How do concussions work? Does this sound normal?
October 30, 2013 5:11 AM   Subscribe

My father is suffering from a severe concussion. He was making great progress but all of a sudden, things have worsened. I have researched/googled concussions but everything is so clinical. I'm looking for real experiences/anecdotes so I can understand what's happening to him and what we can expect.

I apologize if this is chat-filter. I havent slept in six days and am delirious with fear and worry right now.

Six days ago, my father was cutting down a tree and fell from about 30 feet. He was airlifted to a nearby hospital and has been in ICU ever since. Every day, he was showing great progress and getting stronger, but as of last night, he has downgraded severely. The doctors aren't really telling me anything.

He's been breathing better, speaking, recognizing all of us, making sarcastic remarks about stuff, sitting in chair, and just yesterday they started physical therapy and gave him a few bits of real food (in his mouth, not through a tube). Everything seemed to be going great and everyone was optimistic for a full recovery.

Then mid afternoon yesterday, he started getting really lethargic and not responding to the neuro checks (where they ask you to open your eyes, wiggle your toes, etc). All evening and night, we couldn't rouse him no matter what we did. They were going to do an emergency CAT scan but then at the last moment, he responded a tiny bit.

This morning, its the same. He just wont open his eyes, although he weakly did the hand squeeze/toe wiggles they requested. Most alarmingly, his breathing is way down and they've had to suction his throat a few times (which they hadn't had to do since Day 3 or 4.

I guess my question is, have you or someone you know had a concussion and does this sound normal, to wax and wane in your condition like this? My father is really strong and active and healthy, and other than the concussion, did not sustain any life-threatening injuries in the fall (some broken ribs and a fractured pelvis). The C-scans they did the first two days came back fine.

I'm so scared - any advice of what to expect would be appreciated.
posted by silverstatue to Health & Fitness (15 answers total) 3 users marked this as a favorite
I'm no expert by any means, but what's the justification for cancelling the emergency CAT scan? Is there some possibility he's got some kind of slow internal bleeding that might not have shown up on the initial cat scans but which has since become a factor?

I would get ahold of a doctor and insist on getting some straight answers and possibly some more tests done.
posted by cali59 at 5:48 AM on October 30, 2013

First of all, you need to sleep because you cannot be a good advocate for your father that sleep deprived. You just cannot.

Second of all, "the doctors aren't telling me anything" isn't good enough, so rather than asking the internet for medical advice, your family needs to be more assertive. What are they telling your mother, or whomever is his next of kin? That person needs to strongly lay out "We're very concerned about his deterioration and the cancelled CAT scan. What is the current assessment and what is the current treatment plan here?"
posted by DarlingBri at 5:51 AM on October 30, 2013 [9 favorites]

Response by poster: This is a relatively new situation. Up until last night, everything was going great and he was getting dramatically better each day. I wasn't really freaked out until this morning. The nurses say when the doctors make their rounds in a couple hours they will give an assessment. I will push for another CAT scan at that point.

The first few days after his accident, he wasnt sleeping at all - constantly moving, coughing etc. Last night was really the first real sleep he's had and right now he seems to be sleeping very deeply. So everyone is saying hes just really exhausted and needs his rest. Which I guess is possible, but I still want another C-scan just to make sure there isn't a new problem.

My mom and sisters and I are taking turns doing the overnights at the hospital but... even last night when I went home to sleep in my own bed... I'm too worried to actually sleep more than 2-3 hours.
posted by silverstatue at 6:01 AM on October 30, 2013

This is absolutely not normal when recovering from a head injury. Insist on the CT scan or get a really good explanation for why not.
posted by SLC Mom at 6:01 AM on October 30, 2013 [1 favorite]

So this kind of happened to my dad after he was hit by a car (though it sounds like he was in better shape than your dad was to start), where he suddenly stopped making sense, after previously being able to carry on a short conversation relatively normally and knowing what was going on. He went for a CT scan which didn't show anything and IIRC they concluded that it was a reaction to whatever medication. He had a little bleed in his brain that was resolving on its own, but they were worried that it had gotten bigger or that there was another bleed.

(They also managed to overdose him so he stopped breathing at one point, but my brother was there for that, not me. That was also after he was no longer in the ICU.)

I echo the advice of others to get some sleep. If you don't have somewhere to sleep nearby, ask the hospital if they have a blanket and pillow you could use. I was sleeping at my dad's apartment, but there was a family who had someone camped out in the ICU lounge in shifts (I assume they lived across the city).

One of my dad's relatives is a nurse married to a doctor, so I kept phoning them and going 'Help! What am I supposed to ask?' In the absence of anyone else, I think this AskMe is a reasonable thing to be doing. It's what I would have done if I didn't have someone to call. Does your dad have a regular doctor? If they have their shit together (my dad's doctor just doesn't), they may be better able to ask the right questions and answer some of your questions.

Also, do yourself a favour and leave the hospital for an hour, even if it's having a coffee across the street and reading a book. You'll go insane otherwise. It sounds like you're not there alone--leave someone behind and they'll phone if anything urgent happens.
posted by hoyland at 6:02 AM on October 30, 2013 [2 favorites]

Best answer: Wow, how scary and overwhelming.

What your father has is not just a "concussion". If someone is in the ICU for a head injury, that injury is severe. You really, really need more sleep (try some melatonin tonight? Or whatever else you use to sleep?) to understand his situation and support him. But for today, you need to have a real conversation with the doctor or doctors in charge of his care.

