Traumatic Brain Injury
TBI
Each year, between November and April, I monitor storms approaching our area and potential snowfall amounts. The technology we now have to stay on top of news and weather updates is incredible and I was watching another storm that was going to deliver the goods to our local mountains.
Snowfall totals were beyond expectations for the season. After five years of entering the lottery, my name was called and I was fortunate to experience my first LBS, Legendary Banked Slalom, up at Mount Baker in February. To read about that experience, you can visit my previous article entitled "To Be Legendary".
Only two weeks later, on March 2nd, I called my buddy to let him know about the big storm approaching on the 3rd. It was mid-week and that meant fewer people at the mountain and more opportunity to score good snow.
Once at Alpental Mountain, we geared up in the car and made our way to the base area. The report said 14 inches of fresh snow on top of 10 inches the day before, so we knew it was going to be fun. When we got to the upper chairlift, things went on hold. The ski patrol hadn’t been able to bomb for avalanches over the upper parts of the mountain yet, so we waited in anticipation. Most days I try and make it a point to ride with others for safety reasons and more so on deep powder days. Buddy up. Too many others have been a part of or witnessed accidents on the mountain when other people required medical attention. Even multiple hands can be necessary to pull someone out of a tree well. Tree wells are the area around the circumference of the tree that remains hollow and without snow. They can be so deep people disappear on occasion and aren’t found until it’s too late.
Boom goes the dynamite avalanche blasts and we knew the time was near to ride up and experience another great day. Once cleared by the ski patrol, some hoots and hollers filled the air along with the lightly falling snowflakes.
The path of life.
We mind-surfed a few parts of the mountain while riding up the lift. When the snow gets that deep, it feels more like snowsurfing. The first run was super fun. You could hear people in the woods hootin’ and hollerin’. People all around were grinning ear to ear. We made our way back up for the 2nd run, one that would significantly alter the proceeding years of my life.
I remember riding part way down the mountain and meeting up with Jesse to rip through our favorite section of trees, where more times than not, the snow was even deeper. I took off first descending rapidly into the trees, spraying cold smokey snow. It could not have been more perfect.
Looking up near the section of trees where the accident occurred.
Spraying the cold smokey snow.
What I remember hearing next sounded a bit like Charlie Brown’s teacher. I began hearing my name called repeatedly and felt someone moving me around, but I couldn’t comprehend what was going on. I struggled to put together where I was. Once I came to, I was sitting upright and felt ready to ride down the rest of the run and stood up to do so.
Jesse cautioned me. “Dude, you alright?”
Yeah, I responded, “What’s going on? Why are you asking?”
After explaining I was knocked out cold and snoring, he pointed out where he had pulled me out from beneath two large ponderosa pines. I still couldn’t remember anything. Based on my tracks in the snow and the blow to the back of my helmet, we figured I had caught an edge, flipped over backwards and whacked my head, knocking me out. After a couple minutes of breathing, shaking my head and sputtering incomplete sentences, I felt ready to go.
Jesse is a fireman with excellent medical skills and I could see his concern. A little woozy, but I felt like I could ride. There was deep powder to be had. I made a few turns to the bottom where a ski patroller was just passing by. Jesse flagged him down and thought it wise to speak to him and clarify if there was anything wrong with me. I obliged. The first three questions he had for me I couldn’t answer for some time; “what’s your name, your age and who is the president?” I was in denial. I felt fine, but I couldn’t even answer simple questions. “How many runs have you done so far today?” he asked. Without hesitation, I confidently answered, “That was our first run”. Jesse corrected me, “Our second.” I could remember some of the run, but I was foggy and couldn’t put simple answers or sentences together when I spoke. “I think you’re done for the day and maybe the season”, the ski patroller shared with a grin and a pat on my shoulder. He wanted to take me into the clinic and run some tests. I unbuckled out of my board in disbelief thinking I’d pass the tests and return to the fresh snow in no time. I told Jesse to go and make some turns, but being a good friend, he joined me. I think he knew something wasn’t right.
