Dr Ron Granot: What we know happens is with the trauma of the brain moving back and forward or side to side in the skull the brain is a very jelly like organ so the nerves get twisted and can have what are called shear injuries. So it’s a little nerve fibers get torn and damaged at a level that’s so microscopic that we can’t see them on a scan and your MRI was completely normal. There was no bleeding there was no areas of damage visible.
Sarah: My neurologist Dr Ron Granot’s upbeat – he says I’m gonna get better. But he also gives me a reality check.
I chatted to him about this later.
Sarah: It was about six weeks I think after the accident when I first saw you and you referred me for an MRI and to the brain injury clinic at St Vincent’s Hospital and you seemed quite matter of fact at that point that my recovery was going to take time and I…[cut]…needed to accept that.
Dr Ron Granot: Yeah.
Sarah: I think I was quite shocked it hadn’t really sunk in.
Dr Ron Granot: mmm
Sarah: I guess because my brain wasn’t working and hadn’t really thought this was what was happening.
Sarah: Dr Granot told me I couldn’t rush it and if I tried to rush it would take longer. I needed to take it easy. Dr’s orders.Take it easy!?! That’s something I wasn’t generally good at. But I was getting better at doing nothing because I had to.
The MRI’s booked for the following week. The brain injury clinic wants to see me as soon as I had the scans. I guess my neurologist pushed me up the list.
My friends Jane and James invite us on a hike. I like bushwalking but it’s not a big part of my life. Just something I do occasionally. Anyway, Miles is working but I decide to take the kids and Miles’ mum Lenore. I’m not driving yet so Jane drives my car down to Heathcote National Park, just south of Sydney. I’ve never been there before. It’s a steep climb down through scribbly gum eucalypts and banksia trees, and over large rocky outcrops. Grandma Lenore is struggling…it’s a long way from the streets of Chicago. The uneven ground is hard on her body. But she makes it and she enjoys it. Emerald loves the clamber. She’s nearly three and she likes climbing but when the path’s flat and boring she complains until James offers her a piggyback.
I’m noticing that my head feels really clear. I haven’t had a headache all day! The fog lifts. I feel alive. My brain feels kind of stimulated in a relaxing way. I don’t know what this is. But it’s working!
It’s a really hot day so when we get to Kingfisher Pool we cool off in the fresh water. I can’t swim because my shoulder’s still healing, so instead I wade in up to my chest. I stand under the gentle waterfall. It’s Heaven. The pool’s surrounded by lush greenery. There’s probably snakes and eels but the kids’ squeals scare them away.
We picnic on the big rock that looks out over the pool. There’s nobody else here. Our Chicago grandma’s very impressed with our gourmet picnic of cheese and crackers and cakes. James even brews up some coffee. When we head back up the hill we stop for more pastries and tea on a rocky cliff.
It’s been the best day since the accident six weeks ago. I feel happy. Satisfied. I feel more like myself. I feel free. I don’t have a headache. Jane drives our car back to Sydney. I pull out my phone to direct her with Google Maps. A Headache arrives!
But I found it. I don’t know what it is. I don’t know what it means. I don’t know if there’s any science to this. But I know that being in the bush, walking amongst the natural world today, really helped my brain.
Days later I catch two crowded rush hour trains over to Edgecliff in Sydney’s eastern suburbs for my MRI. I feel edgy. I don’t really understand what they’re looking for. It’s pretty scary when the doctor says he wants to scan your brain to check for bleeding or clots or other problems and you’ve already spent a good 6 weeks feeling like something’s really not right.
In the waiting room a breakfast/morning chat show’s blaring on the TV , something about Pauline Hanson hating on Muslims.
I’ve been in a news blackout so it feels surreal. I remove all my jewelry and then I’m led into the room with the MRI machine. It looks spaceage. Everything’s white and shiny. I’ve been warned MRI machines are really noisy. The technician asks me what kind of music I want to drown this out. I try to explain that I’m not really doing music these days. Really? What about classical? No – definitely not classical sorry!
I walk out of the MRI clinic clutching the large envelope with my scans. I have hours to kill before I’m due at the brain injury clinic at St Vincent’s Hospital. The three hours feel like six. No novel, podcast or even social media to distract me.
