Stacking Concussions.

[Phill]

Phil - Thought I may have had an idea of who you were until seeing the
Is your hair unsually straight in that picture?

hmmm? what?

[Crystal_Mt_Dreamin]

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?

So this is a bit random, and I'm not a doc here, but from a contact sports background, there's been talk amongst educated fight docs of requiring a baseline brain scan done, than after every KO/concussion you can't fight again til your brain scan matches that original baseline. Basically the docs are saying that no one heals the same and that the current mandated suspensions post-KO/concussion aren't long enough. Take your time to heal up, like the docs here said it's your damn melon for crying out loud, you don't want to be Mohammad Ali.

Someone mentioned mouthguards earlier, here are two interesting articles I found when I was researching a new one

http://sports.espn.go.com/nfl/news/story?id=2314899
which led me to
http://www.mahercorlabs.com/mouthguard.htm

Anyways, apologize long-winded, non-doc uneducated response. I hope you heal up. I know it sucks being on the IR, I had a habit of coming back too early from injuries early on and they are still nagging me now X years later.

[moracass]

edited it out, most likely mistook you for someone else who totaled their car more than a few days before thread posted date. get well!

[jm2e]

Phil,
I think neurodoc summed things up pretty well for you, but here's my little patronization for you:

go down to your neighborhood trauma center and ask for a tour of their neuro unit. say hi to all the kids with traumatic brain injuries there who are learning how to eat, walk and shit again. when they get agitated and attack their own family members, wait a minute while the nurses strap them down and chemically restrain them. then go over and remind them how lucky they are not to be the kid next door who's got tubes coming out of his head, neck, chest, dick and ass and doesn't recognize his parents anymore.
then take a trip over to neuro rehab. find the kid who's been in there for 8 months learning how to walk, eat and bathe himself before he can go home. find out when he thinks you should get after it again.

sorry if I sound like a dick. you take care of these people long enough and you get a little.......crazy.
Find your friend or relative who's a hospital nurse (everyone's got one) and ask them who the best neurologist in town is. See them and then get a referral for a neurosurgeon. Tell said docs everything you intend to do when getting after it. Tell them you intend to get after it even if they advise against it, but that you still want to be prudent and heal up as much as possible first. Get their advice and take their advice. Brains take a long time to heal and they don't always heal completely.

walking into a concrete post probably suggests that you're a bit less than 100%. getting knocked out from it suggests that you get knocked out pretty fucking easily. Pretty.....Fucking......Easily........
Not a good thing.

[JeffreyJim]

Take it from the guy who had his dream/life severely altered by a "bell-ringer". TAKE IT EASY.

Search "post concussion syndrome" on this board. See what I've gone through and realize it was 9 months ago and I'm STILL not better.

Brain injury sucks. Even "mild" ones.

[kkozski]

So, how is it going? Hopefully better.

[Crystal_Mt_Dreamin]

Came across this (not ski specific) today, thought there were a few interesting tidbits in it

http://mmajunkie.com/news/5269/ask-t...oncussions.mma

[Sugarloafer4Life]

I've have a total of 8 concussions over a span of 4 years. 3 have been K.O.s, the rest have been bell ringers. I'm no longer allowed to play college soccer, but I am allowed to ski. I've seen many of doctors to get cleared after each concussion, and they all seem to say the same thing. No doctor can predict what will happen if you get another concussion, there isn't any kind of a test they can run. At the most they'll suggest that you never do whatever it is that's causing these hits. After the extent of my concussions, I acquired ADD, my mental processing speed slowed and my ability to store quick memories diminished. You wont be able to find out what will happen next time, so just get quick on your feet, and keep your head on a swivel

[Neurodoc]

In this month's Archives of Neurology, there's an article questioning return-to-play criteria after athletic concussion. The author argues that current guidelines are not stringent enough.

Reaction time is persistently delayed, up to six months after concussion; this is most pronounced in athletes with lingering subjective symptoms. The study methods involve presenting complex visual or auditory signals that require an individual to react by tapping the correct key on a computer. An electroencephalogram can also gauge response time, via the appearance of certain brain waves after a stimulus. One group of researchers found a persistent decrease in amplitude in one such brain wave ("P300"). This finding was significantly more marked in multiply-concussed athletes, and persisted for up to 2.5 years, suggesting a permanent deficit.

