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Post Crash/Concussion Advice and Experience?
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Hi, I'm writing this to probe the collective ST community for any advice and/or their own personal experiences. Thanks in advance for your help!

-Pete

What Happened
I crashed on 8/22 while warming up for a MTB race. I hit a steep jump that I wasn't expecting, lost control, and went over the bars. The guy who was a few seconds behind me found me face down in the dirt having seizures, while breathing in dirt with a pool of blood forming around my head. I was unconscious for at least 5 minutes. Thankfully, my helmet took most of the blow. It cracked and cut my forehead, which was causing the bleeding. I was intubated and taken to a local trauma center. X-rays and CT scans showed no fractures or other significant damage to my head, neck, etc.. The real concern was some intracranial bleeding in my parietal lobe, so apparently I was put in a medically induced coma (don't know the details on that). I was held in the CCU until 8/24, when a second CT scan showed the bleeding had stopped. I was awake and they moved me to a regular room. They discharged me on 8/25 after I had passed their post-concussion test and felt everything was OK. I obviously got a fair amount of road rash.


Post-Crash Symptoms/Treatment
Neurologically I feel 100%. My memory up until the crash has come back...I remember going down the hill and vaguely having the "oh shit" feeling when I hit the jump. I feel as if I do occasionally feel I have some other memory issues, but it's so minor. I have a hard time telling how I'm different mentally/emotionally than before the crash. My only other neurological symptom is momentarily feeling light-headed/dizzy when I lie down, after looking up at the ceiling or down at the floor. No sleeping, balance issues, etc. I have my first follow-up with a neuro in a couple of weeks.

I did have some neck/shoulder/side pain the first 1-2 weeks. Went to urgent care and then an orthopedic, but they said no fractures and it's probably just a soft tissue. The ortho gave me a cortisone shot and 1 week of oral steroids, and recommended PT. The steroids pretty much took care of the pain/inflammation. I saw my trauma surgeon for a follow-up yesterday, and he said everything looked good from his perspective

I have had some CV/breathing issues that I'll bring up next in my post-crash fitness.

My appetite and diet has been affected. What's kind of freaking me out is that I've lost 4-5 lbs, since the crash despite pretty much eating the same amount while working out less.


Post-Crash Fitness
So, for a quick benchmark, I was in the best cycling shape of my life before the crash. My FTP was about 300 watts and my weigh was around 140 lbs. I usually biked 150-200 miles per week. Like any good endurance athlete, I was back on the bike (Zwift) 5 days after my crash. I was of course hurting, but got 30 minutes in and overall felt OK. I then got outside 1 week after my crash. I've gradually built my mileage up (longest ride being 40 miles) and got 150 miles in on the bike last week. I haven't tried running yet. My balance, etc. on the bike is fine, and have even taken my CX bike out on the dirt.

Now for what's really bothering me. Going for an easy effort doesn't bother me much, expect I do notice my HR elevated more than usual. What got me was going up a short hill a couple of weeks ago (just 100 feet). I felt like I was going to have an asthma attack at the top (I have allergies, but no real history of asthma). I feel that way anytime I put in a relatively short effort (eg, 250 watts for 1-2 minutes). I now carry an inhaler with me on my rides. I just feel as if my lungs and heart can't keep up. It's almost as if I'm not carrying enough O2 in my blood. Here's a quick comparison of the effect on my performance:

Starcrest Strava segment: 0.8 mile, 253 ft, 5% hill.

Week before crash: 14.5 MPH, 349 watts, 169 bpm, RPE (9 out of 10)
2 weeks after crash: 9.2 MPH, 193 watts, 167 bpm, RPE (12 out of 10) - Barely made it up the hill, and had to use an inhaler at the top

I'm at a loss for why I suck so bad. It's obviously related to the crash, since I didn't loose THAT much fitness in 2 weeks. I saw a pulmonologist yesterday and she's going to have me do a lung function test. Probably the most frustrating thing for me now. Just trying to figure out what's up. If it just needs time to heal, not big deal. Any ideas for the type of physician to see for something like this?

Thanks again for the help!

"Most of my heroes don't appear on no stamps"
Blog = http://extrememomentum.com|Photos = http://wheelgoodphotos.com
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Re: Post Crash/Concussion Advice and Experience? [allenpg] [ In reply to ]
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Dude! That sucks. Sounds like it could have easily been way worse, though.

