Assembling a human: Putting together fragments from a brain injury

t has been almost seven years since I suffered my worst concussion to date. As many have read on the blog about the recovery and the initial trauma of the injury, I thought it would be interesting to do a piece on how life has moved on and find out, whether I was able to assemble a person from the fragments that were left as a result of the blow.

To recap briefly if you haven’t followed this blog long. I suffered a brain injury (which I refer to here as concussion) whilst playing hockey about seven years ago. I can’t remember much from the day it happened or the months following, but what the doctors told me is that I had a bleed in my brain and I was being monitored very closely by medical professionals. Being an idiot that I am, I ignored the doctors’ advice and caused myself more harm, returning to play after a week off (which was WAAAAY too soon). My symptoms were severe. I had to spend days in a darkened room due to intense photophobia, my head was pounding like I’d been on a week long bender, I was iritable, I could not remember what I’d done two minutes prior and I was laughing hysterically one minute, only to break down in tears the next. I felt I lost myself.

The recovery from the concussion took almost a year and a half, mainly because I refused to rest, so I suffered from headaches, dizziness and low mood/irritability for a long time. These symptoms are usually quite persistent in the early phase of concussions and should subside if you follow the appropriate recovery protocols.

In the early phases of the injury, my handwriting changed dramatically and my decision making was impaired. I also did things like try and dry myself after having a shower, whilst still standing underneath the shower. There were also difficulties associated with concentration and anything that required a prolonged period of attention, were difficult to deal with as I got a blistering headache from it.

However, now nearly seven years later, have I and my family managed to assemble a person of the mess that was left from the concussion? Neurologically, speaking I am fine. All my reactions and nervous system work as they should. Also, scans of my brain show no sign of permanent damage. That’s all well and good, however…

Despite getting a “clinical” all clear, I am still left dealing with concentration problems, usually in day to day life and at work. I am good at starting on a task, but then my mind wanders and I’m left thinking, what the hell it was that I was doing. Usually, I have to park the activity for a bit and come back to it once I catch the thread of my thought.

Additionally, some may have noticed in conversations with me that my eyes wander when I’m speaking to them. This again is associated with the concentration problem. Where I am listening to whoever I’m speaking to and paying attention, it is a monumental challenge to maintain eye contact. So, if you are speaking to me, and I’m not looking at you, please don’t be offended.

It is weird as when it comes to game day and the minutes leading up to when we take to the ice, that’s where I find I’m most focussed. Though having said that, it too has been an area where I’ve struggled. I’ve since been seeing a sports psychologist and have been using various techniques from hypnotherapy to NLP to help me achieve a better level of focus before games. I have to do the same in professional life when it is time to give a presentation, for example.

Prior to the concussion I had a pretty good memory. I would be able to recite circulation figures of publications, who the editor of a magazine was, which player played with what number and what sticks they used etc. Today… No chance. I struggle to remember names of people I’ve done business with for a long time and also I get easily confused on how many reps or sets I’ve done at the gym, despite having a workout log in front of me.

I am also maybe a touch more irritable than I was seven years ago. I seem to let little things get to me and eat away at me for days on end. However, I’m not a 100% convinced that my irritability is due to the brain injury, as my close friends and family have often described me as the most wound-up laidback person they know prior to the injury.  

The other aspect which has become more prominent in the wake of the concussion are my depressive cycles. I had been battling depression before the injury, but it seems like it has exasperated the problem, in that my depressive ‘episodes’ are more frequent and tend to be a quick decline, rather than something that happens gradually. Another issue which I remember vividly from the symptoms was that I looked myself in the mirror one day, must’ve been 2-3 months after the initial injury and I broke down in tears. I remember telling my wife that I don’t like the person that is staring back at me in the mirror and that I wanted to change. It was almost like the line in the Springsteen song Dancing in the dark: “I wanna change my clothes, my hair, my face”. Body image was never really a big deal to me, but that was a defining moment in my life and I still have the same feeling everytime I see myself in the mirror. And that is despite losing loads of weight and putting on more muscle. With depression, I’ve reached a good place and have become better at identifying when I’m starting to ‘lose it’ and can seek to rectify it. I am likely to eat pills for this for the rest of my life. With the body image thing… who knows.

