Traumatic Brain Injury and Post Concussion Syndrome For traumatic brain injury (TBI) and post concussion syndrome (PCS).

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Old 06-15-2013, 08:30 PM #1
Tom from Queens Tom from Queens is offline
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Default Not a malingerer

New to the board, though I've been visiting for a couple of months. I respect everyone's struggles.

In the beginning of February, I went out during a snowstorm to get some food and to see the storm. It was an icy snow, and very heavy. Though I thought I was careful, my legs went out from under me, and I fell to the pavement, all 6' 3" of me. Luckily, my head did not hit the pavement (I came within three or four inches, and I am thankful to God every day the worst did not happen).

I never lost consciousness, though I was a little woozy, and though three or four days later, I had some problems understanding things that were said to me (mainly because of tiredness and too much stimuli), when I went to my MD a little bit after that, I passed all his tests, and there was no evidence of any gross brain injury. Same thing when I went to a neurologist in March, who did more exhaustive tests, including an EEG.

One of my best friends, a neurologist, has said that most mild TBI resolves fully within three months, but here I am at month four, and I am not fully healed. I am a medical editor. Luckily, I am still able to function quite highly at my job (though I did have have some cognitive issues and some short-term memory issues which seem to be resolving). But I cannot do a whole lot of thinking on the weekends because I am tired from the week.

I have been an avid reader my whole life, but reading has been at times more difficult than the past, and I have for the time being, given up my work as a volunteer writer/ editor for a kids' newspaper.

I have a mild headache about 70% of the time, and my upper spine and neck bone often has a dull pain, and some days the pain is fairly bad. I started taking B-12 and turmeric every day, per the recommendation of my neurologist. And I had some acupuncture, which definitely offered some relief, and maybe made me a tiny bit better than when I first started the treatments.

I went to a chiropractor this past week, who recommended I take fish oil every day, which I have started. She said that she has been able to help heal people with PCS fairly frequently, but, as I write this, my upper spine is still sore, and her manipulations didn't seem to do much.

I do have a history of concussion--by my count, maybe four or five in my life, with one as recent as January 2012 (before my current one). That one resolved in about three weeks, even though I had hit me head fairly hard. I do remember one concussion in the 1990s that took at least two months to heal. I just saw my GP yesterday, and he suspects the reason it is taking so long this time is because of my history.

The thing that is most puzzling to me, and the reason I write, is that I do not understand the course of my illness--I have no idea if I'm on the path to being "100%." and when that will happen. Nor do I know when I should just blow off a day doing *nothing.* Even though I have a girlfriend, I live by myself, and, regardless of how I feel, there are some things I have to do every day just to take care of myself and organizing tasks can be daunting. I have no sense of when I am doing too much, and even days when I thought I was taking it easy, I'll wake up the next morning feeling crappy.

So much of my self-worth has come from my intelligence, and, because I don't feel as mentally quick as before, there have been some days I've withdrawn a little bit from my girlfriend, because I feel like less of a person.

There have been at least five or six time periods (some lasting two or three days, some lasting as many as seven or eight days), where I have felt almost totally clear-headed and *healed* and even told people I thought I had gotten better. Now, if I have a good day, I don't get as excited about it! But I am still thankful when it happens!

If you have any ideas that could help me, I'd appreciate it. Monday I will be seeing a specialist in traumatic brain disease, and I have some hope, but not a lot. Not so much because I don't think I will get better, but mainly because my intuition is that one day symptoms will resolve on their own, and have nothing to do with what I've done or haven't done.

But here I am nonetheless.

Complaining about my health issues, especially in light of the people who have severe head injuries, makes me feel a little weird, but I am definitely not a malingerer...
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Old 06-16-2013, 09:00 AM #2
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Hi, and Welcome.

First, I hope you have read some of the links on the "Stickies" up top of the main thread of this forum - especially the Vitamin/Supplements by "Mark in Idaho" > very good information.

Also, try reading through Brainline.org .

You give a very good accounting of your history, and its appreciated how you present it - helps with the brief paragraphs for our reading, thanks.

