Page Utilities
Victoria Tilney McDonough, BrainLine (page 2 of 2) Page 2 of 2
- In what ways are you fatigued mentally, and when?
- How is your sleep?
- How is your mood?
- Do you suffer from significant chronic pain?
The more information an individual or their family can provide, the more information a doctor has to make a precise diagnosis.
BrainLine: Can you explain why making sure you get a specific or accurate diagnosis is so important?
Dr. Zasler: With any medical issue, an incorrect diagnosis can set a person back in his recovery. It is important to make sure that you are seeing a clinician who is knowledgeable about traumatic brain injury. You can ask for references from other clinicians, from TBI organizations like your state’s Brain Injury Association, and from other patients. And you want a doctor with whom you feel secure, someone who is truly listening to you and asking questions.
Don’t be afraid to take your time in selecting a doctor. One thing that surprises me time and time again is that no one these days takes the initiative to interview potential doctors before making a selection. You can set up an appointment with a doctor you are considering to get a sense of his bedside manner, knowledge, and philosophy. When it comes to TBI, the patient/physician relationship may continue for many years, so choosing well is very important.
BrainLine: What can make fatigue worse?
Dr. Zasler: If you have neurogenic fatigue — that is, fatigue related to the damage in the brain’s nerve cells — here are some things that can make the fatigue worse:
- not using pacing strategies appropriately, like dividing work into “chunks,” and not getting overly fatigued by working to long at a given task
- not getting regular, restorative sleep
- not taking the necessary naps or getting the rest you need throughout the day
- not getting proper exercise or nutrition
- taking medications that have sedative properties
- having too much stress in your daily life
These suggestions are basic common-sense guidelines that clinicians should apply to help people with fatigue after brain injury. After all, the more a person learns about how and when his fatigue manifests itself, the more he can schedule his day around his levels of energy and create strategies to keep symptoms at bay.
BrainLine: Are there related problems that often occur with fatigue after TBI?
Dr. Zasler: The main ones are depression, anxiety, and stress. These often go hand-in-hand with post-TBI fatigue; one can exacerbate the other.
BrainLine: What advice or strategies do you offer your patients who are struggling with fatigue after a brain injury?
Dr. Zasler: Once I’m pretty sure that the fatigue is related to the TBI, I emphasize basic strategies like:
- getting good regular, restorative sleep
- making sure to get rest when you need it, not after you have become overly tired, stressed, depressed, or in pain
- breaking activities into several steps through scheduling activities, “chunking” (that is grouping certain activities together) and pacing exercising
- eating nutritious foods
- asking for help when needed
BrainLine: What about medications for fatigue?
Dr. Zasler: Medications can sometimes be quite effective. There are different medications that range from more mild, pro-arousal agents like Provigil or Nuvigil to other non-stimulant agents like atomoxetine (Strattera). In the most resistant cases, traditional psychostimulants like methylphenidate or dextroamphetamine can also be considered. In general, drugs are not what should be tried first. They are something to consider for people who don’t seem to be improving with their TBI-related fatigue or when their fatigue is very functionally disabling. The potential for keeping people on long-term drug treatment is certainly present, although to my knowledge this has not been studied in persons with TBI and fatigue. We need more research in this area to determine which drugs might be effective, and for whom.
For a list of current research on fatigue, click here.
Nathan D. Zasler, MD, FAAPM&R, FAADEP, DAAPM, CBIST
Dr. Zasler is an internationally respected physician specialist in brain injury care and rehabilitation. He is CEO and medical director of the Concussion Care Centre of Virginia, an outpatient neurorehabilitation practice, as well as Tree of Life, a living assistance and transitional neurorehabilitation program for persons with brain injury in Glen Allen, Virginia.
He is board certified in physical medicine and rehabilitation (PM&R) and fellowship trained in brain injury. Dr. Zasler is a clinical professor of PM&R at Virginia Commonwealth University in Richmond, Virginia, as well as a clinical associate professor of PM&R at the University of Virginia in Charlottesville, Virginia. He is a fellow of the American Academy of Disability Evaluating Physicians and a diplomate of the American Academy of Pain Management. His main areas of clinical and research interest include neuromedical issues in acquired brain injury (particularly mild TBI, neuropsychopharmacology, and low level neurologic states), differential diagnosis in acquired brain injury community-based care issues, and chronic pain rehabilitation, including headache.