Coordination is something that has been affected. It may be brash to say that it’s all coordination. I am completely fine and in control when I’m playing, working out, driving etc. I’m absolutely fine, but tell me to do start jumps, I’m boned. I get there eventually, but I have to run through everything in my mind as to how it all comes together.

Those are in the main the areas where I still struggle a bit or that I know that have changed. What of the answer to the question: Am I still the same person as I was before the concussion? The answer is no. And to be truthfully honest, no one would be after 7 years. I feel I’ve grown and evolved as a person since then so it is impossible to say whether or not I am the same as I was back then. To what extent the concussion affected that process, I don’t know. but it definitely had an impact.

However, what I do know is that I am incredibly lucky in that my injury was not as bad as some of the ones I’ve seen while I was recovering. In comparison, I felt like a fraud next to people who are having to re-learn to walk, eat, write etc. The drive these people have is astonishing and I have nothing but the highest levels of admiration and respect for people who are going through that level of arduous recovery. 

 

However, whether or not me and those around me have managed to assemble a person of the fragments that were left: I think we’ve done alright. It hasn’t been easy, particularly in the early weeks and months post injury, but I’m a relatively respectable citizen.

 

First Off-Season update

It has been a while since I updated anything on the blog, so I thought that a quickie would be in order. Despite still spending time off the ice, I’m feeling really good. My off ice training is going well and I’m getting consistent good workouts in and I find that I am pushing myself to lift more weight, which is encouraging. As I come to complete the first month of the regime, I’m going to start adding more into the workouts and routines. At the start of May, I’ll be adding cardio and plyometric work into the mix. Hopefully it will pay dividends when I’m allowed to get back on the ice and resume full contact training.

I’ve also been doing a lot of physio work and my physio, Matt Radcliffe has been putting me through the paces. He’s definitely one of the better physiotherapists I’ve had the pleasure to work with. It’s been painful but I can feel that it is working so I’m keeping my fingers crossed that I will not have to have my hip operated on.

The concussion related problems still bug me though. I still get head-aches and I suffer from concentration problems, which is a bit irritating. Additionally I seem to have memory lapses. Like the other week I successfully tied one bow on a sofa bed and went to do the next and did not know how to do it. I’ve been referred to a neurologist for further exams and hopefully a CT scan. I’m not worried that the scans or exams would reveal anything major, but you know, it’s more for my own peace of mind than anything and I guess to my family’s peace of mind as well.

I’ve also started hammering pucks at the net in our back-yard. The only trouble is that I don’t dare shoot top shelf after a few pucks pinged off the cross bar and ricocheted to our neighbours yard, nearly hitting them as they lay on the lawn tanning.

Needless to say, though it’s only been a month into my off-season training, I’ve been encouraged and I’m hoping I can carry the form throughout the summer.

One of the biggest questions I get asked (relating to the concussion) on Facebook and by friends is that whether the ongoing issues mean that I will be hanging up the skates. The answer is no, I won’t be. Aside from the concussion, I feel great and I think after the few weeks rest and ongoing physio the body is starting to feel good as well. I’ve got an itch to get back out on the ice, which is a good sign and you know what, I enjoy playing so there’s no reason to give it up. As long as I’m having fun with hockey I don’t see a reason why I should consider hanging up the skates.

There’s no denying that this concussion has been worse than any before and recovery has been slow, but it’s another bump in the road that I hope to leave behind soon enough.

P.S. Go Habs Go!