Have you had testing - CT's, MRI's? ; Was your Neck evaluated? - with falls like you described, upper neck injuries can and do occur, which can cause whiplash-type injuries including brain injury of a shearing nature, thus concussive. Ice packs to the neck are very useful - Mark has a good formula he uses - I'm sure he'll be on later, and can explain his mixture for you.

Are you taking any prescribed medication?

Are you receiving any Physical or Occupational Therapy or other Therapy?

Many of us have had so many concussive injuries in our lifetime that our bodies have had an accumulation of the impacts to the point that our brains just cannot recover well anymore, and you may also have reached that point to some degree yourself. Read my "Nutshell" in my sig.

Have you had a NeuroPsych Assessment to evaluate your situation, evaluating your current cognition level of problems, if they are a problem? - with your expressed sentiment -
Quote:
So much of my self-worth has come from my intelligence, and, because I don't feel as mentally quick as before, there have been some days I've withdrawn a little bit from my girlfriend, because I feel like less of a person.
- it might be useful.

Time is said to heal many things , but it is relevant......... it does , but that figure of "100%" isn't in the picture with Concussion/PCS/mTBI. And if you have been reading these boards for any length of time, you have seen that we all have pretty much deleted "normal" from our vocabulary, in the old sense at least.

I'm sure others will be on and respond, my Best Wishes to you.

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Current: Changes of more insomnia, new reviews with findings of more Depression, tremors, vertigo, tinnitus, loss of focus, fatigue; SSDI - accepted on Depression, Cognitive Deficits; Seizures ruled out, mTBI changes including cognitive slowing/lapses.
Medication update: Topamax 200mg twice daily it seems to minimize daily headaches to a 1-2/10 quality(I still know they are there); and acute headaches erupt without warnings.
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Old 06-16-2013, 10:43 PM #3
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You state you never hit your head but you suffer from concussion like symptoms.

A few points, Your neck needs more attention. Most chiros are too aggressive for the subtle injuries to the neck from this kind of injury. You need somebody who can help YOU understand your neck and how to take care of it.

Suggesting fish oil is worthwhile but beyond being a minimal suggestion. Same goes for the B-12 and tumeric. They are good but only a small part of the needs of your brain. You need to pursue maximum brain nutrition.

The neuro who did exhaustive tests including an EEG sounds like he has no understanding of concussion and upper neck injuries but does not want to lose out on a chance for some substantial medical fees.

A basic comprehensive neuro exam with a Mini Mental Status Exam takes 20 to 30 minutes at most, much less unless the neuro is very thorough and intuitive. Mine have only taken 10 minutes.

Again, most mTBI resolve by three months. This is more likely, Most mTBI patients stop calling and complaining by 3 months. There is no science to this 3 months statement. 85% of mild concussions resolve spontaneously in just a few weeks. This 85% includes those who never complained about their concussion to a doctor. The rest of us can take months to years to resolve our symptoms.

Brainline has some good information but in my experience, it takes far too long to find the little worthwhile tidbits. You do risk the anxiety caused by reading all the horror stories and research with summaries that have very limited application. They are an easy way to become hooked onto one issue and obsess about that issue or even get hooked on a multitude of obsessive issues.

We get people on here frequently who obsess about every little report they read. In the extreme, this is called cyberchondria. Every problem found in cyber research becomes personal.

As Concussion stated, Icing your neck and upper neck is an important therapy for head aches and upper neck issues. You can maker a soft ice pack with 1 part rubbing alcohol and 3 parts water frozen in a zip lock bag. Make 3 so you can alternate on for 15 minutes, off for 30. Do this as often as possible and especially when you have stiffness of a head ache.

You will do far more toward healing that the doctors will do.

I am very reticent of relying on the pros. Some can be helpful. Most just take your money.

My best to you.
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Old 06-17-2013, 10:03 AM #4
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Hi Tom. I don't really have any advice. I got my concussion just a little bit earlier than yours. But I 100% know how you feel when you talk about the intelligence factor. I went to school for 11 years and, FINALLY, got my doctorate of physical therapy and a medical license. Being educated and intelligent has been my whole adult life. Now I have difficulty holding long intelligent conversations and it drives me insane. I feel like I lost my smarts and that's what has defined me my whole life. After talking to some of my colleagues, they recommend playing brain games, suduko and other things like that. Maybe one a day and then gradually increase. I can't do them bc they either frustrate me or make me tired.

