Traumatic Brain Injury A to Z - Swallowing/Appetite & Weight

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Headache

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The group members share information about their loved ones’ injuries and progress. Learn about managing the effects of headaches resulting from TBI.
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Headache

Tracy
Okay, now that we have all introduced ourselves let’s begin by talking about how to manage some of the effects of TBI. Michelle tell us a little bit more about how Tom is doing.

Michelle
Well, he is talking more, and beginning to recognize people. He waved at his doctor, and he seemed to remember his physical therapist that he had seen just only a few times before. Some people may think these are just little things, but after what we’ve been through, it’s definitely progress.

Julie
That’s great! And all of those small steps will add up. With Sam, we just didn’t know what to expect. We weren’t given a very positive prognosis, so when he said his first word, we were amazed. We know how significant those first steps are. That is great Michelle.

Tracy
Travis, how do you feel about the progress your dad is making?

Travis
I don’t know…It…it scares me. I mean sure he’s making this progress, he’s talking more and he recognizing a few more people…but to me he's still confused a lot. And he’s still in pain a lot of the time…I know that his head hurts and I just want the pain to stop…

Carl
Yeah. It’s tough to see someone you love in pain. When Sam was first waking up, his head hurt all the time. We just felt so helpless because we didn’t know what to do…

Tracy
Sure. Well as you all have experienced, a TBI can affect so many aspects of a person’s life. What we’re going to cover next are some of the things that you, as a caregiver, can do to help that loved one when it comes to specific symptoms. Now this information will be particularly helpful when your family member comes home from the hospital. Since Sam has recently come home, Carl and Julie, we’d appreciate your input on this, if you wouldn’t mind sharing some of the things that you’ve learned.

Julie
Sure.

Tracy
Now keep in mind that your family member is likely to experience some, but not all, of these effects. I mean many effects are common right after the injury; you may have already noticed them. And many are likely to improve over time. But though we know more now about TBI than ever before, no one can say with certainty just what effects each injured person will have.

So we do know that most people with TBI can and will make improvements. I mean of course, with the proper diagnosis, the treatment, the follow-up care... they’re so important, but so are the supportive family and the community.

Michelle
You said many effects are common. What kind of effects are you talking about, Tracy?

Tracy
Well, since we’ve been talking about headaches, let’s start there. Some people have headaches most of the time, others headaches just come and go. There’s fatigue, there’s stress... a history of migraines make those headaches worse. But now the doctor will of course will prescribe medications for your loved one and possibly some other options for later in the recovery.

Michelle
What other options are there?

Julie
Since Sam had so many severe headaches early on we tried several things. What worked for him were acupuncture and exercise.

Carl
Yeah, but we didn’t start out with those treatments. First, we tried medication. That didn’t completely get rid of them, so we talked to Sam’s doctor. He suggested stress management, like deep breathing and lying down in a dark and quiet place during a headache. So Sam tried that, along with the acupuncture and exercise.

Tracy
Well Carl and Julie just mentioned several strategies for headaches.  Depending on where your loved one is in the recovery process, those strategies can change. Another thing to consider is to give your family member some guidance in terms of behavior. For example, encourage him to avoid bright sunlight, wear dark sunglasses. Also, obviously avoiding alcohol, foods that trigger headaches like cold foods, some cheeses, chocolate... things like that.

When a headache does occur, keep track of it in your journal. Note the time of the day, the activity that he was doing, also the intensity of the pain. And if the headaches don’t improve or if they get worse, let a member of the health care team know right away.

Swallowing/Appetite & Weight

Many people with traumatic injuries do not drink or eat for a period of time. As a result, they lose weight.

Once the person is fully awake and able to follow directions, swallowing can be evaluated. It is important to fully evaluate swallowing before the injured person drinks or eats.

The purpose of evaluating the person’s ability to swallow is to make sure that what he or she eats goes into the stomach, not into the lungs. When food or fluid slips into the lungs, it often results in pneumonia.

A speech or occupational therapist evaluates swallowing. This may be done in the person’s hospital room.

If not, the therapist may escort your family member to the x-ray department for a video fluoroscopy. Your family member will consume a barium-laced liquid or food that will light up on an x-ray. The x-ray helps the therapist to see precisely where it is going.

Once your service member/veteran is cleared to drink or eat, he or she may only be able to consume certain types of liquids and foods. Most people do best with medium consistencies, rather than thin fluid or very chewy, tough foods.

With practice, most people will return to a normal diet.

Appetite can be affected. Some people with TBI complain of a reduced appetite. Others gain weight due to boredom, memory problems, and an increased appetite.

Work with the health care team to learn how to help your service member/veteran have a healthy diet and a healthy weight.

What you might see:

  • Choking or coughing during meals
  • Pocketing of food inside the mouth and/or drooling
  • Decreased interest in eating
  • Weight loss, without trying to lose weight (possibly due to loss of taste and smell)
  • Overeating, resulting in weight gain
  • Memory problems: failure to remember when to eat or when last ate

How you can help:

  • Do not offer fluids or food until your service member/veteran has been cleared to drink and eat.
  • If on a special diet with restricted fluids and foods, work with the therapists and dietitians to learn what foods are allowed. Learn how to assist your family member to drink and eat if special strategies are needed (i.e., eat slowly, chin tuck during swallow, double swallow, follow every bite of food with fluid).
  • Short-term changes in appetite are common. Don’t worry about early weight loss. Most often, the weight is regained once the person is home.
  • Monitor your service member/veteran’s body weight and learn what his or her ideal weight range is from the dietitian.
  • Report appetite changes to the health care team. These may be a sign of depression, general emotional distress, medication problems, or other medical conditions.
  • Ask for a dietitian to review dietary intake and to learn more about meal preparation and a balanced diet.
  • It is common to have reduced taste and smell following TBI. Talk with the dietitian about how to use spices and flavorings to perk up the taste of food.
  • Weight gain following TBI is common. It is usually due to lack of physical activity. But sometimes it is due to boredom. Work with your service member/veteran to remain physically active and engaged in outside activities. Establish set meal times. Discourage overeating or too many snacks.
  • Encourage your service member/veteran to be involved, as able, in grocery shopping and meal planning/preparation.
  • Write meal times in the planner/memory book. Check off meals when finished.
Related Information:
Headaches
Other Physical Effects
Glossary
Frequently Asked Questions
"A really super thing for us in terms of communicating with the hospital staff—and the hospital already had this installed in the room—is a big dry erase board. Some people use it and some people don’t. We use it to make a list of all the things we want to talk about with the doctors. That way, if I’m not in the room when the doctors come by on their rotation, they’ve got the big list right there and they can see it clearly. That helps keep the communication going." -  Anna E.

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