Dr. is convinced symptoms are from dehydration!
 

Just got back from another doctor's appointment for my son. I took him this time bc of his new symptoms:

* muscle twitches, sometimes to the point of pain and pain in the muscles after

* dizzy when he stands up from sitting or laying

* arms go cold, tingly, numb and legs too, vision changes, auditory problems, and jaw tightening all when he stands with head tilted at all upwards

* pulse races to 120-130 just from the act of standing up!

Nathan has been on no activity for the entire 4+ months, but was extremely physically healthy prior to head injury. at 6'2" he weighs in at 138 lbs

He takes multivitamin, B100, flaxseed oil, vit E along with his allergy med daily and 25mg amitriptyline at bedtime.

He eats like a horse or teenage boy! He takes in NO caffeine. He drinks tons of water and some milk daily.

Dr says to supervise him drinking 1gallon of water per day and push salty foods. Take his blood pressure and heart rate 6x per day. Call him on Tuesday with results. He says he's 100% sure dehydration is causing all this and may be lengthening his recovery.

We had already added 2 bottles of gatorade a day after last week's visit. Most of these symptoms have gotten worse over the last week.

Any ideas/thoughts?

--jenny

A good way to recognize dehydration is by the color of his urine. If it is a dark yellow with a strong smell, dehydration is likely. If it is a normal yellow, it has a normal amount of water in his system. I am surprised the doc did not order a urinalysis.

Another way is to pinch his skin. If it is flexible and stretchy, it has normal fluid levels. If it shows the pinch mark after releasing the pinch, dehydration is less likely. Dehydration will cause head aches and cognitive issues but they will go away soon after the body is properly hydrated.

But, to please the doc, just keep track of his intake. No need to upset the doc and get his against you.

My best to you both.

Hi,
I had a severe whiplash the day after my cervical fusion (June 2011), while still in the hospital. Long story short, the nurse tech didn't bring the head of my bed upright when I was getting into bed and I didn't know this (was concentrating on holding my IV pole, etc.), and my skull flew back all the way and smashed into my upper back, so in addition to the neck trauma, I had a concussion from my brain smacking around in my skull. I had trouble reading and speaking--I would read a page and my eyes didn't stay focused on one sentence--they would jump to another sentence on the page. When I spoke, I felt I was grasping for words. I wasn't ultra-tired, but I just felt like my body wouldn't MOVE, as if my muscles were gone. I have some comments/suggestions which may or may not apply to your son.

Afterwards, I too hated standing up--I felt weak and woozy when I did. I looked on the internet, and I found out about POTS (postural orthostatic tachycardia syndrome):

"Postural orthostatic tachycardia syndrome is defined by excessive heart rate increments upon upright posture. A person with POTS will experience heart rates that increase 30 beats or more per minute upon standing and/or increase to 120 beats or more per minute upon standing (Grubb, 2000). These exaggerated heart rate increases usually occur within 10 minutes of rising". I'm thinking the doctor may already suspect POTS if he's pushing liquids and salt--that is a primary treatment for it. If you'd like more info., one site that is really good is:

http://www.dinet.org/pots_an_overview.htm

I went to my cardiologist and had a tilt-table test. It was negative, so I didn't have POTS. I noticed that I had weird tingling/numbness, etc. in one arm, and after many months (seeing multiple vascular surgeons and neurologists), I found out I have vascular and neurogenic thoracic outlet syndrome--TOS (often caused by head and neck trauma); you may want to Google TOS for more info. This was verified by an ultrasound, a chest CT, an arteriogram and venogram, and nerve tests (nerve conduction and electromyography). My arm visibly twitches all the time.

I had extreme migraines and nausea for months, all day, every day. In particular, I had a lot of pain in my ear and/or jaw--I wasn't sure which. Have you been to a dentist to check for TMJ? That is often caused by head/neck injuries, which can cause stress on the jaws and terrible pain. Finally my neurologist put me on Topamax (an anti-seizure med that's also used for headaches) and Cambia (a new migraine medication). The Topamax takes a few weeks to take effect, but after taking it for a while, I'm headache free.