But I am here, kind of in a similar situation, if you need to vent.

Nikki
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Old 06-17-2013, 08:16 PM #5
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Brain games have limited value to the concussion patient during the acute phase. The will always be time to use brain games to regain cognitive skills. You need to avoid the cognitive stress of brain games and other mental challenges.

My rule of thumb is to keep busy with manual tasks. Things such as knitting, solitaire with real cards if it does not fatigue you, and activities that are controlled by how fast your hands can function. No video games. You eyes can not keep up with the visual stimuli.

People with advanced degrees and higher levels of study often struggle the most because they have aggressive Type A personalities. Learning to Let Go can be a major growth area that can lead to healing. I am convinced that Type A's who have suffered prolonged concussion symptoms need to SERIOUSLY consider who to make changes to their attitudes toward life. You CAN reduce the aggression you apply to life and getting ahead. You will find that you don't give up much in achievement but the gains in well-being far out weight the give-ups.

Studies show that the injured brain will forever carry a weakness for stress. Learning to make these stress reducing changes will go a long way at reducing the Roller Coaster Ride of PCS. I capitalize Roller Coaster Ride because it is not your average roller coaster ride. It can be miserable and needs to be respected.

Brain injury is not like a joint or bone injury. It needs to heal before you start to stress it. There is no Range of Motion to be maintained in the brain. When you can make it a week or two without a relapse or head aches, it may be time to start to make a small step toward exercising a lost function. Take it slow. This is a marathon, not a sprint. The tortoise wins this race.

My best to you.
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Old 06-17-2013, 08:49 PM #6
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Thanks to everybody for their considered and empathetic responses. Mark, I have been following you a little bit, and, even though I will probably never meet you, you really are an inspiration and your quote from Psalm 46 is one of my favorites.

I'm not exactly a type A personality; maybe a type B+!

You see, about 20 years ago, I had a nervous breakdown, and was on disability for four years. Though not the same as now, it was similar in that my brain didn't function that well. At some point I decided that I wanted happiness like everyone else and to love and be loved. Though I wasn't "100%" when I re-entered the workforce in 1996, over time I learned to deal with how my illness changed me, and re-learned some things that had gotten harder.

At some point, I considered myself *healed,* and I did learn to let some things go...

The memory of 20 years ago has given me some faith; I've done it before, and I can do it again.

Though it's not fun to be in the middle of it, when I am at my more optimistic I think it is giving me the gift of knowing I am loved for who I am, and not how my mind functions.

That thought is not easy to hold onto, though.

Your suggestion about keeping your hands busy is a good one. Since I fell, I have redecorated/ renovated/ repainted my bedroom and bathroom. If I wake up with a headache or not feeling so hot, I can look at those rooms and feel a real sense of accomplishment.

And, as I said in my first post, the fall I suffered might have killed me if I had hit the pavement, and I am incredibly thankful to God it didn't.
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Old 06-18-2013, 02:41 AM #7
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Tom,

I had a nervous break down about 30 years ago. I had been ripped off for most of my net worth by an unscrupulous real estate developer/builder and agent. The stress did me in. I became a mumbling zombie. My psychiatrist got me started on my vitamin regimen that I have posted in the sticky at the top. I recovered with no drugs, just a weekly B-12 shot and good vitamin regimen. Only 8 weeks to a full recovery, just in time for my second child to be born. .

Have you ever had a previous concussion or played contact sports, soccer, etc ?

A mild brain injury with stress piled on top can trigger problems.

I bet there is a history that can be put together to help you understand.

My best to you.
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Old 07-01-2013, 03:19 PM #8
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I just wanted to update the board on how things are going.

I've been to a chiropractor a few times in the past three weeks.

Because of those treatments, most of my neck and spine pain are gone.

