concussion in one subject may heal to no recognizable symptoms quite quickly and another even milder concussion can manifest symptoms for a prolonged period of time. This does support your claim that 100% recovery can not be excluded.

So, shoot for the moon. Maybe you will be one of those who has escaped detection and recovered 100%. Please keep in mind that anxiety is a big factor in slowing recovery so trying to live a low stress and anxiety free life is important.

My best to you.