'Mild' injuries can change careers: How I'm adapting to life after a blow to the head

Friday, 25 September 2020

The national Traumatic Brain Injury Strategy and Action Plan reveals an epidemic of sometimes life and career-altering brain injuries. (Video first published in September 2021)

ANALYSIS: The bloody collision between my head and the door frame happened during a frantic Nerf gun battle with my 11-year-old daughter.

The immediate aftermath was all about staunching the blood, getting me to A&E and getting the wound stitched up. I didn’t go unconscious, underwent a short concussion test in the A&E, and was sent home.

That was in early September. It wasn’t until the following week that I realised I was concussed, though I had not been formally diagnosed, and my professional capabilities were impaired.

Rob Stock was concussed during a Nerf gun battle.

I tired easily. I slept badly. I was prone to headaches. My concentration was poor. Sometimes the world seemed too bright. At times I struggled for words. Once I got flustered to the point of blathering speechlessness.

* Mark Reason: Our young are dying from brain injuries and rugby still looks away

* Concussion, a nagging headache with many knocked out of rugby by it, and worse

I created a homespun recovery routine of working from home for 45 minutes, then lying down with my eyes closed for 15, something that was a lot easier because due to Covid-19, working from home had become normalised.

Mandi McLeod, dairy farmer and animal welfare consultant, is living with a traumatic brain injury.

This worked well, I thought, until I crashed with an epic headache.

I realised I had no insight into the severity of my injury, and was doing too much, driven by a sense of obligation to colleagues. I should have known better. I should have sought medical advice.

HIGH ACHIEVERS AND MILD BRAIN INJURIES

Politely, my friend Tanya Colvin, former head of wellbeing at The Warehouse and Accessibility Tick programme lead, herself recovering from a more severe concussion than mine, says that according to her concussion nurse, who has been doing this for more than 20 years, that “high achievers are the worst patients because they find it hard to stop, and just do nothing”.

Dairy farmer and animal welfare consultant Mandi McLeod who was kicked in the head by a horse in 2007, also struggled to give herself time to rest and recover in the early weeks and months after her injury.

“I fought against the diagnosis,” McLeod says.

“I come from a family where work ethic is ranked really highly,” she says.

Professor Alice Theadom from AUT says the brain is amazing in repairing and recovery after brain injury, but early awareness of symptoms was crucial to ensure proper treatment.

“I really battled with this feeling of being lazy, and that if I was not working, I was being lazy.”

RECOVERING WHILE NOT LOSING YOUR JOB

Dr Alice Theadom, a leading researcher on mild traumatic brain injuries (TBIs), says people who have suffered a brain injury often feel they have to get back to work, or school.

“It’s very common that after an injury, people think they are okay, and try to get back to things very quickly. Often then we do see people crash a few days later, and they crash because they’ve done too much when their brain is trying to recover,” Theadom says.

This can have long-term impacts.

“There is some evidence that if people get good information early on, they tend to have a better recovery. The evidence is just starting to come out,” Theadom says.

MILD INJURIES THAT CHANGE CAREERS

Getting the best recovery possible matters because even a relatively mild injury can have career-changing impacts, research Theadom was involved with has shown.

In a 2016 academic study in New Zealand on patients attending an emergency department after minor head injury revealed that 63 per cent of participants reported experiencing post-concussion symptoms one month after their injuries, some of which were from accidents, and some from violent assaults.

The three most commonly reported symptoms after 12 months are fatigue, headaches, poor memory and “taking longer to think”.

Despite this, 90 per cent of people with mild TBIs returned to work within 10 days, she says.

“We found even four years later, a higher proportion of people that had had a mild brain injury had left employment, or had reduced their hours, or taken a less responsible role because of the difficulties they were having at work.”

Four years after mild TBI, 17.3 per cent of participants had exited the workforce (other than for reasons of retirement or to study) or had reduced their working hours compared with pre-injury. A further 15.5 per cent reported experiencing limitations at work because of their injury.

“The symptom of taking longer to think one month post injury significantly predicted work productivity loss 4 years later,” Theadom and her fellow researchers concluded.

“Identification of cognitive difficulties one month after TBI in working aged adults and subsequent interventions to address these difficulties are required to facilitate work productivity,” they said.

Tanya Colvin says people should be open with their employers, and give themselves time and space to recover.

THE TBI RECOVERY PLAN GAP

Despite the growing knowledge about effective recovery techniques from mild TBIs, many, like me, aren’t offered a plan to recovery.

I got a leaflet in A&E on concussion. I may have been told about managing my recovery, but if I was, I don’t remember it.

“Unfortunately, your experience isn’t an isolated experience,” Theadom says.

“Often there are other injuries which are prioritised. Often the focus is on the physical injuries, and only after the fact do people start to realise, my brain isn’t working as well as it used to,” she says.

I found this worrying to hear because there’s an epidemic of mild TBIs, including many happening to children, and young adults.

ACC’s Traumatic Brain Injury Strategy and Action Plan says international evidence, including a recent New Zealand study, suggested traumatic brain injuries among the general population is significantly undercounted because people with mild TBIs do not always seek medical treatment.

In New Zealand it is estimated that up to 36,000 people suffer TBIs each year, of which 95 per cent are “mild”.

Colivin says “there are so many concussions that go undiagnosed. If we actually had true numbers of how many concussions there were, it would be huge”.

LOSS OF PROFESSIONAL CONFIDENCE

But even if you know how to recover, it’s hard to resist the self-imposed pressure to throw yourself back into work.

