Hate to admit it but I'm scared
 

For the first time in my life I'm scared of something bad happening to me. I'm nearly 50 years old and a veteran of Desert Storm so I've seen things that most people haven't and I've always been strong.

Now to my issues. About 10 months ago I fell of the roof of my one story ranch home. In landed on a concrete patio with all the force on my back and my head snapping back with great force. My wife rushed me to the nearest hospital and then I was sent by ambulance to a hospital with a trauma center. I cracked the back of my skull from basically ear to ear and had bleeding on the brain. Thankfully the bleeding subsided and they didn't have to open me up. I spent numerous days in the hospital and was out of work for a month with severe headaches and uncontrollable dizziness. I went through therapy for my dizziness and after awhile things got better. Can't recall the therapy but it had something to do with loose crystals or what I like to say my rocks in my head were knocked loose. Through it all during the past 10 months I've experienced headaches and some dizziness but I've dealt with it.

Now let's fast forward to last week at work. Something was left on the floor that shouldn't have been there and it was confirmed as a safety hazard after I tripped on it. That's right, I tripped on it and went head first into a wall. The force was hard enough to crack the wall. I was taken to the emergency room and given all tests that were required for head, neck and back injuries. It came back that I had aneck and back sprain and fortunatly no cracked skull or bleeding on the brain. I have a pretty good bump on the side of my head and the doctor said I suffered a concussion.

That sounds like good news but since then I've had severe headaches and dizziness which the doctor said would probably happen. What has me worried now is memory loss, slurred speech and stuttering. My wife wife says I ask her the same things 10 minutes after I asked the initial question. On the phone she and my friends said they have noticed stuttering and slurred speach. I can deal with some physical pain but this mental aspect has me scared beyond belief.

I'm in a job that I feel at some point I'm going to be pressured into returning and to perform at my same previous level. My job requires lots of correspondence through letters and emails and in just the past few days some of my emails have been somewhat incoherent. I'm not back at work but these emails have been through friends. I'm also required to use a computer most of the day and at night I receive phone calls on it job that require split second decisions to be made. My job is important to me and I love it.

I go to my family doctor tomorrow and I know he's going to tell me to stay away from work for a period of time. This may sound crazy but I'm thinking of telling him I'm better. I was wondering if I could just ride this out and hope to get better on my own.

My wife is a nurse and she has told me the seriousness of two brain injuries so close together in time some I'm no fool about this but I'm also bull-headed and I've always drove myself to get better.

Lately I've gone on line and from what I've read I know how serious this is. Again getting back to work and showing my employer I'm not trying to take advantage of them has me on the edge. There were numerous witnesses to the accident and all agree that the company was negligent by creating a fall hazard. Do you think I could have long term problems with this? The first accident from the roof was very serious. In factthe doctors told me I was lucky I didn't die. When I do go back to work and if I have mental lapses I'm worried the company will take action against me. I hope someone can help me sort this all out.

I hope this is coherent enough. I've proofread and had my daughter look at it so please excuse any mistakes.

Thanks for your time.

Wow, so sorry to hear that you have had 2 very traumatizing accidents.

I am not an expert on this, and I have certainly struggled with learning my lessons but the one thing that I know is that pushing through these symptoms will not make things better.

My employer wouldn't let me back to work for fear of me getting worse, and I am now greatful for this.

Please be gentle with yourself, know that these have been serious. Hopefully there is workers compensation or disability available for you to have while you take the time necessary to heal.

Best of luck

Army Vet,

First, thank you for your service. My daughter was in Kirkuk for most of a year and I understand what you went through.

Welcome to NeuroTalk. Sorry for the reason you are here.

Your wife is right. Two concussion of the severity you suffered is a serious issue. I am guessing by your comments that this is being treated as a Workers Comp case. Before going any further, I recommend you find a Workers Comp attorney who specializes in brain injuries. Your prior injury does not weaken you case for Workers Comp benefits.

Check out or better yet, have your wife check out www.tbilaw.com. Mild Traumatic Brain Injuries are very difficult to represent unless the attorney knows the ropes. A good attorney can help determine if the fall hazard was a great enough negligent risk to create a case beyond Workers Comp. Work Comp can be limiting.

