Stacking Concussions.

[Phill]

This is unfortunately about me. A car accident (which totaled my car) the other day left me with my 5th concussion of the year. Fortunately i've managed to space them fairly evenly giving a little more than a month between most of them. After my 4th one I felt, for lack of a better word, stupid. Like I just couldn't think at the level I did before. I could still function and reason and such but often during conversations I would find myself just listening to the other person where as before the incident. I went to see a neurologist and was told that it was fairly normal to not feel 100% for a about 5 weeks after the accident. He was right, and about 4 weeks later I'm feeling back to normal. Later the same week. BAM! and now its back. I feel like Charlie from "Flowers for Algernon" on his regression. Plus I have a fairly constant pain in the back left of my head. Considering it s only been a few days I'm giving the head pain a little while before I go in for that, but this decrease in mental function is honestly scary. I am more scared by this than I have ever been by anything in my life.

So my internet medical experts, what is my next course of action? I've already decided I'm going for a full face and a mouth guard at all times. How long should I give this concussion before I get back after it. How long after subsequent ones. Is there anything else I should do in terms of prevention or or recovery?

[fallin]

Have you thought about this?



Seriously man that sucks, and I'm sorry the world keeps hurling itself at your head. I know there have been some threads on here about post-concussion syndrome so you might want to search those for some nuggets of wisdom since I don't have a ton of experiences in this department. Have you been back to the doc for this one? It never hurts to get xrayed. And what did you mean by "get back at it"--start hurling your head at things again?

Anyway I hope the pain goes away and you're back to your quick witted self in no time.

[Phill]

Have you been back to the doc for this one? It never hurts to get xrayed. And what did you mean by "get back at it"--start hurling your head at things again?

Anyway I hope the pain goes away and you're back to your quick witted self in no time.

Have I been to the doc for this one?

uh yeah I went to the doc....



as for get back at it, yea I mean skiing. Serious skiing.

[Hutch]

I could still function and reason and such but often during conversations I would find myself just listening to the other person where as before the incident.

Before the incident, did you finish sentences? I think we found another symptom of TBI.


Heal up, kid.

[khakis]

I cracked my head so hard once that I couldn't read for the rest of the day. Saw the letters and words but couldn't make any sense of them. Scared the crap out of me! Have definitely had a couple of other less serious crashes skiing/biking/skating where I got my bell rung so hard I felt like it knocked me stupid, but have always recovered by the next day. Or maybe I just got used to it. That's okay stupid people have more fun (see Homer Simpson crayon episode)
I would probably give it a couple of days, maybe a week before running to a neurologist. And I don't know the circumstances surrounding the rest of your injuries but I am sometimes smart enough to take big scares as gentle reminders to reign things in a little bit. Ask yourself "how much worse would the circumstances have had to be for my injuries to be permanent?" This aint a dress rehearsal.

[GoNads]

I know of 3 people with stacked concussions, all from alpine athletes at provincial team or nat'l devo.

Stan has had 7 in 5 years and FIS wont insure him anymore so he retired.

Justine was forced to take 1.5 years off after a REALLY nasty concussion, no skiing whatsoever, but she's doing SX now.. with a mouthguard.

Kristin had 3 in 1 year and the last one was so bad she can't do contact sports anymore.


All I know is that a fullface isn't going to stop you from getting concussions, a mouth-guard WILL significantly lower your odds though.

I've had 4 in the last 5-6 years and am in a similar predicament, STOP FALLING. The last one I had was from rolling my sled onto my head. Nothing like 500ibs squishing you into rocks and crumpling your helmet.

[ODHGABFE]

I'm no doctor, but I would be pretty concerned about the persistant pain in the back of your head. That's definitely a sign that something got rocked pretty good. Go into the doctor and get some tests done asap. Hopefully you have insurance.

As far as prevention, can't really add anything other than reinforcing risk assessment. It's a tough call to make, but you have to decide whether or not say, maching through the trees is worth not being able to remember your phone number/names/places/functions/etc.

Last concussion I had, the day after my motor skills were noticably slower. I tried to pass my keys from one hand to the other, pretty simple task, and they hit the floor before I fully realized they weren't in my hands. Scared the fuck out of me, and I think twice before I go out to skate anymore (flew off the deck to flat on my head when my wheels stuck on a 7ft 1/4pipe)

[sftc]

...Is there anything else I should do in terms of prevention or or recovery?

How do you get so many concussions in 7 months? OK, I get the last car accident one, but the other 4? Maybe you need to look at making some serious lifestyle changes. I'm not kidding or trying to bust your nuts, as usual. When I was a little older then you I went through a phase when I was always getting busted up with lots of injuries and I finally ended up in intensive care for 5 days after a bad crash while skiing.

I finally realized that I wasn't focusing on the here and now- If I was skiing I was thinking about what run I wanted to ski next, if I was mt. biking I was thinking about the next climb, etc. Slow down, focus, concentrate on what you are doing- whatever you need to do, because at this rate your brain is gonna look like a scrambled egg by the time your 25, not to mention how busted up the rest of your body will be.

