Do you have a psychiatric condition or a TBI ? Military TBI: Don’t get misdiagnosed !

  Carol L Henricks

As a neurologist and Traumatic Brain Injury (TBI) specialist, for many years I evaluated military veterans who were still active duty (as an independent practitioner, not at the VA ) for the purpose of “ruling out” TBI. But that is not what happened. Every single soldier I evaluated from the army base had clinical exam findings, symptoms and complaints as well as MRI – DTI finding consistent with TBI but psychiatric diagnoses had been suggested. What is the problem ?

There seems to be a pervasive belief that if you were not knocked unconscious for some significant period of time that you cannot possibly have suffered a TBI. This is untrue. In fact the majority of the soldiers that I saw had never lost consciousness, but had been exposed to blast after blast after blast. They often recalled the acute onset of neurological symptoms associated with each blast injury.

There is also a belief that if you were not within 150 feet of the blast, that it did not have any effect. Wrong again. If you could feel the explosion, it may have had an impact. Not only the force of the impact but embolization of bubbles may cause injury. And just like in the NFL, more injuries equals worsened brain trauma.

Another misconception is that if you have “psychiatric” symptoms, then you have PTSD or some other psychiatric diagnosis rather than the symptoms representing a consequence of your TBI. Psychiatric symptoms arise from brain dysfunction. Psychiatrists prescribe medicine based on descriptions of emotions and behaviors. The unaddressed question is: what is the biological basis for symptoms that are occurring? Concussion causes generalized brain dysfunction, but often there are trauma associated focal areas of the brain that have experienced significant injury. Focal injury causes localized dysfunction. Damage to the frontal lobe of the brain may cause depression, mood instability, lethargy and poor decision making. Damage to the temporal lobes of the brain may cause seizures, poor memory, auditory and visual hallucinations.

There are important questions to ask yourself to determine if your symptoms actually represent TBI:

  1. When did my symptoms begin ? Symptoms due to TBI are typically evident immediately following the physical injury.
  2. Was I exposed to any blasts, jolts, blows to the head even stateside during training, that may have had an impact ? Many physical traumas create TBI.
  3. Do I have headaches ? Headaches are common with TBI and begin after the physical injury.
  4. Am I dizzy ? Loss of balance and a feeling of unsteadiness is a typical symptom of brain injury.
  5. Am I tired ? Being tired but unable to sleep is a symptom of diffuse brain injury, although it can also be associated with hyper vigilance.
  6. Am I able to read as long as I used to be able to read ? Difficulty with visual fixation ( in order to read a word ) and visual follow ( reading across a line of print ) is a complex integrated function of the brain and is a symptom of diffuse brain injury.
  7. Can I remember how to do routine tasks of my life and my job ? Typically a person with primary PTSD is still able to recall how to perform routine tasks.

PTSD symptoms typically revolve more closely around an emotionally painful event. Some veterans are said to have “ complex PTSD” and it is likely that those veterans have experienced both kinds of trauma. Classic PTSD symptoms include re- experiencing the distressing event over and over again triggering a strong emotional response; being motivated to avoid situations that will trigger event – related memories and being hyper vigilant.

Treatment for TBI is different than treatment for primary PTSD. Make sure you have an accurate diagnosis. If you think you have had a TBI but are being diagnosed with a psychiatric condition: make sure you have a brain SPECT scan or a brain MRI – DTI as part of your evaluation. It is important to be diagnosed with both conditions if both injuries occurred. If both are not treated, true healing will not take place.

* Dr Phillip James recently published his book “Oxygen and the Brain The Journey of our Lifetime”. It is available through Best Publishing Company. His book includes a review of the mechanisms of brain healing with hyperbaric oxygen therapy.

Carol L Henricks, MD….Behavioral Neurology, Epilepsy,Sleep Disorders, Traumatic Brain Injury  & Hyperbaric Medicine.                     .
NorthStar Neurology PC…7596 N La Cholla Blvd…Tucson AZ 85741 …Office Phone: 520-229-1238  Office FAX: 520-229-1242

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STOP SOLDIER SUICIDES Awareness Event September 18, 2014

22-Veterans-a-Day-memorial

On Thursday, September 18 Healing Arizona Veterans is sponsoring the STOP SOLDIER SUICIDES Awareness Event at Armory Park in Tucson, Arizona. This event has been created to bring public awareness to the 22 veterans a day committing suicide. Every 18 hours an active duty military commits suicide.

