post concussion-when to go to hospital

[genie68]

I was in a car accident 12/26.  I lost conciousness, have no memory of being hit, and was disoriented and in and out all the way to the emergency room.  I ended up with 41 stitches in my head and after a ct scan, was sent home about 5 hrs later.  It has now been 8 days.  I have extreme fatigue, headaches, numb spots that come and go in my face and head, nausea, and my eye hurts (I developed a black eye about two days later).  These symptoms seem to be listed as normal, but I am very worried both about the symptoms and the resulting depression I feel.  I can't get into a neurologist for 2 wks.  Should I go back to the emergency room?

[genie68]

Hi, all.  Thank you again for taking the time to help me look into this.  At this point, I still have nausea (off and on), headaches, difficulty concentrating for very long, fatigue, and sleeplessness.  I am also having a little trouble when I speak.  I feel as if I am grasping for the words at times.  Like when you have the answer "on the tip of your tongue".  The dizziness and double vision are pretty much completely gone.  The numb spots are completely gone so that is good.  My appointment for the neurologist is in 10 days.  The depression has lifted a bit, anxiety is about half.  I am now writing down frequency of symptoms as suggested.  Any further concerns or suggestions?  Thank you in advance

[Godofredo MD]

Hi.

I do not believe you have disrespected anyone, or have been sarcastic in any way. Bad health care does happen, and not occasionally as one might suspect, but a lot of times. It is during these times that we have to be vigilant and be responsible for our own health, and not take a passive role in our treatments.

Your advice is sound and would seem to be of benefit to a lot of people. I do hope you provide more input on others conditions as they would certainly like to hear from other people who have gone through what they are currently experiencing.

Thank you for the information you have shared in this forum.

[caregiver222]

I did not mean any disrespect or to be sarcastic. Actually, the comment regarding psychiatric consulation so soon after an injury was precipitated by a discussion with my hang-out buddy, who is currently chief of psychiatry at a major hospital. Psychiatrists read from many different hymn books.  My two cents worth is that one of the significant problems after head trauma secondary to "going through a windshield" is long term emotional problems. This is not always the case. A likely culpret is temporary or permanent damage to the hypothalamus, anterior pituitary and posterior pituitary, either through swelling disrupting oxygenation, or bleeding secondary to the injury. These are master glands of the endochrine system. They are responsible for production of signaling substances called hormones which are polypeptides. One of the most famous patients with such a disorder once played in the band "The Beach Boys". An analysis of the potential problems with emotions after head trama was well covered in a Scientif American issue of "Mind". This does not necessarily mean you will experience such problems. A psychiatrist may not be familiar with the literature relating head injury to damage to the endochrine glands. I would lean towards seeking a thorough evaluation from a specialist in the endochrine system, known as an endochrinologist, if you experience long terms emotional issues.  If you then want to see a psychiatrist, they have a niche in the system, and I do not believe they should all be condemned. I do not feel it is productive to be angry about substandard care you may have recieved, but it irritates me that we seem to be rediscovering the wheel every year. Generally when there is neck flexure and loss of consciousness there is high liklihood of a so-called "whiplash" injury, otherwise known as a subluxion. The symptoms generally show up 6 months to 2 years after the injury. The question is "what can be done to prevent development of whiplash pain?". I will tell you what I would do, and urge you to consult your own physician. First off for the next sixty days avoid riding in an automobile or bus. You have to stop working for a while, even if you feel it is a necessary.  If you must ride in a vehicle obtain a supplemtal seat cushion to sit on. The up-and-down motion will irritate the cartilidge between the cervical vertebra. That is where the whiplash problem comes from. You will probably have a cervical collar which you should lose as soon as possible. The reason is that long-term use of a cervical collar causes loss of muscle tone, which creates a new problem. I would attempt to dampen the inflammation by use of a non-steroidal anti-inflammatory (NSAID) such as Ibuprufin. Long term use is a tad hard on the liver, but a week or two will be tolerated nicely. The prescription Ibuprufin contains 800 mg. Civilian drug store doses are 200 mg. So the first day I would take 800 mg in the morning with good and 200 mg with food at night. The next three days three dicided doses of 200 mg, thence two divided doses of 200 mg for at least five days.  Then I would hunt out an axial traction unit with water bag (about $35 without prescription) and for the next eight weeks four times a day for between six to ten minutes urtilize the axial traction unit. Lose the water bag and hook the harness up to the beam between your door and set out a chair and gently lower yourself until you just feel pressure pulling your head upwards. This separates the cervical vertebra a teensey weensey bit and permits fluid drainage. Do this the first day you are on the ibuprufin. After about six weeks begin "range of motion" exercises, through the limits of pain or discomfort. This involves rotating the head 360 degrees to the limit of possibility. This should be done 4-6 times a day. Even following this regimin there is a possibility of developing whiplash pain, but we want to prevent this from developing. No matter what you have heard about people "falsifying" whiplash pain, it is very real. I think you should purchase a small marble cover children's school book and every day on a single page put the date and write down your symptoms. Time of onset, what you were doing, where there was pain, the nature of the pain, the duration, etc. In particular be aware of any potential tingling in the arms, pain in the arm between the elbow and shoulder or weakness of one hand. These are hallmarks of a subluxion problem, and the definitive treatment is intermittant gently axial traction, anti-inflammatories and range of motion exercises. There are specialists who treat subluxion injuries.  I don't want to paint a gloomy picture. Many patients suffer severe head trauma and have no long-term side effects. I would not go back to this particuliar hospital.

