#Post Concussion Syndrome: Why You Still Have Symptoms

[verstappentime]

max revealed this week that he was definitely driving with brain damage after his silverstone crash and struggled to see during his win at the U.S. grand prix that year (3 months later). obviously this yields hurt/comfort maxiel. daniel isn't too happy about all of this. max's poor head hurts.

→ →→ it’s gp who finds daniel, intercepting him as he comes out of his driver’s room. “max needs you, mate,” he says, calm but serious. maybe a little exasperated.

of course daniel goes.

gp presses a water bottle, mixed with some kind of blue powder, into his hand. “he needs to drink this. and tell him we’re having a look at his visor, okay?”

daniel nods, even though that means nothing to him.

he finds max on the floor with all the lights off, almost tripping over him. “baby,” he says, heart already in his throat. “whatcha doing down there?”

max doesn’t say anything. daniel goes for the light switch; max whines straight away, breathing harshly through his nose. “leave them off.” it sounds like he’s gritting his teeth.

fuck. daniel crouches down beside him. “maxy? is it a migraine?” max is all balled up, his forehead against his knees, navy kit making it hard to see him in the dark. daniel sets a hand on the back of his neck – he’s overwarm and still sticky with champagne. he looked okay, after the race. he looked fine. he hasn’t had a migraine in months, after a string of them following silverstone.

max still isn’t talking. daniel’s heart is thumping in his chest. he tries, “gp says they’re looking at your visor?”

max reaches around blindly, finding his phone and holding it out to daniel. “text him and tell him not to do that. say i’m fine.”

“what?”

max waves the phone at him. “tell him good win, thank you, whatever, and there’s no need, and i’m fine. daniel, please text him.”

“max. you’re not–”

“daniel.” max presses the heels of his palms into his eyes. “fuck. just say it. i don’t want anyone staying late.”

“then you’ll tell me what’s wrong?” daniel’s worried enough to resort to bartering.

“yes. sure. whatever.”

it’s enough for daniel to tap out the text, trying to mimic the punctuation max would use. “okay. talk.” max reaches out, and daniel doesn’t realize what he wants until he starts patting the back of daniel’s hand. he links their fingers, squeezing. when max doesn’t start right away, he prompts, “can you tell me why gp is worried about your helmet?”

“on the track. i couldn’t. like. see.” max squeezes his hand harder. “fuck, that hurts.”

“you– what? you couldn’t see what?”

“anything?” max makes a miserable noise. “like, everything was– blurry? is that what you say? and i was trying to focus, it was hurting my head. but i’ll sit here for a while and it’ll be fine. just. probably gp didn’t want to leave me on the floor alone.”

“you– max, what?” daniel worried about this for weeks, after silverstone. he read every pamphlet on what he was supposed to watch for, which symptoms meant max needed to go back to the hospital. watched every meal to make sure max wasn’t nauseous, made him rate every headache out of 10. “you were driving, and you couldn’t see?”

“i was thinking maybe i would stop, but i needed to win this one, and i could, so i did.”

“you were thinking maybe you would stop.” max verstappen was going to pull out of a race. fuckfuckfuck. “max, that really isn’t good. it’s– it didn’t hurt at first? not like a migraine?” they’d explained that in the pamphlet. tunnel vision was a migraine; blurred vision was not.

max gives a little shake of his head.

“that’s. they told us to watch for that, do you remember?” daniel lets go of max’s hand, gripping him at both arms. he wants to fucking shake him, but he’s too afraid of hurting him. “it’s. like. a sign of post concussion syndrome. fuck, max, has this happened before?"

“sometimes in the sim,” max says. “whenever i’m looking at a screen for a long time. i don’t know. it goes away. it’s not– i’m not sick or something.”

daniel wishes he had the fucking pamphlet. “max, it’s been three months since your crash. you shouldn’t be driving, you shouldn’t have been driving, i knew it was worse than you were letting on—”

“daniel, you’re hurting me.” max’s voice shrinking. daniel hadn’t noticed how tight his grip had become.

“fuck. sorry. sorry.” daniel lets go, soothing his hands up max’s arms. “can we go to medical? please?”

“no,” max says emphatically.

“max, i think something’s really wrong.” he thinks of max, woozy on the track, not knowing someone’s coming up on his side. bang. smoke.

“i hit my fucking head at 51G. that is what’s wrong. it will get better.”

max is alive and right in front of him, but he’s thinking of jules, in a coma all those months. “you should have told me. you can’t fuck around with this.” god, he sounds mean, but it’s just that he can feel his pulse up to his ears and he needs max to be alright.

“i just want to go home. it hurts so much, daniel.” max sounds so tired. it’s enough to snap him back. because max actually needs him right now, not in some imaginary future disaster world.

“okay. yeah. i’m sorry, baby. we’ll go home.” he’s giving up too easily, but. max never says anything hurts, unless it’s a papercut or something stupid he can pester daniel about for days. he tries to do some of michael’s stupid box breathing technique. four in. four out. okay. take care of max, idiot.

max lets himself be helped up and settled into a chair. he covers his eyes as daniel turns the lights on. they’ve both long missed their debriefs; daniel doesn’t bother looking at his phone. he assumes someone explained for him somehow.

“there’s medicine in my bag, the headache stuff,” max mumbles.

daniel’s hands feel clumsy as he fishes it the bottle out and opens it, taking out two tablets and pressing them into max’s clammy palm. he hands him the blue concoction gp gave him. “drink that, too, hey?” they’d done this so many times back in july. he’d really thought it was over.

daniel fishes through the bag some more, coming up with max’s sunglasses. max puts them on, looking ridiculous as daniel goes around collecting his stuff. he nurses the blue thing quietly, hugging his backpack to his chest when daniel hands it to him. the only other time daniel’s seen max this quiet was after silverstone, stony-faced and wrung out when they’d finally arrived back to the hotel and max had been cleared to go to sleep.

“okay, baby, i think we have everything,” he says quietly, anxiety starting to fade into guilt. he’s not going to convince max to stay out of the car, and they both know that. if max can survive the next month and a half, he’ll win the world championship and then they can fucking. breathe. daniel will make him rest if he has to.

max lets himself be guided to the car with a gentle hand on the small of his back. daniel does his seatbelt for him like he’s a child. he doesn’t even know why. “are we fighting?” max asks, still hugging his backpack.

“no. no? i don't think so. we can talk later. let’s just. you need a shower and sleep.”

“you think gp got my trophy?”

“i’m sure he did, max.” daniel can’t help the tiniest smile. god, this fucking kid.

[oatlystrawberryicecream]

In your opinion, what is Pit Madness really? Like, in what way does it affect Jason?

pit madness is a symptom that some people experience after exposure to a lazarus pit, to me it is one of those things where maybe you get it maybe you dont like how not everyone who has a concussion developes post concussion syndrome. i didn’t see any evidence that jason has ever been pit mad in my reading of lost days and utrh, ra’s al ghul mentions it but jason seems sensible and lucid for everything he does so i think it was more ra’s being unhappy that talia went around him to dunk jason and using it as a reason she was in the wrong than anything else.

i hate the way pit madness shows up in fanon because it is usually an excuse to ignore things jason has done and the reasons why he did them, or it is some sort of episode where he is not in control and is prone to indiscriminate violence. both of those limit his agency, call his judgement and perspective into question, and take away focus from what i think are more interesting aspects of his character for example:

the paradox of the comfort and safety he finds in isolation vs his human need for connection and love

or another one is his unshakable belief that he doesn’t matter and the numerous and elaborate ways he tries to prove to himself and others that he does

or even the loss of identity and purpose he had after his death and how he still isn’t sure what would be meaningful and fulfilling for him and explorations of him learning to make his good days good enough that they are worth all the bad ones

circling back to pit madness i just don’t think it will ever be as (fraught? urgent? significant? emotionally engaging?) as a fully lucid jason trying to process the feelings of abandonment and rejection and betrayal and anger that he has to wrestle every time he sees bruce be a loving father to everyone but him or a symbol of justice to the whole city or the pillar of morality for a group of heroes. if he loses it and goes green every time the emotions get real intense i lose these moments of agony and the realizations he comes to as a result.

there is no way i can think of to twist pit madness so that it is as interesting to me as some of the things i have mentioned. pit madness gives the same vibes as soap opera amnesia plots and identical twins separated at birth where you get to put white out over large swathes and make up character motivations out of nothing. in fanfic people can do all that but when it escapes fic and starts to inform how people see canon it is pretty frustrating.

[amikyle]

I’ve been watching Elementary for years (finishing tv shows takes me a long time. Leave me alone.) and I got to the last season, where Sherlock is diagnosed with both a TBI and post-concussion syndrome. And it’s giving me some feelings.

I love Sherlock Holmes. He is one of my favorite fictional characters of all time. And that includes the adaptations. I have my criticisms, but I’ll take all the Holmes content I can get. In terms of the most recent/ modern adaptations, for me Elementary’s Sherlock is the closest to the books. I’ve seen some wonderful analysis about how the show is about Sherlock becoming a part of a community, which, along with the focus on his addiction, is one of the best parts of the show. But I digress.

As someone who has had multiple concussions and is still dealing with post-concussion syndrome, seeing a character who I idolized growing up dealing with the same condition is incredible. Is it entirely accurate? No - they definitely hyped up certain symptoms for the drama (hallucinations aren’t really something that happens) - but it is fairly close to my own experiences.

It’s both heart breaking and warming to see the frustration and fear that comes with this type of injury portrayed in a sympathetic way. And Watson’s response? Incredible. I wish I had someone in my life respond in the same way. (I did have sympathetic responses, but no one went out of their way to do research to help me). She is a great support for Sherlock and lets him make the decisions, while acting as a buffer when he needs it. Which is such a great thing for a tv show.

There was a moment in the last episode I watched where Sherlock can’t remember why he’d come into a room and is increasingly frustrated. Joan says that everyone does that and he responds, “not me”. And I felt that in my soul. The amount of things that have changed for me in this way, especially memory-wise, that other people say happen to everyone, when I know it’s because of the concussions is tremendous and terrifying.

Seeing Sherlock express his fears and then Joan take them seriously was healing. The number of people in my life who say “oh but it’ll get better” or “just give it time” when I tell them how I’m worried I’ll never be fully healed is overwhelming. I want someone to be like Joan and say, “you might be right. But that doesn’t mean it’s hopeless”. Because I’ve already accepted that each concussion fundamentally changed my life. But that doesn’t mean I have to give up on my goals and hopes for the future. It just means I have to adapt them in ways that are more accessible to me.

I do hope that the show doesn’t end with Sherlock completely breaking down, as that would be a cop-out ending and would let down all of the fantastic work the show put into it’s complexities. I could see him moving upstate/ retiring to look after his bees, which would not only follow the books, but also give him an outlet for his mind without slipping back into his addiction. That’s the part that is most fascinating: Sherlock is scared because he needs to take a break/ step back from cases, but if he doesn’t keep his mind occupied, he’ll most likely relapse, which scares him because then how will his brain heal? And this complexity is why I love the show. He’s humanized in a way that most people can empathize with/ have compassion for while remaining brilliant. Yes, he definitely comes up with solutions no one else would, but he has the same internal conflicts as everyone else. Which makes the addition of a TBI all the more interesting. For how does Sherlock, someone who is used to having full control and function of his brain, deal with the only thing that could truly put an end to his sleuthing? I think the answer lies in the main theme of the show: by relying on the support of the community around him.

[just-stop]

From AFLW to roller derby, experts say its time to take concussion in women's sport seriously

When the Crows chase their third AFLW premiership on Saturday, captain Chelsea Randall will be watching from the sidelines.

A concussion from a collision during last week's preliminary final left her ruled out of the match.

It's a bitter sweet way to end a season — but as Sarah McCarthy knows, a concussion can have much longer consequences

In 2016, Sarah was the jammer for her Sydney roller derby team, skating at high speed in the league's Grand Final, aiming to get past the opposition and score points.

Risks of contact sport

Sarah McCarthy received a knock to the head during a roller derby match.

"I was a few feet in front of the pack, looking over my shoulder," she tells ABC RN's Sporty.

As she skated, a competitor's elbow hit Sarah's neck and jaw hard and she crashed to the ground.

She doesn't remember if she passed out or not, but recalls feeling briefly sick.

She got up, sat out for awhile, but later re-joined the bout, feeling reasonably ok.

It was Sarah's second concussion that week, having had an earlier blow at training.

The next few months passed in a blur of sickness, dizziness and ringing ears.

"I could barely make it past lunch time without falling asleep. My head felt like it was in a vice 24 hours a day," she says.

What was worse, says Sarah, was the memory loss, heightened emotions, and constant haze in her mind as she struggled to manage a big work project.

Sarah's experience is not out of the ordinary. Experts say sportswomen are at higher risk of concussion than male athletes, and the effects of concussion in women tend to be more severe.

Sarah still lives with the ongoing after effects of her concussion even today.

Almost five years on, Sarah continues to live with the implications of Post Concussion Syndrome.

"I struggled verbally, and I still do now if I have a poor night's sleep," Sarah says.

"It's almost like I'm sitting on a chair in a room with a curtain around me and all of my vocabulary is just beyond the curtain. And I can't reach it or I use the wrong words. I forget people's name all the time," she says.

"I'm fatigued every day. I still can't exercise. I can't handle stress, I can't handle light, I can't handle sounds."

What happens when you're concussed?

Dr Adrian Cohen, an emergency and trauma physician who researches concussion prevention, says concussion is not as simple as was once thought.

He says concussion results in less blood flow to the brain.

This means brain cells, called neurons, don't get enough oxygen and glucose. They also suffer a "structural deformity".

Basically, Dr Cohen says, the brain has a "metabolic crisis" and neurons stop working properly.

Why is concussion more common in women?

We don't have enough data on the size of the problem, Dr Cohen says.

But research and scrutiny of concussion in women in sport is growing — largely in the wake of developments in elite men's sport such as the AFL and NFL.

"Doctors like myself who work in this area are definitely seeing it more often and we're seeing it with more severity," Dr Cohen says.

He says women sustain more concussions than men in high-impact sports such as rugby league, rugby union and Australian rules football. Women also take longer to recover.

One possibility is that women may be more likely to report concussion.

