Early in May, I was in a restaurant in Cortez sipping very mild drink with a friend when I stood up and instantly fainted, for some reason that remains a medical mystery. When I fell, my head crashed into a table so hard that I lost consciousness for a fairly long time.
I was flown to Grand Junction and spent 2 ½ days in the hospital, days about which I remember very little except that I threw up a lot. I had a CT scan and an MRI and a great deal of bed rest. When I was released, I was told to seek follow-up care, but not given any instructions on what to expect. I figured I’d be back to normal soon.
Don’t worry, this is not a “poor Gail” story. All of us have injuries or health problems at some time, and mine could have been worse. But this was certainly a learning experience. One thing it taught me is that concussions are never easy to recover from and there’s really no treatment for them.
Believe me, you don’t want one.
Ringing the bell
Concussions are exceedingly common in our culture, both in real life and fiction. They’re a mainstay of action tales. I can’t count the number of times, for instance, that private detective V.I. Warshawski gets knocked out in the Sara Paretsky novels. After a brief headache, she’s always ready for more action.
Concussions are a staple of TV and movie Westerns – pow, pow! men are always being knocked unconscious with a fist to the jaw or a whack from a pistol. They too recover very quickly and have no lingering after-effects.
How many stories have you seen or read where people suffer amnesia from a blow to the head? (Remember Desperately Seeking Susan?) Loss of memory seems to be the only side effect from the injury. The victims then get whacked again and have their memory restored.
Even in real life, we tend to regard concussions quite casually. I grew up watching NFL football, where players regularly had their “bell rung” but kept on playing. Only recently has that really started to change.
So it’s easy to form the impression that a concussion is a minor thing.
Well, not so.
It’s true that these injuries occur in different degrees of severity, and people who are young and healthy may get over one fairly quickly. But they may not. And especially if you’re old and/or female, impacts from a blow to the head may last weeks, months or years.
My first surprise after I came home from Grand Junction was the amount of fatigue I felt. Normally I’m healthy and active. Suddenly, I hadn’t the strength or energy to go for a hike or do chores.
The house and yard slid into disarray while my husband tended to me and our pets. I slept 12 hours a day, between nighttime and naps. I stayed close to home because the urge to sleep could come over me right when I was in the middle of something and I would have to nap right then – it was impossible to put it off.
Another surprise was that I suddenly didn’t feel much enjoyment in life. Everything – food, books, movies, meetings – seemed either boring or depressing. The only TV show I could stand to watch was Untold Stories of the ER. If it hadn’t been for conversations with my husband, my sister, and friends like Debie, and interesting emails from my pal Doug, I don’t know what I would have done.
What was wrong? Was I going crazy? No one had warned me I would feel this way.
The best help and advice I got came from people who’d also experienced concussions. One assured me this was all normal and healing could take a long time. She urged me to totally shun computers and TV for a spell.
That was great advice. My husband had to read my emails to me and type things I dictated. But I could feel my brain resting and recovering without those flashing screens. Social
Completely avoiding computers and smartphones may not be a good idea for everyone.
According to the website of the nonprofit Concussion Alliance, the most recent recommendations advise avoiding screens the first few days after a concussion if they are making symptoms worse. But it’s important to return to normal activities as soon as possible. For some people (not me, however), digital devices are key to remaining socially connected. Particularly if someone is living alone, shutting off the digital world can result in deep isolation and depression.
But sensitivity to bright or flickering lights – and to noise – is a common effect from concussions.
The Concussion Alliance website offers a number of tips on reducing the visual strain that screens produce.
A dark room
Suzanne Strazza of Mancos, a contributor to the Four Corners Free Press, has suffered two concussions. Her first came six years ago while she was skiing at Hesperus and fell, hitting her head on the ground.
“It was the first ski run of the day,” she said. “We skied a couple more hours after it.”
But she developed a headache, and later that day she felt “really messed up, nauseous.”
The next day a neighbor who was a physicians assistant told her she needed rest. She had little choice. “I couldn’t work, couldn’t use my eyes, couldn’t have bright lights on. I slept all the time,” she said.