Multitasking is impaired in even the lightly-concussed. The study method involves testing balance and cognition simultaneously. Even subjects with a single, mild concussion show significant performance deficits persisting for a month after injury.

In tests evaluating balance, asymptomatic athletes with single, grade I concussions showed balance impairment up to 2 weeks after injury. However, the multiply concussed athletes were impaired even after 30 days; studies were not performed after this point.

Finally, pathologic studies demonstrate widespread neuron damage after concussion. In one study of five mildly-concussed patients who died shortly thereafter (2 to 99 days) for unrelated reasons, axonal injury was widespread, particularly in areas important for memory.

Summary: a concussion, even a mild one, causes widespread damage to the brain. It affects reaction time, multitasking ability, attention, and balance. The effects can be long-lasting. Athletes with multiple concussions are more severely and persistently affected, and can suffer permanent neurological damage.

Mayers, L. Return-to-play criteria after athletic concussion. Arch Neurol 65(9), Sep 2008:1158-1161.

[Phill]

well that sounds good......


not.

[Dromond]

Phil,
I think neurodoc summed things up pretty well for you, but here's my little patronization for you:

go down to your neighborhood trauma center and ask for a tour of their neuro unit. say hi to all the kids with traumatic brain injuries there who are learning how to eat, walk and shit again. when they get agitated and attack their own family members, wait a minute while the nurses strap them down and chemically restrain them. then go over and remind them how lucky they are not to be the kid next door who's got tubes coming out of his head, neck, chest, dick and ass and doesn't recognize his parents anymore.
then take a trip over to neuro rehab. find the kid who's been in there for 8 months learning how to walk, eat and bathe himself before he can go home. find out when he thinks you should get after it again.

sorry if I sound like a dick. you take care of these people long enough and you get a little.......crazy.
Find your friend or relative who's a hospital nurse (everyone's got one) and ask them who the best neurologist in town is. See them and then get a referral for a neurosurgeon. Tell said docs everything you intend to do when getting after it. Tell them you intend to get after it even if they advise against it, but that you still want to be prudent and heal up as much as possible first. Get their advice and take their advice. Brains take a long time to heal and they don't always heal completely.

walking into a concrete post probably suggests that you're a bit less than 100%. getting knocked out from it suggests that you get knocked out pretty fucking easily. Pretty.....Fucking......Easily........
Not a good thing.

5 concussions in 7 months? I'm Mr. practical with jm2. You need to slow your shit down and think about what you are doing or you are going to end up dead or even worse, a vegetable. In 30 years no one will care how fast you skied. Learn to have fun and stay in one piece. This is coming from someone who has also had dumb accidents and nearly killed themselves.

[LHutz Esq]

Wasn't sure which concussion thread to bump but this one seems as good as any:

Short story- begining of September came off my mb in Whistler - out for a few seconds, no recall of about 6-7 hours that day. CT scan was fine, symptoms lasted for a few weeks. I had been bringing myself back slowly - plenty of rest, light exercise etc. and was feeling myself again.

Went out for a ski on Sat. nice easy run to see how I was doing and I hit a bit of wind crust, bailed smacked my head and saw some stars. Now the headache is back, as is the difficulty concentrating, dissorientation etc. Not as bad as the first time, but scary bad.

Any one gone through this? Is it game over for anything besides lawn bowling?

[Vinman]

It's not game over but you need to be cautious. Current info says no sports until your symptoms have at rest and with physical activity. Seeing your doc or certified athletic trainer would be a good start.

[XXX-er]

http://www.cbc.ca/sports/hockey/nhl/...in-fights.html

there was a segment on 10pm CBC news last night about hockey goons with brain injury Chronic Traumatic Encephalopathy (CTE). experiencing drug addiction, emotional instability and problems with impulse control, along with short-term memory problems and disorientation. ... sounds to me like pretty normal behavior for yer average lawyer

but seriously Sid the Kid had his bell rung and was going through the symptoms you mention and he didn't return to the pro hockey game until the symptoms went away

were you skiing with a good helmet?