You are very early in your recovery. Stay away from work until you have been released by both a specialist in mTBI and your attorney. At your age, recovery is much more problematic. The brain does not have the recovery ability for us older guys that it has for the younger ones. Your slurred speech is a serious concern.

Have you had a CT Scan done? It can rule out serious issues that could be life threatening. If you family doctor does not suggest it, ask about it.

You are playing with the rest of your life and the needs of your family when you ignore any symptoms. If you think you are bull headed, I have you beat because I know the long term problems from an mTBI at this age. I live with them daily.

There is no kind of personal drive than can overcome a brain injury. Your bones, tendons, ligaments and muscles can heal strong from pushing the recovery. Your brain is just the opposite.

If your family doctor is not connected to the VA, you should consider getting checked out at the VA. There will be much more understanding of your brain at the VA. As a combat vet, I know you have VA benefits.

Try to stay away from doctors who do not understand concussions and mTBI. They can put things in your medical record that can haunt you.

For the time being, lay low, rest, get good nutrition that is without caffeine and alcohol ( one normal serving per day of each is the maximum) and download the TBI Survival Guide at www.tbiguide.com

Do not play macho man. It is too great of a risk. Work Comp protects your job so getting back to work is the last of your worries.

Let us know how you are doing.

And, have your wife read this post. She needs to be fully in the loop.

My best to you.

Thanks for the quick and great responses. Yes I'm currently on workers comp. I didn't know or still don't know if I need to talk to a attorny. I'm not looking to cash in on this at all that bit I want is for them to treat me fairly and be patient with me when I return to work. Again, they were clearly negligent here, we are in the middle of moving offices around and things were left strewn on the floor over a number of days, but my intent is just get back to work. Many of my co workers say to pursue this route but that's not me. Personally, I actually feel embarrassed about falling and having to face my co workers again.

I also may have jumped the gun in stating they may pressure me back to work. Most of the senior leaders but I do have a few jerks right above me.l

I've been through the work comp system for repetitive motion injuries that eventually became chronic.
I've learned a few things from my own experience as well as reading on our wc forum...

1- your first injury was private and not comp related. It sounds like you still had some residual symptoms from that at the time of the second fall at work. "during the past 10 months I've experienced headaches and some dizziness"

2 - wc may likely try to put some of the blame, and a % the recent injuries as related to your first fall. Nothing personal , but it's how big companies & their lawyers do things.

what they will do is look back at your health history and see the other incident, what the symptoms were, and the amount of time you missed back then.

If it gets to a wc hearing, or claim is disputed, they will be playing to win.

I could be totally wrong, but don't assume anything, and don't neglect your health to prove a point that doesn't need to be proved.

Your health is the most important thing of all, so be honest with your dr and don't deny or minimize any symptoms that need to documented..

It might be good to talk with "interview" some good wc attys , just in case you end up needing one.
With the complications of the 1st fall it will be more difficult to prove all new injuries are really new, unless your dr has been taking wonderful notes all this time.

Army Vet,

Work Comp never ends in a windfall. It is the poorest paying system which is why you need to seek good advice from a WC attorney who understands mTBI. Do not think you are after the money because even in the best cases, you end up with a measly sum for your injuries. You don't say what state you are in. Some states have strong WC regulations that prevent prior medical history from reducing your benefits.

California looks at it as simply an injury that caused problems. If you had not suffered the workplace injury, you would not be facing the injury and job losses.

Consider WC as a safety net that pays very little but can help you if your injury causes lasting symptoms that prevent work. As my signature says, I am on full time, permanent disability for my injury that happened on the job. The Work Comp people were very good at denying me benefits. I qualified for Social Security Disability Income even though it has a much higher disability standard than Work Comp.

Work Comp claims are a tough fight when the injury is mTBI. Get an attorney's advice. Your Multiple Impact Syndrome may very likely leave you with long term or even permanent disabilities.

Were you exposed to explosions or other loud and shocking noises during Desert Storm? They can injure your brain even when you don't notice any immediate symptoms. The accumulation of impacts can be rough on the older brain. Your recent impacts might have pushed your brain past the recovery point.

Check out http://www.subtlebraininjury.com/ so you understand the WC process for mTBI.

My best to you.

Just got back from family doc. Daughter took me and told him everything from headaches, stuttering, slurred speech and dizziness. Doctor also said he recgonized the speech issues. He has set me up with a neurophsycologist and that has me wondering why. Does he think I'm crazy? What can he do for me or to help me.

