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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Neurology
Satisfied Customers: 17525
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I'm 26 I fainted/blacked out and fell back onto my head

Customer Question

Hi I'm 26 I fainted/blacked out and fell back onto my head either on a counter or onto floor when I was 18 (mushrooms, alcohol, marijuana cocktail). I was unconscious for several seconds possibly minutes when I came to I was lying on floor looking up at shape shifting faces of friends sweating profusely scared to death that I was dying or dead. No bleeding or visible skull fractures, went to campus nurse few days later told half true story of how it happened, was told it probably wasn't even a concussion or something, didn't really get far. Anyway several months later i still head a big lump on the back of my head/crown area and still do to this day, as well as a seemingly soft, tingly, numb spot somewhere around the top of my spinal cord/back of skull; for several years following the accident I was convinced something was wrong, either a tumor, hemorraging or something else life threatening. Was on lexapro and Wellbutrin intermittently for severe depression/anxiety
Submitted: 10 months ago.
Category: Neurology
Expert:  Dr. D. Love replied 10 months ago.

Hello from JustAnswer.

I am sorry that you have been having so many problems.

It will hel if you could provide some additional information.

Could you describe your current pattern of pain in more detail?

Where is the pain? Is there anything that increases or decreases the pain?

What evaluation has been done?

What treatment has been done beyond the PT and chiropractor?

Customer: replied 10 months ago.
Hi Dr. Love, thank you for your response. The pain comes and goes seems worse first thing in the morning and at night and during/after bending, lifting, etc. have had MRI (determined spinal stenosis) as well as several x rays for spine/neck, CT scan for head, most recent x Ray was taken with chiropractor who claimed I didn't actually have stenosis I just had one leg shorter than the other and thought that whiplash from accident when I was 17 caused start of issue (hit tree dead on about 20-30 mph with seatbelt on, airbag deployed, no obvious injuries at time). Pain mainly in Lumbar and thoracic regions, persistent numbness, discomfort from site of head injury down neck to left scapula area, where I was told in 2009/10 I had muscle spasm. Lately my spine feels like it is perhaps pushing on internal organs, throat, etc. x Ray from chriopractor showed scoliosis, subluxation in lumbar and cervical, creating a sort of s curve. Constantly stretching, foam rolling, trying to correct posture; at times these things seem to be helping but they never last long and the pain/achiness/numbness returns. No treatment besides the pt and chiropractor as of yet.
Expert:  Dr. D. Love replied 10 months ago.

Thank you for the additional information.

There are several issues to discuss in this situation.

Since a CT scan was done of the head, that would exclude any bleeding or tumor in the skull as possible contributing factors to these symptom.

If there is evidence of spinal stenosis on an MRI of the cervical spine, that is a far more accurate test than the x-rays done by a chiropractor. The other issues identified by the chiropractor may also be present, but it would not exclude the findings on the MRI. The spinal stenosis may only be mild, so may not be a major factor and may not need surgery, but none of the tests done by a chiropractor can reliably say that stenosis is not present.

At this point, there are a couple of options for management. Certainly, the PT was an appropriate treatment, but since it has not been effective, there are several options to consider. A reasonable next step would be to use an over the counter anti-inflammatory medicine, such as ibuprofen or naproxen. ain that is worse first thing in the morning and at night is frequently related to inflammation, such as from degenerative arthritis in the spine. Using an anti-inflammatory medicine also has the advantage of being an intervention that would not require seeing your doctor.

If an anti-inflammatory medicine is not sufficient, there are several medicines that have been shown to be helpful in management of chronic back pain. The most commonly used are certain anticonvulsants, such as gabapentin or pregabalin, that appear to work by suppressing the firing of the nerves that carry the pain message. There also are certain antidepressants that can help with chronic back pain. While most antidepressants may help to some extent, certain antidepressants have more evidence that they can help, such as duloxetine. These medicines require a prescription, so you would need to discuss these medicines with your doctor.

It also may be helpful to consult with a Pain Management specialist. These doctors can help to clarify the source of the pain, plus can perform specific interventions, such as injections of steroids or numbing medicines, to help ease the pain.

So, it would be reasonable to try an over the counter medicine first, then discuss the other prescription medicines with your doctor, and possibly a consultation with a Pain Management specialist.

If I can provide any additional information, please let me know.

Expert:  Dr. D. Love replied 10 months ago.

Please let me know if I can provide any further assistance.

