I had a potentially life changing event happen on August 6th of this year. Like, REALLY could have changed my entire life to the point of if I could work, take care of myself, or if I would be on a ventilator the rest of my life or even if I would be dead. I was having a routine lesson and was going down the last jump line when my girth (which apparently, I did not tighten enough) started to slip, and the next thing I remember I was on the ground confused with a bad headache. My trainer said I rode the saddle until it was almost parallel with the ground then gravity took hold, and I splatted hard--hitting my head on the ground. I don’t remember getting back to the barn. My memory in the ring is spotty (I have pieced together a lot with my trainer and fellow barn mates accounts), and I remember thinking “something is really wrong” when I agreed to go to the hospital after the second time I was told to get in the car. 
 

If you know me then you know that I am very stubborn and hate to go to the doctors or hospital. I even refused the ambulance when years ago my mare kicked me across the barn isle resulting in my head hitting the asphalt isle. I later reluctantly went to the hospital, because after much thought, it would have pissed me off if I had complications later in my sleep. That was my first experience with a CT scan, my second time was after a horrible car accident (I refused the ambulance that time as well but agreed to let my mother take me to the hospital later). Both times I answered the physicians questions, patiently waited in the ED for the CT results, and was fortunately told that I had a concussion that required me to take off work for a couple days to rest; I would have a headache for a while; and I was told not to ride for a week. This time I told myself, “I am sure I have another concussion, guess no work tonight.  Won’t be riding tomorrow, but maybe I can still make it to the show this weekend…” It was no big deal-right? Or so I thought. 

 

The fact that this was the first time I had ever in my life agreed to take a Percocet (because the headache was so bad) should have been a clue this was no ordinary fall. I sat on the gurney, unzipped my tall boots, took off my spurs, and handed them to my mom before being carted out to my third CT of my life! My biggest worry at the time was that mom didn’t loose my spurs/boots and that I could make it to that show (I mean this was Tuesday and I had a few days to recover-though I knew I would probably not be able to jump). After the scan was done I sat on the stretcher chatting with my mother, called my trainer to update her (I remember being mad because she informed me she had already thrown out my helmet, but I figured it was fine since I had already had several falls in it and had gotten my money's worth).  By that time I had visited with several friends (oh, did I mention that I work at this hospital and that I was the neuro critical care pharmacist for many years, so I knew the ED pharmacist, multiple nurses, the physicians, and even some of my fellow pharmacist came down to talk while I was waiting on results). I was fully expecting to hear the same news again "you have a concussion..." but this time I was shocked when the emergency physician told me I had a 5 mm frontoparietal subdural hematoma, (or in layman terms- a brain bleed) and that the neurosurgical team had already been consulted! 
 

I laid on the stretcher listening to him talk and all I could think of was, “Now I can’t go to the show this weekend, oh crap-I am going to have to stay in the hospital, oh no-am I going to need a crani (a brain surgery to remove the blood)?? This can’t be happening to me, I had my helmet on, and it wasn’t that hard of a fall! I am fine, they have got to be wrong! I can’t do a surgery, I can’t be a patient in my own unit, my nurses can't see me naked!!” That’s when a small tear slipped out of the corner of my eye down my cheek. My mother was totally fine until she saw this, at which point she was then visibly upset. You see, I am usually not one to cry in these situations (especially about falling as I have ridden since I was five years old and have had many falls over the years) and this little slip was all my mother (who has no medical background) needed to see to know just how serious the situation really was. 
 

I am fortunate that all our neurosurgeons are spectacular, so any of them would be acceptable, but I will admit I was glad to see Dr. Singleton come in. He is a man of few words that doesn’t beat around the bush, so I knew he would shoot straight and not sugarcoat the situation. When he said that he didn’t think I was going to need surgery, I was elated and thanking the Lord. But he also said I would have to stay in the Neuroscience ICU for the night for observation and surgery was still possible if I declined. If all went well, I would be getting a repeat scan in the morning, could potentially be discharged if no deficits, and would "not be riding for several weeks at the very least". I felt relief. I know just how serious a subdural is, and that I was not out of the woods. But then the rider side of my brain kicked in, and I actually tried to compromise with him, “What about letting me ride this weekend if I just don't jump for a few weeks?” 

