January 2023 Update

I'm making another comeback! In February of 2021, I worked up enough mental strength to get out of bed for 1 hour at lunch. Then in April of 2021 I was able to get out of bed for an hour at lunch and an hour at dinner. I gradually improved, and continue to improve, and have been on a road trip and even went to rock concerts!

April 2021 Update

Long story short, I've been bedridden for the past four years. During the worst of it I could not open my eyes, for much of it I could not even sit up in bed for meals, and for most of it I could not get out of bed to go to the bathroom. That's in addition to 11 months of bed rest a year before that. Stemming from a concussion suffered more than 7 years ago.

The symptoms have mostly been the same - mild headache and dizziness. What changes is the sensitivity and capacity for activity such as conversation (extreme neurofatigue).

I wrote about the first 11-month bedrest stint in the 2016 blog below. Then I was doing good, I was out of bed for a year and I was making steady improvements. I went to a concert in Vegas, and went on a cruise. Of course the music was super loud but it didn't bother me until about midnight which is when I knew my brain had reached its capacity for loud music.

Then we were on a road trip down in Mexico in May of 2017 and the roads were really rough. The van rocked and I bumped my head on the side pillar. I knew there was no way I'd survive the drive back home on rough roads, given what had happened in the past. So we chartered a plane to fly my dad and I to Tijuana, crossed the border, rented a car, and drove the rest of the way to LA with me lying on the back seat.

Once I was back home my head just fell apart (runaway inflammation) and I was back in bed with all the same symptoms and extreme sensitivities as the first bedrest stint. During the worst of it I could not open my eyes, for much of it I could not even sit up in bed for meals, and for most of it I could not get out of bed to go to the bathroom. For a year and 3 months. 

And then I bumped my head on the desk and again I was back in bed for another eight months.

Then I worked up enough strength in 2019 to get out of bed again and go outside for a few weeks. I thought I was doing good so I invited a friend over for dinner. We ended up talking a lot more than what I was used to. That night my head had a shaking sensation from all the talking that wouldn't stop. Then I couldn't get out of bed for a year and a half.

Inflammation

I have a long history of concussions and as time progresses, it's becoming more clear what is going on. Inflammation rages out of control in response to the slightest bit of aggravation to the point where just talking to a friend has resulted in over a year of bedrest.

If a person has had multiple concussions or multiple head bumps, even if the secondary impacts were minor, then the brain's ability to regulate inflammation becomes compromised and it overreacts and pumps out too much inflammation in response to a given stressor. Inflammation is what causes the symptoms so that's why I experienced increased sensitivities and extreme neuro fatigue following a head bump or over-exerting myself. 

Sure the impact force from the secondary impacts was not enough to do any damage, but it was enough to trigger an inflammatory response and the resulting excessive inflammation can have a damaging effect and cause more symptoms than the initial impact. So the brain needs to learn to stop pumping out so much inflammation at such a low threshold. 

But I'm still improving and I should be making another comeback soon.

June 2016 - How Medications and Overdoing-It Turned Me Into A Vegetable | A Post-Concussion Syndrome Story

When you have a concussion and you overdo it, it makes your head more sensitive. When your head is more sensitive it's easier to overdo it. Then when doctors prescribe pharmaceutical drugs, that just makes the situation worse. So after 1.5 years I was almost fully recovered from a concussion when a small bump to the head snowballed downhill and got so bad that I had to eat, sleep, and poop in the same position for 9 months with my eyes closed staring at crazy hallucinations.

Doctors were so ignorant that they either didn't know what a concussion was, didn't know how to treat one, or prescribed medications that did more harm than good. The doctors’ treatment approach is the reason why my head got as bad as it did because I just had a concussion and it never should have gotten so bad. 

In September of 2013 I had a great job doing 3d technical animation. I was an adventurer and had backpacked around the world and even made a feature documentary about my travels. And then all of that came crashing down when I fell, hit my head, and was briefly knocked unconscious. I gave my head the customary 10 days rest and thought that I was able to go back to work. Unfortunately that meant driving two hours across LA, deciding it was a bad idea, and driving a hour back. By the time I got home I had a bad headache which is what triggered my Post-Concussion Syndrome. Little did I know that that simple mistake, and others like it, would cost me more than 3 years of my life.

