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Questioning doctors advice - return to sports?

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Old 01-30-2018, 04:43 PM   #1
Erik
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Default Questioning doctors advice - return to sports?

Hi all,

First time poster here, but have read the forum for a while.

In July, I had a fairly mild concussion. I was running up a set of stairs with a low cement ceiling and stood up too early, thus propelling the back of my head into a corner of the cement door frame. It hurt a lot for a minute or two, but didn't trigger a concussion and I forgot about it. I went mountain biking later that day, had a light fall where I just grazed my face and triggered a concussion (felt squeezing of the brain, stood up and couldn't see straight). It's the first concussion I've had, although I grew up playing hockey and doing extreme sports. I'm 30.

I never had severe symptoms, just troubles with blurred vision and headaches. The vision issues subsided within 2-3 months, but the headaches continued. I went on a daily dose of 50mg of Amitriptyline on October 2nd, and have generally felt a lot better with that.

I am still on Ami now, and have resumed most normal activities. I ran 10 miles this morning with minimal/no symptoms (although have mild 1/10 headache now) and have been lifting weights for about two months.

I still get headaches when I overdo it with exercise, when the weather changes suddenly, when I'm on the computer too much, etc.

I went to the doctor yesterday to ask how I should think about a return to activities I enjoy (mountain biking, skiing, hockey, etc). He cleared me to resume those activities, despite some unresolved symptoms.

I want to know what folks think about this? If I do return, I will certainly be taking it easy and not doing any jumps, drops, etc. I guess the more general question is, is there a time when it makes sense to resume normal life, outside the bubble, if headaches still occur? If in two years I still have mild symptoms, does that mean my brain is still primed for reinjury? I know this isn't exact science.

My docs advice is that my brain is probably pretty well done healing. Potentially I'll just have headaches fairly often forever, or maybe they'll resolve over another 6-12 months, but I don't appear to be at a huge risk of reinjury.
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Old 01-30-2018, 05:47 PM   #2
Mark in Idaho
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Erik,

Welcome to NeuroTalk.

I have a hard time believing you are 30, have played hockey, and done other extreme sports and this was your first concussion. Many do not realize that the 'shake it off' head jarrings are concussion. The hard body checks with some helmet to helmet contact is a sub-concussive impact. The helmet to the ice or mountain bike trail can be a concussion or sub-concussive impact.

People often discount these impacts until they have symptoms that last past a few minutes. But, these impacts are injuring your brain.

Nobody can say what your level of injury is. The science just has not figured that out. [If in two years I still have mild symptoms, does that mean my brain is still primed for reinjury?] Some try to say prior concussions do not impact future concussions and others can anecdotally see an accumulation of decreased function with each impact. My neuro sees the accumulation of decreased function as the more accurate explanation. There are many here on NT who can attest to the challenges of subsequent impacts of almost any magnitude.

You have to decide what lifetime risks you are willing to take. Will your next bike fall be THE FALL that changes your life? Will the next hit or fall playing hockey change your life?

Let me give you just a bit of perspective. I have not done any extreme activities, ever. But, I have had my share of head impacts and one very bad concussion in 1965 from a bike fall. When I started typing your name, I could remember it is Eric, or Erik. I looked at your name and opened a reply window and typed Eric, then I scrolled to see if I spelled it correctly because my memory is so bad.

That is my life since the age of 46 (16 years ago) when I just stepped off a curb and landed wrong jarring from my pelvis to my head.

At 30 years old, your brain is already starting the downhill path in its ability to recover. No concussions recovered fully. Symptoms may resolve but the brain will always be injured.

Your headaches can be indicators of your brain's condition and/or an indicator of your neck's condition causing muscle spams that cause headaches. We call these subtle neck injuries. They happen in 80% of concussions. It is difficult to determine whether symptoms are from the neck or the brain.

The headaches after exertion (computer, exercise, etc) suggest a struggling brain.

btw, 50 mgs of Ami is a powerful dose for PCS issues. The usual dosage is 10 mgs before bed taken to help with headaches and insomnia.

So, I have likely given you more questions than answers. Welcome to the community of Post Concussion Syndrome.

At least, get the best helmet you can find for each activity and consider how you can reduce risk. No checking hockey leagues can help.

My best to you.
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Last edited by Mark in Idaho; 01-30-2018 at 08:12 PM.
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Old 01-30-2018, 06:29 PM   #3
Erik
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Thanks for the detailed reply, Mark. I suppose I mean that I have never had anything that was diagnosed as a concussion, or that stopped me from living my normal life. I do recall days while I was in my early teens when I'd leave ski resorts with a headache after take a bunch of falls where I hit my head. But never anything that caused significant pain or stayed with me for more than a day. Nor have I ever lost consciousness.