[creaker]

Lots to be super cautious about here. I learned the hard way that emergency level clinics don't cut it. Long story short, crashed mtbing, landed on head and split helmet in half, went to clinic, got scanned and released with "mild concussion". Next morning could barely raise my arms in the shower, called an orthopedic doc friend who immeadiately put me on steriods because my spinal cord was swelling. Had I let it go it's possible I'd be unable to type this.
Concussion was not mild. Went for a neuro consult (i'd had 2 the previous winter) and he started with
"let's act as if your brain will be important to you for the rest of your life...".
That's the best advice I can give, along with find out who the 'varsity' is and go for a visit.

[LHutz Esq]

http://www.cbc.ca/sports/hockey/nhl/...in-fights.html

there was a segment on 10pm CBC news last night about hockey goons with brain injury Chronic Traumatic Encephalopathy (CTE). experiencing drug addiction, emotional instability and problems with impulse control, along with short-term memory problems and disorientation. ... sounds to me like pretty normal behavior for yer average lawyer

but seriously Sid the Kid had his bell rung and was going through the symptoms you mention and he didn't return to the pro hockey game until the symptoms went away

were you skiing with a good helmet?

Yah, I might have to switch to litigation.

I have a good helmet and I replace it every other season or so if it needs it or not. The second hit was not a hard fall by any means - just a tip over after hitting some cement like wind drifts on the trail from the T to the chair that looked a lot softer than they were.

It sucks, but as I feed my family using my noggin I think I am putting myself on the IR for a while. I'll probably invest in a mouth gaurd when I come back. I am just getting a bit pissed off with flippant non-skiers or groomer kings saying - oh I guess you'll have to slow down now, act your age, sell the DH bike etc, etc. The annoying part is that they are probably right, just to them it is an easy solution- to me I have to think about changing the way I ski/bike/live. [/whine]

[Neurodoc]

Wasn't sure which concussion thread to bump but this one seems as good as any:

Short story- begining of September came off my mb in Whistler - out for a few seconds, no recall of about 6-7 hours that day. CT scan was fine, symptoms lasted for a few weeks. I had been bringing myself back slowly - plenty of rest, light exercise etc. and was feeling myself again.

Went out for a ski on Sat. nice easy run to see how I was doing and I hit a bit of wind crust, bailed smacked my head and saw some stars. Now the headache is back, as is the difficulty concentrating, dissorientation etc. Not as bad as the first time, but scary bad.

Any one gone through this? Is it game over for anything besides lawn bowling?

I suspect you fell on Saturday because of lingering effects of the concussion you sustained in September. If you had loss of consciousness accompanied by amnesia, you almost certainly killed some neurons, and injured others. This affects reaction time as well as other motor skills.

You should definitely not ski again - or do other contact/collision sports - until you are symptom free. Current guidelines recommend cognitive and physical rest, followed by a gradual return to activity.

Because people who've had one head injury are at increased risk of having more, and you've had two already, you should seriously consider taking the rest of the ski season off. The study I cited above suggests that multiple concussions affect motor and cognitive skills more profoundly than a single concussion does.

I very much doubt this means you need to give up skiing permanently. But you do need to give your brain time to heal, and that can take time. You should definitely see your GP, who may refer you to a neurologist.

[kingdom-tele]

thought Kevin's remarks might be of relevant interest here..


http://www.burlingtonfreepress.com/a...ctext%7cSPORTS

[Vinman]

Neurodoc what return to play protocol are you using these days?

I'm a certified athletic trainer and I see sport related concussion regularly. Currently I'm using the SCAT2 form and iPhone app for sideline and repeat evals. I'm also using there turn to play protocol described in the 2008 Zurich concussion conference.

Basically the protocol is rest until a symptomatic then progressive step wise progression of activity over time with ongoing monitoring of sx.

My only issue is getting the ER and GP docs in my area to recognize and treat this way.


Fighting gravity on a daily basis

[orlowskij]

I'm not a doctor but I'll echo the advice to take it easy until you're completely symptom free. I've had 6 or so concussions over the last 8 years. One during an mx race knocked me out for almost 10 minutes and was followed by 8 months of follow-up testing before I was fully cleared. This year I got one in early May, followed by a second about a month after. I thought the symptoms of the first one were almost gone before the second one happened, but I was feeling the effects of the second one through October. Thankfully I've recovered from all of mine (I think), I can't imagine dealing with the effects forever. Be nice to your brain.