Post-concussion syndrome (PCS) is generally defined as a  concussion that persist for three months or more. It affects one in seven concussives so chances are you or someone you know has had post-concussion syndrome.

The brain has a reduced capacity while recovering from a concussion so if you overdo it and exceed that capacity then the brain over-reacts and pumps out too much inflammation. That overactive inflammatory response is what causes prolonged symptoms, and then it takes the brain a very long time to sort itself out. It's just like a knee injury. If a football player injures his knee, he can still use his leg and walk a bit, but if he goes back in the game he’ll injure it more and it'll take longer to heal.

The First 18 Months

A few months into my concussion I needed more time off work so I went to my doctor. He said that I did not have a concussion because my CT scan was normal. He said the headache and dizziness was vertigo instead. It just goes to show that in this day and age doctors still don't know what a concussion is nor how to treat one.

A month later I went to a neurologist and the neurologist also told me that I did not have a concussion. So I asked for part time work status. I tried to work part time for a month but that proved to be too much and made my head worse.

Then I went to a second neurologist because the first one didn't know what a concussion was. The one good thing the second neurologist did was actually recognize that I had post-concussion syndrome. I have to give him props for that because he was miles ahead of the other doctors. But it only took 7 months to get that diagnosis.

After a few more months the neurologist emailed me and said that since it had been almost a year that my head wasn't likely to heal and that I should just go back to work and do what I can. That was the absolute worst advice the doctor could have given me! I already tried going to work and did what I could and it made my head worse. I couldn’t even go to the beach. That wasn’t going to be a very good life.

Telling me to go to work and do what I can is like telling a football player with a busted knee to get back in the game and play out the rest of the season. Sure he can hobble around and do what he can but his knee wouldn't have a chance to heal if he did that.

I knew what the doctor said wasn't true. I had never read anything to indicate that concussions stop healing after a year. In fact, I had heard stories of people who recovered after more than a year. I knew my head would heal if I gave it a chance to heal. So I told myself I needed to get serious about resting and started taking naps everyday.

After a few months I had improved but then I seemed to plateau again. So I told myself I needed to get even more serious about resting. So I got rid of my smartphone and switched to a basic phone.

Smartphones make it so easy to access the web and social media that you end up using it too much. For example, 70% of young adults use their smartphones in bed. The light from the screen disrupts melatonin production and the increased brain activity degrades your quality of sleep. Because the body does most of its repairing while you sleep, using a smartphone in bed hinders the healing in a big way.

Doctors will tell you not to use computers while concussed but these days people spend more time on their smartphones so doctors should get in touch with the times.

Telling yourself "just don't use your smartphone" doesn't work because your phone is usually within arms reach at all hours of the day. So it's best to just get rid of your smartphone and switch to a basic phone. 

A Turn For The Worse

18 months into my concussion I was greatly improved and could see the light at the end of the tunnel. I was to be the best man at my friend’s wedding that summer and was excited about it. I thought things were going great when...

I bumped my head. It was actually the third head bump after the initial injury and later I would find out that was a very debilitating  detail. It wasn’t until after I got home that my head started hurting and I couldn’t figure out why. And then I was in denial. How could I hurt myself like that? So I went to tutoring then next day. I have been tutoring middle school kids once a week and usually it was no big deal. But it really aggravated my head because I had to go through all of their homework problems with them.

I got worried when I felt dizzy a few days later so I went to the doctor. The doctor injected me with a Toradol shot. When I said I didn't want it she said “well, you say it hurts and then it doesn't hurt and then it does so you should just get the shot.” And then she advised me to take Ibuprofen, and lots of it. In the past I always ignored doctors when they said to take Ibuprofen but this time I was desperate so I thought I'd better do what the doctor said for once.

Very, very, very bad idea. While on the Ibuprofen I felt fine, but when I stopped taking it after a week I was way worse off than before I started.

Toradol and Ibuprofen do not help the brain heal. They suppress inflammation. Doctors have always said that inflammation is bad but it really isn’t all that bad. Inflammation is the body's way of repairing itself. So suppressing too much inflammation basically prevents the healing. NSAIDs also suppress pain which means you can easily overload your brain and injure it more without even realizing it.

