When Everything Changes in Seconds: Traumatic Brain Injury (TBI) + Initial Recovery

One decision, one slip in judgment and everything can change in seconds….

I want to use this post to discuss my accident along with the initial protocol I implemented as a result. My goal is to show those that have suffered you are not alone and for those who may suffer in the future hopefully offer some hope and guidance that there is a lot you can do to help. However, it is important to not get caught up stressing around doing everything but to do what you can because at the end of the day the most important thing is to be stress-free and rest and remember we are all different

Why Bintan 70.3 Ironman?

At the beginning of this year, I set two pretty ambitious goals, targeting World Championship qualification in both Half and full distance Ironman, something I previously never perceived as possible.

In my pursuit to attain an early qualification for 2020 Taupo 70.3 World Championships, I flew over to Bintan, Indonesia to race a Half Ironman. Everything was going perfectly to plan with a solid swim and on target for an awesome bike on a very challenging technical & hilly course, I was racing my perfect race, feeling great with everything going to plan, in fact, if I kept tracking as I was I would have won my Age Group (I needed a podium to guarantee my qualification spot) and also came in the top 5 overall. However, this was not meant to be as at the 75km mark of the bike everything went blank….

I couldn’t tell you what happened first hand because I have no recollection but from what I was told, I came flying around the corner towards two speed bumps, the first I bunny hopped and then hit the second of the two with my front wheel off-centre (according to my Garmin Computer at 42kms) sending me flying over my handlebars headfirst into a curb, with my right side taking most the impact/ road rash but I must have rolled as well because I was cut up on my left as well. I am not sure how long I was out for but I don’t recall anything from my time at the crash site but apparently, I was repeatedly asking the same questions over and over “what happened??” “Is my bike ok??” Once told I would ask the same question straight away again. Not surprisingly the volunteer that was helping me knew I was not in a good place so he called in the doctor to assess me, you would think at this point my race was over but the doctor said if I want to keep going I can and those who know me I am extremely stubborn and a sucker for a challenge so there was no choice in my head (not that it was working anyway) I assume, this is when I jumped straight back on my bike and went on autopilot. This is the part that really scares me because I still have no memory of any of this, I am not sure why the doctor let me go, maybe it was because I was being difficult wanting to jump back on my bike and not listening (I wouldn’t be surprised, I put a lot into the prep of this race) but he should have never given me the option in the state I was in, he should have pulled me from the race. The volunteer that helped me at the time of the accident found me after the race and filled me on all of this he couldn’t believe the doctor let me back on the bike, he also could believe I had finished the whole race.

With no one stopping me there was no way I wasn’t getting back on my bike. Dazed and confused it wasn’t until after the race I looked back to my Garmin Computer for answers and they truly shocked me! Turns out I spent 17mins at the crash site…… No clue how much of that I was unconscious or what was going on and then back onto the bike on autopilot with 15kms left of the 90km bike course. Still with no memory of this, I wonder what was going through my mind because this was quite possibly the stupidest thing I could have ever done, not just because I was back on the bike but the speeds I was going with an extremely beaten up mind, body and bike (Bike had $3700 worth of damage….). My Garmin once again highlighted my stupidity although overall last 15km was slower than it would have been it showed multiple times where I exceeded 60km/hr and if you know anything about concussions the absolute worst thing you can do is have another in close concession… Even within up to 3 weeks. Thankfully I survived this very silly decision.

In to transition and onto the 21km run, this is where I somewhat came to. Dazed and confused and with no memory of losing 17min at the crash site or my slow last 15km, I did my best to keep my mind on what I came here for a podium finish to qualify. Again not a smart move in hot humid 35-38 degree conditions and with a whole host of injuries and road rash that I never took the time to assess my situation. It didn’t take long until I turned my Garmin off the speed setting because I wasn’t even close to my target pace and I just focused on getting to finish as fast as possible. This was not easy as I had also pulled my right calf in the crash so I felt each and every step.

Long story short, I got through the hottest run of my life (thank god for all the sponges) and pretty much collapsed across the line and mumbled the words “medical, I need medical” I was in an absolute state, I could no longer stand and had to be helped and lost all control of my body (even my bladder….) even sitting wasn’t possible. I spent the next 3-4hrs or so getting checked and monitored in the medical tent trying to figure out the extent of everything.

Everything seemed to come somewhat better and was I able to hold a conversation but it wasn’t until I got back to my accommodation (maybe due to all the movement?) things really hit me and went downhill. Travelling alone this can be scary but thankfully I was surrounded by a really nice Italian man, who had also raced and some really helpful resort staff. Although none of their English was great I managed to get my message across (google translate was our best friend). I got them to monitor me every couple of hours and then made the decision if I was not better by 9 pm I would go to the hospital. Reluctant as being on isolated island I can’t imagine they had assessment tools like MRI that I would need to assess a brain bleed etc. Thankfully by 9 pm I felt slightly better and decided to stay and rest.

