Brain Injury – The good, the bad, the HONEST – Part 1

There are many misconceptions about minor, major, or any in-between stages or levels of brain injuries.

All brain injuries – “Acquired brain injuries” (ABI), “Traumatic brain injuries” (TBI), Concussions, and even small impacts to the head – they all cause damage to the brain. Some old adages of information state that it is the severity or number of blows to the head that dictates the amount of damage, the severity of the damage, side-effects or long-term symptoms. This simply isn’t accurate. Even a minor bump – (ONE little BUMP) – to the head can cause a life-long ripple effect in the health of the brain.

I’ll share now my own symptoms, side-effects, and long-term issues due to my multiple TBI (closed head injuries – meaning, my skin wasn’t punctured or broken – which is actually more dangerous do to the pressure that is trapped) and how it has changed my life entirely.

I’ve had numerous TBI’s throughout my life. Many of them were “minor concussions” on the medical ranking system used by hospitals to determine how bad/damaging the injuries are. The fact that I’ve had more than one put me into another ranking system for how much overall damage has been occurring in/on my brain and the surrounding tissues.

My last and most recent TBI was rather bad. It was considered a Moderate-to-Severe concussion – TBI. What that means is, there was a lot of internal bleeding on my brain which caused a whole lot of pressure, and way too little oxygen content — which is ‘no bueno’ for the overall health of my noggin. I lost consciousness (which is another indicating factor on the medical ranking system of severity) for several hours and wasn’t taken to the ER right away, which caused irreversible life-long damage to my brain health.

(The reasons for my not being taken to the ER are not something I’d like to share because it infuriates me to no end, and I’d rather not make it about what “should or shouldn’t have happened” but rather to stick to the facts about my health and the facts of brain injuries.)

My last TBI caused amnesia. I cannot (literally can NOT) remember anything from before the accident, and I have a lot of trouble remembering new information for very long. I can only remember new information (post-accident) for several months, or only a few weeks, and sometimes only a few days. Some things however, if I write things down very accurately and vividly (with a whole lot of description) I can force myself to ‘remember’ through re-reading it often. Really only parts of things are retained that way. Eventually I hope things will start conglomerating and sticking around better, and for longer amounts of time. 🙂

Here is some information about the types of amnesia that have currently been given diagnostic associations and names:
( Cited from – http://www.medicalnewstoday.com/articles/9673 – Last updated: Monday 27 July 2015)
[The day before my birthday!]

Types of amnesia

There are many different types of amnesia. Below is a list of the most common ones:

  • Anterograde amnesia – the patient cannot remember new information. Things that happened recently, information that should be stored into short-term memory disappear. This is usually caused by brain trauma (brain damage from a blow to the head, for example). However, a patient with anterograde amnesia can remember data and events which happened before the injury.

  • Retrograde amnesia – often thought of as the opposite of anterograde amnesia. The patient cannot remember events that occurred before his/her trauma, but remembers things that happened after it normally.

  • Transient global amnesia – a temporary loss of all memory. The patient with transient global amnesia also finds it very hard to form new memories – he/she has severe anterograde amnesia. The loss of past memories is milder. This is a very rare form of amnesia. A transient global amnesia patient tends to be older, and usually has a vascular disease (a problem with the blood vessels).

  • Traumatic amnesia – memory loss caused by a hard blow to the head. People who lose their memory as the result of a car accident may have traumatic amnesia. People with traumatic amnesia may experience a brief loss of consciousness, or even go into a coma. In the majority of cases the amnesia is temporary – how long it lasts usually depends on how severe the injury is. Sports scientists say that amnesia is an important indicator of concussion.

  • Wernike-Korsakoff’s psychosis – this type of memory loss is caused by extended alcohol abuse. The disorder tends to be progressive – it gradually gets worse and worse over time. Patients with Wernike-Korsakoff’s psychosis also tend to have neurological problems, such as poor coordination, and the loss of feelings in the toes and fingers. It can also be caused by malnutrition. It is linked to thiamin deficiency.