But Dr Cohen says there are complex physiological factors at play.

"There are structural differences between men and women's brains," he says.

"They actually have a slightly faster metabolism than male brains, and they have slightly greater oxygen flow to the head.

"The cells themselves can be thought of as being slightly hungrier. So in the context of an injury that disrupts the supply of glucose and oxygen, it can help explain why they suffer more damage."

He also says women are joining high impact sports without years of tackle training and have had less opportunity to build up the strong neck muscles crucial in protecting against impact.

Dr Cohen says these factors are not an argument for reducing women's participation in contact sport — the benefits, he says, far outweigh the risks — but he is urging for new ways to minimise those risks.

"We have to outlaw illegal play that causes damage, we have to get people off the field when they have an injury, we have to recognise concussion," he says.

He is part of a team developing a new device which he says can quickly and accurately assess a player for concussion.

"Instead of just asking somebody whether they're okay, and putting [them] through a 10 minute test, which seems fundamentally flawed at the moment, we have got to put this in the field of objectivity."

Concussion and migranes

Dr Rowena Mobbs, a Macquarie University neurologist who researches and treats the effects of concussion in sportspeople, says there is truth to suggestions that women experience concussion symptoms more severely.

"But there is this really important overlap of chronic migraine after trauma, and the term for this is post-traumatic headache," she says.

"When we talk about migraine ... they're the same multitude of symptoms that can occur in concussion.

"So you can be dizzy and clouded in your thinking, lethargic and have double vision. And we know that women are at three times the risk of chronic migraine than men."

A woman on roller skates playing roller derby can be seen flying up the court.

Experts say more research is needed into concussion in sportswomen.(Liam Mitchell Photography )

She suggests there could be an association between chronic migraine syndrome and concussion, a kind of double whammy for women.

"It's really a complex area," Dr Mobbs says.

"It's fairly new to research because, unfortunately, there's been so much preferred research in men in sport, and we're only just now approaching female concussion."

In Australia, the Sports Brain Bank works on diseases such as chronic traumatic encephalopathy (CTE) and other brain disorders associated with previous concussions or head impacts.

Dr Cohen says there are several Australian sports women who've pledged to donate their brain to the Sports Brain Bank.

"But in general terms, these women won't have been playing the games for as long, and at as high a level," he says.

He says concussion and its long-term consequences "are a numbers game".

"The more impacts to the head you have, the more likely you are to suffer short, medium and long-term consequences. Therefore, the more likely it is to show up as CTE. But we're going to be seeing it in women unfortunately, in the not too distant future."

Invisible injuries

Concussion rules are changing in Australian football codes — the rules that mandated Randall miss the AFLW grand final were brought in earlier this year.

Dr Mobbs welcomes these new rules, but hopes the conversation in elite sport will extend to how concussion is managed at training and in community sport.

In 2019, the Australian Institute of Sport released an updated set of concussion guidelines to improve player safety and address rising concerns in the community around the links between concussion and CTE, which has been linked to dementia and behavioural problems.

Dr Mobbs wants measures like restricting heading the ball in soccer training to be considered.

"We must look after people's brains," she says.

"We can preserve what we love about the sports, they can still be played hard, but it just means that we've got to all get together and think of ways we can preserve brain health for these players."

Sarah McCarthy wishes she'd been stopped from returning to play in the 2016 grand final, and regrets not taking time to immediately rest after the injuries.

She has advice for other people who experience concussion.

"First and foremost, stop everything - stop," she says.

"If you can, stay in a dark room, don't do anything that's too mentally taxing. Don't exercise.

"If I had taken that four to six weeks to rest [and] not have too much mental and emotional stimulation, I think my recovery would have been a lot quicker."

[cryxmercy]

Does HIPPA Still Apply If I Tell You I’m Immortal? || Mercy & Queenie

When: Current, early afternoon Where: White Crest Memorial Hospital Clinic Who: Mercy and Dr. King @drqueenieking

TW: hospitals, death mention, drowning mention, assault mention, injury mention, medical blood, non-con (r/t supernatural powers), mental health, PTSD

A Fury walks into a doctor’s office…  

This was stupid. 

She shouldn’t be here. She didn’t need this. She didn’t need a doctor. It was… ridiculous. 

The slight tremor of her hands - though it happened intermittently - said otherwise. As did the new onset sleepwalking. It had happened again last night. This time she’d ended up in the street, waking up to the blare of a car horn as it swerved to miss her. She would’ve been fine if it hadn’t. Wouldn’t she? It was just a small four-door sedan, after all, and not a semi. She’d had worse. The thought of waking up inside a morgue freezer turned her stomach, and her ire at Dr. Kavanagh, who still had her blocked online (the coward), made her frown.

But it wasn’t the near-miss VVP that had pushed Mercy to call the clinic - asking specifically for the seemingly competent doctor that had treated her in the ER back during the mime-madness - but the idea of not being in control of her body. She hadn’t lied when she’d told Blanche it had never been in issue before. Not in all her 1200 years. And she hadn’t been lying when she’d said she would tell Arthur if it happened again. She would. Later. Once she ruled out any lingering issues of the all too human variety. Still, Mercy didn’t like it here. With it’s antiseptic smell that didn’t hide the lingering miasma of sickness 

that saturated everything. From the stark white walls hung with cheap artwork, to the out of date magazines that begged to be put out of their misery in the nearest trash bin. 

So by the time she was called back, Mercy was damn near ready to scrap the whole thing. But if she ran now, she was no better than a coward. And Mercy was many things, but a coward wasn’t one of them. So she gave the young nurse a forced smile and followed her down the hallway where she was weighed, her vital signs taken, and asked a series of standard questions. Allergies? None. Meds? Nope. Drink? Daily. Smoke? Sometimes. Drugs? Medicinal. 

The nurse gave her a small side-eye, but made a few notes in the chart and left Mercy alone - with instructions to change into the little paper gown on the table - to wait on the doctor. Mercy waited anxiously, finding only mild satisfaction in tossing the ‘gown’ where it belonged: in the trash. She had once again decided this was a bad fucking idea after a solid twenty minutes passed and no doctor. She’d just made up her mind to leave - Fuck this… - when the door finally opened.

The day had been surprisingly slow. Without any near fatal car accidents or wild animal attacks which continued to be one of the most prominent emergency room visits that they received, Queenie had been keeping herself busy by making her rounds around the rooms, popping in with other doctors and requesting that they let her take on some of their work. After all, chances were high that the end result would be better off in Queenie’s hands anyways. Most of the doctor’s in the hospital knew this even if they weren’t willing to admit it. 

However, it turned out that someone had specifically asked for her. Since Queenie did not typically take appointments, this surprised her. The closest thing that she had to a monthly appointment was checking Blanche for a concussion or setting a bone that had come out of socket. And those instances were never scheduled officially, Queenie had just become used to them being a monthly occurrence. If not sooner. So when the nurse had told her, Queenie agreed to it and added it to her calendar, wondering who was coming in and why they specifically wanted to see her.

Queenie often lost track of time at the hospital, and today was no exception. She had been distracted when the nurse told her about the woman’s arrival and had instead been entirely too focused on reminding a fellow doctor that his diagnosis of a patient had been entirely off base and borderline negligent. It wasn’t until the doctor had angrily stormed off that Queenie remembered that she had a patient waiting for her. She jogged across the hospital floor until she found the room on the clipboard that the nurse had given to her and knocked on the door, pushing it open seconds later. “Good afternoon” Queenie began, only glancing at the woman while reading the clipboard. Finally, she looked back up, “You’re a familiar face.” She had been in a few months ago maybe, Queenie couldn’t be sure. “What brings you in today?”

Mercy froze when the door opened and the doctor she remembered from the ER walked in. Well, at least she was seeing the person she’d asked for. Not that this was any easier for Mercy. She hadn’t been to a doctor in… so long that she couldn’t remember. Probably during the Cold War. But this was hardly post-WWII Russia. It was a tiny room at White Crest Memorial. And Mercy wasn’t a spy. She was… tired. She was just… tired. 

It seemed the doctor recognized her too. A double gunshot wound - one of those to the neck - that hadn’t been DOA would probably have been memorable. Or maybe the woman was just being nice. Who knew. Either way, she got right down to business. Mercy appreciated that. 

She sat back on the table, and got right to the point. “I had an accident recently. I drowned. I almost died. I lost my vision for a month afterwards. Vitreous hemorrhage. Since my vision came back… a few weeks now… I’ve started having tremors. In my hands mostly. And I’ve been sleepwalking. I’ve never experienced either of those things before. Insomnia, yes. Nightmares, yes. But never anything quite so severe. So I guess I just wanted to make sure there was nothing… wrong.” She didn’t know what to ask for as far as tests or anything else. So she left it there for now. 

Emergency rooms never exactly gave the best first impression of a person. It was never easy to tell if someone was a friendly person or not when their life was at stake. This woman, Mercy, for instance had been in the emergency room before. She looked lethargic, annoyed even. But she couldn’t tell if these were simply faucets of her personality considering the last time she had seen the woman it had involved a gunshot wound. Most people weren’t exactly sociable after getting shot. 

“You almost drowned? How long ago was this?” Queenie moved toward the table, grabbing at the woman’s wrist and beginning to check her pulse. All seemed normal. “You lost your vision because of it?” That was interesting, and not at all a common side effect of drowning, even the ones with extended periods of exposure to water. “Tremors and sleepwalking… interesting. Have you experienced any shortness of breath? Extreme tiredness?” She glanced down at the patient’s hand she had been using to check the pulse and noticed her finger nails. No discoloration there, that was a good sign. “Where did you almost drown? A lake? The ocean? Your bathtub?” 

Mercy had never been accused of having the warmest personality. And when she was hurt or worried - she’d been both at the time - it only got worse. Usually, she was full of energy. Other than not being a morning person. But who was? And her annoyance came from having enough weird shit going on with her body and in her head that she felt like coming here was one of her last options. So she was thankful when the doctor didn’t dally. 

“A month? Six weeks maybe? Time sorta starts to run together after awhile.” Mercy let herself be examined, watching as the woman checked her pulse. “Yes.” It was either the drowning, or having spent too much time in the place she could only call limbo. A place of darkness and cold, between dying and coming back. “Tell me about it,” Mercy huffed. “Shortness of breath, no. Fatigue…” She frowned. How to explain the eternal weariness that came with being as old as she was? Without revealing how old she was. “Maybe a bit more tired than usual. But I don’t sleep well anyway. Never have.”

Then came the next question: where did she drown. “Dark Score Lake. I was…” Mercy hesitated, but eventually said fuck it. In for a penny and all that shit. “I was assaulted. And that person wrapped their hands around my throat, and held me under until-” The doctor could hopefully draw her own conclusion: until the bubbles stopped. “I was pronounced dead on scene by EMS. So… they took me to the morgue. Where even the medical examiner concluded that I was dead.” Mercy gave the doctor a wan smile. “I woke up in the observation room about four hours later when my friend came to ID my body.”  

So. There it was. 

A month and a half was a long time to continue exhibiting symptoms related to almost drowning. “Fatigue and shortness of breath are both common symptoms of Acute Respiratory Distress Syndrome. Drowning victims that survive often experience this.” She nodded at Mercy’s words, making a note when she mentioned that has never slept well. “Have you ever considered that you may have sleep apnea or some form of insomnia?” Queenie was not entirely concerned about lack of sleep. Not as long as the person was still functioning. However, she knew how long periods of time without sleep could prove to be dangerous. She had too many examples of people falling asleep at the wheel in New York and ending up killing people or getting pretty damned close. “There are doctors that offer sleep studies here. I’m not one of those doctors. However you may consider looking into it.” 

Queenie’s arms dropped to her side as Mercy began explaining the full situation. Her clipboard hit against the railing of the hospital bed as it waved at her side. “You what?” Queenie pressed a finger to her forehead, considering this near impossibility that Mercy had just offered her. “Someone’s heart stopping for that long would risk severe brain damage.” She grabbed at Mercy’s hand again, checking her fingers. No sign that blood circulation had been cut off for an extended period of time. “There is no way you could have actually been dead that long. If I was even going to entertain the idea, I’d recommend a CT scan to make sure you haven’t experienced any brain damage. Honestly, even the thought just seems-” Queenie paused for a moment, noting another point Mercy had made. “You said someone assaulted you? Did they ever catch the person?”

“Insomnia and I are old friends.” Mercy tried to sound blaise, but it fell short. She just sounded... tired. “But no shortness of breath. Not after the first couple of days. And that was mostly because I was coughing so much.” She left out the part about the black oil, if only because she hadn’t seen it for herself. Mercy glanced up to the doctor’s face as she suggested a sleep study. That would probably be a terrible idea. No, it would be a terrible idea. “I’ll think about it,” Mercy nodded, even if she had no intentions whatsoever of letting a complete stranger - likely a human stranger - watch her sleep. 

When she explained the rest, the doctor’s reaction was… well, it wasn’t as bad as Mercy had anticipated. Honestly, she’d expected to be told - again - that it wasn’t possible. That there had been some mistake. Or some other excuse to make Mercy sound insane. “I’m aware,” she said with a note of long-suffering patience. She let the doctor examine her hands again. They looked like normal hands. Small and fine-boned, with neatly manicured nails. There was a tattoo on the underside of her right forearm, and what looked like an old burn scar shaped vaguely like a ‘P’ on the underside of her left wrist. Though she kept it covered with a watch or wrist-band of some sort. 

Mercy huffed when the doctor hit the proverbial nail right on the head. “Yeah.” But that was all she said about the medical examiner. She had her opinions, but she wasn’t here to talk about that. Instead, Mercy nodded in agreement that if she had actually been dead - truly dead - then she would likely not be sitting here now. But then again, Mercy wasn’t human.     

“Insane?” she said, finishing the doctor’s sentence for her. “Yeah. It does. But… there are conditions that mimic death to the point where even a doctor might be fooled. Catalepsy. The Lazarus Phenomenon. Fugu toxin. Even severe hypothermia.” Or being immortal. But it wasn’t as if Mercy could just come out and say that, could she? No matter how much the incident had affected her. 

