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Concussion: Post-Crash Recovery Phase 1, Post-Acute Phase
Related: acclimatizing to altitude, concussion, cycling, health, noise, road biking, training
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 8 to 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 / MacSales.com and B&H Photo for their ongoing support as I work through this.
Continues in Concussion Recovery Phase 2.
Update April 2, 17 days after crash
I gained a lot of strength back over the past 4 days, in spite of some not very restful days (driving long distances). Altitude has not bothered me up to a mile high other than inciting some tiredness, but that is true even pre-concussion (I had to sleep at 5280 feet elevation 3 days ago, unavoidable—no issue). Morning Resting Heart Rate (MRHR) still is ~7 beats higher (50) than it ought (43), and diastolic blood pressure often 20 points high, but I did get normal readings today (116/71, 120/72, 121/70) after several readings earlier in the day of 132/96 or so.
As with most things: 3 steps (days) forward, 1 step back, but only a small one I suspect and really only a rest issue I suspect. Yesterday’s 610 mile drive at too-high altitude (much of it 5000 - 7200 feet) took its toll both ways—it is quite demanding to drive at 65-75 mph. No harm done I think, but it wore me out in spite of my daughter driving more than half the distance, but we’ve arrived and I can now rest for 3-4 days.
I’ve done my cycling test 4 days in a row now (short ride each day). I have observed no negative issues that I can attribute to it. Indeed, over in the Panamints for the first ride, I did high wattage at 90°F at high rpm (98 to 105) for 45 minutes—just felt good and so did the next day. I did not / do not detect any negatives I can attribute to the ride. My heart while riding is tricky to assess; it might be ~5 beats higher than it ought, but the much higher temperatures make that a tough call. Everything feels fine and balance seems fine. Still, I doubt I could manage a 2 hour ride without overdoing it—demands on the brain add up—I’m not ready for even testing a short high speed twisty descent—that will need a few weeks to approach and only after I can ride 3 hours and notice no mental fatigue. I’m going to keep easing into it; the short rides are feel-good ones and for staving off loss of fitness (and weight gain!), but I’ll shoot for a 90 min ride in a few days if I feel well rested by then.
Now I am at my father’s place and should get 3 days of good sleep and rest whenever I need it.
I did get some shooting done on the way which I will publish once I feel I can work on the computer without strain for an hour or more. I’m waiting 3-5 more days to attempt it. Shooting (photographing) not very far from the car is both low risk (falling/tripping) and not very mentally demanding from what I can tell.
I’m not a big fan of the “loving family” idea—blood is an accident of birth and there are plenty of interactions within families including mine that are not conducive to recovery (if only 3 teenagers letting me have no peace just from daily acitivities in a small house from 6 AM to 11 PM). So I do not see “family time” as necessarily helpful for a concussion. Nor do family members necessarily have ny concption of what it is like to deal with a concussion, starting with emotional fragility and stress from even simple things, like a vaccuum cleaner.
Indeed it was not particularly restful in visiting my father, if only because of needing and wanting to interact during the visist, which is demanding at the tail-end of the acute phase, taking energy and taking up hours that I ought to have taken a nap instead. But when visiting family, you visit right? Wrong idea for a concussion, in general, methinks—too much demanding interaction which for a concussed brain take energy.
I need/needed the peace of the outdoors and 1 on 1 with no schedule. As an example of something suitable: I love my daughters and I enjoy showing them things I enjoy where there is peace and quiet and no particular schedule to cause stress or strain. Here I am with my eldest. My advice to concussion victimes once they are past the acute phase and can safely travel (by car): go camping in car or tent or adventure van where there is no TV or newspapers, no people and only the sounds of the wind and birds. This will go a long way towards healing your brain and outlook and spirit. Indeed, quiet experience in nature is scientifically proven to reduce stress, and stress is like poison for a concussed brain.
Update 29 March, 13 days after crash
Waking up at 4:40 AM to be at ADF Sprinters at 6 AM, driving through heavy high speed traffic into San Fernando definitely was not an easy thing for me (constant attention to everything around me, quite demanding), but I tolerated it, and rested later. Given that I could not fall asleep until 11:30 or so, that’s a sleep deficit that would have made it tricky pre-concussion also.
I tested myself on pain banishment last night. Maybe I never tried it and it is just nothing new and has been latent all along, or maybe the concussion is opening new neural circuits. What led me to the idea was yesterday’s thinking about neuroplasticity, in particular retraining the brain to eliminate chronic pain (achievable from what I read). I don’t have chronic pain of any kind, but I posited that the same idea might work for small things.
