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Concussion: Post-Crash Recovery Phase 3, Over the Hump
Related: concussion, cycling, health, Moots, Moots Vamoots RSL, 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 “over the hump” phase, wan inflection point at which things started to feel mostly normal most of the time, albeit with lingering cognitive fatigue.
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.
For context and additional interest and to test recovery for computer work, I am including images shot during each day.
Continues in Concussion Recovery Phase 4.
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April 16 31 days after crash, 26 days after ER visit #2: Being Cautious on Driving
After my evening-to-dusk ride last night on Hwy 89A in the Kaibab National Forest, which felt terrific, I was very tired (mentally), and fell asleep almost immediately from 8:45 - 11:30, then 11:40 - 03:10 and then 04:00 to 08:30 or so. My sleep was thus broken into three periods.
The sleep cycle can be affected by a concussion and this was certainly true for me. But it had improved greatly, back to my normal (not great but not bad) until last night, which follows the first day of highway driving in a week.
The first two sleeps went well, though waking at 11:30 I could tell from the “heavy” feeling that it had only just taken me out of some sleep hole. The 2nd sleep from 11:40 - 3:10 was normal and restful, but I woke up restless. After 45 minutes or so I feel asleep, but this last of the three was disturbed by continuous dreaming of an unpleasant kind. I would say that this third sleep period was “disturbed” in having prolonged dreaming right up to the point of waking, and then feeling groggy. This extensive dreaming was a hallmark of my acute phase as well as something known as common with concussions, so I take it as a warning that driving takes some kind of serious cognitive toll on me, since the previous 6 or 7 days I had biked every day vigorously and felt great during and after, the biking yielding more not less energy, and solid sleep—but on those days I had driven minimally. It might take me longer to get home than I expected.
Very high winds made driving difficult in my Sprinter photography adventure van, with 40 mph gusts bashing it around. I drove down to Fredonia, but retreated back up to 7200' elevation because of both the wind and also a huge pall of brown dust. Because of wind and dust, I did not ride today, and I did take a ~90 minute nap, which helped a lot.
Shown below is Hwy 89A after descending out of the higher elevation Kaibab National Forest. To the left is Pipe Spring National Monument and Zion National Park.
April 15 30 days after crash, 25 days after ER visit #2: Heading Towards Home
Extensive medical massage by Dee Sickles (see April 13) along with cycling seems to have worked wonders for feeling just about normal. My twisted back/ribs/spine (crash problem) are straight again, my sprained thumb is pain-free and various other fixes. Dee is a miracle worker—if you have chronic pain no one else can fix, go see her, certainly before surgery. Never have I had anyone so skilled fix issues so fast. She has some kind of at-a-glance gift, never mind her prior photographic (eidetic) memory.
Feeling vastly better than last week, I made the decision to head towards home, having spent nearly a week near Flagstaff, AZ. It is a nice restful area in the National Forest, and with good cycling too.
In Flagstaff AZ to start today, I am about 1100 miles from home to start today (Flagstaff, AZ). While the southerly route (Las Vegas, Bakersfield, I5) is shorter, it is not at all friendly if I need to pull over to rest and it is high speed and bad pavement. Accordingly, I am taking a northerly route through Zion and then Nevada to the Bishop, CA area then Hwy 89 towards the Bay Area. I expect this to take at least 5 days. I got a late start.
As a reminder that driving is cognitively demanding, two hours of driving seems to have taken its toll: after the driving stint, I pushed off the need for a nap and went for a late-evening ride which felt great, but upon return I was extremely tired (mentally speaking) and I dropped into a deep slumber, which proved a warning sign—see tomorrow’s entry. It is my feeling that something about driving at freeway speeds is very cognitively demanding. I never have that occur while cycling however, but cycling has a host of neuromuscular things going on, and uses a different attention mode than driving.
Below, looking back towards the Vermillion Cliffs / Lees Ferry area in far distance. I camped off Hwy 89A in one of the many side roads—no charge. European travelers take note of the free camping.
April 14, 29 days after crash, 24 days after ER visit #2
My energy level yesterday was very high starting mid afternoon, and so effective was the medical massage with Dee Sickles (see yesterday’s entry) that I felt normal all the way until 1 AM and slept better than I have in weeks.
Today is a new day and I just about feel ready to test myself with a half-day of computer work. Two more days and I will give it a go.
There is one thing that has been bothering me for some days now: a very high frequency faint white noise that I am hearing. It is not real but something my brain is doing—misfiring out of sync neurons? It is always there although it gets tuned out by active mental activity, or cycling, or similar. I want this to go away. I have actually observed this pre-concussion, but only sporadically. Also, in the past I have noticed when out in the wilderness with hyper quiet nights, the brain invent low-frequency rumble noises, very faint, but like it has to invent something when there is no auditory stimulation.
