Fatigue After Brain Injury: BrainLine Talks With Dr. Nathan Zasler

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Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

Dom,

Thanks for the response. You nailed a major symptom… Not being able to tolerate an LCD screen for very long. I hope to learn more about CRH receptors, but have found little information on the internet (most of it I can’t read anyway). Do you recommend any books on the topic? Feel free to email me directly at mister.e33two@gmail.com (***the two is numerical, as in 332).

Thanks!

J

Hi J.

I'm 22 years old astrocytoma survivor, so I have plenty of experience,

most important endocrinologist is your best friend in Cerebellum there is biggest concentration of CRH receptors- you might have problem with crh-acth-cortisol or thyroid axis problem, if you can't tolerate your LCD screen brightness or feel very weak after hot shower or feel strange in air conditioned supermarket it will be cortisol as well check growth hormone level, problems might occur even in sexual area due to wrong signaling to hypothalamus

don't take any stimulants like ritalin it is short term solution, avoid herbs like gingseng or marihuana you might get psychosis long term

CRH stimulants are nicotine (best icywhite niccorete;-)

yoga split works great as well (CRH stimulants)

cold shower in the morning without head or if you think that you have chronic fatigue syndrome take cold shower even 3 times a day it restore adrenal function.

best medication  is modafinil but works only 3 month, but short cycling like 3 miles gives you boost as well

all the best Dom  

Hi all... wow TBI fatigue is such an unknown. I feel compelled to share a brief of my story as reading others post has helped me feel not so alone. I am 16 months post TBI due to debulking of a cerebellar astrocytoma (brain tumor). 31 years of age. Pre TBI held a high level finance job. So I was lucky, Doc said low-grade, good position for removal (even though the tumor was on my brain stem!) short recovery period. At 16 months, I now know that there will be nothing short about my recovery. While the major difficulties are behind me (i.e. normal motor movements, speech, vision), although the period of normalcy is short lived each day - 4/5 hours of good function in the morning, hour nap, 2/3 hours of okay function in the afternoon. I am able to workout for an hour at a time, I have regained some athleticism. Currently I am trying to push it, build up physical endurance. I maintain an elevated heart rate for 1/2 hour involving movements that challenge my vestibular system (squat movements, box jumps, kettle bell swings) and it just wrecks me for the whole day... even post nap I do not recover. I'm in bed before 9pm and sleep 9/10 hours at night, but wake up multiple times ruminating. My hope is that by pushing my capacity of physical endurance the threshold will expand. I have been on this schedule for about 6 weeks now, exhausted all the time, but hopeful I will see good results. It is too early to tell. My experience with a similar approach helped my cognitive endurance. For one month I endured intense cognitive training, while I noticed diminishing returns during the month, after a few weeks off I noticed a boost in cognition.

My wisdom at 16 months post TBI is that doesn't get any easier, it just sucks less.

I want to mention something else that is helping me and hope for feedback from others. When I am in the second half of my day (during the period of okay function), cannabis helps tremendously with motivation and PTSD. I live in Colorado (cannabis is legal) and use a medicinal strain that is low in THC (cannabinoid that gives high feeling) and high in CBD (cannabinoid that is associated with pain relief). I hate feeling like a stoner, but it helps better than any of the pharmacological stuff! Most of the time I'm not smoking it. I ingest it J Does anyone else find this helps with motivation issues caused by TBI? 

Clean, organic food lifestyle and yoga help tremendously too

Be well. j

I'm going to try HBOT treatments either in OK or LA soon. Check out HBOT.com for more information. I've had five brain injuries in just over nine years time. I've had the more extreme fatigue since a fall on the ice in Nov 2013. The second of three TBIs in a two year period. The other two were car accidents where my car was rear ended each time causing whiplash injuries.

I am a vet post tbi 15 yrs ago. I am still having cognitive issues as well as chronic fatigue . Hearing loss/ tinnitus.

