Mysteries of the Mind, Part 3: The Truth About TBI

As a rehabilitation physician, I treated many patients with brain injuries. But it wasn’t until I experienced the effects of TBI firsthand that I really understood this life-altering injury that affects more than 4 million patients each year in the United States, including over 20 percent of U.S. military personnel.

We are, in fact, experiencing a global TBI epidemic. March is TBI Awareness Month, a time to tackle TBI and raise awareness about these injuries that forever change how people think and process information. In my book “Turn the Lights On!: A Physician’s Personal Journey from the Darkness of Traumatic Brain Injury (TBI) to Hope, Healing and Recovery,” I share the story of my recovery from TBI – a process I did not learn by reading medical texts but developed in a survival challenge to return to my old self, to regain my brain. This yearlong process is recounted so readers might understand that recovery is difficult but quite possible.

The first step to recovery is discovering the truth about mild TBI. Unfortunately, there are many myths surrounding this injury, which we are just now defining and treating. If you or anyone you know is struggling from the signature wound of war, TBI or a sports “concussion,” share this information. It may be the difference between light and dark, hope and despair, life and death.

Myth No. 1: You need to be knocked out to have a brain injury. Even mild injuries such as a soccer header or hitting your head on the car-door frame can result in TBI. Often there is a dazed feeling that lasts for only a few seconds, but you do not have to be knocked out to suffer a TBI. The more severe the injury, the greater the risk of blacking out. As a rule, the longer you are
unconscious, the more likely that injury is severe.

Myth No. 2: If you are dazed or only mildly knocked out, you can return to normal activities immediately. Multiple studies reveal that resting the brain is imperative to healing. That includes limiting stimuli from light, noise, and physical and mental activity. For example, high school athletes who suffer concussions may not return to school immediately due to difficulties they experience while studying.

Myth No. 3: A small concussion without noticeable effects is nothing to worry about. Every head injury should be evaluated, treated and followed, based on the diagnosis. The No. 1 predictor for a head injury is having had a previous head injury, even a mild one. In fact, “second impact syndrome” – when the second concussion occurs soon after the first (hours, days or weeks) – can lead to a more severe injury or death.

Myth No. 4: Everyone with a brain injury who fears or avoids crowds has post-traumatic stress disorder (PTSD). Avoiding crowds, light or loud noises is a trait of PTSD but also a hallmark trait of TBI. This results from the injured brain’s ability to filter information and stimuli. If a TBI sufferer experiences high activity areas, the result is stimulus overload for the brain, which creates an adrenaline release that may lead to panic attacks and further avoidance of these activities.

Myth No. 5: Everyone can self-medicate the effects of TBI with alcohol or drugs. Self-medication, especially with alcohol, is prevalent among TBI patients. The initial use may help reduce the brain overload typically related to the injury, but over the long term can lead to significant social, financial and legal problems. A combination of brain injury and addiction is the leading cause of suicide and homelessness among veterans.

Myth No. 6: You just have a headache; aspirin or acetaminophen will help. The persistent headache resulting from TBI is a warning sign and often related to vascular instability in the brain. Migraine-type headaches are common with TBI and should be treated differently. As an anticoagulant, aspirin can increase bleeding, and use of acetaminophen in high dosages or regularly over a long period can lead to liver problems. Any pain treatment, even over-the-counter medication, should be prescribed by a physician.

Myth No. 7: You cannot concentrate or remember things after your injury. You must be going crazy. You are out of your mind. Difficulty remembering and concentrating are functions of the brain that may be affected by TBI. Recent advances in neuroradiology, such as diffusion tensor or functional MRIs, can show us areas of the brain that are injured or deficient. Even a small area of injury can affect a significant function, such as a lesion in the speech center.

Myth No. 8: Your CT scan or MRI was normal, so you must not have an injury. Standard imaging techniques such as MRIs and CTs are unable to reveal lesions or damage in a majority of TBI cases. Newer techniques such as diffusion tensor MRIs, SPECT and PET scans can better determine the extent of injury. Neuropsychological testing, similar to tests done with athletes, also help determine functional difficulties and identify the location of the brain injury.

Myth No. 9: Months later, you still feel out of sorts, so you won’t ever get better. The brain can continue to recover for up to two years or longer after an injury. Brain retraining, through speech therapy and mind strategies such as computer games or other applications, can assist in healing by prompting the brain to lay down new pathways to perform the functions lost through injury.

Myth No. 10: You cannot wait to be fully recovered and your old self again. Even mild TBI can lead to a shift in brain function and personality. Loss of consciousness or decreased consciousness is often followed by a period of heightened awareness or hyperactivity, especially if you were injured at a time when you were adrenaline-charged. While healing and recovery are possible, diagnosis comes first. This requires increased awareness of what TBI looks like to health-care providers, first responders, employers, family, friends and community leaders. From pro football players to veterans returning home, it is our job to support those suffering from this injury.  

“Turn the Lights On!: A Physician’s Personal Journey from the Darkness of Traumatic Brain Injury (TBI) to Hope, Healing, and Recovery” is available exclusively from amazon.com. For more about Chrisanne Gordon and her work with TBI, visit chrisannegordonmd.com or her nonprofit veterans foundation, resurrectinglives.org.