Mercy hummed quietly, acknowledging the question about the assault. “Yeah. I was out by the lake. I walk at night when I can’t sleep,” she gave as an explanation, since ‘I was helping an exorcist and a supernatural bounty hunter kill and banish a squid-demon back to it’s own dimension’ would most certainly get her a psych workup. “This guy - I think he was drunk or on something - figured he could mug me. Didn’t expect me to fight back. He got the upper hand.” Mercy shrugged, as if it was no big deal. “Yeah, he’s... taken care of.” Not a lie, technically. But she wasn’t about to out Nic when it wasn’t his fault. 

“Why?”

“That sounds awful for you and your friend. I can’t imagine what that must have been like to wake up to.” Though Queenie was not entirely interested in the woman’s individual experience, she had to admit that it was fascinating to consider. How could someone have come back after that long without any permanent damage being done? 

The woman named off explanations for her sudden brush with dead and Queenie crossed her arms, “So you know a bit about medicine then? That’s quite impressive” Queenie didn’t use the term lightly, but liked to give credit where credit was due. Most of those were uncommon phenomena that rarely occurred and were even less frequently diagnosed as such. It was easy to pass things off as miracles or unexplainable. Lesser doctors were easily willing to except those explanations at times, whether it was because they were too incompetent to seek out the truth for themselves or because they enjoyed the idea of a miracle being associated with their name.

“I can’t imagine. Well, I am glad that he is taken care of. I do not drive, so I typically walk home from the hospital at all different hours of the day. I don’t like the idea of someone dangerous like that being on the loose.” Queenie explained. For what it was worth, all that time spent in New York and she had never so much as seen a mugger. From the stories she had heard in the ER, she supposed she could consider herself lucky. On the flipside, she had been in White Crest for only a couple of weeks before she had been attacked and her leg injured. Not that Queenie was willing to admit that Regan may have some backing to her baseless claim that animals were more violent here in White Crest. That must have just been an unlucky coincidence. 

“Well considering all the information that I’ve heard, I’m thinking your issue may not be physical at all.” Queenie crossed her arms, studying the clipboard again. “I am no psychologist, but you seem to be in good physical health. From what I’ve heard about your experience both with the mugger and then in the morgue it seems like you may be more aligned with some sort of PTSD. Though keep in mind that I am in no way qualified to diagnose that officially.” It was more of a hypothesis if anything, one that Queenie did not like to give formally unless necessary. However, from what Queenie had seen so far there didn’t seem to be any evidence that Mercy was suffering any visible defects following the attempted drowning. “I would be interested in running a CT scan, just to be sure. I’d be willing to do it myself, and can set up a time with you if interested.” Queenie tore a sticky note free and scribbled her information down on the pad and handed it off to her. 

Mercy had only tried to talk to Regan to explain that what the medical examiner had witnessed hadn’t been a medical oversight, but more an oversight of Mercy not being human. And only because Mercy knew Regan was fae. As the medical examiner, Regan needed to know - for her own safety as well as the safety of others - what she was dealing with when it came to the non-human residents of White Crest. But she hadn’t wanted to hear it. And Mercy wasn’t the type to beg someone to listen which is why she hadn’t gone over to the morgue and confronted Regan herself. It was only a matter of time before her denial would catch up with her. And that probably made Mercy more angry than anything. Because she’d seen the results of people turning a blind eye to one another. It never ended well.  

“It was… not the best,” Mercy said truthfully. “I wouldn’t wish it on anyone. But… we’re alright.” At least, she thought they were. Arthur tended to keep things close to the vest sometimes, not wanting to upset her. She couldn’t manage to be upset with him for that. 

Mercy smiled again at the compliment. “I try to stay informed.” Plus she’d had a long, long time to research certain things. One didn’t live for 1200 years without several periods of wondering how it all worked. Mercy had come to the conclusion that some things were simply unexplainable. At least in human terms. Miracles existed, but they were rare. Even more rare than Mercy herself.

Mercy nodded as the subject of her assailant passed, glad she wasn’t getting too many questions. It was dealt with. They moved on, and after Dr. King was done examining Mercy, she seemed to come to a tentative conclusion. One that didn’t surprise Mercy. Who didn’t like shrinks. At all. “Post-Traumatic Stress,” Mercy nodded as she took the information in. “I suppose that makes sense. I… I used to be a cop. Before I came here. Seattle. New York before that. We got…” She waved a hand towards her head. “- psych screens all the time. I always passed,” she assured the doctor. “But yeah. Okay. I’ll… look into it.” Mercy wouldn’t look into it. She knew what PTSD was. Had probably suffered from it for centuries. Only they didn’t have a name for it then. She was just glad to have checked out alright physically.

Dr. King mentioned a CT scan and handed Mercy a sticky note. “Thanks,” Mercy told Dr. King, tucking the note away in a pocket after she’d read over it. “I’ll think about it and let you know She’d talk to Arthur first, before she made any decisions. Who knew what the brain of a 1200 year old immortal would look like on a scan like that? It might invite more trouble than it was worth. 

“I would be interested in hearing about any further symptoms or experiences that you may have regarding this. Being legally dead that long is practically unheard of, even with the medical examples that Mercy had given. It could be valuable information to study. Not nearly as much of a medical marvel as someone with wings, but still fascinating stuff. If Queenie were a skeptic, she may even consider that Maine or White Crest truly did have something that caused it to be more susceptible to anomalies. If Queenie were willing to make an hypothesis based purely on a string of unrelated coincidences.

Based on the new information, PTSD seemed even more lucky. So Queenie nodded, “Between that and then your recent attack, I would say it’s not unlikely. It may be worth looking into at the very least.” Though Queenie herself had always considered psychology to be more medically adjacent than a study of medicine in itself, she at least acknowledged that sometimes symptoms were outside of her own physical control. Even if she thought that psychiatrists were glorified counselors that liked to play pharmacist. 

Though Queenie did not hold out much hope that Mercy would be returning for a CT scan anytime soon, she also had other things that she could be focusing on instead. She did not have much concern what Mercy did either way. “Well, you have my contact information. If any symptoms get worse please feel free to contact me. Apparently, I make house calls now.” Queenie stated sarcastically, adding in “At least the town seems to think so.” beneath her breath. “If there’s nothing else bothering you at the moment, then I’d guess that you’re good to go.”

The request to hear more about Mercy’s experience of being ‘legally dead’ for almost four hours wasn’t all that surprising. She could understand the curiosity from a medical standpoint - cheating death was what doctors did, wasn’t it? - and part of her even relished the idea that Dr. King was willing to discuss it. To learn. But Mercy wasn’t going to be a science experiment. She’d taken a risk revealing what she had. But Dr. King had been kind, and she’d listened seemingly without bias. So Mercy granted her one thing. “It’s very dark... and very cold,” she said of her experience with ‘death.’ “Wherever I was, I don’t ever wish to return.” She gave Dr. King a small, tight smile. 

As for the rest. “I’ll give it some thought.” And she would. Not a lot, because she wasn’t about to let some human head doctor try and psychoanalyze her. It wouldn’t end well. For either party. Would Mercy be coming back for a head scan too? Also not likely. She’d checked out physically, so that was good enough for her. It might even satisfy Arthur’s insistence that she get herself checked over. Well, now she had. And she was fine. So when Dr. King started to wrap up, Mercy was quite ready to be on her way. She gave Dr. King a small smirk. “Be careful with that around here,” she said of the house calls. “You never know who you’ll run into.” Or what. “People’ll start to take advantage.”

After thanking the doctor for her time, Mercy agreed that if anything new or concerning came up, she’d be sure to call. Though Mercy’s definition of ‘concerning’ was likely far, far different than Dr. King’s. 

~

[oscarhgreene]

Post Concussion Syndrome: Why You Still Have Symptoms

In today’s broadcast will be discussing some of the newest research regarding post concussion syndrome, and how this research is further validating this condition. We will discuss neuroimaging as well as laboratory tests being used to look for the biomarker of this condition.

Please forward us any comments here on our website or go to our Power Health Facebook page http://ift.tt/1LslSK0

References:

1. Head-Eye Vestibular Motion Therapy Affects the Mental and Physical Health of Severe Chronic Postconcussion Patients. Carrick FR, Clark JF, Pagnacco G, Antonucci MM, Hankir A, Zaman R, Oggero E. Front Neurol. 2017 Aug 22;8:414. doi: 10.3389/fneur.2017.00414. eCollection 2017. PMID: 28878731 [PubMed] Free PMC Article Similar articles

2. Sub-Symptomatic Aerobic Exercise for Patients with Post-Concussion Syndrome: A Critically Appraised Topic. Ritter KG, Hussey MJ, Valovich McLeod TC. J Sport Rehabil. 2017 Sep 27:1-14. doi: 10.1123/jsr.2017-0159. [Epub ahead of print] PMID: 28952858 [PubMed – as supplied by publisher] Similar articles

3. Does the fear avoidance model explain persistent symptoms after traumatic brain injury? Wijenberg MLM, Stapert SZ, Verbunt JA, Ponsford JL, Van Heugten CM. Brain Inj. 2017 Oct 5:1-8. doi: 10.1080/02699052.2017.1366551. [Epub ahead of print] PMID: 28980825 [PubMed – as supplied by publisher]

4. Prognostic value of S-100ß protein for prediction of post-concussion symptoms following a mild traumatic brain injury: systematic review and meta-analysis. Mercier E, Tardif PA, Cameron P, Batomen Kuimi BL, Émond M, Moore L, Mitra B, Frenette J, de Guise E, Ouellet MC, Bordeleau M, Le Sage N. J Neurotrauma. 2017 Oct 2. doi: 10.1089/neu.2017.5013. [Epub ahead of print] PMID: 28969486 [PubMed – as supplied by publisher] Similar articles

5. Characteristics of patients included and enrolled in studies on the prognostic value of serum biomarkers for prediction of postconcussion symptoms following a mild traumatic brain injury: a systematic review. Mercier E, Tardif PA, Emond M, Ouellet MC, de Guise É, Mitra B, Cameron P, Le Sage N. BMJ Open. 2017 Sep 27;7(9):e017848. doi: 10.1136/bmjopen-2017-017848. PMID: 28963310 [PubMed – in process] Free Article Similar articles

6. Preliminary validation of the WHODAS 2.0 for mild traumatic brain injury. Snell D, Iverson GL, Panenka W, Silverberg ND. J Neurotrauma. 2017 Sep 12. [Epub ahead of print] PMID: 28895491 [PubMed – as supplied by publisher] Similar articles

7. CranioSacral Therapy and Visceral Manipulation: A New Treatment Intervention for Concussion Recovery. Wetzler G, Roland M, Fryer-Dietz S, Dettmann-Ahern D. Med Acupunct. 2017 Aug 1;29(4):239-248. doi: 10.1089/acu.2017.1222. PMID: 28874926 [PubMed] Free PMC Article Similar articles

8. Assessing the accuracy of blood RNA profiles to identify patients with post-concussion syndrome: A pilot study in a military patient population. Hardy JJ, Mooney SR, Pearson AN, McGuire D, Correa DJ, Simon RP, Meller R. PLoS One. 2017 Sep 1;12(9):e0183113. doi: 10.1371/journal.pone.0183113. eCollection 2017. PMID: 28863142 [PubMed – in process] Free PMC Article Similar articles

9. Characteristics of the King-Devick test in the assessment of concussed patients in the subacute and later stages after injury. Subotic A, Ting WK, Cusimano MD. PLoS One. 2017 Aug 31;12(8):e0183092. doi: 10.1371/journal.pone.0183092. eCollection 2017. PMID: 28859119 [PubMed – in process] Free PMC Article Similar articles

10. The effect of an acute systemic inflammatory insult on the chronic effects of a single mild traumatic brain injury. Collins-Praino LE, Arulsamy A, Katharesan V, Corrigan F. Behav Brain Res. 2018 Jan 15;336:22-31. doi: 10.1016/j.bbr.2017.08.035. Epub 2017 Aug 30. PMID: 28855139 [PubMed – in process] Similar articles

11. [Resting state fMRI study of emotional network in patients with postconcussion syndrome]. Zhang X, Qian RB, Fu XM, Lin B, Zhang D, Xia CS, Wei XP, Niu CS, Wang YH. Zhonghua Yi Xue Za Zhi. 2017 Jul 4;97(25):1951-1955. doi: 10.3760/cma.j.issn.0376-2491.2017.25.007. Chinese. PMID: 28693073 [PubMed – in process] Similar articles

12. Prevalence of Abnormal Magnetic Resonance Imaging Findings in Children with Persistent Symptoms after Pediatric Sports-Related Concussion. Bonow RH, Friedman SD, Perez FA, Ellenbogen RG, Browd SR, Mac Donald CL, Vavilala MS, Rivara FP. J Neurotrauma. 2017 Oct 1;34(19):2706-2712. doi: 10.1089/neu.2017.4970. Epub 2017 Jul 19. PMID: 28490224 [PubMed – in process] Similar articles

13. Resting-State Functional Connectivity Alterations Associated with Six-Month Outcomes in Mild Traumatic Brain Injury. Palacios EM, Yuh EL, Chang YS, Yue JK, Schnyer DM, Okonkwo DO, Valadka AB, Gordon WA, Maas AIR, Vassar M, Manley GT, Mukherjee P. J Neurotrauma. 2017 Apr 15;34(8):1546-1557. doi: 10.1089/neu.2016.4752. Epub 2017 Jan 13. PMID: 28085565 [PubMed – indexed for MEDLINE] Similar articles

14. Neuropsychological alterations and neuroradiological findings in patients with post-traumatic concussion: Results of a pilot study. R?doi A, Poca MA, Ca��as V, Cevallos JM, Membrado L, Saavedra MC, Vidal M, Martínez-Ricarte F, Sahuquillo J. Neurologia. 2016 Dec 19. pii: S0213-4853(16)30218-3. doi: 10.1016/j.nrl.2016.10.003. [Epub ahead of print] English, Spanish. PMID: 28007313 [PubMed – as supplied by publisher] Free Article Similar articles

15. Mild Traumatic Brain Injury: Longitudinal Study of Cognition, Functional Status, and Post-Traumatic Symptoms. Dikmen S, Machamer J, Temkin N. J Neurotrauma. 2017 Apr 15;34(8):1524-1530. doi: 10.1089/neu.2016.4618. Epub 2016 Dec 2. PMID: 27785968 [PubMed – indexed for MEDLINE] Similar articles

16. Longitudinal Study of Postconcussion Syndrome: Not Everyone Recovers. Hiploylee C, Dufort PA, Davis HS, Wennberg RA, Tartaglia MC, Mikulis D, Hazrati LN, Tator CH. J Neurotrauma. 2017 Apr 15;34(8):1511-1523. doi: 10.1089/neu.2016.4677. Epub 2016 Nov 29. PMID: 27784191 [PubMed – indexed for MEDLINE] Free PMC Article Similar articles

17. Diffusion Tensor Imaging Findings in Post-Concussion Syndrome Patients after Mild Traumatic Brain Injury: A Systematic Review. Khong E, Odenwald N, Hashim E, Cusimano MD. Front Neurol. 2016 Sep 19;7:156. eCollection 2016. Review. PMID: 27698651 [PubMed] Free PMC Article Similar articles

18. Neurochemical Aftermath of Repetitive Mild Traumatic Brain Injury. Shahim P, Tegner Y, Gustafsson B, Gren M, Ärlig J, Olsson M, Lehto N, Engström Å, Höglund K, Portelius E, Zetterberg H, Blennow K. JAMA Neurol. 2016 Nov 1;73(11):1308-1315. doi: 10.1001/jamaneurol.2016.2038. PMID: 27654934 [PubMed – indexed for MEDLINE] Similar articles

19. Post mTBI fatigue is associated with abnormal brain functional connectivity. Nordin LE, Möller MC, Julin P, Bartfai A, Hashim F, Li TQ. Sci Rep. 2016 Feb 16;6:21183. doi: 10.1038/srep21183. PMID: 26878885 [PubMed – indexed for MEDLINE] Free PMC Article Similar articles

The post Post Concussion Syndrome: Why You Still Have Symptoms appeared first on Power Health Talk.