Still trying to figure crap out

So it would appear that my physical symptoms of the concussion have subsided. I no longer suffer the headaches that I described earlier. I still get waves of nausea every now and again, but overall things have taken a turn for the better. However, I am still not 100% symptom free. If you saw me on the street and spoke to me, you probably would not know that I had anything wrong.

However, there are clearly still issues in the head that I need to work through. My handwriting, short term memory and general writing ability being the top ones that are my concern at the moment. As you might’ve seen from the twitpics earlier this week, my handwriting has taken a bit of a nose dive, to the point that I get frustrated with myself when I’m trying to write by hand. I have since resorted to taking all my notes on a laptop to make sure that I am able to decipher my notes and actually remember what I was doing, rather than having to hire an Egyptologist to tell me what I’ve written.

As for the writing ability, I can write at my normal pace, but I have to pay extra care into what I write. Sometimes what I write is not what I was supposed to. I forget words from sentences and sometimes the structure of sentences is a little bit wrong. I’m not using the excuse that English is my second language and that would be the reason why, but these are mistakes that I wasn’t making prior to the head trauma.

My memory is still a bit all over the place. For example, I dunked my hand into a coffee cup full of hot coffee the other day as I thought that it was full of sweets. Who puts sweets in a coffee cup? I don’t know but I guess it made sense in my mind before burning my fingers and thinking “Hang on just one darn minute, these are not jelly beans.”

The other issues I still have relate mainly to self image, but this is not an emo diary so I’m not going to start writing about what pants I want to wear and how I want my hair to look and so on.

Suffice to say, I’ve taken significant steps in recovery, but there are still a lot of things that just don’t make sense and a lot of things I find I’m questioning. Whether it’s a personality change caused by the latest concussion and one that has accumulated from the four others I’ve had remains to be seen.

The awesome thing is that I was able to last a whole work out a few days ago. OK I wasn’t pressing nearly the same weights as before, but it felt good to give the body some abuse after laying in a dark room for a week and a bit.

It’s all right man, I might’ve been bleeding man

I thought I’d take a break from updating the daily concussion update, because there was really nothing new to report and I doubt you want to read stuff like: “my head still hurts etc”. Everything is still slightly off kilter and I’m not feeling a 100%, though I have taken significant steps to recovery, or at least I feel I have.

 

I had an appointment with the doctors yesterday and what got told what I had feared. You might recall that I said I had 18 out of 21 symptoms listed for post concussion syndrome (PCS) and basically the doctor told me that I’ve got the condition. I had secretly wished that he would say that you’re still not fully recovered but you’re about 95% there and that it would be OK to resume normal activities.

 

What scared me yesterday was that I was told that it was likely that I had a small bleed in my brain as well that he didn’t spot upon first examination. However, the bleed was (if there was one) was minor to the point that doctors wouldn’t have done anything for it i.e. drill a hole in my head or remove a piece of skull.

 

My moods are still all over the place and I keep going from being happy to being sad to flat out enraged for no apparent reason. On a personal level this has been a trying test of patience, and my patience is wearing thin at times.

 

For the first time today, I wrote something by hand rather than by computer and here’s the difference. This picture: http://yfrog.com/h471529449j is from notes that I took on the 1^st of March and here is a picture of my hand writing today: http://yfrog.com/h2qr2pxj. Spot the difference?

 

On a positive note however, I have been allowed to start doing exercise again. I’m not allowed to lift heavy weights yet (damn it), but I have been allowed to do cardio work (hockey is cardio isn’t it?) and light weights. I went for a run last night and I did OK till about 8 minutes in. After that I had to take several breaks to let my coordination get back. I’m going to attempt the gym today and use the small dumb bells that are normally reserved for women. Man I’m going to get ripped doing that.

Seriously Sensitive But Best Day Yet

After I posted my blog last night, I took a turn for the worse. My headaches intensified to the point I was ready to do the 3m dash to the bathroom at any second. Good thing I didn’t have to as I probably would’ve knocked myself out on a door frame or something else. My headache was so intense that I wanted to perform trephination on myself to try and alleviate the pressure in my head. Luckily the painkillers finally started to work and I was able to get some sleep. I did sleep rather well, to the point that I was woken up only at 13:00 when a friendly Jehovah’s witness rang our doorbell.

