Recovery from traumatic head injury can be a slow process

By RACHAEL KERR

TheNewsOutlet.org

HUBBARD

Dr. Suzanne Wilcox of Hubbard will tell you head injuries are nothing to scoff at.

She should know.

She was sent to two hospitals after a riding accident that resulted in a month of rehabilitation and a continuing battle to overcome mental fears.

Dr. Wilcox, 48, is a veterinarian at Diamond Ridge Equine Inc., and the owner and chief executive officer of Steel Valley Spay Neuter Clinic in Girard. When she isn’t working, she’s riding one of her horses — a retired female and two males — that she shows at competitions and events.

On Oct. 6, 2011, Wilcox was showing Jerome, the black Porter she refers to as “The Bus” because of his large size. During the ride, she lost her balance. One of Wilcox’s feet came loose from the stirrup, sending her tumbling forward and accidentally spurring Jerome hard in the ribs.

Panicked, “The Bus” bolted, taking the horse doctor of 18 years along with him and whipping her into one of the stalls lining the arena.

“When I fell, I kind of twisted in the air. [My trainer] thought I just hit with my leg; she didn’t realize I hit my head,” Wilcox said. “It knocked the wind out. I got up shortly thereafter, and I didn’t realize that I had hit my head.”

Wilcox got back in the saddle and rode for another 45 minutes. Upon dismounting, she had trouble moving around. It was the first inkling there might be something really wrong.

During the drive home, she couldn’t remember her mother’s phone number.

“I wasn’t really with it for a while,” she said. “I started randomly calling people because I wanted someone to talk to because I didn’t feel good.”

Wilcox got home safely. By luck, she called a friend who happened to be a pulmonary doctor. After hearing her story, the friend told her that she needed immediate medical attention.

Wilcox had just become one of the documented 371,490 sports-related concussion cases of that year.

More than just ‘a bump’

Concussions are sometimes dismissed as simple bumps on the head. In reality, a concussion is a form of a traumatic brain injury or TBI. The U.S. Centers for Disease Control and Prevention defines a TBI as anything “caused by a bump, blow or jolt to the head that can change the way your brain normally works.”

Symptoms can be pronounced or subtle. They can include memory loss, vision problems, ringing in the ears, eye problems, visual problems and balance issues.

Although Wilcox had the wind knocked out of her, she hadn’t been knocked out. This false sense of security forced her health priorities to take a back seat.

“I knew I needed to go to the hospital,” Wilcox said. “The last time I ended up at the hospital from a riding accident, I had broke my leg and they cut my $200 riding breeches off, which sent me into about hysteria. You have that thing stuck in your head like, ‘Oh my God, they’re going to cut my clothes off.’”

Dr. Joseph Congeni is the director of sports medicine and clinical co-director of orthopedics and sports medicine at Akron Children’s Hospital. He said the way society views concussions has changed in his 26 years of practice and even more so during the past 10 years.

Many myths about concussions have been dispelled.

“[One] myth is that you have to be knocked out to have a concussion. When I began ... there were probably 80 percent of people [who thought] you had to have loss of consciousness or get knocked out to have a concussion,” Dr. Congeni said. “I think most people know now, you can have many other symptoms ... and that these signs and symptoms sometimes can be pretty subtle.”

Dr. Congeni credits this increased awareness to important research on the effects a concussion has on the human body and brain. Depending on variables such as the point of and severity of impact, the patient’s age and development, and the possibility of previous concussions, the injury can have lasting effects.

“There definitely is a population of people who get more significant, permanent injury — a cumulative effect kind of problem. That’s when we started to take this problem seriously,” Dr. Congeni said.

More than a concussion

After arriving at the emergency room at Sharon Regional Hospital, a nurse noticed that Wilcox’s pupils were not responding as they should. Also, she was having issues following directions and focusing.

The results of two CT scans — one with a contrast dye and one without — showed Wilcox had a concussion and a brain hemorrhage, which happens when an artery in the brain bursts and the blood irritates brain tissue and causes swelling known as cerebral edema. This bleeding kills brain cells.

