WEBVTT 1 00:00:00.600 --> 00:00:03.160 Oh hey, Hi, it's your brother in law who waves 2 00:00:03.200 --> 00:00:05.759 his coffee beans, but in a cool way. Ali Ward, 3 00:00:05.799 --> 00:00:08.839 I'm back with a foggy and groggy and super timely 4 00:00:08.919 --> 00:00:12.119 episode that I never knew so many of us needed. 5 00:00:12.439 --> 00:00:17.719 So we'reknock and noggins this week. Neuropathology. Yes I did 6 00:00:18.320 --> 00:00:22.239 phone up an expert on concussions, but this is a podcast. 7 00:00:22.320 --> 00:00:25.359 It's not an appointment with your doctor, so of course 8 00:00:25.440 --> 00:00:29.359 nothing here is intended to diagnose or treat my or 9 00:00:29.399 --> 00:00:31.800 your head injury. So I'm just putting that up top 10 00:00:31.839 --> 00:00:34.520 because as a person with a very recent head trauma, 11 00:00:35.159 --> 00:00:37.520 I know that things can get a little soupy. But 12 00:00:38.320 --> 00:00:41.079 as I learned this week, over half of folks have 13 00:00:41.200 --> 00:00:43.520 sustained at least one concussion in their lives, So chances 14 00:00:43.560 --> 00:00:47.119 are your brains are curious about this, or someone you 15 00:00:47.240 --> 00:00:52.039 know or love has goose egged their way into concussion town. 16 00:00:52.359 --> 00:00:54.719 So thank you, by the way, to everyone who has 17 00:00:54.759 --> 00:00:58.079 been concerned and sent really sweet messages and looked at 18 00:00:58.119 --> 00:01:01.439 my pictures of me and an an ambulance in the er. 19 00:01:01.600 --> 00:01:04.200 Thank you also, of course, to patrons for sending in 20 00:01:04.319 --> 00:01:07.159 great questions on short notice for this episode. You two 21 00:01:07.200 --> 00:01:09.159 can join for as little as a buck a month. 22 00:01:09.280 --> 00:01:12.280 It's at patreon dot com slash Ologies, but for free. 23 00:01:12.359 --> 00:01:14.040 You can also help out the show just by telling 24 00:01:14.079 --> 00:01:16.920 friends and tweeting and gramming. You can leave a review, 25 00:01:17.319 --> 00:01:20.519 which I have read all of them, including this fresh 26 00:01:20.599 --> 00:01:24.959 one from an angel named Angry Undies who wrote that 27 00:01:25.120 --> 00:01:28.840 Ologies is like a warm hug for your brain. Timely, 28 00:01:29.239 --> 00:01:33.239 We love you, Angry Undies bunch. So, speaking of brain 29 00:01:33.280 --> 00:01:36.319 embraces neuropathology, we're going to get into it. So it's 30 00:01:36.359 --> 00:01:39.200 the study of diseases of the nervous system and neuro 31 00:01:39.400 --> 00:01:43.439 or neuron are those long, stringy cells that relay our 32 00:01:43.599 --> 00:01:48.840 brainy messages via chemicals and zip zaps of energy. That 33 00:01:48.920 --> 00:01:53.760 word neuron comes from the Greek for sinew, chord or 34 00:01:54.159 --> 00:01:59.879 penis what. Yes, according to ancient Greek scholars, your brain 35 00:02:00.200 --> 00:02:04.920 just a tangled clod of electric disco dicks, and pathology 36 00:02:05.040 --> 00:02:08.719 derives from the Greek for passion. Passion gets its route 37 00:02:08.719 --> 00:02:11.080 from suffering. So I'm going to go into detail about 38 00:02:11.080 --> 00:02:15.000 my recent head trauma and why I asked for recommendations 39 00:02:15.000 --> 00:02:17.400 for experts on this later in the episode. But we 40 00:02:17.400 --> 00:02:19.639 were really lucky that she made room and her schedule 41 00:02:19.680 --> 00:02:23.000 to record this