I used my high pain threshold to my advantage and endured the pain and passed on any medication offered (I got some pretty confused/weird looks saying no). Why would I refuse? TBI on their own result in extreme gut damage so I didn’t want to cause further damage by adding them to the mix. Plus I would rather be conscious/mindful of the pain to ensure I can truly assess my symptoms and ensure I am not doing anything to aggravate them.  I am not saying you have to say no to drugs if needed, this is just my personal choice as I like to be in tune with what my system is telling me not masking it. If you do choose to take drugs you do need to be careful especially if there is any chance of a brain bleed as non-steroidal anti-inflammatory drugs (NSAIDs) will increase the bleeding so try your best to stay clear and stick to traditional painkillers eg paracetamol.

I was lucky I didn’t have to leave until the day after the race and my Italian friend broke down and packed my bike for me because there is no way I could even fathom doing that. I spent the rest of my time taking things very slowly which wasn’t too hard as I couldn’t walk after pulling my calf and running a half marathon on it, you could say it was not too happy so walking was very slow with a massive limp. The upside I was thankful to be in paradise, so just chilled and got straight onto my rehabilitation.

Initial treatment

This is the part where I want to share what I did initially to support my TBI and hopefully can help as a resource for others struggling or know someone struggling.

Obviously, on an Island, I had very limited access to support or interventions but luckily I always travel with supplements for optimal health and performance which in this case I was lucky as some of them are also the first line of call for brain health and repair.

Below is a list of the things I implement with dosages and why they were applied, to provide you with a greater understanding. You may note some of these are a little higher than recommended doses so please check with medical professional first. Obviously I had to work with what I had in an isolated location, in the future I will endeavour to provide a detailed protocol of what I would do in an ideal world but for now, here is what I implemented:

Sleep/ Rest:

Why: When it comes to TBI nothing comes close to rest so that became my primary focus. I have an Oura Ring which is one of the leading personal sleep trackers so this was great for me to monitor and assess my sleep. Although sleep is the best thing for a TBI, poor sleep is also often associated in particular REM sleep can be affected. I designed my day around maximise my sleep. Priming the circadian rhythm with early morning

Dose: I aimed for more sleep than normal targeting 9-10hrs. However, I did not always get that

Daily Routines:
Morning:

  • Meditate: to relax the mind
  • Sun Exposure (no sunglasses with as much skin as exposed as possible)
  • Grounding (bare feet),
  • Movement (or should I say limping…)

Day:

  • Napping: As required but no later than 3 pm as I didn’t want to impact my sleep during the night

Evening: Focused on winding down early

  • Early Dinner
  • Blue-blocking Glasses (which were also godsent when over stimulated throughout the day)
  • Meditate: to relax the mind

Meditation:

As mentioned above

Why: Not only is mediation powerful for cultivating a positive perspective but it is great for unloading the exhausted mind. I ensured I had a solid foundation of daily meditation (morning and night) and whenever I overloaded the system and felt symptoms worsening I would take a step back and meditate and straight away fell a release in the pressure within my head.

Dose: 10-20min Morning and night and when needed throughout the day

Exogenous Keytone Salts
Brand: Pruvit

Why: Quite possibly the most important thing I could take early on. Keytones are known to be the most efficient clean fuel for the brain and they can provide up to 70% of the brains energy. Even more importantly a TBI resembles Alzheimer’s disease (AD) as they both present with a reduced ability to utilise glucose for energy. With the reduced capacity to utilise glucose (carbohydrate) for energy, ketones are even more vital in supplying the brain fuel.

Dose: 1 Max Packet per day (half in the morning and the other half in the afternoon)
To increase ketones in the body across the day

DHA (Docosahexaenoic Acid)
Brand: BePure Three

A high strength DHA/EPA Omega 3 Fish oil with Vitamin D and natural vitamins A and E.
Why: DHA is recognized as an essential nutrient for the proper development and function of the brain. In a number of TBI animal trials have shown an improvement in cognitive function, reduction in nerve swelling, stabilisation of cellular energy production and increase nerve repair with the supplementation of DHA & Omega3.