  • Hysterical (fugue) amnesia – this is a very rare phenomenon. Patients forget not only their past, but their very identity. A person could wake up and suddenly not have any sense at all of who they are – even if they look in the mirror they do not recognize their own reflection (the person in the mirror is a stranger). All the details in their wallet – driving license, credit cards, IDs – are meaningless. This type of amnesia is usually triggered by an event that the person’s mind is unable to cope with properly. In most cases the memory either slowly or suddenly comes back within a few days. However, the memory of the shocking event itself may never come back completely. It is important that doctors diagnosing patients for epilepsy eliminate this type of amnesia from their list of alternative illnesses.

  • Childhood amnesia (infantile amnesia) – the patient cannot recall events from early childhood. Experts say this type of amnesia may be associated with language development. Others say it is possible that some memory areas of the brain were not fully mature during childhood.

  • Posthypnotic amnesia – events during hypnosis cannot be recalled.

  • Source amnesia – the person can remember certain information, but does not know how or where they got that information.

  • Blackout phenomenon – amnesia caused by a bout of heavy drinking. The person cannot remember chunks of time during his/her binge.

  • Prosopamnesia – the person cannot remember faces. People can either acquire prosopamnesia, or be born with it.

So there’s all of that….
I’m fairly certain that before my latest and most horrible brain injury, I had a bit of “Childhood Amnesia” as well due to some emotionally traumatic evens.

Anyhow – along with the amnesia, I also have “Post Traumatic Brain Injury Syndrome” (PTBIS) which I will now share information about:

( Cited from – www.msktc.org/tbi/factsheets/Emotional-Problems-After-Traumatic-Brain-Injury – Model Systems Knowledge Translation Center (MSKTC) – Spinal Cord Injury (SCI) – Traumatic Brain Injury (TBI) – Burn Injury (BURN) )

Emotional Problems After Traumatic Brain Injury

Based on Research by TBI Model Systems

Brain injury and emotions

A brain injury can change the way people feel or express emotions. An individual with TBI can have several types of emotional problems.

Difficulty controlling emotions or “mood swings”

Some people may experience emotions very quickly and intensely but with very little lasting effect. For example, they may get angry easily but get over it quickly. Or they may seem to be “on an emotional roller coaster” in which they are happy one moment, sad the next and then angry. This is called emotional lability.

What causes this problem?

  • Mood swings and emotional lability are often caused by damage to the part of the brain that controls emotions and behavior.
  • Often there is no specific event that triggers a sudden emotional response. This may be confusing for family members who may think they accidently did something that upset the injured person.
  • In some cases the brain injury can cause sudden episodes of crying or laughing. These emotional expressions or outbursts may not have any relationship to the way the persons feels (in other words, they may cry without feeling sad or laugh without feeling happy). In some cases the emotional expression may not match the situation (such as laughing at a sad story). Usually the person cannot control these expressions of emotion.

What can be done about it?

  • Fortunately, this situation often improves in the first few months after injury, and people often return to a more normal emotional balance and expression.
  • If you are having problems controlling your emotions, it is important to talk to a physician or psychologist to find out the cause and get help with treatment.
  • Counseling for the family can be reassuring and allow them to cope better on a daily basis.
  • Several medications may help improve or stabilize mood. You should consult a physician familiar with the emotional problems caused by brain injury.

What family members and others can do:

  • Remain calm if an emotional outburst occurs, and avoid reacting emotionally yourself.
  • Take the person to a quiet area to help him or her calm down and regain control.
  • Acknowledge feelings and give the person a chance to talk about feelings.
  • Provide feedback gently and supportively after the person gains control.
  • Gently redirect attention to a different topic or activity.

