Understanding Traumatic Brain Injuries: Exploring Primary & Secondary Injuries

0:00:02 - Hey, I'm Shane from Shane Smith Law. I'm here today with Thomas. He's one of the brain injury lawyers we've got on the team here at Shane Smith Law in our concussion and brain injury group and today we're going to talk a little bit about traumatic brain injuries and sort of the initial components of these kind of cases. So, Thomas, you want to get us started.

0:00:22 - Yeah, I think one of the things that you get started with when you're thinking about a brain injury is that you have not only the primary injury, where you're taking a direct hit to your head and the implications that come after that, but you're also talking about the secondary injury and the things that develop.

0:00:38 - And what's a secondary injury?

0:00:40 - Secondary injury is everything that happens as a result of that initial disruption to the brain. There's a lot of ways of thinking about it, a lot of ways of illustrating it. I think one of the examples that I've seen to illustrate really well is thinking about your brain as a city. Some people talk computer, but the science has kind of told us along the way we're not just computer with input output. There's a lot more complexities that are going on inside the brain.

0:01:05 - The primary injury is the impact right. That's when the brain takes the initial damage and hit on your skull or on whatever it hits. That's that, and secondary is what happens later.

0:01:16 - Yeah, the primary injury boom. Head hits the steering wheel, head hits the head, rest or not even having to strike your head. You've got a massive acceleration deceleration force that smashes your brain up against the hardest object inside your car, which is usually the inside of your skull. Okay, so you've got a massive smash warping of the brain pushing up against there and the primary injury would be well, I'm having a headache or I've got a laceration on my head, or I've got a large bump or migraines or something to that effect. Secondary injury was what happens as a result of that disruption to the internal functions of your brain, because there's a lot more going on inside your brain than just big bowl of jelly sitting in there.

0:01:58 - All right, now let's go back a little bit. You said that the head doesn't actually have to hit anything, and I guess the G-force or the force can cause your brain to sort of shift one way or the other and that can do some of this damage by itself.

0:02:09 - Absolutely yes. You know, I think one of the biggest misconceptions is that you have to hit your head to suffer a brain injury and the reality is that, again, the hardest object inside your car is usually the inside of your skull. So if you think about the whiplash motion, if you're driving along, somebody hits you from behind, your head slams back and then it gets whipped forward and there's kind of that rocking motion. Your brain is attached to the inside of your skull. There's a lot of connections inside of your brain. Things can get sheared, things can get damaged. You can have bruising, you can have swelling, you can have a loss of function in a lot of different ways.

0:02:47 - So all right, I mean that's kind of scary actually. I mean you hear that because everybody thinks brain injury hit your head on the windshield, something else, but it looks like the shearing can cause some damage in and of itself and shearing is just your brain sort of spinning a little bit, or inside, or even going bumping into the front of the skull and for the back of the skull.

0:03:06 - Yeah, I think it's some of the connected tissues almost being dislodged or ripping off a little bit. You know, in terms of things, just kind of, you know, getting twisted, things getting torn, shearing is almost like a cut or tear of some of that tissue. In a way it is scary because when somebody goes to the doctor, I think the CDC has said perhaps something like 80 to 90% of brain injuries are missed when you go to the hospital, when you go to the emergency room because they're just trying to make sure you're not going to die. Right, yeah, they're checking. Hey, is your brain bleeding? Do you have, you know as your skull been, you know, dented in and do you have a skull fracture that's going to cause you something emergently? Or you know, you might have someone go to an urgent care. And I've even had people go to the urgent care and they said I can't, I can't do anything in terms of telling you about your head injury. You're going to have to go to the ER. Really, yeah, so they just hands off, hands off. They don't. They either aren't up to date on what the science says about it or they're just hesitant to say something that I don't know. For whatever reason, you know you would think a doctor would be able to know about. You think that would be a basic area of knowledge for everybody who goes to medical school.

0:04:10 - So the urgent care says we can't touch it. We know if they go to the ER, the CDC says they're missed there. I guess that's one of the reasons why, when people are showing symptoms you talk to them about, hey, we need to go find a, basically a brain doctor. Is that right? Yeah?