I was also overcome with a feeling of sadness and I wanted to ball my eyes out last night. I have no idea where it all came from but my mood changed rather drastically and I wallowed most the night in a mix of intense headaches and self pity. I was a seriously sensitive dude last night Otherwise, today I have been feeling relatively fine. My head is clearer than it has been for days now and I don’t feel as if I was living in a cloud. However, I’m still not 100%. I don’t think I could last a full gym work out or a jog.

There are still issues I’m trying to work through. One thing I have noticed the past week is that I don’t really feel like myself. Where I am starting to feel better, I feel as if there’s a part of me that is missing. I guess the problem with concussions is that they are like breaking a vase. You can try and put it all back together, but depending how bad you broke it, you’ll never be able to fit all the pieces back together. And I guess the symptoms and the emotions are as unique as the person who suffers it.

However, this has been the best day so far, but that’s not to say that I’m OK. I hope from now on I’ll be able to make significant progress day by day. My dreams are still weird and for the past few nights they have had a mexican theme to them. Go figure that out.

I’m also seeing the doctor again on Monday, so hopefully I’ll get some more guidance into where I go from here. Tell you one thing though, once I get the all clear from the doctors, the first thing I’m going to do is have an ice cold beer.

Also, good luck to my teammates this weekend. I won’t be able to join them on the ice, but hopefully I can muster enough focus to make the trip and watch them play.

Fake Sound of Progress

Feels like today  I’ve taken a few steps back. I went to bed last night feeling really positive and up beat, but I woke up with the mother of all headaches and my eyes are really sensitive to light and my ears are ringing probably more than they have during this ordeal. Maybe it’s the fake sound of progress. I don’t know.

 

My eyes have become super light sensitive again and loud noises are still a problem. Doesn’t help that the local council has decided to drill a hole pretty much outside my house. The other set back from today has  been the fact that my hands have been shaking from the intensity of the head-ache. I’ve tried to eat, but as with a bad migraine, food isn’t often the most appealing.

 

On the head ache front; it has been extremely debilitating. To the point that I can’t even sleep properly as the slightest stirring in my sleep wakes me up. I just wish that I could be put to sleep for a couple of days and hopefully it would help. That or some one drill a hole in my head to relieve the feeling of pressure in there.

 

I spoke to my parents again today, but I can’t bring myself to tell them the full extent of how I’m feeling. Mom, Dad, I know you read the blog and I know it must be frustrating to read more in depth updates on me here, rather than get them from the horses mouth. I’m sorry. I just don’t want you to worry yourselves sick over me.

 

On the plus side though, my speech  is not slurred anymore, so there’s some positives I can take from today. One thing that I am super-pleased about is that I’m able to write more at the pace I’m used to. My biggest fear was that I had taken such a blow that my livelihood would suffer from it. My profession relies on writing,  so I was worried I’d screwed up big time.

 

If anything writing these daily updates has been cathartic for me and I hope they shed some light to the world of concussions. I’ve had injuries ranging from bruises, back spasms to torn ligaments, but you know, I would quite happily take one of those injuries over this.

I’d also like to extend a get well soon note to Max Pacioretty from the Montreal Canadiens. He’s worse off than I am, but I can understand what he must be going through. As a sworn Canadiens fan I hope he makes a quick and full recovery.

Baby Steps

Today has been good. I was in a pretty bad place last night and my mood was up and down like a yo yo. If I didn’t know any better I’d say I was going through midlife crisis or menopause or something. The biggest improvement has been in my coordination. I don’t feel as big of a bumbling fool as I did yesterday.

