My concussion story, part 2
In December 2018, I sustained a concussion and developed persistent post-concussion symptoms. They took me years to resolve. Here is part 2 of my story.
This issue is sponsored by LMNT Electrolytes. Read on to see how LMNT helped me post-concussion and with my POTS symptoms—and see how it can help to fuel your exercise, recreation, or work. Get a free 8-pack sampler of LMNT’s top flavors with any order.
If you haven’t read Part 1 yet, start here.
Two years after my brain injury, I was still experiencing a range of weird symptoms: Hot tubs and hot yoga flared my brain injury. Wearing compression socks made me bonk on easy hikes. Hiking at any speed soon became impossible. Any form of exercise made things exponentially worse.
These symptoms grew more and more debilitating. Then, my PT diagnosed me with a POTS-like condition she called dysautonomia, or nervous system dysregulation. This is where the final stage of healing began.
Note: This was summer of 2020, when the pandemic was still in full swing. For me, the isolation the pandemic demanded was a blessing. I wasn’t traveling, as in-person meetings and events had been canceled. By spending so much time at home, I was able to focus more on my healing.
Nervous system dysregulation
POTS stands for Postural Orthostatic Tachycardia Syndrome. It is characterized by a rapid increase in heart rate upon standing, which leads to dizziness, heart palpitations, and even fainting. (Lying down relieves these symptoms.) It is a disorder of the autonomic nervous system, which controls involuntary bodily functions such as heart rate, blood pressure, digestion, and body temperature.
POTS often comes with other symptoms, including heat and/or cold intolerance; exercise intolerance; altitude intolerance; fatigue; migraines/headaches; nausea; brain fog; shaking; coldness, pain, or blood pooling in the extremities; chest pain; and shortness of breath. These can range from mildly challenging to “cannot get out of bed.”
After my evaluation, my PT said I didn’t have POTS, per se. (I wasn’t experiencing the heart rate increase upon standing, which is the hallmark condition of the syndrome.) However, I did have heart rate dysregulation with other activities, and many other symptoms of nervous system dysregulation. I had exercise intolerance, where my heart rate would spontaneously plummet as I exerted myself. (This also brought on shortness of breath.) I struggled with blood flow and blood pressure regulation, as evidenced by my challenges in compression socks. I was also experiencing severe heat and altitude intolerance, which made hiking or exercising in the heat a double-whammy. (This diagnosis happened in August, after a full summer of me trying to hike, run, and yoga as usual. I dug myself into quite the hole.)
Note: Oddly, I did not experience cold intolerance. In fact, I discovered quite accidentally that cold showers and cold exposure relieved my symptoms, immediately increasing my energy and focus and improving my mood. I took a cold shower every single day for a whole year as part of symptom management, and still maintain a cold therapy routine.
My concussion dysautonomia treatment
This diagnosis made all of my seemingly “random” symptoms click—and gave us a path forward. My physical therapy was simple: No altitude, no exercise (including hiking), and minimize heat exposure as much as possible.
My assignment was to walk, keeping my heart rate at a level my body found tolerable. If, during the walk, I experienced a heart rate drop or symptoms, I had to stop. If I didn’t recover by the next day, I’d know I pushed it too hard. I’d have to rest until my symptoms went away, then try again. If I did recover, then I’d stay at that pace until I was symptom-free, then increase my pace by a fraction.
The goal was to improve my tolerance to exercise. Much like strengthening a muscle, the goal was to push my body to just the right degree—not too hard, or I wouldn’t recover. Not too little, or I wouldn’t get stronger. These are the notes my PT gave me in August 2020. (She knew me too well by then.)
“Walk slowly. Not your slow. Like you’re walking an old dog.”
“Yoga is okay, but not your yoga. Gentle yoga.”
Cross-body exercises like dead bug and bird dog.
No weights.
Keep your heart rate below 100 bmp.
ELECTROLYTES (two packs of LMNT a day; more as needed).
Note: Electrolytes, especially sodium, play a vital role in maintaining fluid balance and stabilizing blood pressure. For those with POTS or dysautonomia, increasing sodium intake helps boost blood volume, reducing the dizziness and fainting that often result from a sudden drop in blood pressure. I had been taking LMNT selectrolytes since June 2019, as a supplement for my workouts and hiking. It turns out my LMNT supplementation had been silently helping me manage my concussion symptoms all along.
I don’t know if you’ve ever monitored your heart rate during exercise, but 100 bpm is not hard to hit. I can do that folding laundry. I did have to walk that slow. I couldn’t go up to any hiking trails, I had to stay in the valley. I had to walk in the early morning, before the heat became a factor.
