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F.A.Q.
 True Or False?
- People who use alcohol or other drugs after they have had a brain injury don't recover as much.
- Brain injuries cause problems in balance, walking or talking that gets worse when a person uses alcohol or other drugs.
- People who have had a brain injury often say or do things without thinking first, a problem that is made worse by using alcohol and other drugs.
- Brain injuries cause problems with thinking, like concentration or memory, and using alcohol or other drugs makes these problems worse.
- After brain injury, alcohol and other drugs have a more powerful effect.
- People who have had a brain injury are more likely to have times that they feel low or depressed and drinking alcohol and getting high on other drugs makes this worse.
- After a brain injury, drinking alcohol or using other drugs can cause a seizure.
- People who drink alcohol or use other drugs after a brain injury are more likely to have another brain injury.
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 The answer is TRUE to all above.
Alcohol, other drugs and brain injury often go together both before and after an injury. Alcohol is present in more than half of all brain injuries. Alcohol is a factor in 66% of brain injuries caused by moving vehicles, and 60% of brain injuries involving violence. These numbers do not include the use of other drugs at the time of an injury. Whether or not a brain injury was caused by using alcohol or other drugs, after an injury the brain reacts differently to these drugs. Everyone who has a brain injury should re-think their use of alcohol and other drugs.
WHEN WILL I GET BETTER?
This is the most common question asked of head injury professionals. The best answer to "How long it takes to get better?" is, "I don't know."
In the first six months following a head injury, professionals tend to be poor at long range predictions. I put this chapter at the end of this book because it is the least useful bit of information. If you want to know why this is a problem or have symptoms that go beyond six months, read on.
Let's talk a little about why we can't predict results and some general statistics about recovering from a head injury. In the very early stages of a head injury, it is impossible to predict the long road ahead. Obvious physical injuries (ones that we can see) are an unreliable predictor of the future. For example, some people have "minor" medical problems and are discharged from a hospital within hours of the car accident. In the long run, however, they may never be the same. On the other hand, I've had people who were in a lengthy coma and had multiple physical injuries. These people not only got out of the coma, but are doing extremely well.
WHAT TO DO AFTER LEAVING THE HOSPITAL
When the head-injured person gets home. Often this is a very big event for family members. It's just the beginning of the recovery process. The medical injuries (basically the bruises and broken bones) heal very quickly. But healing from a head injury can take years. When someone goes home, family members think, it will just be just a couple more months. In truth, it's usually a lot longer.
In the months following discharge from the hospital, it's important to be aware that the head-injured person may have a fatigue problem. In other words, they get very tired quickly. When head-injured people get home from the hospital, they may have only 3 or 4 good hours in the day before they're wiped out. They may easily fall asleep, or they may not be able to concentrate. In general, the person is better in the mornings and has tougher times in the afternoons. It's important for family members to remember this. Often the evening comes around and family members want to bring relatives over to see them. Those evenings are often tough on the head-injured person. In the early weeks, one of the things that I would suggest is to try to limit "welcome home parties" and visitors. Have them scaled down and shorter in length. For example, try a welcome home party that lasts for about a hour, then have everyone leave. The head-injured person may want to see friends right away. You may need to limit it to just one hour or two hours, depending on how much the person can tolerate. At the same time, you don't want to limit it too much, because the person may become depressed and feel isolated from friends. It is always a very careful balancing act in terms of how much the person needs versus what can be dealt with.
HOW IS THE BRAIN HURT?
Each year in America, one million people are seen by medical doctors due to a blow to the head. Of that number, 50,000 to 100,000 have prolonged problems that will affect their ability to work and/or affect their daily lives. The majority of people that I see are injured in car accidents. It is important to note that you do not have to be traveling at a high rate of speed to get a head injury. Nor do you have to hit your head on an object (steering wheel, windshield) to injure the brain. Even at moderate rates of speed, traumatic brain injuries can and do occur. Three separate processes work to injure the brain: bruising (bleeding), tearing, and swelling.
- BRUISING (BLEEDING)
If a person is driving a car at 45 miles per hour and is struck head-on by another car traveling at the same rate of speed, the person's brain goes from 45 miles per hour to zero in an instant. The soft tissue of the brain is propelled against the very hard bone of the skull. The brain tissue is "squished" against the skull and blood vessels may tear. When blood vessels tear, they release blood into areas of the brain in an uncontrolled way. For example, one might imagine a dam that breaks, causing water to flood the streets of a town.
Why do medical experts seem so concerned about bleeding in the brain? A major problem is that there is no room for this extra blood. The skull, being hard and brittle, does not expand. So the blood begins to press on softer things--like brain tissue. Brain tissue is very delicate and will stop working properly or may even die off. With large amounts of bleeding in the brain, the pressure will make critical areas of the brain stop working. Areas that control breathing or heart rate could be affected, and a life or death situation could develop within hours of the accident. Some people have sustained a head injury from a car accident and seem "just fine" right after at the accident. Some have even gotten out of the car and directed traffic. Within a short period of time, they began to get more and more confused until they eventually lapse into a coma. So, you can see why Emergency Medical Technicians at the scene of the accident are so anxious to have people go to a hospital following a car accident.
- TEARING
At some point in time, we've all played with the food "Jell-O". If you put a thin cut in a square of Jell-O with a knife and let it go, the Jell-O will come back to shape if you jiggle it. The Jell-O will look perfectly good up until the time you go to lift it up, and there will be the slice. The brain has a consistency slightly firmer than Jell-O, but the same effect applies. In the case of the car accident, the brain is thrown forward, then bounced backward (remember those car commercials where the crash dummy flies forward, then comes flying backward). In this forward/backward motion, the brain can be torn. The brain can also be torn by the effects of "energy". If you take a block of ice and hit it with a hammer (assuming you don't completely shatter the ice), you will see little cracks in the ice. Energy from the hammer has been transferred to the ice, producing the web-like cracks. Tearing in the brain is very serious. Tearing in the brain "cuts" the wires that make the brain work.
One of the problems with tearing is that it happens on a microscopic level (the brain has about 100 billion of these "wires"). This tearing may not show up on typical medical tests. Devices that take pictures of the brain will not see these small tears. Two common ways of viewing the brain are with a CT Scan (using X-rays) and an MRI (using magnetic fields) to create pictures of the brain. Both of these techniques are very good at seeing blood and tumors in the brain, but they are not good with tears (which are very small). In a number of medical studies with people who have head injuries, only 10 to 15 percent had "positive" CT Scans or MRI findings. By the way, a "positive" in the medical business is NOT a good thing. It means that they found something that is abnormal in the brain.
- SWELLING
If I drop a bowling ball on my foot, my foot will turn "black and blue" due to blood leaking under the skin. But my foot will also do something else--it will swell up. The body realizes that the foot has been injured and sends agents to heal the injured area. The problem with the brain is that there is no extra room and the pressure begins to build up. This pressure pushes down on the brain and damages structures in the brain. If there is too much pressure, this can stop important structures that control breathing or the heart rate. Sometimes, doctors will install a "relief valve" (intra-cranial pressure monitor or ICP) to let off the excess pressure.
- OPEN VERSUS CLOSED HEAD INJURY
Not too long ago, doctors made the distinction between open and closed head injury. In a open head injury, the skull is fractured and doctors assumed this would produce a severe head injury. In closed head injury, the skull is not broken and doctors assumed these produce less severe injuries. Wrong! In closed head injury, pressure builds up and damages brain tissue. If you fracture the skull, you may let off excess pressure thus saving the brain from further damage. Because of the wide variation in patients, these terms are no longer used.
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