Need some advice
 

Hi Everyone,

I have just been given a report, which was done a while ago (Oct 2012).

It states "in the vast majority of cases, cognitive recovery following a simple, uncomplicated mild traumatic brain injury takes place within approximately 3 months.....symptoms beyond 3 months you have to consider other factors ie. depression, anxiety etc."

It also goes on to state post concussion symptoms are endorsed by healthy individuals suffering from depression or chronic pain....

It sorts of indicates that if I undergo psychological treatment to deal with mood and anxiety my prognosis will be a lot more favorable...

The research behind this is Dr. Michael McCrea (Mild Traumatic Bain Injury and Post concussion Syndrome: The new evidence Base for Diagnosis and Treatment, Oxford University Press, 2008).

I am having a psychological testing in June and plan to undergo a course of treatment for depression/anxiety issues. While I think that stress, depression and anxiety can have a big impact on recovery, I feel this oversimplifies the situation.

FYI besides post concussion syndrome, I also have post traumatic vision syndrome, mid line shift syndrome, convergence insufficiencies, visual track, and depth perception issues.

I would be interested in anyone's comments.... Maybe I need a reality check??

Thanks

Hmmm....
 

Personally, I think you're right. I agree that depression/anxiety contribute to exacerbation of some symptoms because it's unbelievable how true "mind over matter" can be. However, with this PCS mess (as I like to call it)...when you try to do something that would potentially alleviate said stress/anxiety/depression - like read a book or watch a movie...you end up with a migraine and in my case dizziness from the strain.

Basically, if you try to push through your symptoms, you end up being worse off and from what I've read on this forum, you prolong the healing process. It seems like a lot of doctors like to minimize the fact that it takes the brain a LOOOONG time to heal! And, if you stimulate it while it's healing, you tear up the newly healed neurons!

I think we're all prone to depression and anxiety because of the restrictions that come with this mess and the fact that our lives are basically on hold because doing anything too "strenuous" makes us go backwards 5/6 steps in progress. So a lot of day to day things that need to get done have to be managed in a slower time frame than we are used to - which causes us stress. The limiting of activities that we used to be able to do (for me reading, running, swimming, taekwondo, hanging out for long periods of time, working full time) is also a trigger for depression.

I guess what I am trying to say (sorry if I don't make any sense!) is that it is a vicious circle of depression/anxiety and symptoms. There are a ton of doctors who do not understand this syndrome. I used to be one of those people who would think someone was being lazy/paranoid/melodramatic if they complained about prolonged symptoms for anything. I HAVE BEEN REFORMED!!! Anyway, interested to see what others post.

I completely disagree, and that view has been discredited. If you have vision issues, you have a pretty serious brain injury. People can have psychological problems on top of that, but you have a brain injury with measurable physical damage.

Your symptoms (again, vision, etc.) are a sign of a complicated (not simple!) brain injury. The mild in MTBI does not mean a mild njury, but refers to the fact that your skull was not penetrated, etc.

The word 'concussion' needs to be dropped because it leads people (myself included pre-injury) to thnk that it is a bonk on the head and not a brain injury.

I would ask the person who wrote that how they explain your vision problems. A bt of anxiety and depression causes it? I think not.

You can tell I am passionate about this one!

Good luck!

I agree with Mokey. This researcher is a NeuroPsych. They are the most common profession to try to tell us that our symptoms are all in our heads. Depression and anxiety are definite antagonists of prolonged concussion symptoms but that does not mean the depression and anxiety are the source of the symptoms. Just because the patient tends to improve when depression and anxiety are addressed does not mean depression and anxiety are the cause. Very few NP's fully understand the many overlaps between depression and anxiety and concussion symptoms. The MMPI-II is very easy to misinterpret to support his claims.

This is why I tend to repeat the need to reduce stress and anxiety so the brain can have a better chance at healing.

I think this is strange. Who wouldn't feel depressed when experiencing extreme headache, dizziness, tremors, problems reading etc? I would like to meet the person that didn't feel depressed/anxious in that case. I've never been depressed or anxious before, but this happens when I feel frustrated about my other symptoms.

I agree with Mark and Mokey.

I have never suffered from depression or anxiety. In fact, I worked in a Mood Disorders Clinic prior to my accident.