[Neurodoc]

I'm part of the Sports Neurology Section of the American Academy of Neurology, and let me tell you there is a lively discussion going on about return to play guidelines. The general consensus is that current guidelines are insufficiently conservative. Tools like the SCAT2 are great in that they raise awareness in non-neurologists that the symptoms of concussion can be subtle but clinically meaningful, and outline a gradual program for return to activity. In the office, I do a complete neurological exam, and can send people for imaging or neurospychological testing, if indicated.

Current evidence suggests that even a minor head hit, without loss of consciousness or amnesia, can be associated with significant neuron injury. For recreational skiers, what this means is if you fall and feel even a little dazed afterwards, you should stop skiing. And seek medical attention if symptoms persist. At the very least, follow a stepwise (and slow!) program for gradual return to activity once you are completely symptom free.

American Academy of Neurology Position Statement on Sports Concussion

[L7]

All I can think of is Eric Lindros vs Sidney Crosby. 5 concussions in 1 year!!?? That is not to be taken lightly and a Sidney Crosby approach is by far your better option I would think.

[Piggity]

Reading this post gets me thinking. I couldn't possibly count the concussions I've had from football when I was younger, mostly while delivering the hit on defense, black out type hits. Coming to with all you teammates batting you on the helmet and screaming in your face and then play the next play. What the fuck were we talking about on this thread? Today was sunny


Good luck OP

[LHutz Esq]

Thanks Dr. ND,

I took your advice and I spoke with my GP, we are going to go with rest for a bitn and see how it goes.
No skiing, no hockey,
I now see why depression is listed as a side effect of concussions.
One of the issues I have is that I have a mentally demanding job so that type of rest is difficult to get.

[steezybomber]

Hey Man, i thought for a while about how to best respond to your post. While I wont go into extreme details about my personal situation, if you would like more specifics, feel free to PM me and I can send you an email.

I am not a doctor, so take what I say with a grain of salt.

I will reiterate what others have said, the most important thing you can do now is rest. Rest. REST. I repeat REST. Your brain is swollen. Although you said there appears to be no bleeding, your brain needs time to heal. It is much different than other muscles, tendons, organs etc. While other things can be stitched up and replaced, we only get one brain. Once its gone, its gone.

Concussions are like a domino or multiplier effect. You have one, and if you dont let heal long enough, your more susceptible for another, which is in turn more severe than the first.

While I am still too immature to regret my decisions, and still enjoy the story, I am mature enough to look back and thing WTF was I doing and why was I such an idiot.
Basically between skiing, DH Biking, ATV's, bikes, dirt bikes, etc etc, I had a run of 4 concussions in less than 2 months (closer to 6 weeks). I then proceeded to not tell anyone about it, because I knew they would say I should not go skiing at J-Hole. (FYI, high altitude like a plane is not good with brain injury).

It was eventually divulged that I hit my head numerous times after a very short temper, mis-judging distances, poor spacial reasoning, memory loss, bloody noses, impulsive etc etc. Basically the text book case of post concussion syndrome. I did not take it serious, and still do not to a certain extent. I mostly try to make light of it and joke because if I truly think about it, it scares the shit outta me.

There is a solid 3 months of my life I do not remember. I was found longboarding around my campus listening to music (by my roommates) because I couldnt remember what time I had class, where class was, or what grade I was in. This March is coming up on 2 years, and I am just now starting to think clearly. My memory is still off, but improving, my aggressive nature and impulsiveness is gone, but my head is still sometimes off.

Again, I ignore this and make jokes because its scary stuff. Lost touch with some friends, ruined a relationship, and hated life while working my first job, and think that the concussions had something to do with it. And we are talking almost 2 years after!

I think your idea of a full face helmet and a mouth guard is a great idea, its a good first step. One thing to remember (do not know if this applies to you or not), after a concussion, be very careful with alcohol intake, sleep aids, and pain killers. All of these things affect how your brain processes thoughts, fires neurons etc. I was injured pretty bad on one of the falls, and the doc said no pain meds because of the effect they had on the brain. I am not saying im perfect, but just be cautious on your intake.

Anyway, thats enough of a rant for me. If you want any more information, please feel free to contact me. Been through all the tests imaginable, seen tall the docs, had all the effects. Rest, rest, rest, and no more falls. Missing one season seems like the end of the world (did to me), but not remember part of your life sucks worse. Good luck and heal up quick buddy. cheers