Someone asked earlier where I'm from and it's Virginia.

I saw a neuropsych for a neuropsych test. It helps pinpoint deficiencies like memory, verbal and auditory processing, etc and then give resources to try to improve. It's not a crazy thing!

It probably is just for an evaluation. You could call the drs office and ask, it might be good to know due to the comp claim involved.

I don't know how Virginia comp is, but Oregon wc - when I was in it anyway , generally we could choose a dr of our choice or make a change a few times - but had to be approved by wc.

Does your family dr know of the wc claim and is billing under it or your private medical?
It can get confusing with the previous personal injury follow ups as well as the new work injury.

I do suggest searching out some of the better work comp attys, and some are better than others, check out the offices/staff - do they look/act professional or not organized...? big flag right there.

I learned that after the fact. :(
Generally same with PT, and other treatment providers, if they seem disorganized/not professional - look elsewhere.

Army Vet,

As others have said, a NeuroPsych is to quantify your level of symptoms. It is VERY important that any NeuroPsych who sees you be knowlwdgeable in mTBI. Many are biased against organic causation and will diagnose psychological or psychiatric causation. This can be the kiss of death to a Workers comp claim and then follow you for years. As Jo*Mar said, she learned After the Fact about NeuroPsychologists.

Go to the links I recommended earlier. www.tbilaw.com
and www.subtlebraininjury.com

You need a competent mTBI Work Comp attorney BEFORE your are seen by a NeuroPsych for an assessment.

Here is a link to a Virginia attorney who may be helpful. His web site shows that he understands mTBI and Work Comp. http://www.brain-injury-law-center.com/contact-us.html
This statement from his web site tells the truth <Because insurance companies must be suspect of every WC claim, you may find it difficult to secure compensation for your injuries, despite having a valid claim. Even if your physician documents your disability, the IME doctor may offer a differing opinion. If you are denied treatment or disability payments from your WC insurer, you should talk to an experienced attorney that knows both the complexity of TBI and the WC system.>

I want to scare some attention into you. A biased NeuroPsych killed my chances at a Work Comp settlement. That bias likely cost me $10,000 to $15,000 a year for the next 20 years and the past 10 years. Now, I have to survive on $1284 per month rather than almost $3000 per month.

Please, find a good WC attorney.
And, bring your wife and daughter into this information loop. You need their assistance.

My best to you.

hello
 

Hello, my son was in desert storm too. He was Navy at that time. Sorry you have had such head trauma. Please take the time to heal. You only have one life. If you persist with symptoms as you described, perhaps a trip to the neurologist you had is in order. The memory issue can be scarry, especially because you have to have it for work. Stress from not working, or working after time off is all difficult on a person too. I will hope and pray your place of work will be understanding no matter what you choose to do. ginnie

I have a doctors apponintment next. Until then I'm out from work until then per the doctor's orders. Just got a call from the company that handles my company's workers comp claims and they want to send a person of their own to my appointment. I think they said she is a nurse. This feels kind of invasive to me. What's the deal with that? Would it be wise to bring my wife along who's also a nurse?


This is really strarting to make me feel like I'm the bad guy here. I just want to be rid of the headaches, dizziness and speech issues and go back to work because this boredom is driving me crazy.

As info, I've worked for my company for 15 years and except for when I was out after falling off the roof I can count the number of sick days I took on one hand.

Have you checked with a Workers Comp attorney yet?

Take the comment from the Work Comp company about sending their nurse to you appointment as a warning.

You need good legal advice.

Work Comp is supposed to be a No Fault system but the insurance companies look at the injured worker as the enemy. Their goal is to pay for as little as possible, regardless of your true needs.

You sound like you do not want to be adversarial but you need to be. If you don't, they will take advantage of you. You paid into the Workers Comp system with your 15 years of paychecks. You are due a good result. You are not going after your employer. You are up against an insurance company. They don't care how long you have been employed.