0:04:23 - What we want to do is we want to ask them the questions that a doctor in the ER who's attending to a massive trauma, somebody's you know body broken in half by a tractor trailer, that the questions that they might not have had time to ask or just been too busy to ask or didn't think to ask. So we wanna ask those questions and get that information that they might not have known to share. It's not just are you in pain, it's is there something different after this accident in terms of what makes you who you are or how you typically function?

0:04:55 - What are like the top three questions you would ask somebody?

0:04:57 - One of the ones I think that helps me identify and say, well, maybe this person needs to go to a neurologist. That's asking about ringing in their ears or blurry or double vision. Is that ringing in your ears? That can be. That's one of the big symptoms that would say, hey, you've suffered a brain injury here.

0:05:16 - Now does that ringing in the ears all the time. So it's like 24 seven, or is it come and go?

0:05:19 - From what I understand, is just the do you have ringing in your ears that wasn't there before and is there after the accident, so it wouldn't necessarily be there all the time, but it may be triggered by I have an onset of a migraine and then, okay, I'm starting to get this humming in my ears that's getting louder and I'm not really able to Because you don't suffer from yeah, yeah. So it's just one of those things that can be intermittent or it could be pretty constant. I think it was pretty constant. It would probably say this is something that's more severe.

0:05:47 - And as you mentioned migraines, I know that's one of the biggest issues we get concerned about us. If you're having migraines, what's causing those? Right Cause? Something causes a migraine, you don't just get one.

0:05:56 - Right and thankfully it doesn't seem like most people typically have migraines. It's not something that is just a regular, everyday occurrence. I mean, a lot of people do. But a lot of times when you ask people, it's like, hey, how are you having headaches, does your head hurt? Yeah, is it just a headache or is it something that goes beyond that? What did you talk about as a migraine? Is it when the headache happens? Do you have any other symptoms that come up? And one of the things we'll hear is when the headaches come, I get dizzy. Or when the headaches come, I can't be in a room with any light. I have to shade my cover, my eyes, light sensitivity no, they're big indicators.

0:06:29 - Dizziness light sensitivity ringing in the ears or migraines, I mean, those are sort of the big triggers for us, at least in the early stages of the case, right, yeah, and I like to.

0:06:40 - I always like, when we're talking to a client, to have someone who's a loved one in the room with them, just kind of listening into the phone call, if they're okay with it, and say hey, you know, would you say that you've gotten more irritable or you had dude swings or personality change? You'll sometimes hear somebody in the background oh yeah, you are. You know what I'm saying. They don't know, they don't recognize it, they don't see it, but like oh yeah, maybe you've been pretty cranky lately. You know way more than usual, way more than normal. Yeah, honey, I've never seen you like this. So you get a lot of comments from the gallery that are kind of funny at the same time kind of sad.

0:07:13 - And they trigger us to maybe dig a little deeper.

0:07:15 - Yeah, you start asking those questions about people who are with people who are close to the person who is injured, say, hey, what are you noticing that's different since this happened? You know and again, it might not be something that somebody even picks up on themselves Like, well, he's more withdrawn, you know, instead of playing with the kids when he gets home from work at 5.30, he shuts himself in this dark room and plays video games and listens to, you know, house music or just some change, something that's changed. Something very different usually happens and a lot of times they're saying, man, I knew something was different, but nobody ever really thought to ask, or nobody, I never thought it was related to the accident. It's like, well, did it happen? Was it happening before this? No, has it been happening since this and has it been getting worse? Well, yeah, it's like maybe you should talk to the doctor about this.

0:08:04 - Yeah, so talk to the doctor. Follow up more info.

0:08:08 - Yeah, just share that information, because if you're not sharing the information with the doctor and letting them know everything that's wrong with you, they can't use that information to help you. It's you're keeping something from them that doesn't allow them to diagnose you and get to the bottom of what's going on. So we're saying, hey, tell them anything and everything that's bothering you and let them figure it out, because we're not doctors and we don't even play ‘em on TV.

0:08:29 - So it sounds like part of your job when you're talking to clients is hey, tell us what's going on. Basically just talking to the clients, getting them to give us some info, and then we ask some particular questions and if something comes up then we're like make sure you tell your doctor that, because people don't even know enough about it to tell their doctor.