In the time since my injury, I have had periods where I have felt down, but never to the degree of Clinical Depression and times when I have felt frustrated and upset but not anxiety. It has been over 8 months since my accident and I am still experiencing symptoms.

This is an excellent discussion
 

Yesterday was my first day in a brain injury out patient therapy program. And the discussion started with " we don't think you have a brain injury". Of course I got very upset. But they continued to explain that yes my fall caused an injury within my head but the damage doesn't seem to be primarily brain related because in "prime circumstances" my brain can perform very well. My injuries appear to be more on a vestibular level. Lots of vision and other sensory issues are my primary problems. It is related to the brain, because it sends messages to the brain, but the brain itself wasn't damaged. (?)

Please feel free to clarify/correct anything that I am stating. I am only trying to write what I remember from my reading and what they told me.

They called it central vestibulapathy .

It isn't that the brain isn't involved it is that we need to attack it from different directictions. For instance, Vision is primary for me and at month 8 I am still waiting to see a neuro op. so I need to try work arounds as much as possible related to vision or all of my other symptoms heighten.

In many ways I am pleased that my brain can work. But it can be so difficult to explain that this problem is " real". And that I don't want to stay this way.
And that I need help.
Su seb

Mokey
 

And mokey our symptom seem to be very similar, I'm not disagreeing with your post. I'm just stating how my new program is approaching it. I often read through your posts for tips. Keep them coming.
Su seb

I think I disagree with the clinic :).

What they may be thhinking is you do not have obvious damage to the parts of your brain that deal with memory, thought, planning, calculations, motivation, etc. You are nor paralysd. The traditional view of what 'brain damage' would look like.

Anything to do with messages in the brain (seninding or receiving) IS the brain. Receptors, processing, etc. It is an integrated system. Vestibular, vision, etc.

Always hard to get good, smart, up-to-date care. The absence of smart care leads to depression! :)

"We don't think you have a brain injury" is a classic tell to the biases they have. This is bull. The injury is real. They may be able to isolate different symptoms as not brain injury oriented. OK. But, don't treat the person with the idea their other symptoms are not due to a brain injury.

Therapists tend to view everything from within their own skill set. Psychs say your problem is psychological. PT's say you just need their physical therapy. Athletic trainers say you need to get back to conditioning and work through your symptoms.

I am fortunate. I have had 3 neuropsych assessments that had the same results years apart. I have had 3 different qEEGs years apart that show the same injury.

My improvements have been due to my skill at learning work-arounds and coping skills. My brain is damaged and static. I do have some limited 'healings.' But, when under stress, I am usually back to square one. Fortunately, I have never had any serious vestibular problems. Just an occasional need to slow down to get my balance.

I go on as if I have no injury but am always ready to stop and change course because a symptom has popped up and gotten in the way. I move around that symptom or take some time for quiet rest and then I go on. I just don't rely on a fabulous memory like I used to have. I don't get down if I can't process a mental calculation. I get a calculator and/or pencil and paper.

If this brain injury out patient clinic can help, it does not validate their claim that you do not have a brain injury. The problem with 'you are not brain injured' is it puts an undue strain on the patient psychologically. The patient takes on stress as they blame their symptoms on this 'non-injury' causation.

When you are told this bologna, just nod and move on. Try to use any support and therapy they offer for the gains it provides.

We also must remember the meaning of 'brain injured' in their perspective. The TBI patient may have been comatose or needed to relearn motor functions, speech, or other obvious disabilities. When they are able to function on their own, they are often considered rehabilitated. Their rehabilitated state is often where we as the concussion injured are starting. Compared to those severe TBI patients, we do not have signs of a brain injury.

They consider the patient rehabbed when they have achieved a standardized plateau of function. Improvements beyond that point will often be very slow at coming.

The problem is the rehab therapist has hit their limit, not that the patient has healed.

We see this daily when doctors say that we are OK.

Just don't get stuck in a pity party. It does not help us move forward.

My best to you all.

These quotes from "specialists" discounting mtbi are really surprising!

Dr. Michael McCrea, as Mark points out, is a PhD not a MD. His work focuses on sports a lot, so the role of psychology is really central.

The rehab center is also probably run by OT or PT, and they want to focus on strategies to help with daily accommodation.

