Post Concussion Syndrome. Part 1 – The Bad the Bad and the Ugly.

About three and half months ago I had probably the most profound injury of my life thus far. It looked like nothing substantial. I woke up one day feeling very different. I had a sense of panic that was not my normal fear induced by test anxiety, medical school, or any other urgent situation that would light a fire under my ass. It was date night with Siera and since she had just gotten home she was very excited to go out. I didn’t want to disappoint, so I tried to shake it off, started studying and figured whatever this weird feeling was would go away. It didn’t.

I should probably back up here, two nights prior to this I went to the ER because I was having trouble sleeping, and also felt this mild panic. The night prior to that I had smashed my head onto the ground after double legging someone (a type of wrestling takedown) and then later got repeatedly punched in the head. I originally thought nothing of it because this type of trauma is something I dealt with frequently. Less so recently, but a few years ago when I was more concerned about cage fighting than solely jiujitsu, I would rattle my brain around a couple times a week sparring, now maybe once every other month. The resident physician who saw me in the ER didn’t admit me overnight, prescribed me a muscle relaxer and sent me home with a diagnosis of neck strain and a mild concussion.

The first day after the ER things actually weren’t that bad, I went to training and I felt somewhat normal (I know now concussive symptoms can onset 78 hours later). Looking back on it though, while training I did take a couple elbows to the head from one of our more zealous new guys. He was extending his arms a lot to escape, so I would arm bar him. My coach noticed that he was making this error so we did some situational rolling, where he had to escape mount without getting his arm taken by me. I didn’t want to smother him, so he could get a sense of escaping mount properly, but my distance and his flailing meant me eating a lot of it on the chin. Each time they hit me I was more… aware of it than normal. It felt weird, but I shook it off and kept training.

The next day (two days post head trauma), date night with Siera, is when things started to spiral out of control very quickly. As I mentioned I had begun studying, but I couldn’t focus, this was beyond being distracted, I felt as if I was going to leap out of my skin. Every room I walked into felt like someone had thrown out a flash grenade before I stepped into it. Every second of my existence seemed to be a nightmare. To this day I can’t exactly describe what anxiety feels like, but for those plagued with chronic Generalized Anxiety Disorders (GAD), or Panic Disorders, my heart goes out to you. (Seriously, if someone ever confides in you that they have a mental illness, please do not trivialize it by saying you also have it. These are serious debilitating conditions, there is no doubt when you have it, it isn’t just a little bit of nerves. I’ve always considered myself mentally tough, I’ve put up with a lot of stress in my life, but this is different — it makes you feel literally crazy).

Again, not wanting to ruin date night I tried to keep my cool. I told Siera that I wasn’t feeling very well and she reassured me that we could stay in, but ever the people pleaser, I decided to go out. We went to Hibachi, worst idea ever. If you ever have symptoms from a concussion, do not go to Hibachi, I felt like I was literally in hell. I was barely able to speak, my mind was racing a mile a minute, but I just tried to grin and bear it.

When we finally went to sleep that night, I took muscle relaxant just to ease my mind and fall asleep. It worked for a couple hours, but then I was right back up in my anxiety hell. I felt at all times as if my body were shaking, cold and like I couldn’t get enough air. The worst part was the mental feeling, not the physical. If you can imagine the mental fear you have when you are underwater and running out of air. That desperation to just get to the top and breathe; not the burning of your lungs, or the soreness of your muscles,but the intense fear, the dread, the feeling of doom, the panic. That is how I felt for 24 hours a day.

Still I tried to suck it up and study, being a 2nd year medical student, our next exam was right around the corner. It was useless, I was just staring at pages and not understanding anything. I remember stopping and realizing, something was very wrong. This feeling is not going to go away on its own and I needed to do something about it. I went into my room, asked Siera to join me and I just started heavily crying. I didn’t know what was wrong, or what was happening but I wanted it to stop. Siera was stunned because in three years she has never seen me get that emotional. We went again to the ER. After a lengthy stay and all normal results on exams, they gave me half a xanax, and I was sent home with a diagnosis of Adjustment Disorder, which is basically medical speak for, “we don’t know what the hell is going on with you, but you are suffering mentally probably due to stress maladjustment.”