two days ago, even though I was 42 00:02:23.039 --> 00:02:25.879 five minutes late. This ologe just went to medical school 43 00:02:25.960 --> 00:02:29.479 at Georgetown. She did her residency in Physical Medicine and 44 00:02:29.520 --> 00:02:34.360 Rehabilitation at Harvard Medical School and at Spalding Rehabilitation Hospital, 45 00:02:34.639 --> 00:02:37.879 where she was chief Resident. She also works with nonprofits 46 00:02:37.960 --> 00:02:42.159 to assist veterans who are suffering from mild traumatic brain injuries. 47 00:02:42.680 --> 00:02:45.919 Is the attending physician in the Massachusetts General Hospital for 48 00:02:46.000 --> 00:02:50.000 their Children's Youth Concussion Program. She's on boards to help 49 00:02:50.039 --> 00:02:54.479 identify risks in contact sports, and is an instructor in 50 00:02:54.520 --> 00:02:58.840 the Department of Physical Medicine and Rehabilitation at Harvard Medical School. 51 00:02:59.240 --> 00:03:02.120 What a feast for brains. But wait, there's more. I 52 00:03:02.159 --> 00:03:05.159 also talked to doctor Headbutt and in a bonus mini 53 00:03:05.159 --> 00:03:06.879 episode out this week, we're going to take a brief 54 00:03:06.919 --> 00:03:10.080 look at concussions in the animal world. So that is 55 00:03:10.120 --> 00:03:12.840 coming out later this week. But right now, fix your 56 00:03:12.879 --> 00:03:15.520 head protection and gear up for a chat about everything 57 00:03:15.560 --> 00:03:21.159 from brain bruises to after school rugby, falling off horses, headaches, 58 00:03:21.400 --> 00:03:28.560 ADHDC and stars, comorbidities, video games, solitary confinement, convulsions. The 59 00:03:28.599 --> 00:03:33.759 best time to tumble down some stairs, post concussive syndrome, holds, 60 00:03:34.000 --> 00:03:38.400 rom coms, and more with head trauma specialist, minor traumatic 61 00:03:38.439 --> 00:03:44.800 brain injury researcher and concussion coach and neuropathologist, doctor Mary 62 00:03:44.919 --> 00:03:46.479 Alexis I Karino. 63 00:04:05.520 --> 00:04:12.560 My name is Mary Alexis Ikrino, and I go buy Alexis. 64 00:04:12.840 --> 00:04:17.199 She her didn't plan on this episode at all, at all, 65 00:04:17.319 --> 00:04:19.879 at all, but you fall down some stairs and then 66 00:04:19.920 --> 00:04:22.839 before you know it, you're like, who knows something about concussion? 67 00:04:24.519 --> 00:04:28.800 That's usually how people get in touch with me. Nobody 68 00:04:28.920 --> 00:04:33.800 likes coming to my office. I bet, I bet, yeah, 69 00:04:34.000 --> 00:04:36.800 So I'm sorry to hear that I did. Think. Well, 70 00:04:36.879 --> 00:04:39.439 I'll give her an extra ten minutes since she's recovering 71 00:04:39.439 --> 00:04:40.399 from a concussion. 72 00:04:41.800 --> 00:04:43.399 I know, you know, I haven't had my phone on 73 00:04:43.480 --> 00:04:47.639 me much as a clock the last week because I 74 00:04:47.680 --> 00:04:51.240 have been ordered off screens essentially. But here's the deal. 75 00:04:51.439 --> 00:04:53.920 Like what happened was, I'll make this quick, but I 76 00:04:54.040 --> 00:04:56.160 bounded down the stairs to surprise my sister in law. 77 00:04:56.160 --> 00:04:57.920 We flew in early, and I was like, I'm here 78 00:04:58.519 --> 00:05:01.920 and absolutely shit on a flight of stairs. But I 79 00:05:02.000 --> 00:05:04.759 hit the back of my head pretty hard, and I 80 00:05:04.800 --> 00:05:07.000 was like, oh no, I just really killed the