Returning to Work — And to Life

On any given day, the Psiaki’s Atlanta home is filled with kids, adults, and dogs.

Mandy Psiaki and her husband, David, have three children, ages two to 10. Right now, the family has five dogs, but since they foster for the Atlanta Humane Society, add one mama and her puppies, and that number could easily rise to more than a dozen.

Mandy, a West Point graduate who served in Iraq, works full-time at Chick-fil-A’s corporate headquarters. She oversees around 70 company-operated restaurants throughout the country, a job that requires her to travel regularly.

But when Mandy sustained a severe concussion in November of last year, her busy routine came to an abrupt halt. The night of her injury, Mandy got up in the middle of the night and tried to massage a severe pain in her neck. The next thing she remembers is waking up with her cheek against the floor of her bathroom and a bleeding cut on her head. She and her husband couldn’t fully piece together what had happened.

After a trip to her primary care physician, Mandy tried to resume her life but still wasn’t feeling quite like herself. A few days later, when she arrived at her dentist’s office, she made it only a short way from her car before she was so dizzy that she had to lie down in the parking deck and call 911. Over the next few weeks, doctors ran many tests on Mandy’s brain and heart — CT scans, a carotid artery ultrasound, an MRI scan of her brain, an electroencephalogram (EEG), an echocardiogram, and an electrocardiogram (EKG). Still, none of them revealed the cause of her fall or the symptoms she was experiencing.

“I was so dizzy,” Mandy recalls. “Extremely nauseous. I had a terrible time with light and noise sensitivity. I felt like my brain was just shaking. I had terrible tingling all over my body — I was in terrible shape. I couldn't do anything really. I didn't sleep. It was awful. “

A Turning Point

Finally, Mandy’s cardiologist suggested that her fall could have resulted from a vagal response — a reaction when the vagus nerve is stimulated, causing a decrease in heart rate and blood pressure.  When Mandy put a lot of pressure on the vagus nerve while rubbing her neck, it led her to faint and hit her head. Her cardiologist suspected the symptoms she was experiencing were due to a concussion she sustained in the fall.

“He was the first doctor who ever brought up concussion — and that was when I decided, ‘I'm going to find a way to treat a concussion.’ I Googled and found the Shepherd Center’s concussion clinic,” Mandy says.

When Mandy arrived for her first appointment at the Complex Concussion Clinic (CCC), she immediately sensed a difference.

“Before then, I could barely make it through an appointment. It was just so hard to be anywhere — every place you go into, there is so much noise and stimulation in just a waiting room,” she explains. “And so, getting to Shepherd Center, there were no TVs, the lights were dimmer, and then Cheryl (Appleberry), I just remember, her voice was so soft and kind. She ran a bunch of tests, and I felt horrible when we started. And then, as we ran tests, somehow, I started feeling better. It was eye tests, memory tests — things that were stressing my brain. But as my brain got stressed, it didn't get worse; it actually got a bit better.”

The CCC team recommended that Mandy participate in physical, occupational, and speech therapy and meet with a psychologist.

“I left there feeling so hopeful,” she says. “Just, ‘Wow, someone knows what's wrong with me.’ I'd been in limbo — every time I’d go somewhere, I'd leave feeling like I’d gotten nothing accomplished. And now I finally had a sense of the next step and hope for improvement.”

Putting in the Work

Mandy had PT, OT, and speech therapy, often back-to-back, twice a week. When she wasn’t at the Complex Concussion Clinic, she was still using the exercises, tools, and strategies her therapists gave her.

“Nothing that they told me to do was easy. It was hard, and you have to push through the ‘This is uncomfortable, but I know this is helping me,’” she recalls. “There were incredible people who have knowledge and expertise in concussions, and they have a path forward and a plan and can help you through.”

In PT, Mandy’s therapist, Rachel Frank, helped her work on balance and treated the benign paroxysmal positional vertigo (BPPV) that had been so debilitating. Her occupational therapist, Bekah Odom, helped her address issues she was having with her right eye. Her speech therapist, Matthew Brown, focused on helping Mandy regain her cognitive abilities, including her memory, and develop strategies to get back to her life, even in activities where the high level of stimulation made the situation uncomfortable.

“Like going to my kids’ sporting events, making phone calls, walking in the grocery store — anything I enjoyed or needed to do for my family. He really helped me with all of that. So, not speech in the sense of, I couldn't speak, but cognitively, my brain wasn't able to process things in the way that it used to, and I needed help getting back to that,” she explains.

Mandy especially appreciates how her therapists worked together to determine the best ways to support her recovery.

“The fact that they all communicate with one another, I never had to go to an appointment and say, well, here's what I've been doing for the last four weeks with someone else in some other facility,” she explains. “Everyone is there. They're all talking about your treatment plan and how you can get better and working with one another.”

Getting Back to Life

After about three months of therapy, Mandy was able to return to work. She has started gradually and uses tools like a timer to remind her to take frequent breaks to step away from her computer screen and move. She says she still gets fatigued by the end of the workday, as she rebuilds her stamina, but she has learned to plan for situations that might be taxing.

“Matthew walked me through an exercise where you think ahead of time about what the stressors are going to be and what you need to plan for based on what you expect to experience. And do I perfectly walk through it written down every time? No. But it helps me mentally think through, ‘Okay, how do I prepare for a situation that I know could be hard?’ Maybe the first time, I just survive, and the second time, I can be more engaged, and then the third time, I can finally enjoy it and be myself. And maybe it's not perfectly one, two, three, but I’m getting to a place where it doesn't feel so hard to be there or to do the thing.”

Mandy has started swimming again, an activity she loves, and she and her family just took a trip for fun, which she says will help her prepare to return to travel for work.

As Mandy reflects on the months following her concussion, she underscores just how much the injury upended her life. “I’ve faced many tough challenges in my life,” she says, “But nothing was as difficult as recovering from my concussion.

“The suddenness and uncertainty made it incredibly challenging, but the hardest part was how it affected every aspect of my life. For the first time, I couldn’t simply ‘tough it out’ or push through with a ‘mind over matter’ mentality. I had never felt so physically and mentally incapable.”

Mandy relied on her faith as she worked to recover. She says she’s grateful for her family's unwavering support and Shepherd Center’s compassionate care.

“I love Shepherd Center so much. I truly am so appreciative, and gosh, I don't think I'd be where I am today. I know I wouldn't be — if it weren't for the amazing, amazing people I got to work with,” she says. “Every person I met had just such care and desire to help me get better and was so engaged and involved in my journey that I just felt like, ‘Man, I can't imagine doing this without this amazing team who is supporting me.’”

Written by Ruth Underwood