[FrustratedMomma]

My 13 yr old son suffered a severe concussion on 09/29/11. Since then, our lives have been turned upside down. He has constant/every day headaches, terrible meltdowns with angry/violent mood swings, and constant lethargy. He is on 20 mg of amitriptyline (sp?), and Tylenol 3 only as needed.

Right after the accident in the ER he had a CT scan which came back clean. At the 4 week mark post accident, because of his continued and even increased symptoms, he had an MRI. It also came back not showing any skull francture, lesions, bleeding, etc.

He is only going to school for his core classes, every day from 10-2. That is still sometimes too much. The noise and fluorescent lights of school are his undoing, along with the concentration needed.

Our biggest adjustment is to his emotional meltdowns. He literally 'snaps' and becomes this person we do not know. It seems to happen if he's dealing with a particualrly bad headache or has 'overdone' it for the day...over-stimulated/tired. He will start talking in this baby talk kind of voice, and then just becomes so very hateful and mean. He will order everyone around, demand things, and if you do not do what he wants or try and combat him in any way...watch out. He has become extremely violent at times. A couple of weeks ago he demanded that his sister (age 14) get up and give him the seat on the couch and let him watch TV. She did not recogize he was "in mode" and just handled it like a normal sibling spat. He lost it completely, physically attacking her while wild-eyed and purple in the face, screaming all the while that he was "going to slash her throat, beat her with a baseball bat...." Last night at bedtime he was feeling very bad and he couldn't sleep. After about 1 hr, he walked into my room, completely off-balance physically. I led him back into his room, and he starts thrashing around saying "Im going to kill someone. Someone's going to die." The night went on and on, and needless to say, I stayed on watch and edge all night.

None of this was even remotely in his character before the accident. It is truly like Jeckyll and Hyde. Right now I am just thankful that he is a little guy and not some big sized 13 yr old.

These really bad episodes are not constant or even every day. He does have some decent days. He almost always hits some sort of wall though at the end of the day, even if he just becomes irritiable and starts the baby talk thing.

The Dr he is seeing is a Sports Medicine guy who specializes in concussions. He has been very good with him, and us as well. He has said that with the severity of his concussion, we could still be seeing and dealing with symptoms for months to come. He has suggested that if at the 3 mos mark we are still dealing with a lot of the emotional issues, it may be time to dig our heels in for the 'long haul' recovery plan and to think about getting him with a Behavioral Specialist to help him cope through the next stage of his recovery.

First and foremost, we want to help him. It is breaking our hearts to literally watch our sweet boy turn into this mean/hateful/violent person we don't know. Secondly, we are struggling mightily to make sense and keep our heads above water in this new world we've entered into. Because of his revised school schedule, our work schedules have taken a beating. Because of his issues, our home life and family evenings are completely battered. My daughter is getting the brunt of his negative attention and our lack of positive attention due to all of our concentration on him, however hard we try for that not to be the case.

I really wouldn't wish any of this on anyone, but at the same time, if anyone out there has/is dealing with a similar situation, it woud be nice to hear from you.

[wtrpk]

could it be the amitriptyline?? did you read side effects of that med? From what everyone on here says it makes them very tired at night...is he normally sleeping well at night?

[nightnurse30]

Im assuming he hit the front of his head....it sounds like he has a frontal injury. Im so sorry you are going through all this. My first thought after reading your post is that something is sending him over the edge during his day. Is there any possibility to take him out of school? Im getting anxiety jsut thinking about him walking in the hallway in between classes. There is so much stimulation in a school setting and need for concentration. I cant imagine he is comfortable for those 4 hours and it is a sign that his brain just cant handle it.

I have a close friend who was a senior in high school and was pulled out for 5 months due to her concussion. It was too dangerous for her to be there with the amount of stimuli and need for attention, concentration, planning, etc. These executive functions were not ready for that type of environment. She did graduate, but will be taking a year off before attending college because she wants to be fully recovered before attempting to learn anything new.

Im wishing you the best of luck. Praying that his symptoms lessen and that his anger and impulse control return soon to the old him.

[Mark in Idaho]

Have you taken him to a neuropsychiatrist? Or the behavioral specialists? He may need a different or additional med. He needs a thorough evaluation.

I remember being very over-reactive to others and to very minor issues. I was miserable inside. I was the same age.

It sounds like he is having seizure like events.

Sports medicine doctors who work with concussion often are more focused on getting an athlete back in the game. He needs more help than the sports doc can provide.

At his age, his brain and body are going through some serious changes, hormonally and else wise. He needs help getting through this time.

