Concussion

briantrumpet

I tried dismounting over my handlebars a couple of weeks ago, fortunately breaking my fall with the back of my helmeted head, so no bones broken (and the helmet appeared to have prevented structural damage to my skull and brain). I didn't get knocked out at all, and after a few moments of disorientation, fellow cyclists aided me to the pavement. I got my orientation back, got to my feet, walked the bike to the bike shop for repair for the commute home, and carried on to work. Halfway through the day, I decided to stop work, stay with colleagues, who later persuaded me to go to A&E ( a short walk from work).

The doctor assessed no head trauma (I had no problems with all the tests), and told me to take it easy, call back if any specific symptoms developed, and to take it easy for a while. I did all that, and feeling considerably better, started getting back into normal routines.

To cut a long story short, that was a bad move, on the concussion front. I've since learnt that concussion is a slightly strange beast, and though one might be feeling 95% OK, that 5% will grab you and pull you down if you do too much too early. After an up & down couple of weeks (including thinking for a few moments that I was going to be the reason on a flight for the captain asking if there was a doctor on the plane), and 6 hours of (waiting around and) being assessed in A&E yesterday, I'm clearer about post-concussion recovery: the doctor told me to take a few days off work entirely now, and to phase in subsequent efforts, with plenty of rest. Not my style at all.

Anyway, just putting this here in case anyone has a similar experience and is tempted not to follow doctors' orders following a blow to the head. I'm used to bouncing back after most things, but this one has caught me by surprise.

imposter2.0

Glad you're ok Brian

I read something the other day which recommended several days of complete home rest (ie practical immobility) immediately after a concussion, which seems to be borne out by what you are saying...

briantrumpet

Imposter wrote:

Glad you're ok Brian

I read something the other day which recommended several days of complete home rest (ie practical immobility) immediately after a concussion, which seems to be borne out by what you are saying...

Thanks.

Indeed. I did two complete home days, felt much better, so started to think all was fine. Apparently it can take 6 months or more. I'd not really taken in the difference between head/brain trauma and concussion - two totally different things. The danger from trauma is really in the first few days, if there's any bleeding on the brain - once that's passed, the various symptoms of 'post-concussion syndrome' are less specific, and, certainly in my case, almost absent for a while until you do too much, and then it's debilitating. That would explain why I've been in 4/5-day cycles: feel better, do stuff, then feel totally rubbish... back to square 1. It's the first time I've really not been able to trust how I've felt to judge what I can do. I was slightly surprised not to find more experiences here, given that cyclists do occasionally fall off their bikes and hit their heads.

harry-s

It seems a grey area for the medics, although I don't understand why. At least you had a few tests, even if they didn't prompt better advice over care. I hope all is well now.
I had a bad fall on a descent a few years ago, with a fractured skull being the worst of my injuries. After x-rays and a grim night in the A&E Dept of the nearest hospital, I was literally wheeled out to front door and discharged. I was so disorientated and dizzy that I was unable to walk a few steps.
"What the f*** am I supposed to do now?"
"Errr, maybe your wife could bring the car right up to the doors..."
There should be a protocol in place for head injuries and medics made to follow them, but I can't see any signs of this happening.

briantrumpet

Harry-S wrote:

It seems a grey area for the medics, although I don't understand why. At least you had a few tests, even if they didn't prompt better advice over care. I hope all is well now.
I had a bad fall on a descent a few years ago, with a fractured skull being the worst of my injuries. After x-rays and a grim night in the A&E Dept of the nearest hospital, I was literally wheeled out to front door and discharged. I was so disorientated and dizzy that I was unable to walk a few steps.
"What the f*** am I supposed to do now?"
"Errr, maybe your wife could bring the car right up to the doors..."
There should be a protocol in place for head injuries and medics made to follow them, but I can't see any signs of this happening.

Sheesh, that's awful. They were really clear that the first couple of days were critical, and I was under the distinct impression that they'd have put a rapid programme in place if I'd failed their various tests for brain trauma. I've been brilliantly and patiently looked after, despite them being entirely sure from those tests that there was no bleeding/trauma - on the last visit yesterday, the doctor was totally confident that the scan would show up nothing untoward, but they did it anyway for peace of mind. I'd gone to my GP this last time, but he seemed less confident about making a pronouncement, hence sending me back to A&E for the third time. At no point have I been made to feel like a time-waster.

top_bhoy

I hope you are well recovered because it's not something to treat lightly that's for sure.