Post Concussion Syndrome: Why You Still Have Symptoms

[wheelchair-punk]

when i was eighteen i got sick, and i never got better

i was a freshman in my first semester of undergrad, starry-eyed and thrilled to be enrolled in real actual college. i’d never had any significant health issues before; nothing more than bruises, bumps, and mild colds. then, when i was home on fall break, i got sick.

at first i thought it was just a typical flu. even when i fainted in the airport on the way back to college, even when i became too weak to walk more than five or ten feet, i chalked it up to a particularly bad viral strain. but as the days turned into weeks and i didn’t recover, i started to realize something was really, really wrong.

my symptoms didn’t stay the same. at first, it was just a cough, a runny nose, a sore throat-- all the normal flu stuff. eventually, those faded, and were replaced by much more debilitating symptoms. i slowly became weaker and weaker. when i sat up, my vision swam, and i became incredibly dizzy. i could feel my heart pounding in my throat. everything ached, and i was more tired than i had ever been in my life. even after fourteen, fifteen, sixteen hours of sleep, i could barely keep my eyes open. when i tried to walk, i immediately fainted. in those first few weeks i sustained countless mild concussions as i stubbornly tried again and again to walk to the dining hall, to class, to the bathroom, only to come to on the floor with a throbbing lump on the back of my head.

as you can probably imagine, this made it nigh impossible to get to class. my grades plummeted. eventually, i just gave up. i don’t remember how long i spent laying in my bed, relying on my roommate to bring me food, barely managing to stumble to the bathroom. it felt like months. i lived in a haze of fatigue and confusion, not understanding what was wrong with me, not understanding why i wasn’t getting better.

obviously, i tried going to the doctor. one of my friends drove me to the clinic on campus, and supported me as i stumbled inside, swaying like a drunk person. i explained my symptoms to the doctor, detailing the debilitating fatigue, the body aches, the racing heart, the fainting six or seven times a day. he raised an eyebrow and took my heart rate (which was extremely elevated), and my blood pressure (which was abysmally low).

then he told me to try breathing into a paper bag and to schedule an appointment with a therapist. he told me it was just anxiety and shooed me out of his office.

i went back to my dorm, confused and frustrated. i could barely stand up, and this doctor was telling me it was all in my head. i knew what anxiety felt like. i’d had panic attacks before. i had a long history of anxiety disorders. this was not anxiety. but i trusted his medical expertise, so i tried to just ignore it and go on with my life.

not long after that appointment, a club i had been active in before i got sick took a field trip to the renaissance fair. i desperately wanted to go, and decided to power through my mysterious and unexplained symptoms and try to just have a good time with my friends.

long story short, i ended the day in the emergency room.

the doctors there established that i was not dying and, even though i was unable to walk or feel my limbs or sit up without gasping for air and sobbing with chest pain, they discharged me and referred me to a local psychologist.

a few days later, i was once more having severe chest pains and shortness of breath. it was the worst pain i had ever experienced, and i curled up in my bed, wailing and gasping. i didn’t want to go to the emergency room, but my roommate dragging me there, convinced i was having a heart attack. once again, i was discharged and told it was all in my head, though this time they humored me and wrote me a referral to a cardiologist.

in between the last emergency room visit and my appointment with the cardiologist, i stumbled across a story on tumblr about a woman with something called Postural Orthostatic Tachycardia Syndrome, or POTS. it wasn’t a very long post, but the symptoms were familiar, so i did some googling. lo and behold-- fainting, chest pain, fatigue, shortness of breath, heart palpitations, flu-like aches and dizziness were all listed as symptoms. when i saw the cardiologist i brought it up, and he agreed that it sounded like that was what i had.

i went through a few more doctors and many more tests-- i was poked, prodded, scanned, stabbed, electrocuted (yes, electrocuted), and finally strapped to a tilt table and had my heart rate and blood pressure measured when i was laying down and when i was held upright. my blood pressure dropped, and my heart rate skyrocketed. finally, i had a diagnosis of POTS.

i had very clear, measurable physiological symptoms and it still took me months to get properly diagnosed. and i was lucky-- many people wait years. this is absolutely unacceptable. we deserve better. i deserved better.

anyways, i’m sharing my story in the hopes that someone else will read it and recognize themselves. maybe it will bring someone one step closer to a diagnosis, the way finding a similar story on tumblr helped me get diagnosed. maybe it’ll just be a mildly interesting anecdote. either way, i’ve rambled on long enough, so i’m going to wrap this up here. thank you for reading, and i wish you good health and understanding doctors.  <3

[averagepostconcussionsettle-blog]

Making A Post Concussion Syndrome Claims & Post Concussion Syndrome

A concussion could be a gentle traumatic brain injury (TBI) that typically happens when a blow to the top, however, it may come back from having one’s head and higher body violently jolted. Concussions don't seem to be uncommon. The general public thinks about concussions as happening throughout soccer games or fights, however, they'll even be caused by automotive accidents or falls.

Most concussions don't cause loss of consciousness. The symptoms of a concussion will embody headaches, inability to concentrate, and impairment of memory, judgment, balance and/or coordination. Most concussions are gentle, and the general public World Health Organization get concussions to recover totally. For more info about average settlement compensation - PCS injury, Visit our website

After AN accident, you will be able to create a claim for the injury – likewise, as a claim for the pain you’ve suffered – however, you’ll prove somebody else was to blame for the accident, and you’ll want medical proof to duplicate your statements.

What About Post-Concussion Syndrome?

Post-concussion syndrome could be a complicated condition within which the patient’s symptoms will last for weeks, months, or perhaps a year or additional when the concussion. Or so a tenth of individuals World Health Organization get concussions to suffer from post-concussion syndrome.

The symptoms of post-concussion syndrome are just like those of concussion, however, may embody new complications like giddiness, fatigue, insomnia, irritability, anxiety, light-weight and noise sensitivity, and activity or emotional changes. The symptoms are worse in some individuals than in others. Post-concussion headaches will desire hemicrania headaches, however, are typically additional like tension headaches. The physiological aspects of post-concussion are still not utterly understood. Physicians still don't agree on specifically why some individuals get post-concussion syndrome, whether or not a person’s symptoms are after all post-concussion syndrome as against additional regular headaches, and the way and why post-concussion syndrome happens physically within the body.

Problems in Cases Involving Post-Concussion Syndrome

The biggest downside with claiming damages for the post-concussion syndrome is that its symptoms will generally be imprecise which cheap physicians can disagree on whether or not a particular patient so has post-concussion syndrome. This is often additionally true for additional severe cases of TBI.

When making an attempt to settle a post-concussion syndrome case, you'll run into the matter that insurers like their claims to be simple and obvious. They like broken leg cases. Everybody is aware of what a broken leg is, the way to diagnose it, however long the recovery amount is, and what the symptoms are. As a result of post-concussion syndrome isn't this clear, insurers might not provide high dollar, and you will be forced into visiting trial. Find out your claim amount for Post concussion syndrome injury visit here https://averagesettlementcompensation.com/post-concussion-syndrome-claim-amount/

At trial, you will run into an identical problem. The jury also will need to create positive that it understands specifically what your injury is, and the post-concussion syndrome is often troublesome to differentiate from different headache-like conditions.

Another downside would possibly arise if your doctors disagree on whether or not you have got post-concussion syndrome. Jurors prefer it once all of the plaintiff’s treating physicians agree. Jurors perceive that insurance doctors usually afflict the treating physicians, so they typically discount what the insurance doctors say. However, if your treating physicians disagree on whether or not you have got post-concussion syndrome or not, the jurors would possibly marvel if you actually have that condition, which will convince be a controversy for you.

[handfulofsky]

So @actiaslunaris came up with an Elementary prompt that I just couldn’t resist (the first line of the story, to be specific) and @joaneuglassiawatson helped pimp it.  Partial spoilers through early season 6. Unabashedly Joanlock, rated T.   1/1

Notice

“I’ve made you aroused. Why?”

Sherlock’s question is casually phrased, but it crashes through what had been a comfortable silence between them and rocks her completely out of her reverie. “I, uh—“

I don’t know what you’re talking about,

she wants to say. But that’s not fair to either of them, and, although he would likely drop the subject, the lie would continue to hover between them indefinitely.

The truth is far from simple. Joan’s been watching him like a hawk ever since he first revealed his post-concussion syndrome to her, and she still feels a little guilty for not putting the pieces together earlier. He suffered needlessly and in silence, and the doctor in her has been taking note of his symptoms almost obsessively ever since. He’s tried to take a less active role in their investigations, but Sherlock’s never been the type to skate around the edges of a mystery—he leans in for all he’s worth—and it’s been up to her to see that he doesn’t overbalance and fall flat in the process.

Maybe that’s how it all started; or maybe it started a long time ago, and she was loath to acknowledge it. But she’s been keeping a close eye on him, and she can’t help liking what she sees. Not the pain, of course, or his frustration with the limits placed on his activities, but she’s far more physically aware of him than she used to be.

The eyes that she looks to for early warning signs of a change in his condition are clear, focused, and ever-changing, ranging anywhere from gray to green depending on the lighting and his clothing choices for the day. But they droop with fatigue more often than they used to, and the tiny wrinkles around them deepen when the headaches begin in earnest. He’ll close them when the pain gets bad and cover them entirely when it’s excruciating, and she thinks it’s probably just as well that he can’t see her fists curl in frustration at her inability to help him.

Sleep poses problems as well. He still needs more of it than he used to, although it’s typically broken into intervals of an hour or two here and there. His shoulders hunch awkwardly when he gets overstimulated and needs a break, so she’s become adept at reading his body language before he can reach that point of discomfort. Urging him to put his head down for a few minutes (she’s scattered throw pillows over all the sofas) usually results in him being able to nap or at least breathe deeply for a few minutes until the worst has passed. Sometimes she puts her work aside and takes advantage of the opportunity to study him. Like those of most people, his features soften while he’s relaxed. His lashes look longer when they’re resting just above his cheekbones, and his lips, so often pursed in thought, twisted in contempt, or pressed together tightly with resolution, are smooth and full above the ever-present stubble dotting his chin.

He’s been working with the single stick more than he used to as well. The exercise is good for him, but he’s taken it too far a time or two and experienced headaches brought on by overexertion. She now makes it a point to check in on him every time she hears the slapping sounds of wood hitting plastic resonating through the brownstone. Sometimes he wears an undershirt, but more often than not she finds him wearing nothing but a low-slung pair of sweatpants and a fine sheen of sweat over his back and chest. He’s always been lean, but the increased workouts have left new accumulations of muscle and sinew standing out like whipcord beneath and between the tattoos. Even when he’s fully clothed, she can see the effect of the exercise in the way he moves. He’s never been clumsy, but he moves with the control and grace of a dancer now. On his good days, at least.

And when, just a few moments ago, she glanced at his hands to check for any signs of tremor, she also realized just how fine and articulate they are, especially the strong, slim fingers that are equally at home wrapped around a singlestick or a lockpick. Those hands were resting atop the arms of his chair while he studied the crime scene photos plastered on the wall, and his thumbs were idly stroking circular patterns against the upholstery. The thought welled up in her without warning—unbidden, but decidedly not unwelcome—

How would they feel on my skin?

Even as startling as the idea was, she couldn’t let it go. Maybe more to the point, she really didn’t want to. And it hadn’t taken him long to recognize that and call her on it.

She clears her throat and starts over again.

“Because you’re...” What? Beautiful? Strong? Brave, intelligent, remarkable in ways she’s only now beginning to appreciate? All of those, really. And more.

“Because you’re you, Sherlock.” 

He snorts dismissively, but not unkindly, and gives her a sad little self-deprecating smile. “Some days more than others. One could make the argument that simply being me, as it were, is not considered by most people to be a positive thing.”

“Of course it is,” she blurts out. She’s a doctor, and well-versed in worst-case scenarios. His symptoms could’ve been caused by an aneurysm, a blood clot, a tumor—treatable conditions, of course, but the thought of someone using a knife inside that brain makes her sick to her stomach. The fact that he’s still himself in all the ways that matter is nothing short of an absolute miracle, and the sudden surge of emotion blurs her vision and constricts her throat, but not enough to keep her from whispering, “It’s everything.”