So I tried yesterday and today—anytime a headache or a small ache/pain arose, I made it go away through mental effort alone, a sort of visualization of massaging away the spot of discomfort. I was a little shocked to find that so far, every such attempt has succeeded, usually in 5-10 seconds. Whether I can succeed for serious pain like a nasty road rash—I’ll push that off until when it happens! But now I recall over the years having mastered a broken finger, shearing of muscle and fascia (sliding bike crash) and other things. They never caused me more than short-lived pain, and in retrospect I think that unconsciously I’ve already been developing the habit, though sometimes forgetting to use the skill.
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Update 28 March, 12 days after crash
I am down in SoCal getting the table installed in my Sprinter van, along with a reference-grade state-of-the-art rewire for my 10 kw lithium iron phosphate battery system (the kind that won’t burn up like most lithium batteries do). The 47.5 gallon fuel tank rocks, and after filling it up from 8 to 47 gallons, the van rides better with the extra 320 pounds, which is down low so even the handling improves—you wouldn’t believe how good it drives with so much mass down low, as tall as it is. My daughter did a nice chunk of the driving, which helped a lot.
I am getting a little stronger each day and will soon start probing recovery with some (very short) bike rides to start, increasing effort and distance only when the prior day’s effort has no perceptible fatigue results. Already my tolerance for computer stuff has increased substantially, and I can tolerate much more than even just 3-4 days ago. But I still feel it hanging on me, so I keep reminding myself to take it easy—tomorrow I’ll rest a lot while the van is being worked on. I bought some Sony noise canceling headphones, which work great in many conditions,
Exercise vs aging
For some years I’ve commented now and again in the health articles of mine at WindInMyFace.com that I was certain that cycling has major positive effects on health, e.g., I can’t remember having any significant infection for years, and only a sniffle or two per year at most.
Indeed before this concussion, I was on track for the strongest double century performances of my life and I am now almost in my mid-50s—for the first two doubles this year, I outrode hundred or more other cyclists by a large margin, excepting a team of 3 working together who did not beat me by much. I had the Perfect Plan this year, I was way ahead of my already audacious goals, but all that was upset by one stinking pothole.
The New York Times in How Exercise Can Keep Aging Muscles and Immune Systems ‘Young’ comments on two aspects of health. See the entire article for a fascinating read that dovetails with my own self perceptions over some years about exercise and health. My father is 78 years old, and he still rides about 16-20 miles three days a week—most of his old friends are dead.
Remaining physically active as we grow older could help to keep our muscles and immune systems robust, according to two inspiring new studies of older recreational cyclists.
Together, the experiments add to growing evidence that some of our assumptions about aging may be outdated and we might have more control over the process than we think.
...For their inaugural study of the riders, which was published in 2014, the scientists measured a broad range of the cyclists’ physical and cognitive abilities and compared them to those of sedentary older people and much younger men and women. The cyclists proved to have reflexes, memories, balance and metabolic profiles that more closely resembled those of 30-year-olds than of the sedentary older group.
... older cyclists are not like most of the rest of us. They are healthier. They are, biologically, younger. Their muscles generally retained their size, fiber composition and other markers of good health across the decades, with those riders who covered the most mileage each month displaying the healthiest muscles, whatever their age.
The impacts on riders’ immune system also were marked. In the older sedentary people, the output of new T cells from the thymus glands was low. The inactive older peoples’ thymus glands also were atrophied, compared to those of the younger group. The aging cyclists, on the other hand, had almost as many new T cells in their blood as did the young people. Those who exercised also showed high levels of other immune cells that help to prevent autoimmune reactions and of a hormone that protects the thymus against shrinkage.
Update #2 27 March, 11 days after crash
One thing concerning me is that when I do return to cycling, it might to 6 months to a year to push down the fear response when going fast again—I experienced this as a teenager after a crash in the French Alps, though I don’t think I had a concussion then, as I slid nicely through rocks and weeds rather than an abrupt shock.
This is the first concussion in cycling that I know of (a few minor crashes here and there), and that I’ve done 80,000 miles in the past decade, and none of it slow. Of course I have to verify that I recover with my former mental response time and balance before resuming what had been routine high speed descents and similar.
Some readers have in effect questioned my judgment on wanting to cycle again at all. That would be a major psychological blow impacting me in negative ways—I’d probably have to fight off depression with a huge hole like that taken out of my life—it is something I greatly enjoy with no easy substitute. Plus I see it as an essential counterbalance (health and comfort) to many hours in front of a computer. Walking and running and swimming and weight lifting would either bore me to tears and/or damage my body (osteoporosis with swimming, cartilage loss with running) in relentless ways. My old favorite of speed skating would be fine, but that carries similar risks to cycling, and there is no good stretch of pavement nearby anymore. All my life I have not just desired but required intensive physical activity, which I know from experience ultimately provide the deep well of energy for all my mental activities. I can’t see anything but cycling fulfilling that need physiologically and in terms of time and cost and enjoyment.