April 13, 28 days after crash, 23 days after ER visit #2z
To bed at 21:50, woke wide awake at 03:15 and felt restless and uncomfortable. This wee-hour waking has been a pattern recently. It takes an hour or more to get back to sleep and then to waken at 7:30 or so. I’ve tried melatonin, but I can’t tell that it does anything. My sleep has been less good in recent years, but this pattern is more consistent. Hopefully it will settle down to a solid 8 hours. Still, I felt good by 8 AM, then tired myself out with blogging, email and a phone call by 10 AM. It’s hard to look at a computer screen for long.
Outstanding bike ride today with effortless power and full lung capacity (~230 to 250 watts for 1+ hours at 7200' elevation is pretty good!). As days ago, it cleared my head and I felt great afterwards with no balance problems, yet earlier in the day I felt OK but not crisp. I had not been able to ride for two days due to cold temperatures and ferocious wind (Flagstaff, AZ area at 7200' elevation) and those days it was on and off a fog/fatigue thing.
Something about vigorous cycling is a huge help to me and I am not going to skip a day again unless the conditions are very bad. my working theory is that cycling pushes enough blood through the brain to oxygenate things and speed healing as well as firing off all sorts of neuron of many types, which in turn activate other brain areas. I would guess based on heart rate (135 to 140 bpm @ 250 watts at 7200') that about 3X more blood is pumped while cycling than while at rest. This has to have a positive effect.
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Prelude—I’ve been doing a lot of reading on the brain and nervous system, a prior but more sporadic interest pre-concussion. Many things have come together in my head over a long reach of time as well as recent events. I can’t possibly hope to describe this in detail but here I touch on a just a few things which might seem unrelated, but which I now see as part of a consistent whole:
- I’ve never perceived the world like anyone but a few handful of people I’ve met in my life. This has never changed.
- At the age of 16, I had a cavity drilled without anaesthesia; I blocked the pain somehow. And I have always had a high physical pain tolerance.
- In my early 20's I had a nagging hamstring ache for 6 months. An extreme skeptic of acupuncture, I finally gave in, and walked away pain-free in one treatment.
- The recent scientific findings on a claimed new organ, the interstitium show that modern science has much to learn about things right in front of its face. Often what passes for accepted science seems to be ignorance. It is my view that neuroscience is still a primitive area largely consisting of unknowns, with huge potential to unlock incredible potential for healing and human improvement. Hence concussions are largely a mystery as to treatment, at least to the mainstream medical establishment.
- In early January/Feb of this year, remarkable physical and mental changes occurred: cycling endurance, exceptional mind/body interaction while cycling, euphoric highs from extremely hard workouts, lungs going from highly impaired small airways for most of January (an issue for 30 years) to better than I can remember for years. I would note that I developed asthma from a virus; it is my view that an early January lingering virus flipped *off* some gene expression switch.
- My concussion rewired my brain. I noted certain changes in my April 12 entry. It is still evolving and I am still exploring, but I would summarize it by saying I am much more self-aware than before, both physically and otherwise. And yet I feel that my prior cognitive faculties are undamaged (though still slowed by incomplete healing)
And more. All my recent studying pointed in one direction: recovering from a concussion or other brain malady boils down to a single key thing: stimulating the brain and nervous system in a way that lets it heal itself. The problem is that for the most part, modern medicine knows next to nothing about how to do this and with most of the profession having until very recently a cognitive commitment that the brain cannot change or heal itself beyond childhood (the modern medical profession is rife with such ignorance, the gut microbiome being another very recent example, epigenetics, etc). All recent science as well as documented medical treatments by leaders in the field point to one thing: the brain remains highly 'plastic' even in old age.
This got me to thinking: patient, heal thyself—what did/do I need to do to stimulate my brain and nervous system to not only recover from the concussion, but to enhance the new self-awareness and perceptions it has brought on, with its forced rewiring.
I hit upon several things that made sense to me in this context: cycling, skilled massage therapy triggering the nervous system and thus the brain, electronic devices such as magnetic pulse stimulation.
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Cycling is actually a complex neuromuscular interaction, greatly increased blood flow, hormonal changes, visual and auditory stimulation, and sensor perceptions of touch, heat and cold, odors, etc. It is my view that cycling has been a major factor in healing my brain.
Skilled medical massage / hands on nervous system stimulation
Call it chance if you will, but in Flagstaff AZ far from home I called last night to make an appointment with Dee Sickles, in accordance with my thinking that one way to stimulate the brain is through the nervous system of the body. I was not disappointed.