My vitals checked out okay, but the clinical staff suggested I go to a hospital for further tests. Based on advice and wisdom from the ski patrol clinic, it is important to be closely monitored for at least a few days after any concussion. Being an independent, sometimes stubborn person, I refused to go to the hospital. I didn’t think it was necessary and I felt fine. It couldn’t be that big of a deal. Jesse drove my car as we descended back into Seattle. I would stay at his place for the day, so he could monitor me. Hours passed and I insisted I was fine to drive home, so I left.
Over the next couple of days a lot changed. I was having intense migraines and sensitivity to any noise and light. I wore sunglasses most of the time and that didn’t do much to remedy the pain. I noticed when speaking with people, mid-sentence, I would lose track of what I was saying or fumble to come up with words. I isolated myself and depression came on strong. I didn’t want to talk about it with anyone because the concentration and effort it took to describe my situation and the pain I was in would bring on symptoms and throbbing/pulsing migraines. Sitting up in bed made me nauseous and unable to stand for a few minutes. When I did, it brought on the migraines in the back part of my head that hurt so bad, it brought me to tears. Normal voices and laughter seemed loud and annoying. When I was in an area where there was more than one conversation, I couldn’t focus on the person speaking to me; I was hearing all the conversations around me at once. This made me isolate myself more and brought on more depression. Trying to decide anything became frustrating and difficult, even knowing what or how to make a meal. Decision-making on the most basic level became taxing. Everyday tasks became exhausting mentally, physically, emotionally, and psychologically.
I finally decided to call my primary care doctor and set up an appointment to be evaluated. She recommended that I receive an MRI to see about possible brain damage from the accident. Once at the MRI center, I had significant anxiety about climbing into that “tube” for an extended time. I know from experience the MRI machine isn’t that big of a deal, but with TBI (Traumatic Brain Injury) and the noises that the machine makes, I worried. I closed my eyes, breathed, and prayed through the entire episode. The results were sent to Harborview Medical Center where I would meet with TBI specialists and begin my concussion analysis and recovery. My memory was mostly intact, except for the two minutes before the actual accident. My cognitive skills were okay, but my sentences were repetitive, incomplete, and erratic. I learned there is cause for major concern if patients are feeling nauseous, vomiting, and/or can’t remember thirty minutes or more before the concussion.
MRI image.
Doctors and nurses thought I would make a full recovery. I was prescribed ibuprofen for the headaches, as needed, and told to rest a lot. As an active person, I sensed the seriousness of my injury was settling in and realized I might not be doing much of anything for months to come. I began seeing a physical therapist to help with rehabilitation. After TBI, it is vital to reintroduce physical activity, which stimulates blood flow and healing. At the same time, it is important to increase heart rate and physical exertion very slow. The first week, I was encouraged to walk two times a day on flat surfaces, no hills, for seven minutes, at a slow pace. As the concussion (throbbing/pulsing in my head) symptoms came on, I was to slow the pace. Though I still didn’t feel right mentally/physiologically, I showed quick progress physically.
It is a challenge for me to walk slowly without raising my heart rate very much. I usually have only two gears; fast and faster. Where I live, I am surrounded by hills, so there is only one road I can walk down and back. I quickly became familiar with things in the neighborhood I hadn’t before; cracks in the sidewalk one might trip over, or, where the elderly woman with the two ugly dogs lives, or, where a homeless friend named Rich lives, and where dogs relieve themselves - land mines. I felt like I was Bill Murray in “Groundhog’s Day”. I told myself I could get through this one day at a time. The mental game is real. I started taking time to smell the roses. Not my favorite smell, but it helped slow me down. The second week I improved and was able to do two, ten-minute walks at a slightly faster pace. Six weeks went by and I was walking hills and raising my heart rate significantly. I even got out with a few friends to chase around the frisbee at the park. Though it was difficult for me to engage socially, being at the park, doing something, anything, was helpful. The doctors and physical therapists were happy with the rate I was progressing. I felt like I would return to normal within days. I still struggled with noise and light sensitivities, couldn’t read or concentrate well, and felt isolated/depressed. My body seemed to be recovering physically and that gave me some hope.