[Phill]

How do you get so many concussions in 7 months? OK, I get the last car accident one, but the other 4? Maybe you need to look at making some serious lifestyle changes. I'm not kidding or trying to bust your nuts, as usual. When I was a little older then you I went through a phase when I was always getting busted up with lots of injuries and I finally ended up in intensive care for 5 days after a bad crash while skiing.

I finally realized that I wasn't focusing on the here and now- If I was skiing I was thinking about what run I wanted to ski next, if I was mt. biking I was thinking about the next climb, etc. Slow down, focus, concentrate on what you are doing- whatever you need to do, because at this rate your brain is gonna look like a scrambled egg by the time your 25, not to mention how busted up the rest of your body will be.

Since you asked.

1. Fairly minor caught a branch under the snow while skiing trees in powder. Tripped me. Head first into a tree

2. Maching down a bowl that I have skied 100x and twice as fast. Hit a frozen chunk binding which is set at 14.5 comes out like it is at 2. Lose the ski. See the groomer ahead and knowing crashing at this speed would suck I decide to try to keep it together. There is a slight drop on to the cattrack I didn't see and I get off balance catch an edge and get "fly swatted" into the ground. Brief black out. Adrenaline got me down just fine, by the time the adrenaline wore off I was walking around the base area like I was lost for an hour before patrol grabbed me.

3. Less severe. Alpental in the spring one of the few times I wasn't wearing a helmet. Mached a smooth corn bowl was slowing down as I came to the bumps carved into the smaller bumps but one was just soft enough that my ski went about a foot into the mogul as opposed to going over it. Broke my squad. Couldn't talk clearly for an hour. Thinking impaired for a day or so.

4. Walked full tilt into a cement post. Blacked out. Went to the ER. Cat scan revealed no bleeding or abnormalities.

[sftc]

OK, well here's a suggestion on how you could prevent doing any of those things again- slow down, focus, concentrate on what your are doing.

#1- Helmet or no helmet?
#4- WTF?

[Dug]

I think it's time to go find someone to buy you a shitload of alcohol for you to binge on, and then consult richie rich for prophylactics the next day.

[splat]

4. Walked full tilt into a cement post. Blacked out. Went to the ER. Cat scan revealed no bleeding or abnormalities.

This one kinda jumps out at me as an indication of a lack of awareness due to your head being in the clouds, figuratively speaking. I see people all day every day who are not in their bodies, not in the moment, yet somehow managing to carry on until they simply fuck up themselves and sometimes other people when they collide with the world.

I think they are so lost thinking about their past and worrying about their future that they have no energy left for living in the moment, ie, being here now. You seem to be a reader, Phill. I suggest you pick up a book called "Why People Don't Heal and How They Can" by Caroline Myess.

If you like it, follow it up with her next book "Anatomy of The Spirit." Daron Rahlves attributed his back to back downhill wins in Norway to having read that second book on the plane on the way to the race.

[nick > jesus]

weren't you planning going to SA next month? i some how have a feeling that doctors are going to advise you to avoid concussions at all cost for at least another month, if not more. to add another head injury now could be bad. Why take the risk? lay off till winter.

[Neurodoc]

Hi Phil,

First, the advice above to return to see your neurologist is a good one, particularly as you have a persistent headache.

The anatomy of what's happening to you with each successive concussion is called "diffuse axonal injury." Essentially it is damage in the long structures (axons) that brain cells (neurons) use to communicate with one another. This injury can range in severity and be cumulative.

This is a technical article, but it gives at least the flavor of the metabolic and structural changes that happen in the concussed brain:

http://www.pubmedcentral.nih.gov/art...medid=12937489

I very much wonder if your first concussions put you at risk for some of the subsequent ones. Your walking into a cement post and also having a traffic accident could be related to impaired concentration - a subtle and often long-term sequela of a head injury. It sounds like you've had at least three "Grade III" concussions: loss of consciousness and prolonged impaired thinking. If you played a team sport, most coaches would say your season is over. Below is a chart summarizing various guidelines regarding return to play:

http://www.momsteam.com/health-safet...s-a-comparison

Note that the Colorado Medical Society guidelines discourage a return to collision sports after the third Grade III.

Look at it this way - pretty much any part of you can be stitched up, grafted, pinned, replaced or otherwise fixed - except for your brain (and spinal cord).

The good news is that because of your youth, you will probably recover well from this concussion. Young brains are "plastic", meaning they can easily make new connections and route around areas of damage. However, you've got to give your brain a chance to heal first. Your next concussion might mean you have to relearn how to do arithmetic, for instance - or worse.

Feel better and PM me if you have any more questions,

Neurodoc/Acrophobia

[AsheanMT]

..

Yikes! What a bad haircut!!




Seriously though, go see a doc about the persistent headache as that does not sound good at all.

[Huckin eh?]