The physical address of Armory Park is 220 S. 5th Ave., Tucson, AZ 85701. Website:   http://armoryparkcenter.com

Below is the information for the event and information on our solution to this national tragedy happening daily. TIME: 8 AM – 1 PM

Please click on image to increase size and readability.  We hope you will join us at the event and help us to spread awareness to this tragedy happening daily.

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STOP SOLDIER SUICIDES Awareness event information
STOP SOLDIER SUICIDES Awareness event information

Combat Traumatic Brain Injuries Part of Veteran Suicide Trigger

22-Veterans-a-Day-memorial
Memorial to 22 veterans a day committing suicide to be seen in Tucson September 18 at event in Armory Park and in many cities throughout the U. S.

by Carol L Henricks, MD

 It is Suicide Awareness Month and it is time to connect the dots and understand why the suicide rate is so high among our active duty military and military veterans. It is a consequence of the brain – blast injury (a form of TBI) they have sustained! Dr. Duncan, COO of Patriot Clinics, Inc. states that “Not since World War I have service members in a war theater been exposed to the level of blast injury that US service members have experienced in recent wars. “

A blast – brain injury has 2 mechanisms of injury to the brain: the concussive force of the blast and the decompression injury. You don’t need to hit your head or lose consciousness to be injured. Even one concussion brain injury is associated with an increased risk of depression and suicide – but military members are typically exposed to blast after blast after blast. Most of the military veterans I have seen in my office don’t even “count” the more distant blasts they experienced or view repeated blasts experienced in a single day as separate events. Every blast creates injury and the sooner after one injury you are exposed to more injury the worse the cumulative injury.

Blast – brain injury injures the whole brain. On a pathological level, the decompression injury causes ischemic lesions (like tiny strokes) all throughout the brain. When this occurs in an elderly person they are clinically diagnosed with Alzheimer’s dementia. The axonal shear component of injury is also a diffuse injury and disconnects the networks in the brain. The networks that perform basic processes such as the cycling between wakefulness and sleep are destroyed. Attention, concentration, short-term memory and executive function (planning) are lost. Emotional control is unstable and unpredictable. Life with a brain injury is a life that feels out of control. It is disorienting and confusing. This cognitive – emotional state triggers suicide. When a psychiatric diagnoses is made medication is prescribed resulting in clinical worsening.   Substance abuse also causes clinical worsening.

If you don’t diagnose and correctly treat brain injury, there will never be a successful treatment program. Medications do not heal the brain. This is a call – out to all military veterans: if you have been exposed to IED’s, RPG’s and other blasts and concussive forces, be evaluated with a SPECT brain scan, brain MRI – DTI (diffusion tensor imaging) or some other high level technology. Routine brain MRI scans (even with contrast) or head CT scans (even with contrast) are not able to “see” the injury. It is a limitation of technology, not proof that the TBI is not there.

There is treatment for this type of brain injury: Hyperbaric Oxygen Therapy (HBOT). The Patriot Clinics, Inc. of Oklahoma and the International Hyperbaric Medical Foundation have championed the cause to set up HBOT treatment facilities in every state. In Oklahoma, the Oklahoma State House, the Oklahoma State Senate and the Governor all signed a bill into law that would create a funding mechanism so that money would be available for their hyperbaric facility to treat all the military veterans in their state. The state of Oklahoma recognizes the connection between brain injury, PTS and suicide and the effective treatment. The goal is to have every state set–up a program for its military veterans so they can be treated at no charge.

Military traumatic brain injury and its consequences are at a crisis level. There are HBOT facilities, non – profit organizations and concerned citizens around the country that are prepared to come together and help insure that those who need it are treated. This is a grassroots movement and we the people must rise to the occasion. We must be heroes to our Heroes.

 

Carol L Henricks, MD

Behavioral Neurology, Epilepsy,Sleep Disorders, Traumatic Brain Injury  & Hyperbaric Medicine.                     .

