IME Assessment on Depression verses Mild Brain Injury

[Godsgrl444]

I have a history of depression from over 10 years ago 1990. I have had to go on my antidepressant meds a few times since then but,would stop taking it as soon as 6 months and would do fine until something really bad would happen again. In 2010, I was involved in a bad car accident where I passed out at the accident. I was hit from the front of my car. When I woke up I was told to get out of the car because it was really bad (totaled). I was then rushed to the hospital but later  that night released. My car insurance company denied my claim for medical care and my normal insurance said no also because it was an accident injury. Now 6months later I am in a lot of pain including headaches, fear while being driven in the car, shooting back pain, and really weak but with no physical therapy. My car insurance company finally sent me to a neurology IME doctor for evaluation and after he noticed  all of my physical signs like trembling, weakness bad pain he asked me had I ever had depression before and had I ever tried to commit suicide before. I answered him truthfully but am wondering what does my past depression have to do with my present injury? I was working and had just graduated with a BSN Degree right before my car accident. I hope someone can help me to understand this.

[ggreg]

Dear Godsgrl444,
I know precisely what you are going through, as I was also in a bad car wreck and have had multiple health issues resulting from that, some just like yours.  I do not know for sure why the doctor asked you questions about your depression.  But I can tell you that I have depression and it is as a direct result of my own car accident.  You see, I had compression fractures in my thoracic spine, which was yanked to one side, pulling all the muscles and nerves with it.  So, while my fractures healed, my back was never the same after that, and it hurt off and on with different intensities throughout the rest of my life.  Whenever I was uncomfortable, my mood changed and I got depressed.  So, maybe that's why your doc asked, to see if you were depressed from your first incident or the recent incident, or if it is just the way you are, OR even perhaps he might think your complaints of pain and so forth come from the depression and thus not the accident, which I think is a ridiculous idea, as I know I'M not imagining the serious pain I live with.

But nevermind all of that.  What you need is medical care for your car accident injuries, which you have many symptoms that need treatment.  Look, you may not have broken a bone, but you can have lots of other health issues from a wreck.  While your regular health insurance wouldn't pay for your ER visit, which I do not understand, but anyway, I DO think they would pay for any doctor within their provider group to treat your current symptoms, which sound pretty serious to me.  ANYBODY who is in a wreck will almost always have lingering pain for a period of weeks, throughout their whole body.  But you have more than the standard discomfort and it exists a YEAR after.  You were knocked out by the wreck, you have shooting back pain, you have headaches, your hands tremble (somewhat unusual) and you have weakness, plus on top of that you have wound up with a type of panic disorder, which yours is the fear of riding in cars.  I MYSELF have tremendous fear of riding in cars, I went through a year of therapy, and I still take tranquilizers to be able to get into a car, all becuz of my wreck.

Anyway, I do think you should be evaluated and treated by a neurologist group, which I am not sure that is exactly the function of the IME neuro you saw, I think those people just give opinions in legal matters, so I think you should seek out your own group of neurologists to diagnose your various conditions and then provide good treatment for you.  As long as they are in your health insurance company's list of providers, they should pay for it, minus your deductible and copays.  

I think your neurologist should have a scan done of your brain and whatever part of your back that hurts, which will help him decide what part they play in your symptoms.  I think he should get you into physical therapy, perhaps give you a neck collar or brace to wear while he treats you, and he should give you really good medicines to make that pain in your back stop.  For it is the pain that will cause you the most problems with all this, including a worsening of your depression.  In addition, he may want to refer you to a group of psychiatrists and psychologists for your anxiety over the wreck.... OR you can yourself go to the "free clinic" that is part of the county mental health community, they're in the phone book.  They can give you tranquilizers to assist you in your fear of cars, and also maybe some short-term psychological therapy to help you get past the whole thing.

I think you've probably really torn up some muscles, tendons, ligaments, nerves, and maybe even you have ruptured or bulging disks pushing on your spinal cord, not to mention some evidence of old fractures.  I also think being knocked out can have strange effects on a person, might even be the reason your hands shake.  You need a thorough physical evaluation to include a scan, adequate pain control, physical therapy, maybe a back brace, and tranquilizers, AT THE VERY LEAST.  Actually, even if your health insurance wouldn't pay for this for some strange reason, you could work out payment arrangements with the neurology group and chip away at the bill you wind up with, which should not be all that dramatic, with the exception of a scan that will surely need to be done, they can be a few thousand.

I am so proud of you for obtaining a BSN Degree, and I honestly think once you get all this car accident stuff sorted out and your pain and discomfort under control, plus hopefully some really good physical therapy designed to at least greatly reduce your symptoms, I think you could successfully be a nurse, could be you'll have to wear a back brace for some time to come and take some medicines, and could be you'll need to rest frequently, but keep your mind on that goal of being the nurse that we all need you to be.  

I hope something of what I've said will point you in the right direction, and I am sure you can get some medical assistance one way or the other, and I think you should begin to take care of that immediately.  You can always call your health insurance people, make sure you will be seeing a neurology group within their list of providers, and make sure they will indeed cover your bills with them, so you will know whether or not you need to make a payment arrangement with the neurology group you wind up going to.  

Keep us posted on how things go for you, I know precisely how you feel, I deal with my back situation continuously, and it is amazing that even all these years later, especially since I am older now and my body is not what it used to be so I endure more and more pain, how some docs simply WILL NOT help me very much.  Sometimes it takes a couple docs before you can settle on one who is sympathetic and really interested in helping you with your symptoms.  But it can be done.  Back pain is not a simple matter, injuring it can have a profound and long-term effect on a person's sense of well-being, and a good neurologist will respond kindly to your pleas for help.
GG

[SamPCS]

You lost consciousness after the accident and did they do any CT scan/MRI?  If they did, what are the results?  For 6 months insurance denied coverage?  That is unacceptable.  

You may have concussion, cervical injury etc.,  you have to do all the MRIs, tests to begin with.  Neurologist thought it is a depression after seeing the all signs?  Change the Neurologist if you can.  She is probably an anti-depressant Neurologist.  Some neurologists that is all they can prescribe for anything.  You certainly need a good specialist to rule out all the issues.  

I had a mild Traumatic Brain Injury 2 years go and still suffering with lot of symptoms (after going through many many specialist  in my case).  For me each one call what they think it is - Post Concussion Syndrome, Meniere's syndrome, Post Traumatic vision syndrome, Depression, Anxiety etc., and still no one can help to relieve my symptoms.   (headaches, dizziness, fatigue etc.,)  I am still looking for some one who can think out of the box.