vibe. 81 00:05:07.079 --> 00:05:08.839 And then I was like I'm fine, I'm fine, and 82 00:05:08.879 --> 00:05:12.279 I got up and then I passed out and apparently 83 00:05:12.279 --> 00:05:15.040 I started convulsing. They picked me up, I passed out again, 84 00:05:15.480 --> 00:05:17.759 and then at that point that all of the gay 85 00:05:17.839 --> 00:05:20.319 you're here turned into like the ambulances on its way. 86 00:05:20.639 --> 00:05:25.199 Such a buzz kill. So I have never, to my knowledge, 87 00:05:25.199 --> 00:05:29.519 had a concussion before. But what is happening when you 88 00:05:29.560 --> 00:05:31.879 get bonked on the noggin like that? 89 00:05:33.279 --> 00:05:39.800 Wow, well that sounds like you had a pretty significant injury. Yeah, 90 00:05:39.879 --> 00:05:44.839 But you know, concussions, even within themselves, can vary, right, 91 00:05:44.920 --> 00:05:47.560 So there can be these very very mild hits to 92 00:05:47.600 --> 00:05:50.040 the head and then people who you know might have 93 00:05:50.120 --> 00:05:54.959 a convulsion or a loss of consciousness or even you know, 94 00:05:55.040 --> 00:06:04.360 amnesia for some time. But essentially is the brain shaking 95 00:06:04.800 --> 00:06:09.639 within the skull from some force or impact, right, And 96 00:06:09.680 --> 00:06:12.439 so that can be a direct blow like I fell 97 00:06:12.959 --> 00:06:15.839 and I whacked my head or I got hit with something, 98 00:06:16.319 --> 00:06:19.879 but it can also be a shaking motion like if 99 00:06:19.879 --> 00:06:23.040 you're in a car accident, you get whiplash and the 100 00:06:23.120 --> 00:06:25.800 head shakes back and forth, but it never actually hits 101 00:06:25.879 --> 00:06:28.639 another object. And then the other time we can see 102 00:06:28.639 --> 00:06:32.439 it is if somebody's around, like an explosion, right, because 103 00:06:32.480 --> 00:06:36.879 remember the brain sits in fluid, right, since it has 104 00:06:36.920 --> 00:06:40.959 this yellow like consistency, and it sits in fluid, and 105 00:06:41.000 --> 00:06:44.279 there's space there for it to move within the skull, 106 00:06:44.720 --> 00:06:47.800 which is really good because if you know, there's a 107 00:06:47.839 --> 00:06:51.079 little swelling or something like that, there's some room for 108 00:06:51.160 --> 00:06:54.000 the brain to expand a little. But that also means 109 00:06:54.000 --> 00:06:56.279 that it can shake around and hit the sides of 110 00:06:56.279 --> 00:06:59.079 the skull. So essentially, when you talk about concussion, you're 111 00:06:59.120 --> 00:07:04.279 talking about some force making the brain shake inside the skull, 112 00:07:04.639 --> 00:07:12.920 and it usually doesn't produce your classic bruising or bleeding. 113 00:07:13.160 --> 00:07:20.959 It actually is this more microscopic kind of injury or change. 114 00:07:21.240 --> 00:07:24.639 And sometimes you can get changes in some of the 115 00:07:24.759 --> 00:07:27.680 electrical activity in the brain, which is why you can 116 00:07:27.720 --> 00:07:31.959 get a shaking spell right afterwards. Oh and so that 117 00:07:32.079 --> 00:07:34.360 you know is something that can happen the' I'll tell 118 00:07:34.360 --> 00:07:37.560 you it's pretty rare, pretty rare, but possible. 