I've had several concussions in my life, including one with a subdural hematoma. Never had symptoms like you describe. Heck when I was 9 I played half a soccer game without telling anyone until the headache was just too much.

Seems like a really good question for your doctors.
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Re: Post Crash/Concussion Advice and Experience? [allenpg] [ In reply to ]
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I have never had anything close to what you want through. In fact, the head bump I took in my first bike lay down is child's play compared to the sound of your incident. But I can say that even with what was at most a mild concussion, I had a week of light sensitivity, headaches, general reduced feeling of fitness. 2nd week I started feeling better, but had good and bad days. And that was just from a wheel sliding out in a slow, wet turn that caused my head to slap the concrete a bit (helmet in tact, nothing crazy).

I would expect it to take a month to get back to normal. It's why you see quarterbacks having to sit for an extra week or two when they get a concussion. And those guys weren't put into a coma. Your brain runs your body, and if it isnt healed, your body likely isnt going to run at its highest efficiency.

Kudos for getting in the saddle so quickly. I'm always finicky after incidents.
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Re: Post Crash/Concussion Advice and Experience? [allenpg] [ In reply to ]
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You need to slow down. There may or may not be a link between your concussion and what you are experiencing. You are at a significantly increased risk for further damage or death during your post concussive period if you sustain another injury. Seeing a professional for concussion rehab is a significant need for you. Do not rely on just your feelings or perceptions.
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Re: Post Crash/Concussion Advice and Experience? [allenpg] [ In reply to ]
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I had a similar injury in a road race in 2015. I never tested it but I seemed to lose 50-75 watts off my ftp and dnf'ed IMLP 4 or 5 weeks later. A few days after the accident I felt fine but just could not produce power. It took several months for it to come back.

I did a little google medical research at the time but I could not find anything to support my experience. In hindsight, I wish I would have searched out a specialist, I knew something wasn't right.

Sorry I don't really have any advice but know that your experience isn't unique.
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Re: Post Crash/Concussion Advice and Experience? [Thom] [ In reply to ]
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Any idea what could be a medical reason for a concussion trashing ftp? Indoor on a trainer what is keeping his heart and legs from working full speed ?
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Re: Post Crash/Concussion Advice and Experience? [copperman] [ In reply to ]
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copperman wrote:
Any idea what could be a medical reason for a concussion trashing ftp? Indoor on a trainer what is keeping his heart and legs from working full speed ?

I have no idea. I'm not even certain the accident was the reason. I did a century in June at 200+ watts and felt fine afterwords. After the accident I did Lake Placid in July I could only manage 166 watts and was too shelled to finish the run.
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Re: Post Crash/Concussion Advice and Experience? [allenpg] [ In reply to ]
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Ditto what others have said, you need rest and to prioritize concussion recovery above all else. This is a very serious injury and your brain needs time to recover. Not just not riding, like sit quietly in a dark room and not be on the computer rest. I had a concussion from a very minor 5 mph crash a couple years ago and it took at least a month to be back to normal, roughly, and I rushed that. My injury wasn't nearly as severe as yours.

You only get one brain, so do. Not. Mess. Around. With. It.
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Re: Post Crash/Concussion Advice and Experience? [allenpg] [ In reply to ]
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Check my posting history here and in the Lavender Room over the years (since Sept 2011). Feel free to PM me.

Intracranial bleeding (subdural heamatomas) are serious. Mine basically caused me to be permanently disabled.

Citizen of the world, former drunkard. Resident Traumatic Brain Injury advocate.
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Re: Post Crash/Concussion Advice and Experience? [allenpg] [ In reply to ]
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First of all, thank goodness you are doing so well.

With that out of the way, why are yo so careless now? Are you so type A that you can't wait to be cleared by neurology. You COULD have died but by some good fortune (and good helmet design) didn't. You are at risk for delaying recovery. It sounds as though you have minimized some of the residual neurologic symptoms in your post eg dizziness looking up. Remember you didn't just have a concussion, you had a bleed. Perhaps you are healed but CNS injuries take time.