The walk between the MRI in Edgecliff and St Vincent’s passes Rushcutters Bay. I plonk myself under a tree on the grass and just watch the boats…I’m distracted by the lapping water.. Here I am again using nature to get by. I switch trees a few times so people don’t think I’m weird.
Finally. It’s time. I walk into the hospital feeling freaked out. I still don’t know what’s wrong with me. I haven’t felt like myself for nearly two months.
Miles: You were a bit more demanding. I dunno I mean it’s hard to say what your personality would be like without the accident as people grow and change. I could see often things would come to head pretty quickly in terms of temper and you know anxiety, you would kind of lash out with more anger than previously and I still see that
Sarah: How soon after the accident did you notice that then?
Miles: Well I guess In a couple of weeks but again I could think she’s in pain irritable low threshold for things that upset her so understandable.
Sarah: This is my partner, Miles. I recorded this conversation in our living room.
Miles: But then over time when symptoms of the accident were gone to this day I wonder if part of your personality changed through the accident.
Sarah: I remember you saying that to me you felt like I had changed, that I was different a different person. You had known me for quite a few years before the accident, what – 7 years or something?
Miles: But then the other thing that has developed during this time is you do seem to have more empathy. I also notice like You give Emerald and Billie a lot more hugs. And you’ll stop and listen you know even if they are screaming and crying sometimes your response is often to give them a hug.
Sarah: I hand over my MRI scans at St Vincent’s brain injury clinic. Before I see the specialist his registrar asks me a hundred questions. He encourages me to just accept my situation. Accept that I have, what they’re calling, a “mild traumatic brain injury”! He explains that when my brain struggles with a task and a headache arrives, if my reaction is to grow frustrated, stressed, upset and anxious, I’ll make the headaches worse. I have to overhaul my attitude to this whole thing.
I’m already seeing a neurologist. Now I see brain injury rehab specialist Dr Stuart Browne. He has more tests.
Later on I interview him in his rooms.
Sarah: When I first came to see you, you did some more extensive tests some sort of comprehension type test. And there was one that it was quite noticeable that I didn’t do so well on. It was the test was where you have to name….
Dr Stuart Browne: Words beginning with the letter of the alphabet for example.
Sarah: Yeah and they are not allowed to be whast is it they’re not allowed to be something as.
Dr Stuart Browne:So Proper nouns. Yeah typically it just has to be.
Sarah: And I really struggled with that and I remember just thinking oh my God this is really weird that I can’t do this why is this so hard
Dr Stuart Browne: In traumatic brain injury we tend to see in some of this simple cognitive testing a few areas that people do worse than expected.
And one of them is that particular test the ability to come up with words that fit a particular structure.
Sarah: Proper nouns are people and places etc, the ones that need capital letters. That’s in case you’re part of my generation that wasn’t taught grammar. Anyway, let’s give this test a go now. I’m gonna set the timer for a minute. See how many words you can think of that start with the letter A. Remember they mustn’t require capital letters. Count them out on your fingers. OK, go!
How did you go? Well I can’t tell you exactly if your score fits in the normal range because it depends on a few different things about you, but if you finished high school and you’re between 25 and 50 years old the average number of words you should have come up with is 15. I fit into that group and I only got a handful of words.
Dr Stuart Browne: And we think of that as being particularly a frontal lobe skill. And so the frontal lobes in traumatic brain injury tend to cop a bit of the injury out of proportion to perhaps other areas of the brain. And so it’s very common that we see people with frontal lobe difficulties and the frontal lobes are important for our ability to multitask to concentrate to respond to feedback to inhibit our behavior so to know when to not do a particular behavior.
And one of the one of the aspects of this test of generating words is that we think it is a frontal lobe skill. So if people have difficulties in that area we’re thinking that the trauma the traumatic brain injury may be impacting on frontal lobe function. It’s subtle. the frontal lobes are an important part of our independence of our thinking ability of our ability to work and live complex lives. And it is the frontal lobes that are also injured more frequently than other parts of the brain.
Sarah: The results of this word test point to which part of my brain’s injured. Turns out it’s not the part of my head that hit the road.