I’m getting my appetite back as well which is pretty good. I’m still suffering from a headache and i’ve got a constant ringing in my ears, kinda like having been in a concert or nightclub and you’ve spent the night right under the speakers. Which reminds me.. loud voices and sounds are not good either. Sort of sucks, because music I like is loud. I had a little walk around the block. I started to feel a bit dozy afterwards and my eyes had trouble re-focussing when I checked the crossing.

The biggest problem I still have is with my short term memory. It’s getting better, but I find I’m asking the same things or remember I have to do things that I’ve already done. That and I’m still sleeping a lot and still getting easily irate.

I guess this is the ‘dangerous’ phase in recovery as I’m feeling better, I’m getting the itch to get back on the ice and I’ve partially forgotten my own frailty. But I’ll carry on taking baby steps to make sure that I’ll be able to get on top of this quickly.

As ever, I remain appreciative and humbled by the messages of support I’ve received.

Worst Injury EVER

I’ve recently really gotten into Twitter. I’ve seen many interesting hockey conversations and it has been one of the first places where I’ve seen on trades. However, I saw a few tweets about a writer for The Hockey News tweet about a few concussions and players’ experiences. I posted my own accounts of concussions by confessing that during my 29 years, I’ve sustained 4 of them.  Admittedly only 2 of these have been in hockey situation and two in non-related matters. I should’ve probably clarified that in my tweets. And despite popular belief, none of the hockey ones have been sustained whilst falling off the bench.

One thing that isn’t really discussed at lenght is how a player feels, so I’m trying to give accounts of my feelings after a concussion. By far the worst concussion I’ve had was when I was in middle school on 8^th grade. I was playing shinny at a school PE lesson and back in those days, helmets were an unknown quantity and the only protection you had for your noggin was a beanie hat.  As you might guess it was non checking.

What happened was a classic rookie mistake. I broke out of the d-zone and was ahead of the play and was waiting for a pass and then… BAM! I collided with another guy and our heads hit. We were both carrying quite a bit of speed at this and I can’t remember if I hit my head on the ice when I fell down. All I remember was that the impact was to the left temple as I was looking back. From then everything was really hazy. I was taken to the school nurse who called an ambulance for me and I was taken to the hospital for observation.

After I got back to school, I found it really difficult to concentrate. To be fair I was never a straight A student and my mind was always on something else than the lesson at hand, but this time it was different. It wasn’t like I was gazing out of the window or day dreaming. I felt like I wasn’t really present, and that I was like an empty shell. I found that different smells really got to me and I could not put up with Design tech at all. I was really iritable and even slightest of things set me off. To the point that I threw a pair of scissors at my brother’s friend because of something insignificant he did. Luckily my aim is as good as it is now and I missed. I kept snapping at small things, like TV adverts. I felt incredibly frustrated and for a while things like trading cards that I was really into did not interest me at all.

My mom still has the chopping board that I built in DT and it’s built sort of wrong. The curves of the wood should match but in mine they are all over the place, because I knew how it was supposed to be assembled, but I put it together thinking that I had done it right. After I got it back at the end of term (fully recovered by now) I saw that mine was all wrong compared to everyone elses’ symmetrical rather aesthetically pleasing chopping boards. I’ll never forget how the smell of glue and how that made me feel during my first lesson back.

As a result of the incident, the school made it compulsory to wear a helmet during hockey at PE. They even invested in a bunch of Bauer helmets. I guess something good came out of it.

Before that I had sustained a minor concussion playing king of the hill (during winter) with friends and lost my footing on the hill and fell and hit my head on a bloc of ice. Back then I only suffered from a slight head-ache and discomfort and I was so young that I can’t properly remember how that felt exactly or what the effects were.

The last two concussions happened during my time in Holland. I got a concussion when I was breaking down on the wing and I had just dumped the puck into the zone and I was in what is now referred to as a vulnerable position. I got hit and as far as I can remember the hit was clean, it was just that I flew into the boards with the back of my head first. You know in the cartoons like Tom & Jerry when one of the characters gets hit in the head and they see birds or stars? Well, I definitely saw stars after that.