I'll get off my soapbox now. In regards to your respiratory issues, perhaps you suffered any pulmonary contusion from the sudden deceleration. It might not get picked up on CXR so might have required a CT chest which might not have shown up during the initial trauma series. Sometimes neurologic injury/trauma can also result in some non-cardiac pulmonary edema but this is probably less likely.

Good luck and don't be dumb ;)
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Re: Post Crash/Concussion Advice and Experience? [allenpg] [ In reply to ]
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Hi,

So sorry to hear about this. I am out of town on business today and short on time but wanted to comment so I can find this easily later in next day or so. I have shared parts of my concussion/post concussion syndrome experience on ST in the past. Best I can say in the interim is keep your head up and don't bump it again!

Cheers
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Re: Post Crash/Concussion Advice and Experience? [allenpg] [ In reply to ]
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Glad to hear you're doing better.

I was hit by a car about a month before the Gulf Coast Half IM. I was knocked out but no where near what you experienced. I DNFed that race, something wasn't right and I knew it when I tried to push through the bike. No way.

Take it easy for a bit and heal up.

Good luck.
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Re: Post Crash/Concussion Advice and Experience? [allenpg] [ In reply to ]
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I will echo what others have said- take your time! I went down with a heavy duty concussion, broken bones, punctured lung and blood on the brain. Days in the ICU and then sent home a hot mess. I had a bit of memory loss from just before and after the crash but was otherwise okay in that department. Doctor said I was no dumber after the crash than before it. It was by no means my first concussion but was certainly my most severe. I experienced a lot of dizziness when moving suddenly and upon standing and sitting. It all went away over time. Due to the bone and lung damage I had no choice but to sit and watch the spring classics all the while thinking about how long it would take to get back to where I was form wise. I couldn't read as that caused headaches. TV was okay in moderation. Good chocolate and better coffee and televised cycling did the trick while the clock moved slowly. I went down in April and was racing again come end July. I was antsy but took to heart my Neuro's advice-trust the process and heal. He had a bit of experience with other OCD types and understood my anxiety and discomfort at sitting on the couch. Go slow, heal and in a while it will be far enough behind to push it again- good luck man.
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Re: Post Crash/Concussion Advice and Experience? [allenpg] [ In reply to ]
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Hey--

Grade 3 concussion suffered here Aug 3, 2014. Grade 2 actually just a couple of weeks ago. Grade 3 was a bike crash where I stopped from about 30 MPH in 0.3 seconds, apparently using my shoulder and face as the primary braking mechanism. I wish I could tell you I knew what happened. I just don't know. I woke up in the middle of the road in a lot of pain and unable to breathe well. I fractured three vertebrae, whiplash in the neck, plus the TBI.

Over the last three years, I've had two cognitive function issues - one with regard to short-term memory, and one with regard to verbal recall. If you were to meet me in person, and haven't met me pre-crash, you probably wouldn't be able to tell. But occasionally my thoughts "catch," so to speak - and I have to find my way around that roadblock. I also get a bit paralyzed when I don't have a gameplan going into a high-pressure situation - which is very much not my normal (you can find my blog post about the disaster I had race morning at Ironman Lake Placid - that's something I'm normally very good at that I had a lot of trouble with.)

Your physical fitness is going to be impacted both by the neurological function as well as the memory trauma. Your body is healing, and you need to take it easy. Like, lots easier than this. Too much exercise too soon can actually hinder your recovery from a neurological function perspective. Additionally, you're likely carrying around some PTSD. I can't recommend highly enough speaking with a therapist. Specifically, seek out somebody who specializes in EMDR; it went a long way to putting me back onto the bike comfortably.

As for the vertigo issues, I'm about to go through some vestibular rehabilitation. Post that, we'll see how it impacts some of my coordination and cognitive function before going through the four hour neurological rehab test.

If you want to chat, DM me and we can trade emails.

----------------------------------
Blog and Product Reviews | Twitter
"It ain't easy being green..."
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Re: Post Crash/Concussion Advice and Experience? [Calvinbal6] [ In reply to ]
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Calvinbal6 wrote:
You need to slow down. There may or may not be a link between your concussion and what you are experiencing. You are at a significantly increased risk for further damage or death during your post concussive period if you sustain another injury. Seeing a professional for concussion rehab is a significant need for you. Do not rely on just your feelings or perceptions.

x2.

