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Concussion: Acute Phase, First 9 Days After Crash

2018-04-10 • SEND FEEDBACK
Related: concussion, health

Legal disclaimer: Since we are not doctors, never follow anything based on health-related topics on this or related sites without first consulting with your doctor or other trusted health professional. OTOH, the study of brain injuries is at best in its infancy, like studying outer space with primitive telescopes.

This page contains observations during the acute phase, which for me was about 10 days post crash. During this period, I had very little tolerance for exercise and almost none for computer work.

Thank you to supportive readers, and especially my loyal subscribers. The latter are critically important to me as I recover, and I am grateful to them. I also want to thank OWC / and B&H Photo for their ongoing support as I work through this.

Crash was on March 17; I went to the ER but I was not even evaluated for brain injury in spite of telling the attending physician that I had crashed hard into an embankment at 25 mph as well as (in retrospect) having obvious concussive symptoms.

A short bike ride the evening of March 21 (just over 4 days later) sent me to the ER the next morning (March 22) with symptoms severe enough that I would not have been able to drive myself there (my wife drove me). It is my theory that the initial injury was exacerbated by my activities following the crash, light as they were (I knew something was off and was not doing much).

Continues in Concussion Recovery Phase 1.

Update 25 March, 9 days after crash

I felt better this morning after a half-day of napping and a good night's sleep (albeit with prolonged detailed and vivid dreams for a 2nd night). But 30 minutes at the computer was about all I could muster. My optimism about quick recovery seems not so well founded.

I’m getting the biofeedback message loud and clear: another day of napping, repeat until better.

When I rode my bike on March 21 (4 days after the crash), I felt “off” and did a 1/3 ride at light aerobic pace, well below typical. I felt very tired afterwards. I am now certain that this is what precipitated the next day’s morning ER visit (March 22, 5 days after the crash). The ER physician at Cottage Hospital in Solvang CA did not even evaluate me for a concussion, even though I told them I had struck an embankment at 25 mph. Hence I had no idea I had a concussion. Add cognitive impairment and my own cognitive commitment stemming from years of being strong and healthy in general, and that’s a bad combination for figuring it out on my own. The failure to evaluate me properly at that ER seems to have cost me dearly.

My upcoming trip I’ll have my daughter do most of the driving, or all of it unless I am alert and feeling normal (which I do for a portion of the day). And I’ll scratch my ass near sea level in Death Valley for a week or two if need be. Home is actually not good—a very small house and 3 teenagers is not a restful quiet place, so I’ve been napping and sleeping in my Sprinter van.

The one thing now that I hesitate on is visiting my father, who lives at 4000' elevation. While I’d scarcely notice that elevation under hard cycling effort pre-crash, hypoxia for concussion recovery seems unwise, based on a research paper I’ve found: see Traumatic brain injury (TBI) and effects of altitude.

Update 24 March, 8 days after crash

Yesterday I was a bit slow, but steady. Running some simple errands was too much of a toll; today was not so good. states:

For about 9 in 10 people with concussions, symptoms disappear within 7 to 10 days. Scientists have been working to learn more about those who take longer to recover.

Today is 8 days exactly from the crash. Discharged from the ER two days ago, I was categorized in a form letter as being "fit to return to work in 2 days" in spite of a diagnosis of a severe concussion with unconsciousness. I don’t blame the ER docs really—they are there to forestall loss of life, and brain injuries are very complex though I can’t reconcile the attending physician’s diagnosis of severe concussion with a 4-day recovery period after the ER visit!

In retrospect however, I do blame the original ER on the day of the crash as incompetent for putting me at much greater risk by failing to even evaluate me for concussion, in spite of presenting with obvious concussive symptoms and telling them that I went from 25 mph to 0 in an instant. Thus landing in the ER a 2nd time, 5 days later.

OTOH, I had one bright spot yesterday, with some intellectual fluidity returning in an animated conversation for half an hour—felt almost normal. It proved to be too much, along with running a few basic errands, and I’m paying for that today.