Anxiety

Anxiety is a feeling of fear or nervousness that is out of proportion to the situation. People with brain injury may feel anxious without exactly knowing why. Or they may worry and become anxious about making too many mistakes, or “failing” at a task, or if they feel they are being criticized. Many situations can be harder to handle after brain injury and cause anxiety, such as being in crowds, being rushed, or adjusting to sudden changes in plan.

Some people may have sudden onset of anxiety that can be overwhelming (“panic attacks”). Anxiety may be related to a very stressful situation— sometimes the situation that caused the injury—that gets “replayed” in the person’s mind over and over and interferes with sleep (“post traumatic stress disorder”). Since each form of anxiety calls for a different treatment, anxiety should always be diagnosed by a mental health professional or physician.

What causes anxiety after TBI?

  • Difficulty reasoning and concentrating can make it hard for the person with TBI to solve problems. This can make the person feel overwhelmed, especially if he or she is being asked to make decisions.
  • Anxiety often happens when there are too many demands on the injured person, such as returning to employment too soon after injury. Time pressure can also heighten anxiety.
  • Situations that require a lot of attention and information-processing can make people with TBI anxious. Examples of such situations might be crowded environments, heavy traffic or noisy children.

What can be done about anxiety?

  • Try to reduce the environmental demands and unnecessary stresses that may be causing anxiety.
  • Provide reassurance to help calm the person and allow them to reduce their feelings of anxiety when they occur.
  • Add structured activities into the daily routine, such as exercising, volunteering, church activities or self-help groups.
  • Anxiety can be helped by certain medications, by psychotherapy (counseling) from a mental health professional who is familiar with TBI, or a combination of medications and counseling.

Depression

Feeling sad is a normal response to the losses and changes a person faces after TBI. Feelings of sadness, frustration and loss are common after brain injury. These feelings often appear during the later stages of recovery, after the individual has become more aware of the long-term situation. If these feelings become overwhelming or interfere with recovery, the person may be suffering from depression.

Symptoms of depression include feeling sad or worthless, changes in sleep or appetite, difficulty concentrating, withdrawing from others, loss of interest or pleasure in life, lethargy (feeling tired and sluggish), or thoughts of death or suicide.

Because signs of depression are also symptoms of a brain injury itself, having these symptoms doesn’t necessarily mean the injured person is depressed. The problems are more likely to mean depression if they show up a few months after the injury rather than soon after it.

What causes depression?

  • Depression can arise as the person struggles to adjust to temporary or lasting disability and loss or to changes in one’s roles in the family and society caused by the brain injury.
  • Depression may also occur if the injury has affected areas of the brain that control emotions. Both biochemical and physical changes in the brain can cause depression.

What can be done about depression?

  • Anti-depressant medications, psychotherapy (counseling) from a mental health professional who is familiar with TBI, or a combination of the two, can help most people who have depression.
  • Aerobic exercise and structured activities during each day can sometimes help reduce depression.
  • Depression is not a sign of weakness, and it is not anyone’s fault. Depression is an illness. A person cannot get over depression by simply wishing it away, using more willpower or “toughening up.”
  • It is best to get treatment early to prevent needless suffering. Don’t wait.

Temper outbursts and irritability

Family members of individuals with TBI often describe the injured person as having a “short fuse,” “flying off the handle” easily, being irritable or having a quick temper. Studies show that up to 71% of people with TBI are frequently irritable. The injured person may yell, use bad language, throw objects, slam fists into things, slam doors, or threaten or hurt family members or others.

What causes this problem?

Temper outbursts after TBI are likely caused by several factors, including:

  • Injury to the parts of the brain that control emotional expression.
  • Frustration and dissatisfaction with the changes in life brought on by the injury, such as loss of one’s job and independence.
  • Feeling isolated, depressed or misunderstood.
  • Difficulty concentrating, remembering, expressing oneself or following conversations, all of which can lead to frustration.
  • Tiring easily
  • Pain

What can be done about temper problems?