Many well wishers for all their intended good deeds are often ignorant to medical risks because I have experienced something similar to you after a van unexpectedly pulled out immediately in front of me which resulted in a head knock and a fully split helmet. Despite my world spinning around and I was seeing stars in the sky at 4pm, people wanted to help immediately move me because I was in the middle of the road and there was traffic waiting to pass. Simply put, because I was awake, they were oblivious to any other medical risk.

FatTed

Harry-S wrote:

It seems a grey area for the medics, although I don't understand why. At least you had a few tests, even if they didn't prompt better advice over care. I hope all is well now.
I had a bad fall on a descent a few years ago, with a fractured skull being the worst of my injuries. After x-rays and a grim night in the A&E Dept of the nearest hospital, I was literally wheeled out to front door and discharged. I was so disorientated and dizzy that I was unable to walk a few steps.
"What the f*** am I supposed to do now?"
"Errr, maybe your wife could bring the car right up to the doors..."
There should be a protocol in place for head injuries and medics made to follow them, but I can't see any signs of this happening.

https://www.nice.org.uk/guidance/cg176

harry-s

Thanks for the link fatTed.

I can't say that advice was followed with my admittance (5 years ago). I was booted out (from Brighton/Royal Sussex) with a TBI and unable to walk unaided. After a night at home I was back into my local hospital. By this time, Brighton had lost my records and couldn't send any info to my local hospital. All a compete f*** up, really.
The advice is probably good, if the resources are there to back it up.

Edit: In hindsight, I'd say it's important to have someone with you, friend or family, to fight your corner once admitted to A&E. If you're suffering from concussion, chances are you don't know whether or not you're Martha or Arthur, and having a cool head with you to make decisions and listen to what's going on is worth having.

Matthewfalle

Harry-S wrote:

It seems a grey area for the medics, although I don't understand why. At least you had a few tests, even if they didn't prompt better advice over care. I hope all is well now.
I had a bad fall on a descent a few years ago, with a fractured skull being the worst of my injuries. After x-rays and a grim night in the A&E Dept of the nearest hospital, I was literally wheeled out to front door and discharged. I was so disorientated and dizzy that I was unable to walk a few steps.
"What the f*** am I supposed to do now?"
"Errr, maybe your wife could bring the car right up to the doors..."
There should be a protocol in place for head injuries and medics made to follow them, but I can't see any signs of this happening.

its not a grey area.

protocols are in place and followed extremely carefully.

head trauma is a massive matter and we are extremely careful when looking at h/t and MOI.

briantrumpet

Harry-S wrote:

Thanks for the link fatTed.

I can't say that advice was followed with my admittance (5 years ago). I was booted out (from Brighton/Royal Sussex) with a TBI and unable to walk unaided. After a night at home I was back into my local hospital. By this time, Brighton had lost my records and couldn't send any info to my local hospital. All a compete f*** up, really.
The advice is probably good, if the resources are there to back it up.

Edit: In hindsight, I'd say it's important to have someone with you, friend or family, to fight your corner once admitted to A&E. If you're suffering from concussion, chances are you don't know whether or not you're Martha or Arthur, and having a cool head with you to make decisions and listen to what's going on is worth having.

In comparison with this, my knock was the equivalent of having a slight tickle, but they still took it seriously. And, as mentioned earlier, I'm definitely in need of a bit of a system restore, despite the mildness of my knock (and the certainty of the doctors that there wasn't any trauma). It's sobering.

briantrumpet

Rats. On Tuesday I'd had a week of no setbacks, was feeling good, so went for a very gentle short ride, met a friend for coffee. That was the day's activity. And then yesterday felt pants: appetite gone again, and feeling lethargic. Not quite square one, but not good. Frustrating, to say the least.

The more I read about it, the more I see that this is quite normal - in fact, I'm at the milder end of possible symptoms - but it's still quite hard to work out what to do: how much activity is 'too much', and what will set me back. I'm not the sort of person who likes to sit around doing nothing for too long...

harry-s

I'm sad to hear that Brian, it seems like a setback, but best to treat and rename it as 'progress'. All part of the journey!

The appetite is a strange thing, and I experienced similar. Although I was sure my diet continued as normal, I lost a kilo a week for about 10 weeks, and was just on the verge of going back to the docs when it seemed to bottom out. I would have been described as wiry, before the tumble, so didn't have a lot to lose.

