February 19, 2012

Concussion Update

The second time i saw the neuropsychologist, he gave me the green light to work.  (Incidentally, he also said i could start skiing again!)

So i worked the 4-12 shift this past week, and i think i'm getting close to functioning at 100%.  I've had normal interactions with patients, and i'm able to extract the relevant parts of the history, integrate them with the physical exam and ancillary studies, and come up with a reasonable diagnosis and plan.  My main issue is a persistent "fogginess" to my thought process; that is, needing to exert a little more energy to be able to focus.  It's not unlike the feeling one gets after working 24 hours straight, and it's a good thing that my residency trained me to work under those exact conditions.  

Another problem is multitasking, in that i have to completely concentrate on finishing one thing before paying attention to another lest i forget what i'm doing (although this may have been a pre-exisiting issue that i'm just more aware of now).  The underlying knowledge base and decision-making ability otherwise seem to be completely intact.  Despite my rising confidence in my post-concussive abilities, i'm still thankful that the inherent redundancy in what i do (e.g. the resident/APP sees the patient before i do, and my partner rounds on him/her several hours later) ensures that nothing gets missed.  

My mental picture of what happened closely match the way my doctors explained it: my brain was so severely rattled by the fall that the connections between my personality and my memory were completely ripped apart for a few hours (hence the six hours that i can't remember).  Since then, the connections have started to reform, albeit at a glacial pace.  While i'm frustrated that it seems to be taking forever, i'm told that i'm progressing as expected.  Patience, grasshopper... it'll get better eventually.  

My normal CT scan.  Proof that i have a brain.

February 10, 2012

Injurious Behavior: The Day I Rattled My Brain

Three days ago we went out to Crystal Mountain for more skiing lessons.  Adrian is progressing along quite  well: his teacher finally let him get on the chairlift to go down a "grown-up hill."  Gianina and i signed up for a two-hour lesson, and we're slooowly becoming competent skiers (parallel turns!).  It was a great day for all of us, and it's a pity that i don't remember it.

Towards the end of the lesson (around noon), i apparently got down near the end of a green run, did a 180-degree turn, fell back, and slammed the back of my head against the snow/ice.  Gianina and Brett (our instructor) quickly caught up with me and noted that i was awake and lucid.  So far so good.

Unfortunately, retaining consciousness was the only good thing about it.  Gianina almost immediately noticed that i was acting odd: asking her what happened, listening intently to her explanation... and immediately asking again what happened.  Over and over.

I couldn't form any new memories.

In short order, Gianina got the ski patrol involved and had me transported (via ambulance!) to the closest hospital.  I was seen by an ER Physician, had a CT scan done (normal), and was ultimately diagnosed as having a mild concussion.  Thankfully, we were given a green light to proceed with the rest of the day's activities.  However, it should be kept in mind that while being discharged from the ED usually means that one is not in danger of dying any time soon, it doesn't necessarily mean that one is in tip-top shape.

So we went on our way to enjoy the local waterpark, and by Gianina's account, i was completely lucid and reasonable the whole time, just unable to remember anything that just happened.  She says it was like taking care of two children (or more aptly, i think - one child and one pleasantly demented old person).  I'm happy to report that i never exhibited any antisocial behavior at any point, and was even conscientious enough to request Gianina to call our hospital division chief to let him know of my ongoing incapacity when i realized that something wasn't kosher.

At around 9:30 pm (almost ten hours after the initial event), things eventually started "sticking" - and from a cognitive standpoint, i can accurately say that it was when my brain finally woke up and decided that it was time for business as usual.  Things are clearer from that point onwards.  But i can only remember the preceding three hours in the waterpark like images from a near-forgotten dream, and the six hours immediately following the event are completely nonexistent.  Cervical collar, stretcher, ambulance ride, hospital stay, even checking into the waterpark and changing into my swimsuit... zilch.  Gianina even came up with a list of things that i repeatedly asked and commented on.  On reviewing said list, i can remember asking none of those things, although i can recognize my thought pattens in the frequency of the queries.

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What amazes me the most is that i was otherwise completely normal the whole time.  I've seen a similar phenomenon before with something called Transient Global Amnesia (which is usually not preceded by a head injury, but with similar clinical features), which i've always been fascinated about.  To have actually lived through the same experience is equal parts amazing, scary, and creepy.  But it was much, much worse for Gianina, who actually had to endure losing her husband (or parts thereof) for a number of hours.  I can't imagine how it must have been like for her, and i think one of the worst parts was around the beginning, when the diagnosis was still uncertain and Adrian asked point-blank: "Is Papa going to die?"

At present, i think i'm mostly recovered.  I don't have any residual headaches or vertigo, and my only mental problem appears to be accessing certain memories, specifically the three days leading up the the accident (this is quickly improving - i can clearly remember Tom Brady's final "Hail Mary," for example).  My mind also momentarily goes blank when asked to remember something, although i wonder if this last bit is something that i (and everyone, for that matter) already did before without paying too much attention to it.  As with any other body part that gets injured, i'm "favoring" my brain and may just be overly concerned about every little hiccup that occurs.

My main issues are actually physical.  My sternocleidomastoid muscles hurt like the devil (they presumably stretched out when my head snapped back), and i have various aches and pains all over my body from skiing that have no correlation with any memories that i have.  Surprisingly, i don't have a bump on my head, which makes me wonder if it was truly the impact (which would have been absorbed by a helmet) that caused my concussion, or just the acceleration-deceleration event.

Anyway, i saw a neurologist yesterday who confirmed the diagnosis.  Today i saw a neuropsychologist who thinks that i'm overall doing okay, but given the nature of my work, would rather that i go back to working on Tuesday (as opposed to Monday) pending further testing.  I have no doubts that i'll be fine and dandy then, with only a little amnesia to "remember" my injury by.

One question that's bugged me from the start is: if i had worn a helmet, would it have prevented the concussion?  On researching the topic online, it seems that the answer is no; the type of injury that helmets are supposed to prevent did not occur anyway (remember that i have no bump on my head).  Stated differently: even if i had worn a helmet, i would likely still have gotten the concussion.  Regardless, it could have been much worse (under different circumstances - harder ice, or an actual collision with something hard enough to break my skull), and the next time we go skiing, i'm definitely wearing one.