As nightnurse said, he needs time off from school. It will be much better for him to get better then catch up than to do mediocre work and be at risk for behavioral issues.

He may even benefit from a stay in a comprehensive rehab hospital/center with all of the disciplines of care. A team approach to his care may do wonders. The availability to quick acting meds may also be important.

I say this because I remember how volatile I was during this time. My family was moving from New Hampshire to San Jose with 6 kids including a 6 month old and a 30 month old. I was very close to going over the edge. I don't know how we all made it through that time. My mother has commented how my personality changed drastically. I was 12.

I hope you can find the help he needs.

My best to your whole family.

[FrustratedMomma]

Originally Posted by Mark in Idaho

Have you taken him to a neuropsychiatrist? Or the behavioral specialists? He may need a different or additional med. He needs a thorough evaluation.

I remember being very over-reactive to others and to very minor issues. I was miserable inside. I was the same age.

It sounds like he is having seizure like events.

Sports medicine doctors who work with concussion often are more focused on getting an athlete back in the game. He needs more help than the sports doc can provide.

At his age, his brain and body are going through some serious changes, hormonally and else wise. He needs help getting through this time.

As nightnurse said, he needs time off from school. It will be much better for him to get better then catch up than to do mediocre work and be at risk for behavioral issues.

He may even benefit from a stay in a comprehensive rehab hospital/center with all of the disciplines of care. A team approach to his care may do wonders. The availability to quick acting meds may also be important.

I say this because I remember how volatile I was during this time. My family was moving from New Hampshire to San Jose with 6 kids including a 6 month old and a 30 month old. I was very close to going over the edge. I don't know how we all made it through that time. My mother has commented how my personality changed drastically. I was 12.

I hope you can find the help he needs.

My best to your whole family.

Thank you for all of your insight and suggestions. No, as yet he has not been to a specialist. We have though come to the conclusion that we need to take that as our next step. I am taking alot of your suggestions to heart and praying over the right course of action. Thank you for your thoughts and prayers.

[Mark in Idaho]

My research says that he should not be mixing the amitriptyline and codeine. The Tylenol 3's should be stopped 4 hours before his amitriptyline dose is taken and not taken again until 8 to 12 hours after the last amitriptyline dose.

If his doctor has OK'ed him to take aspirin, he can take a maximum dose of aspirin and Tylenol together. They are about as good at pain relief as the Tylenol 3's. I was taught this trick by my doctor. I use it for my worst head aches.

He needs to take a break from the Tylenol from time to time, at least 12 hours or more. Tylenol is rough on the liver.

[FrustratedMomma]

Originally Posted by Mark in Idaho

Have you taken him to a neuropsychiatrist? Or the behavioral specialists? He may need a different or additional med. He needs a thorough evaluation.

I remember being very over-reactive to others and to very minor issues. I was miserable inside. I was the same age.

It sounds like he is having seizure like events.

Sports medicine doctors who work with concussion often are more focused on getting an athlete back in the game. He needs more help than the sports doc can provide.

At his age, his brain and body are going through some serious changes, hormonally and else wise. He needs help getting through this time.

As nightnurse said, he needs time off from school. It will be much better for him to get better then catch up than to do mediocre work and be at risk for behavioral issues.

He may even benefit from a stay in a comprehensive rehab hospital/center with all of the disciplines of care. A team approach to his care may do wonders. The availability to quick acting meds may also be important.

I say this because I remember how volatile I was during this time. My family was moving from New Hampshire to San Jose with 6 kids including a 6 month old and a 30 month old. I was very close to going over the edge. I don't know how we all made it through that time. My mother has commented how my personality changed drastically. I was 12.

I hope you can find the help he needs.

My best to your whole family.

Input needed please....! I requested a referral from the Dr he has been seeing to a neuropsychiatrist. When I got on the phone with the referred Dr.'s office, I found out the Dr. is actually a sport and performance neuropsychologist. After many questions to the front desk, the gal connected me with the Dr himself. I spent 15 min on the phone with him. I told him that I thought my son actually needed a neuropsychiatrist, as his injury/recovery is not sports related, and many medical issues seem to be involved. I said that I really didn't want to waste our or his time by starting with him if he was just going to need to refer us elsewhere. He told me that there really is no such thing as a neuropsychiatrist (??!!). He said that the neuropsychologists, like himself, would do a very time-consuming, detailed assessment, which is what is needed to find out where his issues are exactly. He said there really isn't a 'one-stop' fit. If an EEG and/or meds are needed, he would refer to a neurologist. If behavioral management needed, he would refer to a psychiatrist. Is this right?? My gut tells me that this Dr. is not the solution for him.