Re exercise and how much is too much, who's to say? I know I was straight on the Wattbike as soon as I could stay on it without falling off, so my fitness didn't suffer too much. Whether or not it helped with recovery, I couldn't say, but it was definitely good for morale. IIRC it was about 2 months before I got back on the road. Just in time for the Marmotte...

Take it easy dude.

briantrumpet

Harry-S wrote:

I'm sad to hear that Brian, it seems like a setback, but best to treat and rename it as 'progress'. All part of the journey!

The appetite is a strange thing, and I experienced similar. Although I was sure my diet continued as normal, I lost a kilo a week for about 10 weeks, and was just on the verge of going back to the docs when it seemed to bottom out. I would have been described as wiry, before the tumble, so didn't have a lot to lose.

Re exercise and how much is too much, who's to say? I know I was straight on the Wattbike as soon as I could stay on it without falling off, so my fitness didn't suffer too much. Whether or not it helped with recovery, I couldn't say, but it was definitely good for morale. IIRC it was about 2 months before I got back on the road. Just in time for the Marmotte...

Take it easy dude.

Thanks Harry.

kingrollo

I think the best thing to do with concussion from a bike fall is to go out and spend £3k on a new bike.

briantrumpet

kingrollo wrote:

I think the best thing to do with concussion from a bike fall is to go out and spend £3k on a new bike.

Being self-employed, that broken link has cost me about £2k so far...

kingrollo

briantrumpet wrote:

kingrollo wrote:

I think the best thing to do with concussion from a bike fall is to go out and spend £3k on a new bike.

Being self-employed, that broken link has cost me about £2k so far...

Only jokin - hope you recover soon.

briantrumpet

kingrollo wrote:

briantrumpet wrote:

kingrollo wrote:

I think the best thing to do with concussion from a bike fall is to go out and spend £3k on a new bike.

Being self-employed, that broken link has cost me about £2k so far...

Only jokin - hope you recover soon.

Haha, thanks, I know. I'd rather have jokes than be smothered in sympathy. It just struck me how expensive one broken link could be.

eeney

About 2 months ago I had a fall, alone cycling to meet a group. I can remember coming around from the concussion, but nothing for 45 minutes before, so the concussion could have been anything up to 45 minutes (memory loss is very weird). I had a scan for bleeding, then regular check-ins at the GP, every few days at first, then every week until symptoms had gone.
It took about 5 weeks before I felt normal, for those 5 weeks everything needed concentration, even standing still and I had a constant headache or feeling of pressure on my head. Even now I still have some symptoms, namely with loud background noise, or slight dehydration. Someone has since told me that 'on average' for every 10 minutes of concussion you have one week of constant symptoms, and one month of recurring symptoms/sensitivities. It's kinda like a bruise or cut, the brain has to repair itself and is sensitive during that period. After about 4 weeks I was starting to worry that I might never return to normal, but the doc was right, things sorted themselves out.
I'm told the good news is that the brain seems to repair well from mild/moderate concussion, but doesn't like repeated occurrences, like the old days when rugby/football players would go back on the pitch.

The important thing is to get to the doctor/hospital, take it easy to let the brain recover, and listen to the doctors.

briantrumpet

eeney wrote:

About 2 months ago I had a fall, alone cycling to meet a group. I can remember coming around from the concussion, but nothing for 45 minutes before, so the concussion could have been anything up to 45 minutes (memory loss is very weird). I had a scan for bleeding, then regular check-ins at the GP, every few days at first, then every week until symptoms had gone.
It took about 5 weeks before I felt normal, for those 5 weeks everything needed concentration, even standing still and I had a constant headache or feeling of pressure on my head. Even now I still have some symptoms, namely with loud background noise, or slight dehydration. Someone has since told me that 'on average' for every 10 minutes of concussion you have one week of constant symptoms, and one month of recurring symptoms/sensitivities. It's kinda like a bruise or cut, the brain has to repair itself and is sensitive during that period. After about 4 weeks I was starting to worry that I might never return to normal, but the doc was right, things sorted themselves out.
I'm told the good news is that the brain seems to repair well from mild/moderate concussion, but doesn't like repeated occurrences, like the old days when rugby/football players would go back on the pitch.

The important thing is to get to the doctor/hospital, take it easy to let the brain recover, and listen to the doctors.