NorthStar Neurology PC…7596 N La Cholla Blvd…Tucson AZ 85741

Office Phone: 520-229-1238

Office FAX: 520-229-1242

Insights Into Military Traumatic Brain Injury (TBI)

 Carol L Henricks, MD

 I just returned from the 2014 International Hyperbaric Medical Conference with new and powerful insights. My thanks to Dr. Paul Harch and to physiologist Tom Fox for helping to bring to light the mechanism of injury of a TBI  as well as the proper treatment.

As a neurologist – specialist I have seen many active duty military veterans returning from deployment in my office to assess them for a diagnosis of Traumatic Brain Injury (TBI) or Post Traumatic Stress (PTS). As I go through the interview, many insist that they have not had a TBI because they have never been struck on the head or lost consciousness from a blast explosion. Unfortunately that does not mean that they have not had a TBI, and when I study them with brain MRI – DTI imaging the evidence of injury is present.

When you use a high-powered gun / weapon or are exposed to a blast (even from a distance of 150 yards or more) and you feel the impact of that blast you have a potential for injury from that event. The high power pressure wave that is created correlates to the pressure that you would feel if you were deep – sea diving. Quickly following the pressure wave there is a period of time of decreased or hypobaric pressure. This is physiologically like coming to the surface too quickly after a deep dive. So a blast exposure may create symptoms of decompression sickness. Many military veterans have been exposed to explosion after explosion after explosion, and the brain injury is cumulative. We know the treatment for decompression injury: Hyperbaric Oxygen Therapy (HBOT). This treatment was not offered on the battlefield (despite the possibility of using deployed chambers) and has not been offered as a choice for healing the chronic effects of the TBI.

Protective body armor worn by troops may multiply the brain – blast injury. Helmets protect against bullet wounds and flying debris, but they reflect the energy from the pressure wave back from inside the helmet.

Even sending injured military by life – flight may compound their injury. If you have decompression injury, one of the most harmful things you can do is to be transported in an airplane at a high altitude. Many severely injured military were transported by air to hospitals in Europe.

The more exposure you have to blasts, the closer in time those injuries are, the more injury. Many military warfighters were exposed to blast after blast after blast during the time they were deployed. IED’s. RPG’s. Repeated injury produces more disability. The injury to military veterans is similar to the injury that NFL football players suffer from repeated concussion. In fact, football players suffer repeated TBI injury from repeated impact even if they don’t clash helmets. There is more than one league of denial.

Symptoms of TBI have an extensive overlap with symptoms of PTS. If military veterans are not aware of the connection between blast injury and their symptoms, they may be falsely diagnosed with PTS or some other psychiatric condition that does not apply. It is important that all health care providers are aware of the injury associated with blast injury and ask interview questions that will bring that history to light. If we do not know the nature of the injury, we cannot treat.

Even one concussion / TBI blast injury increases the risk of suicide. The majority of warfighters have had many assaults. We cannot continue to allow our military veterans to suffer and to take their own life because we do not provide them with effective therapy. The number of military veterans that take their own life, on average, daily is 22 – 35 or more. That is 8030 – 12,775 a year and is many times more than the number of military members that were lost in combat during the recent conflicts.

The use of HBOT for TBI has been extensively documented by Dr. Paul Harch. A treatment protocol of an initial 40 treatments x 1 hour @ 1.5 ata will treat most military veterans with TBI from blast injury. As with all medical therapies, there are no absolute guarantees, more treatments may be needed, nutrition is key and adjunctive therapies may be appropriate for ultimate symptom resolution. It is a national crisis that we need to combat with urgency and effective solutions. Stop Soldier Suicide.

 

Carol L Henricks, MD

Behavioral Neurology, Epilepsy,Sleep Disorders, Traumatic Brain Injury  & Hyperbaric Medicine.                     .

NorthStar Neurology PC…7596 N La Cholla Blvd…Tucson AZ 85741

Office Phone: 520-229-1238

Office FAX: 520-229-1242

 

 

Amazing Healing Powers of QiGong and Tai Chi Kung.

