#1---"short-term memory loss due to head injury sustained during motor vehicle accident in December 2002".
Treatment for your short-term memory loss: Items can be maintained indefinitely in short-term memory by rehearsal: e.g. by repeating the information over and over again. An example would be a seven-digit phone number, which is maintained in short-term memory by repetition until the number is dialed, and then fades from short-term memory once the conversation starts. Repetition may also increase the probability that items in short-term memory will enter permanent storage in long-term memory.
#2---"lapse of control- consciousness- when provoked, at times"
In closed head injury, the incidence of posttraumatic epilepsy varies from 2.9-17% for moderate and severe head injury. Seizure disorders involve periodic disturbances of the brain's electrical activity, resulting in some degree of temporary brain dysfunction. People with a seizure disorder are more likely to have a seizure when they are under excess physical or emotional stress or deprived of sleep. Strong stimuli that irritate the brain--such as injury, certain drugs, or sleep deprivation--- can trigger a seizure whether a person has a seizure disorder or not. These seizures are known as "provoked seizures." Avoiding such stimuli can help prevent seizures.
In tonic-clonic seizures and primary generalized epilepsy, abnormal discharges result in a temporary loss of consciousness and a convulsion, with severe muscle spasms and jerking throughout the body. The seizures usually last 1 to 2 minutes. Afterward, the person may have a headache, be temporarily confused, and feel extremely tired. Usually, the person does not remember what happened during the seizure.
Anticonvulsant medication may be needed to reduce the risk of having another seizure. They are necessary for people who have had more than one seizure. For most people, seizures can be controlled with a single drug. If seizures recur, different anticonvulsants are tried. Determining which anticonvulsant medication is effective may take several months. There are many drugs for a physician to choose from to treat seizures. Some of the drugs are Carbamazepine, Clonazepam, Divalproex, Ethosuximide, Felbamate,
Fosphenytoin, Gabapentin, Lamotrigine, Levetiracetam, Lorazepam, Midazolam, Oxcarbazepine,Phenobarbital, Phenytoin, Primidone, Tiagabine, Topiramate, Valproate,
Vigabatrin, or Zonisamide.
If you have a seizure disorder you may have to make some adjustments. For example, you should not drink alcoholic beverages or take recreational drugs. You should not engage in activities where a sudden loss of consciousness could result in serious injury: e.g. you should not swim alone or operate power tools.
A family member or close friend should be trained to help you if a seizure occurs. If a defect in the brain such as a scar can be identified as the cause of your seizures and is confined to a small area, surgically removing that area may eliminate your seizures or reduce their severity and frequency.
Electrical stimulation of the vagus nerve can reduce the number of a certain kind of seizures called partial seizures. A device that looks like a heart pacemaker is implanted under the left collarbone and is connected to the vagus nerve in the neck with a wire that runs under the skin. The device causes a small bulge under the skin. The operation is performed on an outpatient basis and takes about 1 to 2 hours. When people who have such a device sense that a seizure is about to begin, they turn the device on with a magnet. Or, the device may be left on all the time. For some people, vagus nerve stimulation prevents seizures or reduces their frequency and severity. Vagus nerve stimulation is used in addition to anticonvulsants.
#3---"mild asthma"
Mild asthma is generally a sporadic condition. Wheezing and breathlessness may be experienced a couple times per month when triggered by a personal "trigger" e.g. extreme exercise. Treatment for mild asthma is generally relieved with a bronchodilator. Bronchodilators relieve asthma symptoms by relaxing the muscle bands that tighten around the airways. This action rapidly opens the airways, letting more air come in and out of the lungs. As a result, breathing improves. Bronchodilators also help clear mucus from the lungs. As the airways open, the mucus moves more freely and can be coughed out more easily. There are three main types of bronchodilator medications: beta 2-agonists (short- and long-acting forms) for example: Albuterol (Proventil HFA, Ventolin HFA, Accuneb) or Alupent, anticholinergics e.g. Atrovent, and theophylline.
#4---"high blood pressure"
High blood pressure is a blood pressure reading of 140/90 mmHg or higher. Both numbers are important. Uncontrolled high blood pressure can increase your risk of serious health problems. Headaches, dizziness, or nosebleeds typically don't occur until high blood pressure has reached a more advanced stage--- possibly life-threatening. The risk factors for high blood pressure that you can control or manage include: Obesity. The greater body mass you have, the more blood you need to supply oxygen and nutrients to your tissues. The volume of blood circulated through your blood vessels increases and creates extra force on your artery walls. In addition, fat cells produce chemicals that circulate and affect your blood vessels and heart. Inactivity. Lack of physical activity increases your risk of high blood pressure by increasing your risk of being overweight. Inactive people also tend to have higher heart rates. Their heart muscles have to work harder with each contraction, increasing the force on the arteries. Tobacco use. The chemicals in tobacco can damage the lining of your artery walls, causing the arteries to accumulate fatty deposits that contain cholesterol (plaques). Nicotine also constricts your blood vessels and forces your heart to work harder. Sodium sensitivity and salt intake. People who are sodium sensitive retain sodium more easily, leading to fluid retention and increased blood pressure. Low potassium intake. Potassium is a mineral that helps balance the amount of sodium in your cells. If you don't consume or retain enough potassium, you can accumulate too much sodium. Excessive alcohol. Over time, heavy drinking can damage your heart muscle. Stress. High levels of stress can lead to a temporary but dramatic increase in blood pressure.