I am six most post tbi. I would like to offer some information that I believe will be helpful to myself and others. Yoga Nidra is a type of healing meditation yoga that puts you in a deep healing sleep. Its like getting 4 hours of sleep in 30 minutes. Please do the research and look this up Yoga Nidra. I plan to go for a weekend and learn the techniques. Ill do anything at this point to get my life back. Good Luck 

This is helpful. I conked my head six weeks ago and am keen to resume exercise but walks wipe me out. I really can't figure out if I should rest up or resume regular light training. Sounds like resting too much can cause fatigue which is what I hoped but maybe I'm reading this as I want to. My doctor is ok with gentle exercise.

I'd be interested to know how exercise effects people? I'm post tbi 4 years and the after effects of exercise still causes stunted or slurred speech and difficulty retrieving words. Sometimes I feel agitated or annoyed about an hour post workout. I used to be a runner before my accident. Thanks.

Hello. I know this is an older post but I am reading it just now and not sure if you will see this reply. I am ten months post concussion after two head injuries about ten hours apart. Previous severe brain trauma 13 years earlier with a severed vertebral basilar artery. You are the only other person I have heard experiencing increased symptoms after exercise. It is weirdly comforting to know others experience similar things. I hope you are doing much better now and will continue to improve. Best, Mic

Me too guys. I am 6 years down the line and exercise has never been the same for me.

I suffered a TBI in early 2013 and also developed post-traumatic epilepsy. I also am terribly fatigued and wonder if anyone else with a seizure disorder has tried any of the stimulants mentioned in this article? I'm not sure if it is an option in my situation. I will discuss with my MD but am curious about anyone else's experience.

I just thought of someone else's comment I would like to respond to in regards to insomnia and being awake all night (even though tired) but not being able to "turn the thoughts off" and go to sleep.  My psychiatrist said she thinks it may be because during the day there is so much going on (stimulation) that sometimes makes it hard for us with TBI to concentrate and focus. So ... we seem to "try" to get more done during the night time when things are more calm and quiet and we can focus more without the additional stimulation of day to day life. Hope this helps ... it makes sense to me.

My TBI was in 1997 and I still to this very moment fight fatigue. I am on Social Security disability. There are two drugs I have taken (as needed) for energy if I have a day with alot going on and need "help" staying awake and focused. I was told that these drugs were originally for people with narcolepsy. They are called Provigil and Nuvigil ... they are pretty much the same.  They really do help but sometimes I'll take one and STILL get extremely tired and CANNOT sleep but most of the time they help alot. I do not take them daily because I do not want to become dependent on them. Good luck and hope this helps!

I work with individuals who have sustained TBI and I am also putting together my latest research idea. I have read tonnes of literature and have noticed diet changes can help. Eat lots of eggs and red meat is one of the things I have seen

My 'injury' was the surgery performed to remove a glioblastoma. Lucky as hell and in generally very good condition, including virtually no loss in cognition, or so it seems most of the time. Depending on how well I've been feeling, I can push my brain 4,5, 6 hours or a little more before I'm outta gas and sleep is going to happen. I'd better at least sit down. Golf is a bit of mental exercise, but the physical side of that is enough to keep me awake. I can take up to three naps a day, but am usually awake, up and going between 5 and 7 every morning. My ability to sleep at night is interrupted by an aging male's prostate, too, eliminating my chances at a good night's sleep. More of my great luck is an ability to turn the euphoria enjoyed through the use of cannabis into an energy that motivates activity. It's why I walk 5-8 miles a day, depending on how well I hit the ball, 4-5 days a week. Fatigue is unbeatable, but we can still lead active and reasonably normal lives.

Wow! God bless you. I’m so happy to hear you have survived Glioblastoma. I hope you continue to improve. My son had glioblastoma so I know how difficult it is to fight.

Anna here, I get 2-3 hours of sporadic sleep a night.  Was told I have Chronic Fatigue Syndrome.  I cannot takes meds because of my TBI, we've tried.  I'm so tired of being tired.  My TBI came about from an auto accident in 1993, so, for almost 20years I have been exhausted.  Sad because my son was 8months old and I couldn't do much with him that little boys are supposed to do.  I constantly worry about TBI's and Alzheimers.

I am tired often. I need to sleep for 4-5 hours after a seizure. I sleep at least 8 hours a night. But force myself to stay awake often.