Feeling better now at about 11:33 AM. I took a short nap bare-backed in the sun while I used me own form of meditation, briefly for just 10 minutes or so. And I’ve been able to use the computer for an hour or so now and no headache. But time to stop now, what I reflected on follows.
I think I am going to apply neuroplastic healing consciously, once I figure out the best approach. In fact, I realize that I have already been doing that meditation-like while half napping—and it seems to always refresh me.
Thank you to the reader who suggested The Brain’s Way of Healing by Norman Doidge, M.D.. I’ve just been skimming but so far I am dumbfounded in realizing that the little cycling tricks I’ve trained myself on for years seem to be precisely a form of neuroplastic learning.
Put another way, my huge gains this year * are the direct result of an accelerating pace of neuroplastic training applied to cycling, something I have become increasingly conscious of and thus focused on more and more. So why not healing?
I am certain that I have already learned to exert a form of neuroplastic improvements of various kinds while cycling—see Thoughts on Recent Training, What I’ve Learned and What Remains to Learn, “#3 Smile and be happy”.
I applied this idea another way just this year in Jan/Feb for massive gains in strength (and dropping 15 pounds), while completely turning off discomfort in my legs, even as I was riding 3 weeks averaging 60 miles a day (90, 60, 40, 80, 70, 40, 70, 50, 40, ... miles per day, etc). It was mind over matter. If I can do that, then I am sure I can heal my own brain. The question is how to do it quickly and in all areas—harder.
* See what I did at the 2018 Joshua Tree Double, especially the Results section—aside from the team small win over me, I was 43 min ahead of the next finisher, this accrued directly from intensive neuro-feedback training while cycling. See for example my Feb 8 blog post. While I don’t mention it there, I had been working for weeks on a mental/physical feedback loop while cycling.
Brain wiring — highly sensitive
I thought I would add this note, partly in response to some readers who have written to me to understand the way my peculiar brain works. I am a highly sensitive person, as are at least two of my three daughters (two actually tested as such, the third not tested but highly likely I think).
Sensory processing sensitivity (SPS) is a personality trait characterized by a high level of sensitivity to external stimuli. The trait tends to correlate with a greater depth of cognitive processing and high emotional reactivity. A human with a particularly high measure of SPS is considered to be a highly sensitive person (HSP)...
According to the Arons and colleagues, people with high SPS make up about 15–20% of the population and are thought to process sensory data more deeply due to the nature of their central nervous system.
IMO, research is pretty scanty and some of the description is both true and false at the same time (context), but there is no doubt the core trait is fundamental to my wiring.
This trait caused me many challenges during most years of my adult life (particularly from age 20 through 40 or so). It was only when I hit my 40's that I finally had some explanation of why I always seemed to react differently than those around me, to hear (real) things other people would not even notice. And why I fatigue and become irritable in high-stimuli environments, particularly noise. It is why all my life I have disliked cities, excepting short visits in the right context.
In terms of pre-concussion, I know that I can become highly stressed by excessive noise in particular, which makes a concussion harder to deal with—right now there is hammering, grinding, airplane noise, etc and that’s following lawnmowers, leafblowers and trucks—my brain tracks all that crap simultaneously like radar tracking incoming bogeys, and when stressed I cannot turn it off. It is one reason I hated cities the first 35 or so years of my life and definitely why mountain time with its (at times) cave-like quiet is so appealing to me—my stress level plummets.
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Update 27 March, 11 days after crash
Starting out slowly yesterday, I improved greatly over the course of the day, but I also had 2 doctor appointments and one physical therapy appointment (hamstring tear), and then a 'float' (relaxing). Too much but didn’t feel any of it was something to skip.
Napped only an hour or so total and certain other factors (hard to say which) might be why I was restless all night and very hot for hours, even at 40°F ambient and light summer comforter—had to throw it back several times. Still, it was very common for me pre-concussion to go metabolically very hot for hours at night from training hard, so last night and some other nights post-concussion are consistent with pre-concussion, albeit without the workouts.
Still, yesterday was encouraging and my to do list today includes napping a few hours.
I am limiting my work to answering email at this point. Waking from a late afternoon nap two days ago, I actually shot a few nice photos a stately crane in my backyard that was stabbing for frogs or mice or something. But I found that going through the photos was tiring me, so I quit that for now—will show/publish another day.
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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.
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.
Below, pre-concussion, I was about as strong as I have been in my life after the 2018 Joshua Tree Double Century, outriding all but the 3-man team, and outriding the last 5 aid stations. Boy, did I feel good, and it felt easy!