Treatment for Your High Blood Pressure:
The goal of treatment is to prevent health complications that may occur as a result of high blood pressure. The safest way to control your blood pressure is to change your lifestyle. But sometimes lifestyle changes alone can't reduce your blood pressure enough. You may also have to treat another medical condition besides high blood pressure. In these cases, you may need medication. Discuss with your doctor the goals of treatment and the roles that both lifestyle changes and medications can play. Maintaining lifestyle changes may improve the effectiveness of the medications you're taking and may mean you'll need fewer drugs or lower dosages. Eat a healthy diet based on a variety of foods, such as the Dietary Approaches to Stop Hypertension (DASH) diet
http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf. This diet emphasizes plenty of grains, fruits, vegetables and low-fat dairy foods. It can promote weight loss and help to lower blood pressure. Limiting sodium in your diet can also reduce blood pressure.
Exercise. Regular aerobic exercise seems to lower blood pressure in some people, even without weight loss. For example, walking for 30 minutes most days of the week will lower blood pressure and help with weight loss.Measure your blood pressure at home. Take your medications properly. Release negative thoughts and maintain good relationships, and remain patient and optimistic.
#5---"coma for 3.5 days"
Both direct impact and contrecoup injuries, in which the moving brain careens onto the distant skull opposite the point of impact, can result in focal bleeding beneath the calvarium (upper part of the skull). Such bleeding can result in an intracerebral focal contusion or hemorrhage as well as an extracerebral hemorrhage. After traumatic brain injury, the brain is bathed with potentially toxic neurochemicals called catecholamines.
Prostaglandins are also elevated dramatically in the plasma of patients with moderate-to-severe head trauma during the first 2 weeks after injury. The intracranial pressure is increased in head injury by intracranial bleeding, cell death, and secondary hypoxic and ischemic injuries. Loss of consciousness can be a marker of severe neurological injury.
Some patients acutely recovering from head trauma demonstrate no ability to retain new information. The Mini-Mental State Examination emphasizes left hemisphere functioning patients with mild head injuries score less than 24 out of 30 points when assessed with this instrument 1 year after injury. Patients with any loss of consciousness should undergo CAT scanning. Behavioral disorders, memory, and executive dysfunction correlated with abnormalities of cingulate gyrus metabolism in patients with severe head injuries who underwent resting PET imaging and neuropsychological tests. 80% of patients with severe head injuries experience recoveries with no or little disability after volume expansion, mannitol, CSF drainage, and vasopressors.
Anecdotal reports exist of dramatic alerting responses to both levodopa and methylphenidate in patients with vegetative or comatose states. Levodopa treatment also has resulted in improvement in patients with akinesia and rigidity secondary to traumatic substantia nigral damage. In a randomized trial in 120 military personnel with moderate-to-severe head injuries, in-hospital cognitive rehabilitation proved unsuccessful compared to a limited in-home program, but a subgroup post hoc analysis indicated that patients with unconsciousness lasting 1 hour or more had a greater functional recovery with cognitive rehabilitation than those in the control group.
Medications are used to control seizures, reduce intracranial pressure, and correct electrolyte abnormalities. Nimodipine may be neuroprotective in the subset of patients with traumatic subarachnoid hemorrhages.
Selective serotonin reuptake inhibitors benefit patients with head injuries and emotional incontinence e.g. Sertraline (Zoloft)
82% of 67 patients with mild or moderate head injury experienced a good 1-year outcome, and 73% were able to return to work. However, subjective complaints persisted in a large minority, with more than one third of patients reporting drowsiness, fatigue, forgetfulness, poor concentration, and irritability. Other studies have identified dizziness along with analgesic and psychotropic medication use as predictors of failure to return to work after mild and moderate head injuries.
#6---"busted knee"
Fractures of the knee include fractures of the patella, femoral condyles, tibial eminence, tibial tuberosity, and tibial plateau. Nondisplaced transverse fractures with an intact extensor mechanism are treated with a knee immobilizer, crutches, restriction to only partial weight bearing, and 6 weeks of immobilization. Displaced fractures, or fractures associated with a disrupted extensor mechanism, are referred to orthopedics for possible open reduction and internal fixation. A partial or total patellectomy may be required for severe comminution.
