at a complete loss…
Whoever coined the phrase “the easy ones are easy” when referring to the patients we treat, must have also understood on some superior intellectual level that the inverse is also true; the challenging patients can be stressful. I refer not to their demeanor, attitude, nor their level of compliance; rather, to the pieces of their particular jigsaw puzzle we work so diligently at locating and reorganizing. Sometimes the answers or the proper path to travel are just not as clear-cut as we’d like. When this occurs treatment may be tough, and even cause us to analyze, re-analyze and then over analyze the situation.
Yes, I’m having one of those weeks.
This particular patient is a 15-year-old female who I will refer to as “V”. She has been in VT for 8 sessions following a series of dizzy spells; one of which resulted in loosing her bearings while in the swimming pool, and hit her head while swimming full speed into a wall. The second significant dizzy spell, which occurred about two weeks later, resulted in bumping her head on her headboard one night as she lay down. As she explains it, her dizziness caused her to lose track of how fast she was moving towards her pillow, and she misjudged the space. Noticing that her behavior became sluggish and lethargic after the second event, V’s mom took her to the doctor a few days later, who diagnosed her with a mild concussion based on symptoms, gave her orders to stay home and rest for a week, and sent her home. Since then, V’s symptoms have multiplied. She has developed what she calls “black vision” where everything goes black for several seconds to a full minute. It can happen when she stands up, it can happen when she moves too fast, it can happen when she’s laying on the floor watching the Marsden Ball. She can still hear, speak and is conscious, but cannot see. She has developed an intermittent tremor that seems to partially coincide with her visual black outs. Unless it is pointed out to V, she does not realize her tremors are occurring. She has begun to lose her natural peripheral suppression of objects moving in the background to the point where Marsden Ball makes her nauseous because she sees the rest of the room swinging too. She has headaches, is often confused, is light-sensitive, and often times has the gait of resembling someone who is significantly inebriated. On a good day, she can mask her symptoms enough to come to Vision Therapy and maybe visit the grocery store. On a bad day, she’s in bed or a fixture on the couch. Since I met V, her symptoms have multiplied, compounded and intensified.
I know what you’re thinking. Call her a taxi, pay her fare, and tell the driver to drive straight to the ER.
Not so fast. She’s already been. Twice.
V had an MRI the same week she started VT, which came out completely clear. She’s had a general blood panel, also clear. As I wrote earlier, her pediatrician told her she has a mild concussion and sent her home. V’s mom, quite unconvinced, did some research and was able to convince the pediatrician to refer V out for further testing. She saw a neurologist who offered no answers beyond dismissively suggesting a psychiatric evaluation. She also saw a cardiologist, whose best suggestion after considering all her symptoms was for her to eat more salt. Huh?
Meanwhile, this vibrant, beautiful young lady with a magnetic smile continues to noticeably deteriorate to the point of becoming overwhelmed with lights, sounds, internal volume fluctuation, inability to concentrate and now a new twist – insomnia.
As I’ve seen V every Friday for the last eight weeks, I’ve watched this downward spiral continue. Becoming increasingly uncomfortable that we’re just dealing with post concussion symptoms, I’ve requested my doctor step in, and she will be meeting with V’s pediatrician via telephone on Monday to review V’s case and push for another MRI considering the deterioration of symptoms. We’ve also suggested strongly to V’s mom that she find a different neurologist, one specializing in pediatrics, and make the first available appointment. As I told V’s mom this morning, I’ve worked with many patients who have suffered a concussion or a Traumatic Brain Injury and although all are different, explaining V’s situation as one of these just doesn’t feel right. There are too many variables and too many unexplained changes since she hit her head. They need to keep looking for the cause.
Since starting this blog almost two years ago, the majority of my posts have been championing the wonderful benefits of Vision Therapy. This week, however, has been a reminder that we also have a responsibility to recognize the occasion when our services may not be appropriate, and to educate our patients as best we can about the different pathological possibilities especially in the face of worsening symptoms whose origin could be far more serious.