Consequently my head became so sensitive that at times all I could do was sit in my room and stare at the wall. I couldn’t drive and just being around people who were talking felt overwhelming. Of all the concussions I’ve had over the years, my head had never been as sensitive as it was then. And because it had become so sensitive, especially the sensitivity to talking, it enabled the events to come and kept getting worse and worse.

Inflammation is like a double edged sword in brain injuries. It is essential for healing but it can spread and cause more inflammation and do more damage. But so far treatments involving NSAIDs have failed which indicates that the brain’s intrinsic neuroinflammatory response should not be stomped out.  

Yes, PCS is an inflammatory condition so it seems logical to prescribe anti-inflammatory drugs, but unfortunately NSAIDs don't work.

Therefore I think other anti-inflammatory supplements such as fish oil omega-3 and curcumin should be used but only for a few days after a blow to the head. You want to let some inflammation set in but stop it from spreading and causing more inflammation.  It is analogous to how you would only ice a knee injury for the first couple days, just to reduce excessive swelling.  

After several weeks I had improved enough that I could go to the park and read my book. I thought I was doing well when...

I went to a dizziness therapist because the neurologist said it would help. The therapist made me roll over and look every which way which made me really dizzy. She had a hard time finding anything wrong with me and wasn’t sure if the therapy was worth it. I was in bad shape afterwards such that it was a struggle just to get through the day.

I had figured out that my head had become so sensitive and it was so easy to overdo it that seemingly innocent activities could have devastating consequences and I had a hard time restraining myself. So I asked my parents for help to not overdo it. They thought it was a joke and made me go on camera and promise to do what they said.

A few weeks later I went to a physical therapist because my neck was sore and thought it might be exacerbating my dizziness. When the physical therapist saw that my neck was curved she thought that must be what was making me dizzy. And without even telling me, proceeded to straighten it. She was very forceful and when I asked her what she was doing she said the wings were twisted and she was putting them back. When she was done she said “well I don't know how it was before!”

My neck is naturally twisted from scoliosis so I did not need or want forceful manipulation! The adjustment was so traumatic that it made my feet numb, my head hurt, my neck was sore, and my neck would grind every time I moved my head. Within a few days I was so dizzy that I could barely get out of bed. It was miserable. I knew I couldn't do anything to bring on the dizziness so I only got out of bed once a day for bowel movements.

I talked to the neurologist on the phone and he prescribed Nortriptyline, an antidepressant. He said he would help the headache and hopefully help the dizziness, with a big emphasis on “hopefully.” While on the Nortriptyline I was improving but I don't think I improved any faster than I would have without it.

I tried to explain to my parents that my head was so sensitive that just talking on the phone was overdoing it  (because people tend to talk fast and loud on the phone) and when I overdo it it makes my head more sensitive and when my head is more sensitive it’s easier to overdo it and that vicious downward spiral is why my head got so bad. But they didn’t understand and wouldn’t listen.

Being bedridden wasn't a good enough excuse to get off the hook for the best man speech. So I dictated a few sentences at a time and then my dad went to the wedding and delivered the speech for me. Despite barely being able to speak, I still managed to write and amazing best man speech.

After a month I had worked up enough strength to go out on the patio for a few minutes each day. I thought things were going well when…

A friend came to visit. I told her that I wasn't well enough and that just talking can be too much for me. When I ignored her calls and texts somehow she got hold of my dad's phone number and called him asking to come visit. Since I had been confined to my room for the past month I reluctantly agreed.

She promised a silent visit in the afternoon but instead showed up for dinner and yapped away for an hour. All the talking made my head a lot worse. Because the Nortriptyline suppressed the headache, I didn’t feel any aggravation until it was too late. So it was back to pissing into a bottle.

I reminded my parents that I really wasn’t joking when I said I needed help to not overdo it because having a friend over for dinner seemed like a harmless thing to do but it really messed up my head and when I overdo it the concussion gets worse and takes longer to heal. It was then that they started to get the picture. But instead of getting serious, they got scared and panicked.   

