Post-concussion syndrome: Why do you still have symptoms? (part 1 of 2)
- January 2, 2018
- By Martin Rutherford, D.C., C.M.F.P., and Randall Gates, D.C., D.A.C.N.B. | Power Health
- Categories: Healthy Mind, Wellness
You get hit by a car, fall down, are attacked physically, hit your head on an open closet door, etc. Maybe you didn’t “hit” your head directly, but suddenly you feel nausea, maybe blurred vision; you feel dizzy, lightheaded, can’t remember why you’ve walked into the room, forget people’s names, and have anxiety “out of nowhere.”
You go to the ER, they do an MRI, CAT scan, EEG, etc. All turn out fine. Everything’s “normal” — just take this pill and if you’re not good in a week or so, go see your regular doctor.
In a week, you’re not good — in fact you’re worse, and now you can’t sleep, you’re developing headaches, maybe your libido is off and you’re depressed. Doctors say MRIs are normal, that it should go away — and here, take this for your depression.
Two weeks later, it’s the same or worse. Your GP/Nurse Practitioner sends you to a neurologist and a cursory exam is done. You’re told it should go away in six months and that MRIs and CAT scans were normal. No bleeding. And then more medications are given to handle whatever symptoms you’re experiencing, and again you’re told to see them in six months.
In six months, you’re the same or worse, but now you’ve developed bad gut problems that are wreaking significant havoc on their own. You know the gut problem came from the concussion, but nobody believes you. You go to the doctor, and now you’re told you need to get over it.
You’re just depressed, you need counseling — “you didn’t even hit your head”? Now you’re paranoid. Your doctor doesn’t believe you but you’re still very sick, you’re getting worse, and you wonder if this will ever get better or worse. You wonder if you’re a hypochondriac.
This is the general thumbnail sketch of the average patient at the time he or she walks into our office for evaluation of post-concussion symptoms. The stress alone from the above experiences has at this point made it even worse, much worse. So why does this scenario seem to happen over and over again?
First is the fact that you don’t have to hit your head to get a concussion. But insurance companies and their attorneys say you do. For the record, they know that’s not true. You may not know that and become frustrated or stressed that they don’t seem to understand, nor are they interested in you being further treated for something you “don’t have” or are “faking.”
But my doctor must know I’m suffering from post-concussion syndrome (PCS) — so, logistical problem No. 1 is that most doctors don’t. For perspective on this matter, Dr. Gates’ favorite neurological textbook lambasts concussion patients, indicating they are faking it and malingering because they often experience “trivial or no” hits to the head, but yet have these severe symptoms of dizziness, poor spatial localization, headaches and personality changes.
They must be seeking money. For the record, I (Dr. Rutherford) have had 11 concussions (that I know of) and have never sought money — but I’ve had all of these symptoms and experiences.
My MRIs are normal and my doctors suggested I was depressed. But what’s a physician to do when the insurance companies know more about concussions than some “respectable” neurology books, and they tell these doctors that they won’t cover care because the patient couldn’t possibly have concussion problems?
That brings us to logistical problem No. 2 — even if your doctor believes that you have a concussion, with all due respect, today’s doctors are poor diagnosticians.
In my day (I’m 65), we had to diagnose conditions correctly without MRIs, CAT scans, EEGs, etc., because they didn’t exist. We learned to do a thorough history, a real exam and know within a very narrow scope of diagnostic probabilities what was wrong with the patient.
In fact, John Patton, who is the consultant neurologist at King Edward VII hospital in Midhurst, Sussex, England, and who wrote the neurological diagnostic bible “Neurological Differential Diagnosis,” also practiced largely before the current era of MRI and CT scanning. In the intro to Volume 2, he pounded the fact that neurologists were superior diagnosticians in his (and my) day because we couldn’t defer our diagnostic responsibilities to “questionably reliable” tests (i.e. CAT scans, MRIs, EEGs, etc.).
He further goes on about having to determine (without MRIs or CAT scans) whether patients needed neurosurgery for a brain bleed or tumor, versus something benign that would simply resolve without today’s testing.
People (patients and doctors) today don’t seem to think that can be done, probably because the present day doctor and patient have never experienced what a genuine diagnostic procedure looks like.
Today, diagnostics in all fields have changed dramatically. Neurology in particular has changed vastly to where neurologist only do scans, blood tests, EMGs, EEGs and more. Mostly due to insurance restraints and the threat of litigation, doctors these days skip or perform a simple neurological history and exam and skip directly to the test.
It’s the test that is the crux of receiving payment or getting or not getting care. So in reality, the average neurologist is not as astute in diagnostics in general, and particularly so when it comes to concussion. They have almost completely deferred diagnostic responsibilities to “the test.”
If you don’t have a split skull, a raging hematoma or a bleed on testing, then you’re told you don’t have a concussion, even though you have every concussion symptom and exam finding in Patton’s “Neurological Differential Diagnosis” textbook.
Clean and safe for the doctors can mean a disaster for the patient. But there are ways to diagnose PCS and ways to correct or improve it.
Next month, we will discuss the pathological reasons you still have symptoms and “the fix” — i.e, how to improve or resolve them.
Martin Rutherford, D.C., C.M.F.P., is a Certified Functional Medicine Practitioner and clinic director of Power Health in Reno. Randall Gates, D.C., D.A.C.N.B., is also a doctor there. Visit www.PowerHealthReno.com to learn more.