Strazza suffered more headaches and severe mood swings. “I was so emotional, out of control.”
Her consciousness seemed to come in blips. At times she didn’t have any idea what was going on around her. And she could barely endure flickering lights.
“I had a computer job in a place with fluorescent lights. It was months before I was able to work more than a couple hours.”
Lizzy Scully of Mancos had a bad concussion about two years ago, while on a multi-day bike backpacking trip. “I had just started. I wasn’t very good,” she recalled. “I took a corner too fast and hit my head on the sand.” Even though she was wearing a helmet, a week later she “got really sick and nauseous. That lasted three days.”
She began to forget things and make mistakes at work.
One morning her bosses scheduled a meeting at 1 o’clock that day. But at noon, Scully started to take off, until someone asked her where she was going.
“I totally didn’t remember we had planned that meeting, though it was not two hours earlier that we had scheduled it.”
The husband of one of her supervisors had had a concussion, and the supervisor advised Scully to get checked out, which she did. But there was little that medical care could provide at that point.
Scully had to adjust her working conditions. She had been in a room with four people, but that had to change.
“I moved into a tiny, dark little closet. It helped. There was no noise and no people around. Lights and noise bothered me. Everything was too bright. That’s why I worked in the dark room.”
For several months she worked just 20 hours a week. “I came home every day and lay on the couch and listened to podcasts. I didn’t read at home. I didn’t do much exercise. I walked and did yoga, but it was pretty minimal stuff.”
‘A big goose egg’
Carolyn Dunmire, another contributor to the Four Corners Free Press, hit her head on the edge of a Volkswagen camper van in 2002. She didn’t black out, but “I had a big goose egg on my head and it really hurt,” she said.
She and her husband were camping, but they drove an hour to the nearest ER. “They said, ‘There’s really nothing we can do.’ I was basically treated for a skull injury.”
At that time, concussions were even more poorly understood than they are now.
“Hockey was about the only sport where they talked about concussion protocols, because the players wanted to get back on the ice as quickly as possible,” Dunmire said.
It was about a week before she realized the blow to her head had been more serious than she realized.
She suddenly had trouble sleeping. “I would fall asleep quickly but be up after an hour and be up the rest of the night. I got headaches for awhile. “I was not remembering things. I didn’t feel normal.
“I was working on a bunch of technical writing at the time, trying to wrap up a big article and make the deadline. I turned in a half-finished article with sentences that weren’t complete, which is something I would never do, but I didn’t realize what was wrong. I was confused and anxious. After all the not-sleeping, I wasn’t thinking clearly.”
Unfortunately, there is little remedy for a concussion other than rest, along with treatments for specific symptoms – such as sleep disturbances, headaches, dizziness, depression, and sensitivity to noise and light, all of which are common after such an injury.
Dunmire finally saw a neurologist in Durango who prescribed something to help her sleep and reassured her about her condition.
What helped her most in the long run was sitting quietly in nature. “I spent two summers in Alaska doing nothing and that was really what brought me back,” she said. “I do research and writing. When you make your livelihood with your thinking cap it’s really hard. If I was in some other job, I might have felt better faster.”
Scully saw a chiropractor frequently as well as a therapist. Working in the dark, quiet room also helped.
Several months after her first concussion, Strazza ran into a licensed massage therapist she knew in Mancos and burst into tears. She wound up receiving craniosacral massages that she said helped her enormously. She also saw a chiropractor and a psychotherapist.
But Strazza wasn’t done with concussions. “Once you have had one, you’re more susceptible to hitting your head again,” she said. “Your spatial awareness has changed. You have to be extra careful.”
Two years ago she stood up on an outdoor retaining wall to water a hanging plant and slammed her head into a juniper branch, blacking out and landing in the grass. She had a CT scan but it showed no damage.
Strazza went to a chiropractor right away, but still struggled with the effects of the second concussion.
“I couldn’t get a grasp on what was real and what wasn’t. It was a struggle to come out of the fog.
“I didn’t really start feeling like myself till a few months ago. It takes a long time.”
