[nightnurse30]

Hi all, Im an ICU nurse who suffered a TBI- coup-contrecoup closed head injury from a fall. My amnesia time is around 12 hours and my unconsciousness time is about 10 hrs. Ive been reading all these posts and have such respect for everyone going through this. Im only 4 weeks out. I have such waxing and waning symptoms that are making me so frustrated. I went back to work 3 weeks after my accident because i would have lost my insurance (had a back injury and now this equals 12 weeks of FMLA used this year). Im a night nurses as well, so my job requires intense physical and mental demands in the ICU. My first 2 shifts were so tough with all the stimulation and since then ive had such a tough time getting through my day. My limbs feel so useless, takes me hours to get out of bed. I had to call in sick tonight because i have absolutely no energy at all.
My current symptoms
Headaches
light sensitivity
ringing in ears (sometimes sounds like popcorn popping in my ears)
dizziness
extreme fatigue

Ive been seeing an acupuncturist, chiropractor, a therapist, massage therapy, getting B12 shots once a week, and saw an opthalmologist along with my primary care doctor
Im definetly a type A personality who always had an abundance of energy and now having absolutely none is really bothering me. Ive been reading about people taking anti-depressants....is this also to help with energy levels along with preventing depression. i dont necessarily think im getting depressed although i am bummed out about the length of time it will take to feel normal again and just want more energy. Besides resting...which i am getting really good at, are there any medicines that will give me more energy. Antidepressant suggestions? What about ADHD drugs?

[Jomar]

Does your chiro do the upper cervical adjustment? (c1 c2?)
If not I think I'd start with finding one that does that and then move forward again from there.

May not be the cure all, but having the full spine in alignment might help.

[Mark in Idaho]

nightnurse,

The most important thing you need to limit the fatigue is good REM sleep. You also need to avoid caffeine like the plague. Limit your intake to one serving a day. Stay away from MSG and any processed soy products.

The B-12 is useful but alone is not enough. Omega 3's, B-6 and all of the other B's and anti-oxidants will help over time.

Anti-depressants are definitely not prescribed to increase energy levels as they can/will cause excessive sleepiness. They do often help with the anxiety symptom of PCS, though.

ADHD drugs are usually stimulants that are counter to what the brain needs. It needs rest, not stimulation.

Unlike most ailments that doctors can treat the symptoms of with targeted meds, there is no med that will treat the broad array of symptoms of PCS. Each individual symptom needs to be addressed individually. Work-arounds and accommodations are the usual way of living with PCS.

Type A personalities are the toughest as dealing with PCS. We just don't want to accept that pushing harder will not overcome the limits.

I would be very careful with chiros if your chiro uses the head twist and pop adjustment technique for your neck. The neck after a concussion is traumatized enough without the additional stress of twist and pop chiro adjustments.

I hope you can find a way to get the rest you need. It will be key to your ability to return to work without continual absences.

My best to you.

[nightnurse30]

Originally Posted by Jo*mar

Does your chiro do the upper cervical adjustment? (c1 c2?)
If not I think I'd start with finding one that does that and then move forward again from there.

May not be the cure all, but having the full spine in alignment might help.

Yes, my chiro is doing the whole spine including upper cervical. His initial adjustments were much lighter in my first few visits after the trauma. He is quite skilled in blunt force head trauma, and ive felt better after seeing him since my neck had such bad knots in it afterwards.
I have long lasting lower back issues as well, and must say that is the least of my problems at the moment, but nice to get my alignment out of the way to rule out that as a cause of the headaches.

[nightnurse30]

Originally Posted by Mark in Idaho

nightnurse,

The most important thing you need to limit the fatigue is good REM sleep. You also need to avoid caffeine like the plague. Limit your intake to one serving a day. Stay away from MSG and any processed soy products.

The B-12 is useful but alone is not enough. Omega 3's, B-6 and all of the other B's and anti-oxidants will help over time.

Anti-depressants are definitely not prescribed to increase energy levels as they can/will cause excessive sleepiness. They do often help with the anxiety symptom of PCS, though.

ADHD drugs are usually stimulants that are counter to what the brain needs. It needs rest, not stimulation.

Unlike most ailments that doctors can treat the symptoms of with targeted meds, there is no med that will treat the broad array of symptoms of PCS. Each individual symptom needs to be addressed individually. Work-arounds and accommodations are the usual way of living with PCS.

Type A personalities are the toughest as dealing with PCS. We just don't want to accept that pushing harder will not overcome the limits.

I would be very careful with chiros if your chiro uses the head twist and pop adjustment technique for your neck. The neck after a concussion is traumatized enough without the additional stress of twist and pop chiro adjustments.

I hope you can find a way to get the rest you need. It will be key to your ability to return to work without continual absences.