Quite interesting, thanks for sharing. A large, and oft overlooked contributing factor to neurofatigue is diet. I sustained a TBI 10+ years ago and found that fatty, carbohydrate saturated foods dramatically increased the mid-day "brain drain" that so many survivors report. I found that modifying my diet and including regular cardio exercise into my daily routine drastically improved my fatigue.

I'd be interested to see what research exists on exercise and also nutrition on fatigue after a brain injury.

While I was fighting to get social security disability, the judge looked at the variability of my fatigue levels as reason to assume the problem was not disabling. He was not impressed that on the only day that I did not get regular naps, my daughter's wedding, that I was rushed to the hospital against my wishes because my lips were blue, in addition to other obvious signs that I was mostly not awake. When I heard my lips had been blue, I purchased an oximeter and checked my blood-oxygen saturation over three days. I took the evidence to my doctor. In spite of the doctor observing blue lips at the wedding himself, he did not believe I had low oxygen levels because staff in his own office misread their oximeter, swapping pulse and oxygen levels in her report. So I had to go through a CT scan to rule out that I might be hallucinating before the doctor actually used a third party to check my oxygen levels. Since my TBI fatigue was at least partly due to inadequate oxygen, I wonder how many other TBI survivors are also struggling with low oxygen levels?

i have lost my smell sensation to some extent, i in 90% cases dont feel smell what others can,but while and after exercising , smell sensation works well but for 30 minutes after exercise.

and after passing stool , feel completely energy less.i need to eat a lot which helps me feel energetic and have no fatigur in the morning but again makes me fatigues in the afternoon,so even if i take a nap or eat food, i get fatigued.I need to take a nap and exercise to get back to work.

i had forgotten to mention-  the real cause for my fatigue is constipation , i dont pass stool for 3-4 weeks or more if i dont exercise and if i exercise , i pass stoll but in a very less quantity, after passing stool , fatigue goes off.

my previous comment-

When did the symptoms of post-TBI fatigue start?before weight loss

Did the onset of fatigue symptoms correlate with any other event such as starting a new medicine or getting depressed?depression after accident

What helps make the fatigue go away, or decrease? exercise in the morning and evening and fitnessblender metabolism 5 minute exercise every 2 hours , speak a lot the whole day and keep thinking and repeating things in brain

What aggravates it?no exercise, little or excessive food, walking fast for around 10 minutes and not for an hour to get enough exercise(i lost wt by walkingfrom 7pm to 2 am in the 3rd month of wt loss)

What triggers it? lack of exercise, depression, negative thoughts, inability to focus,

In what ways are you fatigued physically, and when? afternoon or after heavy exercise for 10 minutes.After 9.30pm and 12.00pm , sleep is must and my body automatically sleeps and i cant think at all and i must sleep.TO work at night, i must take a nap at 9.30 pm for 30 minutes

In what ways are you fatigued mentally, and when?morning

one day no exercise, its all over

How is your sleep? 6-7 hours

How is your mood?depends

Do you suffer from significant chronic pain?back injury , otherwise, i do feel left front brain and sometimes right front brain paining a bit and at the rear of the left brain.Apart from this, i sometimes feel something wrong with my right side of the heart, some sort of choking.and sometimes, this heart pain becomes severe and i can feel the vein of that right part of the heart tapping some 4-5 times very heavily.

Apart from this, on monday i have signs of panic anxiety, as doctor says.Chest becomes real hot, brain stops working and pains a bit and i become nervous.

All my heart and brain reports are normal.ECG report was abnormal but doctor said its a machine error, there are p waves in the report which the machine isnt able to recognise and hence is generating wrong report

and  comment of the 52 kg loss

When did the symptoms of post-TBI fatigue start?before weight loss

Did the onset of fatigue symptoms correlate with any other event such as starting a new medicine or getting depressed?depression after accident

What helps make the fatigue go away, or decrease? exercise in the morning and evening and fitnessblender metabolism 5 minute exercise every 2 hours , speak a lot the whole day and keep thinking and repeating things in brain

What aggravates it?no exercise, little or excessive food, walking fast for around 10 minutes and not for an hour to get enough exercise(i lost wt by walkingfrom 7pm to 2 am in the 3rd month of wt loss)

What triggers it? lack of exercise, depression, negative thoughts, inability to focus,