They tried to force me to go to the doctor and they were relentless - at breakfast, after breakfast, at lunch, after lunch, they took turns badgering me. The nurse from the doctor’s office called and threatened me that a mobile psychiatric team was going to come and haul me away if I didn’t go. At the time my head was so sensitive that I had to keep conversation to a bare minimum. How was I supposed to defend myself against this onslaught? I just didn’t have the strength to talk sense into them.

My mom thought I was mentally ill because I wouldn’t to go to the doctor.  My dad thought I was going to lose my muscles if I stayed in bed any longer. Having Muscular Dystrophy means that my muscles don't grow, they only atrophy. Although that was a legitimate concern, there was nothing the doctors could do about it.

I couldn't even go outside of my room. How was I supposed to survive an excursion to the doctor? I told them it would make my head 20 times worse. But the more I said it would get 20 times worse the more they thought there must be something horribly wrong with me that required urgent medical attention.

Eventually I cracked and agreed to go to the emergency room in a gurney van. I thought I might have a chance if I was lying down. I knew it was a bad idea but I just couldn’t argue or think anymore.

Hospital Wreckage

In July of 2015 I went to the emergency room. The hospital ordeal wrecked my head so badly that I couldn't open my eyes for 7 months. What should have been a four hour visit turned into a 45 hour extravaganza because the doctors couldn't find anything wrong with me. So they covered their bases and I got two separate CT scans of my head and neck, a chest x-ray, an anti nausea shot, lots of needle pricks, and I was interrogated by every doctor in the hospital.

The CT scans were horrible. I saw bright flashes of green light during both scans. Then I was so delirious that I couldn't talk for an hour afterwards.

In the end the neurologist said to stop the Nortriptyline and take Meclizine, a motion sickness pill, instead.

By the time I got home from the hospital the mental task of coordinating the muscles to bring a fork to my mouth was too much for me. And then the dizziness and light sensitivity quickly worsened and within a few days I was so dizzy that I couldn't lift my head off the pillow. Opening my eyelids just a crack sent a jolt of stimulation to my brain that made it spin.

My mom had to cut off my t-shirt because I couldn't tolerate any kind of movement. Rolling over in bed took 2 hours because I could only turn my head a few degrees at a time. Just reaching a few inches for my drinking tube made my head spin. Even chewing food made me dizzy.

I knew I had to do whatever it took to stay ahead of the dizziness and if that meant not eating and starving, then that's what I had to do. So I limited myself to two meals a day that I could drink through a straw. So it was a smoothie for brunch and carrot soup for dinner.

Because the withdrawal effects of the antidepressant were causing the severe dizziness, the neurologist had me start the Nortriptyline back up.

Somewhere in between the radiation and the change in medications I started getting vivid hallucinations and flashing lights. At first it was like monkeys tackling football players on a big screen TV.

The hallucinations followed a common theme throughout the day. It was bright RGB static in the morning, bricks and geometric patterns in the afternoon, and lions and tigers bickering with each other at night. Sometimes there was a pile of dolls that was surprisingly detailed. Often everything was swirling which made the dizziness feel worse. On top of that were the flashing lights. Any light that penetrated my eyelids amplified the hallucinations and made the flashing lights go crazy. My parents had to block out the windows with dark drapes so it was so dark that they needed a flashlight to see me.

The Nortriptyline was causing the lucid hallucinations and they were interfering with the healing. If I stopped the antidepressant then it caused even more severe dizziness. I was entrapped by the medication! So I just had to put up with the hallucinations and hope that I would get strong enough to survive the withdrawal effects of the antidepressant.   

It was absolute misery. I felt like a vegetable because I could think in full sentences, but when I tried to speak I could only mumble a few words.  All I could do was lie as still as possible, keep my eyes closed as much as possible, count my breaths to keep my mind calm, and cry to myself. The worst part was that I knew it would be a very long time before I would get out of bed. I just held on to the fact that I knew I would see better days.  I just never imagined it would be as long as it was.  

I stopped the motion sickness pills after 2 months because they weren't helping much. When I did so, I got so dizzy that just moving my legs in bed made my head spin. Then within a few days the dizziness was the same as with the medication. So the Meclizine didn’t do much except make me super dizzy when I stopped taking it. And yes, dizziness is a side effect of Meclizine.

