2 - What is a Concussion anyways??

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Recently I went to a talk on neuroplasticity.  If there is anything I learned from that talk it is that very little is truly known about how exactly the brain works. The researcher and professor giving the talk likened brain research to opening one Pandora's box, only to find another Pandora's box, only to find another, and another… though as I doubt neuroscience research releases any evil into the world, I picture it more as opening never ending nesting dolls, each one revealing another confusing mystery, wrapped in a riddle, tucked inside the enigma that is the brain.

You know that expression people use when they are trying to say something isn't that complicated? “It's not rocket science…” Well rocket science is child's play compared to scientific research into the brain…

I'm not here to give a quality science lesson on the pathophysiology of brain injuries; this isn't a university dissertation and I don't have the energy to insert proper citations. But I figured as this entire blog is about my experience with concussion, for context, I might as well share what I have learned. Some of this information I learned through presentations I’ve attended, or research publications I have finally started to have the energy to read (I do in fact have an educational background in science nerdery ;D). Otherwise, information found here can be reviewed through the Ontario Neurotrauma Foundation, the Ontario Brain Injury Association and Concussions Ontario. You can check out their websites and resources here: www.onf.org, www.obia.ca, www.concussionsontario.org, or you can look up your local brain injury association.

There are different kinds of brain injuries. Concussions are one type of brain injury and they may also be called mild traumatic brain injuries or mTBI for short.  Concussions can happen from a hit to the head, however that is not the only way a person can get a concussion. Trauma to the neck, whiplash, or anything causing the brain to jostle around quickly inside the skull can cause a concussion.  A person does not need to lose consciousness to have a concussion. In fact, of my 4 or 5 concussions, I don't think I have ever blacked out.  However, I can't be too sure about that one time I slipped on ice as no one but my dog was around and my dog refuses to tell me the story…  This sets off quite the cascade of biochemical brain pandemonium: the blood vessels of the blood brain barrier become leaky; brain blood flow is disrupted; there is some messed up influx of ions into the neurons, which screws up energy production; toxic type particles are released and that damages neuron DNA and proteins, which eventually causes the neurons to die. All in all, cells in the brain are damaged and no longer have the energy to work properly, until they are repaired and the brain is healed.

Most people who get a concussion will recover in 1 to 4 weeks. I find myself in the unlucky 10 to 15% of people whose recovery lasts more than one month. When symptoms don't resolve, this is called Post Concussion Syndrome (PCS) and this can last from months to years.

Everyone may have different symptoms or experience them with different severities. The SCAT-3 is an assessment tool healthcare providers can use.  One part of it assesses these common symptoms: headache, pressure in the head, neck pain, nausea or vomiting, dizziness, blurred vision, balance problems, sensitivity to light, sensitivity to noise, feeling slowed down, feeling like in a fog, don't feel right, difficulty concentrating, difficulty remembering, fatigue or low energy, confusion, drowsiness, trouble falling asleep, more emotional, irritability, sadness, nervous or anxious… It’s a long list and yeah, I've had them all, often experiencing multiple symptoms at one time.

When I explain to people what PCS feels like, I've often said it feels like being drunk and/or stoned. The response I usually get to this is something like “ah, cool!” I shake my head. Sure, everyone likes a happy drunk or giggly intoxication, but that's not what this is.  So let me clarify: it's like when you've been out all night drinking and you wake up in the early hours of the morning, hungover, but also still a little drunk. You feel like shit and you still don't have your full capacities back yet; it feels like you need a university degree to figure out how to make a sandwich, even if you had the energy and focus to make your way to the kitchen… It’s also like when people try some weed, but instead of feeling calm, they develop anxiety.  You didn’t choose or plan for this drunken, hungover, anxious state, and it never ends. So… Not. That. Cool.

The jury is out on the best form of treatment. Heck, the jury is out on a good diagnosis. Right now, if a patient is sent for scans or brain imaging, this won't show the concussion. Scans and imaging will show significant bleeds in the brain, or other causes of symptoms like a mass, but the current routine hospital scans don't diagnose the nuanced leaking and damaged neurons that have caused me so much trouble. There also currently does not exist any blood tests to definitively show a mild traumatic brain injury. So, the diagnosis relies on the concussed patient to clearly and accurately articulate their story and their symptoms. This is a serious problem and challenge when to do that the concussed patient needs a well functioning brain… Without a clear understanding of what’s going on in the brain, there is no clear way to diagnose and no clear treatment path.

Because of the unclarity in all of this, there is also no good support from the healthcare system.  Wait times to get in to see a specialist covered by the provincial healthcare system have been so long, that the specialists have instituted an exclusion criteria - if your injury was more than a certain number of months ago, they can’t take you in… The patient is then left to seek out other treatment options, none of which are covered, and a number of which might be less than evidence-based…  This creates a lot of tough decisions for the patient to make.  This for me at times was near impossible.  Often, the part of the brain needed for decision-making is buggered by the concussion - even just trying to choose a type of yogurt at the store was enough to send me to bed… And what yogurt to buy wasn’t nearly as important of a decision as how to spend my hundreds to thousands of dollars to get healthy again…

So what's going on inside my brain? A lot. I commend, I appreciate, I am grateful for any researchers and healthcare professionals seeking and practicing evidence-based answers and advocating for people like me. I hope to join those ranks. But for now, as I continue to improve, all I can do is write this blog. In comparison to the never ending and mysterious brain nesting dolls, writing this blog isn't that hard. After all, this blog is not neuroscience. 

- Krystal