Thanks - all very interesting.

Actually, from what I've read, there's no formula for how long the recovery takes, and no real link with how serious the initial knock was (e.g., a quite light knock can still lead to a long recovery). In my case, I wasn't unconscious at all, but I'm now into my 6th week of recovery (now signed off work for another two weeks, and still feeling very ropey), and the doctor warns me that full recovery (at my age) could take months. The only cheering thing is that everyone says that it will get better, but I'm still finding it quite hard to deal with, not least as my system is used to large amounts of exercise and a ridiculously large appetite, and now I'm having to persuade myself to eat, because of almost constant nausea.

briantrumpet

Update (if anyone is interested) - now signed off till 7 January. This really is slow - the doctor suggested 6-9 months is average. And along the way, the progress is up & down - nausea, lethargy, headache, and mood all linked. Frustrating, as when I feel OK it seems like I've 'turned a corner', but then a few days later, I seem to be back where I was. Ho hum.

FatTed

briantrumpet wrote:

Update (if anyone is interested) - now signed off till 7 January. This really is slow - the doctor suggested 6-9 months is average. And along the way, the progress is up & down - nausea, lethargy, headache, and mood all linked. Frustrating, as when I feel OK it seems like I've 'turned a corner', but then a few days later, I seem to be back where I was. Ho hum.

I guess you need to think (find out) about the consequences of another (mild) head injury, so should you now stop cycling or other activities that make it more likely that you have another fall?

briantrumpet

FatTed wrote:

briantrumpet wrote:

Update (if anyone is interested) - now signed off till 7 January. This really is slow - the doctor suggested 6-9 months is average. And along the way, the progress is up & down - nausea, lethargy, headache, and mood all linked. Frustrating, as when I feel OK it seems like I've 'turned a corner', but then a few days later, I seem to be back where I was. Ho hum.

I guess you need to think (find out) about the consequences of another (mild) head injury, so should you now stop cycling or other activities that make it more likely that you have another fall?

It's a fair question, as repeated concussion is bad bad news. But given that I've been riding for 50 years, and have done (rough guess) somewhere between 50,000 and 100,000 miles on a bike, and this is the first time I've hit my head, the odds seem reasonably low enough not to entirely change the way I get around. Head injuries are actually far more likely in the home, by things such as falling down stairs, and there's something else (using stairs) that would be hard to avoid. Life is full of risks, and it's always a case of assessing and balancing risks and actual practicalities/fun of getting on with life.

Anyway, I'm on the fourth of four good days, so am keeping fingers crossed.

FatTed

briantrumpet wrote:

FatTed wrote:

briantrumpet wrote:

Update (if anyone is interested) - now signed off till 7 January. This really is slow - the doctor suggested 6-9 months is average. And along the way, the progress is up & down - nausea, lethargy, headache, and mood all linked. Frustrating, as when I feel OK it seems like I've 'turned a corner', but then a few days later, I seem to be back where I was. Ho hum.

I guess you need to think (find out) about the consequences of another (mild) head injury, so should you now stop cycling or other activities that make it more likely that you have another fall?

It's a fair question, as repeated concussion is bad bad news. But given that I've been riding for 50 years, and have done (rough guess) somewhere between 50,000 and 100,000 miles on a bike, and this is the first time I've hit my head, the odds seem reasonably low enough not to entirely change the way I get around. Head injuries are actually far more likely in the home, by things such as falling down stairs, and there's something else (using stairs) that would be hard to avoid. Life is full of risks, and it's always a case of assessing and balancing risks and actual practicalities/fun of getting on with life.

Anyway, I'm on the fourth of four good days, so am keeping fingers crossed.

Good to hear

briantrumpet

FatTed wrote:

briantrumpet wrote:

FatTed wrote:

briantrumpet wrote:

Update (if anyone is interested) - now signed off till 7 January. This really is slow - the doctor suggested 6-9 months is average. And along the way, the progress is up & down - nausea, lethargy, headache, and mood all linked. Frustrating, as when I feel OK it seems like I've 'turned a corner', but then a few days later, I seem to be back where I was. Ho hum.

I guess you need to think (find out) about the consequences of another (mild) head injury, so should you now stop cycling or other activities that make it more likely that you have another fall?

