TBI Thoughts

Somebody had posted this in a TBI group…

Hi everyone, how’s everyone doing? Quick question: what’s the recovery process like for Diffused Axonal shearing? Is there any coming back from this severe type of brain injury? 4 months in and my brother still doesn’t talk.

–Anonymous

And, because I can’t leave well enough alone, perhaps the world may stumble onto my thoughts and find some benefit from it:

Okay, here’s the thing: “DAI” and “Shearing” are the terms that are used medically to describe what’s occurred.

Can anyone come back from it? Well, maybe. It depends on… well… everything.

We’re talking about the one thing in the whole of the known universe that can, so far as we know, interpret the universe. And if one’s brain has been jarred from an impact, if it’s survivable, it may effectively scramble all of the memories and knowledge that person had.

Brain Injuries are as unique as a thumbprint. No two TBIs are the same. With two identical twins in the prime of their health and youth were to sustain identical trauma, they will absolutely have a completely different array of issues. One may feel a bit tired for a few days… and the other may be fatal. They’re that unique.

So, can somebody come back from it? That, like all things, depends.

My TBI was about three years: 4m fall, head first onto concrete, knocked unconscious instantly, coma, DAI, CNS shearing. I was 45 and generally in perfect health. I was in a coma for about two weeks and had to relearn absolutely everything (and I do mean everything) and have been frustrated now and again with proprioception and dexterity challenges.

Today, I’m still relearning and gaining more understanding of the various bumps and ridges of my own particular TBI.

Have I come back? Eh, it depends on one’s interpretation of “coming back”. And upon who one asks. I don’t think I have, yet. But in some ways, I can do more now that I did before. I still walk with a cane every now and again, but don’t like it — yet I can still run a 5K or more (I ran a 1/4 marathon a few months ago). I get mentally exhausted much sooner than some people. But I’m learning how to work around it… and work with it.

It’s been a long journey through a mental and emotional hell — and through it all, it was critically important that I had support and understanding of my wife and family.

Achievement Unlocked

The first time I’d read Heinlein’s Time Enough for Love was in High School. About 30 years ago. One line from the book that seemed most meaningful that, in varying forms, stuck with me throughout the years was on specialization.

Rather, it wasn’t directly from the story itself, but it was a sub-story within the story — from the section, “Excerpts from the Notebooks of Lazarus Long”. Lazarus Long, is, of course, the’s book’s the kilt-clad protagonist.

His notebooks contained wise sayings, recommendations, cautions, realizations, what have you.

One of those excerpts from his fictitious notebooks was this:

A human being should be able to change a diaper, plan an invasion, butcher a hog, conn a ship, design a building, write a sonnet, balance accounts, build a wall, set a bone, comfort the dying, take orders, give orders, cooperate, act alone, solve equations, analyze a new problem, pitch manure, program a computer, cook a tasty meal, fight efficiently, die gallantly. Specialization is for insects.”

Heinlein, Time Enough for Love

For a long time, I had commented that somebody must learn of and actually do each one of those varied tasks throughout life.

Save one. That last.

Not very convenient — you won’t witness your own death.

But it wasn’t until quite recently that I realized that I had, in fact, achieved every single one of those diverse skills as of December nearly three years ago. In fairness, whether it was “gallant” is open to interpretation — so, die gallantly, provisionally.

I’ll take it.

Oh, also:

Yeah, I’ve always been the person who did things out of the natural order.

Something’s Changed – I’m Not the Same

One of the most difficult things for me to accept was an offhand remark from, I think it was my occupational therapist about two months after my injury: the person you were is gone.

I suppose I became rather defensive.

I think my response was something along the lines of, “I have all of the memories of self from a full lifetime, how can he be gone?! I’m right effing here!”

Now, looking back after two and a half years, I don’t think that she or any of the other therapists, nurses, neurologists, or physicians were quite as clear about how true and profound that statement was.

Yes, it hurt emotionally to hear it as if she was speaking of me as if I were dead. But thinking back, it was, for me, exactly what I needed to hear.

It should have been repeated.

Untangling Everything

…on our last episode.


In retrospect, any single one the things that I had described in the previous posts about migraines over the course of a lifetime would be innocuous:

  • chronic persistence of worsening migraines
  • some occasional, mild discomfort with abdominal exertion
  • occasional remarks from various practitioners over the past two decades that my WBC was on the higher end of average
  • significant injury (in 2016) that presented as a rib fracture, but no bruising observed and Xray revealed nothing
  • infection — demonstrable, evidential

We still don’t understand what the exact cause of the infection was. It’s not resolved until we’re certain of the vector itself. So, the big question would be: how was it contracted? When? How long did I have it? Was it something that I’d had since the 1980s? Did I live through Basic Training in 1989 with it? Was it worsened from the 2016 injury? And did that lead to the fall in 2017?

Sure, it’s been identified and treated. Mitigated, perhaps. But not eliminated.

Yet, I find myself wondering whether the infection itself, and the periodic brief episodes of light-headedness — not quite a syncope episode, but brief periods (fleeting, much like PVCs) of a half-second or less experienced in October, November, and December of that year — perhaps in a light-headed moment when I was atop the ladder, I fell.

Apart from the fall itself, any one of the issues above, by themselves, would be insignificant. Yet, together, over a lifetime, they would combine to lead to a realization which ultimately stopped the migraines with which I was contending.

From one perspective, I suppose that it could be said that I had to nearly die in order to accidentally stumble into a cure for the life-long migraines.

⌨️

The End of the Chapter?

…on our last episode.


I mentioned antibiotics… I underwent an extraordinarily intense, many weeks-long IV antibiotic regimen to address what was determined to be a Streptococcus anginosus infection.

What’s curious, I think, is that Strep-a is typically an ENT infection — it’s that “strep throat” thing. Same species of bacteria. And, yet, there it was having taken up residence in my liver. One might wonder, how in the world such a thing could get there. There aren’t many plausible vectors. But, there it was.

Nearing the end of the primary antibiotics — about two weeks worth — it dawned on me that I didn’t have migraines anymore.

The migraines had ceased.

The assorted and worsening symptoms of the prodrome with which I had endured for so many years. The classic “migraine” headache.

Gone.

Completely.

Now, about 18 months later, I haven’t had any recurrence of a migraine. I had also not been aware of until it was gone, that I had some abdominal discomfort — that I thought was just normal — for decades. Since as far back as 1988 or so.

Did the aggressive antibiotics put a stop to them? Scientifically, I’d say they didn’t. But looking back at all of the small, overlooked, issues that’d I’d become accustomed and desensitized to, I’m rather confident that there’s a solid link between them.

My experience is little more than a single data point — and a single data point does not a trend make.

But it’s interesting and something of a curiosity, to me, that the life-long recurrence of migraines completely ceased after the intense IV antibiotic put quite an abrupt halt to the unperceived Streptococcus anginosus infection.

Obviously, we can’t subject everyone with migraines to full-body CT scans in pursuit of zebras, treat the symptoms. But I think it would be interesting to investigate and observe the WBC trend is in those otherwise healthy patients who suffer from frequent migraines. But it wouldn’t be unreasonable to consider that an infection may be contributing.

* A few days before posting this, I had shared this backstory tale with my physiologist. We both reviewed the abdominal CT scans from August 2018 and the scans captured on the date of the fall (December 2017). We’re in agreement that it’s simply inconclusive. The scans do not provide any visible indication of infection within any organs, liver or otherwise. Yes, the scans from 2018 absolutely make clear that there was a significant abscess. But from 2017, there wasn’t enough information to indicate “Yes, there is.” Nor “No, there isn’t”.

Further study is needed.

…🕸📜


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