Hi All,

I waited to post until today with the hope of being able to remember and piece together the details of my visit...one, to help others and two, well..quite honestly...I'm not sure I understand a lot of what was said..

My Fiance' Marc accompanied me...the Neuropsych started out telling me what my strengths were during testing...I scored "Superior" in one area (that made me half smile) and overall did "well"...

He stated that my weakness was focus/attention; taking too much information in at one time (I need time to allow my brain a break in between...I'm assuming this would fall under processing??); my eye/spatial something or other is severely impaired (but he feels that this has nothing to do with the injury???); I'm terrible at Math lolol...that's a life long hurdle!!!

I am severely depressed. As in a "8/10". I wasn't shocked by this, ironically, it made me feel sad. (I have ALWAYS been the life of the party, happy go lucky, cheer everyone else up and make them laugh sorta girl)...

He didn't address any physical symptoms and stated he will refer me to a Neurologist, Neuro Psychologist for treatment...he utilized the term "disabled" frequently which made me squirm...He once again reiterated that my issue is that I "look great on the outside, my disability is not visible, that will be my challenge"...obviously.

He feels that my near future goal would be to secure a job 2 days per week in my field, but not in an administrative or supervisory capacity...(I'm not sure he understands what the role of an RN is)...He feels at my age (45), it is still important to me that I have a "purpose" and that he feels with appropriate treatment I should be able to work my way back in to the work force...so one one hand he seems to validate that the accident caused me to have a Mild Traumatic Brain Injury, but on the other hand, am I hearing that the Mild Traumatic Brain Injury is Depression? I'm confused.

My Fiance's take away from the visit? "Your depressed and you need to get a job and you'll be fine"....oh boy.

I'm hoping I will feel more confident once I begin treatment (but wait!!! This is worker's comp...so, that means...Neuropsych needs to send report to Atty. and Commissioner; Atty. requests formal hearing which will be a few months, then request auth. for treatment, etc. etc.)...We are looking at an easy 6 more months here (and I hope I'm wrong, but my gut knows better)...

I'm hoping the Neurologist can break it down for me...if this is ONLY depression (well, it's clinical depression so let's get that ONLY out of there)...then meds and treatment will help. Right? It will help with the fatigue, mood swings, anger outburts, vision, ringing in my ears, balance etc. etc. I'll receive a copy of the report and be better able to elaborate at that point....

I feel like I took a big step forward and landed in quick sand...treatment can not begin soon enough....

Obviously I wasn't there, but to me it sounds better than how you are interpreting it. You are still cognitively at or above average according to the testing (which is good) but he has recognised that your injury has caused problems which aren't necessarily tested for in these tests (also good - that he has recognised this I mean).

Among these problems is depression, which can be a direct symptom of PCS or can be caused by the stress brought on by the other symptoms of PCS. He thinks you will be able to work again, but advises starting small so as not to overdo things and relapse or make dangerous mistakes. To me this sounds like good advice.

Perhaps you should not go straight back in to a nursing job to start with - maybe look for something with less responsibility and associated stressors and challenges. Hopefully you will improve or learn to work around your remaining deficits to the extent that you can return to nursing, which is obviously something very improtant to you.

Like I said, this all sounds like sound advice to me. Good luck!

I got the same diagnosis of 'depression' as the main cause of my cognitive difficulties, even though some scales showed no depression at all. The MMPI-II showed depression but those same elevated scales can be better interpreted as evidence of organic brain injury.

There are many symptoms of PCS that mimic depression. And some symptoms of depression that are simply the PCS person being protective of themselves by limiting their environmental stimulation. It is very logical but the PhD's struggle to understand.

A divergence of functions (some high and some low) is highly indicative of organic injury. Depression usually causes a global decrease in function.

I feel like I should give your fiancee' a kick in the groin and say "wake up" and Pay attention. I would slap him on the head except I know the damage a simple head impact can cause.

Has he done any reading about mTBI or PCS? Does not sound like he has.

I hope you comment about meds was being sarcastic <It will help with the fatigue, mood swings, anger outburts, vision, ringing in my ears, balance etc. etc.> Meds may lessen the volatility of mood swings but do nothing for the rest. Anger outbursts is a behavioral management issue. Avoiding the stressors, identifying the indicators that you are building to an outburst, establishing a support structure for times when you will be in outburst prone environments ( airport security check point is my worst environment).

At least he was good at identifying your symptoms as disabling. Not good for you but good for your WC claim.

It will be interesting to hear further details of the report. I am surprised that he did not give you a copy at your meeting. Maybe you need to receive it through your attorney.

If it is more written diagnosis and evaluation without many of the metrics (scales, usually a raw score and a percentile score), it would be good to request an in-depth report.

They tried to withhold the in-depth report from me in fear that I would see through their diagnosis and become upset. When I finally got the in-depth report with scales, They were right. They defied the meaning of the scales and tried to say I was depressed and faking poor performance. I scored almost perfect (48 and 49 out of 50 ) in the validity scales showing no malingering/faking evidence at all.

It sounds like you got a more reasonable diagnosis. Reducing the impact of the depression diagnosis will be a task your attorney needs to tackle. Attorney Gordon Johnson at www.tbilaw.com has some good information about that task.

My best to you.

