Deep Dive into TBI Treatment: Medications, Symptoms, and Recovery Part 1

0:00:09 - Kiley Como
Hey, welcome back everybody. Welcome to another episode of Mind Matters: Navigating Head Injuries and Concussions. My name is Kiley Como. I am the nurse coordinator with Shane Smith Law. Here today with one of our senior concussion and brain injury group attorneys, John Mobley. John, thanks for taking some time to be with us and sharing your knowledge. So today we're going to be talking about traumatic brain injury. We're going to kind of take a deep dive into this. There's a lot of information, so we're going to break this up into two parts. So stick with us, please. So, john, let's get it going. Let's talk about some treatments for TBI. You know, for so many things, we're in allergy season. You can take a pill off the shelf, take care of your sniffly nose all of those things. But TBI is a little different than that. So what are we looking at there?

0:00:49 - John Mobley
Absolutely, Kiley, thanks for that intro. And really what we wanted to do, our big goal today was to kind of address some of the things that people can face once they receive that TBI diagnosis, right. What is next? What does life entail? What does the future hold from a medical standpoint, financial standpoint?

You know there's a lot of things that are involved with TBI treatment. You know a variety of treatments can help a person recover from TBI. It can sometimes reduce or eliminate or mitigate certain, you know, the physical, emotional and cognitive problems that our TBI survivors and victims that we represent experience. So the specific, you know treatment, including the type and the setting, the length, depend really on how severe that initial TBI is and really what area of the brain was injured. And I know we've talked about that at length, in depth, with the viewers previously.

You know, depending on what area of the brain experiences the injury results in different types of symptoms that our clients and victims see.

0:02:00 - Kiley Como
And so you know the brain, it's vast, it's complex, we know there's a lot we don't know about it. We'll say TBI is kind of similar, right? So I know one thing that the firm sees a lot in its clients, you know that, those varying degrees of TBI that you mentioned, let's start with that mild TBI kind of something that may be a little more insidious, right? So tell us about that.

0:02:14 - John Mobley
Absolutely, Kiley. So you know we've gone over in the past kind of the spectrum that a head injury victim can sustain on a medical chart. It can range everything from a mild concussion to post concussion syndrome, to a mild TBI, moderate, severe and up to death. So depending on where you fall on that line in that diagnosis depends on how bad that initial either impact is or basically how the brain responds to the injury. Every brain is different and this is something that we have to explain to our clients. And sometimes our, in these victims of these motor vehicle accidents or head injuries is that, you know, every brain is going to react differently. For mild TBIs it's, it's interesting, Kiley, because it is, there's nothing mild about it. It's almost a misleading label, but that's just the terminology that the medical community has chosen. But trust me, if you have experienced or been diagnosed with a mild brain injury, there's nothing mild about it because it will have a huge impact on your life.

Mild TBIs can include everything from concussions, things like that.

They may not require specific treatment other than just rest sometimes.

However, you know, it can be important to follow your healthcare provider's instructions for, you know, complete rest and a slow return to normal activities for recovery from a mild TBI.

You know, one of the things that we see is that if someone tries to resume their normal life activities with a mild TBI too soon or before completing the treatment, they experience real setbacks. Real setbacks and real complications, either with home life, normal activities or, a lot of times we see, with jobs. And depending on if your job is something that requires, you know, some serious responsibility or cognitive abilities. People really struggle. So we urge our clients to treat until you get completely better, and sometimes that includes even interviewing family, friends or spouses, because a lot of times it's really a sad reality, Kiley, our clients don't even realize they're experiencing some of these traumatic brain injury deficits until we talk to the spouse, until we talk to the family member who sees them every day, and then they tell us they're not back to normal. So that's the real imperative that we place and the onus we place on our clients is just go to the treatment, follow the medical
professional's advice.

They do this for a living all day, every day, and that's typically like your primary care physician. But for an elevated treatment path it would be the neurologist who is a brain doctor. These are smart guys and gals and they really help clients, give them a good treatment protocol path to get better. And it really helps for them to navigate what can be one of the hardest times and injuries of someone's life.

So, you know, other things we see with mild TBIs is certain activities such as working on a computer, concentrating for too hard or too long can tire the brain out, even though it's not necessarily physically demanding. A lot of our mild TBI clients will say you know, I used to be able to go four, five, six hours on the computer straight at work and now I have to take, you know, breaks every 30 minutes. So that's just an example of some of the stuff that we see.

0:05:32 - Kiley Como
Yeah, that's, I mean there was a lot there. You hit on some gold there. I think one of the things that struck me the most is, you now, with mild TBI, I think it's something we probably see the most in our clients, right? Those, those more severe ones are are less frequent, which is great. But mild, can, you know, be-- it's misleading, that name, don't you think? I mean you mentioned it. It's uh, it's something that our clients take, need to take, very seriously, and that's one thing I do appreciate about these podcasts and folks like you sharing your expertise and knowledge with everybody listening because it is such a serious issue. So that's some things about mild. So what about, like when a traumatic brain injury first happens, we might be in an emergency situation.