When after-effects of a concussion last more than three months, according to the Diagnostic and Statistical Manual of Mental Disorders, the victim has “post-concussion syndrome.” There are a host of physical, cognitive, behavioral, and sleep-related symptoms associated with the syndrome; each individual will have a different set.
Anywhere from 10 to about 40 percent of victims will come down with it, according to the Concussion Alliance’s website. However, every person I talked to still had after-effects more than three months after the injury.
Even now Scully gets “crazy headaches in the back of the head where I hit my head,” she said. And she no longer can tolerate alcohol. “To this day I get a headache almost every time I drink. I didn’t use to.”
Patients with post-concussion syndrome may have damage to the white matter in the inner part of the brain, according to an article in the journal American Nurse Today. CT scans won’t reveal that.
“This damage may cause problems in how the brain processes information, which possibly leads to the clinical signs and symptoms of PCS,” the article states. “The degree of severity of PCS after minor head injury has been shown to be significantly correlated with the degree of damage to white matter. “Unfortunately, common tests in the clinical setting typically do not identify this physical damage.”
‘I am breakable’
Scully said she is feeling better. She has stopped drinking any alcohol and is working to get off the antidepressants she took for a time. Depression is a very common consequence of a concussion.
A number of people experience motion sickness following a head injury, and it can last a long time. One friend I spoke to still has difficulty with car rides or raft trips, even years after her concussion.
Increased sensitivity to stimulation is another effect that may be permanent.
Strazza said she is overstimulated very easily. “I still can’t do a long time on the computer,” she said. “My eyes get funny. It incites panic.”
She also believes her memory has changed.
“I’ve got holes in my memory like Swiss cheese, and I repeat myself more.”
The emotional consequences are also lasting.
“Your brain has been traumatized,” Strazza said. “It changes you for life. I never will ski again. It’s more than worrying about hurting my head. It’s feeling that I’m breakable.”
Strazza’s sons have also had concussions, she said. One had earned a football scholarship to Fort Lewis College in Durango, but after he saw the Will Smith movie Concussion, which is about chronic brain damage to NFL players, he decided not to continue with the sport. Strazza was relieved.
“It takes a long time to recover,” she said. “I didn’t really start feeling like myself till a few months ago. I have had a lot of orthopedic surgeries in my life, but this is the first time something has made me naturally cautious. I have learned I am breakable.”
Dunmire is also doing well, but has permanent consequences from her concussion close to two decades ago.
“I have memory loss in general. Also, that limited capacity to handle a lot of input, whether a loud rock concert or flashing lights. I ran out of a meeting once because a fluorescent light was flickering. I have tinnitus now that either happened because of the concussion or was exacerbated.”
Like Strazza, she is unable to work at a computer more than a modest amount of time.
“There’s something unique about brain fatigue,” Dunmire said. “We all know when our eyes are tired, but this is something different.
“It’s like a shutdown. That really hasn’t changed for me. If I have too much input or too much going on, it happens.”
The unpredictable nature of concussions is one of the most difficult aspects for victims.
“It’s hard to know that you’re getting better,” Dunmire said. “That’s the most frustrating part because you have good days and bad days.
“You feel completely out of control. You can’t process or deal with the world.”
Anxiety and dread
After six weeks, I got past the fatigue and entered a stage where insomnia was the problem. Some nights I prowled the house for hours, cleaning out cupboards. By then I’d returned to using the computer. One website described a clinic that treated postconcussion insomnia. I was ready to go there until I realized it was in Canada!
The insomnia eventually passed by itself. It’s been six months since my fall, and I finally feel pretty normal. I’m reading books again and watching the news and listening to music. But I’m not sure I will ever be back to the way I was. My lingering aftereffects include a constant low-level state of anxiety and dread, and a weird need to sleep sitting up.
I’m very aware now of how fragile our brains are. I wonder how long the NFL can continue, and how boxing is even legal.
My concussion changed me, but all our experiences change us to some degree. I just hope I’ll be able to cope with the changes.
You may see me walking and hiking the way I used to. Just don’t be surprised if I’m wearing a helmet, or if I’ve maybe strapped a pillow to my head.
One concussion is more than enough.