Dr. Zasler is a practicing clinician who is involved with community-based neurorehabilitation and neuromedical assessment and management of persons with brain injury, neurodisabililty, and chronic pain. www.tree-of-life.com.
BrainLine
Nathan D. Zasler, MD, FAAPM&R, FAADEP, DAAPM, CBIST is an internationally respected physician specialist in brain injury care and rehabilitation.
He is CEO and Medical Director of the Concussion Care Centre of Virginia, an outpatient neurorehabilitation practice, as well as, Tree of Life, a living assistance and transitional neurorehabilitation program for persons with brain injury in Glen Allen, Virginia. He is board certified in Physical Medicine and Rehabilitation and fellowship trained in brain injury.
Dr. Zasler is a Clinical Professor of PM&R at VCU in Richmond, Virginia, as well as a Clinical Associate Professor of PM&R at the University of Virginia, Charlottesville, Virginia. He also serves as a consultant in neurorehabilitation to the Northeast Center for Special Care in New York. He is a fellow of the American Academy of Disability Evaluating Physicians, and a diplomate of the American Academy of Pain Management.
Dr. Zasler is a practicing clinician who is involved with community-based neurorehabilitation and neuromedical assessment and management of persons with brain injury, neurodisabililty, as well as chronic pain. www.tree-of-life.com.
The contents of Brainline (the “Web Site”), such as text, graphics, images, information obtained from the Web Site’s licensors and/or consultants, and other material contained on the Web Site (collectively, the “Content”) are for informational purposes only. The Content is not intended to be a substitute for medical, legal, or other professional advice, diagnosis, or treatment.
Specifically, with regards to medical issues, always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the Web Site. If you think you may have a medical emergency, call your doctor or 911 immediately. The Web Site does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Web Site. Reliance on any information provided by the Web Site or by employees, volunteers or contractors or others associated with the Web Site and/or other visitors to the Web Site is solely at your own risk.
Comments [5]
I am a 60 yr old survivor and midlevel provider of 3 Severe TBIs from one incident, now 2 yrs. My story or comment is intended for help to others and TBI Awareness. Prior to my TBIs I interviewed potential military mTBI, and seen or managed very few mod or severe TBIs. These were done bt generalist AND REFERED TO SPECIALTY. I interviewed and followed minor cases and refered to determine further rehab management. All cases complained of fatigue in ome form or another most had family, work or family involvement, esteem, depressed or anxiety/frstration components. If applicable would be refered to BH mainly for safety. I didnot and really have not understand the full story of a TBI and idiosincrasies until mine. I donot have headaches or bad memory lapses or confusion. However I HAVE EXTREME FATIGUE TO POINT OF EXHASTION, SPEECH GARBLE OR SLURINESS and word droping, but I BECOME Tangent, wordy and try to talk to get my point across. Sometimes I feel like the energizer rabbit, but my collegues and friends laugh always with me as they don't see this as abnormal, as I seemed to be like this before my injury. The difference now is that they try to be polite and wait till my point is made which I usually forgot a long time prior, before they would leave. I wake up tired, get tired if ride in auto more than 20-30 min, at diinner time, but at 12 midnight like now Wide awake, can not turn thoughts off at night, insomnia during bedtime. During night can't turn off, day unable to be fully awake. Ask my phsiatrist who told me fatigue is common, usually if made aware seem to accept and becomes waiting game. I HAVE ANTE AND POST AMNESIA OF MY EVENT THEREFORE NO PTSD, but experience vivid dreams. I experience polyuria due to my worse diabetes from oral to insuliN dependent which also causes fatigue, drowsiness with hyperglycemia. Rarely hypoglycemia and no coma episodes also normal thyroid. nOW i INTERTAIN MY DREAMS TIRER ME AS THEY ARE PANORAMIC, LARGE SCALE BUT NON TERROR. Than I read my med may interact on the fatigue and diabetes which is Cymbalta. Seen Psychiatrist who felt cognitive stable and most physical didn't need to see him unless want to change med so will start Prosac soon after 1 week taper and sleep hygiene. Was originally d/c with Oxygen but NOT MONITORED AND HAVE NOT USED SINCE D/C'D 2 yrs ago. May restart. Was using aricept caused me increas urinating got up too much at night, also anti spasmotics and pain meds increased drowsiness so d/c'd and didn't notice change with provigil but it raised B/p. I am in for long haul will wait and see. This articl is helpful and is reference for use now and fture. I sustained a Glasscoe Coma 3 on presentation, remained in coma 2 weeks, sustained a intra cranial subarachnoid bleed, frontal and temporal shearing, thus 3 severe TBIs that were confirmed by spect scan 3-4 months later. Subarachnoid bleed resolved in accute phase. Released after cervical fusion C5C6 24 days post trauma to rehab and sent home 34 days later. Initially return to work trial, however fatigue was very interfering thus awaiting MMI and retirement. Hope this helps someone. Just sharing this is helpful for me.