The xanax calmed me down enough to think rationally for the first time in several days. I had spoken with my father who thought maybe I had been drinking too much, he is a physician and called me in a benzodiazepam prescription. I’ll admit medical students do go heavy on the sauce and given my family history of alcohol abuse, it seemed possible. Even so, I wasn’t drinking every day, or even every other day for that matter. I don’t fit any of the screening criteria for alcoholism, except for binge drinking and that wouldn’t really produce withdrawal. Either way it was the only plausible etiology, except for maybe the spontaneous onset of GAD, or Panic Disorder. Neither of us, nor the ER physicians, were thinking concussion, especially since it was such a mild bump on the head (I’ve suffered worse knockouts with literally  zero symptoms after a few days — I also have friends who have had severe brain trauma, who had to relearn how to talk and walk, so this injury seemed trivial in comparison).

My dad instructed me to use the benzodiazepam very strictly and only when I really needed, as they have a high abuse potential. They were a god send for the anxiety and I’m proud to say I only used them for three days and then I tapered off them. While the anxiety wasn’t gone, it was somewhat subsided, so I could at least function. If we are talking in terms of percents, I was probably feeling like 25% of my functional self. Still I wanted to know what was happening to me. I scheduled an appointment with my primary care physician, during my visit he was the first one who actually attributed my symptoms as likely due to the concussion. He ordered blood work and an EKG to rule out some other less likely diagnoses and prescribed me xanax, to only take in worst case scenarios, which I wound up never using.

After this appointment, I was glad to have some answer and direction as to what was happening to me, but I was having a hard time accepting it. After a symptomatic concussion the first part of rehabilitation is generally rest, no bright lights, no computer time and to limit your mental work as much as possible. As a medical student, this was nearly impossible.

My grades slipped for the first few weeks. I am also president of a club at school and I completely flaked on my duties. It was exceedingly difficult to study. What would normally take me an hour to get through would now take me 4. I would get headaches constantly. I couldn’t wear my glasses for more than 15 minutes. The worst part, however, was my emotional volatility. I would have extremely bad anxiety, but then after the first week this started to develop into short episodes of feeling very depressed. This feeling of depression was also new to me. I thought I had experienced sadness before, but now I knew what depression was. I felt empty and sad for no reason. One moment I would be having a panic attack, the next I would be crying. I didn’t want people around me and I would get legitimately worried I would breakdown in front of people. If you know me at all as a person you know that this isn’t me. I am usually a very outgoing and I am generally an optimist, even in the face of extreme adversity. Looking back I probably should have taken the year off of school.

After my two week follow up with my primary care doctor, we decided that I should see a concussion specialist and a psychiatrist. While I was feeling slightly better, the new found depression and the fact that most of my symptoms hadn’t subsided yet were getting worrisome. There was a problem, however, I had just commissioned as an officer in the Army and I was waiting for my health insurance to kick in. In the mean time I decided to get coverage under medicaid. The most renowned specialist for concussions within a 6 hour radius, The Rothman Institute was literally within 20 minutes of my apartment, but I couldn’t see them because my insurance wouldn’t cover it. Bad news. I actually had even gotten to see one of the doctors lecture on concussions at my school that week, but I couldn’t actually see him as a patient. I asked to pay out of pocket and the receptionist told me it would be literally illegal for the practice to see me because they don’t accept medicaid and I am covered under that insurance. Bummer.

 

I will update with the second half of this story later, but to not leave you in too much suspense: I am feeling much better now, not 100%, but I think I am getting there. In the meantime watch this youtube video of Jared Weiner a black belt in BJJ who went through a similar scenario, his story is crazy and when I say I felt every symptom he did, I mean it.

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