#7---"broken ribs"
Unfortunately, you can't do much about broken ribs except control the pain until the fracture heals. Broken ribs are a common injury, usually caused by trauma to the chest. Signs and symptoms include: pain with a deep breath and pain with pressing over the area of injury. Pain medications may help relieve discomfort. Doctors typically don't recommend compression wraps for broken ribs unless absolutely necessary for pain. This is because compression wraps can keep you from taking deep breaths, which can increase the risk of lung infections. Broken ribs usually heal completely in about two months.
#8---"a broken arm"
A broken or fractured arm means that one or more of the bones of the arm have been cracked. This is a common injury. Most fractures need to have a splint or partial cast applied to stabilize the broken bones. Some breaks especially in the upper arm and shoulder may only need to be immobilized in a sling. In addition to splinting the broken arm, the physician will prescribe medicine for pain control and ice to decrease swelling. Wounds that warrant admission to the hospital are bones that have gone through the skin or have lacerations over the broken area, fractures that are associated with nerve damage, fractures that are associated with blood vessel damage, complicated fractures that have multiple breaks, involve the joints, or are unable to be stabilized in the emergency department or in a doctor's office. Most broken arms do not require admission to the hospital. For all other fractures, the treating doctor will suggest you follow up with an orthopedic doctor (bone specialist). At that time, the orthopedist will determine what further care (continued splinting, casting, or surgery) is necessary based on the type of fracture.
#9---"lost consciousness for 3-days"
Traumatic amnesia is brain damage caused by a severe blow to the head, such as in a motor vehicle accident. It can lead to anything from a loss of consciousness for a few days all the way up to coma. During post-traumatic amnesia, a patient usually fails to remember not only the accident, but also all information learned for several years before the brain injury.
#10---"tried several times over the next 4 months to report problems, yet he never returned my calls"
***WALLI, PLEASE. . . . REPORT SUSPECTED WRONGDOING IN VETERAN'S ADMINISTRATION PROGRAMS AND OPERATIONS BY TELEPHONING THE OFFICE OF THE INSPECTOR GENERAL'S (OIG) HOTLINE--- 1 (800) 488-8244***
#11---"replaced the splint on my arm....some 4 months after the fact...with a cast"
Perhaps you can file a case of Orthopaedic Malpractice
http://www.richfish.com/results.htm
#12---"suffered a serious imbalance for almost 2-years, though some might be attributable to the heavy medication"
You seem to be rational and objective regarding your accident and you remember things pretty well. I commend you. I doubt that you have a serious imbalance; although, as you know, medications can contribute to your psychological confusion or imbalance. I recommend that you be re-evaluated by a neurologist to have your medications up-dated. You may not require as much medication or there may be more recent drugs that can help your condition.
#13---"I can't sleep sound at night"
Insomnia is the perception or complaint of inadequate or poor-quality sleep because of one of more of the following: difficulty falling asleep, waking up frequently during the night with difficulty returning to sleep, waking up too early in the morning, and/or unrefreshing sleep. Evidence supports that trauma (in particular mild concussive injury to the head, neck or upper back) precedes the onset of sleep disorders, such as insomnia, hypersomnia, sleep apnea, and narcolepsy, in certain cases. Following the trauma, sleep disorders can be triggered immediately or can take months or years to develop. Insomnia is frequently associated with depression, which is also linked to head trauma. An upper cervical examination is necessary in each individual's case to assess whether an upper cervical injury is present and whether you might benefit from Chiropractic care to help you sleep.
#14---"cough violently: momentarily "loose control" of all activity, with a rush in my head, spots everywhere, then a waterfall affect. . . . . . .even when there is no cough. I totaled my auto during one of these downloads"
Occasionally syncope may occur during violent coughing spells (especially in men). Syncope is the temporary loss of consciousness and posture, described as "fainting" or "passing out". It's usually related to insufficient blood flow to the brain, accounting for 3 percent of emergency room visits and 6 percent of hospital admissions. Fainting often occurs when the blood pressure is too low (hypertension) and the heart doesn't pump a normal supply of oxygen to the brain. Causes include emotional stress, pain, pooling of blood in the legs, due to sudden changes in body position, overheating, dehydration, heavy sweating or exhaustion. Syncope may occur during violent coughing spells because of rapid changes in blood pressure. It may also result from several heart, neurologic, psychiatric, metabolic and lung disorders. And it may be a side effect of some medicines.