If you want to see inexpensive & beneficial health care look no further than China that has been using the healing arts of Qi Gong (pronounced Chee GONG) practiced there for over 5000 years and is much older and much simpler to do than Tai Chi. Last year I witnessed the power of this ancient art when I met a man named Joe Pinella that has been practicing QiGong for over 40 years and teaches it here in Tucson. He will be working with Healing Arizona Veterans as part of our comprehensive healing program.

When you read his story you will be convinced that this healing exercise can literally change lives and give hope to our veterans that perhaps had given up any hope for recovery.

After a catastrophic car accident, Joe Pinella was diagnosed quadriplegic and told by doctors that he would never walk again. But, against all odds, Joe Pinella used the ancient Chinese healing techniques of Qi Gong and Tai Chi Kung to relieve his pain, regain his strength… and train his body to walk again!

Joe Pinella knows firsthand what it is to recover from severe injuries that medical doctors and physical therapists said would leave him permanently disabled. Joe broke his neck and back in a catastrophic car accident. The doctors who treated him in the emergency room were amazed that he survived. They removed two vertebrae and four discs from his neck. They told him he would be a quadriplegic. When Joe proved them wrong, they told him he would be severely disabled for life. He could not feed himself, wash, shave or dress himself. Joe did not accept this verdict and turned to his background in the Chinese healing arts.

As a young man, Joe had studied the ancient Chinese healing arts of Qigong and Tai Chi Kung… and he was certain that these healing movements would offer him a way to recovery. He knew things were possible that Western medicine did not accept. And he was right. As he turned to this ancient form of self–healing, Joe fully recovered his ability to walk, take care of himself and relieve the unremitting pain by using Qi Gong and Tai Chi Kung.

Joe
Joe Pinella

Tai Chi Kung is based on very specific slow movements that help strengthen the body’s muscles and connective tissues. It is the same ancient Chinese healing art that Joe Pinella used to retrain his body to walk again.

For centuries Tai Chi Kung was a secret art, known only to a select few in the monasteries and royal households of China. In the early 20th Century, the practice made its way to North America and has gained a great deal of attention in recent years as more and more people discover the amazing healing benefits from this type of very specific, slow and low impact exercise.

Medical studies now validate that the slow, repetitive movements of Tai Chi Kung measurably increases internal circulation, improves balance, relieves stress, improves cardiovascular fitness, helps regulate blood pressure and can have a positive impact on Arthritis, Diabetes, Chronic Obstructive Pulmonary Disease, Multiple Sclerosis, Fibromyalgia and Parkinson’s.

Joe PInella teaching a class his healing movements program.
Joe PInella teaching a class his healing movements program.

Years later, after having helped himself recover from pain and regain full motion, Joe set out to help others by creating his Healing Movements System. What Joe found in his own recovery process – and what he found in teaching hundreds of people – is that some Tai Chi and yoga can be just too difficult to do for people in pain.

Tai Chi is most often taught as a “Form.” A “Form” is a sequence of individual moves. A form may consist of hundreds of moves in a specific sequence much like a choreographed dance. This kind of Tai Chi is wonderful, but can be very daunting to someone just starting out, or to someone who has a specific complaint, like severe arthritis of the knees or a tennis injury they would like to address.

Likewise, some aspects of yoga are very helpful and other aspects can be harmful if attempted too soon or not performed accurately. In developing his Healing Movements System, Joe went back to the fundamental principles of these ancient techniques. He took the best elements of each… and then put them into a format that is easy to follow and easy-to-do by people of any age and any skill level. This system consists of breathing exercises, slow gentle movements coordinated with breath and visualization. These healing exercises are similar to the individual movements used in Chinese physical therapy… and have been proven over the years to help loosen stiff joints and relieve pain. Many people who have tried Tai Chi and found it too difficult to learn all the steps have done Joe’s program easily. Joe’s program is Chinese physical therapy.

Joe Pinella teaching a class demonstrating his proven methods.
Joe Pinella teaching a class demonstrating his proven methods.

By rotating all the major joints of the body, you expand and contract most of your muscles, thus increasing circulation and range of movement. You stimulate the production of synovial fluid, which bathes and lubricates all your joints. Breathing exercises open your lungs allowing you to take in more oxygen and expel toxins.

Healing Movement builds muscle strength, which is critical to catching yourself from falling. It improves the health of your entire circulatory system as well as gently working the heart. Its slow, calming motions coordinate your nervous system and your muscular system.

