[AnnieDayNow]

Hi.

I am recovering from my second concussion in 8 months. There is some debate as to whether or not there might have been another concussion before that -- I was knocked on the head pretty good about 3 years ago, but was never treated beyond the initial injury.

I had symptoms of PCS back in December that lasted for about 2 months. Dizzyness, headache, concentration and memory problems, etc. I never sought treatment then and just 'muddled through'.

This time I have all that plus a depression that comes and goes, irritability, and a weird brain fog that sometimes accompanies it all. The dizzyness and headache seem to have gone away. The concentraion and depression, however, are getting worse.

So, long story short, I made an appt with a doctor. My ins "covers" behavioral health, but no psychiatrist or counselor in town "takes" my insurance. The nearest dr on my plan is 200 miles away. I made an appt at the local health clinic to see a 'regular' dr, 3 weeks out. My friends suggested I contact workers comp, since the latest injury was at work. I didn't think they'd cover depression, but thought I had nothing to lose by calling.

They set an appt up for me at the urgent care/occupational health clinic that had treated me originally to determine if this was related to my injury, or just me being depressed. I was in one of my 'space out' periods when I went and the doctor panicked and sent me to the ER for an "emergency" CT scan. I put emergency in quotes because the ER doc berrated me for wasting the ER's time with something that was not only not an emergency, but totaly (in his opinion) unnecessary. That I had PCS, and should just get some rest and wait it out. He did refer me to the 3 psychiatrists in town who are taking new patients (but still aren't taking my insurance).

So now, the wc doc wants to refer me to a neurologist, even with an "unremarkable" CT scan. I haven't cancelled my appt with the clinic (1 week away, now). I'm debating what I should do. I am still trying to work, but really, I am not doing very well there. I was having trouble with my schedule before my last injury -- it's an 8 on/ 6 off fulltime graveyard shift. Now it's just torture to go to work. But it's a good job and I need the money.

Sorry for the long post, but I am really just out of my depth with this. I don't know if I should pursue this with wc, or just see the clinic, which is just family doctors, but claims to have a 'depression program'. Any suggestions?

Thanks in advance,
Annette

[Mark in Idaho]

Annie,

Welcome to NT. Sorry for your reason for being here but you are in the right place.

Your experience with doctors is not uncommon. All of your symptoms are classic PCS. Your head impacts the past few years are all adding up to your current symptoms. It is called Multiple Impact Syndrome. Your brain has become sensitized to any impact.

The research shows that 'subconcussive' impacts can be just as damaging as the more serious impacts. Subconcussive impacts are head hits that do not cause immediate symptoms. They have a cumulative effect.

I wish I could help you with getting medical care. There is not much that can be done with PCS/MIS. Sometimes, a knowledgeable doctor will prescribe a low dose (10mg per day) of amitriptyline (Elavil). It is a tri-cyclic anti-depressant than helps with some PCS symptoms.

Work Comp is a challenge with PCS. If you can get assessed by a Neuro-psychologist with good experience with PCS, you may get lucky and Work Comp will help you. Since the last impact was at work, WC is a good direction to go.

It is hard to find a Neuro-psych in northern AZ. Frances Margaret Robbins, LP; PHD is in Flagstaff. She is affiliated with a Rehab hospital there so likely has experience with head injuries.

You will benefit from writing a journal. If you can, list the prior impacts and any symptoms that you may remember. Then list the more problematic symptoms after this recent impact at work.

Try to avoid 'feelings' type of symptoms. It is better to list how you function, like, can't focus, sensitive to noise or light, memory problems, headaches that interfere with ability to think, lose focus and 'space out,' Etc. You may struggle to understand your symptoms and describe them in words. This is not uncommon. Just do your best.

An unremarkable CT is normal for PCS. There is no imaging system that can routinely image damage from a concussion. The symptoms are mostly within the neuro-psych spectrum.

It will be worth it to drive a distance to be seen by someone who understands concussion. Professionals who understand concussion are hard to find. It may help to pre-screen any doctors you see. Call and ask if Dr ??? has experience with persistent symptoms from concussion.

Many doctors do not believe a concussion will cause persistent symptoms. You need to avoid them. You need to be cautious to avoid any doctors who may put comments in your medical record that you are malingering or have somatoform disorder or are a 'head case.' Bad comments in your medical record can be difficult to overcome.

With diligence (hard with a concussion, I know) you can get the care and diagnostics you need.

My best to you.

[Toni S]

Hi Annie,

If your Head Injury originated 3 yrs ago while at work and a workers comp claim was filed then, they should have documented records of that on file. Have you gone back and obtained copies of your medical records with dictations?

I would continue with the workers comp claim due to the initial injury being at work. Should be considered "pre-existing". I'd give my supervisor a written request for FMLA papers if needed for additional documented leave of absence while recovering.

Start and keep yourself a paper trail, documented log with dates, times & who you spoke with & communication. Document, document, document....paper trails are a wonderful tool with any and every situation that could possibly get sticky.

Whether you have a successful outcome or not, You'll be glad you did that in the long run.

Toni

[AnnieDayNow]

Hi Toni. Thanks. No, the first injury was at home. My roommate had left a power drill on the top of the refrigerator (don't ask why, I don't know). I was getting something out of the bottom of the fridge. My cat got his foot caught in the cord of the drill.

He kicked the drill off and it landed on the back of my head, followed by the cat. The cat was fine. I, however, fell over and saw stars for a few minutes. I talked to my roommate on the phone shortly after that, and was apparently so incoherent that she called 911. I don't remember the conversation.

It was only the most recent injury that was at work. I have started to document everything, just like you said. I don't care who pays for it, really, as long as I get better. I guess time will tell.