What might that look like if we have an emergency?

0:06:12 - John Mobley
Absolutely. So the emergency care treatment for a TBI generally focuses on stabilizing and keeping the patient alive. That includes everything from, you know, making sure the brain gets enough oxygen to controlling blood and brain pressure and preventing, you know, further injury to the head or the neck. Stabilization, that's always the key with the ER. So a lot of the times we'll see in the ER, you know, the main, one of the main scans they do is a CT scan.

We talked about how mild TBI can be a sometimes misleading label. Well, a CT scan can unfortunately sometimes mislead a person to thinking that they have dodged a serious injury, because a CT scan is only going to show brain fractures, bleeding in the brain. The real serious stuff only a later, only later testing in a more powerful MRI scan that they don't typically do at the hospital, believe it or not, is going to reveal more of the nuances and more of the specifics of the brain injury. And so sometimes we have to explain to our clients, look, the ER said follow up with a neurologist for a reason. It wasn't just for fun. It's because you probably need to do some additional testing to rule out these mild TBIs or some other brain injuries that you may have experienced.

But at the ER in the emergency medicine, you know, one of the things that they do is it can be dealing and removing with blood clots. Bleeding in the brain or between the brain and the skull can lead to, you know, large areas developing clots. Sometimes we see hematomas or subdural hematomas. What that means is that you've got some bleeding, and bleeding on the brain or around the brain is never a good thing and it's definitely a medical emergency.

So, and I know we've addressed it on past podcasts, but the big thing, if there's one walkaway here, is: if you've been in a motor vehicle accident or taken a bad fall on a slip and fall on at a business or at someone's house and you hit your head and you have any sort of symptoms nausea, dizziness, vertigo, ringing in your ears, double vision, it's crucial that you get checked out. It's crucial because something like bleeding that could be easily controlled in an emergency hospital setting, if it goes unchecked, can create a life-threatening emergency. So we always say just please go, get checked out. This is not a time to try and save money or to be wary of going to the doctor. If you're someone who's allergic to going to the doctor, now is not the time. You really just want to get checked out.

Sometimes it's as simple as a brain scan, so that's what they do another thing in the emergency room that they'll do sometimes is, you know, actually repairing skull fractures. That can be, you know, removing pieces of, of the fracture of the skull or other debris in the brain area, so that that healing process can actually begin. You know, another thing that the emergency room will do is relieving pressure inside the skull.

And you, as a medical professional as well Kiley, you're probably familiar with, you know, intracranial pressure. That's a big fancy word, for you know the brain is an enclosed area, so if there's an injury that occurs and swelling, all that swelling and pressure has nowhere to go. So that's another medical emergency and reason why you need to go to the emergency room. Because if you are experiencing that intracranial pressure, it can be a thing that can kill you and that's, that's a scary thought, but another, usually easy fix if you just go to the doctor. So, you know, that's, that's one thing we reiterate to our clients, especially if they call us early. We're like, and they're, they're complaining of headaches and oh, I've been-- sometimes my clients will say I've been sleeping for two days straight. These are not good signs. You need to go and get checked out. Don't wait for, you know, being seen by your family doctor. You probably either need to go to an urgent care and let them assess, or an emergency room.

0:10:01 - Kiley Como
So right. I've seen a lot of things. You're right, the emergency room is where usually that initial care goes on. But you know the brain right, it's inside the skull. It's a finite space. There's nowhere for it to go except for the little opening at the bottom of your skull where the spinal cord comes through. And if you, like you said, if you build up pressure, there's nowhere for that brain to go but through that hole and that can be catastrophic and life-threatening as you said.

I've seen it happen. You know, another thing I've seen is people feel fine, they go home, you know everything's great, but they have this sudden increase. There's a bleeding in the brain that happens suddenly in this epidural space or like one of these small spaces. You felt fine and all of a sudden you don't. So I think the job's not over. You mentioned the family, the friends. It takes a village. You got to keep watch on that person, right? Because if you see anything changing, even though the doc at the ER said you look great, scans are clean, you still got to watch that for quite a while after that right?

0:10:49 - John Mobley
Absolutely. Couldn't agree more. That's the big thing, is that sometimes people don't realize is the ERs main goal is to kind of triage injuries and make sure you are not dying. But some of the kind of finer, specific things that may be impacting your health afterwards are things that really need to be fleshed out under a closer microscope by a specialist. And that's really why the ER you'll see when they give you that little packet and when, on your way out the door, right before you have to stop off at the billing office, you know it'll typically say something along the lines of, like you know, here are your medications and here are the specialists that you need to call immediately to get scheduled with. So please do that, folks. That's important.

0:11:29 - Kiley Como
Yes. Let's talk about that. Medications that can be daunting to some people, especially for people who are otherwise healthy and really don't take medicines. What, uh, what might we expect from a medication list for someone with a TBI?