Pride will not pay the bills when your Work Comp benefits get cut off. Hard work will not overcome a brain injury. You need to get legal help so they can protect you and your families interests.

bring someone
 

Hello again. I think it is always a good idea to bring someone with you to the doctor. If nothing else they may remember something you forget etc. I also take notes. It is also mental comfort to have someone with you who understands.Bring your wife if you can. Good luck to you. ginnie

explore our work comp forum for ideas & tips, it's just good to have some info ahead of time and to go forward with.
check the sticky threads up near the top of each forum too
wc forum-
http://neurotalk.psychcentral.com/forum30.html


Did or does employer know you were still having some issues w/ dizziness before the work accident?
[Through it all during the past 10 months I've experienced headaches and some dizziness but I've dealt with it.]

If not keep mum on that & don't talk about the wc claim or your injury to any work friends or employer any more if you may have before.
Just best to keep details to yourself.

I learned all this after the fact also, the HR /risk management lady acted like she was my friend and was acting helpful , but i think she sabotaged me - I was naive about the whole thing and trusted her & the system.

Luckily mine was not a major injury but ended up a mild and sometimes moderate chronic thing.

Jo-Mar

Thanks for all this information.

Donna:grouphug:

It's been a few days since I posted so here's an update. Been to the doc twice. I'm still away from work and I'm hoping to go back next week. I still get 2 or 3 headaches a day and still experince dizziness. My wife and daughter say I still ask the same questions over and over again.

My main issue is with these headaches. If those would just go away I feel my life would be much better. One other issue my family and I have noticed is I lose my temper and I easily fly off the handle. This bothers me because I've always been calm and cool before my second injury.

One other concern is my doc wants mr to see a neurophsyc. Why and what can the do? I've been reading up on some test they give you and it seems these test are nothing but bogus and the interpretation of the results is conflicting.

What if you return to work and fly off the handle there, or repeat things over and over??
Will employer work with you or ??

Might be better to wait a little longer if you can , so you don't risk problems or complications at the job or with employer.

But I don't know what your specific work situation is.
If you work alone most of the time, or in a group or team.

ArmyVet,

The NeuroPsych Assessment is the only way to determine what your true symptoms/dysfunctions are. If the proper battery of tests is done and interpreted by an NeuroPsych Ph.D. who does not have a bias against Post Concussion Syndrome, you will get some valuable information.

If the NP Assessment is done using the wrong or an incomplete battery of tests, the report can be used against you in your Work Comp claim. If the NP Ph.D. has a bias against PCS as a cause of your problems, it will be very difficult to ever get the bad report discounted.

This is why you need to talk to a Work Comp attorney.

I am curious where you read that some of the tests are bogus. They are researched extensively. The problem is the interpretation, not the tests. The Halsted-Reitan battery is the most commonly used battery of tests. It includes the WAIS, WMS, Trail Making, Finger Tapping, and some others. Each has a focused objective.

For example, the Trail Making test tests memory, visual perception with distractions and the ability to switch tasks while retaining memory. The PASAT (Paced Serial Addition Test) tests cognitive skills and multi-step processing. A good battery will include a test or two to check for validity and malingering.

If you decide to have a NP Assessment done, consult a WC attorney first. You need to be sure the proper battery is done by a reputable NeuroPsych.

I wish I could sit down with you, your wife and your daughter and explain what happened to me and the mistakes I made with my Workers Comp claim. I was hesitant to push hard with the Work Comp claim and now have to try to survive on about 15% of my previous pay. My wife had to find a job. She had not worked since before we got married 24 years earlier. Her meager pay and my SSDI disability check still have us in the poor house. A proper Work Comp settlement would have made a huge difference.

Please, have you wife read these posts. She will be the one to care for you as your condition gets worse. Post Concussion Syndrome hits hard as the subject ages into the 50's.

My best to you and your family.

Neuro Test
 

I have a neuro test next week. Nervous too. I have just found this site through another PCS person and am finding things on here that scare me. I have PCS. I hit my head on a solid wood door that became stuck on a mat and when it got stuck I pulled harder and hit my head on the soft spot. Also damaged my eye. I read a post about using the wrong words or thinking of aword and it does not quite reach your lips. I have had this injury since 09/10 and am worried that this will not go away. That this is what my life is going to be like. That I will never be the same person again. I have read where it has made some people a better person, I am not there yet, it has not made me a better person. I am struggeling everyday. So many things wrong, dizziness, spacey, blurred vision, tinnitus, fatigue, anxiety, can't sleep, light/noise sensitivity, headaches, etc.

All most everyone on this site has had their injury for a long time and still have symptoms. That is the part that scares me.

