A Crash Course on Concussions and the Road to Recovery
Illustration: Hanna Barcyzk
I fell. No big deal. I was walking through a snowy, wooded area of the Banff Centre in early November 2017 when I slipped on some hidden ice. I had piles of papers in both hands — a writer’s occupational hazard — so I couldn’t break my fall. Ironically, I was editing the manuscripts of some mountaineers and adventurers who had survived falls on much more perilous terrain than a level path with an inch of snow. I was mostly worried about fracturing something, that slippery slope to immobility, as I landed on my hip and my head. Then I got up, collected my scattered pages and gingerly carried on down the path. Whew, I thought, that was lucky.
Twenty minutes later, the back of my head began to pulse and ache, as a wave of anxiety, unease and nausea welled up. Something was not right. I retreated to my room, shut the curtains — the light hurt my eyes — and lay down.
Conveniently, one of the writers I was working at Banff with happened to be an ER physician. He came right over, checked my symptoms and told me what a trip to the local hospital would soon confirm: I had a “mild to moderate” concussion. Rest in a dark room, he advised, and stay off the computer. But I have work to do, I yelped. He then gently added, “I should tell you that you might experience these symptoms for the next week or two.”
Well, that won’t be me, I thought. As a veteran of migraine headaches and countless other afflictions, I have a certain vanity about being able to soldier through significant pain. (I am even the author of a book on pain.) So I agreed to rest for a few days but silently planned to forge on with my work. The laptop, c’est moi.
Fifteen months later, I am still wearing orange foam earplugs to eat in restaurants. As I deal with lingering headaches, weird all-night bouts of insomnia and an aversion to stimulus (otherwise known as “fun”), I have learned that soldiering on is the last thing you should do with a fresh concussion.
“That was my big mistake, too,” said a friend, a 68-year-old journalist proud of never missing a deadline. (She will remain nameless because she doesn’t want uninformed employers questioning her ability to think.) “I kept on working. It’s been three years since I fell and suffered a concussion. It hasn’t affected my writing, but I still have headaches and balance issues, I can’t handle stress the way I used to and I’m mortally afraid of falling again.
“My first advice to anyone with a concussion would be to stay off all screens,” she said. “At the very least, take a weekend where you do absolutely nothing. But we’re so used to stimulation, all the time. It’s hard to do nothing.”
Most people recover from a mild concussion in a matter of hours or days. But those of us over 55 might take longer. At the age of 59, Maxine Heppner, a dancer and choreographer, suffered a concussion that kept her “out of action” and in dark rooms for almost eight months.
“I didn’t have headaches or nausea. I just couldn’t think. I discovered that more than two people talking to me was too much.” Heppner was used to multi-tasking, handling all the logistical aspects of a busy one-woman artistic career. “I used to be able to juggle 700 things. So when I could only do 500 things my neurologist was not overly concerned. But the truest thing she said, I think, was, ‘We don’t really know very much about this.’
“I did follow my doctor’s advice. I totally rested for what turned into three months. I developed a physical regime that involved mobility and breathing exercises, and meditation — things that help re-integrate the brain and body. I found working and reading on screens impossible at first. I became very aware of how many stages of computation are required just in order to type words.”
So what did she do in that dark room? “I liked to look at a tree outside my bedroom window,” she said simply. “I felt all right looking at a real tree but not a picture of a tree.” The work required for the eyes and the brain to translate a two-dimensional image into “tree” was still out of reach for her.
Did anything else help pass the time? “Mending clothes,” she shrugged. “I’m good at it and I liked doing it. But by the seventh or eighth month, I was getting bored.”
Now, five years on, Maxine Heppner is fine. She dances. She is back juggling 700 things a day. And her clothes are in perfect shape.
Roughly 200,000 Canadians a year suffer concussions. There’s more awareness now about sports-related brain injuries, especially among football and hockey players. But the issue of concussion among the older population is under-represented and under-researched. People over 65 are more likely to suffer concussion, mostly as a result of falls — and about one in three over the age of 65 will fall at least once a year. That’s a lot of potentially bruised brains.
The good news is that although the brain is fragile, it has great recuperative powers. The majority of people with concussion recover. The more alarming finding, from a California study involving 164,661 patients, is that moderate to severe concussions in those over 55 have been linked to an increased risk of dementia. Thankfully, this is not the case with a mild brain injury. But 15 to 25 per cent of those diagnosed with a concussion like mine will have symptoms that can linger for weeks, months or even years.
“That means that every year about 50,000 more of us are walking around with residual symptoms,” said Dr. Charles Tator, founder of the Canadian Concussion Centre, based out of the Krembil Brain Institute at Toronto Western Hospital. For 10 years, the clinic has been a leader in conducting research and raising public awareness about concussion. But the neurosurgeon who may know the most about the subject admits that we’re still in the dark.
“There’s a tremendous lack of knowledge around concussion,” Tator said. “After 30 years of studying it, treating it and doing research, we are still scratching our heads. We don’t understand why it happens and we can only diagnose it by observing the symptoms — up to 65 of them — rather than through blood tests or CT and MRI scans. These scans won’t capture a concussion. What you need for a diagnosis is a knowledgeable examiner.”
But medicine has been slow to accept concussion as a serious condition, perhaps because it eludes the usual tests. Since a quarter of medical schools still don’t have concussion in their curricula, when you show up in the ER feeling nauseous and dizzy after a fall, a “knowledgeable examiner” is not always going to be on hand. So concussions often go undiagnosed.