Healing Movement exercises also enhance the performance of specific functional movements so that the activities of your daily life are easier to perform.

In Healing Movement, you work on training entire movement sequences rather than just building the individual muscles involved in the movement, like you do in conventional strength training. Your brain controls the movement of your muscles, and it thinks in terms of whole movement sequences, not just individual muscles.

These gentle movements, based on Qi Gong have helped thousands of people with Arthritis, Parkinson’s, diabetes, heart disease, and cancer lessen their pain, regain more movement, increase their energy, and live a better quality of life.

Here are some brief testimonials on how the exercises changed lives of some local residents he has taught.

Comments from Marion.

An 88 year-old woman who wears her long gray hair in a bun on top of her head. She did the program for six weeks in a wheelchair. One evening after class she pulled Joe close for a kiss on the cheek. She told him that for several years she had been unable to put her own hair up; her grown daughter did her hair every morning and she did not like the way her daughter did her hair! That morning was the first time in three years that her arms were flexible enough to reach up and do her own hair.

Elizabeth. A sixty six year old woman who always had to unbuckle her seatbelt to back out of her driveway. Her neck and shoulders were too stiff to look behind her while backing up. After doing Healing Movements System for eight weeks, she is now able to keep her seatbelt on!

Kathy. A reflexologist who had to stop working because of the pain in her hands. She is back to work now.

Comments from Amanda

Tai Chi Kung has been very beneficial to me. I have severe osteoarthritis in my neck, knees, shoulders and wrist. Since I started practicing Tai Chi Kung I feel a lot looser, have more flexibility and less pain overall.

I like this form of exercise because it is low impact, easy to learn and I can practice it at home on my own. Anybody can do it. You don’t have to be in great shape to do it or be very flexible as for instance Pilates or Yoga. Also you don’t need any special equipment. I have improved my lung capacity and stamina. I can now go for walks for an hour or longer and not get winded at all. This is a great way to get in shape specially for older people who may have physical problems and can’t do some of the more strenuous exercises.

Comments from Ana

I have arthritis and tendonitis in my right wrist. The doctor, recommended physical therapy sessions twice a week which included ultrasound, hot and cold pads and various exercises. I was still in treatment when I went to your class and had not been able to play golf for three months. I was not making any progress fast and was quite discouraged. I was in too much pain to even pick up a golf club, let alone try to swing it.

I started going to your classes twice a week and also practiced the Tai Chi Kung exercises at home. A week later I started playing golf again and did not have too much pain. I have stopped all the other treatments but continue to practice Tai Chi Kung and attend your sessions. I am very pleased with the results. I feel a lot better and have more energy. My wrists are getting stronger and my golf handicap is going down.

Comments from Pete

I have a really bad back, with severe scoliosis and degenerative disc disease. I’ve been going to a very good physical therapist for five years who has me do “corrections” several times a day to help balance my pelvis, which often gets out of alignment, causing hip pain and sciatica. Once a month or so he does deep tissue work on my back and also balances my pelvis.

I’ve been doing Joe’s Chi Gong exercises for six weeks now. This past week I went to my physical therapist for a regular treatment, and FOR THE FIRST TIME SINCE I’VE BEEN SEEING HIM he didn’t have to balance my pelvis. He still did the deep tissue work, but said my back felt much less tight than usual and that my legs were not different lengths, as they usually are. Since nothing else has changed, I have to credit Chi Gong for this positive result.

These are just a few of the testimonials I have read and I use them to show you additional convincing proof that Qi Gong and Tai Chi Kung can help many to heal and have a more hopeful future than they imagined possible.

To see the video showing you Joe’s remarkable story visit this youtube video:

http://www.youtube.com/watch?v=Nkl1UXY3XAQ

Here is a video explaining the difference between Qi Gong and Tai Chi Kung.

http://healingmovementqigong.com/

He has a DVD for sale of The Healing Movements System and it is available at http://www.joepinella.com.

