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Viewpoint: My father died twice

By Kim Solomon, River Falls

My father died twice. The first time was a car accident when, after a severe head injury, he came home from the hospital ... different. A kind gentle man became an alcoholic with a mean streak and a fiery temper. The second time my dad died was when his heart stopped in the hospital nearly 25 years later after surgery.

Many of us know people with a traumatic brain injury (TBI) or maybe post traumatic stress syndrome (PTSD). Or both. Maybe you heard on the local news of the fireman who watched his best friend die and wasn't able to resuscitate him in time. And maybe that fireman took a hit or two on the head in his career but he was diagnosed with PTSD. Or someone like my stepbrother, a talented artist who served two combat tours in some of the worst areas of Iraq and came home to only paint in black and white instead of the beautiful, brilliant colors he was so well-known for. Or it could just be a dizzy football player who took too hard of a hit and was sidelined for the rest of the game.

If someone in your family is in a service career or participates in sports or is even a crime victim, it's important to know that several of the symptoms of TBI and PTSD overlap. People with either have been known to experience hallucinations, emotional distress, confusion, fatigue, memory and concentration problems, mood swings, and depression. However, the treatments called for are very different. PTSD is best treated by a therapist while TBI calls for quick and continuing treatment by a physician.

How do you know someone has TBI? If they've passed out from being hit on the head or having their head jolted, they have a TBI. If it happens in sports or if someone slips and falls, we call it a concussion but it is still traumatic brain injury and proper diagnosis and treatment are critical. Because of this it's especially important to understand that TBI comes in different degrees of severity and that some methods of identifying how bad the TBI is are better than others.

One measure of TBI severity is the length of time a person is unconscious, with "mild" TBI classified as unconscious for 0-30 minutes, "moderate" 30 minutes to 24 hours, and "severe" for more than 24 hours. Another way of describing TBI severity is by memory loss. Mild TBI is memory loss of less than one day; moderate 1-7 days; severe more than seven days. It's important to understand though that this memory loss is of time after the head trauma, not before it.

The most commonly used measure of TBI is called the Glasgow Scale. This would be what you see when a baseball player is knocked out and, after revival is asked their name, what day it is, how many fingers are being held up, that sort of thing. For the Glasgow Scale, scoring is qualitative and more of a judgement call than anything else.

Symptoms of mild TBI are pretty well-known and many of us have experienced them: brief unconsciousness, dizziness, loss of balance, the classic "ringing" in the ears, light and sound sensitivity, even trouble getting to sleep. Mild TBI is a serious matter but it is something that most people recover fully from.

Moderate and severe TBI can come with additional symptoms, including confusion, repeated nausea, slow recovery from unconsciousness, and possibly one dilated pupil.

Some symptoms with severe TBI are a danger signal: inexplicable mood swings, difficulty thinking, trouble remembering things, slurred speech, and agitation. It's also important to watch for longer term problems with severe TBI such as changes in behavior and emotional control as well as difficulty understanding and thinking things through.

That almost sounds like PTSD doesn't it? If you look carefully at the diagnosis criteria for PSTD (DSM-5), I wonder how many "PSTD" cases are actually traumatic brain injury and how many people didn't get the time-critical care they needed?

If you find someone unconscious, however briefly, dial 911 immediately. Keep the person comfortable and quiet if they awaken but don't move them without the aid of emergency personnel. Be sure to have them evaluated by an emergency room physician. The person may seem like they're ok but it's very possible something critical and potentially life-threatening is going wrong. The days of someone with a concussion (TBI) "walking it off" are gone.

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