I really hope you feel better soon. Jumping right back into being an RN is not that easy. If you have TBI, that can cause the depression. Any injury that takes us our of commission can result in depression. Treat both, and go back easy into the work force as you can tolerate. Being an RN, and especially a charge nurse or administrative head is one of the hardest jobs there is! My neighbor was one, and that job took alot out of her. Get all the help you can like you are doing. I hope you heal fast, and can get the council to help with the depression. I lost my carreer overy my health issues, and it put me into a tail spin for long long time, and it took alot of help and council for me to feel better. I wish you all the best. WE NEED our nurses, they are the ones who really do the work to help us to get better. I hope you make a full recovery, and can go back to this wonderful profession. I will keep you in my thoughts and prayers. ginnie

My mom was an RN, I know it's a very tough job!

I don't know exactly what kind of nursing you did, but maybe you can find an RN job that is less stressful than your last one was. (Although, I have no idea what it could be!)

Maybe you can get in touch with some of your professional contacts, or a local university or college and see if anyone needs a good RN who can't quite work in quite the same capacity as most can... And remember, (this is something I have trouble with), just because you can't work in the same way that you could before the accident, doesn't mean it's not good enough.

FYI, chronic pain can also cause the depression scale to be high. Basically, it just shows that you are dealing with a lot of psychological distress whether it is of mental, physical, or emotional origin.

Hi Mark,

You hit the nail smack dab on the head for me...you put into words what I was thinking, hard as I tried...!!

My fear is just that. That I will be labeled as having "depression" when there is an actual underlying organic etiology for it. I can't tell you HOW many times I told him that I don't have any real reason for feeling the way I do...he kept reiterating how much worse it could be for me...that I should feel lucky that I can walk, talk, drive etc...and gave me examples of previous patients who are far worse off than I am.

Part of me wanted to screech, "I KNOW DUMMY, I've taken care of a thousand TBI's and there is not a SECOND of any given day that I am NOT thankful that it wasn't worse"...instead of focusing on how much worse it could have been, how about we deal with WHAT is in front of us?? Just because I look good, can drive walk and talk, by no means states that my quality of functioning is acceptable because I'm dealing with pain, fatigue, vision issues, light/sound sensitivity..you know the deal. Between him and my Fiance', it was a toss up who was getting smacked first...they should be thankful my impulse control is intact

I'm sick of trying to "convince" people of what I know. After all, it's happening to "me"...I know this is organic, it's a direct result of my injury and it needs to be reflected as such. Period. Just because it's not "worse" doesn't mean that I'm not "suffering".

As for my Fiance'...I've given up trying to help him understand as well. It takes too much energy and I have to take care of myself. If he comes around, fine. If not, that's OK too. I know better than to make a life altering decision at this point, but I won't have the detriment of a non-supportive person in my life either...(that's for another post lol)...

Glad you caught on to my sarcasm. I have never been one to believe that medication is a cure all. You have to understand what the underlying cause is first...I won't be a medicated zombie. Not even for a day.

There is an important component to my injury that I have been hesitant to elaborate about, but feel that maybe it's necessary to mention. I did not mention it to the Neuro because he was clear to say that whatever we discussed would be included in my report to WC.

Upon my return to work last October, I was dealing with a person in authority, someone who had a direct impact on my everyday...who informed several staff members that she thought I was "faking"...who proceeded to challenge me at every turn, who subjected me to the harshest of irrational behaviors...(cornering me in my office with the door shut, screaming obscenities at me because I disagreed with her)...purposefully assigning me multiple tasks when I asked her not too, telling me she was going to purchase a "pink helmet" for me and laughing about it...and then denying she said things to me stating, "you must have forgotten"...making comments like, "geez, maybe you did hit your head a little hard huh?" I believe the accumulative effect of this caused me to crash. I didn't tell the Neuropsych, and am regretting that as I type this. I needed to go with my gut.
Despite my complaints to HR, the person(s) maintained the position within the company....(another boss jumped on the bandwagon and forbid me from having further contact with HR)..I was left no other choice than to file a formal complaint with the big guys...that's all I can really say at this point. It definitely had a poor effect on me...no doubt. I wanted to keep this seperate from my injury as I absolutely did NOT want it to be perceived as "using" my injury for a gain. I look at it so simply, but I know how this convoluted system works too.

Thank you for your support...I will get a copy, he wasn't done compiling his report yet. Then maybe I can make heads or tails from this. Right now, I'm just really trying to focus on getting stronger

He did validate that I'm not "faking"...that superior score showed that...there was a definite divergence in a few areas which I mentioned...we shall see.

I'm really taking it easy today...gonna go take a nap so I don't crash at dinner time again....thanks again so very much for your expertise and kindness...I appreciate it so very much!

That is awful what your boss was doing to you!!! That is completely harassment and your boss is in direct violation of your hospitals harassment policy. (im pretty sure every hospital has a similar policy). You have every right to report your manager for this behavior and in the same token, you should have a no retaliation policy for reporting this. If there is a retaliation by your manager, she could be fired. Good for you for reporting it.

Totally agree with nightnurse. Not to mention violation of ADA. Outrageous!!

I can certainly relate Julie. I did a neurotesting and they said everything looked good and my anxiousness is causing my symptoms. I almost broke down when I couldn't do simple parts of the test like write down an image i just saw or remember a series of words that would've been no problem before my accident. I could actually see that something was severely wrong with my brain functioning but apparently I scored well enough for this not to alarm them. The test seems pretty useless if you don't have a baseline and they're looking to put a psychologist diagnosis(depression, anxiousness as the cause rather than the effect of PCS symptoms)

I just got married and my wife still doesn't understand what I go through. It's too much of a battle to try to explain it to her and I don't want to deal with the stress. It's sad that we have to go through this extremely tough time in our lives alone and the people we love aren't there for us. I don't know why it's so hard for people to get.