I finally did see a TBI Neuro, who prescribed two MRIs: one of the cervical spine and the other of the brain, which I had two weeks ago. My Neuro seems really good.

Today, I had a neuropsychiatric evaluation, which took about 2- 2 1/2 hours. Strangely enough, my mathematical skills were fairly high. My verbal skills were average, but across all tests, I had a slow reaction time, and my recall of figures was poor.

There was one test where I was given a list of words, and I had to recall them. I tested poorly, and my learning curve was fairly flat. That didn't worry me too too much, because I have never been good at remembering sequences of things, even in HS, college, and grad school. In school, if I had a list of things to remember like: cat, hat, justice, and tremble, I would remember the initials "CHJT" and figure out the words from there. Never a strong suit.

My "consolidation" is poor. I've been mediocre at that even before my fall, but it's definitely worse now.

Though he didn't test specifically for other forms of memory, he said it's fairly obvious I have superior long- and medium-term memory and that I am highly intelligent. (I needed to hear that!!!) There were some things that tested fine on the computer that, when he probed in paper tests, it was evident I had deficits.

I think if I had taken the tests last week, I might have done better--I was off on Friday and I think I overdid cleaning my apartment, which got me tired and *foggier* until today. But I would have to say that, nonetheless, today was a broadly *average* day for the last four months...

More important, though, they found multiple contusions in my brain on my MRI. I am not sure if they said cortical or not, but, in any case, they were "non-hemorrhagic" and consistent with concussion/ coup-contrecoup and/ or multiple concussions.

[The above description was provided by the Neuropsychologist, who read the report with me; I have not spoken to the Neuro yet (I speak to him later this week), but the contusions are there.]

The Neurospsych said he would classify the deficits overall as "mild," and said outcomes (after therapy) are usually good, but he was doubtful I would hit my pre-fall scores.

He recommended INTENSE reading every day (not sure I agree, but I think it's a good idea to read until my comprehension wanes). He also recommended cardio exercise three times a week for 30 minutes to make my brain's consumption of energy more efficient.

Also, I should be sure to eat enough.

Lastly, he recommends cognitive therapy, which I start on Saturday morning; its aim is to help me relearn/ compensate for my deficits.

Please keep me in your prayers,

Tom
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Old 07-02-2013, 03:32 PM #9
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Hi Tom, thanks for the update, sounds as if you have found a good team with your chiropractor, neurologist and neuropsychologist. Overall sounds like your neuropsych evaluation went pretty well. The fact that some deficits exist will help them tailor your therapies to be most effective.

Your recommendations sound similar to the ones I was given. Even while still in a wheelchair in the hospital they had me doing both cardio and weight training exercise. By cognitive therapy, is this with a speech pathology therapist? I always kind of wondered why they call them speech therapists as they do so much more than that.

Maybe they have researched and determined that reading improves memory, I tried to read a lot early on but I didn’t retain much, now that deficit seems to have resolved.

Congratulations on your progress and thanks for checking in.
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What Happened: On November 29, 2010, I was walking across the street and was hit by a light rail commuter train. Result was a severe traumatic brain injury and multiple fractures (skull, pelvis, ribs). Total hospital stay was two months, one in ICU followed by an additional month in neuro-rehab. Upon hospital discharge, neurological testing revealed deficits in short term memory, executive functioning, and spatial recognition.

Today: Neuropsychological examination five months post-accident indicated a return to normal cognitive functioning, and I returned to work approximately 6 months after the accident. I am grateful to be alive and am looking forward to enjoying the rest of my life.
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Old 07-03-2013, 01:15 PM #10
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Quote:
Originally Posted by Tom from Queens View Post
Complaining about my health issues, especially in light of the people who have severe head injuries, makes me feel a little weird, but I am definitely not a malingerer...
I've been labeled as lazy all my life, and a complainer. People don't get it! I'll say though, no matter what the symptoms are, or however insignificant they may seem, they are very real. Many of my Saturdays are spent taking it easy and resting if i can. I can accomplish more on Sunday than I would over the two days had I not rested. What I'm trying to say is that by understanding your limitations you can learn to work around them.

Jamie
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