In what ways are you fatigued physically, and when? afternoon or after heavy exercise for 10 minutes.After 9.30pm and 12.00pm , sleep is must and my body automatically sleeps and i cant think at all and i must sleep.TO work at night, i must take a nap at 9.30 pm for 30 minutes

In what ways are you fatigued mentally, and when?morning

one day no exercise, its all over

How is your sleep? 6-7 hours

How is your mood?depends

Do you suffer from significant chronic pain?back injury , otherwise, i do feel left front brain and sometimes right front brain paining a bit and at the rear of the left brain.Apart from this, i sometimes feel something wrong with my right side of the heart, some sort of choking.and sometimes, this heart pain becomes severe and i can feel the vein of that right part of the heart tapping some 4-5 times very heavily.

Apart from this, on monday i have signs of panic anxiety, as doctor says.Chest becomes real hot, brain stops working and pains a bit and i become nervous.

All my heart and brain reports are normal.ECG report was abnormal but doctor said its a machine error, there are p waves in the report which the machine isnt able to recognise and hence is generating wrong report

this is how i damaged my brain-

1. I gained too much fat (130kgs) that i needed to sleep after every meal and after that meal i again felt hungry.I had no exercise for 9 or more years before i lost weight.

then one day i decided to loose weight and then in 3 months i lost 52 kgs ,the last month without having food.(ketones found in blood)

Even after weight loss, the sleep issue didnt got resolved and i had one more issue ,i couldnt focus at all while sitting.

So i need to stand and speak aloud to read something and i gained too much interest in reading that i never took a single second pause and keep on reading.Then i took a pause.This is when i felt something isnt good.I am losing listening power, bvefore weight loss i used to write at the speed at which someone speaks but now i cant

another issue that i am facing after weight loss is in the morning.BEfore wt loss, i could wake up any time in the night or anytime i want and i never lack energy but now i just have hardly any energy to think.I need to do exercise to start my day.

This answered a lot of questions I had and still have about TBI's. It explains a lot to me, about why I'm so tired all the time.

It is a feeling like you brain is in quicksand.

Hi Nicole (Nov 11 2013)

I know what you are going through. Please call/email.

bjry@hotmail.com

252-757-2627

Jean

Hi I acquired a traumatic brain injury when I was 11 years of age, am 28 now, and suffer quite badly from fatigue. It is only in more recent years that I can read a full chapter of a book without wanting to sleep. Anyway I'm back in college now doing a masters and college days are very long. Usually after Lunch I can't stop yawning until little break, 2 hours later and so am not taking in afternoon lectures. As far as memory goes I have trouble encoding information so being alert is very important. Can you please give me any suggestions as to how to combat this. Thanks Nicole :)
Going into my 3rd week after brain tumor removal. Feel 100% better than when it was in there. But get very very tired. Trying to do the right thing and listen to my body. If it says I need rest or a nap then thats what I do. Never been one to be idle during day, but I have discovered that if I rest im much nicer.
For me, coffee - several FDA approved caffeine compounds - alertness aids temporarily improve my alertness level a little as well as temporarily reduce fatigue/provide some small, real energy - both mental and physical. Charles Thomas Wild - Inattentive ADHD/Organic Brain Syndrome as a result of a non-normal, three day delivery (identical twin) in 1946. ADHD at one time in the USA was officially called Minimal Brain Damage (MBD). Thank you.
These comments are good to hear in that I see that I am not alone in being exhausted. I sustained a sacral spinal injury and one yr out sustained first of two TBIs where I loss consciousness, developed epilepsy, memory loss, chronic fatigue, etc. Although I hold a MSN I cannot work for a variety of reasons. My speech came back after about 5 months and I also relearned how to perform simple tasks. I still had energy after the spinal cord injury but the TBIs really took it from me, especially the second one. My left arm movement returned. My anti-seizure meds had to be adjusted after the second TBI because of the fatigue. I just hate that I am so tired.... I used to be the most energic person with endless energy. If I don't rest and overexert, I wind up seizing and losing bladder and bowel function. I hope that more research is done as TBIs are so common now with our veterans. I started taking Savella for fibromygia and it has helped the fatigue tremendously. I recommend it! Does anyone take any herbs or vitiamins which help? Thank you and Good Luck!!
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.
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.

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