Dee Sickles LMT, MMT - Divinely Nurturing Medical Massage
3100 N West St 200-D Flagstaff, AZ 86004
I will keep it short: some people have natural gifts that defy explanation. Dee at one glance can see pain points and similar issues and set to work fixing them instantly, intuitively. She located 3 old injuries and was uncannily accurate in her questions about them. I had a number of lingering issues from the crash and six hours over two days solved a host of issues from a knee area ache to tight forearm tendons (a problem causing me pain for two years) to a twist in my spine/ribs from the crash to a strain on one side of my head neck. The improvement was remarkable.
If you have a seemingly intractable physical problem including things that seem to require surgery, call Dee.
To my original point on stimulating the the nervous system: working my arm and hand (and also quad/calf area for a strain), I could feel the stimulation tingling the back of my head, showing that the nervous system transmits much to the brain. The tight tendons in my leg relaxed and equalized. As to my right arm, the grip strength doubled, the strain in my thumb (bothering me for 3+ weeks) all but disappeared, inner/outer arm rotation increased, tactile sensation in my hand and fingers was notably better.
Pulsed electro magnetic field stimulation
I will have much to say on this when I can personally attest to it, but existing products disappoint and there is a product out there that takes a new approach which I will evaluate myself soon, but which I have strong reason to believe will be a breakthrough product with major benefits.
tDCS (trans cranial direct current stimulation)
I use the Halo Sport. It works. I expect more advances in this area to allow stimulating neuroplasticity in more than the motor cortex.
April 12, 27 days after crash, 22 days after ER visit #2: Muddling
I am writing this late April 12.
Not much was bad April 11 or April 12, but I did not perceive any progress. I suspect that trouble sleeping the night of April 10 (after that terrific day) set me up for a need for more rest. The entire day of April 10, I felt restless, and unsettled, and naps did not satisfy or refresh me and didn’t even work right. So something was unsettled.
April 12 (today’s entry) was significantly better but like April 11 in general, but I was tied down by ferocious winds that made biking a risky idea, so I did not ride. Plus it was 10°F colder, not at all a pleasant combination. Still, a nap helped a great deal on April 12 and I felt as if I could have written my head would have cleared and it would have felt good.
I am expecting that April 13 will be a solid day.
April 11, 26 days after crash, 21 days after ER visit #2: Executive Control Asserts Itself
Today while talking with a friend for about an hour about this process and his own challenges, I observed a distinct change not seen to this point, which I deem a return to normalcy, what I would call the analytical/judging/alternatives executive functions asserted themselves and coincident with sustained attention. I watched myself as this happened (it startled me a bit) and then worked to consciously control it. It seemed to me that two areas of listening/thinking were competing, with the analytical side wanting to dominate, as has been my wont. More practice is needed, but t’s a skill that might serve me well in the future to control that.
As I understand it, what I felt happening are cognitive functions at the highest level in the brain (top of the pyramid so to speak), thus it suggests that full recovery is getting close (whatever "full" might mean, no one knows until the years pass).
April 10, 25 days after crash, 20 days after ER visit #2: Breakthrough Day
Continued late in the day after a bike ride. See the morning’s entry in Recovery Phase 2.
Why split the day over two pages? Because only later in the day did it become clear that an important change has occurred. See the morning’s entry in Recovery Phase 2.
This entry requires some background, to set the stage.
As a first effort at computer work, I have organized and added to the subject most important to me at present—getting back to full health—this series of pages describing my journey back to full functionality. Indeed my goal is to take some newly learned lessons and not only recover, but improve in various areas. I will not resign myself to any limitation until I have tried everything possible. I’m obstinate that way before or after The Crash; I tried to think of anything I’d ever quit for a few weeks now, and I could not. I am not going to quit on this one.
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Do NOT hope for the best, expect it!
So long as it is realistically possible, that is. Do not engage in false hope or expectations, and thus guarantee disappointment. Stay within the realm of the possible, which can be way out in left field / far out, but not impossible.
First, a little story. Nearly 20 years ago, my first daughter was born 12 weeks early with no warning. Dr Sunshine (his real name) pulled me aside to in essence tell me that she would be dead within a day or so. All the particulars logically pointed to that. I am neither religious nor mystical nor anything similar, but somehow I knew that all would be well with an unshakable certainty. Not for a moment did I even consider death as an option. How could I know/feel that? Who can say. Today she is healthy and strong and intelligent, a tough cookie who made it, including near-fatal sepsis a month later.
The point of that story is that I had the same feeling with my concussion, which I think manifests in my chronological log going back to the first days (see prior pages). And while my daughter is a separate individual, my point is this: the right attitude in and of itself increases the odds of a positive outcome. The mind and body are not separate, but support each other, interacting in incredibly complex ways that science has only begun to probe. This basic fact is lost on much of the medical profession, though that is slowly changing.