Nutrition for the Wounded Warrior– Optimizing Nutrients for Healing and Recovery

Article by Timothy M. Marshall PhD and Carol L. Henricks MD

Hundreds of thousands of military veterans are returning from war with serious symptoms of brain injury. The negative health impacts of war on brain health are multifactorial. We have sent healthy young people to war and they have returned with neurological symptoms that interfere with their ability to function in their life. Many are so despondent that 22 military veterans a day are taking their own lives. Nutrient optimization is a critical starting point for recovery.

The focus needs to be on giving these veterans the necessary nutrients that their “war-torn” bodies need to promote optimal healing and regeneration. It is well-known that under prolonged stress (e.g. a hypermetabolic state) the body uses up a number of important nutrients such as magnesium, zinc, iodine, chromium, iodine, lithium and the essential B-vitamins at an accelerated rate – as well as increasing urinary losses of these nutrients. For healing to take place – optimized levels of the above nutrients along with a nutrient and dietary program that focuses on and facilitates neural regeneration and detoxification of heavy metals such as mercury, lead, and other chemical burdens, which ultimately impair healthy brain functioning and slow or prevent healing.

Another serious condition facing our returning veterans is something very little known by the American public. A growing number of veterans who served in Iraq and Afghanistan are becoming sick and dying from what appears to be overexposure to dangerous toxins produced by burn pits, which are used to destroy waste.

Over 227 metric tons of trash are or were being burned daily. Waste products in burn pits include, but are not limited to: chemicals, paint, medical and human waste, discarded human body parts, metal / aluminum cans, munitions and other unexploded ordinance, petroleum and lubricant products, plastics and Styrofoam, rubber, wood, and discarded foot , lithium batteries, tires, hydraulic fluids, and vehicles. Jet fuel keeps pits burning twenty – four hours a day, seven days a week exposing thousands of our troops and contractors to toxic fumes on a daily basis.

Symptoms from burn pit exposure include constrictive bronciolitis ( a rare disease that affects the smallest passageways of the lungs ), brain lesions, Parkinson’s , headaches, memory loss, cholelithiasis, abdominal pain, skin lesions, skin cancer, rheumatoid arthritis and colon cancer to name a few. Toxins in burn pit smoke may affect skin, eyes, respiratory and cardiovascular systems, gastrointestinal tract and internal organs.

Toxic exposures of this magnitude require a detoxification protocol and a carefully designed regimen of nutrients to restore health. A Burn pit registry for exposed veterans has been established.

The constant stress of being in a war zone creates risk for adrenal fatigue. There are approaches to supporting recovery from adrenal fatigue.

The realities of war experiences help to create the pattern of responses we know as PTSD. Magnesium supplementation coupled with therapeutic levels of the B-vitamins and essential trace minerals – selenium, zinc, boron, chromium, iodine, and lithium – together have a calming and healing effect on the brain and promote deep neuronal healing (particular in combination with HBOT). Healing is optimized and greatly aided when the body receives the nutrients it needs, and is in a calm state of homeostatic balance.

Many are exposed to IED’s and other explosions and physical trauma which cause TBI and often multiple TBI. Healing the brain is critical to cognitive and emotional recovery. Even one concussion may lead to depression and increase the risk of suicide. If the brain does not heal, a degenerative process begins. The correlation between concussion, early onset dementia, ALS and Parkinson’s disease has been made. A special form of magnesium supplementation (e.g. mag threonate, MT) has recently been shown to promote improved cognitive functioning and neuronal cell healing. Stemgevity – a proprietary nutritional supplementation containing powerful healing herbs, and low-dose lithium in nutritionally relevant doses promotes the production and release of stem cells from bone marrow which further supports neuronal healing processes. Ambrotose, a patented formula of “smart sugars” enhances a number of essential metabolic activities, cell-to-cell communication in the brain, the endocrine system and the immune system.

Due to inherent flaws in our broken medical system –when these veterans return home, they are not effectively treated. The medications function to merely suppress systems, at best, and cause further nutrient depletions that undermine health and healing processes. In an attempt to cope with the pain and distress they feel, veterans often self-medicate with alcohol and drugs which results in further health and nutritional compromise.

Nutrition is typically not a focus of their thinking, but as healthcare practitioners, it needs to be a focus of our thinking. Medication may treat some symptoms, but medication creates dependency, not healing. Particularly with brain injury, if you do not heal the brain, continuing neurodegeneration takes place. Nutrient optimization is a critical starting point in this healing process.