0:11:41 - John Mobley
Right. So we want to talk about medications because, you know, this is the point of this discussion today is I've been diagnosed with a TBI. What next? What do I expect? One of the huge, you know, medical tools that our medical practitioners use to get our clients who have sustained a brain injury better is medications. Medications can help treat symptoms of TBI. They lower the risk of, you know, some of the conditions that are associated with it.

And when we talk about conditions associated with it, we're talking about all those weird symptoms that just sprout up out of nowhere seemingly depending on what area of the brain you injured. So some medications are useful immediately after a TBI, while others will treat symptoms and problems related to the actual recovery way after the injury. These medications, and there's a list of them, but it's important to go over them just because we see a lot of times that this whole list is recommended to our clients who have sustained particularly bad head injuries.

So that can include, you know anti-anxiety medications, things like an alzaprolam or anxiety medication. Because a lot of the times, you know, if the part of the brain that controls your stimulus response you know fight or flight gets damaged, we see clients that all of a sudden develop nervousness disorders or fear or just general PTSD and depression. That's a symptom of a head injury as well, is that is actually yhey go hand in hand is depression and PTSD. So we'll have clients that are like I just feel down and blue and that anti-anxiety medication can help them return to normalcy while the brain is healing. Anticoagulants would be used to prevent blood clots and improve blood flow for some of those brain bleed and clotting issues that we discussed earlier at the ER. In very serious cases we'll see anticonvulsants sometimes used Kiley, and that is used to actually prevent seizures. So in the more serious cases or sometimes we have clients that have had seizures in the past or maybe have a seizure disorder that has been under control and then they have a particularly bad brain injury and those seizures either increase with frequency or they come out of dormancy and all of a sudden they're having seizures again. And that's such a sad situation because anyone that has a family member with seizures knows the life impact that has. You're talking about the loss of the driver's license, revocation of driver's license, inability to, you know, sometimes be alone without someone watching you. So when we talk about the symptoms and the impacts of these brain injuries, they're some of the most serious cases we handle.

Another thing that is used is antidepressants. I know we talked about anti-anxiety medication, but antidepressants are used too because they'll help treat the symptoms of depression and mood swings. Believe it or not, mood swings is one of the top symptoms that we see reported by not our injury victims but the family members. It's hard to ever admit that you're having a mood swing or step outside of your body to give a proper audit of yourself.

But I'll tell you, when we do the interviews with family members and ask them sometimes to give feedback on the impact that the accident has, you know they're quick to say look, you know so-and-so. The victim used to be so patient, so calm, would never snap at us. And now, after this injury, you know it's like I'm either married to a stranger or, you know, dad is completely different. And now they snap at us at the smallest thing. You know, if there's a mess around the house, they absolutely lose their mind and they were never like that before the accident. Well, it's not that they've suddenly gone crazy, it's just that their brain, and that portion of the brain that controls impulse control, is now damaged. Just a sad, sad thing, unfortunately, because it really impacts who you are as a person. And if you think who you are as a person, that's sometimes the most important thing we all have, who we are. Another thing that is used is muscle relaxants.

So muscle relaxants are used to reduce muscle spasms and relax some of the constricted muscles. We see them prescribed all the time for tension headaches and release, especially when you're thinking whiplash injuries, that forward back hyperflexion motion to the neck causes a ton of inflammation. So muscle relaxers help with releasing that clenching feeling that can, a lot of people feel after being involved in a bad motor vehicle accidents. Stimulants, believe it or not, are used to increase both people's attention and their overall alertness. So one of the big problems with brain injuries is that it completely disrupts people's sleep patterns.

Completely. They'll say, you know, I used to sleep like a baby and now I'm waking up four or five times, or they can't get to sleep. Well, what does that mean? You still have to be functional, especially if you're working a job or the breadwinner for the family and you have a family and a mortgage to pay for. You got to be able to do your job. So unfortunately, sometimes the neurologists and doctors will battle sleeplessness and general fatigue from the brain injury with stimulants, which can range from Adderall, ritalin, the various forms of stimulants, controlled caffeine, so that someone has that alertness, just so they can be functional. This isn't to give them an edge. This is just so they can be somewhat normal again.

0:17:22 - Kiley Como
Sounds like a lot of medicines and I think one thing as a nurse I think I have to throw out there is there are a lot of folks out there that may not like taking medicines right? You know, again, maybe they've not really taken a bunch of medicines prior to all this, but is a new, this is a new stage. It's new normal, like you said. It's temporary, hopefully. So I would caution to say always consult with your doctor before you stop taking any of those medications.

A lot of the medications that you mentioned can be damaging if you just abruptly stop them. So always communicate with your doctor about hey, this is making me feel a certain way, or, why am I even taking this, right? So they can always inform on that. Just you know, you can keep that communication line open, right. ALright. Well, that's going to do it for this episode of Mind Matters: Navigating Head Injuries and Concussions. Please, again let me remind you there is a part two, so come back and visit us to catch that information. John, thanks again for being with us. Everybody, please remember to like, hit subscribe. If you're in pain, call Shane at 980-999-9999.