All through this, I struggled with hope to make it through a day, let alone weeks and months of recovery that I knew were in front of me. The reality that others have greater struggles inspired me and filled me with empathy. It drives me physically and motivates me to pray for those around me that I know deal with disease, cancer, and things that affect their health every day of their lives.
Then, two months in, I had a setback. The doctor’s explanation was, that “setbacks can happen during TBI recovery and last anywhere from six weeks to two years, depending on the person.” I was at a loss for words. I wept. I went from walking hills for up to thirty minutes before feeling symptoms to not even being able to stand up again without symptoms returning. It was demoralizing. After my next visit to the hospital, they recommended more rest, minimal short-distance walks on flat ground with only a slight rise in heart rate and gave me a prescription for a synthetic pill that would help with recovery and the migraines. I was skeptical. I am very healthy. I eat well, I’m active and I’m mindful of what I put into my body. It was a stretch for me to consider ingesting these pills they were recommending to me. Researching the pills and talking to friends it didn’t seem like it would be that big of a deal. One of my best friends and I agreed since I was being seen by Harborview Medical Center with some of the best medical care in the world, I should trust their medical advice.
“F***”, I yelled when I walked in the door and slammed it behind me. I lost it emotionally. I wasn’t able to work, think, move, listen, read, or do anything without symptoms and pain returning to the back of my skull. The migraines were intense. Days spent in bed with the blinds shut and no noise turned to weeks and months.
I am generally a laid-back person, but my frustration was getting the better of me. I was angry and it seemed like none of the doctors or specialists knew much of anything. Time was precious. After I awoke, I only had an hour or two that I could spend on the computer reading and researching about TBI, its effects, and how to manage migraines before my brain seemed to malfunction. My mind went foggy, I couldn’t concentrate and then the migraines came on strong for the rest of the day.
A self-portrait I took of my computer screen. At the time, I felt it depicted my 'fogginess' well.
These “anti-depressants” made me more uncomfortable, depressed, isolated, frustrated, anxious, and physically nothing changed. If anything I felt worse and in a fog all the time. I began having nightmares about family members being killed and would wake up with symptoms and migraines. In one dream I found a guy sitting on my Dad and hitting him over the back of his head. I jumped on him and beat him to death, blood flying everywhere, and woke up sweating, unable to breathe, with a heavy, intense migraine. My head/neck/teeth/jaw hurt from straining during these intense dreams and it would take hours to fall back asleep. I prayed. It’s the only way I knew how to calm down. I took slow and deep breaths. Sometimes I would call a friend crying my eyes out and sometimes I would lay there alone and pray that my life would end, so that I wouldn’t have to deal with TBI anymore. Even crying or laughing made everything hurt more. I considered suicide and realized I had the means to do so right in my apartment. This was not surprising to the specialists I was seeing. The more I researched, the more I became aware of so many athlete’s that have ended their own lives because of TBI and concussion symptoms. They just couldn’t deal anymore. I can relate. I completely understand how people would want to end their life.
At the next check up with the doctor, I expressed my experience and frustration with the synthetic pill she prescribed to me and admitted my thoughts about suicide. They reminded me again that TBI is still a new science and doctors are still researching and learning about the effects of concussions and migraines and what helps and what doesn’t. I trusted the doctor’s wisdom and begrudgingly agreed to try a second synthetic pill she thought would help in my recovery. In addition, they scheduled me with a psychologist.
My meetings with the psychologist seemed comical. I tried to comply without laughing through our sessions. She would have me close my eyes and start talking to me in a hypnotic voice. The only thing missing was the Enya music in the background and some candles. It felt a bit like the scene in “Good Will Hunting” where multiple psychologists are trying to "get to" Will. In order to keep calm, I instead continued meditation/prayer, stretching, and doing breathing exercises in the quiet of my own apartment.