119 00:07:38.040 --> 00:07:41.720 Okay, So if you're shopping for a minor traumatic brain injury, 120 00:07:41.759 --> 00:07:45.800 there are three flavors of concussions. It's exciting Grade one. 121 00:07:46.120 --> 00:07:49.680 There's mild, with symptoms like headache or dizziness or blurred 122 00:07:49.800 --> 00:07:53.720 vision that last less than fifteen minutes, there's no passing out. 123 00:07:53.800 --> 00:07:58.279 Grade two moderate those symptoms I mentioned, lasting longer than 124 00:07:58.319 --> 00:08:02.319 fifteen minutes, still passing out. Then there's Grade three, which 125 00:08:02.360 --> 00:08:06.600 is severe, in which the person loses consciousness, sometimes for 126 00:08:06.720 --> 00:08:10.160 just a few seconds. So kind of an overachiever. And 127 00:08:10.360 --> 00:08:14.480 I went for Grade three, but I don't fully remember it. 128 00:08:14.879 --> 00:08:16.360 So I fell down the stairs and I got up 129 00:08:16.360 --> 00:08:18.079 a minute later, and then I walked to the kitchen, 130 00:08:18.120 --> 00:08:19.879 and the next day I knew I was on the 131 00:08:19.879 --> 00:08:23.040 floor again, apologizing, and I actually heard my sister in 132 00:08:23.079 --> 00:08:25.759 law on the phone with nine one one saying that 133 00:08:25.839 --> 00:08:27.759 I passed out twice, and I was like, no, I didn't. 134 00:08:28.120 --> 00:08:32.080 But honestly, I was the worst eyewitness in the room 135 00:08:32.159 --> 00:08:36.120 because I was not conscious twice. But I'm told that 136 00:08:36.200 --> 00:08:39.399 my limbs seized up and started shaking, and my speech 137 00:08:39.480 --> 00:08:42.720 was slurred and my eyes rolled back, So it was 138 00:08:42.759 --> 00:08:47.159 scary for everyone. Was this a seizure though, depends on 139 00:08:47.159 --> 00:08:50.440 who you ask, But TBI researchers didn't want this post 140 00:08:50.440 --> 00:08:55.240 concussion brain activity to be confused with seizures caused by epilepsy, 141 00:08:55.639 --> 00:09:00.480 So the rather musical term concussive convulsions arose to describe 142 00:09:00.480 --> 00:09:03.679 those benign impact seizures, and as the medic in the 143 00:09:03.679 --> 00:09:06.320 ambulance explained, it's kind of like your brain shutting down 144 00:09:06.600 --> 00:09:10.320 and then rebooting. Also, in the bonus episode about headbutting, 145 00:09:10.639 --> 00:09:13.600 we're going to go into exactly what it takes to 146 00:09:13.879 --> 00:09:17.639 assess impact damage to neurons. So what they're really looking 147 00:09:17.679 --> 00:09:19.879 for when you go to the er is the big stuff, 148 00:09:20.200 --> 00:09:23.639 like visibly bleeding traumas in your head, rather than the 149 00:09:23.679 --> 00:09:27.000 micro damage, which is probably what I got. 150 00:09:27.200 --> 00:09:31.639 Yeah, so it's not something we can really see. If 151 00:09:31.720 --> 00:09:35.399 we were to take like a conventional cat scan of 152 00:09:35.480 --> 00:09:38.320 your brain, right we get a picture or an MRI 153 00:09:38.600 --> 00:09:40.399 of your brain, or we get a picture, we usually 154 00:09:40.399 --> 00:09:44.360 wouldn't see anything because it's something happening closer to a 155 00:09:44.519 --> 00:09:49.279 cellular level. But nonetheless it can be quite impairing and 156 00:09:49.360 --> 00:09:52.080 can give people a lot of symptoms. It's a tough 157 00:09:52.120 --> 00:09:53.840 injury that way, because you want to be able to 158 00:09:53.879 --> 00:09:55.399 see it. Right, if you break a bone, you want 159 00:09:55.399 --> 00:09:58.799 to look at the X right and see where it's broken. Yeah, 160 00:09:58.840 --> 00:10:02.399 But with concussion, and we don't really have that nice, 161 00:10:02.519 --> 00:10:06.000 neat picture to show people where injury happened. 