My best to you.

Thanks so much for your input. That does make sense that a stimulant wouldnt be the smartest idea when i need rest. Ive been getting B12 and B6 shots from a naturopathic doctor and im making fruit and veggie smoothies everyday to try and get as many antioxidants as i can.

Using spinach, carrots, strawberries, blueberries, rasberries, mango, banana, greek yogurt and V8fusion juice. Im also drinking protein shakes that have a lot of my vitamins and minerals. Been having mahi fish and tuna fish for my omegas....allergic to shellfish.

At night, i take restoril (an anxiety/sleeping medicine) along with a soma (muscle relaxant for my back) and wondering if maybe this combination is increasing my decreased energy levels. Its so hard being on this roller coaster ride where i have days where i feel great, and others where i can barely move.

Im going to see my doctor again this week to discuss options. Its amazing how labile my emotions are, and energy levels. I dont drink much caffeine (maybe a diet coke every other day). And its tough because i work 12 hour night shifts, starting to wonder if i should go back out on disability for a few months until these symptoms pass and just do cobra for my health insurance and take the financial burden to give myself the best opportunity to heal.

But worried not working will cause me to get depressed. Ive been a nurse for so long and always taking care of my patients that its hard to stop and take care of me!

[Mark in Idaho]

The Restoril (temazepam) is not necessarily the best for your condition. As a benzo, it can be causing much of your sleepiness. I was on Klonopin (clonazepam), another benzo and was switched to gabapentin (Neurontin). The gabapentin does not leave me sleepy during the day. It helps my body and mind get settled. I take 900 mgs an hour or two before bed.

Long term use of benzos can be problematic. There is some research that suggests it causes permanent changes/damage to the brain.

Emotional lability is a very common symptoms of PCS. It can be frustrating. The opposite (flat emotions) can also be a symptom of PCS. When the two combine, things can get weird.... Flat emotions until something triggers crying or anger.

Learning to recognize the triggers is important, especially the anger or outburst triggers. I can tell when an outburst is building and try to remove myself from the environment. Outbursts at your work could be a threat to your career.

Fortunately, Soma (carisoprodol) has a short half-life of about two hours. In some people it can last a bit longer. It should not be causing your sleepiness during the day or your shift. I have it for the occasional need. I can imagine how it can help with your back. Be cautious to sleep with good posture when using it. There is concern that an overly relaxed spine can be stressed if allowed to be in poor posture as could happen during sleep.

As one who has lived with shoulder and upper back problems for 12+ years, I know how good sleep posture can help. It takes practice to learn to sleep with good spinal alignment but it is worth it. Body pillows can be used to lay against in a way to help you stay in proper alignment while asleep. Adjustable beds and recliners can also help maintain better sleep posture.

You will need to experiment to find what works best for you.

Sweet dreams and my best to you.

[nightnurse30]

Thanks again Mark.....your suggestions and encouragement are very helpful. I had thought of neurontin already as a possibility and with your suggestion, i think i may bring that up with my doctor the next time. My injury actually occurred after taking an ambien and slipping and falling (because of my night shift work, i have chronic sleep issues as you can imagine). Im off the ambien because im scared of having a second insult and worried it may affect my memory further, but thats a great point about the benzos and my sleepiness. And yes....ive felt very apathetic and flat at times, and suddenly an emotional period develops out of nowhere and im crying and not sure why. Ive felt very alone for the past 4 weeks with no one understanding how this feels and finding this forum and support is really helping allay that feeling. God bless

[nightnurse30]

Today my primary doc is starting me on celexa to help with my energy levels and depression worry along with Fiorinal for my headaches (the aspirin counterpart of fioricet). Hopefully these med changes help. I also am at work tonight and spoke with our neurosurgeon who wants to review all my imaging and see me this week in his clinic so I can have neurology monitoring as well as see a concussion headache specialist he thinks may be able to help. Thinking happy healing thoughts!

[freezerdoor]

I have been very flat and apathetic. Only a few outbursts, not much to speak of - mostly if someone doesn't listen when I say "turn it down." (about the tv or radio...) didn't even realize sound bothered me till that came out of my mouth. lol.

Please let me know if any therapies work for you because I'm convinced that rest is the only solution. If there is something else I can do, let me know what works.

thanks.

[nightnurse30]

well, i tried to work last night and it was an epic failure and now i am back to where i started....out on disability for 2 more months. I guess i really just need to rest and let my brain heal. I spoke with 2 neurologists at work who want to work with me and see if they can help, but both agreed i had no business coming back to an ICU and trying to take care and save someones life with the type of injury i have. So, rest it is....see if the meds help....and try my best to stay positive and heal. Probably was pretty stupid of me to try and work in an ICU 4 weeks after my injury.