It's a fair question, as repeated concussion is bad bad news. But given that I've been riding for 50 years, and have done (rough guess) somewhere between 50,000 and 100,000 miles on a bike, and this is the first time I've hit my head, the odds seem reasonably low enough not to entirely change the way I get around. Head injuries are actually far more likely in the home, by things such as falling down stairs, and there's something else (using stairs) that would be hard to avoid. Life is full of risks, and it's always a case of assessing and balancing risks and actual practicalities/fun of getting on with life.

Anyway, I'm on the fourth of four good days, so am keeping fingers crossed.

Good to hear

I suppose I should update this.

Still struggling with this, five months in. The same cycle of better periods (I had a good 2½ weeks over half term) followed by slumps - I'm at the end of a week-long one. (Ironically, the longer the good periods get - as I slowly recover - the harder the slumps are to cope with, in some ways.) The slumps are tough, as any sense of getting back reliability is snatched away. It's still costing me a fortune in the loss of self-employed work, but my 0.2 contract employers are being utterly brilliant, so at least that's something coming in, despite me being on & off on my phased return to that salaried work.

But boy, I'd not wish this on anyone. I was not entirely surprised to see concussion featuring in the sad reports of Kelly Catlin - it sounds like she was trying to cope with this while training hard. "Concussions are linked to chronic traumatic encephalopathy or CTE, which can only be diagnosed after death. CTE has been found in hundreds of former American football players although it is often associated with NFL veterans rather than young athletes. Symptoms of CTE include depression, memory loss and mood swings. Mark Catlin said Kelly’s death was due to a “perfect storm” of overtraining, taking too much on, depression and not fully comprehending the effects of her concussion."

At least I've had piles of good advice and support, and space to recover, so nowhere near that. But I can certainly sympathise.

eeney

Fingers crossed the good patches will get longer and more frequent. Since my concussion, I've spoken to many others and it's interesting to learn how it affects people differently, guess every concussion is different. Perhaps you can identify things that trigger the symptoms? For me the 'downs' were usually triggered by dehydration and/or background noise, I had to wear earplugs in public areas otherwise nausea would kick in.... after about 5 months it dissipated, what a relief. However, a guy I know still has issues if he gets dehydrated (easy in a Sydney summer) and it's been over 2 years since his concussion, and he's only in his 20s.

Another person I spoke to had to undergo 6 months of therapy because her hearing was affected due to a damaged nerve. Fixed through some exercises her medical professional gave her.

I've been riding every day for 12 years, much of which was solo on the road training. Since the concussion I have taken to using Zwift for solo workouts, only cycling on the road for group rides and commuting. I'm now a very careful commuter, it isn't an experience I wish to go through again, quite scary in retrospect.

Pross

Makes you wonder what damage professional sportspeople are doing as I can't imagine there are many pro cyclists getting the sort of time off you have needed and many will take another knock within a few weeks of racing. I know they now have protocols in rugby and some other high contact sports but you don't hear of many getting more than a few weeks off before going back into a sport where their heads are getting regular jarring.

That said, I can't imagine an orchestra pit in front of the percussion section is a great place to be with concussion either.

I've been lucky over the years as I've been to hospital 3 times following racing crashes and once after being knocked out playing rugby with minor concussion but have always been fine within 24 hours.

briantrumpet

Pross wrote:

Makes you wonder what damage professional sportspeople are doing as I can't imagine there are many pro cyclists getting the sort of time off you have needed and many will take another knock within a few weeks of racing. I know they now have protocols in rugby and some other high contact sports but you don't hear of many getting more than a few weeks off before going back into a sport where their heads are getting regular jarring.

That said, I can't imagine an orchestra pit in front of the percussion section is a great place to be with concussion either.

I've been lucky over the years as I've been to hospital 3 times following racing crashes and once after being knocked out playing rugby with minor concussion but have always been fine within 24 hours.

Indeed, re not having the time to recover - that would be awful.

It does seem to be random as to who ends up with post-concussion syndrome (PCS) - it's a quite separate thing from concussion itself. It's been suggested that those who get migraines are more likely to end up with PCS (and yes, I have had migraines in the past). And it doesn't necessarily manifest itself straight away - it can kick in weeks after the impact.