Dude
Get well soon, though soon probably isnt the right word. More like "completely" however long that takes.
And ya, no SA for you!

[Phill]

And ya, no SA for you!

Well fuck thats what its starting to sound like. I'll be going to to a doc to get a real medical opinion but

[Uncle Ficus]

Neurodoc brings up some good points which I will add to.

What you may be feeling now is what some call "post-concussive syndrome". It consists of abnormal symptoms in how you feel or behave. Outbursts of anger or irritability, headaches, dizziness, difficulty concentrating, cognition and many more. It can last from days to over a year. It happens in 30-80% of people with mild traumatic brain injury.

Neurodoc can correct me, BUT I am under the impression that diffuse axonal injury does not always happen in concussion, but it may. It tends to show up on scans in its most severe form, in which case you will probably be in a coma.

Now another explanation for how you feel besides DAI or PCS, is the risk of having symptoms "locked in". If enough time is not given after a particular head injury, and you are experiencing any post-concussive symptoms, they can become much harder (or impossible) to get better if you have another concussion soon after. Hence the symptoms becoming "locked-in", and Mike Tyson's speech.

5 concussions in a year is more than Eric Lindros had in his whole career, and it forced him to retire from hockey because they feared for his health. That should tell you something.

[Neurodoc]

Neurodoc can correct me, BUT I am under the impression that diffuse axonal injury does not always happen in concussion, but it may.

This is a cartoon from the first article I cited:



Injured, unhappy neurons tend to dump calcium, which does a bunch of bad things. Calcium influx causes swelling and injury of the axon (the thing on the right). This biochemical injury is potentially reversible unless the swelling is so severe that it causes organelle damage and the axon dies ("secondary axotomy"). It's also possible to get DAI via mechanical shearing forces ("primary axotomy"). This is usually accompanied by hemorrhages that light up on a CT scan. It's Not Good, as you've noted.

Now another explanation for how you feel besides DAI or PCS, is the risk of having symptoms "locked in". If enough time is not given after a particular head injury, and you are experiencing any post-concussive symptoms, they can become much harder (or impossible) to get better if you have another concussion soon after. Hence the symptoms becoming "locked-in", and Mike Tyson's speech.

Yes - in PCS, you've got a population of sick neurons that might otherwise recover fine if allowed to heal. However, a second insult before they've recovered can kill them.

There is also an entity called second-impact syndrome. The brain's blood vessels tightly control blood flow into and out of the brain, maintaining the pressure of the brain at a precise level. This is called "autoregulation." However if you have a concussion, even a mild one, followed shortly thereafter (days, weeks) by another, the autoregulation can go haywire, leading to swelling and catastrophic increases in brain pressure. Because the skull is a closed box, the pressure can increase to the point that no blood can circulate...and I think you can guess how that story ends.

Just as aside, I'd like to comment on the phrase "locked in." "Locked in syndrome" refers to an injury (usually a stroke) in the brainstem in the setting of an intact cerebral cortex. Patients can hear and see, and their thinking is intact. But they can't move or speak. Typically they can only move their eyes vertically and perhaps blink.

[GoNads]

I was looking through some photos and these reminded me of you in a sort of "what not to do" way.

So for the future...

Trying to flip trucks over with your head is out of the question.


So are head butting contests...


And jumping into trees, COMPLETELY out of the question


Dog hats, also probably not to be encouraged.


That's my medical advice to you.

[Gerome]

Trying to flip trucks over with your head is out of the question.

GoNads, back in the day when I played center/guard, our lineman coach taught us to hit using our face. If you're driving in to the truck at that angle, you would crush your neck and spine. Maybe you didn't want to ruin your visor, but just sayin' ya'know.

[kkozski]

Hi Phil,

First, the advice above to return to see your neurologist is a good one, particularly as you have a persistent headache.

If your headache is increasing and persistent, please get medical attention asap. I don't know if I would even wait to get into the neurologist. Maybe the ER for follow-up scans. I am an ICU RN, and the consequences of too much swelling in too little space can make it so you never ski again. I don't mean to sound hysterical, but your post really scares me. It is your BRAIN, take care of it.

[truth]

Neurodoc....

Seems that Colorado Med society guideline is really weighted on LOC which to me seems less important than the symptoms exhibited after the incident. LOC might be a great indicator but that scale really hinges on it which to me would seem to put many injuries outside the scope of the scale. According to them if there was no LOC it doesn't matter how long symptoms persist.

[splat]

Since you only have a finite number of axons, this shit will eventually not get better if the injuries are continuous.

[80's4eva]

How long does it take between concussions for them not to be "stacked" or is it the sort fo thing that everyone counts no matter the length of time in between? I had two concussions withiin a month of one another. The first was a really bad impact... blacked out for about 2 hrs and was disoriented but ok after than. THe second impact wasn't nearly as bad but the results were worse. Couldn't walk right for a full 24 hrs and had problems with my memory for awhile. I had two other concussions before these last two

Its been a year since I had a concussion so is the damage repaired or is it just going to keep stacking up?