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Thursday 24 August 2017
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Recovery Advice

Recovering from subarachnoid haemorrhage can be a very challenging experience for a variety of reasons; not least that it is a traumatic illness that happens without warning. Optimum recovery can take many months to achieve.  The symptoms experienced and the convalescence required will be similar for the majority of people, regardless of the cause of the bleed, or any treatment required.

 

How long will it take for me to recover?
What should I be doing whilst recovering?
What can others do to help?
When should I return to work?
Will I be able to drive?
Headaches
Tiredness
Cognitive (thinking) difficulties
Memory Problems
Difficulty Concentrating
Feeling more emotional and/or anxious
Physical Disability
Speech/Communication Difficulties
Symptoms specific to surgery (clipping)
Symptoms specific to coiling

 

How long will it take for me to recover?


The time it takes to recover is very individualised, and will be influenced by many factors. However, recovery will take a minimum of several weeks and for many, several months. On average, individuals will take at least 3 months before they feel capable of returning to their previous level of activity, including returning to work. Don’t be concerned if your recovery period appears to differ from that of others, you will recover at your own pace.

 

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What should I be doing whilst recovering?


You are likely to feel very tired for some time, and therefore you should rest whenever you feel the need to. In the first few weeks it is advisable to plan to have a rest period each day. As you begin to feel stronger you should gradually resume your previous activities, building up as you feel able. Try to avoid doing too much too soon. You will have good days and bad days.

 

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What can others do to help?


Following discharge practical support will be needed such as shopping and transport. Emotional support will also be needed but allowing time and space to regain your maximum possible independent lifestyle.

 

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When should I return to work?


You will require a period of time off work. The exact amount of time will vary according to your individual rate of recovery, and the type of work that you do. However on average, individuals will need to be off work for at least 3 months, and often longer. Some people who recover quickly, and do very well, may be ready to return to work before this time.

 

You should return to work when you feel physically and mentally capable of doing so, and ideally following discussion with your GP, Surgeon or Specialist Nurse. Regardless of the type of job, you are advised to discuss your situation with your employer and where possible you should initially start back on reduced hours and/or lighter duties, and build up, as you feel able.

 

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Will I be able to drive?


Everybody who has a subarachnoid haemorrhage and holds a driving licence must inform the Driver Vehicle Licensing Authority (DVLA), this is a legal requirement. An example of a suitable letter can be found in Frequently Asked Questions, or a form can be downloaded from the DVLA website. DVLA contact details can be found in the Useful Contacts.

 

You will also need to inform your insurance company. If you do not inform the DVLA, or continue to drive, you may find your insurance is void and you may be liable to a fine. They will ask you to complete a form, and collect information from your doctors, before deciding how long you will be suspended from driving.

 

Everybody will be suspended from driving for a period of time whilst they recover, the length of which will vary depending on your specific situation. The minimum is likely to be several weeks, and may be up to a year before you will have recovered to a point that you will be safe to drive. Suspension for group 2 driving license entitlements will be longer than that of group 1.

 

Following a subarachnoid haemorrhage you may experience one or more of the following symptoms

 

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Headaches


A sudden and severe headache is characteristic of a subarachnoid haemorrhage. Headaches over the first few days will remain quite severe, but fairly constant. This is due to the blood that is present around the brain, causing it ongoing irritation. This blood will be slowly broken down and reabsorbed naturally, but may take several weeks to do so.

 

General frequency and severity of headaches will reduce as time goes by, but many people find that they may be more prone to headaches over the coming months. After the first couple of weeks, headaches may be associated with tiredness or following periods of concentration for example.

 

Pain killers such as Paracetamol can be taken as needed. If you still have concerns then you should discuss them with your GP, Secialist or Specialist Nurse. Remember, headaches are common for most people and are usually caused by things such as tiredness, tension or viral illness; subarachnoid haemorrhage is rare.

 

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Tiredness


Overwhelming tiredness is the most common symptom people experience following subarachnoid haemorrhage, and takes the form of both physical and mental fatigue. In the first few weeks, normal daily activities such as taking a bath, will leave people exhausted.

 

Tiredness is the body’s way of telling you to rest. As time goes by the amount of rest needed will get less, it is common in the first six weeks or so that a rest period during the day will be required. You may find a worsening of common symptoms, such as headache, when tired, and may cause unnecessary worry. A gradual return to previous activities is recommended; it is likely that resuming all previous activities will take at least 3 months, and often longer. You may find that you have a reduction in your level of stamina for a year or more.

 

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Cognitive (thinking) difficulties


Cognition describes functions such as memory, concentration, decision-making and general thought processes. Some of these functions may be affected to varying degrees after a subarachnoid haemorrhage, some people may find that they have more difficulty learning new skills or information.

