JAVS Fall 2022

was unwilling to refer me to a neurologist or concussion specialist. I had an additional MRI taken but it was also normal. The new GP thought it was stress, a virus, or the move. He gave me an antibiotic, told me I had a mild concussion, and told me to rest. I was still experiencing a lot of day-to-day issues, so I found a different GP, who did take my concerns seriously and referred me to a neurologist. Due to the worsening issues with vision and balance, I decided to see an optometrist and otolaryngologist while I was waiting to see the neurologist. I had my retinas and optic nerves examined and had an ear bone CT scan, hearing test, and vertigo test. Those all came back normal. That process in Seattle took about three months, which was six months post-accident, and the neurologist referred me to an occupational therapist. 2 That was also about the time I started doing sessions with you as well. 3 K: Post-concussion syndrome is still a relatively new topic in the medical community, and it’s rarely addressed in musician wellness. How was your playing affected? What were your challenges playing in ensembles? D: Oddly enough, my viola playing chops felt almost normal. Beyond that, I struggled with pretty much everything else, mostly skills that I never thought about or appreciated until they were diminished or gone. In my own playing, everything sounded harsh and ponticello, like an electric guitar (due to sound sensitivity), it was harder to keep track of where my limbs were in space, and when I was tired, my right and left arms felt like two separate entities. Keeping up with learning the volume of repertoire is also challenging even under normal circumstances, but it was extremely difficult at times. Regarding ensemble playing: switching between looking at the conductor, principal of the section, and keeping track of where I was on the page was enough to make me nauseous and motion sick. 4 There were several concerts where I was very close to puking on stage. Benaroya Hall also has some live spots on the stage surface which vibrate with heavy bass, and I felt ungrounded from that sometimes. Things like the bright lighting and reverberant acoustics made it hard to focus, especially with mixed meter and other unintuitive passages often found in the inner voices of contemporary works. I was also in the process of meeting ninety new colleagues and getting to know them. All

K: How was the summer after that? D: After the season ended, I was definitely declining; I had frequent headaches, more trouble staying focused doing daily tasks, and I was planning my move and constantly stressed. The prospect of moving was overwhelming, but I ended up driving my belongings to Seattle from Calgary. K: At this point, did anyone say mention post concussion syndrome or that you might have new symptoms that would emerge after the concussion? Post-concussion Syndrome is defined as, Post-concussion syndrome, or PCS, is the persistence of concussion symptoms beyond the normal course of recovery … In cases where symptoms last longer than one or two months, doctors may diagnose post-concussion syndrome. Patients with PCS can experience concussion like symptoms at rest or in response to too much physical or cognitive activity, often forcing them to withdraw from their usual physical, professional, and social lives. 1 D: No one had mentioned the possibility of concussion symptoms worsening after the incident. I electively had an MRI done in Canada but there were no abnormal findings or lesions. Conversely, an MRI cannot reveal the extent of a concussion or traumatic brain injury. K: At this point, you suspected that something was abnormal, even though medical professionals weren’t giving you a diagnosis. Once you had moved to Seattle and started playing with the symphony, did you notice any effects in your playing and day to day life initially? D: In hindsight, I think the combination of moving and starting a new job made my condition worsen and was at least part of the reason I developed new symptoms several months later. During my first few concerts in Seattle, I still had light and noise sensitivity, but also had new issues with vision and motion sickness. It felt like a combination of the flu, a hangover, and sleep deprivation while on a sailboat, in the midst of an orchestral concert or rehearsal. K: You found new doctors once you were in Seattle: what clinicians did you see and what tests did you do? What did the tests reveal? D: When I got to Seattle, I initially saw a general practitioner who referred me to behavioral health but

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Journal of the American Viola Society / Vol. 38, No. 2, Fall 2022