  • Reducing stress and decreasing irritating situations can remove some of the triggers for temper outbursts and irritability.
  • People with brain injury can learn some basic anger management skills such as self-calming strategies, relaxation and better communication methods. A psychologist or other mental health professional familiar with TBI can help.
  • Certain medications can be prescribed to help control temper outbursts.

Family members can help by changing the way they react to the temper outbursts:

  • Understand that being irritable and getting angry easily is due to the brain injury. Try not to take it personally.
  • Do not try to argue with the injured person during an outburst. Instead, let him or her cool down for a few minutes first.
  • Do not try to calm the person down by giving in to his or her demands.
  • Set some rules for communication. Let the injured person know that it is not acceptable to yell at, threaten or hurt others. Refuse to talk to the injured person when he or she is yelling or throwing a temper tantrum.
  • After the outburst is over, talk about what might have led to the outburst. Encourage the injured person to discuss the problem in a calm way. Suggest other outlets, such as leaving the room and taking a walk (after letting others know when he/she will return) when the person feels anger coming on.

[[[[Did I mention this is a very LONG post???]]]]

Since I am exhausted – also part of the side-effects of TBI – I’ll leave this the way it is and write “Part 2” later on.

I’m hoping that sharing this information – once all of the parts are finished – will assist the world at large to truly comprehend how life changing something as simple as three words (traumatic brain injury) can really be. It doesn’t just affect the survivors. It affects their families, loved ones, the ability to work, socialize, have a normal sleeping schedule, and the overall health and wellness of the survivor (both emotionally and physically.)

It affects every single part of life. Some of the most simple and taken for granted portions of everyday life is altered so drastically that the survivor will never return to the “normal” they were before their injury. That’s really the whole point and reason for sharing ALLLLL of this plethora of information.

(As an example) Having a child changes your heart/emotions, your priorities, your habits, your reasons for your choices, etc – but a brain injury does the same things for many intricate different reasons.

Brain injuries don’t just alter capabilities (skills) and limitations (things that cannot be controlled or corrected without rehabilitation, if at all,) they alter the entire structure of the mind and the lives of those living with such injuries. What you used to enjoy or get excited about can dramatically change. The things you find tasty and delicious before a brain injury could disgust and appall you after one. I could go on and on – but I’ll bet you’re already eye-tired and would love to take a break (like I’m feeling right now.)

I’ll post “Part 2” soon! Thanks for sticking with me and continuing reading. If you’ve made it this far, you undoubtedly do care about the facts about brain injuries and whomever it is in your life who is affected/surviving one. Thank you for your diligence and concern. I believe that education and honesty about not just the “clinical jargon” but the personal journey brain injury survivors really go through is vital to breaking the stigmas and unrealistic expectations about how much/ how quickly-slowly / and how well anyone with a brain injury can heal. The BEST thing you can do is not expect too much from the survivor. Most brain injuries never fully heal, and the survivors will never have the same “normal” they had before their injury. (No, that’s not very encouraging, but it’s damned honest – and that’s something that needs to be very clear.) There is NO “Cure,” there has never been a “Full Recovery” from a brain injury (TBI’s most especially,) and there may never be either.

That doesn’t mean you shouldn’t support, love, and encourage someone with a brain injury. But – if you do encourage them, do so with accurate, realistic, and non-expectation. Do not say to a TBI-survivor that they’ll “be back to normal” in any amount of time. The truth is, it takes several years to heal to a certain point, and then the healing plateaus and the brain starts “compensating” instead of continuing healing. The “new normal” is what should be encouraged. Accepting that there is no cure, no full recovery, and no “old normal” is nothing short of awesomely realistic and fair to the survivor. Giving them unrealistic expectations or false hopes is damaging. A survivor cannot adjust and adapt if they expect false hopes to “come true” for them and their injury. It truly is a life-long change. One that everyone in their lives must accept and become familiar with. 🙂

Again – THANK YOU for reading all of this…. thank you, thank you!

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