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Post-Concussion Syndrome (PCS)

I suffered a moderate to severe concussion in a bike crash at mile 87 of the Solvang Spring Double Century:

Lloyd’s Mild Traumatic Brain Injury (mTBI / concussion) Experience and Log

Post-concussion syndrome (PCS) is a term used to describe lingering effects of a concussion.

From Guidelines for concussion/mild traumatic brain injury and persistent symptoms:

2.3 The patient should be advised that a full recovery of symptoms is seen in the majority of cases.

In most cases, patients who experience mTBI will recover fully, typically within days to months. The concern is that up to 15% of patients diagnosed with mTBI will continue to experience persistent disabling problems.

The consequences for these individuals may include reduced functional ability, heightened emotional distress, and delayed return to work or school. When symptoms persist beyond the typical recovery period of three months, the term post-concussion syndrome or disorder may be applied.

This is very good advice (2.3)—an expectation of full recovery (to be distinguished from hope) is critical. But it doesn’t mean that full recovery will be realized in the proper sense of zero lingering effects.

I am now sure that I suffer from Post Concussion Syndrome in several ways, 3.5 months after the incident. I am “fully recovered” in most senses, but life-altering limitations remain. In particular my ability to work long hours is diminished to the point of causing financial stress (being self employed). Along with emotional distress and handling of stress in general, greater sleep requirements.

Maybe six months or a year will slowly repair things, maybe not.

I suspect that few concussion victims having a concussion of a severity like mine (or even somewhat less severe) are ever going to ever be the same nor will they have zero after effects months or years later. I say this because not one of perhaps 30 emails I received from concussion victims indicated as such; not one indicated recovery in every way back to pre-concussion functioning. On the positive side, most all reported regaining mostly normal functionality eventually.

Medical science has few ways to fully evaluate post-concussion functionality and at best a handful of qualified clinics to do so (and what of a baseline?). Then there is the expense, prohibitive for me at least (even though I pay $3300/month for health care!), and surely for most people.

IMO, medical science remains ignorant about concussion recovery: blind men feeling different parts of an elephant, and clueless about what “full” means. There is an incentive for doctors to be authoritative and appear knowledgeable when real knowledge is severely lacking. In my view, the concussion guidelines provide fodder for such doctors (read the whole thing), and thus does a disservice to patients. Still, there is much good in it also.

Finally, if medical science is so smart, why is research only now emerging on fundamentals? See Exercise may be best medicine to treat Post-Concussion Syndrome. My answer is that the medical knowledge about concussions is a vast desert wasteland by and large.

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