My 17 year old daughter is 7 years post TBI. Stills becomes extremely fatigued, both physically and mentally. she needs to be in bed no later than 9 pm or she is exhausted the next day. We have her taking Yi yoga and she sees a personal trainer to try to build her muscle/body strength. But she has developed these extreme 'startle reactions" to simple noises!! We have tried meds like Stratera with no evail. Any suggestions? could this be related to the fatigue; since you mentioned anxiety. It's so bad that we have to warn her before we sneeze! Any suggestions would be greatly appreciated.
I sustained mtbi in 1994 and 1998 and still feel like a failure because fatigue makes me less able to take care of myself. People can often see the debilitating fatigue come over me before I feel it. It comes with blurry vision, slurred speech, slow processing, clumsiness. Glad to see fatigue addressed here. But I am confused by the doctor's comments, "One thing that surprises me time and time again is that no one these days takes the initiative to interview potential doctors before making a selection. You can set up an appointment with a doctor you are considering to get a sense of his bedside manner, knowledge, and philosophy. When it comes to TBI, the patient/physician relationship may continue for many years, so choosing well is very important." In my case, the tbi prevented me from doing the things that I knew to be reasonable. I can't even set up one doctor appointment much less set up some (dealing with medical office structure, insurance requirements, telephone answering methods, scheduling, arranging transportation, dealing with MD's (even when appt is for discussion only) who place a person with tbi in a disabling physical environment, etc. All the things that are tbi to me are the things that prevent me from doing as the doctor is surprised more people don't do. It's like expecting me to hop to the drugstore on a broken leg to get a pain pill. I am stunned at the doctor's surprise. I wish I lived in the world where I could do those things-or had someone to do them for me. I'm just too damn tired.
o HAD A RPUTURED MIDDLE CEREBRAL ARERY ANEURYSM IN LATE oCTOBER 2009, EQURING CRQINOTOMY TO DIP THE WNEURYWM, WITH CRQINOPLASTY IN LATE jANUARY, SUFFERED 3 MINOR STROKES ON mri AND MOTOR FUNCGION HAS COMPLETELY RETURNED THANKS TO 4 MONTHS O F HARD THRAPY. i STILL AM COMPETELTIED OT. IS THIS USUAL? FURTHER COMPLICAIONS INCLUDED BLOOD CLO OT THE LEG SHOEWEING TO THE BRAIN CAUSING HE "STROKES". I JUST WAN MY USUAL ENERGEY BACK. DIET IS HELATHY, ND TAKING A DAILY MUTI-VITAMIN ON TOP OF POEIN SHAKES.
See All TBI Topics
Startle reaction: yes, I experience it too. I thought I was the only one in the world because it happened once in a doctor's office and he yelled at me. I was sitting during a rough exam and he reached across my face, in front of my eyes, to touch the other part of my head. Inadvertently, I jumped and my arm swung out and I hit him. I told him I was sorry, that I jump when things surprise me visually, but he was angered and threatened me with cancelling the rest of the appointment. In retrospect, I should have cancelled it. But he was the only game in town and I was too dizzy and physically stressed to take the affirmative steps that I would have taken if I had not been injured and had not been there in the first place. Still hopping to the drugstore on a broken leg for pain pills. (By the way, this happens in response to aural stimulii as well. There is a special sense of unreality when the people paid to treat us have so little understanding of our condition.
Apr 4th, 2011 9:57am