Hello!

So I had a minor concussion about a month ago. My symptoms went away and have relapsed a bit. I've had problems in the past with really crappy doctors being dismissive.

I also have anxiety and other issues that were present before the PCS...

SO I was wondering in your opinion what is the best doctor for me to see?
I realize a Neuro won't be able to do much but I just need help clearing the fogginess, dealing with pain, and sleep problems.
I want to get back to being as functional as possible but right now my old life patterns are not possible to maintain.

Sometimes a specialist in Physical Medicine and Rehabilitation can be helpful. Sometimes they are called physiatrists. There is usually a section under physiciansi in the yellow pages. Look under Physical Medicine and Rehabilitation.

Good luck to you.

A neuro would be your best bet when it comes to dealing with symptoms. neuro docs are trained to care for psych issues, but just know neuro docs focus on treating symptoms with meds and not necessarily behavioral changes--which is often the major contrast with psychologists. you should see multiple specialists (including speech therapists, MH providers )to help develop an overall gameplan: because PCS involves so many symptoms

You could also see a neurotherapist. They specialize in administering neuorfeedback for brain injury rehabilitation. Make sure they have experience treating brain injuries. Also, stay away from neurologists/neurosurgeons. They only do what they were taught in medical school: prescribe drugs. Most, but not all, have no idea how to treat an injured brain without using medication. A neuropsychatrist might be worth looking into though.

QUOTE=MdotDdot;534566]A neuro would be your best bet when it comes to dealing with symptoms. neuro docs are trained to care for psych issues, but just know neuro docs focus on treating symptoms with meds and not necessarily behavioral changes--which is often the major contrast with psychologists. you should see multiple specialists (including speech therapists, MH providers )to help develop an overall gameplan: because PCS involves so many symptoms[/QUOTE]

^I agree, most neurologists don't think about the long term management of your symptoms without resorting to meds. so it is important to speak to a neurologist who is adept at treating PCS with varied techniques. unfortunately, most neurologists do not get compensated for discussing behavioral and non-med techniques so they cannot afford to spend the time to discuss this with patients. neurosurgeons just cut and should not be consulted. neurophysiatrist is a great idea!

MdotDdot,

Where do you get the idea that neuros are trained to deal with psych issues? That is not the case. Just because they are board certified as neurologists by the American Board of Psychiatry and Neurology does not mean they are psych trained. The ABPN has a specialty for each discipline.

Most neurologists are limited in their diagnostic and treatment skills to only those ailments that they can image by MRI, CT, EEG, AEP, VEP, EMG. They are almost useless for concussion and other non-imageable ailments. They tend to either dismiss concussion symptoms or refer the patient to a psych for evaluation.

Unfortunately, concussion issues go widely unresolved by our health care industry. Even neuro-psychs tend to put causation on issues other than concussion.

Part of the problem with good diagnostics is that concussions are rarely treatable. The natural healing that the brain does after a concussion is expected for almost all concussions.

If the doctor can't treat it, it does not exist. If the drug companies can't sell a medication for it, it does not exist. That is the case for concussion.

The only treatment that sounds worthwhile is progesterone. The clinical trials are still ongoing but so far, an intravenous infusion of progesterone within hours of the injury has very good results. It is not effective at a later time. Other than that, all that can be done is treat the symptoms such a head ache, depression, insomnia, etc.

Whatever you do, don’t be talked out of seeking treatment. I have discovered that the average GP is so shockingly ignorant about head injury I’m convinced they had five minutes of optional instruction after the lecture on bill padding. Many are far too quick to discount concussions – but there is no such thing as a minor head injury. The concussion I was supposed to be over in a month turned out to be a diffuse axonal injury. You don’t have to be knocked unconscious to sustain a serious, life-altering brain injury.

I’m not trying to scare you, but if you think something’s wrong, you’re probably right. Talk to the people close to you and you may discover that there are other behavior changes and symptoms to which you’re oblivious. At the very least, consider having a neuropsych test to see where you stand.

There’s no magic pill for brain injury. However, the brain is enormously plastic and the sooner you start Attention Processing Training, etc… the better.

Good Luck

Hi, I think if you deal with the sleeping issues the other problems may sort themselves. I found that my biggest help was my psychiatrist. Initially - well for the first 2 years I didn't trust him, then studied up and found that he was reputed to be the best in the country. Eventually I told him that I "surrendered" and would trust him. I take Nortrypiline at night and 1 zopilclone sleeping pill and have been a lot better since. The fog only comes back when I am overtired or stressed to the maximum.

I have just been send to a neurologist - sent by my insurer who of course are wanting me to go away. Of course didn't want to go, however he straight up said that he did not have any contract etc with the insurer and was totally independent. He is from the US - William E Wallis. Despite my initial thoughts I warmed to him. He explained that he did not believe in a lot of cognitive rehabilition therapy and that in some cases can actually make you worse. I took him my QEEG report and he admitted he knew nothing about nuerofeed back and his opinion was that it was unlikely to have any physical value - or something similar to that in case I have misquoted


Lynlee

Dear Lucy,

A couple of things you said about your neurologist raised red flags for me.

Firstly, no matter what he claims, your insurance company selected him for a reason – by very wary. I speak from experience here.

Secondly, a lot of old school neurologists are hostile to some forms of cognitive therapy. However, if he out and out rejects neuroplasticity, he is flying in the face of decades of solid research. Are you familiar with the book The Brain that Changes Itself? The Canadian science programme the Nature of Things did an excellent documentary on it available at CBC.ca

There is an ever growing mountain of empirical evidence that demonstrates that proper cognitive therapy can improve function in the brain injured. However, insurance companies don’t like that therapy because it is slow and expensive. They would rather you believe that time is the only treatment and that you will only get as well as time allows. That’s rubbish – don’t believe it for a minute.



Cheers

I have seen a number of docs. My PCS came after a fall from a hospital bed while having a seizure (rails not up). So I have a neurologist. Her only concern is my seizure disorder. She has never once helped me with my PCS symptoms. When I explained to her about my continued headaches, lack of interest etc. she told me that these symptoms could last as long as 6 months. That's it.

I saw my family physician with PCS complaints, and she was convinced that I was depressed. She increased my Prozac to 60 mgs. a day. Told me to see a psychiatrist.

Saw a psychiatrist - he told me I wasn't depressed and is decreasing my Prozac to hopefully wean me off of it.

It wasn't until I saw a sports med doc who specializes in concussions that I finally felt my complaints were validated. My husband was with me and he got a chance to vent about all of this too. So, he suggested that once I am off the Prozac, he would start a trial of amitriptyline to try to get my brain functioning again. I told my neurologist about this and she seemed to be okay with it. Why couldn't she figure this out? I also asked her if she would be able to right me a letter describing the effects of the concussion versus the seizure disorder. She told me it would be hard to decipher. My feeling is that if I would have just had a seizure, I wouldn't be having all of these other problems. What is so hard about that? She may be a great neuro for epilepsy, but she stinks at the PCS stuff.