I went 3 months without actually “seeing” my parents because I had to keep my eyes completely closed and covered 100% of the time. They had the hardest time spoon feeding me because I was lying on my side and I couldn't open my mouth very wide. They put the tip of the fork in my mouth and tried to dump the food in but the food just spilled all over the place. I couldn’t tolerate being washed more than once a week so my armpits always smelled like a very fine cheese. Every time I pooped my parents said “yay!” to make it somehow seem like they just loved cleaning poop out of a bedpan for 9 months!

I pondered questions like why did this happen? Just a few months before I was doing great and then I can’t open my eyes for 7 months. How is that possible? I guess if you do what the doctors say it can happen pretty easily!

I just had to trust my brain that it would be able to sort itself out once I got off the antidepressant. But doing so would not be easy.

How Post-Concussion Syndrome Works

Because no one seems to understand the dizziness or why it’s such a bad idea to overdo it, I drew a picture:

The line segment on the left is sloped downward because it takes a day or two for symptoms and inflammation to set in which makes it difficult for doctors to detect a concussion upon initial examination.

Path A shows the typical recovery of a concussion. You’re in bad shape at first and then you make steady improvements until you're one hundred percent.

Let's say that after a few days of resting you've improved and you're up to 50% capacity so you decide to go to work. But going to work bumped your activity level up to 75% which exceeded your 50% capacity and aggravated your head. Because you aggravated your head your brain launches an increased neuroinflammation response which makes your condition worse and knocks your capacity down. Then it takes the brain a very long time to sort itself out. (Path B)

When your brain’s capacity gets knocked down then it's easier to overdo it and make your concussion even more worse (Path C). In the beginning it took going to work to overdo it but towards the end just talking to a friend was detrimental.

The headaches and dizziness are a RESULT of the brain being overloaded. When the brain is overloaded, it is injured more and takes longer to heal. It's like if you run with a knee injury then it's going to hurt because the knee is being overexerted and you will injure it more.

The word pain comes from the Greek word poine which means "penalty or punishment."  Pain is the body's way of alerting you that what you're doing is causing damage. So that pain should not be ignored. Hence, pushing through the pain will make the concussion worse.

The opposite is also true - if you stop the damaging activity then the pain goes away. Therefore, staying in the safe zone alleviates symptoms and gives the brain a chance to heal.

When doctors prescribe medications that makes the situation worse because the medications blur that line so you don't know what your limit is.

So when recovering from a concussion you want to keep your activity level within capacity at all times. If you do so, then your brain will heal. As your brain heals, that capacity line will rise. As that line rises, you will be able to sustain more and more activity without aggravating your head. But if you exceed capacity, then that line will drop a whole lot faster than it will come back up. And no matter how low that line goes, you have to stay below it.

The reason why it is so easy to overdo it is because the aggravation accumulates and has a cumulative effect. For example, the morning I left for work I felt fine but the more I drove the worse my head hurt and next thing I know I have post-concussion syndrome. If I had turned around sooner I probably would have been ok.

Post-concussion syndrome is so devastating because that downward step can repeat itself over and over again. The first few times you overdo it you don't notice your capacity being knocked down because most of your activity is still within capacity. It's not until you've overdone it a few times that your capacity gets down to where your normal activity level is and then all of a sudden regular activities have devastating consequences.

As you can see from the graph, it's critical to rest properly from the beginning. So when you go to the doctor with a concussion and the doctor says “oh you just have migraine” or “you just have vertigo” or “you're being overly dramatic,” in reality they’re setting you up for months or years of suffering! And the number of times I was told I did not have a concussion is alarming! I’m sure other readers can attest to that.

Getting off the Nortriptyline was challenging and frustrating because whatever progress I made was wiped out when I tapered the dose down. In addition to the dizziness, vertigo, hallucinations, and flashing lights, the withdrawal effects added on electric shocks, tremors, blackouts, and insomnia. I stepped the antidepressant down ten percent a week and still had wicked withdrawal effects. So  for 10 weeks I really didn’t make any improvements.