Dr Stuart Browne: It’s very common that people who fall and hit the back of their head may have superficial injuries over the back of their head and indeed often fracture the skull at the back but it’s the front part of the brain that receives the greatest injury and that’s because just of mechanics the brain effectively bounces forward at the time of the strike and damages the inner surface of the front part of the brain. Ironically however if you get hit at the front part of your face it’s still the front part of the brain that cops the greater part of injury. So that’s why we commonly see frontal lobe problems
Sarah: You might think this diagnosis would drown my spirits. But part of Dr Browne’s treatment seems to be positivity and confidence. He expects a full recovery. I just need to “accept.”
Dr Stuart Browne: One thing that we look at in traumatic brain injury rehab is we’re looking at markers that might give us some indication of how much the brain has been injured and it’s not necessarily looking at a at a scan of the brain although that is helpful you can actually have a pretty good if not almost normal looking scan and yet be really having functional difficulties and then the opposite you can have a brain that’s got a lot of acute blood in it the neurosurgeons may need to go in and actually remove the blood and the person functions quite well. We look at how long someone’s unconscious. Both at the scene but also what happens when they’re in the emergency department. And we also look at another important thing and that is the length of time that someone has memory or confusion after their trauma and that is a very powerful predictor of how someone ultimately recovers. And I was pleased to see in your situation that it was a brief period of time it was it was an hour or so
Sarah: Nothing comes up on the MRI but they can diagnose my brain injury clinically – from consults instead of physical tests. This is actually a huge relief. I’ve been released from the fear of the unknown.
This is how my neurologist Dr Ron Granot explains it:
Dr Ron Granot: After any any brain injury we struggle at the moment in terms of demonstrating things physically from MRI scans and so on. your MRI was completely normal. There was no bleeding there was no areas of damage visible. But if we looked at it under a microscope we would find that there are some changes there of injury. Nerves are cut and that takes a long time for nerve cells to regrow rewire to get you back to where you were. There are new tests starting to be available and I think one’s probably just been approved by the FDA in America. Where you can do a blood test to estimate the quantity of brain damaged in a head injury. They’re thinking of using those to manage concussion as well as accidents and things like that to tell who will have a better outcome who will have a worse outcome in terms of overall estimate of damage to brain tissue.
Sarah: So do you think if had done one of those, I would, something would have shown up.
Dr Ron Granot: Probably.
Sarah: Oh that’s so interesting.
Dr Ron Granot: The MRI itself is not at this stage strong enough to be able to see those microscopic changes. The standard MRI these days is double the strength of about 10 years ago. They can find out more microscopic level detail because the pictures are better. You’d have to do a different MRI and that’s very very difficult to get hold of. And that may show more.
Sarah: OK, interesting.
Sarah: I’ve been told to slow down. I literally slow my fast walking pace right down. I start noticing people’s gardens on my way to physio in Marrickville. Instead of making it a brisk 15 minute walk along main roads I take 25 and explore leafy back streets. I check out the impressive veggie gardens in the front yards of Lebanese and Greek families. I notice one guy cuts his parsley right back to leave just a few stems. He assures me it’ll grow back soon. He’s right. I soon notice the parsley has grown back. I spot big pomegranate trees full of fruit. This older Lebanese couple don’t offer me any pomegranates but they explain something’s not right with the fruit, or the weather. They offer me a cutting to take home and plant.
So I slow down but my diary fills up. Not with work and kids activities and friends. It’s a full-time job just getting better. Physio three times a week. Appointments with my GP, neurologist, brain injury rehab specialist, shoulder surgeon, occupational therapist and soon I’ll be adding a few psychologists.
I kept a record of my headaches. Something I continued to do for three years.
Mostly it’s just times and events – what I was doing before the headache came on.
But today, it’s 2 months after I was hit, and I excitedly report lots of improvement:
Diary:
Gradually increasing activities, mostly staying below headache threshold.
Managed to read short simple stories to Emerald
Backgrounds music is OK!
Used laptop to pay bills, look at statements and help Billie with homework
Read the school newsletter!
But google maps hurt my head
Sarah: These are pretty big accomplishments. I feel like I’m testing the boundaries….sometimes going over my threshold…. but it’s a start. I’ve still got a long way to go.