I am lucky to have a great employer working with me and am currently receiving long term disability. Worried about the money, but my husband is making it work some how. I have been denied SS benefits. Although they think I should fight it. My husband says not to cause I may be better by the time I get a hearing.

I am going to keep on reading this site and hopefully get a little hope.

KB Phil,

If your injury was in September of 2010, it is too soon to get approved for Social Security Disability. You can not get it until you have been disabled 12 months.

While you are waiting, download the TBI Survivors Guide at www.tbiguide.com
Print it out. It has great information.

Don't get too anxious about your long term condition. There are many things that you can do to work past the symptoms. I have some serious dysfunctions but can still live a full life.

Tell us about your worst struggles. Hopefully, we can help you learn some work-arounds and accommodations that lessen the limitations you have.

My best to you.

going back to work
 

hi army vet
going back to work really complicated things for me. I did not know how badly I was functioning thinking I would get better, I worked as a project manager working with life safety systems my employers were good at first

but when they realized I was not getting better and was being totally overwhelmed I was asked to leave I was being payed by the company my boss said take as long as you need so was not officially off sick, the pressure to go back to work was there ,I have since been diagnosed with an ABI and medically retired
in fact it made my injury worse by trying to use a damaged and healing brain

so although we all wish to get back to normal, for me at least its a new normal
rest and time we have said here many times are the best thing for ABI
talk with a lawyer you may recover but until you do going back to work may not be a good thing for your health

best wishes

Please listen to everyones advise
 

Hi Army Vet...I cant stress enough for you to listen to the advice posted by all those before me. I too fell, hit my head on a sidewalk...thought it would heal and didn't want to sue - wasn't looking for money...just wanted to get back to my life. Unfortunately, I Was diagnosed with PCS, mTBI and too numerous other things related to the accident. All I can say is THANK GOODNESS I LISTENED TO FRIENDS ADVICE TO SPEAK TO AN ATTORNEY before it was too late (BECAUSE THERE ARE STATUTES OF LIMITATIONS INVOLVED).

Finally found one who understands mTBI and he is affiliated with the brain injury association of my state - so he "gets it". My recommendation...check your state BIA(brain injury association) site...there are attorneys there that you can have a free consult with and yes...make sure they're familiar with WC. Their site may also give you recommendations as to places for treatment to help with your issues. Also the neuropsyc is a really good thing to do. It's not because you're nuts - you're not, you're injured...it's needed to help you understand what's been affected and course of treatment suggestions.

I thought my injury would just take a little while for me to heal but I'm now
2 years/4 months into this, and unfortunately with no real end in sight of recovery. I had to close my childcare business that I ran for 25 years and never in my wildest dreams thought this would be my outcome...let alone the 10's of thousands of dollars we've spent looking for the right treatments - and we're not done yet. So before you make the blanket statement ...you're not looking for money - and while your intentions are good to take care of yourself (as were mine)...Reality dictates this and You need to protect yourself & family financially.. Check out all the links Mark in Idaho gave you...his info is good and he's obviously been through all the tough times with his injury.

Good luck to you...and God Bless you for serving! I hope you have a good outcome.
Regards,
Anneteaem

Hey guys I'm sorry I haven't post in a while but my world seems almost turned upside down. I thank all you and especially Mark in Idaho for the support and great advice. I don't want to repeat everyhing but you can read my original post to get up to speed.

Here's where I'm at now after I guess is just over one month aver having my concussion. I've been back to work for half days. I don't know if that helped or not. Just got back from dr. and the will keep me on half days for the next two weeks. I just don't know what going to my family dr. does because I basically tell them my problems and that's it.

At this time I'm still getting 3 or 4 headaches a day along with getting dizzy. It seems I get dizzy when the headache begin but perhaps I'm imagining that. Three times during the past 2 weeks I woke in the middle of the night with severe headaches along with vommitting. Is that normal? My memory and speech seem to be better but since returning to work I've notice my reaction time isn't what it used to be. My wife and daughter also believe I'm suffering from depression and they've said I've developed anger issues also. I just tell them I don't want to hear any of that. Am I in denial?

Also next Tuesday I go to the nuero psych. I've asked everyone what is a neuro psych going to be able to do to make me better and I don't belive anyone knows. Can anyone tell me?