“Watson?” He stands and crosses the room, stopping directly in front of her perch on the sofa before bending at the waist and looking intently into her brimming eyes. “Are you...” He rocks back and forth on his heels for a moment as though he’s concerned about offending her.  “Are you flesh, or are you phantasm?”

She gets to her feet, not caring that the motion makes the tears finally spill over the edges of her eyelids. “Would anything I say really convince you?”

“I suppose not. My mother was very... realistic. I fear I can no longer fully trust my own eyes, nor my ears.” He waves a hand toward her body. “If I may...?”

“Of course.” She welcomes his touch, wants him to know that her thoughts and feelings are just as real as she is, so she steps well inside his personal space to facilitate that contact.

He bends over towards her and she sucks in a quick breath in unconscious anticipation of a kiss, but instead, he lowers his face into the space just above her shoulder, nuzzling lightly against her hair. The perfume she dabbed there this morning has largely diffused, but she still catches a whiff of it occasionally, and it seems that he’s reassured when he finds it as well. Then he turns his head just far enough so that his lips brush against the line of her jaw and her breath catches at the fleeting caress. When he straightens again, she sees the dot of moisture at the corner of Sherlock’s mouth vanish as his tongue edges out to capture the stray tear. He nods almost imperceptibly at the salt tang, and Joan shudders at the raw intimacy of the moment.

His fingers reach hesitantly for the knot of her tie, and this time his hands really are trembling as they loosen the knot and then remove the fabric altogether, tossing it onto the couch behind her. He gazes questioningly into her eyes once more time, sees her consent, and proceeds to undo the top button of her blouse. It’s a recent purchase, and his brow furrows a little at the stiffness of the material as he undoes another. Then a third. And just as Joan begins to wonder just how far he intends to go in order to verify her existence, he slides a warm hand into the opening of her shirt, resting the heel of it against her sternum with his fingers splayed across the skin directly above her carotid artery.

They stand there silently with her heart literally in the palm of his hand; it’s beating out a rhythm as strong and as steady as the course of their friendship. He tilts his head back as his eyes close, but she’s seen that look on his face often enough to know that it’s not resignation but recognition—that sudden, magical moment when all the disparate pieces fall into place and the mystery ceases to be.

She takes his wrist and presses his hand even more firmly against her body. “So what’s the verdict?”

His eyes fly open and focus intently on hers, and she watches, mesmerized, as the the dark pupils shrink rapidly into the hazel irises. He looks more than a little stunned, and she knows her expression must match his.  

“You are indeed flesh, Watson, as well as fidelity personified.”

“How so?” She wanted his skin on hers even before she had any idea how good it would feel. Now that his investigation is concluded, he’ll likely withdraw again, and she steels herself against the loss of that touch as she reluctantly releases his arm.

Instead, he’s content to leave his hand where it is, and his thumb resumes the sweeping motion she’d noticed earlier, only now it slides along the curve of her collarbone, dipping briefly beneath the strap of her bra before making the return journey—back and forth, warm and gentle, the motion slowing slightly even as the pace of her breathing picks up.

“You told me that being myself wasn’t just a good thing, but, to use your word, everything. And in that particular moment, I was able to see myself the way that you see me. I wasn’t just an addict with relationship issues and odd synapses that insist on firing at random intervals. In your eyes, I was whole.”

“You always have been.”

“Not to anyone else,” he says gently. “Not to myself, especially in my current condition. Make no mistake, I’ve known for quite some time that you value our relationship, that it’s grounded in mutual respect and trust. But then to suddenly realize that you might want something more? It’s truly been an evening full of epiphanies.” The smooth glide of his skin against hers slows even further before finally stopping entirely, but thankfully, it seems as though he’s in no hurry to break their contact.

“I didn’t try to hide this from you,” she explains. “I just never really realized it until now.” As much as it pains her to have to say them, her next words are of vital importance because she knows from experience that he will do just about anything to keep their partnership together. “And I need you to understand—I would never want anything more from our relationship than you’re willing to give.”

He shakes his head a little and smiles, as though she’s said something amusing. “Willing isn’t the word I would choose, Watson. Eager would be more apt. Perhaps now that our eyes have been opened, maybe even bordering on desperate?”

Sherlock finally pulls his hand away from her heated skin, but before she can begin to feel bereft, he plucks at her placket, quickly undoing the remaining buttons. She makes quick work of his shirt as well, and, within moments, the entirety of their respective wardrobes is scattered around the study.

His eyes darken and take on a dangerous gleam as they reach for each other.  The shoulders she admired while she watched him practice are firm and supple beneath her hands, and when he finally kisses her, his mouth is a revelation:  full, warm lips, softer than she expected, and a little reserved, right up until she teases his tongue out with her own. His hands are restless, constantly moving, stroking, igniting sensations she couldn’t possibly have imagined a scant few minutes ago.  She never told him about that first stray thought that she had entertained—the one that started this cascade of desire and emotion.  But it seems as though he recognized it anyway and is intent on answering her question just the same.  As always, she’s more than happy to let him.

fin

[adambrown275]

Information For Parents and Coaches: Concussions in the Context of Sports

Concussions refer to mild but traumatic brain injuries and are common in sports – whether you are an athlete or a sportsperson. They happen to almost everyone, from young players to professionals. Despite being so common, young sports people often suffer worse consequences as it takes them longer to recover as compared to adults.

This is why school administrators, coaches, and parents must know that a concussion has several symptoms, and they can affect sports, social, and school relationships as well. Concussions happen when the player collides or has a hard fall, which is why they must always wear protective gear and follow the rules. If they have suffered a concussion, they must take adequate rest and require a doctor’s clearance to return to play.

What is a concussion?

A concussion occurs when the child’s mental status changes due to trauma, usually by a head injury that affects the brain. Symptoms include forgetfulness, difficulty concentrating, dizziness, headache, and fatigue. Though they disappear in about ten days, they can remain for months with behavioral, mental, physical, and emotional changes.

Over time, you will notice other symptoms such as memory loss, confusion, irritability, drowsiness, balance problems, depression, and change in sleeping patterns. You need a medical professional’s opinion if the patient experiences blurry or double vision, confusion, memory loss, difficulty in concentrating, ringing ears, loss of taste and smell, nervousness, sadness, slurred speech, seizures, and sensitivity to light.

How does a concussion happen?

Our brain is a soft organ, which is protected by the cerebrospinal fluid inside the hard skull. The brain floats in this fluid, can move around or even bang against the skull during a fall or concussion. This can injure nerves and tear blood vessels, causing a temporary loss of normal brain function. Sports-related concussions are caused by incorrectly heading a soccer ball, helmet-to-helmet banging, biking or skateboarding wipeouts, and collision.

How is a concussion diagnosed?

As soon as a concussion is suspected, a certified athletic trainer, coach, or physician must perform a symptoms list review, focused orientation examination, focused neurological examination, and assessment of the child’s ability. If left untreated, these injuries can develop a second-impact syndrome, where they sustain a second head injury before the previous injury has completely healed. A child who loses consciousness during sports must be admitted to a hospital’s emergency department to evaluate their vital signs, consciousness, and other possible injuries.

Concussions are usually diagnosed using neuropsychological assessment, where the child is subjected to short memory, attention, and information processing tests. This is done within forty-eight hours of the injury and regularly afterward.

How is a concussion treated?

Apart from following the doctor’s advice, the best medical treatment for concussion is complete bed rest to reset balance, mood, and vision. If the child has suffered a concussion, the parents must know about the worsening symptoms, medical follow-ups, and future guidelines. They should rest for a week to ten days, though the symptoms may remain for weeks or months. Recovery to the children’s baseline performance level is essential before they are allowed to return. Otherwise, they are considered for intensive neuropsychological evaluation.

Once the symptoms have cleared up, they can gradually return to the field. They must be careful as the brain injury is still healing itself, which might be symptom-free. Keep things slow and steady as they catch up with school, college, work, and sports to let the injury heal completely. They might suffer mood swings, fatigue, memory loss, concentration problems, headaches, insomnia, personality change, and drowsiness – also called post-concussive syndrome.

Children who are suffering from this condition after a concussion must not return to play; if they have had multiple concussions, they should end the sport as there is a high chance of brain damage or death.

When can the child return to play?

Though the child may seem fit enough to play, they must be determined so by a qualified and certified healthcare provider. They can play once their symptoms have receded during and after their physical examination. Neurocognitive testing determines brain functioning, preventing future risks of injury and damage. It examines different aspects of brain functioning such as problem-solving, processing speed, memory, and reaction time. Other testing methods include balance testing and Sideline Concussion Assessment for evaluation.

A concussion is a severe medical condition and requires immediate attention and guidance to rule out significant injury. If you are looking for effective treatment for a concussion, ring us up at MVS Woundcare & Hyperbarics immediately.

[thetragicallynerdy]

So I wanted to add to this excellent excellent list from the perspective of “long-term concussions” - aka concussions that don’t heal within the up-to ~4 months that is considered the “typical” healing range for concussions. I write this as someone who has been healing from a concussion with persistent symptoms (also called post-concussion syndrome) for a 1.5 years, and approximately 4 other concussions. This is really to give y’all some other ideas to work with, especially in terms of long-term healing from concussions.

Concussion symptoms can take over 48 to show up. For example, when I first got concussed I was kinda tired, had sore eyes, and a headache. Two-three days later I was so fatigued I could hardly leave the couch, and had developed significant light/noise sensitivity, balance issues, nausea, etc. So for some folks - they may not know if they just had a bad concussion, because the symptoms might not show up right away. It may be 3-4 days later that they go “oh shit, I am actually not okay.”

Passing out is not an indication of how bad your concussion will take to heal, or how long it will take. I passed out with a concussion when I was 19, got ambulanced to the hospital, and was back to work in 4 days. I did not pass out with my more recent, ‘lighter’ concussion, and even drove home from my sports game, but I’ve been off work for over a year. This is in part due to it being my ~4th concussion, my age, and other factors - but if someone does not pass out this does not mean it is a ‘minor’ concussion. Even the most ‘minor’ concussions can take a *very* long time to heal. For your characters - this can add another level of “what is wrong with me” because it’s pretty common to have feelings of “my concussion wasn’t that bad, why am I not healing”

You can have seizures after a concussion, as a result of it. A family member of mine got concussed, walked to a coffee shop to sit down, and had a seizure about 10 min after the event. The doctor she saw explained that it is basically the brain “resetting” itself. So use this as you will for fic writing purposes!

If you have had a bad concussion (i.e. one that takes months or years to heal from), or if you’ve had a lot of concussions and know how bad they can get, you are often terrified of getting another concussion. When I hit my head I freak the fuck out, and am worried for days or weeks that I reconcussed myself. It’s a huge, huge scare. So if your character has had a lot of concussions, they may also have a huge freak out if they get hit in the head.

In the experience of myself and my family member with a bad concussion, it’s often hard to ‘rate’ your symptoms and know how you are doing with a concussion. So it is normal to insist you are “fine” even though you can barely stand up.

Doctors have no fucking idea what to do with concussions, especially ones that last longer than than the typical 4 months for recovery. Most doctors are still using the “stay in the dark and rest” method of care, which is extremely unhelpful for concussion recovery after the first 48 hours. (i.e. resting and the dark are very important in the first 48 hours, but after that you are supposed to start re-exposing to sensory stuff, moving, etc - just slowly and at a safe/manageable pace). It is very normal to have doctors shrug, say ‘i don’t know what to tell you’, push for you to return to work (especially if you are young), etc etc. Hospitals, from everything I’ve heard are even worse - for example, I know folks in the concussion communities I’m in who have been told “you’re not throwing up, so you are fine” when coming into the emerg room at hospitals.

OP is very correct in that when you have a concussion, and you do too much, it hits a point when you just can’t. Either because of fatigue, or because your head is pounding so hard you can’t focus, or if you do anything more you’ll throw up, etc. It is hard to explain how incredibly tacky/slow my thoughts get when I’ve pushed too hard -  thinking becomes like trying to grind gears that are sticky with molasses. Cognitive fatigue is real! It sucks.

A lot of folks with concussions get sensory issues! This includes things like sensitivity to light/photophobia, sensitivity to noise/hyperacusis, difficulty when there is a ‘lot’ going on, difficulty in crowds, etc.

VISION ISSUES. oh my god vision issues. A lot of folks with concussions have fucked up vision after - stuff like binocular vision dysfunction, oculomotor dysfunction, accommodation issues, etc etc. For me, my eyes hurt all the time. This gets worse when I have to read, look at screens, watch moving things like cars going by, watch tv, etc. It’s also worse depending on how tired I am. It can also lead to things like double vision, blurry vision, difficulty looking at patterns and busy visuals, etc. What this means for your writing: it’s pretty normal for me to try and close my eyes or cover them if I’m tired. Sometimes when I open them, everything is blurry. It takes a while to bring things back into focus. Vision stuff is very useful to include.

It is really hard to explain how a concussion can feel, especially when it becomes your norm! Different ways me/concussed friends have described our concussions include: 

it feels like you’re drunk 24/7 but without the fun stuff or the alcohol (b/c of dizziness, fatigue, difficulty focusing, confusion, disorientation)

like you have a cold, all the time, but without a runny nose or sore throat.

like you just finished writing 5 exams in a row - that kind of fatigue/brain fatigue

It is a lot easier to get concussed if you don’t know a hit is coming. This is because you can’t brace for impact, and your neck snaps in the direction you were hit. (Most concussions include some degree of whiplash.) And when you aren’t expecting the hit, let me tell you from experience, it is so much worse feeling.

Concussions often fuck up your sympathetic/parasympathetic nervous system. When you first get hit your body goes into a sympathetic state - think flight/fight/freeze. For folks with long-term concussions, this is often dysregulated - they are continuously in a state of heightened sympathetic responses, and it makes symptoms so much worse. A lot of folks also have a ton of anxiety - this is a symptom of concussions all on it’s own. What this means for your writing: anytime your characters heart rate increases, their headache/dizziness/fatigue/brain fog might increase. This includes when exercising, when they get anxious, when they get in an argument, etc. When this happens, it feels like you just got smacked by a train of fatigue and headaches. It sucks. It can also happen slowly, and suddenly you realize ‘oh fuck i can’t stand up straight right now’.