I am now intent on napping and doing nothing at all for at least a week because “severe” looks to have been right. I don’t think I’ve lost any intellectual capacity (various self observations), but I am operating on “impulse engines” with warp drive down (if you’re an original Star Trek fan!), with very limited stamina.

Late in the day (7 PM): I napped about half the day. This seems to have resolved the mild headache. Maybe tomorrow will bring better things and I will nap some more and hope this is all about letting my body do its thing.

Update 22 March (5 days after crash)

Thanks to all the well wishers. I did not respond to many, for obvious reasons.

I felt really out of it this morning along with headache and “tight” feeling in head, and I felt the onset of a repeat of symptoms very similar to after the crash, only more severe. My wife drove me to Stanford ER and I was diagnosed with moderate to severe concussion which is now termed “mild brain trauma” or some such—I can’t remember exactly if that is the right term because I was mentally muddled as the attending physician stated it as “all the classic symptoms” of severe or moderate-severe concussion.

The good news is that I ought to have a full recovery, indeterminate but perhaps as quick as a a few weeks. But that’s all guessing really and I’m supposed to take great care not to knock my head any time soon again. I’m going to rest and sleep for at least a few days and hopefully my physically robust condition will contribute to healing of the brain, quickly.

As on the day of the crash, I had a repeat event of a severe emotional swing this morning (sadness/crying and then back to alert/upbeat in the space of a few hours). I’m told this is one of the 'classic' symptoms of concussion. Again as on the day of the crash, I had some difficulty speaking and remembering simple things. There is an onset, and then over an hour or three it passes. This I’m told is what is to be expected from a concussion. I can’t fully describe the total feeling but if you knock your head be on the lookout for those types of signs and get checked out.

Tests: CT scan of head showed no fluid around brain (good). EKG (twice) normal, detectable Troponin (damage to heart releases it) but just barely, probably due to the endurance riding more than the trauma.

Blood pressure tested from about 170/110 to 152/102 which is an unprecedented high for me (normally 118/64). I also noticed an elevated heart rate of 10-15 bpm above normal. Both things are normal for the body’s reaction to trauma, so I’m told.

I still can’t figure out how the entire arch area of my right foot was bruised black and blue! It all happened so fast, and I don’t even know for sure if I passed out briefly.

All for now, I’m having cognitive trouble reading and proofing the above, so I’m going to take a nap.

Update 13 April: I forgot to add this interesting observation: while lying in the hospital bed a few hours into things, I was able to function again. This is what I noticed: bifurcated pain, that is, the left side of my body from eyeball to hips had a general low-level ache right to the middle of my skull as if I had left/right halves (I declined to treat it). It occurred to me even then that this might reflect the fact that the right side of the brain is responsible for the left side of the body, and vice versa. Whatever pain there was was highly asymmetric.

March 21, evening, 4 days after crash

I’m not functioning quite right—I think my bike crash at 25 mph left me with a mild concussion (doctor concurs), so I might not be updating things for a few days or more. So if I suddenly start raving about Fujifilm X or switching to Windows, you’ll know something is up.

One symptom right after the crash was an inability to speak even "yes" or "no" for about 15 minutes. It took 30 minutes to speak in short sentences again. Doctor thinks that's a likely sign of concussion. About 90 minutes after, also had wild mood swing. I wrote that off as adrenaline surge plummeting, but now I think it makes more sense. CT scan showed no internal bleeding in abdomen at least.

Of course this is horrible even beyond just recovering—taking time off, that is, no one pays me for sick leave—that would be me paying myself.

Below, 5 days prior to crash. This is the kind of road I could easily ride for 100 miles for fun with ease. For doubles I often take two spare tubulars by taping the 2nd one under the saddlebag. It’s amazing just had poor iPhone 7 quality is—yuk.

Lloyd after finishing 2018 Joshua Tree Double Century (winning non-team by huge margin)
f1.8 @ 1/500 sec, ISO 20; 2018-03-10 15:32:24
iPhone 7 Plus + iPhone 7 Plus back dual camera 3.99mm f/1.8 @ 28mm equiv (4mm)

[low-res image for bot]


March 20, 3 days after crash

March 19 2 days after crash

March 18, day after crash

April 17, day of crash

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