 

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Memory Problems


Memory problems may be subtle, or more noticeable, temporary or permanent. You are unlikely to remember a lot of your time spent in the neurological unit, this is normal. Short-term or day-to-day memory can commonly cause people difficulties after subarachnoid haemorrhage. Memories from prior to the incident remain intact for the majority of individuals, but it is day-to-day memory that can be impaired to varying degrees, such as things people tell you, or what you have gone to the shop for.

 

Memory difficulties are very common during the initial period following the haemorrhage, but will improve throughout recovery. You may notice that short-term memory difficulties are more apparent when you are tired. Your memory may completely recover, however, some people find that their short-term memory is never quite as good as it was before. If memory problems persist a referral to a Neuropsychologist may be useful.

 

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Difficulty Concentrating


You may find your ability to concentrate affected, but again, like memory, this will gradually improve with time. You may find that you can only concentrate for shorter periods of time, and that concentration is more easily broken by distraction. In the early stages you may find that you need to concentrate more intently when carrying out previously straightforward tasks. If you find concentration difficult, it is advisable to avoid trying to do more than one or two things at one time, and, if possible, avoid distractions or interruptions.

 

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Feeling more emotional and/or anxious


After leaving the security of hospital you may feel a lack of confidence, and may feel isolated and fearful of the future. Some fear recurrence of the illness. Men and women alike often find that they are more emotional. You may experience mood swings, and find that you feel like crying more easily, or for no particular reason. You may find that you feel quite low on occasions throughout your recovery. Feelings of low mood and depression can be common during recovery, and often occurs during the first few months .

 

These feelings generally improve with time, but if you are feeling very low it may be worth discussing it with your GP. You may also find that you and your family can get quite emotional when thinking about all that you have been through. Often individuals lose their confidence generally and feel more anxious about day-to-day occurrences. Confidence will slowly be regained as progress through recovery takes place. But in the early stages you may feel unhappy going out alone or speaking to strangers, for example.

 

You may find yourself feeling stress more easily; when you are experiencing a stressful situation you may notice more difficulties with memory and concentration and you may find you are more likely to develop a headache. You may find it useful attending a support group and speaking to others who have had similar experiences, or you can contact your specialist nurse or neuropsychologist if you need to talk. You may also find relevant helplines details in Useful Links.

 

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Physical Disability


Occasionally people have a weakness of one or more limb. The severity of the weakness can vary from person to person, as can the response to therapy. You will be assessed by a physiotherapist, and offered an exercise programme if appropriate. Strength in limbs generally improves over the months following the subarachnoid haemorrhage. In the initial weeks after the bleed, it will be difficult to predict the final physical recovery any given individual will make.

 

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Speech/Communication Difficulties


Some people find that they often have problems with finding the right words, or that speech may be a little slurred, or slowed, particularly when tired. In most cases this gradually improves. Speech difficulties may vary and a speech and language therapist will assess those people with serious speech difficulties.

 

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Symptoms specific to surgery (clipping)


Discomfort in jaw During the operation the surgeon may have cut the muscle at the temple in order to expose the skull. This muscle is involved in the movement of the jaw, and many people experience discomfort, stiffness and a limitation of opening of the jaw, for example, when chewing or yawning. This muscle will slowly heal, and as it does this pain and stiffness will improve.

 

Facial swelling The majority of facial swelling will go down in the first week, but sometimes swelling around the temple area may be more persistent. People who wear glasses are often aware that the arm of the glasses seems to dig in a little. Some people also find that for a few weeks their eye(s) may be puffier in the mornings, gradually settling once they have got up. These symptoms may be variable from day to day. Pain or numbness around the scar The scar will feel more sensitive generally, and may feel itchy or have a sensation of pins and needles some of the time. The nerves that supply the sensation to the scalp will have been damaged during the surgery, making the area around and behind the scar feel numb. This area of numbness will gradually reduce in size, but the scar itself may always be numb. Odd creeping sensations and sharp pains are also common. If the wound becomes tender, red, inflamed and hot, and/or begin to weep, then you should contact your Neurosurgeon or specialist nurse. The area around the scar may also feel lumpy and uneven, this is due to the piece of bone that was cut during the surgery, and stitches under the skin. The piece of bone may feel as though it moves in and out slightly on occasions, this is due to normal pressure changes inside the head, and whilst it may feel strange, it is not a problem.

 

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Symptoms specific to coiling


Bruising/tenderness in the groin You may experience some discomfort in the groin area where the catheter was inserted into the artery. This will settle down over a couple of weeks. If pain persists, or gets worse, or you notice the area to be red, hot, inflamed or weeping, then you should contact your Neurosurgeon, or specialist nurse. Some patients have reported a patch of hair loss following coiling treatment. The reasons for this are not entirely clear. This usually is a temporary symptom and resolves after a few months. Please feel free to discuss this further with your Consultant or Specialist Nurse.

 

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