Only days after I started taking the 2nd pill, the same things ensued; dizziness, drowsiness, feeling in a fog, blurred vision, loss of balance, crazy dreams, etc. I stopped contact with almost everyone, didn’t answer phone calls/texts from friends or lied about how I was because I couldn’t deal with people. I had a hard enough time having a normal conversation with a doctor and that was only once every week or two. Phone calls to doctors, therapists, psychologists, and specialists became overwhelming. Communication with administrative assistants was horrifying. They talked too fast, spoke unclear or treated me like a number instead of a person. My patience was tested every call and my symptoms worsened while concentrating on listening and explaining everything. I began breaking things in my apartment out of frustration that I couldn’t understand or hold a conversation. Each sound on the phone became annoying, specifically the music they play while you’re on hold. That music sucks anyway, but with TBI, it felt like hell. People that choose the on hold music for any medical office should all be fired. They suck at their job. And why is it so loud? The speakers in my phone can’t even handle that many decibels. If I could’ve reached through the phone and destroyed whatever machine was playing that music, I would’ve.
I continued to get outside to walk 2-3 times a day and showed no improvement for weeks. I was determined, yet continually frustrated. On one walk, I only made it two blocks before I noticed a raven on the streetlight above me. I gazed up at it and kept walking. I could tell by the noises it began making that I was mistaken for someone that had attempted to end his life the previous day. He began calling for reinforcements. “Caw.. cuh-caw.. CAW!” I was doomed. I laugh about it now, but in the moment, with TBI, I felt like my life was in jeopardy. Two of them began dive-bombing me. My brain was literally freaking out. Hard drive malfunction. I was laughing, crying and blurting expletives all at the same time. This only intensified the symptoms and pain I was already experiencing. I walked down the rest of the street backwards for what seemed like an eternity and eventually I was left to retreat for home. Here's a video I think will help you better visualize the moment.
More depression, frustration, nightmares, and migraines led to suicidal thoughts – I would be better off, I wouldn’t be in pain anymore, etc. I continued researching what helped previous TBI patients on medical websites, personal blogs and anything else I could find. I spoke with a family member who has been through TBI and received a lot of helpful insight. I needed to ask for more help. Again, my independent nature would be challenged. It was recommended that I should ask for help with grocery shopping, meals, cleaning, phone conversations and appointments. Too many of the every day tasks I was doing may have been inhibiting recovery. I reached out to a few people and asked for help. I had a plan in place to continue more naturopathic recovery. Part of this plan included taking natural supplements that some patients had prior success with fighting migraine headaches; magnesium, riboflavin, turmeric, and fish oil. I was eating many different “brain foods”, including but not limited to avocado, walnuts, and fish. Unfortunately, nothing seemed to be working.
I can't explain how good it felt to get rid of these pills that sent me to the dark side.
I started reading medical research that showed CBD’s were effective in fighting migraines with some patients. CBD’s, or cannabinoids if you’re not familiar, are an extract from the cannabis plant. Cannabis breeders have changed the dynamic of the plant to contain more THC these days. CBD’s, when taken in pill form have shown to reduce headaches and migraines in TBI patients. Before the next appointment with my psychologist and doctor, I printed out some information explaining what I found and asked what they thought. They laughed. Somehow I expected that response. Anything natural from a plant couldn’t work. It HAD to be these stupid synthetic chemical pills they prescribed. I responded with frustration explaining it was ludicrous that they were ok with pushing synthetic pills across the counter treating me like a lab rat, but when I came up with research that showed something alternative and natural may actually work, they laughed. After hearing my frustration, the doctor had the nerve to ask me, “Have you been meeting with the psychologist regularly?” I wanted to punch her in the face. This says a lot about western medicine. No offense to my friends that work in the medical field, but a lot of this doesn’t make sense. Frustration does not begin to explain how I feel about western medicine, it’s practices or what doctors deem a remedy for anything, including TBI. It doesn’t take a rocket scientist to figure out doctors, multi-million dollar pill manufacturers and insurance companies are in cahoots. They are making millions of dollars off people that don’t know any better. People, educated and uneducated, rely on the wisdom of doctors for help. More times than not, whatever the doctor says goes and the insurance companies back their word all the way to the bank. Ever wonder why naturopathic remedies are not covered by insurance or recommended by most doctors? People, generally speaking, take whatever pill is prescribed to them without researching or knowing what they’re ingesting. Once there are side effects from the initial pill, doctors prescribe another pill to counter those effects and so on and so on. A lot of western doctors don’t seem to care what people are putting into their bodies. I’m betting a lot of them don’t because their paycheck depends on it. We’ve all known about this, but to be amidst it while fighting for good health and gaining frustration with every appointment is scary. I had to continually be reminded no one knows very much about TBI and setbacks. Stress, anxiety, frustration, depression, none of it help in the TBI recovery, let alone any other injury. Needless to say, it was crazy to deal with the medical rigmarole that overall, only exacerbated my symptoms.