“The symptoms can be so varied, and every concussion is different,” Tator says. “There may even be a genetic component — some families ‘concuss’ more than others. Women have also been shown to be more vulnerable to concussion, and the symptoms can last longer in women for reasons we still don’t understand.”
At 82, Tator is a lively educator still energized by his work. “Whenever I teach kids in a classroom, I bring along a Jell-O mould in the shape of a brain. This is your brain, I tell them; it has the same consistency. They pass it around very, very carefully.” Tator began his career working with spinal cord injuries until 20 years ago, when a colleague convinced him that concussion was also important and that it was “time for him to get up above the shoulders.” The clinic now has data on more than 1,000 patients as its research continues to evolve.
“We know that a short period of cognitive rest and quiet are important for a day or two but now we’re learning more about the value of exercise in recovery. Not jogging or anything that jiggles the head, but using elliptical trainers or stationery bicycles, where the head remains steady, can help.”
Anxiety and depression is sometimes part of the concussion picture as well, and “people need to be aware that this often happens and is treatable.”
What would be his first advice to someone freshly concussed? He smiles. “Don’t get another one.” Because the cumulative effects of multiple concussions can be tragic. That’s how some boxers and football players and other athletes who sustain repeated blows to the head end up with CTE (Chronic Traumatic Encephalopathy), a devastating condition that can alter personality, trigger profound depression and cause dementia.
I had just bonked my head after a little tumble on a snowy path. Oddly enough, in one of my hands when I fell was the memoir of a revered British mountaineer, Paul Pritchard, who had sustained a massive brain injury after being struck by a boulder on a climb and falling. He did improve over the years, but never completely regained his speech and mobility. Now I can’t watch a football game without seeing it as a perilous dance of fragile young brains. I would make a very poor hockey mom.
In the months after my concussion, my main symptoms were a painful sensitivity to light and noise and a ramp-up of my customary low-grade anxiety. “Going to the big Loblaws” was a major expedition. My ability to handle stress shrivelled, and for months I couldn’t tolerate alcohol, alas. Loud parties, socializing with more than two people at a time — too much. If I pushed through my symptoms (which I often did), I would pay for it with three-day pulsing headaches. I had joined a choir, a weekly outing I looked forward to, but 25 people singing in one room became both a source of joy and a test of my limits. My pockets were always full of earplugs, and there was always an eye mask in my purse. I had tinnitus. Blobs of pain would sometimes drift around inside my skull like bumper cars. Bored out of my skull (so to speak), I would overdo it on the computer, after which my eyeballs felt as if they were wearing Spanx.
One of the many insidious things about concussions is that some symptoms only emerge weeks or months later. These may be wildly diverse and resemble a raft of other afflictions. And one’s judgment is often affected. Two months after my fall, I thought I was almost back to normal. I was not. With some trepidation, I went on holiday to Mexico with friends; I spent most of my days in a room with the shutters closed. Even a gentle walk on the sunny beach was too much stimulation. Mexican restaurants? I quite like mariachi bands, but they were like an audio version of an NFL tackle.
The other frustrating aspect of concussions is their invisibility. I got tired of people saying, “But you look fine” and often wished I was wearing a large plaster cast on my head. I felt a weird combination of guilt and self-doubt. Was I just weaselling out of social invitations? No, I just couldn’t handle groups.
I learned that when your brain is injured, you must slavishly obey whatever your symptoms are begging you to do — to rest, retreat and to let your patient but exacting brain recover. Learn to revel in slow, incremental progress. Discover tiny pleasures (ice water sipped in the dark was mine).
Although I kept up my writing, which reassured me that my brain still worked fine, I pursued all sorts of treatments for my other symptoms: osteopathy, physiotherapy, cranial-sacral massage and acupuncture. I went to a sympathetic psychotherapist who practiced neurofeedback, a sort of visual gym for learning to retrain and re-pattern disrupted brain activity. Everything helped, a little. I meditated in a desultory way and did lazy yoga. In fact, meditation and yoga were key. And I found that I rather enjoyed scaling my life back to elemental pleasures: sleep, silence, walks, music instead of TV. (At first, I would “watch” Netflix with an eye mask, peeking once in a while.)
It’s not a bad thing to reduce the amount of stimulation in our lives, I discovered. Concussion is a lesson in self-awareness and in respecting one’s physical and mental limits.
Catherine Wiseman-Hakes is a Toronto-based clinician-researcher with expertise in the area of brain injury. She urges people to go to their family doctor if they suspect a concussion or to the ER if they are experiencing severe headache, vomiting, dizziness, any changes in or loss of consciousness.
“But there’s definitely a place for rehabilitation for those with persistent symptoms as well as alternative practices. For instance, concussion often has a component of whiplash, so it’s worth having your neck examined once the initial recovery has taken place. There are some chiropractors, osteopaths and physiotherapists doing good work in this area.” (That’s next on my list.)
It’s been more than 15 months now and — this could be the last wisps of concussion talking — I’m back to normal now. The other night I went to a party without my ear plugs and I survived. I am fun-worthy again!
Concussion has made me more attuned to how I interact with my environment — which scenarios to avoid and which ones calm me. Time spent in Nature has become more important; like Maxine the dancer, I would rather look at a real tree than a picture of a tree. I won’t say that I’m glad I fell. But injuring my one and only brain has helped me know and respect it a little more.
A version of this article appeared in the May 2019 issue with the headline, “A Crash Course in Concussion,” p. 59.