I guess I pretty well agree with everything you've said, although struggle to accept it. I've always been someone who prided myself with risk assessment when I participate in activities, and decide which risks I'm willing to take. It's so hard to decide whether to take a risk to do something I love (e.g. biking) when I just don't have much of a perspective on how big the risk is. Sure, the worst case scenario is really bad, but the worse case scenario was always bad when I launched a 60 foot jump. I just wonder what the scenario looks like, where I have a bad, but not that unusual crash. Say one where I land with a hard impact on my body, but not my head. That's the kind of thing that's nearly guaranteed to happen eventually in a sport like mountain biking, but I have no idea how my body will respond.

I certainly will be investing in a great helmet for biking and definitely won't play contact hockey again. Ironically enough, after my crash I realized that after washing the padding of my helmet, I had put the pads back in backwards. Who knows if that could have contributed...

Regarding the Ami, I am planning to start a gradual wean off of it. I do wish I knew this before, as I didn't ever even try 10mg. The doctor just prescribed me 50mg off the bat, when my symptoms weren't even that painful.
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Old 01-30-2018, 08:40 PM   #4
Mark in Idaho
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Very few concussions are ever diagnosed by a doctor. It is only the past few years that a doctor 'diagnosis' has become common. This is because teams have had to implement concussion protocols for liability reasons and the movie Concussion.

The risk of undiagnosed concussions or ignored concussions is that the person does not take a break to allow the brain to recover. Studies suggest that those low intensity hits that are repeated (hockey, football, etc) without a break from play or practice are the most dangerous. These are mostly sub-concussive impacts without even a need to shake it off.

I think you need to consider the various peak risks of each activity. No contact hockey reduces the repeated body checks and knock downs from them but leaves you with falls and pucks to the head. So, you have reduced many of the risks. Mountain biking trails have risk levels to consider.

Then, consider whether you have adequate disability insurance compared to the risks you decide to endure. Risks tend to have an exponential increase in long term injury or disability as the intensity increases. A fall at 30 mph is substantially more injury risk than a fall at 20 even though the speed is only 50% more. Add the greater ability to recover from a near fall at 20 vs 30.

So, only you can calculate the risk to you.

btw, I learned that helmet padding has a limited life. Check yours.
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Old 01-31-2018, 04:16 PM   #5
Erik
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Thanks Mark, I appreciate all your advice. Definitely going to invest in a fresh bicycle helmet if I go back to riding this summer.
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Old 02-03-2018, 02:59 AM   #6
russiarulez
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Erik, I was right about your age when I had my last concussion that did me in and your story really resonated with me, since I used to do some fairly extreme stuff in my late teens and 20s (paragliding, skydiving, dropping cliffs on skis and snowmobiles, downhill mountain biking, etc...)

In addition to all of that I was into martial arts/boxing/kickboxing since my late teens.

Just like you I never had a diagnosed concussion (before this last one) or a hard enough hit to black out, mostly just headaches for a few days after a hard fall/landing or a rough sparring session.

So I went on with my life without worrying too much about it. Looking back at it now I realize that some of the issues that I've had in the past were the result of these concussions that I just shrugged off and moved on (vision issues, sleep issues, etc).

Well, it all caught up to me eventually in a big way. I had a concussion (no loss of consciousness or memory loss) while at a boxing sparring, just a hard hit that "rang my bell". I didn't think much of it at first, but then things started to spiral out of control to a point where I couldn't get out of bed for two weeks.

Things eventually got better after about three months, and I thought that I'm all healed (after all, the doc told me to get back to normal life as did my friends/family) and I went for a fairly easy snowmobile ride with some friends.

Well it turned out not to be such a great idea... Things went to hell for me and it was worse than the initial 3 months...

Now 5 years later I'm still not back to normal and deal with the consequences of not taking it seriously back then.

The point of my story is that you need to take this last concussion as a warning and a learning experience. Trust me when I say that what you've experienced is not even close to how it can be if you keep hitting your head. Your body is telling you something, please listen.