My frustration led me back to my primary care doctor asking for a follow up MRI and a second opinion. She set me up with a neurologist at Swedish medical center, another excellent medical facility and group of doctors, or so I’m told. The wait was six weeks for an appointment. How is this possible? Six weeks wait for someone with TBI? I had a trip to Michigan planned during those six weeks. Per the advice of my doctor’s, specialists, psychologists, family, and friends recommendation to go, I decided to get away for a while. I had anxiety about flying, but a pair of Bose noise-canceling headphones shut out all the background noise, literally and figuratively. Mellow music helped keep me relaxed. For months prior, I wasn’t able to listen to music at all without being annoyed and/or bringing on symptoms.
The view of Mount Rainier on the flight out of Seattle.
Self-portrait walking through Chicago airport listening to "Ricky's Theme" by Beastie Boys.
I believe the three weeks in Michigan away from everything was crucial to my ongoing recovery. My friends and family looked after me by cooking, playing cards, telling jokes, and keeping track of how I was doing. In moderation, I began swimming, riding a beach cruiser, and continuing prayer/meditation plus stretching and breathing exercises. I know from experience with all my injuries that physical movement and blood flow are important in recovery. Honestly, I likely side a little too much on pushing the boundaries of what I “should” be doing physically, according to the doctors anyway.
I enjoyed riding my old 1967 refurbished Schwinn cruiser bike, but with the slightest uptick in heart rate, a migraine would throb and pulse. I would stop on the side of the road and hold my head until things calmed down. Swimming was the same. I could tread water, but if I exerted myself, the pain started. Each time these migraines occurred, I heard noises like I was in a cave and echoes of voices and noises bounced off the walls unexplainably loud and intense.
My mom and I out for a ride on the cruiser bikes.
While back in Michigan, I spent two of the three weeks at my family’s cottage on a small lake. It is one of the most peaceful places on earth. Most days, herons, kingfishers and a bald eagle are the main traffic around the lake. Kayaking and fishing brought me out on the water away from the noise and even felt therapeutic. Other times, I would just sit on the top deck overlooking the lake taking in the peace and quiet. I debated extending my stay but decided to get back to Washington in time for my next appointment with the Neurologist.
Fishing with Dad.
I was happy that I was going to be seen by someone else, but my guard was up. I had a lot of questions, thoughts, and ideas ready to ask the neurologist. After running a series of neurological tests, he thought I was okay. He recommended time and rest, plus getting another MRI because he was worried about the intense migraines, pain, and lack of progress I was showing. So, back I went into the annoying metal tube for more testing. I was given an IV for a dye solution, Gadolinium, which they would inject to help see possible tissue defects, disease, or abnormalities more clearly. The cold sensation through the veins upon injection was interesting, to say the least. I felt more comfortable this time through the MRI “tube test” and looked forward to receiving good results, which came the next day. I was relieved to hear there wasn’t anything that happened during the injury or something they missed on the original brain scans. I was encouraged to continue resting, exercising minimally, stretching/breathing, and giving it more time.
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Thoughts from my friend David:
Looking from the outside I didn’t think much of it. I don’t remember how soon it was after the accident that I talked with Looman. Usually, we don’t go much more than a week without checking in, but this may have been longer. Where Looman would reach out occasionally by an innocuous text or a mail forward I wasn’t getting much. I thought it was time to check-in.
What he related the accident to me left me somewhat spellbound. More so regarding the providence that he was snowboarding with someone else, that the other person was behind him, and that he wanted to continue snowboarding afterward. That’s Looman, that is the gritty, I am hurt, but I am having a hell of a time attitude I would expect.