Whether it is bias or blind spots or gaps in their knowledge, I am shocked that they are so categorically dismissive.

My neuro-ophthalmologist was very kind in underscoring that many specialists and doctors want to emphasize the "psychological" when they encounter difficult or a-typical recoveries.

With mild, traumatic brain injuries the injuries are "invisible" but create so many debilitating symptoms.

The truth is vision and vestibular functions are central to our body's orientation. If these vital systems are impaired, it is natural to feel off center. This isn't driven by psychology but by physiology, even if there are psychological aspects.

I've not been depressed in the clinical sense (I have too many friends who are therapists)-but I am more anxious to try to figure out my recovery when so little is known.

I think when specialists dismiss mtbi they reveal more about their limited understanding than anything else!

Thanks to Everyone for their replies....
 

I was really annoyed yesterday by this report and the interview with the person who gave me the report. I really feel some days more than others that no one realizes what our lives are like.

I also find there are a lot of people who know nothing about post traumatic vision syndrome and all of its components.

Thank you for your support as always it is really nice to know other know what I am going through.... sometimes you just question whether you have things right.

Norma

The sad thing is this guy recently received monies, like 1.9 million, for studies on the military projects for our troops suffering from their injuries.

Of course we have Depression, we are going through loads of changes we have problems with.

However, that cannot discount our PHYSICAL problems.

Mark pegged it, as usual.

I agree with Mark and Mokey.

We need to let go of other people's label of what's "wrong" with us, whenever possible. Who needs it, really? Does knowing what exact strain of virus you have make you any less sick? In the same way, let go of what doesn't sit "true" to you and focus on minimizing symptoms, and using work-arounds for the lingering symptoms.

I liken it to "dumping the cache" of what the latest professional has said that filled my head with self doubt.

I was there when I hit my head to pavement. They weren't. I suffered a brain injury. They didn't. Nearly 8 months later I'm still feeling its effects. No one can take that and minimize it. It is my truth.

I will use "them" (professional supports) when they are useful to me. Otherwise I dump their nonsense from my brain. Particularly if their opinion does not affect your return to work or your insurance coverage, then it has little impact and is worthless.

I refuse to believe that we PCS'ers suffer depression or anxiety due to emotional reaction or adjustment to the injury, as many professionals lead us to believe or insist to be true. I firmly believe that those symptoms are physiological, directly linked to tissue damage, and we are left to cope with them. Either way, we are left to cope. So who's "right" doesn't exactly matter and is currently impossible to prove.

I can't wait for the day (and it will come) that the dark ages of brain injury are over. I may be in my nineties (if God wills it) when the diagnostic tools are finally sophisticated enough to detect and "prove" what we've all experienced.

Until then, validated or not, I must cope and discipline my thoughts.

Oh. I also meant to say that I don't believe it's limited understanding at is the cause of broad false statements about brain injury.

FWIW, I think it comes down to money. The more doubt cast on good research that shows even one concussion can have a lasting effect on the brain, the fewer insurance payouts or legal settlements or changes to major money making enterprises such as professional sports.

I don't believe all of the doubts cast are intentional. Some ppl really are working with outdated information. But those who quote "new" information that minimizes brain injury and projects blame onto the patient (the mental health angle) may be aligning themselves with a researcher who was paid handsomely to cast doubt and minimize cost to an interested entity. Military likely can't afford rehab for all the concussions, too busy buying guns. Sports can't afford the truth to come out. Truth costs. JMO!

Thank you
 

Very well said. One of my biggest struggles is organizing thoughts and words. What you wrote above is very helpful.
Su seb

I find this topic interesting, because I think the opposite. I firmly believe that the psycological factors of PCS heighten the physiological symptoms, and vice versa. I am uncertain if you are fully healed at 3 months, but the vast majority of healing happens early on.

Getting stress and anxiety under control is crucial for recovery. In my case an antidepressant combined with isolating myself from others (including my family) pushed me forward and into recovery

Before this I had a dreadful migraine, light and noise sensitivity, insomnia etc. The turning point was being prescribed the right medication resting, relaxing and de-stressing.

My psychologist was correct in stating that my mood and anxiety was increasing my physiological symptoms. Why else did they all reduce when I was prescribed an SNRI?