Emotions get fucky. This means your character might be fine one moment, then like - struggle to open a bottle of water, and find themselves crying. Or panicking and crying over anything minor or major that goes wrong. Anger is also super normal, and being easily aggravated. Depression and anxiety are very common.

Anyway sorry for the very long addition! Hope some of y’all find it helpful.

Writing Tips: Concussions Edition

In keeping with my typical style, this post is not about the medical facts of concussions, as you can google those yourself pretty easily. Instead, it focuses on the more writing-oriented aspects of head injuries, as well as details that require some first hand knowledge to get right. I’m a hockey player, so in my day, I’ve both seen and had some nice bonks to the head to draw from. I’ll start with the hits themselves and then move into the immediate aftermath, and finish up by touching briefly on long-term effects.

The sounds of a concussion are surprisingly varied, and depend both on location and perspective. If you hit your head on something hard like concrete or a gym floor, you will hear a crack like something brittle breaking. You may not focus on the sound for very long (or possibly not notice it at all) but those around you will definitely hear the same gunshot-esque crack. On softer surfaces, like firm dirt and grass, the sound of your head hitting the ground will be more of a konk sound, both to you and those around you. 

When you hit your head, it will probably bounce. If you’re not too out of it already, you will feel this and it is kind of funny. In my experience, you get maximum bounce from hitting grass or hitting a hard surface while wearing a helmet, and minimum bounce from direct skull-to-concrete action. 

If you hit the ground shoulders or back first, the momentum from your fall will whip your head into the ground, making the impact to your head worse than the initial fall. You can also hurt your neck like this. This motion will be dramatic enough to be noticed by outside observers.

Hitting your head fairly lightly doesn’t usually hurt right away. There will probably be a moment of shock before a wave of pain comes, originating from the point of impact and sweeping through your head. 

Light hits to the head (which I will now refer to as non-concussion hits) can still cause a significant amount of pain and disorientation. It may take a little while to accurately judge how hard you actually hit your head, as it is a sensitive region of the body. If the hit was a non-concussion hit, however, the original wave of pain will move through your head and fade away soon after.

Hard hits (concussion-causing) are a bit different. Those might start hurting right away, though not in a way that registers as pain to you. You might indeed see bright lights and blurry images, though they probably won’t seem like the cartoon kind. It’s more of a look like you’re still moving very fast, even though you’re still.

In that same disorienting time period, you probably won’t be able to tell what you’re doing or what kind of position you’re in. Your brain is scrambled and your body is in high-alert. For a good panic-inducing ten seconds or so, you will be living in a world of extreme pain, bright colors, blurry images, and confusion. The best way to describe it is that sensations register in their most simple forms. Someone yelling to you will simply register as sound. Nothing more specific. Just sound. 

From the outside, this is a very distinctive look. Someone who has just hit their head will probably curl their arms around their head instinctively, balling up to protect themselves. They may seem completely panicked and unreachable for a little while, and they’ll need some time to process what happened.

Now, there is another level of head injuries: the ones that knock you out. If you get hit hard enough, you might just briefly black out. People around you probably won’t notice unless they know you well (example: I can tell right away when one of my teammates has passed out, but for another girl, I wouldn’t know), and it doesn’t seem like a big deal. If you manage to get up after this, it’s probably because you have no idea what’s happening. You won’t feel any pain. You won’t feel or think much at all for a little while, actually. 

If someone is severely concussed (the brain injury kind) they might be in and out of consciousness for a while. They’re not totally out, but they might as well be. This is very dangerous, and you should call emergency services. 

Now it’s time to get into the aftermath of a head injury. Not the medical treatment, but the much later stuff. Someone with a history of concussions is much more likely to get one again. That’s fairly common knowledge. What’s not is the fact that those same people may react differently to even light hits to the head. What may seem like a simple tap to you could cause them extreme pain for several minutes at a time. The more times you get hit, the longer it takes you to recover. 

Now, let’s talk about writing experienced characters. In the same way a wrestler can tell their weight without a scale, someone who is used to head injuries can probably tell right away if their injury is severe. They know all the signs. They don’t need to wait for the bump.

Fight scenes and concussions make good combos, especially when you bring in experienced characters. A character who is focused on their own safety or some goal will probably spring right back up from a non-concussion hit or even a light concussion-causing hit. There will be a moment of disorientation, sure, but after that, their first instinct will be to run for safety. Get somewhere safe ASAP so you can assess the injury. This occurs almost unconsciously. When I hit my head in hockey, I’m at the bench almost before I know what’s happened. 

However, you cannot “fight through” a major head injury. This is something I see a lot in fiction. No matter how badass you are, there comes a point where you just can’t get up, and even if you can, you’re useless. It’s not about pain tolerance or any kind of toughness, because concussions aren’t normal injuries. When you hit your head hard, your world goes away for a little while. You’re in pain, you’re confused, and you can’t really control your own body. There’s no getting up from that, at least not right away.

Hope you guys found this helpful! I’ll be back soon with more whump writing tips, turning my hockey playing into creativity.

[vsplusonline]

How concussions became a 'significant' risk for workplace injury among teachers

New Post has been published on https://apzweb.com/how-concussions-became-a-significant-risk-for-workplace-injury-among-teachers/

How concussions became a 'significant' risk for workplace injury among teachers

TORONTO — Robin Teal never considered her line of work to be particularly dangerous, until she suffered a debilitating concussion that left her painfully aware of the risk teachers face daily.

The educational assistant was monitoring recess when she was accidentally hit in the side of the head with a football thrown by a student.

“Things instantly went black, but I caught myself before I hit the ground,” Teal told CTV News.

“I took off about four days… when I went back to work on Monday it was unbearable. I was still not able to do my job. I couldn’t stand, the nausea, the headaches, the spinning… it was all just too much.”

But Teal’s experience is not a one-off.

Experts say an increasing number of teachers are suffering concussions at work due to accidents in the classroom or at recess, leaving many — Teal included — with debilitating, long-lasting symptoms.

“Teachers wouldn’t think it’s a high risk job, but concussion is a significant risk at school,” Dr. Charles Tator, director of the Canadian Concussion Centre at Toronto Western Hospital, told CTV News.

“Awareness is improving, which is why I think more teachers are coming forward and saying hey it’s not just happening on the soccer field it’s also happening at recess.”

According to Tator, the majority of concussion patients recover within a month, but 20 per cent of patients experience long-term symptoms, including sensitivity to light and sound, vertigo, headaches, fatigue and, in some cases, severe depression or anxiety.

“There are so many symptoms and it drives people literally around the bend,” he said.

“So imagine… if you’re a teacher in front of a class of 25 noisy kids with the bright florescent lights. That’s very difficult for a person recovering from concussion.”

In Teal’s case, she endured months of debilitating symptoms which prevented her from returning to work full-time.

“I started with an hour back [at a time] with a supply in the classroom. But after about an hour in the classroom the nausea and the headaches and the dizziness would start again,” she explained.

Michela Bodnar, a fellow teacher and concussion patient, suffered a similar blow to the head during yard duty. After years of migraines, dizziness and sound sensitivity, Bodnar realized she had suffered a concussion.

“My husband used to say that I was superwoman before and now I have been knocked down a notch,” she told CTV News.

“Sometimes in class I will put earplugs in if it is too loud …. Then my body just shuts down.”

Bodnar says her concussion has had a serious impact on her cognitive ability — so much so that she transitioned from teaching science to religion to reduce the amount of time spent marking and speaking in front of the class.

But it seems more schools and school boards are taking the issue more seriously.

In 2018, the British Columbia Teachers’ Federation reported that teachers had a much higher rate of claim for head injuries than the provincial average.

“Principals want to know when you have been hit and boards want us to report that sort of thing,” said Christine Proulx, a teacher who suffered a concussion while teaching gym class.

“I think it always been happening. I know of other teachers who this has happened to, some recover in two weeks no problem and others have post-concussion syndrome like myself.”

Both Bodnar and Teal say their injuries have made them increasingly aware of the risk to both teachers and students.

“A lot of the schools have gone to not allowing the balls and I think it’s a smart move,” Bodnar said, noting that designating specific spots for kids to play ball sports could reduce the number of accident on the playground.

Teal says her experience has become a teachable moment, opening her eyes to the frequency of which these accidents happen and just how severe concussions can become.

“I just physically make sure I am aware of my surroundings at all times now,” she said.

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[ntrending]

Americans reported hearing torturous sounds in Cuba—and now their brains seem changed

New Post has been published on https://nexcraft.co/americans-reported-hearing-torturous-sounds-in-cuba-and-now-their-brains-seem-changed/

Americans reported hearing torturous sounds in Cuba—and now their brains seem changed

The new study, published in the Journal of the American Medical Association (JAMA), used brain scans to look at three different aspects of brain function in 40 people who were clinically evaluated after reported exposure to the as-yet undetermined phenomenon. (Deposit Photos/)

Beginning in late 2016, government officials from the United States and Canada stationed in Cuba started reporting clusters of symptoms that seemed a bit like a concussion: a sudden onset of headaches, dizziness, and confusion after hearing a high pitched noise. The illness soon became referred to as “Havana syndrome” and the cause has been subject to intense debate, and some experts have suggested that the condition is purely psychological. But a new study, which found that those affected have differences in their brains compared to healthy people, pushes back on that skepticism.

The research builds on a previous study from the same research team outlining the neurological problems experienced by people who lived in Cuba and who reported symptoms. “This is the imaging findings that underlie those clinical symptoms,” says study author Ragini Verma, a professor of radiology and a brain imaging specialist at the University of Pennsylvania School of Medicine.

The new study, published in the Journal of the American Medical Association (JAMA), used brain scans to look at three different aspects of brain function in 40 people who were clinically evaluated after reported exposure to the as-yet undetermined phenomenon. It looked at the overall volume of various regions in their brains; at the fine structure of brain tissue in the cerebellum, which regulates movement and controls balance; and at the connectivity of brain networks involved in hearing, vision, and high-level cognitive skills like memory.

The authors selected those brain regions and networks based on the observed clinical symptoms, Verma says. “It seemed like there should be something wrong in the cerebellum, and that helped form our hypothesis,” she says. Patients in the study also reported visual, auditory, and memory problems.

Images from the brains of those patients were compared with two control groups who had different educational backgrounds. “The first was matched to this population, with at least a college degree, good motor skills, and jobs that require multitasking. The second was a traditional traumatic brain injury control group,” Verma says. The team was not able to build a control group of unaffected government personnel also stationed in Cuba, which is a limitation of the analysis, says Dorina Papageorgiou, a neuroimaging specialist at Baylor College of Medicine. They also didn’t have scans available for patients from before symptoms started, which would have allowed them to have an established baseline for each person and thus pinpoint changes case-by-case.

The analysis found that the patients who had been stationed in Cuba had less volume of white matter, which contains the parts of neurons that connect brain regions together, than the control groups. They had differences in their cerebellum to the control groups, and had lower connectivity in the auditory and visual networks of the brain (though not those involved in executive function).

Notably, Verma says, the patterns of changes in brain volume and in the cerebellum, were unlike the patterns of changes seen in any other diseases—they didn’t look like the changes seen in patients with traumatic brain injuries, for example, or other neurological conditions.

“To the best of my knowledge, this is something unique to these patients,” she says. Seeing a new pattern, she says, is extremely rare.

The findings do indicate, though, that there are structural and functional changes in the brain that offer a potential basis for clinical symptoms. It’s a counter to some criticisms levied on the team’s prior paper that evaluated the neurological symptoms of this patient group, which included skepticism that their experiences weren’t just psychogenic. “The clinical element said there should be a problem in the cerebellum, and the imaging showed changes in the cerebellum. It’s an objective measure,” Verma says.

However, it’s not clear what the overall changes seen in this study mean clinically, for patient function, according to an accompanying editor’s note also published in the JAMA. It’s also not clear how significant the changes between the two groups are, says Gerard Gianoli, a neurotologist (someone who specializes in neurological disorders of the ear) at the Ear and Balance Institute in Louisiana. Gianoli says he’s more convinced by a 2018 paper that showed inner ear damage in those affected. The new paper, though, still provides important data. “It’s a part of the puzzle, and it adds a piece of information,” he says.

The changes in these patients, both in the brain and in the inner ear, could be caused by multiple different things, Gianoli says—this research doesn’t answer questions about the initial trigger. It may never be clear what happened, Verma says. “If you asked me, did something happen, I would say yes. But this doesn’t tell us how or why.”

Written By Nicole Wetsman

[biofunmy]

How The State Department Botched Its Investigation

The second time the American diplomat felt the attack was in her apartment kitchen, after a long day working at the US Embassy in Havana. “I felt an extreme pressure like the full, frontal top of my face was exploding off my head.”

Unsteady on her feet afterward, unable to work, she was medevaced to Miami and diagnosed with a traumatic brain injury. But what caused that injury, and more like it to dozens of other US diplomats and their families? That’s still unknown — and may stay that way due to the way the US State Department began the medical investigation into what happened.

“Day to day, we still don’t know how to attribute it,” said the injured diplomat, who spoke to BuzzFeed News anonymously to preserve her future chances of working overseas.

For the past three years, diplomats working in Cuba have complained of an array of mysterious ailments and symptoms — dizziness, headaches, difficulty concentrating — that often started with reports of metallic shrieks inside their homes in Havana. Many report long-lasting, perhaps permanent effects.

The “Havana syndrome” mystery has been the subject of intense, and public, scrutiny, with much of it focused on the search for some sort of weapon — ultrasound, microwaves, psychology, and even crickets have been offered as explanations. Yet despite intense political pressure, international headlines, sanctions against Cuba, and withdrawal of most US diplomats from Havana, very little still is known about the cause of the “health attacks” as then–secretary of state Rex Tillerson described them in 2017, that affected at least 40 US and Canadian personnel working in the country.

The syndrome is now under investigation by the big guns in biomedicine, federal health agencies, and the US National Academies of Science. But public health experts who spoke to BuzzFeed News said the State Department dropped the ball by not opening the investigation earlier to a wider swath of medical experts outside of its immediate sphere.

“The fundamental problem is you can’t trust anybody here.”