Colvin, who was concussed in an accident while out walking her dogs on a stormy night, used to work for ACC with people who had more severe head injuries, but even she has struggled with the worry of what others were thinking.

She has been open with her employer about her concussion, and says it has been supportive.

“I had to tell them because I had just started a new role, and I was in intensive training, and there’s no way I could have done it,” she says.

Mandi McLeod, dairy farmer and animal welfare consultant, says she still grieves for her loss of work capacity.

In a time of great job insecurity like a recession people recovering from mild TBIs may fear they will lose their jobs, and push themselves to far, Colvin says.

“It’s in the back of your mind always.”

“All my energy has been focused on getting back to work. I’ve had to cut out everything else,” she says, including, for the time being, her work with disability charities.

ADAPTING WORK AFTER TBI

McLeod has accepted she will now never recover fully, and has had to adapt.

“I try not to schedule early meetings and definitely don't like them after 3pm,” she says.

“I struggle with doing things that may be really easy or simple when I am fatigued because it is just one more new thought process and my brain has had enough.

“My fatigue is the biggest issue and something I just can't push through like I could before.

“Networking is extremely difficult because it is generally at night and by that stage my battery is totally flat,” she says.

And there is the headaches.

“We won't go there, suffice to say they can be completely debilitating,” she says.

Being self-employed allows her to manage her time, and to lie down in a darkened room when she has to.

She has also had to learn new ways of doing old things to compensate for her deficits, such as intermittent struggles with memory.

“When I speak at conferences or do presentations I need detailed notes, as opposed to just trigger points,” she says.

“If I am travelling overseas I will always go a few days early so I can get some sleep before I need to work. This is time that can't be charged for, like any of the downtime I need.

“In the early days, I had my mum travel with me because I get overwhelmed or sensory overload too easily and so needed a minder,” she says.

Insurance lawyer Tim Gunn warns people who suffer temporary impairment due to a concussion not to lose professional confidence.

EARNINGS IMPACT

“The financial implications of my syndrome have been huge. Not only do I earn half of what I would be earning on a salary or if I could work full time, I have medication to buy and extra expenses when I travel,” she says.

She does still grieve for the loss of energy, but says: “We get so good a hiding the impact from people that they then underestimate the impact it actually has on our lives.”

McLeod says society has become more tolerant, and aware, but “I think there is a professional confidence that suffers, especially when you know that you are not all that you could have been”.

“I know what I have lost even if it isn't obvious to others.”

FOCUS ON MISSION

Lawyer Tim Gunn specialises in fighting for clients whose cases have been turned down by life insurers.

He experienced a sporting concussion six years ago, which took a long time to recover from.

He took a temporary break from the law, in part because his self-belief took a knock, but he was hired back by an understanding law firm and he remains convinced everyone recovering from mild TBI needs a supportive champion in the workplace to rebuild confidence. This rebuilding has been sufficiently successful to allow Gunn to open his own law practice.

“It’s quite a scary feeling when you have a perceived loss of capacity, and you wonder if you will recover your full function again,” he says.

Gunn, who has scored some notable victories for clients in recent years, still occasionally has times of fatigue but this has become easier to manage with time.

His legal analytical skills remain unimpaired, but his experience, which is now largely behind him, has given him more insight into the people he fights for.

“Having your own insight into the client’s experience gives you a depth of empathy that causes you to fight harder,” he says.

“Walking in their shoes has taught me that you need a degree of resilience to keep going when it feels like your computer isn’t working at its full capacity,” he says.

His awareness of the energies required to balance work and family life gives him a sense of mission that is essential to his work.

KNOWLEDGE AND FUNCTION GAP

I was completely unaware of the frightening possible professional impacts of a mild TBI.

I’ve now sought medical advice, and have a recovery plan, and my employer is supporting me with it.

I would not have done this but for my friendship with Colvin, and the researching of this article.

Theadom says New Zealand has improved treatment of TBIs, but there’s more work to be done.

“If people are still struggling after seven to 10 days that’s when we need to get them back into the system quickly,” Theadom says.

The average time in Auckland to get a specialist concussion service appointment is 60 days, she says.

“For me, that’s too long. We do need to be doing more to enable people to get help much earlier to prevent people getting to the point where it becomes a real problem for them,” she says.

Given what’s at stake professionally, I now believe I should have been directed to see my GP within three days of the impact. If nothing else, it would have got the concussion onto my medical record.

Penny McGarry, a concussion nurse at Active Plus in Auckland, would go further, especially with children, as children who suffer mild TBIs can end up falling behind in school.

“I honestly feel that for kids who have even moderate concussions, there needs to be a register that follows these kids through,” she says.

TBI MAKES SELF-CARE HARD

Chiropractor Gary Dennis says people with mild TBIs are often not aware of the severity of the impacts on them, and their brains are literally not functioning properly

Dennis founded the Concussion Care clinic in Auckland after recovering from a concussion himself.

When he sees private-paying concussion patients, he insists on them bringing a champion, someone from their life who knows them well, and can support them in their recovery.

He always asks each of them to score how well the concussion patient is compared to their normal self on a scale of one to 100.

Invariably, their champions give the patient a lower score than they do themselves.

Currently, however, my experience, and the research, indicates too many people with mild TBIs are left to muddle their way through their recoveries, navigating complex healthcare systems and bureaucracy, potentially making things worse through the medical incompetence.