 

Timothy M. Marshall, Ph.D.

Holistic Neurospecialist / Pharmacologist

E-book on Amazon/Kindle:  http://www.amazon.com/dp/B00LDML3RI
cell: 520.370.6044
********

Carol L Henricks, MD

Behavioral Neurology, Epilepsy,

Sleep Disorders, Traumatic Brain Injury

& Hyperbaric Medicine.                     .

NorthStar Neurology PC

7596 N La Cholla Blvd

Tucson AZ 85741

Office Phone: 520-229-1238

Office FAX: 520-229-1242

Traumatic Brain Injury: out of the “game”, but not out of danger! by Carol Henricks, M.D.

Awareness of concussion as a consequence of playing professional football and other sports and exposure to blast injuries for military veterans has reached an all – time high. A single bomb blast causes soldiers NFL – like brain trauma. The message has been received by the public: concussion is a real injury and you should NOT “go back into the game” after the injury. However the long term medical consequences of the injury – particularly if the brain has not healed – are less well established. With the recognition of acute and sub – acute concussion, players make decisions to stop playing sports altogether – they “get out of the game” while they believe they are still “cognitively clear”. But does that solve the problem ?

Young military veterans taken out of active duty or medically discharged don’t recover from their concussions even years after their injury and are often never able to re-enter the work force. The American Headache Association presented data at their July 2012 meeting that even 8 years post concussion – injury, most veterans continued to have persistent headaches, sleep disturbance, cognitive and emotional problems. The link between concussion injury and neurodegenerative conditions in the NFL has been acknowledged ( at least by the players and the judge ) and resulted in a huge settlement to compensate injured players – and studies of concussion injured military veterans are supporting that conclusion. It is clear that a new approach to post – concussion management is necessary.   It is time to put together a game plan to save the brain.

Our brains are like computers.

The brain is a complex network of fiber tracts: to carry out any brain function there is a locus of control and a network that needs to be activated.   Our brains are much more like computers than we would have believed. If the locus of control that triggers the algorithm / pathway is knocked out or there are “glitches in the system” the network cannot function as a cohesive system and the task is not completed. Multiple concussions destroy the control and networking of the brain and result in poor cognitive ability and a consequent failure to function in society.

Connections that extend from the neuron cell body and make connections with other areas of the brain are called axons. Axons gathered together form fiber tracts. The hallmark of concussive brain injury is diffuse shear injury to axons. The shear injury may involve only the fatty covering around the axon ( the myelin ) or it may also involve the underlying axon structural components. The extent of injury to the axon affects the ability to recover from the injury. A shear injury in the brain is like a glitch in a computer network.

Network connections are critical.

Fiber tract connections create networks. Fiber tracts formed from the right hemisphere ( for example ) connect to the left hemisphere through the corpus callosum. Connections through the corpus callosum allow the right side of the brain to know what the left side of the brain is doing and vice versa. Fiber tracts from the parietal lobes of the brain ( which perform sensory integration / visual association ) connect with the occipital lobes of the brain ( primary visual information processing ) so we can tell the difference between our visual reality versus stored visual images: is it real or a hallucination ? Fiber tracts connect the frontal lobes (which are responsible for decision making) with the temporal lobes of the brain (which store our memories of past experiences) so we can use our experience to help us make good decisions.   All these connections form networks which allow us to function in our world. If you disrupt these connections throughout the brain these disconnections or “glitches” result in poor cognitive function. And then things get worse.

Disconnections and loss of brain cell function are the basis for post – concussion symptoms.

Disconnections create problems in an acute injury, but if these connections never heal, there is chronic brain injury. Even if new networks are formed by “re-wiring”, the injured brain cells begin a degenerative process and as the neurons “die back” brain cells are lost. Dysfunction worsens over time if new connections are not formed and old connections and damaged neurons do not heal. Healing is not guaranteed. Spontaneous healing in both the Central Nervous System ( CNS ) and the Peripheral Nervous System ( PNS ) is a very slow process. Amazing cases of people “waking up” after spending many years in a persistent vegetative state following brain injury are examples of people naturally healing over time.

A traditional approach to recovery is observation and supportive care.