According to interviews with public health officials and affected personnel, as well as documents obtained by BuzzFeed News via a Freedom of Information Act request that included hundreds of emails exchanged between researchers and the US Navy’s research office, much of the early research into the mystery may have been botched or biased. The initial investigation was confined to two competing sets of researchers, both eager to publish studies on their own work, and whose findings have been at odds with each other. In one case, researchers were also seeking to promote their own newly approved medical device as a diagnostic tool. And until now, the effort has lacked broader oversight by an institution capable of cross-disciplinary research.

“The fundamental problem is you can’t trust anybody here,” said medical ethicist Sergio Litewka of the University of Miami, who has written about the political cloud of secrecy and distrust surrounding the diplomats’ injuries. “Not the US State Department and not the Cuban government.” (BuzzFeed has filed a lawsuit with the State Department requesting its communications related to the medical research into the injuries, after the agency denied a request for them on medical privacy and ongoing investigation grounds.)

The two medical teams the State Department first tasked with treating victims — one from the University of Miami Miller School of Medicine and the other from the University of Pennsylvania’s Perelman School of Medicine — diagnosed the diplomats with injuries centered on their own respective areas of research expertise: inner ear damage and concussions. That drew criticism from other medical experts who saw them and the State Department as embracing familiar theories while closing off other explanations, ranging from viruses to poison to mass psychology.

“Medical groups do tend to see what they are used to seeing,” University of Virginia applied ethics professor Deborah Johnson told BuzzFeed News, comparing the situation to the joke about intoxicated people who look for lost keys under a streetlamp because that’s where the light is. “It’s why it is best to hear from a lot of disciplines in an investigation.”

Until now only those two US medical teams have reported, inconclusively, on the injuries to 26 US diplomats (and 14 Canadian ones) that began in Havana in late 2016. The US National Academy of Sciences will begin an investigation starting in the next few weeks, consisting of three standing committees of varied specialists investigating for a year. But outside experts are worried it might be too late to crack the case, starting now one year after the last report of injuries in Havana. They also fear that the State Department and other federal agencies have hobbled the medical investigation by keeping the details closed and hidden from the outside world.

“The National Academy is an excellent choice, likely to bring in sophisticated scientists with a good arm’s length from the political players,” UCLA neuroscientist Mark Cohen told BuzzFeed News. “I hope that the NAS will also take the step of bringing in experts from outside the US, as well.”

Emails show the teams quarreled, refused to share data, and disagreed over study authorship, as they raced to publish in high-prestige publications.

The State Department does not fund medical research but, after the teams from Miami and UPenn failed to reach a consensus, did ask the CDC to investigate the injuries in December 2017. The CDC has not yet published the results of its investigation, more than a year later. The NIH’s brain trauma research, now open to injured diplomats and their families, is a five-year study.

“Our response continues to be guided by the medical facts,” State Department senior medical adviser Behzad Shahbazian told BuzzFeed News in a statement. “World-class brain injury specialists and other scientists” at UPenn, NIH, and CDC, he said, “continue to examine the medical data to gain a better understanding of the nature and mechanism of injury that caused these patients’ symptoms.”

But according to public records obtained by BuzzFeed News, emails show the teams quarreled, refused to share data, and disagreed over study authorship, as they raced to publish in high-prestige publications. (The UPenn team requested copies of their own emails, and then declined to comment on them to BuzzFeed News. The Miami-led team responded after it was presented with a list of incidents in the emails.)

The emails show the Miami-led team discussed turning the investigation into a multiyear effort at the US Office of Naval Research (ONR) and, more unusual, also looked at the research on the injured diplomats as a marketing opportunity for diagnostic goggles — a medical device that one researcher and his university had a patent application on. (Via a spokesperson, the researcher denied having a financial interest in the patent.) They also worried about “State trying to reclaim ownership” of the investigation, according to their communications, which also privately suggest some saw little chance that the cause of the illnesses that started more than two years ago in Havana would ever be found.

Miami Herald / Getty Images

Workers at the US Embassy in Havana leave the building on Sept. 29, 2017, after the State Department announced that it was withdrawing all but essential personnel from the embassy because Cuba could no longer guarantee diplomats’ safety.

In November 2016, the first cases of strange noises and injuries began appearing among a handful of diplomats posted to Havana. Initial reports were of buzzing sounds inside private homes. Embassy security at first thought these were just noises meant to annoy staff, according to US Senate testimony by State Department security official Todd Brown. The erratic nature of the incidents, a few one week, and then none another, added to the confusion, but by February 2017 it was clear that around half a dozen embassy staff were ill with headaches, hearing loss, or vertigo.

From the beginning, the medical investigation into these reports was ad hoc, a side project run by the doctors tasked with diagnosing and treating the diplomats and their families. The research investigation was allowed by the State Department, but not run by it.

“I literally got this call, ‘This is the State Department, we have a problem,’” University of Miami medical school otolaryngologist Michael Hoffer told a Pentagon-sponsored presentation last August. “All of these individuals had experienced a loud noise or pressure before and during the symptoms.”

Hoffer, a former Navy doctor with two decades of military experience, had experience with blast victims who sustained traumatic brain injuries during the Iraq War, even receiving funding from the NFL Foundation for his research. Since Miami was the evacuation point for the embassy, it made sense for the State Department to ask the University of Miami expert to look at what resembled head injuries. He and his colleagues examined evacuated staff members with injuries in Miami, giving them neurologic, hearing, and physical exams. He later traveled to Havana to see many more, mostly unaffected personnel.

In late March 2017, embassy staff were gathered in Havana by then-ambassador Jeffrey DeLaurentis, who warned them about the incidents and said they would be evaluated if they wished. It was the first time many had heard about the injuries or the sounds. According to news reports, Canadian diplomats and their families, including children, also began reporting such ailments that month — including headaches, nosebleeds, dizziness, and ringing in the ears — from similar sound-linked incidents. (Fifteen Canadians, including five diplomats, sued their country in February, charging that their government “downplayed the seriousness of the situation, hoarded and concealed critical health and safety information, and gave false, misleading, and incomplete information to diplomatic staff.”)

And the injuries kept coming.

“Like a teapot on steroids, such a very high-pitched sound,” the injured American diplomat told BuzzFeed News about the incident in her Havana apartment in April 2017, one month after the embassy town hall. While in her apartment kitchen, “I literally had to duck around a corner to get away from it,” she said.

“Like a teapot on steroids, such a very high-pitched sound.”

Her vision started to blur over the next three days, so she went to a Cuban eye doctor, who diagnosed bleeding in her retinas. “We couldn’t tell the [Cuban doctor] anything,” she said, but the State Department quickly evacuated her as soon as she alerted them about the problem. She stayed in Florida for about six weeks for treatment for her eyes, before returning to Havana “to resume life.”

Shortly after her return, there was a second incident in the apartment, accompanied by a buzzing noise. She said, “A sudden force on my face was pulling it up, everywhere above the nose.” Afterward she felt unsteady while walking and had fatigue and difficulty concentrating. She was evacuated to Miami, where she was evaluated for a traumatic blast injury, in the process donning a pair of experimental diagnostic goggles that tracked her eyes to measure the severity of her vertigo, and serving as a data point in Hoffer’s research. (Essentially, the goggles claim to track how the pupils of the eyes constrict in response to seeing objects move back and forth, an involuntary response that people with even mild traumatic brain injuries find difficult.)

By April, the University of Miami’s Hoffer had invited his longtime colleagues, bioengineer Carey Balaban of the University of Pittsburgh and Kurt Yankaskas, their grant officer at the US Navy’s Office of Naval Research hearing loss program, to collaborate on investigating the diplomats’ injuries. The three scientists discussed inner ear “cavitation,” damaging implosions of blood bubbles caused by focused sound waves, as an explanation. In an email obtained by BuzzFeed News, Balaban shared a proposal for a “blood vessel” grant with Yankaskas later that same month.

Still more diplomats reported injuries. On May 23, 2017, the State Department told Cuba to send two of its diplomats home from its Washington, DC, embassy, unsatisfied with the Castro government’s protests of innocence concerning the injuries. Cuba had a long history of constant surveillance aimed at US diplomats. It was also known to engage in petty harassment, such as leaving unplugged refrigerators and cigarettes in ashtrays after break-ins. It made the notion of the regime lacking any knowledge of the injuries, or responsibility for them, implausible in US eyes.

In all, Hoffer’s team would see 25 diplomats or their families affected by the incidents, 10 who lived with them but were unaffected in Miami, and another 105 unaffected personnel seen separately in Havana. “There was no media attention given to what was happening in Cuba when we saw these individuals,” Hoffer said at the later Pentagon teleconference, calling the group “in a sense, pure.”

On July 6, 2017, Hoffer and other medical experts met with federal officials, reportedly including top State Department medical officer Charles Rosenfarb, to discuss the still-secret injuries with the diplomats. The expert panel “came to a consensus that the initial findings were most likely related to neurotrauma from a non-natural source,” according to the Journal of the American Medical Association (JAMA).

That consensus was perhaps unsurprising, given the experts who were looking under the lamppost: They included neurologists and hearing specialists from the National Institute on Deafness and Other Communication Disorders, and the Johns Hopkins University School of Medicine, according to a State Department email asking them for travel receipts. But there were no infectious disease, toxicology, tropical medicine, or psychiatric experts listed as meeting specialists — no one who might have had a competing explanation for the injuries was present. Competing theories would, however, come into play much later.

Complicating any collaboration, and the research overall, was secrecy about the injuries. This remains a problem today. BuzzFeed News asked the four scientists from Johns Hopkins who were listed as participants in the July 2017 meeting, for example, to comment on the progress of the medical investigation into the Havana injuries so far. A university media representative said that one, otolaryngologist Frank Lin of the Cochlear Center for Hearing and Public Health, had signed a nondisclosure agreement, and that the rest “can’t comment” for undisclosed reasons.

The July 2017 meeting also included neurosurgeon Douglas Smith of the University of Pennsylvania Perelman School of Medicine. The State Department looked to his Penn Center for Brain Injury and Repair, a highly regarded center for the treatment of brain injuries near Washington, DC, where many of the injured diplomats and their families lived, for their extended treatment.

“It was good care, they took very good care of us,” the injured diplomat said of UPenn. “They told me, ‘We need to fix you and make you better,’; they would treat us like anyone else who came into their center with our symptoms.”

Outside, however, a storm was brewing. On Aug. 9, 2017, in answer to a question from a CBS News correspondent, State Department spokesperson Heather Nauert said that some embassy personnel “reported some incidents which have caused a variety of physical symptoms,” and mentioned the expulsion of Cuban diplomats in May. Headlines quickly erupted of “hearing loss” and “brain damage” to diplomats caused by an “acoustic attack,” all suggestions that outside experts have later found questionable.

Cuban state television in October 2017 blamed the noises heard by the diplomats in the incidents on cicadas or crickets, something the diplomat interviewed by BuzzFeed News scoffed at. “I’ve heard cicadas before,” she said. “It sounded different.”

In September, another injured diplomat who spoke to BuzzFeed News under similar conditions of anonymity was evacuated from Havana ahead of Hurricane Irma, which devastated the island. He had heard a buzzing noise in his home and the sensation of pressure, followed by problems with vertigo. “I fell out of my chair at work,” he said. He was also evaluated at UPenn, and is back at work now in the US, although he still has trouble concentrating.

“I don’t function at the level I did before,” he said, and worries about the long-term effects, especially, he said, in light of the US government’s longtime wrangling with war veterans with unexplained illness tied to Agent Orange and Gulf War syndrome.

Yamil Lage / AFP / Getty Images

Cubans wade through flooded streets in Havana on Sept. 10, 2017.

Ernesto Mastrascusa / Getty Images

Containers in the garden of the US Embassy in Cuba after Hurricane Irma barreled into Cuba on Sept. 11, 2017, in Havana.

By the middle of August, according to emails reviewed by BuzzFeed News, Hoffer’s University of Pittsburgh colleague Balaban was corresponding with Smith about collaborating on a study of how UPenn’s brain images of injured diplomats might explain how ultrasound beams could selectively damage a person’s inner ear from a distance.

“Your data will be very important in narrowing down plausible scenarios,” Balaban wrote in an Aug. 20, 2017, email to Smith. Smith was dubious, asking how ultrasound “can go through air and [a] possible glass pane, then the skull, to selectively affect the brain.”

Competition to publish research results first is the lifeblood of US scientific process. But for Havana syndrome, this drive pitted the two medical teams against each other in a race to publish in the world’s two most prestigious medical journals, the New England Journal of Medicine and the Journal of the American Medical Association (JAMA). The fastest team, from UPenn, would submit a paper to a journal within a few weeks of looking at the last diplomats in their study.

By November 2017, Hoffer and Balaban were drafting a paper on the diplomats that they had seen, which they planned to submit to the prestigious New England Journal of Medicine. That same month, the Food and Drug Administration approved sales by Pittsburgh-based Neuro Kinetics Inc. of the diagnostic goggles that Hoffer used to assess the diplomats’ injuries. Along with his university, Balaban had applied for a patent on the goggles with Neuro Kinetics. They shared the news with Yankaskas, their US Navy ONR grant officer:

“It does not seem imprudent to speculate that a highly specific unidentified energy exposure, perceived as a sound or pressure, could be producing a mild traumatic brain injury (mTBI) or similar inner ear concussion,” said a December 2017 update of the draft paper, obtained via FOIA request. It compiled symptoms that ranged from ringing ears to foggy thinking to dizziness, all signs of inner ear damage, to come to this conclusion.

Such symptoms were hallmarks of the blast damage to the head that the medical team had seen and diagnosed during the Iraq War. Those investigations, too, were not without controversy. The Defense Department’s inspector general in 2011 released a report critical of research that Hoffer and Balaban had conducted on US soldiers at Camp Al Taqaddum, Iraq, who were injured by explosions from 2008 to 2009. “Neurological assessments did not adhere to clinical practice guidelines” for mild traumatic brain injury, the report found. It also said that a “potential financial conflict of interest” in the experimental antioxidant tablets was not revealed to the injured personnel in the study, a research ethics violation. (Hoffer held patents on a method of administering the tablets.) A US Navy representative told Time, “The evidence suggests that no physical harm was caused by the administration of the investigational drug,” after the report came out.