My brother was concerned that I was spending so much time in a dark room with my head covered so he shined infrared lights on my head everyday. He said that the light would help my brain heal and I think it did improve my condition. My mom did puzzles in my room as a way to keep me company in a quiet way. As soon as I was able, I started doing exercises to keep my muscles conditioned and fend off depression. My dad rigged up a bucket of bricks and cement through a series of pulleys that I could hook foot on and push.

Four months after the hospital ordeal I was off the antidepressant, but still had all the withdrawal effects. The hallucinations began to fade, I could elevate the head of the bed, open my eyes for a few seconds here and there, and tolerate the corner of the curtain being lifted. I thought things were going well when...

Another friend came to visit. This person was only in my room for two minutes but while she was there she “word-barfed” on me. She said a lot of things and talked really fast which totally overloaded my brain. Even when I plugged my ears and said “enough” she kept on talking. And then it was Back to Basics. No more opening my eyes, no more elevating the head of the bed, no more lifting the curtain, and the flashing lights and electric shocks came back with a vengeance.

Medications

It seemed like the medications made my head ultra sensitive and so delicate that just the slightest bit of overstimulation had detrimental consequences. Why would the neurologist prescribe medication whose side effect is dizziness and tell me it would help my dizziness? The Nortriptyline was only supposed to help the headache, which it did, but my head didn't hurt much to begin with. I was mostly dizzy and it made the dizziness worse. Why was it necessary to put up with such horrendous side effects for so little gain?

When the doctor says “this will help your headache,” what does that mean? Does it mean it will help my brain heal? If it really did help my brain heal then wouldn’t it help the headache and dizziness and not make the dizziness worse? How can a medication and causes electric shocks, dizziness, vertigo, and hallucinations possibly help my brain heal? There are volumes of research that show that antidepressants have serious side effects so it was a crime for the neurologist to prescribe it in the first place.

Every doctor I’ve been to for concussions over the years has prescribed some sort of medication, usually Ibuprofen but more recently Nortriptyline for headaches and Meclizine for the dizziness. My experience is that those medications do not help the brain heal. Yes, they work as advertised, but just because you're feeling better doesn't mean you are better.

Doping yourself up on drugs so that you can feel normal and can do normal activities is like the scene from the movie Varsity Blues where Wendell injures his knee and the coach wants to give him a cortisone shot to deaden the pain so he can continue playing.

If Wendell got the shot then sure, his knee would feel better. But if he went back in the game he would injure it more and risk permanent injury. In the beginning of the movie you see Lance getting his knee injected before a game. Look what happened to him - he tore every ligament in his knee and it cost him his scholarship.

My theory is that if something aggravates your head you shouldn't be doing it and no amount of medication is going to change that. Sure, medications will suppress the pain and dizziness but they won't change the fact your brain is being overloaded and when your brain gets overloaded it is injured more, takes longer to heal, and triggers post-concussion syndrome.

I admit, I made a lot of mistakes. The biggest mistake I made is not relaxing enough. Of course I was eager to jump the gun and get back to my life. But the doctors were no help with that. A lot of things happened to me and each mishap/mistreatment on its own should have been no big deal. But taken as an aggregate everything added up to this. The bottom line is that my head never should have gotten as bad as it did.

Incompetent Doctors

Sadly, my case is not unique. I’ve heard too many stories of people who suffered for years at the hands of ignorant doctors. Spending 9 months in bed with your eyes closed is something no human should have to experience. Isn’t it about time doctors got their act together?

What if this happened to someone who didn't have a family to care for them? Because post-concussion syndrome is so devastating, happens so easily, causes so much misery, and impairs your ability to work for such a long time, don't you think doctors should make an effort to prevent it? Simply saying “take these pills and do what you can” isn't good enough and only makes it worse.

And if you do happen to come down with post-concussion syndrome don't you think doctors should do a better job of treating it? Telling me that I don't have a concussion and should return to work is not how you treat a concussion. Telling me that my brain is not going to heal and should return to work is not how you treat a concussion. Prescribing medications that mask the pain or cause horrendous side effects is not the answer either.

The Answer 

The answer to post-concussion syndrome is so simple that it does not require 3 years off work. Just rest. Give the brain complete rest from the beginning. And reduce inflammation and prevent inflammation.