I had a wreck during a race, with a concussion, multiple skull fractures, and subdural hematoma. Fortunately, no surgery was necessary, and I was released from the hospital the following date. BUT, my doctors told me I could not, in any circumstance, put myself in a position to have another concussion for at least a year. That meant no outdoor riding. That was because if I had another concussion, the likelihood of permanent brain damage was significant. I have no skills and rely on my brain for my income, so I had no trouble unhappily accepting my riding ban.

Did your neurologist have a similar discussion with you? If not, consult him/her. I hope your other symptoms resolve themselves.

Attacking this day with enthusiasm unknown to mankind.
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Re: Post Crash/Concussion Advice and Experience? [allenpg] [ In reply to ]
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Thanks to everyone for the advice and words of wisdom. I posted my story for this exact reason. I heard exactly what I didn't want to hear. My own thinking is it's own worst enemy.

I definitely am going to slow things down. I know the risks associated with a secondary head injury, and the potential long term effects of concussions/mTBI. I wasn't too impressed with the post-crisis care that I received in the hospital. My discharge instructions and guidance were pretty laughable (a big part of my job deals with patient education). I made an appointment with a different neuro who focuses on concussions and neurophysiology. While I've been more obsessed with other effects of the crash (eg, CV), I know most of the ongoing care will be neuro-related.

There are a couple of reasons that I jumped back on the bike right away. First, I want to "get back in the saddle" as soon as possible after any sort of accident, whether it be car or bike. Second, like many of you, running, cycling, etc. is a way of life...both for the physical and mental benefits. Unfortunately, like any injury, I get worked up if I can't perform at the same level. My therapist gave me some good advice, especially regarding PTSD.

FYI, I am in recovery, so working a program has been a blessing. The love and support of those my AA fellowship was overwhelming. It also helps give me a good perspective on things, and cope with what has happened (for those of you who work a program, you'll know what I mean).

It is a miracle that I wasn't more seriously injured, but my injuries are still very serious. Thanks again for all of your thoughts!
-Pete

"Most of my heroes don't appear on no stamps"
Blog = http://extrememomentum.com|Photos = http://wheelgoodphotos.com
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Re: Post Crash/Concussion Advice and Experience? [allenpg] [ In reply to ]
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It's not that I have been where you are at, I am there. On August 24, 2017 in the AM was on a training ride. Woke hours later in the hospital with my wife there. I remember nothing of the crash and leading up to it. I was on a major road and had the right of way. I had a lady turn in front of me out of a subdivision and I ran into the side of her car. Her words from the police report and she was ticketed. I was bleeding in two spots in my brain and now am in a don't train or drive my car until my next CT scan on September 22 and then neurologist appointment on the 26th. I still feel numb and weird in my head. I want to get back to training so bad but will wait it out until cleared. I did break a helmet and had some minor road rash. Also trashed a pedal and the bottle cages on my bike. The paramedics or the doctor cut off my jersey and arm warmers. I had several friends come visit me in the hospital and I don't remember them being there. Scary stuff but heck I beat stage 3 throat cancer last year and I will survive this too.

My short term memory now sucks and it takes me a while to recall some long term memories.
Last edited by: Juanmoretime: Sep 16, 17 2:33
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Re: Post Crash/Concussion Advice and Experience? [allenpg] [ In reply to ]
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allenpg wrote:
Hi, I'm writing this to probe the collective ST community for any advice and/or their own personal experiences. Thanks in advance for your help!


-Pete

What Happened
I crashed on 8/22 while warming up for a MTB race. I hit a steep jump that I wasn't expecting, lost control, and went over the bars. The guy who was a few seconds behind me found me face down in the dirt having seizures, while breathing in dirt with a pool of blood forming around my head. I was unconscious for at least 5 minutes. Thankfully, my helmet took most of the blow. It cracked and cut my forehead, which was causing the bleeding. I was intubated and taken to a local trauma center. X-rays and CT scans showed no fractures or other significant damage to my head, neck, etc.. The real concern was some intracranial bleeding in my parietal lobe, so apparently I was put in a medically induced coma (don't know the details on that). I was held in the CCU until 8/24, when a second CT scan showed the bleeding had stopped. I was awake and they moved me to a regular room. They discharged me on 8/25 after I had passed their post-concussion test and felt everything was OK. I obviously got a fair amount of road rash.