When you get to the hospital today, tell the nurse, or if s/he isn't helpful, the charge nurse (boss nurse for the shift) that you want to speak with the doctor today. You don't understand the plan of care or the current diagnosis and you want to be more involved. If possible, coordinate this with when your mom and sister can also be present.

Prepare a list of questions that are very specific. It is important to write them down, or you will skip some in the moment.

Good questions are:

Please explain my father's current diagnosis.
Please explain why he's here in the ICU.
What are the biggest risks he's facing right now?
What are some of the best case scenarios that could come out of this?
What are some negative things that could happen now?
What tests do you use to assess his progress?
I can see that he is worse off today than he was two days ago in X,Y, and Z way. What are some of the reasons his condition might be worsening right now?
What tests are you running to find out whether those things are happening?

Some specific things to ask about a head injury:
Was there bleeding in the brain?
Is there increasing pressure in the brain?
What are the long-term effects of this injury likely to be for my father?

If it were me, I wouldn't necessarily focus on insisting that another scan is done. I would focus on getting more information about what's happening, and then asking follow up questions as in,

You: What are some of the reasons my father may be having these worsening symptoms?
Doctor: It could be, that XYZ is happening, but we don't know for sure.
You: What are some of the tests you can do to find out if XYZ is happening?
Doctor: ABC test.
You: What were the results of those tests? (or) Why aren't those tests being done?


Best of luck to you and your family.
posted by latkes at 6:18 AM on October 30, 2013 [38 favorites]

What are the long-term effects of this injury likely to be for my father?

In my experience, doctors are very reluctant to speculate about what is likely in this scenario, perhaps because people will take that as a guarantee of some kind. My stepdad had a severe head injury in a car accident, and this was one of the hardest things to deal with: they just did not have anything better for us than, wait and see how much is left of him.
posted by thelonius at 6:36 AM on October 30, 2013

Sudden negative changes in mental status or personality following a traumatic head injury are an emergency. I would insist that another scan be done. For all anyone knows he could have developed some ischemia in his brain from a small bleed opening up or a clot shifting around and impinging on blood flow. Not to frighten you, but the kind of symptoms you are describing are not something that I would wait on.
posted by Scientist at 6:42 AM on October 30, 2013 [1 favorite]

Response by poster: Ok the doctors have scheduled another MRI. The nurse is saying that the MRI will show if there is anything bad going on, but it is very possible that this is just a result of severe exhaustion.

Thank you everyone for your input so far. Sorry for the thread-sitting.
posted by silverstatue at 6:51 AM on October 30, 2013 [3 favorites]

Is he on any pain meds? Is it possible they are contributing to the deep sleep and relative lack of response?

On preview, it sounds like you are on the right path - keep on the doctors for information and take care of your self...
posted by NoDef at 7:05 AM on October 30, 2013

For sleep, try a Zquil, or Benedryl (same thing actually.)

Ask lots of questions even if you feel pushy and challengy.
posted by Ruthless Bunny at 10:28 AM on October 30, 2013

Sorry for the thread-sitting.

FWIW, I don't think you're thread sitting. You're giving valuable feedback that people need to give good suggestions for your situation. I'm glad you're turning to Metafilter to give you the structure to have good conversations with your dad's doctor. The uncertainty is so difficult to deal with but even though some questions about long term effects are unanswerable, the short term diagnosis and treatment plan are absolutely answerable questions and your family should have that information. Wishing you and your family all the best.
posted by slmorri at 10:32 AM on October 30, 2013 [4 favorites]

silverstatue, check your MeMail.
posted by tommasz at 11:20 AM on October 30, 2013

Response by poster: Thank you so much everyone for the feedback. It did me good just to read rational conversation about my dad's condition because I was in a pretty bad freakout this morning about everything.

I spoke with the neurologist before and after the CAT scan and he assured me that there was nothing to be alarmed about. The test showed a "tiny wisp" of new blood, but he said it was extremely minor and there was no swelling or pressure.

This afternoon, my father's condition improved vastly. He was sitting up and opening his eyes, responding to the doctor's requests to move parts of his body, eating a few spoonfuls of applesauce, and most amazingly, able to stand up (with assistance) for a few seconds. I guess... he was just super tired last night and this morning and it took him a while to get out of that sleepy phase. Now, after all that activity, he is conked out again.

I'm so glad we had the C-Scan today to ease our fears, and the list of questions to ask the doctor helped a lot, so thank you latkes. Thank you everyone. I think we're going to get through this.
posted by silverstatue at 1:42 PM on October 30, 2013 [10 favorites]

silverstatue, I realize you've gotten more information on your father's condition now, but I just wanted to answer you by breaking your question into two salient parts.

- Is it normal to wax and wane in your condition after a concussion? Absolutely. It is also normal to have difficulty with memory, concentration, headaches, and increased fatigue after a concussion, for days to weeks after the concussion occurs.

- Is the situation you described with your father, above, normal after a concussion? No, absolutely not. Concussion means a bruise to your brain, it cannot be seen on a CT scan. Concussion is considered more than a minor head injury, but much less than a severe head injury, because it does not involve any bleeding inside your skull. The normal outcome after a diagnosis of concussion is a discharge home immediately from the emergency department. In cases of severe concussion, or concussion with other worrisome neurologic symptoms, a person might be admitted to the hospital for overnight observation with expected discharge the next day, but that is unusual.

A weeklong stay in the ICU for concussion alone is essentially unheard of, to the point that I suspect you are either not in the United States or that your father has other serious medical issues aside from concussion that prompted his admission and ICU stay.
posted by treehorn+bunny at 4:57 PM on October 31, 2013

« Older seek and ye shall find   |   Studying for the A+ Newer »
This thread is closed to new comments.