Drew's Concussion Protocol

Concussions and Post Concussion Syndrome are complex conditions that require a multi-pronged approach. Treatment should focus on 4 goals: Rest, Reduce inflammation, Prevent inflammation, and then Gradually re-introduce activity.

• Rest

The brain needs rest to heal, just like any other injury such as a knee injury.

• First, Relax because anxiety can cause the brain to produce inflammatory compounds which can be a roadblock. You can't change the past, you can only change the future, so rest and relax.

• The amount of rest you give the brain depends on the severity of your symptoms. So lower your activity to a level that you can tolerate comfortably with minimal pain. For most people that's just quiet time around the house but in severe cases that may mean bedrest. Once your condition stabilizes and begins to improve, then gradually increase your activity level while being careful to not overdo-it. Use the pain as a gauge of how much you can do so as to not induce excessive inflammation. 

• Ditch your smartphone and switch to a basic phone. Limit computer, TV, video game and tablet time to 1 hour per day. Electronic devices stream so much information at you so fast that it's a big chore for your brain to process it all.

• Focus on getting more deep restorative sleep. Turn off electronic devices an hour before bedtime. Install incandescent lighting or use low color temperature light bulbs at night. Dim your computer screen with a blue light filter.

• Take naps during the day and Avoid noisy environments.

• Avoid driving. It takes a lot more mental cognition to scan the road and manipulate the controls than to sit in the passenger seat and watch.

. 

• Space out activities and appointments so you have a couple rest days in between to recover.

2. Reduce Inflammation

Inflammation is the cause of concussion symptoms. The inflammation after a head injury cascades and can spread and cause more inflammation. This inflammation has a damaging effect and can cause more symptoms than the initial force of impact so steps should be taken to minimize this secondary injury. 

• Take a maintenance dose of anti-inflammatory supplements such as fish oil Omega 3 and Curcumin. Look for an Omega 3 supplement that has a high proportion of DHA because that is the component that is beneficial for brain injuries. 

• Adopt an anti-inflammatory / ketogenic / sugar free / gluten free / organic diet to help keep the inflammation down. Don’t eat sugar or wheat because they cause inflammation, lack nutrition, and are acidic. Replace wheat with whole grains such as Quinoa flour, Almond flour, or Chickpea flour. Avoid processed unsaturated fats such as Canola oil or Safflower oil as they cause oxidation which can be destructive. Cook with healthy saturated fats such as Coconut oil, Olive oil, or butter instead. 

• Also try colon cleansing and detoxification because poor gut health causes inflammation in the brain so you want to do everything you can to stop fueling the fire.

3. Prevent Inflammation 

• If your head hurts then stop what you're doing and rest. A little bit of aggravation is okay but a lot of aggravation is bad.

• Take a double dose of curcumin and fish oil when you experience intense symptoms or after a bump to the head. They have a neuroprotective effect and will slow the cascade of inflammation.

• Protect the head with a helmet or protective hat or bump cap if head bumps become a problem. Many people complain that minor head bumps bring back their symptoms or wipe out their progress. Keep in mind that each successive head bump is harder to recover from and the symptoms get worse, and if you get another concussion before the first one heals, that's very bad. If you've already had one or two setbacks from head bumps then you should consider head protection because the longer your PCS drags on, the higher the risk of another head bump. And if that happens then you will sink deeper into the pit that is PCS and then it will be harder to climb out than it ever was at the beginning, before the first head bump.

• Avoid high risk activities. Do not participate in activities that put you at risk of another head injury such as sports or heavy drinking. 

4. Gradually Re-introduce Activity

• Then gradually increase activity level while being careful to not overdo it. Do just enough activity to cause mild discomfort but not so much to cause a setback. As your condition improves you'll be able to do more and more activity without aggravating your head. It requires patience and discipline, but if you follow the logic, it works.

• For example, dine out at quiet cafes before going to busy restaurants or shop at small stores before going to big box stores. Then do a little more each week. 

5. Neurogenesis and Neuroplasticity

The brain is capable of generating new brain cells. (Neurogenesis.) But the brain needs optimal conditions and optimal nutrition for Neurogenesis to occur.

• Diet and Nutrition: A lot of the foods we eat cause inflammation, which inhibits neurogenesis, so it's important to stop eating inflammatory foods. (See list below). 