Post-Crash Symptoms/Treatment
Neurologically I feel 100%. My memory up until the crash has come back...I remember going down the hill and vaguely having the "oh shit" feeling when I hit the jump. I feel as if I do occasionally feel I have some other memory issues, but it's so minor. I have a hard time telling how I'm different mentally/emotionally than before the crash. My only other neurological symptom is momentarily feeling light-headed/dizzy when I lie down, after looking up at the ceiling or down at the floor. No sleeping, balance issues, etc. I have my first follow-up with a neuro in a couple of weeks.

I did have some neck/shoulder/side pain the first 1-2 weeks. Went to urgent care and then an orthopedic, but they said no fractures and it's probably just a soft tissue. The ortho gave me a cortisone shot and 1 week of oral steroids, and recommended PT. The steroids pretty much took care of the pain/inflammation. I saw my trauma surgeon for a follow-up yesterday, and he said everything looked good from his perspective

I have had some CV/breathing issues that I'll bring up next in my post-crash fitness.

My appetite and diet has been affected. What's kind of freaking me out is that I've lost 4-5 lbs, since the crash despite pretty much eating the same amount while working out less.


Post-Crash Fitness
So, for a quick benchmark, I was in the best cycling shape of my life before the crash. My FTP was about 300 watts and my weigh was around 140 lbs. I usually biked 150-200 miles per week. Like any good endurance athlete, I was back on the bike (Zwift) 5 days after my crash. I was of course hurting, but got 30 minutes in and overall felt OK. I then got outside 1 week after my crash. I've gradually built my mileage up (longest ride being 40 miles) and got 150 miles in on the bike last week. I haven't tried running yet. My balance, etc. on the bike is fine, and have even taken my CX bike out on the dirt.

Now for what's really bothering me. Going for an easy effort doesn't bother me much, expect I do notice my HR elevated more than usual. What got me was going up a short hill a couple of weeks ago (just 100 feet). I felt like I was going to have an asthma attack at the top (I have allergies, but no real history of asthma). I feel that way anytime I put in a relatively short effort (eg, 250 watts for 1-2 minutes). I now carry an inhaler with me on my rides. I just feel as if my lungs and heart can't keep up. It's almost as if I'm not carrying enough O2 in my blood. Here's a quick comparison of the effect on my performance:

Starcrest Strava segment: 0.8 mile, 253 ft, 5% hill.

Week before crash: 14.5 MPH, 349 watts, 169 bpm, RPE (9 out of 10)
2 weeks after crash: 9.2 MPH, 193 watts, 167 bpm, RPE (12 out of 10) - Barely made it up the hill, and had to use an inhaler at the top

I'm at a loss for why I suck so bad. It's obviously related to the crash, since I didn't loose THAT much fitness in 2 weeks. I saw a pulmonologist yesterday and she's going to have me do a lung function test. Probably the most frustrating thing for me now. Just trying to figure out what's up. If it just needs time to heal, not big deal. Any ideas for the type of physician to see for something like this?

Thanks again for the help!


Hey there, didn't forget about you. Again, so sorry to hear about your concussion. They suck. There have been a few topics about concussions in the past in case you want to read some more stories:

brain injury history and helmet options
Take care of your head - concussions suck

I shared a bit of info about my concussion in those threads and I'll try to give some of the same and possibly more info here. Most of my story is in that 2nd link, on the 2nd page.

First off, you were concerned about losing weight when you've been eating the same. That is normal. You described that you were in the best shape of your life immediately before your accident. The weight loss based on what you describe is probably muscle loss. Most people think you lose weight by exercising, which is true, but since muscle is more dense than fat when you are extremely fit you will first lose weight (muscle) followed by gaining weight (fat and size).

Now for your real concern about progress and what other people have hinted at already...DO NOT OVER DO THINGS. Seriously. Like you, I was over ambitious after my concussion and was racing as early as a few weeks later. I did pretty good in that race too, but as time went on and the more I pushed myself, the worse my symptoms got. Next thing I know it's several months later and I'm getting diagnosed with post concussion syndrome. I'm now in the land of ~1.5 years of dealing with PCS and dreaming of normalcy. Things have definitely gotten better overall, though I still have bad head days. Currently due to work/school/moving I've been having more bad head days than usual. I'm not sure why I'm one of the lucky few to get PCS, but part of me wonders if I did this to myself by over-doing things and pushing myself too hard, too often, too soon. I don't want to repeat too much of myself so go ahead and give those threads a read.