Dose: 2 capsules Morning and Evening

Probiotic
Brand: BePure

Why: Probiotics offer a health benefit to brain function and promote the diversity of gut microbiota.
TBI has shown to greatly impact the gut-brain axis. The communication pathway that has lead to the gut being known as the second brain. TBI results in increased colon permeability, leaving individuals 12 times more likely to die from blood poisoning which is often caused by bacteria, and 2.5 times more likely to die of a digestive system problem, compared with those without such injury. However, a good probiotic can mitigate these effects and help in assisting the healing of the gut.

Dose: 2 capsules Morning and Evening

Antioxidant:
Brand: Viberi Powder

Why: Following a TBI there is a significant increase in reactive oxygen species (ROS). It is the ROS which causes the cascading of events and the primary stress to the brain following a TBI. Antioxidants are important early on as they can fight the increase ROS, reducing the load on the brain allowing it to heal.

Dose: 1 sachet/day (However sadly ran out over there so split them over a few days)

Magnesium
Brand: Bepure

Why: Depletion of magnesium is observed in the animal brain and in human blood after TBI. Magnesium is critical in restoring brain plasticity and for improving cognitive function. Researchers showed that with magnesium supplementation they could reverse brain ageing by as much as nine to 14 years. Anything that helps the health of the brain long term can be assumed is helping in the short term acute situation like a TBI. Not only this but magnesium is great in regulating inflammation along with assisting in sleep which can be challenging when suffering from a TBI

Dose: 2 capsules Morning and Evening

Diet: Fasting + Whole Food Antioxidant-Rich Diet

Why: Fasting: Purpose of fasting is to naturally increase levels of ketones in the body, reduce inflammation and along with providing the gut a period to heal and repair following the onslaught of racing and the TBI. However, important to note I was not strict, I did not want to place any unneeded additional stress on my system so when hungry I would eat.

Outside of the fasting, I tried to limit carbohydrates as much as possible and a trend towards a more keto approach. Although this turned out to be challenging to do due to limited food choices over in Asia. Interestingly, I did find myself craving carbohydrates more, I am not sure if this was due to having more than normal or if my body was requiring them so I would listen to the body and not restrict when craving carbohydrates.

Aside from the fasting and minimising carbohydrate where possible I aimed to eat a diverse wholefood rich diet. With a special focus on getting in vibrant colourful foods as vibrant colours are closely associated with nutrients and antioxidant properties. Also in a new country presented a great opportunity to try new foods and develop a bit more of a diverse microbiome.

Does: Length of Fasting is dependant on your ability and adaptation to do so. The key thing to keep in mind is you need to listen to the body. I can happily do 16-18hrs but this is never a target! I just listen to what the body was telling me and adjust accordingly.

Activity:

Walking: Broken and chronically exhausted I couldn’t do much but walk/limp so I took it easy and stayed well within my limits and walked as much as possible and gradually increase easy day.

Why: Movement is phenomenal for recovery as long as you stay within limits as it increases blood flow, Neurotransmitters, (the chemicals in your brain that transmit messages between neurons) and activates neuroplasticity (the brain’s ability to rewire and repair itself after brain injury)

Dose: Every morning and as much as my mind/body would allow throughout the without aggravating symptoms. Gradually increasing each day as my body/mind allowed. For me mornings where best by the afternoon-evening I was exhausted and just rested

Two days post Crash: Bintan to Singapore

 

Then Tuesday rolled around and it was time to leave and catch the ferry back to Singapore and straight to the airport to fly home. Still waiting to hear back from my travel insurance I slowly and painfully got myself to the airport. While waiting to check-in, they finally got back to me and told me to get straight in a taxi to the hospital to be cleared before catching my flight home. At the time, however, this just seemed like too much! I just wanted to get home even as much as I was dreading the flight. However, after talking to my mum, as I was in no state to make a decision she made me realise they were right, you only get one brain and I have worked hard on mine so just not worth the risk. I thought I would only have to stay one night but the insurance company still wouldn’t let me fly so I ended up staying for another 4days in Singapore going back and forth from the hospital for assessments, scans and then for my road rash which became infected. In this time I persisted with my protocol as listed above the best I could.

When it comes to assessment for concussion there is not much they can do in the way of identifying the extent of damage, all an MRI can do is look for a brain bleed which would be a worst-case scenario. Thankfully I was cleared to fly home which by this time I had exhausted my supply of supplements so I was keen to get home to get back on to them to regenerate my brain.

Home:

Finally back home with access to all the resources I need and touched base with a couple of friends of mine a special mention to Cliff Harvey who was really helpful to bounce some ideas and get his thoughts and advice. Especially with a foggy mind, this was extremely helpful as reading literature wasn’t really possible at this time. I then distilled what I knew and what Cliff and others had suggested into a protocol. In my next post, I will discuss what I have implemented in the month or so since coming home.