• Low-carb High-fat diet: In the absence of sugar, the body burns fat for energy and when doing so, it generates Ketones which fuel the brain. So stop eating starchy foods like bread, pasta, and pastries. 

• Fats and oils are important because they provide the building blocks for new brain cells. So add lots of healthy saturated fats to your food, especially Coconut oil. Fats also improve the absorption of nutrients in other foods so always use full-fat dressing on salads.

• Rest: The brain needs rest to heal, just like any other injury. The brain needs extra downtime to recuperate and repair itself and rest is essential for neurogenesis and neuroplasticity to occur.

• Sleep is important because the brain flushes out excess gunk while you sleep. If you are not getting enough sleep at night, then nap during the day. Also take mini-breaks throughout the day to allow the brain to recuperate.

• Exercise: Sustained aerobic exercise promotes neurogenesis so incorporate brisk walking, cycling, or cardio exercise into your routine.

• Dark Chocolate: Flavonoids in cocoa promote neurogenesis because they contain antioxidant and anti-inflammatory agents. But regular chocolate is highly processed such that most of the beneficial flavonoids are stripped out and lots of sugar is added which makes it bad. Dark chocolate is less processed, so it's best to use pure cacao in recipes.

• Time Restricted Eating: Consume food in a 8-10 hour window during the day. The long period of time between meals at night triggers a healing crisis which promotes neurogenesis and synaptic plasticity.

• Stress: stress reduces neurogenesis, so learn to manage stressful situations in a calm manner. Meditation also helps calm the mind.

• Gut Microbiome: Gut health affects mental health and brain health. An overgrowth of bad bacteria causes inflammation in other parts of the body, including the brain. Sugar, refined carbohydrates, medications, and artificial sweeteners feed the bad bacteria. So address your gut health as part of the treatment plan. Probiotics and fiber help, but a proper diet is the best way to cultivate a healthy microbiome.

Stop eating these inflammatory foods-

• soda

• sugar/fructose/corn syrup

• wheat/gluten

• fast foods

• processed foods

• fried foods

• refined carbohydrates

• processed vegetable and seed oils (polyunsaturated fats)

• (safflower oil, canola oil, sunflower oil, corn oil, soybean oil, cottonseed oil)

• Trans fats (shortening, hydrogenated vegetable oils, margarine)

Eat this instead:

• Cook with lots of healthy saturated fats (Animal fats, Coconut oil, Butter, Olive oil, Avocado oil).

• Replace wheat with whole grains. (Paleo flour, quinoa flour, almond flour, coconut flour, chickpea flour, etc)

• Eat lotsof protein, lots of vegetables, some fruit

• bone broth

• Eat cold water fatty fish for the Omega 3 DHA

• Eat organic foods because pesticides contribute to neurodegeneration

The strategies above will not cure PCS overnight, but it will give the brain the conditions it needs to heal. As long as you keep making small gains while minimizing setbacks, then you will get better.

Many of the tips above are lifestyle choices we should all strive for so it would be wise to adopt them for any severity of head injury. If doctors put more emphasis on resting and less emphasis on medications then their patients’ head injuries would heal faster and more completely and there would be less chance of developing PCS.

The Home Stretch

Around Christmas 2015 my wish came true and I began improving. I starting elevating the head of the bed, just a few degrees at breakfast and then a few degrees more each day. And then at breakfast and dinner. In late January I started sitting at the edge of the bed, just for 20 minutes once or twice a week (because it took a few days to recover) and then every other day.

It wasn't until February that I could open my eyes for a decent amount of time. As the hallucinations faded I was able to tolerate more light and peel the corner of the curtains back. In March I could sit up for at least one meal every day.

In April something amazing happened. I put my feet on the floor and stood up! Despite lying in bed for 6574 consecutive hours, I did not lose my muscles! In May I went outside on the patio for the first time in 10 months. The sun felt great and the colors of the flowers in the garden seemed exceptionally vivid after being in a dark room for so long. And in June I was able to celebrate my birthday with a picnic in the park.

I’m off all the medications now. It has been 33 months since I fell and I continue to make steady improvements. As long as I don’t overdo it I should make a full recovery. By sharing this story I hope to spare others the suffering that I went through.