Think negative thoughts and the body responds, with problems. Think positive thoughts, and the body responds positively. Those who reject this baseline fact see only half the world and must experience cognitive dissonance at the placebo effect being not only real, but superior to many medications. I would say this: any doctor who treats the body as a lump of flesh independent of the brain doesn’t really know what s/he is doing, at least for many maladies. As just one example, does the brain control blood or vice versa?
The key, I think, is to stay upbeat and to not hope for the best but to expect the best, and to reject the ignorance of most doctors (no offense to doctors in this context!), few of whom have the patience or skill or training to understand mind/body interaction, let alone the training to have insight into the most complex injury of all (traumatic brain injury) and that in a unique individual. This has been my experience with other doctors with non brain injuries. I am not a statistic; I am a discrete individual and so are you and no woman bears 2.037 children, to drive the point home.
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I camped at an altitude of 7500 feet last night—quite high but I feel fully acclimatized and it does not seem to be an issue at all. Waking up, I felt good, and for the first time, I decided to take my own advice: be lazy and rest. Which I did until 9 AM, then I did a little blogging and decided to just rest and relax.
I have never tried meditation or mindfulness training, so what follows is purely my own speculation as to the states of mind those techniques beget. I would also say that post-concussion, I have observed changes in my control over my own sensations; I can now dissipate and eliminate minor pains in a few seconds, a skill I never had before. I am also able to consciously enter a state of relaxed awareness, awake yet relaxed as if asleep, and I can exit that state at will. That is, unless there is auditory or visual interference—I can’t tune that out, at least not yet. Maybe that relaxation is what meditation achieves; I don’t know.
I had been doing some reading (fairly extensive and a number of scientific papers). Acting on a hunch, around 9 AM I took some GABA for which there is no proof that it helps with concussion. Still, I had this hunch. Next, I used the Halo Sport for some tDCS neuro stimulation, first the as-designed way (motor cortex), then axially (neither recommended nor approved). My goal was to stimulate more of my brain—brain hacking. I found that this combination put me into a highly relaxed state, neither sleepy nor totally alert, but calm and at peace, yet fully under conscious control; I am certain that I could have stepped out of that state at any time, but I chose to enjoy the peace even as I observed myself doing so (hey, I’m by nature analytical!). I was aware of how restful this state was and while I was not sleepy, I decided to nap, for about 2 hours. Perhaps this state is what the literature refers to as “theta waves”—I don’t know, but it a distinctly different operating state of mind.
When I awoke, I felt rested and a little hungry and with a clear mind. Everything just felt right for my hardest post-concussion test yet: a ~49 mile ride with about 3000 vertical feet of climbing. I sensed intuitively that this would not be a problem, that I was ready, that the time was right. And I was right. The graph of the ride is further below.
The ride went well, power production was easy and fluid and I loved the wind in my face and the sunshine. I must have been exuding some vibe because 6 or 7 people at the pueblo at the bottom all reacted with friendliness. This was no accident, I think; it was a direct result of my body language (of all kinds); I was beaming out happiness.
Late in the day I started back up. I had just enough water and two GU packets (100 calories each). Nothing felt hard; I felt good. In the top 1/3, I thought I would try my own advice: smile and things will feel even easier—a smile invokes the brain, just as the brain can invoke a smile (a proven neurological fact). I was impressed that smiling elicited an involuntary big grin in response. At the same time, the late-day beauty and sensual feeling of the wind and warmth and coolness and shadows and light all felt like a coherent whole, which words or images really cannot put together properly. All systems were hitting on all cylinders.
The monument road was deserted and it was nearly full-on night as I returned, with the air turning chill at 7500' elevation. But when my body is working well, heat production wards off temperatures as low as 45°F with no discomfort; when this occurs it is like a gauge of wellness as I have learned over decades. And that was the case.
I do not think I amy ready just yet for a double century—more time is needed. But I do feel that I am over the hump. The next test is computer work for 3-4 hours, to see if my brain can handle that, a different kind of stress (mental, not physical).
Odd how things work: I sensed that a turning point was near, and I bought this celebratory bottle anticipating it just the day before. Positive thinking plus self awareness? Still, I did not drink it this same day; after a hard ride it is unwise to drink alcohol as a rule. It can wait a few days. Dan M, there is a bottle of this for you whenever you ask.
Finally as further proof that a turning point has been reached, I just now finished this essay at 10:50 PM, three hours later than my bedtime for the past 3 weeks—and I feel a bit tired, but normally so.