Gotta disagree on that. I don't think it is picky at all to want to have a 100% recovery from a minor concussion. I think it's a pretty natural response, considering it was diagnosed as minor. I do understand that with some residual I will still be able to live my life and take my boards. But I don't think it is picky or misguided to want and see it as possible to recover on all levels from an injury such as this.

I agree, having the knowledge on what may be contributing to increased stress is definitely comforting and a good thing to have. I am grateful that I have that knowledge in case a scenario did arise.

I can also understand if there would be some residual from incidents like a severe concussion or traumatic brain injury, but to think that from a minor possible concussion from falling off a snowboard with no neuro changes at all, that I will be **permanently forever** more prone to stress and sensitive to high altitudes, seems a little over the top to me. You mentioned tearing up my knee. Well I have seen people recover 100% from torn rotator cuffs through self healing modalities when all doctors told them they are screwed and would never have a chance of recovery without surgery. And in some cases yes, there will be scar tissue, but there are also supplements that can be taken to dissolve scar tissue in order to enable neighboring tissues to regenerate.

Obviously our bodies aren't perfect but I do believe they are capable of 100% recovery and a return to 100% *resiliency* if given the right circumstances (for example, gradual exposure regimens within levels of tolerance can rebuild back to pre-condition levels). To say we are forever destined to a level of mental or physical health/resiliency at a step below pre-injury levels seems pretty self-defeating. Ive seen it be done, so why not always shoot for 100% in stead of limiting yourself to the 95%? Yes of course its important to be realistic but why not aim for a full recovery on all levels? Im not saying it will happen all the time, but I feel like it is definitely possible, especially with lower level injuries.

Oh, and the 1960 refers to something else. I am 32.

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.

I appreciate your feedback Mark.

The thing with my headaches is that they are usually accompanied by some minor neckpain as well. It could very well be that the neck pain is radiating upwards and causing a headache. Do hard hits to the head *always* amount to a concussion?

Also, since I am an ex smoker, I have been chewing 8mg of nicotine gum multiple times daily since the fall. Do you really think this has had an impact on the healing of my brain? I asked 2 MDs and they both didn't think it would. One of them has had extra training in PCS as well.

So you are saying, even if my body has the most optimal conditions to heal, my bodily defense systems/stress tolerance abilities will forever be a step below my pre concussion self? It's just set in stone now. I understand 98% healing is great but to say I am permanently left with residual damage just irks me.

I understand the brain is different from other parts of the body, but in comparison, this feels like a little scrape compared to a major laceration. Scrapes usually heal completely without any sign of scarring versus lacerations usually leaving behind some scar tissue. I don't know, I just feel like the body would have developed the capability to 100% recover from a *minor* brain injury.

Are you saying if I spoke to my neurologist and he said 100% recovery was possible, that he would be white lying to pacify me? Or that he has a knowledge deficit on the true workings of the neurological system?

I'd say the majority of head bumps, concussion or not will recover just fine.

I had a LOC @ age 15 , but don't recall any other problems other than a bit fatigued for a day or 2 after.
I do think it somewhat affected my neck a bit ( went off horse head first onto ground ) so that in my middle age years and with repetitive job, I started having issues w/ neck, shoulders hands etc..
I definitely think my c1 c2 got knocked out of alignment back then also.
Your neck muscles could be affected , do you know about trigger points and referred pain?
You could ask for a few sessions of PT - they should know how to check for spasmed muscles & trigger points..


Perhaps it could be the actual chewing of the gum more than the nicotine??

It might be wise to see a upper cervical chiro just to make sure there is no problems in the future. Especially if you have had other bumps or falls that might have jarred the neck/head.You can see some videos on youtube if you want to know how it is done.

John, You appear to be misunderstanding me. Your neuro is correct with qualifications. A 98% recover to a neuro is a 100% recovery. He can not diagnose the difference. Neither can you. As I said. recovery is relative. Your neuro looks at recovery as able to function is life, good motor control, functional sensory systems, etc. He can not (due to lack of training) and very likely would not try to diagnose anything beyond that. There is no purpose.

Insurance companies drive health care and they refuse to even acknowledge the diagnostics that show less than full recoveries because they do not want to have to pay for further attempts at treatment or for residual disability. By setting the full recovery bar low, they get off the hook with less money paid out.

"Do hard hits to the head " always " amount to a concussion ?" Very likely but it is not the hit to the head that determines a diagnosis of concussion. It is the change to neurological function, even if it is very brief, that is the diagnostic factor. As I said before, there is no correlation between impact intensity and depth of injury. There are just too many variables. i.e. Rotational forces tend to cause more injury as the brain impacts the rough interior of the skull. Whiplash back and forth forces can cause coup-contra-coup injuries as the brain bounces inside the skull.

