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Distress: Kathe Fothringham suffered a skiing accident with long-term implications for her neurological abilities
To the outsider, Kate Fothringham may appear to have an enviable life. The bright 44-year-old has two young sons and a loving husband, not to mention a PhD and a high-flying career as a headhunter on her CV.
But, despite appearances, she is battling a hidden injury that turned her life upside down and forced her to adjust to what is, in her own words, 'a new normal'.
In April 2010, on a family ski trip in the Alps, Kate was knocked over on a nursery slope, suffering a blow to the head that left her briefly unconscious.
'Two men skied straight into me and my instructor. I was thrown backwards downhill onto the back of my head with the combined weight of three men on top of me,' recalls Kate, who was wearing a helmet at the time.
'I was apparently unconscious for about a minute. I don't remember a thing, but got up unaided and was walking and talking, although obviously confused.'
Taken to a nearby medical centre with suspected concussion, Kate had her hazy memory prodded by a doctor.
'I remember a voice needling in my head, asking questions - it was distressing as I didn't know the answers. I knew my own name and my family, but little else.
'But over the next two hours he was satisfied there was improvement in my recall so I was discharged, without referral for a CT scan or any advice - save to take paracetamol.'
She says the pills were 'like putting a plaster on a car crash victim' and that night, suffered with 'thunderous pain'.
'I felt like I'd been run over by a truck. It hurt everywhere, especially my head, and I couldn't talk properly because it was painful using my tongue. I had no short-term memory so kept asking my exhausted husband Thomas the same questions.'
Amazingly, Kate decided to soldier on, and two days later returned to the slopes, vowing not to let her accident spoil her holiday. Her memory had slightly improved, although she still felt weak, dizzy, nauseous and in pain.
Back home in Perth, Scotland, she saw an osteopath for the whiplash and damage to her pelvis she had suffered.
'I thought I'd improve then. But when the physical pain fades, you notice neurological symptoms that are not fading at the same time.'
Among these was impaired cognitive function. Kate found herself groping for words, lacking concentration and struggling to make decisions or plans. 'At this point I was a full-time mother, but couldn't have gone back to work anyway.
'In my job I'd analyse large amounts of information. Now I couldn't finish a newspaper article and reached information overload quickly. Even reading my son's (then five, now seven) school report was too much - I'd panic because I couldn't understand it.
Cause for concern: One million Britons a year go to hospital after bangs on the head
'I'd be in tears trying to work a new mobile phone. Having been a touch typist for decades, now I could only do one key at a time.'
Kate felt constantly exhausted, suffered from a chronic headache and developed a stutter when stressed.
She couldn't watch television because light and noise were painful, and regularly felt anxious and tearful. 'My family were supportive, but I was overwhelmed by the tiniest things - it was like I was holding on to life by my fingertips.'
Despite feeling something was profoundly wrong, it was months before Kate received a satisfactory label for her problems. Visiting a GP shortly after the accident proved fruitless - he dismissed the idea of her having a scan because she was walking and talking.
Five weeks later, suffering from blinding head pain, she saw another GP who referred her for a CT scan.
'I was on tenterhooks waiting for the results - I wanted proof there was a reason why I felt this way. But nothing showed up and I was told I was fine.'
Seven months after the accident, having experienced only a gradual improvement in her symptoms, Kate contacted brain injury charity Headway and, on their advice, sought a referral to a neurologist.
'I couldn't wait longer so I got a private referral. He did tests to decipher my cognitive levels. I scored highly, but there were clear gaps in my mental functioning.
'In my job I'd analyse large amounts of information. Now I couldn't finish a newspaper article and reached information overload quickly. Even reading my son's (then five, now seven) school report was too much.'
One million Britons a year go to hospital after bangs on the head - from minor to life-threatening. Kate appeared to be suffering from residual effects of mild traumatic brain injury. Such problems are sometimes called post-concussion syndrome - while symptoms typically resolve within weeks, they can last much longer and sometimes be permanent.
Sometimes people may live with problems for years without connecting them with an old injury. These injuries can occur during sport, and due to more everyday knocks - from banging your head against a wall to slipping off a bike.
Those most at risk include young children, young men and the elderly. Up to 80 per cent of head injuries are thought to fall into the minor category.
'For some there may be no long-lasting effects, but major consequences can follow seemingly trivial injuries,' says Colin Shieff, consultant neurosurgeon and Headway trustee.
'Anyone who's banged their head probably didn't feel perfect for a few minutes. It's not remarkable to have some headache the next day or a few days afterwards. But if functioning is abnormal - any problems of speech, communication, vision, cognition, or just finding everything more difficult - the patient may not be able to recognise it.
'If you feel at all unwell after banging your head, seek help or supervision. And if those symptoms persist for more than a few minutes, go to a hospital or doctor to be checked.'
Although Kate was not told at the time, returning to the ski slopes after her injury was risky. Patients are usually advised not to play contact sports for three weeks after a minor head injury.
Post-concussion syndrome: Residual effects of mild traumatic brain injury can sometimes last for weeks
'You may be more likely to have a second injury - perhaps because you're a bit clumsier or have lost insight,' Mr Shieff says. 'And if there's some structural damage in the brain, a second bang on the head may increase the problem.'
Kate's frustration over a lack of diagnosis is not uncommon, and Headway wants GPs to recognise the sometimes-subtle warning signs. Mr Shieff says: 'If someone has fallen and is bleeding from the ear, the doctor will know they need to go to hospital.
'But if they're having headaches and trouble concentrating, the doctor may not associate that with a bang to their head last week that they've neglected to mention.'
And, as Kate found, a brain scan may not identify the 'invisible' injury she suffered.
'A CT scan looks for big clots of blood and bits of bone driven in rather than showing that the brain may not be working sensibly,' says Mr Shieff. 'These patients need to be assessed by someone with relevant skills.'
Such people may have microscopic disturbances that have affected the electrical activity in parts of the brain - sometimes described to the patient as tiny abrasions.
Dr Richard Warburg, a clinical neuropsychologist who worked for 30 years in brain injury rehabilitation for the NHS, says the 'mild' head injury label can be troublesome because people may have quite severe difficulties afterwards.
'This can be problematic psychologically, because common-sense thinking is you should recover quickly from mild injuries. There can be a vicious cycle of worrying about the symptoms, being unable to get an explanation, and consequently getting more worried.'
For Kate, support from a neurologist and clinical psychologist has helped get her life back on track. A further diagnosis of post-traumatic stress allowed her to untangle her psychological symptoms from neurological ones.
Three-and-a-half years on, she's learned to cope with how her brain now functions.
'If I forget a word, I take a deep breath and think of another, and I make lists of everything. I'm incredibly lucky - I've basically recovered. But it had a major effect on my life and I wish I'd had the support I needed sooner.'
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