162 00:10:06.600 --> 00:10:09.279 Yeah, I keep wondering, like, is there a spot on 163 00:10:09.600 --> 00:10:13.399 the back of my brain where I hit that is 164 00:10:13.440 --> 00:10:16.159 like a bruised peach. If I could look into my brain, 165 00:10:16.200 --> 00:10:19.399 would there be kind of some redness there or would 166 00:10:19.440 --> 00:10:21.960 it really really be microscopic where you're like, I can't 167 00:10:22.039 --> 00:10:25.159 tell that there's a bunch of like busted oozing cells. 168 00:10:25.200 --> 00:10:27.279 Like I'm trying to get a mental picture so that 169 00:10:27.320 --> 00:10:28.919 I take better care of myself. 170 00:10:30.600 --> 00:10:33.039 So yeah, it is a hard one. It is a 171 00:10:33.080 --> 00:10:35.639 hard thing to visualize, and it's hard for a lot 172 00:10:35.639 --> 00:10:38.519 of people too, because it's not like we put a 173 00:10:38.720 --> 00:10:40.759 band aid on your head or put your head in 174 00:10:40.799 --> 00:10:43.840 a cast, right, So here you are walking around and 175 00:10:43.879 --> 00:10:47.200 you look just fine to most people, but you don't 176 00:10:47.200 --> 00:10:50.399 feel fine. And so that also can make it kind 177 00:10:50.440 --> 00:10:52.679 of a tough injury in that way for a lot 178 00:10:52.720 --> 00:10:53.120 of people. 179 00:10:53.960 --> 00:10:57.320 And from what I understand, a concussion is something that's 180 00:10:57.320 --> 00:11:01.000 a clinical diagnosis, Right. They can't yeah, like look at 181 00:11:01.200 --> 00:11:04.240 a scan necessarily, but they can say, based on what 182 00:11:04.279 --> 00:11:06.840 you told me, sounds like it's like you did have 183 00:11:06.879 --> 00:11:07.519 a concussion. 184 00:11:09.399 --> 00:11:13.639 Yes, you are exactly right. So it is a clinical diagnosis, 185 00:11:13.679 --> 00:11:17.120 meaning we hear about the injury right and you have 186 00:11:17.320 --> 00:11:22.120 some force that was substantial enough to cause trauma, and 187 00:11:22.159 --> 00:11:26.440 then we ask people how they looked and felt right afterwards, 188 00:11:26.799 --> 00:11:33.080 we can do some examination testing like balance testing or 189 00:11:33.799 --> 00:11:38.320 cognitive testing, where we test things like reaction time or 190 00:11:38.480 --> 00:11:43.360 memory or attention, and that can show us sometimes that 191 00:11:43.600 --> 00:11:47.399 people are not doing well in some areas. But there 192 00:11:47.519 --> 00:11:53.000 is no single diagnostic tests like a blood test or 193 00:11:53.480 --> 00:11:58.919 a scan that we can do to clearly diagnose concussion 194 00:11:59.519 --> 00:12:02.679 or to actually say that it's over. So people also 195 00:12:02.679 --> 00:12:05.320 want to know when am I better? Yes? And could 196 00:12:05.360 --> 00:12:07.879 you get me a scan or a blood test that 197 00:12:07.919 --> 00:12:11.840 says this is gone? And we actually don't have that either. 