If I can help you with future questions, I can be reached through my profile at
www.justanswer.com/medical/expert-DrDLove

Customer: replied 9 months ago.
Thank you for your response, sorry it has taken me so long to reply. I do take Otc anti inflammatories from time to time but I don't take them regularly because they don't seem to help that much and because I don't want to take them continuously for fear of long term side effects. I have no desire to take any pharmaceutical wether it be antidepressant or anticonvulsant, I have taken lexapro and Wellbutrin in the past without any lasting results that I'm aware of and again I am skeptical of taking these long term. The truth is I'm not in constant severe pain from this, it's more intermittent, and the most frustrating part is that it interferes with my ability to live a healthy lifestyle. Prior to having all the tests down and seeing the orthopedic specialist I had been doing fairly intense weightlifting routinely for about a year, and had gained somewhere between 30 and 50 pounds from a combination of lifting and consuming at least 4000 calories most days. I was in very good shape, weighing about 215 lbs at 6'3 with 15-20% body fat. However, during this time I knew something wasn't right with my left scapula, as I had already been told I had a muscle spasm back there but wasn't given much in the way of solutions. So the whole time I was doing this weightlifting the motion of my left arm and shoulder was somewhat different than that of my right arm and shoulder. I discovered I couldn't position my left hand and arm identically to my right when doing push-ups, bench presses, etc. it seemed like I was compensating for deficiencies in certain muscles with other muscles. I had previously been told by a physical therapist that I had over trained my chest in years prior and neglected my back muscles. So when I started lifting heavy and frequently I tried to focus as much on my back as my chest. The PT deacribed it as my pectorals and front/deltoid pulling forward and compromising the back muscles. I have not engaged in routine lifting in almost two years now, I stopped abruptly due to a combination of the pain and discomfort I was experiencing and a loss of motivation as I started realizing I needed to address my shoulder and back issues and avoid compounding them further. Over the next year or so I lost a lot of weight due to eating a lot less, taking adderall, and not exercising. My self esteem and disposition really took a hit. I dropped down to 160 pounds over the course of the year. Through all this I was in much worse pain than when I was lifting, and it felt as if structural changes in my anatomy were taking place. My spine felt (and still feels) like it is shifted and/or shifting, and my left rib cage feels like it has been pushed out of place, to the point where I can see my lowest left rib pushing out further than my right. The chiropractor I saw a few months ago took x rays that seemed to show a double a curve, one in my lower lumbar near the sacrum I think and then the one in my cervical where the stenosis is (although she told me I didn't have stenosis, contrary to the orthopedic diagnosis) she said I had disc subluxation stage 2 or something, and of course recommended a proxy treatment plan which my insurance would only partially cover and I therefore declined, I haven't ruled chiropractors out as an effective plan of action, especially since I am a naturalist at heart that wishes to avoid pharmaceuticals and chronic pain management. I know my sitting and sleeping posture are at least partially to blame for all this, and although I sit for fairly
Long periods of time in a rolling office chair at work, I do get up and walk around fairly frequently, and I try to stretch throughout the day, sometimes I think j stretch too rigorously; it is primarily targeted towards my ribs and left ahoulder, usually as a response to pain and discomfort, and it's usually focused on trying to rotate my shoulder and arm back, and sqeexzing my scapula together. I also use a foam roller frequently although not recently as much, and I can always tell how screw up my back and shoulder is on the foam roller because I can't seem to roll evenly on my left and right side and my shoulder always spasms when I try to force it to stay aligned. I feel like whatever is causing the permanent spasm In my left scapula (it also is incredibly numb in that area and has been for years) may be the root of all my problems either directly
Or indirectly, it's just so frustrating to want to be very active and exercise but end up avoiding it for fear of making things worse and not knowing how to solve these problems. Sorry that I am rambling, unfortunately it's the easiest way for me to get all my points across lol. Thanks again for your time and help.
Expert:  Dr. D. Love replied 9 months ago.

It is fine to try non-medicinal treatments, as long as you are getting adequate control of symptoms. However, the potential interventions are limited. Physical interventions, either through a chiropractor or a physical therapist, would be fine. Mind-body interventions, such as self-relaxation, yoga, or biofeedback, may also be helpful. There also is some evidence that acupuncture can help some people. If you are able to achieve adequate control of symptoms with these interventions, then there is no reason to pursue medicinal interventions, but you are the best person to be able to judge whether there is adequate control of symptoms.

Customer: replied 9 months ago.
Thank you again for your reply Dr. You reaffirmed for me what I have come to accept as the most feasible strategy in addressing this. I need to motivate myself to do more yoga and deep breathing as this always seems to alleviate pain and discomfort temporarily and is without a doubt very beneficial to overall health either way. I have considered acupuncture but hesitated due to cost and feeling that it was nothing but a snake oil salesman. But even my former PCP suggested I look into it so maybe that would be the logical next step. What exaxctly is biofeedback? I know eating healthy and avoiding harmful toxins in the environment whenever possible is crucial, not sure if this relates to that or not. Any more specific advice you can give me? Is it possible the acupuncture could get rid of the muscle spasm permanently? Again thank you for your time and consideration.
Expert:  Dr. D. Love replied 9 months ago.

Biofeedback is a method that helps persons use their minds to affect physiologic functions that are usually outside th control of the individual, and uses a variety of monitoring to provide feedback about these functions. Certain therapists are trained in biofeedback techniques. The clinical response to acupuncture is quite variable, and while some people can have great responses, the likelihood that someone will have complete and permanent improvement is small.