0:08:46 - Absolutely, and it's. It's one of the things just being a good listener and not just trying to get information to use it for your purpose, but hearing someone's story and hearing what they're going through and kind of making them a whole person, because a lot of times you meet with somebody or you talk to somebody on the phone and they just become you know another number, you know another case or another, you know something like that, but these are people and they have stories and those stories are what make them who they are and their story is so much more complex than we can ever really gather. So one of the big things I think that we do and we do well is really getting to know our clients. You know, know what makes them tick, know what you know makes them smile. What do they do when they're, when they're not at work? What do they do at home with their kids? What are their relationships like? What is that every day like?

0:09:31 - And you know you talk about, you know the irritability right Kind of thing and you know which sounds. I mean everybody gets irritable, certainly with their spouse. Somebody gets irritable, I think when we talked to John, one of the other lawyers in the group, he said you know, the statistics for divorce and stuff after head injury is significantly higher because of things like that. People go more irritable than suddenly they're having more friction with their spouse. Things go south, especially if nobody knows the reason why. Right, and I think that's one of the great things about just finding it out, as it makes it real. Then people are like, oh okay, Kind of like, oh, that's the brain injury talking, not you.

0:10:06 - It's not. You know, the symptoms of a brain injury aren't just going to be your pain, it's going to be the emotional aspects of it. What happens to you psychologically? Do you become more depressed as a result of a brain injury, as a result of some of the chemical functions or hormonal issues or hormonal functions that the brain is responsible for? Do those trigger a cascade of effects? That's another one of the questions we ask is do you have any anxiety or depression? You know, if you had some before, okay, but has anything become heightened as a result of this? And we get a lot of people saying why? You know I hadn't. Yeah, I'm incredibly anxious since this happened, where I feel like I'm in a fog and I can't function and I'm more lethargic and I don't want to play with my kids, I don't want to emotionally involve with my wife anymore or my husband, I'm just, I'm withdrawn. So there's, the brain is just so incredibly complex. You know, like, let me say, for computer versus a city. I think a city is a really good illustration to kind of show what's the difference between those primary and then what's that secondary.

0:11:07 - And I think one of the key things is, once we identify somebody who's had that brain injury, we can at least talk to them about it. The family can even experience some sort of treatment. But also, they know it's real and they know what caused it. So then we can begin to get them treatment for it, versus just go out and live your life and nobody knows what that is going on.

0:11:26 - Right, Definitely definitely, and that's one of the biggest comforts to our client is when somebody actually hears them and it's not just I'm living in this way that my life has never been led before. All these changes are going on. No doctors are talking to me about it, but then all of a sudden you speak with somebody who hears you and then connects you with a neurologist or a brain injury specialist who can say hey, look, this is real and we can see it in this imaging. We can see in this particular area of your brain for the first time, and on the last couple of years technologies come out. For the first time we can actually see physical, physical damage to your brain, this part water fluids don't go through it anymore.

0:12:05 - This is this. This maybe why you're a little more irritable. Yeah, this lines up in theory, lines up exactly with regulation or this, why you're having the dizziness issues or the ringing in your ears. And it's not just imaginary, it's real going on. And here's why and I think that's one of the things when you were talking to me about the testing software you know the MRI, that you can see that. And then the doctor, who doesn't even know all the symptoms, can say I bet you're having issues like this. And then the client's like yeah, 100%. Yeah, you know. Or they've even told us in the you know previously, yeah, I'm having a bunch of these issues. Then we get it back and they're like oh, this client's probably struggling with these issues. Well, bam, you know it matches up.

0:12:46 - I don't want to say 100%, but really close, yeah correlates really strongly, and this is new technology that 20 years ago nobody would have ever known. They would have just said oh, your head hurts. Yes, sure, my head hurts too. Anybody can say that your head hurts. Anybody can say that your mood's changed, you're more depressed, everybody's depressed. But now we can say no, there's actually been brain damage to this particular area of this person and, as a result, there's been a cascade.

0:13:13 - We're going to struggle with these other issues. It's cascade mean. When you talk about a cascade effect, what does that mean?