[SmilinEyesMs305]

Frustrated Mamma-

Not knowing anything about the dr or his credentials/methods, I can tell you what my experience has been.

I was referred to a neurologist two weeks in by my primary care. 3 months later, I wasn't any better, and kept being told go home and rest (which is VERY important, don't get me wrong). However I continued to be plagued by dizziness, nasuea, migraines, neck pain, extreme fatigue, emotional outburst, memory issues, etc. When I started having trouble regulating body temperature, the neurologist said, it was all in my head and that my symptoms were no longer neurological. Really? all of the above symptoms are "just in my head"??? I immediately decided I did not want him continuing my care.

A few acquaitances with children who play sports suggested a local concussion clinic for sports medicine. I too said, it's not a sports related injury. However, I soon found out that the treat many people who have concussion, who are not related to sports at all. For me, it has been a great fit. He did the neuropsych evaluation and a physical exam. From the results he referred me to: Vestibular therapy (for balance); physical therapy for my neck; vision therapy, (I was unable to get my eyes to focus on anything closer than 2 feet from my face.). He also referred me to a phsyical medicine and rehab dr who put me on meds for sleep and the headaches. I also see a psychiatrist for the emotional rollercoaster.

So as this person told you, that is what my Dr. did. He has been great, and given me hope. I am now actively engaged in all the various therapies and am making progress. So for me, choosing the sports medicine doctor was a life changer.

However, as a mother if he gave you the vibe that he wasn't going to be a good fit for your child, then by all means follow your gut! If you have any questions about my experience, let me know. Hope this helps!

[FrustratedMomma]

Originally Posted by nightnurse30

Im assuming he hit the front of his head....it sounds like he has a frontal injury. Im so sorry you are going through all this. My first thought after reading your post is that something is sending him over the edge during his day. Is there any possibility to take him out of school? Im getting anxiety jsut thinking about him walking in the hallway in between classes. There is so much stimulation in a school setting and need for concentration. I cant imagine he is comfortable for those 4 hours and it is a sign that his brain just cant handle it.

I have a close friend who was a senior in high school and was pulled out for 5 months due to her concussion. It was too dangerous for her to be there with the amount of stimuli and need for attention, concentration, planning, etc. These executive functions were not ready for that type of environment. She did graduate, but will be taking a year off before attending college because she wants to be fully recovered before attempting to learn anything new.

Im wishing you the best of luck. Praying that his symptoms lessen and that his anger and impulse control return soon to the old him.

Yes, the front right side. We really are starting to think that taking him out of school may be what is needed for him to heal. You are right, all of the stimulation that is associated with school is just too much, and I believe every day works kind of like a set back to his brain.

I very much appreciate your kind words and thougts/prayers.

[SmilinEyesMs305]

Have you thought about seeing a psychiatrist? I know many people are reluctant to try anti-anxiety meds or mood stablizers. However, dealing with some similar issues myself, I would be completely unstable right now without them.

Post accident, if I over do it or am tired, I feel like I'm going to snap. I have said some really hurtful things and have been very close to getting physically aggressive a few times. (And believe me, this is SO not what I am normally like. I was working as a behavioral therapist for aggressive children before this, and had to have a TON of patience to do my job. I had no problem keeping my cool for extended periods of time, despite challenging situations and behaviors.)

Now there are times when if feeling symptomatic, it's very hard for me to have any patience. I can't imagine feeling this way at such a young age, without the experiences of my life to back me up to try and keep my cool.

This was a daily struggle for me until:

1) I slowed my life down to a pace that wasn't overwhelming me. This meant no work, and no Grad school. Perhaps your son needs to back off the 4 hours aday. Is there anyway he could do his work from home so he could spread it out over the day and take breaks? Or perhaps only do part of the 4 hours each day? I know you are worried about his education, but you may be prolonging his recovery majorally.

2) I went to a psychiatrist recommended by my dr, (also in sports medicine). I was put on Effexor daily and ativan as needed. This took me from feeling like a raging made person who felt like they were extreme pmsing 24/7 to someome who only has a mild outburst here or there. I've learned what my triggers are and have used the ativan to prevent even these. I maybe feel pushed to the edge now once every two weeks, rather than everyday, all day and the ativan helps calm me down to reel me back in when this does occur.

I feel for your child. It is an awful place to be, and it really is something you have no control over. As I explained to my boyfriends mother, it is seriously like having the most intense PMS I've ever had. I feel awful after I explode on someone. But when it happens, I really CAN'T stop myself. You just feel so out of control. Like I said, the above two things were really what helped me get my control back.

Hope this helps and your son is continuing to make great strides in recovery!