[Godofredo MD]

Hi.

I understand your concern for the genie68 about having psychiatric drugs "mask symptoms and alter reality", which does actually occur in many cases. But I, too, want to clarify my advice on going to one.

There is a common misconception that a visit to a psychiatrist for symptoms associated with depression would automatically result in a prescription for anti-depressive medications, which is actually evidenced from your last post. Not all depressive symptoms need pharmacologic treatment. The main purpose of psychiatric consult for this case is to help the patient understand what he/she is feeling and thinking (the fears, anxieties, worries), and to help him/her deal with them better, Studies have shown that those with better coping strategies do indeed recover faster than those who have not been coping with their conditions.

You are correct, however, on the observation about the apparent deficiency in the care provided to genie68, which resulted in her being released apparently too quickly. But there is nothing that can be done about it as it had already passed long ago and being angry about it would not help the condition in any way. What is essential here is to continuously monitor at home the progression or persistence of the symptoms. Any hint of progression or lack of improvement after some time would necessitate a visit to a doctor or hospital.

[caregiver222]

I want to clarify my objections to your seeing a psychiatrist. First off, anyone in your situation would experience depression. This is usually self-limiting.  More importantly, your progress and recovery requires monitoring of your aches, pains and mental status. Any pharmaceutical (and a psychiatrist will prescribe one) masks symptoms and alters reality, making a competent neurological assessment problematic. I was frankly outraged they released you from the hospital so quickly. That is the standard of care in Nigeria, perhaps, but not in the civilized world, circa 2008. There is a "window of opportunity" to prevent swelling, and that window was lost.

[caregiver222]

Normally the long-term problems associated from head injury involve swelling, and that issue is well resolved after a week. It is unusual for nausea to persist that long. I would go back to the ER tonight if you are still experiencing nausea at this time and/or headaches. The symptoms should be progressively disappearing. I would not waste money on a psychiatrist. But that's just me. I doubt your problems will resolve faster.  And I would only see a counseler if she is especially attractive, like seven-of-nine in Startrek. I think a visit with 7 of 9 would be very helkpful in curing depression. If you are a female, find a counselor that looks like Tom Cruise. The hospital that send you home after 5 hours of observation should have it's license revoked the the physician who signed your release have his license to practice medicine revoked. The standard of care following loss of consciousness is 24 hours observation. One of the wats they measure brain swelling is to constantly check your blood pressure and heart rate during this period. The failure to do so constitute gross inexecuseable negligence and malpractice. I would suspect if this was done, and attention paid to reducing the swelling, you wouldn;t be experiencing the problems you have now. Cheer up. The chances are things will resolve nicely and you won't have long term problems.

[genie68]

thank you, so much for replying.  I think part of the depression is not knowing if i made a mistake driving, so I have quite a bit of anxiety related to this.  It just seemed so out of nowhere and out of the norm for me.  The symptoms haven't worsened; they just haven't lessened yet either.

[Godofredo MD]

Hi.

I am so sorry to hear about your accident and I do hope you recover from your symptoms soon.

The symptoms associated with a post-concussion syndrome (PCS) can last from a few weeks to several months, and is dependent on the severity of the concussion. Have your symptoms worsened during the last 8 days? The symptoms you mentioned do indeed fall under the known symptoms associated with PCS. The important thing to watch out for with these symptoms is any progressive worsening of symptoms, which might suggest something that needs immediate medical attention.

You should probably talk to a counselor or psychiatrist about your depression. This would not only help you deal with your depression but may also lead to faster resolution of your other symptoms because being educated about your condition might ease your fears and help provide some peace of mind.

If your symptoms have indeed worsened, you could go to the emergency department to have them checked out, otherwise, you could just observe your condition for the time being and wait for your neurologist appointment.

Hope this helps.