198 00:12:12.080 --> 00:12:17.039 It's a very gray space in every way, in every way, 199 00:12:17.120 --> 00:12:21.759 and gray matter space. But let's wedge some terminology into 200 00:12:21.759 --> 00:12:25.559 our squishy gray matter space. Can you explain the difference 201 00:12:25.559 --> 00:12:29.600 between a concussion and an mTBI and a TBI. 202 00:12:30.200 --> 00:12:34.639 I am happy to try to explain that, but I 203 00:12:34.679 --> 00:12:39.720 will tell you that even among scientists there is some 204 00:12:39.960 --> 00:12:46.279 debate still between the terms concussion and mTBI. Okay, so 205 00:12:47.120 --> 00:12:51.879 for most of us and me included concussion and an mTBI, 206 00:12:52.159 --> 00:12:56.039 the M standing for mild, So a concussion and a 207 00:12:56.159 --> 00:12:58.919 mild TBI are the same thing. 208 00:12:59.360 --> 00:13:00.000 Ah. 209 00:13:00.200 --> 00:13:04.120 Not everybody out there would agree with me, but most 210 00:13:04.679 --> 00:13:08.200 I think people in this area of medicine, in this 211 00:13:08.320 --> 00:13:09.720 space would agree. 212 00:13:10.240 --> 00:13:12.720 Okay. So, as you can imagine, there's all kinds of 213 00:13:12.799 --> 00:13:16.039 terminology and things change really quickly, and looking it up, 214 00:13:16.080 --> 00:13:19.039 I felt like your mom in twenty fifteen googling BD 215 00:13:19.600 --> 00:13:22.240 on Urban Dictionary. But I have also learned that there's 216 00:13:22.399 --> 00:13:26.000 a ton of debate with concussions and traumatic brain injuries. 217 00:13:26.039 --> 00:13:28.320 Like so much, there's a ton of shit we do 218 00:13:28.440 --> 00:13:30.919 not know. There's also a lot of money at stake, 219 00:13:31.360 --> 00:13:36.879 either via industries that involve occupational hazards or through making 220 00:13:36.919 --> 00:13:40.480 money on the recovery from them, and some doctors have 221 00:13:40.559 --> 00:13:45.559 moved to call athletics head injuries srcs sports related concussions 222 00:13:45.720 --> 00:13:49.679 instead of using the term minor traumatic brain injury. Others 223 00:13:49.840 --> 00:13:53.720 consider a concussion a subset of mTBIs, which are in 224 00:13:53.759 --> 00:13:57.000 and of themselves, a subset of more serious conditions that 225 00:13:57.080 --> 00:14:05.360 may include skull fractures, penetrated penetrated penetrative injuries. I'm not 226 00:14:05.399 --> 00:14:07.320 going to say that word right, but it means getting 227 00:14:07.360 --> 00:14:10.759 poked real bad with something and hematomas, which would be 228 00:14:10.879 --> 00:14:15.200 considered TBIs. So all of those things under the umbrella 229 00:14:15.200 --> 00:14:19.759 of TBIs. It's confusing, even if you haven't recently blacked 230 00:14:19.799 --> 00:14:22.879 out on a kitchen floor and then passed out being 231 00:14:22.919 --> 00:14:25.080 carried to a couch. It's been a wild week, folks. 232 00:14:25.840 --> 00:14:28.200 I'm not going to say penetrative right now. 233 00:14:28.399 --> 00:14:33.320 TBI is a broader term, right, Traumatic brain injury encompasses 234 00:14:33.480 --> 00:14:40.639 everything from concussion through people who have severe trauma to 235 00:14:40.720 --> 00:14:45.039 the brain and are in coma or have paralysis. Right, 236 00:14:45.159 --> 00:14:50.159 so it encompasses all trauma to the brain from very 237 00:14:50.200 --> 00:14:55.399 mild through very severe. And so within this category of 238 00:14:55.559 --> 00:15:01.080 traumatic brain injury, mTBI, or concussion is the most mild. 239 00:15:01.440 --> 00:15:05.000 And when should a person get checked out? I feel 240 00:15:05.039 --> 00:15:09.480 like since the death of Natasha Richardson for what seemed 241 00:15:09.480 --> 00:15:13.600 like a relatively minor skiing accident, Richardson suffered ahead injury 242 00:15:13.639 --> 00:15:16.159 Monday