People in the forum may jump on me for this, but this is my opinion: a chiropractor doing adjustments on the neck (or anywhere else) is very dangerous, so I would strongly advise against doing that, but again, my personal opinion. That kind of manipulation of the neck is not good for the discs, at all. You may want to seek out a pain management physician--mine is fantastic. I trust only him and my orthopedic surgeon with my neck and back.

If the amitriptyline doesn't agree with him, there are other antidepressants which have fewer side effects. I take Ambien (a sleeping pill) so I can get a restful night of sleep, and I wake up refreshed, not at all groggy.

One thing my pain management doctor mentioned, that you may want to look into, is trigeminal neuralgia, which can be caused by this trauma.

As for caffeine, it can actually help with some types of headaches, although I don't know if it's acceptable for young people (I'm 47). Some migraine/headache meds do contain caffeine.

Did he ever have a brain and neck MRI? CT scans are not great at showing soft tissue damage or brain bleeds/strokes. Also some of his symptoms could be explained by herniated/bulging discs in his neck, and X-rays are useless for showing those. An MRI is the gold standard for disc problems; trust me--I've been through lower back and neck disc injuries for years.

Mark in Idaho is totally correct--dehydration is simple to detect by looking at the urine, and also by having the doctor do a simple urinalysis (dipping a cheap strip in the urine). Also, you can buy urinalysis strips yourself (I got mine on Amazon) for him to test his urine. Make sure you get the ones that test "specific gravity" which is the concentration of the urine.

I'm so sorry if I've panicked you with all this info.--I just learned it all the hard way. You may want to search on the internet for some of the things I mentioned above. Knowledge is power, and it's essential to do research so that you can ask these doctors probing questions, because sadly, some of them don't know about some of these more obscure conditions. Again, I apologize for rambling and maybe boring you, but if I can help you save time, it may be worth it.

Um... can't they test his electrolytes in the office? I don't know why you need to be observing him for so long.

It also seems that, if they think it's dehydration, they should be able to give him some IV fluids and see if the symptoms abate. If they do, problem solved. If not, it must be something else.

What kind of doctor are you seeing? Sports medicine? General practitioner? I'm just wondering if it's someone who typically sees a lot of dehydration and so might be stuck on that diagnosis when there could be something else going on?

jmaxweg,

You guessed right. Many of us have had good result with chiros, especially upper cervical chiros who do not do the twist and pop adjusting. The neck needs to be adjusted carefully and gently.

Spine surgeons are usually against any chiro treatments. There are overly aggressive chiros just like there are overly aggressive spine surgeons.

Pain management usually means meds when getting the upper cervical vertebra in proper position can cure the head aches related to neck issues.

I have found great relief from my chiro and PT for some TOS problems I have.

But, others mileage may vary.

From an athletic perspective, I would say inactivity may be part of the culprit. I'd get him to do some exercises just to ease him back in to doing something physical. 4+ months is a lot of time passed to do nothing, and I remember being at that age, it's very important to keep active, even if it's at a minimal level.

I'd start with simple stretches, do anything he can handle and don't push it. Incrementally increase the effort so it doesn't put a strain on him. Do things that feel good to him.

Hope this helps.

Dear Jenny
 

Mark is correct in how to see if his urine is OK. Lighter the color, the better hydration. This doesn't sound like de-hydration to me at all. I also have not heard of a doctor who recommends an increase in salt. As Americans I am under the impression our foods are overly salted as it is. For your own piece of mind, I would seek another opinion. I do wish you all the best. I am glad you found Neruo Talk. ginnie

I am not a doctor, but the dehydration explanation seems odd to me. It sounds like your son is drinking plenty of fluids.

I haven't experienced some of the symptoms you mention, but I will say that at right about the 4 month mark, I developed a new symptom - muscle spasms and twitches (no pain with them though). It really freaked me out at first, and I still worry about them a bit. When I told my neurologist about them, he didn't seem overly concerned. He made it sound like they were related to the physical and emotional stress of having pcs for several months. Who knows if this is correct. He did tell me I needed to start exercising. Before my injury I was very active, but had basically been sitting around for 4 months due to the pcs. I now exercise at least 4 days a week and the spasms and twitching are less frequent and less intense. I really have no idea if it's the exercise or the fact that I've been feeling generally a little better the past few weeks that's helping. Maybe it's a combo. It could be something to ask your son's doctor about though.