Wilcox needed to go to a trauma center.

The doctors concluded Wilcox was stable enough to go by ambulance. She was rushed to the trauma center at Presbyterian Hospital in Pittsburgh for care and monitoring.

Life after brain injuries

The Brain Injury Association estimates 5.3 million Americans — approximately 2 percent of the population — are living with disabilities caused by brain injuries.

Katie Frank is a certified athletic trainer at Action Physical Therapy, a rehabilitation center in Wilcox’s hometown of Hubbard. Between that and her work as a sports trainer in the local school system, she’s seen a number of concussions.

While Frank doesn’t deal directly with the rehabilitation of someone suffering severe multiple concussion side effects, she knows about the painstaking process of rehabilitation and the long-term effects.

“What I’ve dealt with is anxiety and depression, believe it or not; short-term memory and lack of concentration. I’d say those three are the biggest things that I’ve seen,” Frank said. “As far as long-term effects, you could get Alzheimer’s [disease]. I think [the medical profession] is worried mainly about Alzheimer’s and about the depression that repeated hits in the head cause.”

A 2013 study by Michelle Mielke, a researcher at the Mayo Clinic, found that 18 percent of the people she tested who have memory problems had suffered some sort of concussion or head trauma. Also, those with memory and thinking impairments and a history of head trauma had an average of 18 percent more amyloid beta plaques — an indication of Alzheimer’s disease — than those with no history of head trauma.

Wilcox’s case was far from a small “bump to the head.” Doctors say her recovery is nothing short of miraculous, with no major lasting physical or cognitive effects.

During her 30-day rehabilitation, she wasn’t allowed to drive or lift anything heavier than 10 pounds. Rehabilitation consisted of body massages for soreness, and plenty of rest.

“I was so sore. I’d say for about 45 days, most of the time I did a good deal of sleeping,” she said. “I’d go to work, I’d do surgery and then I’d go downstairs and I’d sleep on the couch at work and if they had questions, they’d come wake me up.”

Wilcox has some memory loss. She can’t remember the exact details of how she was hurt and what happened while she was in the hospital.

She does remember what the doctor at the trauma center told her, however.

“He told me, ‘You’re very lucky the bleeding stopped. If you didn’t have a riding helmet on, I don’t know if we’d be having this conversation — if you’d be alive.’”

Getting back to normal

Although Wilcox has recovered physically, there are still some repercussions from the experience.

It took seven to eight months before she was able to coax herself to ride “The Bus.” She’d had no problem riding Nick, her other male horse.

“I have not been able to bring myself to canter on him yet. I know a lot of that is a psychological barrier with myself. I know he’s not going to do anything,” Wilcox said.

“One day, I’m going to have to buckle up Buttercup and do it. I do it with my other horse. [But] every time I try to do the same thing with Jerome, I think about it and psych myself out.”

She doesn’t blame Jerome for the accident, but the accident has hindered her ability to show him — which is a shame because he’s the best show horse she’s ever had, she said.

“I know I’ll get back to it with him, it’s just, I don’t know, it’s that psychological thing that you have to battle yourself sometimes,” she said.

Renewed focus on safety

Wilcox is a big believer in safety “now more than ever.”

She makes sure to don her safety gear before taking the saddle. She said organizations involved in horse showing should require riders to wear helmets.

“I go to these little open shows and I see kids [without helmets] riding horses that are behaving badly. I’m thinking, ‘Oh my, God. Why would you ever let your kids get on a horse without a helmet?’ It just blows my mind that people do that, especially having the experience that I had.”

Throughout her life, Wilcox has had quite a few concussions because of her hobbies and lifestyle. She’s been kicked by a cow and fallen from an all-terrain vehicle. Still, she continues to participate in the activities that she loves.

“My family still thinks I’m crazy,” she said. “But I love what I do, and I wouldn’t change it for the world.”

Wilcox has shipped her equestrian helmet to the Safety Equipment Institute of the American Society for Testing and Materials for evaluation. ASTM will determine the damage and what could be done to better protect riders from an incident such as hers.

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