I've always been positive but I must admit that I'm getting tired of this whole process and at times I just want to say the hell with it and give up and just deal with this on my own. I know that sounds selfish because many of you have and are dealing with much worse than me.

One other thing. I was given medication for the headache pain and I'm also suffering from insomnia. I was given Lunesta and it worked the first night but after that it didn't help so I quit taking them. I also didn't take the pain medication because it seems my headaches only last a hour or so.

It's been a while since I posted so it's time for an update. It's been about 3 months since I had my second concussion that happened at work. I'm still getting 3 or 4 severe headaches a day. I can tell when they are coming on and they usually last for about an hour. In the last 2 weeks I've experienced quite a bit more dizziness. When I stand or lay down everything spins around. When I look up I experience the same thing. It seems to me that my family doctor is at a loss and he has me seeing a neuoroligist next week. It seems to me my wife and others doubt that I'm still having problems. With that being the case what can a neuoroligist do for me except take my word for what I'm going through.

I'm back to work full time but it's a struggle to just get through the day. I try to hide because I don't want others to think I'm a slacker but I just don't know how much longer I can do this.

Any response would be appreciated.

I had my car accident on 3/8/11. 6th months post accident I am still dealing with dizziness, headaches, visual problems, light/hearing sensitivity, intense mood swings, disabling fatigue etc.

My best advice would be to find a neurologist who has a great deal of experience with TBI and PCS. Although neurologists know a great deal about the body, many are CLUELESS when it comes to PCS. After 3 months of feeling awful 24/7, my first neurologist told me that I was basically crazy and that my symptoms could not be related to my accident at this point.

At that point I researched other doctors and found a great team of Drs who deal exclusively with concussion cases. I am now involved in vestibular therapy, physical therapy and vision therapy and also taking medication for my anxiety, anger and depression. Although my progress is slow, there finally is some progress and I feel better knowing I'm doing some active to get better.

As for your employment, I too tried to return to work after my accident. However, the strain it was putting on my made everything worse. I felt I couldn't keep pushing myself anymore, and my employer felt I was struggling as well.

I therefore went on medical leave. When that was exhausted, I tried again to return, but much to the same result. My dr put me back on leave. He said that if I stayed working, my brain would be unable to work on healing because of the strain I was putting on it daily and that I would not get better until my brain's only "job" was to focus on healing. He was right.

Six months later, I am still not working. But rather work daily with various therapies and resting. You brain WILL NOT heal or you will not feel any better until you take the strain of your work away. Can you take a medical leave? or have your dr or new neurologist put you on leave? I hate that I am no longer at my job and it was a tough decision to make financially, but I couldn't go on the way I was.

I am finally making progress, albeit slowly. However, with no work related strain, my brain is starting to heal, and I feel like I'm among the living again...

My advice to you:

1) Find a neurologist who has a great deal of experience in TBI/ PCS. Although neurologist have a wealth of information, unless you find one who has experience with what you are going through, they won't be very helpful. Finding one who does, has made a HUGE difference for me.

2) Take a medical leave or whatever you need to do to stop working, so that your brain can focus solely on healing. If someone had told me this at the very beginning, I don't think I would have been down and out for so long. However, I tried to push through, and wasted time that my brain could have been healing.

3) Take your wife with you to your medical appointments. My boyfriend really struggled to see that PCS could be so long lasting and so debilitating, until he came with my to see my concussion doctor. As we talked about my symptoms, the Dr stressed how devestating and long lasting they could be, and that I needed to be completely focused on relaxing, even if that meant some household responsibilities had to be passed off to someone else. It was really eye opening for him, and has mad my recovery a lot easier. I know feel like I have an ally against my PCS and not someone who thinks I should be better by now and just faking it.

I urge you to really think about these three things. Before I did these, I continued a daily nonexistence of pain, strain and being constantly bombarded with PCS symptoms. I am now finally, 6 months later, slowly starting to come out of the whole that consumed my life. I wish the same for you.

priority
 

I have a friend with head trauma, so your post struck me. He had to work until it turned into something worse. He should have quit work, long before but he was afraid of applying for dissability and all the rest. He put work first and paid a terrible price. See to your injury first even take a leave of absence from work if you can. Brain injuries I found out though this friend of mine are very complicated. So are our brains. Please do go to another doctor and take very good care of yourself. I am sorry your are suffering. ginnie