I'll try to wrap this up by quoting part of my prior post:
Quote:
That said, my advice is this:

  • make sure you emphasize getting enough rest. It is seriously important.
  • You're going to require more sleep than you normally would.
  • Make sure you don't hit your head again.
  • I'd recommend getting the app "Migraine Buddy." It lets you log your headaches/migraines, where they started, how intense they were, possible causes to the headaches/migraine and what relief you found to it. If you don't use the app then keep a written/digital record somewhere. It was very helpful when I was seeing my neurologist to be able to say that I was having recurring headaches everyday for 2 weeks at a time without relief or upon follow-up visits to tell him it had been 7 days since my last headache. Stuff like that.
  • Don't stress out, it will only make things work. That includes stressing out about your recovery


Feel free to shoot me a PM if needed and best of luck on your recovery. I sincerely hope you're not one of the lucky individuals who gets post concussion syndrome. It seriously sucks as much as the original concussion.

That last bit is out there for you and anyone. I'm no expert but I know concussions suck and they can be terribly isolating so please don't hesitate to reach out if you have anything you're not wanting to share for the interwebs. Best of luck on your recovery.
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Re: Post Crash/Concussion Advice and Experience? [Juanmoretime] [ In reply to ]
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Juanmoretime wrote:
My short term memory now sucks and it takes me a while to recall some long term memories.

Also sorry to hear about your concussion. I also really struggling with short term memory and on bad head days i still struggle with short/long term memory.

One thing that has been a massive help for me is doing memory exercises. My favorite is playing one on my phone. There's an app called Ingress which in simplest terms is like a giant game of capture the flag but on a global scale and the two teams are fighting over points of interest instead of capturing flags. inside of that game there is a "glyph" mini game where you interact with those points of interest and they give you a series of symbols one after another and you have to repeat them back.

A standalone practice of this mini game on android is called "Memo Glyph" though actually playing the full ingress game made it more fun for me to go out there and practice my memory exercises. Your Miles May Vary since I already enjoy video games quite a bit, but regardless, find some sort of memory recall exercise.

Here's a short video of the mini-game within ingress: https://www.youtube.com/watch?v=0uQzZ1d3AvA

Best of luck on your recovery,
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Re: Post Crash/Concussion Advice and Experience? [racehd] [ In reply to ]
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Thanks you for the links. It really helps understand what is going on inside my head. I'm thinking, since I have it, I should use my short term/long term disability at work and just need to get my doctor on board to speed up the cycle of recovery.
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Re: Post Crash/Concussion Advice and Experience? [allenpg] [ In reply to ]
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I had a concussion a few years ago after a crash. It was mild enough that by the time I got to the hospital the doctor didn't even feel a scan was necessary. That was a Thursday night. Friday was rough (took it off work), the weekend was mostly OK.

The following Thursday, I was driving the work crowd to lunch. We went to a restaurant we frequented in a complex that also housed my favorite bike shop. Upon turning into the lot, my head swam - I couldn't find my way to the restaurant and was completely disoriented. Scary.

Because of bruising and tightness, I couldn't work out much and recovered enough to run literally on the day of my local half-iron. Did that sub-5 (a considerable PR for me), and felt fine. However, that was late in the season (right about now, in fact). I took the winter off from riding on the road and went out in spring. Once. It was a terrifying, PTSD-riddled ride, and I hung up the clothes for years to focus on running. Only now, three years later, can I think about riding without a sudden panicky feeling. I'm back riding the trainer as cross-training and will try riding some easy roads next spring to see how that goes.

Hopefully you recover better and faster than I did. The point here, though, is that it wouldn't surprise me if your symptoms are psychological to some degree - couldn't a low-level panic attack, induced by PTSD, make breathing difficult? Which would in turn make your aerobic performance lower. You're right, two weeks off shouldn't wreck your fitness (my post-crash layoff was longer), but if it's hard to breathe...

---
The point is, ladies and gentleman, that speed, for lack of a better word, is good. Speed is right, Speed works. Speed clarifies, cuts through, and captures the essence of the evolutionary spirit.
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