To close out 2017, the State Department asked the NIH to investigate the diplomats’ injuries — a move the top Republican and Democrat on the House Foreign Affairs Committee called for on Dec. 5 — with staff members quoted as critical of the medical investigation.

AFP Contributor / AFP / Getty Images

Reflection of the US Embassy in Havana, Oct. 3, 2017.

In January 2018, the journal JAMA notified Balaban and Hoffer that the UPenn doctors had submitted their paper and added them as coauthors. The notice led to an angry face-off between Smith and Balaban, who wanted to see the data and delay publication of the JAMA paper. He told Smith he had complained to ethics officials at the University of Pittsburgh, which posed the threat of a scientific misconduct investigation. (University of Pittsburgh’s communications office did not respond when asked if there had been an outcome of that complaint.)

BuzzFeed News

“In or out” email from Smith to Balaban, Feb. 9, 2018.

JAMA released the UPenn study online less than a week after Smith told Balaban he was either “in or out,” without him or Hoffer as authors. The study of 21 people, 11 women and 10 men, concluded “they had sustained injury to widespread brain networks,” a constellation of symptoms similar to concussions caused by physical impacts. “Clinically, it’s clear they have suffered some sort of neurological insult. Something happened,” UPenn’s Randel Swanson, the lead author on the study, then told BuzzFeed News.

Other experts weren’t so certain. Neuroimaging expert Arthur Toga of the Keck School of Medicine at the University of Southern California told BuzzFeed News the study was “inconclusive,” noting its MRI results didn’t indicate anything grossly wrong with the diplomats’ brains that corresponded to their symptoms. Neuroscientist Sergio Della Sala of the University of Edinburgh said that the study’s standard for brain damage, seen in only two or three patients, was so loose as to describe roughly 40% of the general population as having brain damage.

“Clinically, it’s clear they have suffered some sort of neurological insult. Something happened.”

The JAMA study authors noted that privacy and secrecy restrictions precluded the release of some of the data about the injured diplomats, noting that only Smith and Swanson were responsible for the data. Nonetheless, they ruled out a viral cause of the injuries, because no one had reported a fever, and called poisoning unlikely to have worked so quickly after the sounds heard by 18 of the 21 patients, some of them on the island for less than 24 hours before reporting symptoms. It also ruled out a mass psychology or “functional” disorders, triggered by everything from whiplash to migraines, because the diplomats wanted to return to work and didn’t show signs of “malingering.”

This last conclusion is at odds with how “psychogenic” injuries actually work — people suffer physically from injuries triggered by stress in such cases, often with symptoms like dizziness, headaches, and the others reported in some of the Havana cases. They do not fake injury to get time off work. Despite the presence of neuropsychologists on the UPenn team, the description called into question how well the JAMA study authors had really investigated the possibility of psychology to explain the injuries, medical sociologist Robert Bartholomew, coauthor of Outbreak! The Encyclopedia of Extraordinary Social Behavior, told BuzzFeed News.

Four days after the study appeared in JAMA, the State Department’s Rosenfarb gave Balaban and his colleagues authorization to publish their own paper in submission with the New England Journal of Medicine. “My apology for the delay,” said Rosenfarb.

They had lost the high-prestige publication race, and the delay hadn’t helped, according to an April 2018 email from Balaban. “An NEJM editor has asked us for rights of a first look before the JAMA paper was published. Our release occurred after the JAMA on-line edition appeared,” he wrote to a University of Pittsburgh publicist planning a news conference with the University of Miami’s medical school on publication of their paper, now under consideration by the journal Frontiers in Neurology.

Plans for the press conference included a presentation of the Neuro Kinetics goggles that the paper described as able to uniquely diagnose people with the Havana injuries, as well as setting up advance interviews with the Miami Herald and the New York Times. A draft of the paper in review with Frontiers lists no financial conflicts of interest in the study.

BuzzFeed News

A University of Pittsburgh email from Balaban, April 17, 2018.

That seems troublesome to neurologist Mitchell Joseph Valdés-Sosa of the Cuban Neuroscience Center, a leader on a Cuban panel that concluded in 2017 that the injuries were likely caused by mass hysteria. “There could be a conflict of interest, and that could have [led] to confirmation bias,” he told BuzzFeed News by email. “Their hypothesis could have been that they were going to find evidence of vestibular [inner ear] damage, which is what the [Neuro Kinetics] helmet measures.”

In response to this concern, University of Pittsburgh media relations director Joe Miksch told BuzzFeed News by email, “Balaban has not and will not receive any financial benefit from Neuro Kinetics or the sales of the Neuro Kinetics diagnostic goggles, even if the patent is granted.” He did not answer whether Balaban’s employer, the university, which owns intellectual property on the patent and can license the invention, would financially benefit from the goggles. The university has not entered into any license with Neuro Kinetics, according to Miksch.

The last report of a US diplomat injured in Havana came one year ago, in May 2018. Cuba’s foreign ministry said the US State Department had informed it that a woman had “reported health symptoms as a result of ‘undefined sounds’ in her place of residence.” That same month, Secretary of State Mike Pompeo reported that two US diplomats in China reported the same sort of illness “entirely consistent” with the past Cuban cases, prompting the State Department to launch a task force with the Health and Human Services and Energy departments to investigate. (Eventually 15 US diplomats from China would be investigated for such incidents, with the Associated Press later reporting that 14 of them were ruled out from suffering the syndrome, with the 15th inconclusive.)

In August, a series of letters critical of the JAMA study were published in that journal, written by a mixture of neurologists critical of the brain damage claims, and experts in “functional” disorders triggered by stress who blasted its dismissal of psychology as an explanation.

“Research with this patient cohort was not originally anticipated due to secrecy and privacy concerns,” Smith and his colleagues said in response to the letters. They restated the criteria for “neuropsychological impairment” and wrote, “we are performing advanced neuroimaging studies of the patient cohort, hoping to identify structural brain changes that may underlie the neurological manifestations.”

These studies have still not been published. As mentioned, after asking to see the public records of communications released to BuzzFeed News, Smith did not reply to requests for comment.

“I can only vet the (published) cognitive data, and these do not hold water,” Della Sala, the editor of the journal Cortex, told BuzzFeed News by email. “These further explanations made things even worse.”

Also unpublished was the submitted Frontiers in Neurology paper by Hoffer’s team. The next appearance of their results instead came in August in talks at a “SOFWERX” Defense Department think tank in Tampa, where Hoffer discussed the injuries suffered by the diplomats. Balaban described the “Frey effect” in his talk, the production of clicking noises in the ears by exposure to microwaves, a phenomenon researched in the 1970s. “So, the ability of radiofrequency to affect the nervous system is real,” he said.

Balaban also touted the Neuro Kinetics goggles at the talk, claiming a 90% ability to tell Havana subjects apart from either blast victims or healthy people. “This is a fieldable technology,” he said.

“The promotion of the silly goggles is a shameless attempt at commercial promotion,” said Cohen, the UCLA neuroscientist.

Little more than a week after Hoffer’s Tampa appearance, the New York Times published a story citing the Frey effect and suggesting that microwaves were the prime suspects as the technology that hurt the diplomats, with an endorsement of the idea from UPenn’s Smith. This caused some suspicion on both Hoffer’s and Balaban’s part that their August presentation had been eavesdropped upon and their ideas pilfered (in reality, a University of California, San Diego, news release had touted the idea a few days ahead of the story).

BuzzFeed News

Email from Hoffer, Sept. 2, 2018.

“I think State trying to reclaim ownership [is] a strong possibility because we noted that the Penn group (which is a group entirely composed of clinicians) now is convince[d] this is microwaves,” Hoffer wrote in a Sept. 2 note to Balaban and Georgetown University neuroethicist James Giordano, another colleague. “Definitely smacks of what we call ‘Penngazzi’. Lol.” The group discussed arguing for the Office of Naval Research, instead of the State Department, to lead an investigation into a “multi-layer” plethora of various kinds of energy beams causing the Havana injuries. They also discussed dropping a “red herring” as part of a “misinformation” campaign at their next talk, scheduled for later that week at a Pentagon-sponsored teleconference.

(As mentioned, BuzzFeed News has filed a lawsuit with the State Department for public records of Hoffer’s communications on his research.)

“There was no misinformation campaign,” Hoffer told BuzzFeed News by email. The “red herring” was a symptom to distinguish real Havana syndrome patients from pretenders, he said. “Indeed, we have seen patients who present themselves as such.”

“Definitely smacks of what we call ‘Penngazzi’. Lol.”

When asked about the context of the email suggesting the State Department was trying to reclaim ownership, University of Miami Miller School of Medicine media relations director Joanna Palmer replied, by email, “Dr. Hoffer has no further comment.”

Meanwhile, outside experts threw cold water on microwaves, calling the Frey effect wildly implausible as an explanation for the injuries, since its inner ear clicking noises it caused were far too weak to damage tissues.

“Maybe Fidel Castro is subjecting them to an ESP attack from beyond the grave,” said University of Pennsylvania bioengineer Kenneth Foster to BuzzFeed News, when shown the discussion of the “multi-layered” radiation attack idea. Foster, who has no affiliation with UPenn’s medical school team, first described the mechanism behind the clicking effect in 1974, but is dubious it is in play in Cuba. “Unless there is some independent evidence for an exposure of some kind, one could speculate endlessly.”

Nevertheless, the Pentagon teleconference received press coverage, noting Balaban’s theory of some confluence of radiation and ultrasound perhaps triggering targeted cavitation in the inner ears of the injured diplomats.

“I do not believe that we are close to claiming victory. In fact, I doubt that we can identify ‘the source’ for Cuba,” Balaban wrote to ONR’s Yankaskas in the aftermath of the news coverage.

In the outside world, skepticism abounded about both mystery noise-making secret weapons and the diagnoses of the research teams. On Oct. 8, 2018, a neuroscience reporter from another news outlet contacted Yankaskas at ONR, for example, asking whether they could discuss “wildly implausible” ideas that Balaban had presented, and questioned whether he had a “proprietary interest” in the diagnostic goggles.

Yankaskas forwarded the interview request to Balaban the same day, writing: “He’s the same reporter that I mentioned this morning.”

BuzzFeed News

Email from Yankaskas to Balaban, Oct. 8, 2018.

Asked by BuzzFeed News whether alerting a grantee about misconduct questions was appropriate, ONR communications director Robert Freeman told BuzzFeed News, “Grant officers typically have close relationships with grantees, and I might ask one, ‘Hey, what about this?’ if someone asked a question.”

He advised BuzzFeed News to submit the exchange to the US Navy’s Office of Inspector General, which might decide if it warranted an investigation. When it was pointed out that inspectors general don’t confirm or deny investigations to the public, he acknowledged, “That’s right, they generally don’t.”

Meanwhile, NIH was seeing some injured diplomats in Washington, DC, including the woman who spoke to BuzzFeed News. “It was definitely for research, not treatment,” she said. “We really miss the treatment at Penn. Now, we are all sort of on our own, seeing our own doctors now. There was some talk of the research continuing at Penn instead of NIH. We kind of wish it had.”

One person frustrated with both the UPenn and the NIH investigation was Mark Zaid, an attorney who represents some of the diplomats affected by the incidents in Havana. Another client of his, Michael Beck, a former National Security Agency counterintelligence officer, was the subject of a recent 60 Minutes report. Beck suspects he was exposed to a microwave attack while on an overseas assignment with a partner in 1996. Both of the men later developed Parkinson’s disease. In his effort to get Beck disability compensation, Zaid has gotten the NSA to release a 2014 letter, which reads, “The National Security Agency confirms that there is intelligence information from 2012 associating the hostile country to which Mr. Beck traveled in the late 1990’s with a high-powered microwave system weapon that may have the ability to weaken, intimidate, or kill an enemy over time and without leaving evidence.”

Neither UPenn nor NIH will accept Beck into their study of the diplomats, said Zaid. “This guy might be the long-term result of whatever these people went through; wouldn’t you at least like to look at him?”

In December, the paper by Hoffer and Balaban was finally published in Laryngoscope Investigative Otolaryngology, a journal where Hoffer is an editor. It came to the same conclusion as the draft paper from a year earlier: “It does not seem imprudent to speculate that a highly specific unidentified energy exposure, perceived as a sound or pressure, could be producing an inner ear disturbance or demonstrate findings suggestive of a mild traumatic brain injury.” Among the findings in the paper was that only two diplomats actually had hearing loss, despite the initial headlines about deafness. Both of them had hearing problems before the incidents in Havana.

As with the JAMA study, outside experts such as Cohen complained the study took for granted that the diplomats had been attacked by some device and accordingly came to their conclusion. In science, this is called “confirmation bias,” as mentioned by Valdés-Sosa, seeking and finding information in a way that confirms one’s beliefs or hypotheses, while discarding alternatives.

Asked whether their communications pointed to good scientific practice in the medical investigation of the Havana syndrome, Hoffer told BuzzFeed News by email that they only reflect scientists “discussing possibilities” and “preparing papers for publications that sometimes don’t end up in the first journal to where they are submitted.”

“Yes that is the way good science is conducted,” he added.

Outside observers are less satisfied. “It’s just such a mess,” said Cohen, who along with other experts had long called for the National Academies of Science to weigh in on the Havana incidents. That panel’s start is still awaiting a contract, however, and Cuban scientists have not been contacted about participating.

For the research community, the next step will be seeing the epidemiological report the CDC produces, expected this year, followed by whatever NIH concludes from its five-year investigation.

“The evaluation of some of the diplomats at NIH is ongoing and any discussion about the evaluation would be premature. NIH has not drawn any conclusions at this stage,” NIH’s Renate Myles told BuzzFeed News by email. The State Department has offered entrance into NIH’s research to its injured employees, and healthy volunteers to serve as controls in the research.

“The safety and security of U.S. personnel, their families, and U.S. citizens is our top priority, wherever they are located,” State’s Shahbazian said. “We will continue to provide our colleagues the care they need, regardless of their diagnosis or the location of their medical evacuation.”

The injured diplomats still waiting on answers, however, are worried about the future.

“All of this research does not help us right now,” said the injured male diplomat who spoke to BuzzFeed News. “Some of us are not getting better.”

“What if this happens again, somewhere else overseas? What are we going to do when that happens?” ●

Sahred From Source link Science

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