I'm having a phone discussion with someone from Headwayl followed by a visit to the GP on Friday. I suspect that both will just say that I just need to be patient (and I know that's true), but I'd like to see if there are any other things I can do to make the slumps less debilitating. I've tried various levels of physical activity, from torpor upwards (but nothing at all exhausting or stressful), no work, little bits of work, drinking lots of water, keeping light levels down, etc., and not been able to work out any triggers at all. I've no idea how quickly triggers will bring on the headache, nausea, tiredness & depression, so it's really rather tricky to work out if there's any pattern. On the plus side, they can go a quickly as they come on, so the good periods are fantastic... but as I said, that makes the next slump no easier to bear.

And the fact that I look perfectly well on the outside (unless I'm in a real slough of despond), makes people say "you look so much better!", when I know I've almost certainly still got more weird brainsh1t to come. Not fun.

Oh, and also on the plus side... I'm still alive.

courtmed

Firstly, all the best in your recovery Brian! Concussions are a strange thing to get your head around (no pun intended). I'm 26 & recently had my 6th (that I know of!). A youth playing mostly football, rugby & martial arts was not great in that respect, part of the reason I graduated to cycling, running, climbing etc. I now suffer with hemiplegic migraines that affect my speech, co-ordination & cause pins & needles down one side & has even on occasions made my smile droop. No surprise that the first few times these happened 999 was called & they thought I was having a stroke!

I've got a pretty good grasp on it nowadays & have found that my main triggers are a poor diet (I literally had a Chinese takeaway before the first 2 proper migraines), lack of sleep, dehydration, drinking too much alcohol. Basically I just need to look after myself & that more or less sorts it out. Although stress is definitely a trigger in my case which is maybe the worst part for me, wondering if at some point it's going to limit my career.

When I was going through quite sever post-concussion symptoms, especially the type where you need to concentrate at all times on everything, I found that some mindfulness type activities helped me. Sounds a bit wishy washy but using the Headspace app & dedicating 15/20 minutes of my day to that made a huge difference to me.

If like me you're interested in the treatment, and to a lesser extent the science, of concussions the NFL is a fascinating case. The "League of Denial" documentary is a truly eye-opening read (the film is okay, if you can get past Will Smiths' Nigerian accent!). Seen it reported that playing in the NFL for one season, including pre-season, training throughout the season and games, is equivalent to driving in to a wall at 30mph over 1,000 times :shock: absolutely horrifying.

briantrumpet

Thanks, @courtmed. After this single instance, it makes me shudder to think of repeat concussions! I've twice had a tiny drink (like half a pint of beer) since, and both times have had repercussions. I think I eat reasonably well, but as yet I've not been able to pinpoint other triggers. I'm still trying to work out why I had such a good spell when I was in France - probably slightly higher levels of activity (mostly walking), and maybe I was drinking more water/squash - that's two of you now who mention dehydration.

Had I not had such an understanding employer, I think the outcomes might have been quite different in career terms - thankfully that's not been a worry - and yes, worry and stress do seem to have a pronounced effect.

What I really want to find out is what sort of levels and exertion could be beneficial (or at least not hamper recovery) - I know that thinking has changed (not least in American Football) from the times when they thought that complete rest was the answer. But judging the right level does seem to be hard.

briantrumpet

I had a lengthy chat with a Headway person, and she wrote a really useful summary of what I might expect, and some relevant anecdotes of things to bear in mind, one of which is that overdoing it can take a couple of days to manifest itself in negative brain reaction - it makes it so difficult to gauge, and almost impossible to pinpoint possible triggers.

Given what I do (one-to-one teaching, leading youth music ensembles, and playing the trumpet), her recommendation was that if I did *one hour* of work one day, I should take the next day off. Hmm. Ditto "hmm" to the suggestion that I might think about using an electric bike. Having said that, it does give an indication of how careful I'll have to continue to be for a while yet: her view is that recovery can take 12 months - beyond that, and then the GP and I might need to look at other possibilities.

Reassuringly, she did say that although any 'slumps' can be enormously frustrating, although they feel like set-backs, they don't put recovery back at all - they are just hiccups along the way. The GP was happy to keep the anti-nausea medication on a somewhat longer-term basis, not trying to phase it out as soon as I didn't feel nauseous, but over the next three months or so: at least if my appetite stays reasonable, I'm not lacking energy for lack of food! And, very positively, the GP said that gentle/moderate exercise promotes brain healing, not least because of the chemicals exercise produces, and the increased blood flow to the brain.

I might just carry on riding my bike, in that case. But no hundred-milers for some time yet. Steady as she goes...