I also continued my PT exercises, and yoga in my garage gym. I did occasionally push my yoga practice, paid for it, took a day off, and went back to more gentle movements. It was slow going, but after three weeks of consistency, I began feeling better. I was also testing better in my PT’s office.
By the end of September, I successfully completed a short, easy hike, which I took at a toddler’s pace. In early October, I took my paddle board out (again, in a relaxed fashion) with joy and comfort. On October 21st, I completed a weighted workout with zero symptoms. And in early November, just as the snow was starting to dust the mountains, I pushed my limits with a 10-mile hike and 3K feet of elevation gain… and felt good!
Concussion symptoms resolved… mostly
With care and attention, I was able to increase my exercise and altitude tolerance, such that I was able to return to normal workouts that fall and winter. However, from 2021 - 2024, I still struggled with other activities.
Traveling was a horrific overload. (I was still traveling less due to the pandemic, but it started picking back up in mid-2021.) Airports combine visual stimulus, auditory stimulus, spatial stimulus (people everywhere), stress, and altitude, all of which flared my symptoms every trip. I still couldn’t sit in a hot tub or take even a mildly heated yoga class. Huge conferences, team offsites, and longer stretches of podcast interviews or media required an enormous amount of pre-planning and post-recovery. A three-day team offsite would leave me at half-capacity for a week, and that was after tapping out of team dinners and extra events.
Over time, however, I continued to increase my tolerance to all of these stressors. By 2025, I found myself needing less recovery time after big events and conferences. I was able to join my team for Top Golf and dinner after our offsites. I could complete a one-hour in-person interview, with bright lights and the added pressure to be articulate, without much of a struggle.
I continue to think of it like building a muscle: I’ll push myself on a travel day, and see if I can recover by the next day. If I can’t, I’ll know I went too far, so I’ll scale back the next time. If I can, I’ll continue my slow progression of increasing the stimulus.
Today, my concussion flares happen far less often. When I do flare, my symptoms aren’t as severe, and I’m able to recover faster. The only serious trigger I still have is heat. I still can’t run or hike if temps are high, and hot yoga is still unavailable, although I can now sit in a hot tub for 5 minutes. I continue to push my tolerance to heat by deliberately exposing myself to heated environments, slowly over time. (I don’t care about hot tubs, but I really miss hot yoga.)
Will I have concussion symptoms forever?
Today, I spend most of my days symptom-free. However, the only reason I’m mostly symptom-free is because I spend so much time preparing myself around known triggers.
Before a work trip, I lie low at home for a few days. I don’t go out, I get plenty of sleep, I eat food I know makes me feel good, I don’t push my workouts, and I avoid the heat. After a trip, I'll take a few days and repeat these safeguards to ensure I return to full capacity as quickly as possible.
The way I live my life has also changed. I haven’t gone to a concert or festival since my accident. I say no to large events I don’t have to attend, even if they sound fun or support my favorite charity. I don’t take nearly as many vacations requiring an airplane, preferring to drive to hiking destinations. I still beg off the occasional team event, knowing I have to be fresh for the following day’s meetings.
Will it always be like this? I don’t know, and I’ve stopped worrying about it. I realized long ago that trying to get back to where I “used to be” was both unrealistic and incredibly stressful. My accident changed things. There is no going “back.” Instead, I’ve accepted this new reality, and practice gratitude for what I am able to do today. August 2020 Melissa would have given anything to be able to hike and run as much as I have this summer. This is what I focus on.
Is it easy? Nope. Do I have days (weeks) where I can’t muster gratitude and wallow in, “this sucks, it’s not fair?” Of course. But I know I can either stay there and be miserable, or let myself throw the tantrum, then move forward with gratitude and hope in my new reality. Though I’ve dealt with post-concussion symptoms far longer than is typical, I’ve still been able to make a tremendous recovery.
Truly, I’m one of the lucky ones.
XO, MU
LMNT Electrolytes played a huge role in my post-concussion therapy. LMNT’s sodium-forward, balanced formula was recommended by my physical therapist to mitigate my POTS-like symptoms. I noticed an immediate improvement in energy, focus, and general health with the right supplementation—a feeling echoed by those of you taking it during your hikes, workouts, paddles, and landscaping. You don’t have to be post-concussion or have POTS to reap the benefits! Whether you’re sweating from exercise, recreation, or your job, LMNT can keep you hydrated, muscle-cramp free, and energized. Get a free 8-pack sampler of LMNT’s top flavors with any order, including their newest bestseller Lemonade Salt.