Medications do not create healing. Medications do not inhibit cell death or any neurodegenerative process. Non-healing is where the pathology of neurodegenerative disease begins. The current medical model of treatment for an individual who has sustained a concussion is to avoid further injury and let the brain heal itself over time using adjunctive therapies such as physical therapy, speech therapy and occupational therapy. Re -evaluations by neurologists may establish that a concussion injured person has achieved a certain baseline of functional recovery, but that is not confirmation that injury has healed and that an individual will avoid future consequences of that injury. There is no standard of care therapy that has been recognized to treat brain injury.

Making the connection: the consequences of injury.

The consequence of significant untreated concussion injury is early onset neurodegenerative disease. The more concussions, the worse the cumulative brain injury. Injured brain cells that do not heal die, and may help to create the clinical syndromes of Alzheimer’s disease, Parkinson’s disease and ALS for example. SPECT scans have been a helpful tool to identify injured areas of brain. New imaging techniques such as brain MRI with DTI may be a better choice to show the disruption of connections caused by concussion as well as providing a follow – up measure of healing. It’s time to refocus our thinking on healing. The future is now and therapies to recover brain function are available.

HBOT is essential because every healing reaction requires oxygen.

Revolutionary emerging technologies will change neurological recovery forever. The operative term here is the recoverable brain. Our brains are designed to learn all throughout our life, and brain cells may heal given the proper support. Hyperbaric Oxygen Therapy ( HBOT ) is the first therapy that has been demonstrated to heal brain injury. The extensive research of Dr. Paul Harch covers the basic science of healing with HBOT, animal research and human research and his work has been submitted to the FDA confirming the effectiveness. There has been more research on HBOT than on any drug or device ever approved by the FDA.   Dr. Harch’s textbook “The Oxygen Revolution” outlines his years of research and experience in treating brain injury. HBOT therapy is radically different than simply providing oxygen by nasal cannula in a hospital setting at atmospheric pressure. HBOT creates oxygen radicals which in a hyperoxic environment stimulate healing mechanisms including activation of intracellular healing processes, stem cell mobilization and modification of gene expression.

Brain recovery requires building from basic nutritional essentials.

For healing to take place, nutrient optimization including consumption of proper fats, adequate proteins, critical trace minerals, balanced electrolytes and smart sugars. Without the proper building blocks for recovery, the brain cannot recover. Please see our article, written with neuropharmacologist Dr. Tim Marshall: “Nutrition for the wounded warrior: it takes more than a vitamin” for details.

Neurobiofeedback is a simple retraining of the brain.

Brain waves may be retrained to a pattern that will minimize an anxiety reaction or to help activate less active areas of the brain. Even an injured brain is able to learn, re – wire, re – network. Brain Paint for example is an excellent Neurobiofeedback program for recovery. Re-establishing the normal rhythms of the electrical activity of the brain promotes functional recovery.

Magnetic fields enhance intracellular energy so that healing can take place.

Magnetic fields, particularly pulsed electromagnetic field therapy or PEMF results in direct energy transfer intracellularly to facilitate healing. PEMF has been used in Germany to treat advanced dementia and Down’s syndrome with great results. It is being studied in the US for TBI recovery. A similar but more focused tool is transcranial magnetic stimulation ( TCMS ) which has been FDA approved to treat depression and is being studied in various neurology centers to treat patients post – stroke.

Autologous stem cell transplants boost recovery.

Safe, effective mechanisms for obtaining autologous stem cell transplants are available in the US. These procedures are primarily still under IRB protocols and are self – pay but are proving to be a powerful adjunctive therapy for recovery. Initial results from physicians performing that procedure indicate that it is a very safe treatment and results for patients with neurodegenerative conditions including severe TBI have been positive.

Save your brain.

Concussion is a major contributing factor to neurodegenerative conditions; although there are many other factors impact brain health and healing. A potentially huge “at risk” population for neurodegenerative disease exists and it is not only an “end – of – life” phenomenon. Functional recovery of an injured brain has never been as possible as it is now. Combining available therapies, a good nutritional baseline and lifestyle habits the best neurological recovery can be achieved. It is critical to anticipate the consequences of post – concussion injury and actively pursue healing therapies.