Looking back, it is amazing to see how altered a concussion can make your reasoning. To actually think that was going to fly, and that I proposed it! You know that saying about medical professionals being the worst patients? That’s me. And we all know stories of riders getting back on WAY too soon? That's me as well. The crazy thing is I know how serious this situation is, (when in a clear mind) because I have taken care of more patients with subdual’s than I can count, but as a patient with a concussion, I thought I was the exception, and I could actually be riding that week!   
 

Well long story short, I did as I was told, and thank the Lord I only had a one night stay in the neuro ICU. A repeat scan the next day showed the bleed had stopped, and I could go home. I did as I was told (my trainer, mother, and friends all threatened me) and stayed at home with the lights off battling constant headaches for weeks, and abided by the "no driving, work, gym, or riding until cleared by the doctor" rule. The repeat CT at two weeks showed a speck left, but was good enough that I did not have to get another scan. I ended up not being able to ride until a month and three days after the accident. I went to work on half shifts the following day. In fact, now two months and two days later as I write this, I still am having headaches and light sensitivity, but I am grateful to be back to riding (fingers crossed will be back to jumping this week) and am back to work. I am very blessed and I know it.
 

For years I have heard we are to replace our helmets every 5 years and after every fall, but will admit I hadn't, until now, really believed that or practiced it. In fact, I was a little mad that my trainer made me throw away my beloved velvet Charles Owen show helmet prior to Camp Leaping Horn in July because it was "just 10 years old", and she said it was no longer safe. I had not wanted to admit at the time just how right she was and had thought, “I only use it when I hunt or do side saddle classes,” because it was “traditional” looking so, "it’s not worth spending the money every 5 years-it can't be that bad." I didn’t take it seriously, because you figure you aren’t riding in it “that long,” and what is the likelihood of something happening? 

Just a week before my fall I had read an article in a local horse magazine and spoke to a friend about her new helmet with MIPS technology (Multi-Directional Impact Protection System). She was going on about how much safer it is and trying to get me to buy one. In the article Duma was discussing Virgina Tech's helmet rating system and mentioned, “Equestrian sports have an unusually high risk of head injury, and I don’t think that’s widely recognized. Per exposure, there’s a higher risk of head injury than playing football or hockey or racing cars. That, to me, is the big story — and that there’s so much room for improvement.” That hit a nerve, so I did look up helmets and decided on the Saturday before my fall to order a new one the next time they were on sale (did I mention I am frugal?) because Helmet Awareness Day was coming up, so it would be cheaper, and I could get by until then. 

Looking back, I kick myself for not having thrown away my current schooling helmet after the first fall in it last year when my trainer told me to. I had told myself several things: "It's not that big a deal. I will do it later. It wasn't that bad a fall. It's a waste of money to change them out after one fall..." All these statements are false and lead to injury. I always wear a helmet, but I wonder if I had replaced my old one with a new one, especially one with MIPS technology, if maybe I would not have gotten the subdural and just would have had a concussion? Saving that little bit of money led to a ton of medical bills, missed work, missed riding time, and a lot of on-going headaches not to mention potential memory issues in the future. 

I am thankful I did not have more serious injuries and am certainly blessed as it could have been so much worse, but I am concerned how repeated concussions from years horseback riding falls and now this bleed will impact me in the future. After this, it has also solidified just how important it is to ALWAYS wear a helmet (even for pictures, costume classes and parades), to replace your helmet after any fall, and to change your helmet out every five years as directed. You will also be happy to know I now have two new Trauma Void Lynx helmets (one for schooling and one for showing) that utilize MIPS technology, and I triple check my girth before getting on!

Here are some additional websites if you would like to learn more about helmets and head trauma:
https://vtnews.vt.edu/articles/2019/04/ictas-equestriancrowdfunding.html 

https://medlineplus.gov/concussion.html
https://www.cdc.gov/traumaticbraininjury/symptoms.html
https://mipsprotection.com
https://traumavoid.com/mips-helmet-technology
https://www.charlesowen.com/how-charles-owen-uses-mips-technology-to-top-up-helmet-safety/