Читать книгу Concussion - Kester J Nedd DO - Страница 15

CHAPTER 9

The Walking Wounded – Missing the diagnosis

WE HAVE LOOSELY used terms such as “the walking wounded” and “missed TBI/concussions” in the brain injury world. In many cases, these conditions go unrecognized and can cause pain and suffering that last a lifetime. My practice is filled with patients who present with major depression, anxiety, OCD, panic attacks, headaches, dizziness, vertigo, memory disturbances, and anger management disorders, and who for reasons not of their own doing have suffered from a TBI or a concussion that went unrecognized. In many cases, these injuries were only discovered as a major contributing cause to the patient’s problems much later.

Robert Laskowski calls this condition (TBI in general) a “silent epidemic” because “many of the acute and enduring alterations in cognitive, motor, and somatosensory functions may not be readily apparent to external observers” (Laskowski 2015). A study by JS Delaney showed that as much of 88% of concussions may go unrecognized (Delaney 2005). According to a national public radio poll, one in four Americans reported having suffered a concussion. (NPR 2016).

This late discovery of the existence of a TBI/concussion is not only true of many in the prison population and the military but can also be true for people who are functioning in the society and are otherwise experiencing limited fulfillment from their lives because of challenges with interpersonal relationships, trouble advancing in their company, or in the case of a person’s inability to achieve what they believe to be their life goals or reach their fullest potential.

(Case # 5)

I was presenting a lecture in the Caribbean on the clinical features of concussion and TBI when a young lady (we shall name Jill to protect her identity) came up to me and said, “I have what you described in your lecture and I want help.” She was 25 years old at the time and, for all practical purpose, felt lost because she could not achieve her life goals. Jill saw her brothers, sisters, and colleagues of her age excelling but could not figure out why she could not.

Her getting a visa to come to the US, find out what was truly going on, and finally receive treatment was next to impossible. Gathering enough funds to buy the ticket and pay for care in the US was also challenging.

Somehow, she managed to overcome both hurdles, and two whole years after meeting her, I was able to evaluate and treat her at my clinic in Miami. The unique part of this story was that neither she nor her prior treating physicians had any idea as to what the cause of her symptoms was. She was given various diagnoses, including bipolar disorder, major depression, fibromyalgia, Meniere’s disease, and multiple sclerosis. Jill was unable to work and had become antisocial. Her parents and siblings attributed it to being lazy, as those close to her questioned the legitimacy of her disease. In fact, she was thrown out of her parents’ house and forced to live with an abusive boyfriend.

Jill would have crippling panic attacks, sometimes up to 5 or 6 times a day. Moreover, despite been treated by many health care professionals and with medications, she could not shake off those attacks. She had also developed a fear of leaving the house and could not enter an elevator or places with closed doors. She had a negative outlook and a firm belief that she could not succeed at most things. This got her to a place where she had just stopped trying. I became impatient during my examination, as she would not allow me to interrupt her while she was telling her story. If interrupted, she would start telling her story all over again. She was obsessed with telling her story. Like many persons with TBI/concussion, she experienced dizziness, vertigo, and severe headaches, had trouble reading while driving, and could not tolerate being on a boat or riding a bus. Jill could not multitask, had trouble handling multiple conversations, and was easily distracted. Her family and friends started asking what was wrong with her over the years. She graduated from high school at the bottom of her class with significant struggles, as she could not retain information. Jill could never hold a constant job by which she could support herself. Unfortunately, she developed an emotional and economic dependence on her boyfriend to the extent that she was afraid to leave him, despite repeated physical and emotional abuse. By now, after reading all these signs and symptoms, you must have gotten the story.

Until Jill heard my lecture and visited me as her doctor, she did not realize the impact being hit at 9 years old by a rock on the forehead had on her life and future. The details of the incident became clearer when she recalled she was in a childhood fight with her neighbor’s son. He had thrown a rock that impacted her on the left forehead just above her eyebrow. She recalled very little as to what transpired afterward, but her mother related how she could not attend school for over 3 weeks and thereafter developed severe headaches. No connection had previously been made between her significant decline in academic performance and reduced motivation for life and being hit by the rock. Until I showed her the head scar in the left frontal supraorbital region, she did not realize the seriousness of the incident. Her mother confirmed that the scar on the forehead was that from the rock incident. The neuropsychological testing performed at our center demonstrated findings consistent with frontal lobe dysfunction, findings commonly seen in TBI/concussion. An MRI was performed with two sequences: one called diffusion tensor imaging (DTI) showed damage to the white matter tracks in the brain, and the other known as susceptibility weighted images (SWI) showed the evidence of a past injury due to the presence of blood breakdown products in the brain. These blood breakdown products confirmed a prior bleed or hemorrhage in the brain at some point in the past. After spending 2 months in the US with medication management and therapy, Jill went back to her country and was able to complete 2 years of college. She now works for a small company as a receptionist.

I saw her about 5 years after my initial treatment. Despite her progress, she could not come to terms with the fact that until the age of 25, she was not able to understand why her life was out of control. Her story is one that I hear on a regular basis, and she is only one of the few success stories of patients whom medical science was able to discover and help. In the context of what we now know about TBI/concussion, you can imagine the number of injured individuals who have not been able to receive medical attention and, thus, have suffered the consequences of such condition.

If you are reading this book and you are wondering if you fit this picture, then it is important that you seek help from competent professionals because you can in fact change your life, depending upon your situation.