There is no comparison between a skin laceration or even deep cut and a brain injury. Skin tissue regenerates continuously. It can fill in missing areas. It is a static tissue in that it does not do a complex function like brain cells. They do not constantly regenerate nor do they fill in missing areas. Scrapes can take years to heal so there is no scare left. I have scars from decades ago. I have laceration scars from when I was a child.

The concussion training doctors receive is for sports concussions and making return to play decisions. It is primarily to try to reduce the risk of Second Impact Syndrome and subsequent concussions/injuries due to balance and other functions needed to be safe on the field. Most concussion training is at weekend seminars done by companies like ImPACT and CNS Vital Signs. This is so they are qualified to participate in evaluations for return to play. They are not taught about long term concussion issues.

Even the creators of the ImPACT system admit it does not predict the brain's ability to tolerate future trauma.

You said, "I don't know, I just feel like the body would have developed the capability to 100% recover from a *minor* brain injury." Even a devout evolutionist would have a hard time explaining how natural selection and survival of the fittest processese would cause the brain to develop these capabilities. They do not change survival and reproduction rates.

Regarding nicotine, it is not the best thing for your brain while healing but nobody can say what impact is has on healing other than it has a negative impact on capillary function and regeneration. As an trained medical almost professional, you should be able to understand the value of good blood flow, especially capillary blood flow.

Do you actually believe your alcohol issues did not leave your brain with any residual issues ? Just like you have struggles to stop nicotine, you brain has been changed by the nicotine and alcohol. It appears you may have some memory issues and possibly logic processing issues. I'm not judging you. Just making an observation from my perspective. But, none of these issues mean you can not find ways to overcome any limitations they cause.

As Jo*mar said, you likely need some neck issues treated. They can contribute to concussion symptoms or cause similar symptoms. Your head aches could be from either the concussion, neck injury or both. The slight hazy feeling indicates a neurological trauma.

If you don't want to accept the less than 100% recovery concept, why are you even asking about it ? It sounds like your mind is already made up . Are you just an anxious person with these questions repeating over and over ?

Mark I understand what you are saying relating to doctors and the medical field being trained to treat 100% recovery as the ability to function, quality of life, motor control etc. As well as the same approach from the insurance company standpoint.

When I speak to my neurologist, I plan to ask him in a more in depth way, as I am asking you, about the possibility of 100% recovery. 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.

What you are basically saying is that, from your research, and from studies you have read, it is your conclusion and your *opinion* that the brain cannot heal 100%. I can accept that. But to say that from what you have gathered, that this opinion is fact, I'm going to disagree with you on that. I guess in my mind it's still up for discussion. Medical science is constantly evolving, especially research on the brain, so to say anything is 100% conclusive and fact I believe is shortsighted. But I will agree, by what you have presented, the evidence leans more towards there being a lingering residual damage thus far.

Anyways, at the end of the day, I would be ok with the form of recovery you are referring to. But it is still unsettling to think the brain doesn't have a full capacity to heal to pre-injury levels.

And of course I understand the role of nicotine in regards to its vasoconstictive properties. That is precisely the reason why I asked if anyone knew anything more in depth, studies etc, about its possible impact on the healing of a concussion. Just because something is vasoconstrictive, does not mean it will automatically impair the healing process. There are thresholds.

You wrote this: "Do you actually believe your alcohol issues did not leave your brain with any residual issues ? Just like you have struggles to stop nicotine, you brain has been changed by the nicotine and alcohol. It appears you may have some memory issues and possibly logic processing issues. I'm not judging you. Just making an observation from my perspective. But, none of these issues mean you can not find ways to overcome any limitations they cause. "

And Mark, I don't know why you are still bringing up your opinion on my history and bringing it into this thread after I specifically requested you not to. I asked if you could focus on the questions I had. Yes, I agree, since I have not completely been able to accept permanent residual damage as fact, I have come off as a bit repetitive through trying to bring up certain points again. But for you to nonchalantly diagnose me as having logic and memory deficits (where memory even comes into play here, not sure where you're going with that one), and then try to smooth it over by playing the neutral non judgmental card, is honestly rather distasteful and smells of some frustration on your end for me continuing on with questioning.

Again, I appreciate your feedback on my actual questions, but I'm not looking for anything beyond that. Im hoping you can be respectful of this going forward.

I will ask my neurologist these questions, see what his opinion is, and report back.

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 ?