Your primary care physician should examine your heart. An electrocardiogram (EKG or ECG) is used to test for abnormal heart rhythms . Other tests, such as exercise stress test, Holter monitor, and echocardiogram may be needed to rule out other cardiac causes of syncope. If EKG and cardiac tests are normal, then you should undergo a tilt test. The blood pressure and heart rate will be measured while lying down on a board and after the board is tilted up. Someone who has neural mediated syncope (NMS) will usually faint during the tilt, due to the rapid drop in blood pressure and heart rate. As soon as the person is placed on his back again, blood flow and consciousness are restored.
#15---"striking me in the right rear head, causing brain hemorrhaging"
Epidural hemorrhaging, also called extra dural, is an accumulation of blood between the skull and the dura mater. It is usually the result of acceleration-deceleration trauma. This type of bleeding results from lesions of the arteries, most commonly the middle meningeal artery. This means that blood flow is very rapid and may cause a very sudden increase in intracranial pressure that results in loss of consciousness. The patient is usually unconscious immediately, then lucid briefly, then loses conscious again from a large clot in the epidural space. The clot may compress cranial nerves resulting in pupillary dilation, as well as ipsalateral weakness or sometimes paralysis. Surgical aspiration of hematomas resulting from epidural bleeding is often used as a life-saving technique.
#16---"a foreign object penetrated my left forehead....just above the eye."
The definition of a penetrating head trauma is a wound in which a projectile breaches the cranium but does not exit it. The local variations in thickness and strength of the skull and the angle of the impact determine the severity of the fracture and injury to the brain. Traumatic intracranial hematomas can occur alone or in combination. Patients present with the signs and symptoms of an expanding intracranial mass, and the clinical course varies according to the location and rate of accumulation of the hematoma. The classic clinical picture of epidural hematomas is described as involving a lucid interval following the injury; the patient is stunned by the blow, recovers consciousness, and lapses into unconsciousness as the clot expands. Most traumatic epidural hematomas become rapidly symptomatic with progression to coma.
Acute subdural hematoma occurs in association with high rates of acceleration and deceleration of the head that takes place at the time of trauma. This remains one of the most lethal of all head injuries because the impact causing acute subdural hematoma commonly results in associated severe parenchymal brain injuries. Penetrating objects to the cranium must traverse through the scalp, through the skull bones, and through the dura mater before reaching the brain. The dura mater or pachymeninx is the thickest and most superficial meninx. It consists of 2 layers—a superficial layer that fuses with the periosteum and a deeper layer. In the same region between both layers, large venous compartments or sinuses are present. A laceration through these structures can produce significant blood loss or be responsible for producing epidural or subdural hematomas.
Patients with severe penetrating injuries should receive resuscitation according to the Advanced Trauma Life Support guidelines. Patients are triaged based on their clinical condition and findings on CT scan/angiography. Patients without significant mass lesions on CT scan are triaged to the intensive care unit (ICU) for further management. Head elevation to 30 degrees appears to facilitate venous drainage and reduce intracranial pressure. Sedation may be useful in comatose patients for control of ICP. Mannitol is administered. Seizure prophylaxis and antibiotics are administered. A major reason to operate is the removal of hematomas. Patients with penetrating head injury often require cranioplasty secondary to craniectomy. Cranioplasty should be delayed for approximately 1 year, when the patient is medically stable and risk of infectious complications is low.
#17---"Traumatic Brain Injury (TBI)"
Hospitals are mandated to provide information to the Department of Health on all individuals with brain injury that are admitted to the hospital overnight. Data is available on the nature and cause of the injury. Analysis of the data allows staff to pinpoint where and how injuries are occurring, what age groups are affected, and enables the development of programs to prevent injuries. All Tennessee residents listed on the registry receive a letter to inform them of the services available through the TBI Program. Each year approximately 6,000 persons in Tennessee are admitted to the hospital with at least one diagnostic code for head injury.
I recommend that you ask your primary care physician to order neurological rehabilitation. You are an intelligent man. You deserve to receive appropriate rehabilitative care. The Traumatic Brain Injury Program is authorized to provide grants to county and municipal governments and/or non-profit organizations for home and community based programs to serve the needs of those who have suffered traumatic brain injuries and their families. Since 1995, 27 grants totaling $2.3 million dollars have been awarded for a variety of programs including day treatment, housing, supportive living services, education, and prevention, behavioral counseling, camp, professional training, and service coordination.
http://www2.state.tn.us/health/TBI/index.htm
Walli, write a letter to Kenneth S. Robinson, M.D.
Commissioner, State of Tennessee Dept. of Health, or to Governor Phil Bredesen and explain your situation. Some of the million dollars should be spent on rehabilitation for traumatic brain injury patients such as yourself.
Edited by DrHanson on May 17 2006 at 6:08am__________________
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