By the way, 99% of doctors have no idea what they are talking about when it comes to concussions, just ask any of the long term users on this forum.
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12/02/2012 - Light concussion at boxing practice. Ended up having PCS for about 3 months.
March 2013 - Thought that since most of my symptoms resolved I could start having fun again.
Went snowmobiling once (didn't hit my head) and concussion symptoms returned and got even worse than before.
June 2013 - accidentally bumped my head against a deck railing, and had a month-long setback.
November 2013 - drove to work after a big snowstorm and the roads were very rough, ended up having another setback.
2014 - Having setbacks after coughing/sneezing too much, or someone slapping me on the back, or any other significant jarring.
Feb 2014 - Started seeing Atlas Orthogonal chiro - most helpful doc so far.
June 2014 - Two months of physical/visual therapy - no noticeable improvement.
September 2014 - Diagnosed with Perilymph Fistula in right ear.
November 2014 - Fistula surgery (switched to left ear before the surgery after additional testing).
January 2016 - Quit work to "work" on figuring out PCS, so far it seems that eyes/vision issues are the most contributing factor, especially computer work.

Current symptoms are: inconsistent sleep patterns, headaches, vertigo/dizziness, anxiety/panic attacks, mental fog/problems with concentration, problems with computer screens.
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Old 02-04-2018, 10:13 AM   #7
BlueSkye1962
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Quote:
Originally Posted by Mark in Idaho View Post
Erik,

The headaches after exertion (computer, exercise, etc) suggest a struggling brain.

btw, 50 mgs of Ami is a powerful dose for PCS issues. The usual dosage is 10 mgs before bed taken to help with headaches and insomnia.

I'm on 50mg as well ????? I still have horrible headaches that never completely go away, along with intermittent, severe stabbing pains. Physical or mental exertion exacerbates. I also still suffer from insomnia.
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Old 02-05-2018, 09:23 PM   #8
Bud
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Blue,

Hang in there, sleep will return.

You can learn to eventually ignore the headaches, my head hurts still after 4 years, I was whacked pretty hard but most of the time I'm not really aware of it until my wife asks how my head did today. I know that might not be the answer you want but I mean it when I say it really isn't that bad. For some reason we seem to handle a sore knee but a sore head spells doom to us.

Bud
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Old 02-07-2018, 05:21 PM   #9
Erik
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Quote:
Originally Posted by russiarulez View Post
Erik, I was right about your age when I had my last concussion that did me in and your story really resonated with me, since I used to do some fairly extreme stuff in my late teens and 20s (paragliding, skydiving, dropping cliffs on skis and snowmobiles, downhill mountain biking, etc...)

In addition to all of that I was into martial arts/boxing/kickboxing since my late teens.

Just like you I never had a diagnosed concussion (before this last one) or a hard enough hit to black out, mostly just headaches for a few days after a hard fall/landing or a rough sparring session.

So I went on with my life without worrying too much about it. Looking back at it now I realize that some of the issues that I've had in the past were the result of these concussions that I just shrugged off and moved on (vision issues, sleep issues, etc).

Well, it all caught up to me eventually in a big way. I had a concussion (no loss of consciousness or memory loss) while at a boxing sparring, just a hard hit that "rang my bell". I didn't think much of it at first, but then things started to spiral out of control to a point where I couldn't get out of bed for two weeks.

Things eventually got better after about three months, and I thought that I'm all healed (after all, the doc told me to get back to normal life as did my friends/family) and I went for a fairly easy snowmobile ride with some friends.

Well it turned out not to be such a great idea... Things went to hell for me and it was worse than the initial 3 months...

Now 5 years later I'm still not back to normal and deal with the consequences of not taking it seriously back then.

The point of my story is that you need to take this last concussion as a warning and a learning experience. Trust me when I say that what you've experienced is not even close to how it can be if you keep hitting your head. Your body is telling you something, please listen.

By the way, 99% of doctors have no idea what they are talking about when it comes to concussions, just ask any of the long term users on this forum.

Thanks man, I appreciate the response and I'm sure that's good advice. I am trying to justify returning by listening to doctor's advice that I know isn't good. Glad I found this forum!

Quote:
Originally Posted by Bud View Post
Blue,

Hang in there, sleep will return.

You can learn to eventually ignore the headaches, my head hurts still after 4 years, I was whacked pretty hard but most of the time I'm not really aware of it until my wife asks how my head did today. I know that might not be the answer you want but I mean it when I say it really isn't that bad. For some reason we seem to handle a sore knee but a sore head spells doom to us.

Bud
It's so true isn't it? I practically love the feeling of sore muscles after a hard workout. Yet somehow a relatively mild headache can ruin my day. It's because of the association - 'what did I do that caused this?' It's crazy making.
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