0:13:19 - Yeah. So when I say cascade, it's like we talked about that primary injury had the initial impact acceleration, deceleration or direct blow. It's what happens as a result of that initial blow and that can be something that manifests itself over the course of months. So, using the example of a city, if you thought about the brain as a city, it's bustling, metropolis, charlotte. Things are going on. People are going to work all kinds of things to keep the lights on, keep the train running on time You've got. Basically, let's think about the primary injury is an earthquake. Earthquake comes into Charlotte Not typical for Charlotte Earthquake, maybe New Madrid Fall in Tennessee causes an earthquake in Charlotte. That's your direct impact, that's your primary injury. As a result of that, you're going to see a lot of things change in the city. You're going to see power lines down, you might see traffic disruptions due to cracks in the road. You might see structural issues in the buildings due to the intense shaking that's going on. So these are delayed effects. They're not caused by the actual earthquake being there, but this is stuff that ripples, cascades down the line as a result of that. So that would be what we talked about with the cascade. There are certain functions within the brain that happen, they're disrupted by that initial impact. When we talk about biochemical and cellular responses to that primary injury.

0:14:45 - So I want to go back. When you said we've run into experiences where the ER doesn't diagnose somebody or the urgent care doesn't diagnose somebody, I guess it shows me that this is such a specialized area of medicine that your regular docs really probably not equipped well to deal with that. I mean. Would you say that? I mean, have you seen any primary care doctors order the imaging studies that show the injured parts of the brain, or just the regular generic MRIs?

0:15:12 - Rarely even seen an MRI, and I think part of the reason would be is that the brain, like the ocean, is largely unexplored and we're learning more about it every day, just like they say we know what 5% of the ocean. I think it's probably similar to what we know about the brain, and the science is changing by the day, massive studies being released all the time about changing clinical definitions of it, how a concussion or MTBI mild traumatic brain injury may not just be an event, it's a process. It really plays out, a disease that plays out over a period of time.

0:15:45 - So just the concussion itself is just the first part, and then you're gonna have ripple effects that just continue on, sometimes longer and longer, and longer, absolutely yeah, and just seeing how those play out and what those do to a person.

0:15:57 - And that's why it's important to have those specialized doctors who are on top of these things, and it's not just somebody who's an orthopedic surgeon or a primary care physician who's trained to look at a very specialized area but the brain is a very specialized area on its own and it would be probably be unreasonable and you wouldn't want a doctor who knew everything about every area because Jack of all trades master or none.

0:16:19 - I was trying to think has my primary care doc ever asked my spouse like hey, is he more irritable? And stuff? The answer is no, you know, but it sounds like in the brain injury is one of the primary diagnostic tools is talking to the friends and family around that person and say, yeah, what's different, what are the changes?

0:16:35 - Yeah, yeah, cause I mean you can have all the diagnostics in the world. You can have someone say this is a concussion. Well, what does a concussion mean? When you're talking to an adjuster, to a jury, you know, a lot of times it's yeah, he has a concussion. Well, what's that mean? Let's talk to his friends and family and see what happened. Had a gentleman lived on the beach, used to go to all different shag clubs just style of dancing and all that shag clubs, be on the beach doing all the activities with his almost retired community. Got his head almost put through a windshield when the seatbelt didn't catch on him, left a you know indentation on the windshield the size of his head and after that moment his relationship with his fiance completely fell apart. He became a hermit, stopped cutting his grass, and that was a story that I was able to use with, you know, an adjuster and explain it to her. Hey, look, this isn't, we're not just saying this is a concussion. This has had massive cascading effects on this guy's life. So, um, there's, there's a lot there in terms of of what happens after that initial boom.

0:17:35 - Wow, the. The lesson we would leave our listeners with is if you have a concussion, you know it's not just a concussion. You got to look for all the secondary effects that may be impacting you or those around you from the concussion, or even you, and make sure you're getting treatment for those and that you're not just dealing with it or toughening it out, kind of deal, yeah, yeah.

0:17:55 - You just want to get back to feeling the way that you did before the accident. That's what the laws are here to protect you for. That's what we're trying to do when we help people. It's like, let me get you back to the way that you were before this, if not as close to it as we possibly can. And that's why people have insurance to protect and take care of people. Um, you know, sometimes, a lot of times, maybe most of the time, insurance doesn't really do that, so that's why you get lawyers to fight for you, all right.

0:18:17 - Well, Thomas, thanks for being with us today. And uh, Thomas once again is one of the lawyers in the concussion at brain injury group at Shane Smith Law. And uh, for our listeners out there, like and subscribe for future episodes. And uh the bell for notifications, Thanks.

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