This happened right in front of our bench, so at least I had a short trip to get off the ice. I managed to get off on my own wits, but the minute I sat down, I knew something wasn’t right. I slumped to the changing room and one of the players’ mothers who was a nurse came in and checked on me. As I laid on the massage bench, one of the most excruciating things was when she tested how I reacted to light. Whenever I saw the light for the first time it felt terrible.

I changed back to my clothes I saw that my helmet had paint off the boards on it (the rink had wooden boards). My dad drove me to the emergency room and I was faced with yet another wait in the emergency room, me wanting to do nothing else except sleep, not that I was tired, I felt really drowsy, as if someone had given me a sedative. The doctors’ told me that I had a concussion. I have no idea whether it was minor or severe. Again I had similar symptoms, except I was really tired. To the point that I would sleep every chance I had. If it was a lunch break or a break, I would find a place where I could doze off. Again I felt iritable, more than your usual teen angst  and I found it difficult to concentrate again. I was working by this time, so I was as good as a dead shell at work. I was able to function, but I had a hard time focus on the tasks at hand, so I might as well not have been there. What didn’t help was that I was working a call centre job.

You know the one ‘mistake’ I made? I didn’t ask the doctor how long I should stay out of hockey. If I didn’t ask or the doctor didn’t say about sitting out, I was good to go in my books. Despite the headache, I went back the following week, but it didn’t feel right. I wasn’t going to the corners and I felt scared on the ice, but I wanted to persevere with it. But looking back on it, what would the doctor have said? Back then there was a lot of confusion about concussions and its effects on sports and so on. I remember the most common advice was that get back when you feel comfortable.

It wasn’t really like I was put through a test or anything to see what stage my symptoms and recovery were at.

Once I started to feel better and I was out with friends, I got head butted in a bar and I was down for the count again. That was the second consecutive concussion I had sustained, it was in 2002. And I have not have had one since.

The trouble is that concussions were really difficult to deal with and when the levels you play at you don’t really have a team doctor and back then you relied on the your own feelings. If you were able to skate, you were able to play, or at least that is how I felt. When I say that, I’m not saying that my team was negligent in letting me play. They asked me if I was good to go and I said yes, I’m good to go. The right thing to do would have been to sit out for a while, but when you love doing something, you don’t want to stay away from it.

What about the long term consequences? Maybe the hits to the noggin are a reason why I am really prone to depression, often severe and hellish bouts of it. It is really difficult to say what the long term consequences are, but I guess it is safe to say that I will not have a career in astro physics. Despite having a relatively high count in concussions I still play and I feel normal most the time. Whether I get another one remains to be seen, but for the past 8-9 years I’ve felt good.

The real shit thing about concussions is that to the outside you seem fine. It’s not like you’re holding your wrist or limping because you’ve got a bummed leg. You tend to get a lot of stick from teammates for it, because they don’t know what your head feels like and to the outside you seem fine. One of my teammates sustained a concussion not too long ago and he is already playing. He says he is fine, but every time he gets hit, I’m worried about him, because I know what the consequences are, but like said. It’s not like we have tests to check. Our coach is really good at really pressing guys about their injuries and making sure we don’t play if we are trying to push through something.

So what would my advice to kids or players with concussions be? Rest it and do something I have never done: LISTEN TO YOUR BODY! As long as you feel the effects of it, stay off things for as long as it takes. I know it’s hell but, you will not be helping your team and you wont do yourself favours in the long run. I know hockey is supposed to be a tough man’s game but when it comes to head injuries, the manly thing to do is to sit out till you feel 100%.

In that breath I wish all the players in the NHL and elsewhere suffering with concussions a quick and steady recovery.

I can’t come up with an appropriate ending of my own to this post, so I’ll quote the Comic Book Guy from the Simpsons: Concussions are the WORST…. INJURIES…EVER…