The word concussion is almost omnipresent nowadays regarding sports. You hear it during every football game and so many other sports. Kids aren’t supposed to head the ball in soccer anymore. I recently learned there is a protocol after particularly hard hits in football and referees can single out a player to be examined if they suspect something may be wrong. Despite all that media attention, the majority of people aren’t attuned to the magnitude of what a concussion means. I wasn’t, and, unless you experience it yourself, you won’t be. Therefore, not having much context, I wasn’t aware of the severity. When we first talked I don’t think Looman did either.
Not only was I inexperienced with concussions in general I couldn’t relate well to how debilitating a migraine could be. The closest I have come to a migraine was a headache (which was probably a migraine) that came on so quickly and so severely that I left work in the afternoon and slept for the next 48 hours. Then it was gone and I have not had anything similar since.
Thinking back though, whatever I had dealt with 20-some-odd years ago, was beyond words terrible. It felt like something was being physically drilled into the back of my skull.
As the weeks progressed and my calls to Looman continued there seemed to be a general decline in acceptance and patience. This I can understand knowing him. If there is a day that goes by when he isn’t out doing something active, snowboarding, surfing, biking, hiking, or even frisbee in the park, then something is wrong. I have not known another human that spends more time outside. That I can’t even understand because of other responsibilities that keep me busy. However, I know when I need to get out and run my motor. I know when I need to be physically aggressing, exerting loads of energy, and exhausting myself. Looman wasn’t able to do that for months and it was wearing on him.
Conversations with him were filled with as much encouragement and prayer as I could give. The lack of trust in doctors/medicine was a conversation we had several times. And as misguided as it may have been to say trust the doctors, it became something that I think he needed to hear to move him from his fixation, whatever that may have been that day.
Grown men don’t cry. I learned though, that anyone dealing with a concussion is going to cry. Mental capacity is already challenged when dealing with a concussion. The cacophony of emotions becomes overpowering. I am probably not far from the truth when I envisioned Looman lying in the fetal position at various times, probably multiple times a day.
It was difficult looking at it from the outside not knowing what to do. I called often, encouraged in what ways I could. But I didn’t know how to best help and not being near, I don’t know how I could have.
Hardly anybody wants to admit they are struggling with something. Furthermore, when it adds fuel to the flames of a migraine to explain why you might need help I can understand why Looman didn’t do it until much later with the prodding of a concussion sufferer. That being said, if it were to happen to someone else who is close to me I wouldn’t offer help, I would insist. I offered to go visit Looman and didn’t. I should have, but still didn’t comprehend the storm that had descended on him. If I had gone to see him, being physically present probably wouldn’t have helped as much as just being able to care for him.
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Throughout my injuries, my mind always seemed to wander to: how long is this going to take, what can I be doing to improve the recovery, why did this happen, should I quit doing the activities I enjoy, what is the lesson to learn, etc. I usually end up taking something from each injury. I don’t take health for granted and am grateful for every day I get to live. I may not know for a long time what the reason for this injury is, but I trust in one way or another God has my best interest in mind. Shit happens, but it’s how we respond and what we learn through trials.
Healing and recovery from this injury are super slow. TBI and its effects can last years. Thankfully, I am getting better and have been able to get out and walk, bike, and even jump in an alpine lake. With an increased heart rate, I still experience minor migraines, but I can tell the threshold is changing and I can push myself more each month. I do have minor sensitivities to noise and light and have slowly been reintroducing myself into social settings. To those of you who have helped with work tasks, food, money, visits, phone calls, texts, encouragement, love, and prayers, I cannot say thank you enough. This is one of the most difficult things I have experienced and I couldn’t have made it through the hard parts without you.
Not being able to do the activities I love for a while has been challenging, but it makes it that much better each time I'm able to get out again. As the seasons change and our local mountains see white stuff fall from the sky, I'm anticipating more deep powder days, the ride up the lift, feeling the cold air on my face, and putting a lot of frustration behind me.
Another view above the clouds on a good pow day at Alpental.