while taking a ski lesson in Canada. She was 243 00:15:16.159 --> 00:15:18.840 pronounced dead Wednesday at a hospital in New York. She 244 00:15:20.039 --> 00:15:23.240 died two days later. I feel like there's something really 245 00:15:23.799 --> 00:15:27.559 innately scary about, as my dad would say, thumping your 246 00:15:27.600 --> 00:15:31.279 pumpkin really hard. When is it time to go to 247 00:15:31.399 --> 00:15:32.960 urgent care and make sure you don't have like a 248 00:15:33.039 --> 00:15:36.559 giant hematoma, and when is it just like, if you're 249 00:15:36.600 --> 00:15:38.360 not passing out, you're probably fine. 250 00:15:38.639 --> 00:15:41.600 I think it's good for most people to get checked out. 251 00:15:41.799 --> 00:15:46.279 Not everybody will, and there are certainly some symptoms that 252 00:15:46.320 --> 00:15:49.960 people get that should make them get checked out more 253 00:15:50.000 --> 00:15:52.679 than others. For example, if you have a shaking spell 254 00:15:52.799 --> 00:15:56.360 or seizure, you absolutely need to get checked out. If 255 00:15:56.399 --> 00:15:59.159 you've been unconscious for any period of time ring, you 256 00:15:59.279 --> 00:16:03.200 definitely should get checked out. If you have other trauma, 257 00:16:03.600 --> 00:16:06.120 right like, if you got hit hard enough or you're 258 00:16:06.120 --> 00:16:09.759 a big enough accent that you broke other stuff, you 259 00:16:09.879 --> 00:16:13.000 probably should get checked out. If you're somebody who's prone 260 00:16:13.000 --> 00:16:16.720 to bleeding, right people, sometimes older folks who are on 261 00:16:16.879 --> 00:16:19.840 blood thinners, those people definitely need to get checked out. 262 00:16:20.639 --> 00:16:23.279 And then if you're somebody who's thinking about going back 263 00:16:23.320 --> 00:16:25.519 to do something where you're gonna whack your head again, 264 00:16:28.159 --> 00:16:32.360 you definitely should get checked out. But really, anybody who 265 00:16:32.600 --> 00:16:36.480 thinks they've experienced any head trauma, whether you know, you 266 00:16:36.519 --> 00:16:39.120 can't say with certainty it's just a concussion or it's 267 00:16:39.120 --> 00:16:41.960 something else, like in the case of Natasha Richardson. So 268 00:16:42.440 --> 00:16:46.200 it's very reasonable to go get checked out. Most people 269 00:16:46.679 --> 00:16:50.279 would should feel comfortable doing that. It's not an overreaction 270 00:16:51.000 --> 00:16:53.519 to go and get checked out and make sure that 271 00:16:53.600 --> 00:16:57.919 this is really just a concussion versus something like an 272 00:16:57.919 --> 00:17:02.879 epidural hematoma or fracture or something else. Yeah, that is 273 00:17:02.879 --> 00:17:06.960 going to require more monitoring or potentially a surgical intervention. 274 00:17:07.359 --> 00:17:11.599 Okay, So now we understand that within TBIs there are mTBIs, 275 00:17:11.640 --> 00:17:15.680 and within mTBIs there are concussions, and then within concussions 276 00:17:15.720 --> 00:17:20.160 there are srcs or sports related concussions. And I promised 277 00:17:20.160 --> 00:17:22.559 myself when we started this at this episode would be easy, 278 00:17:23.160 --> 00:17:26.480 but researching it was actually it felt like carving a 279 00:17:26.480 --> 00:17:30.079 set of Russian nesting dolls out of my own skull 280 00:17:30.119 --> 00:17:33.319 bones and then painting it with other people's flame wars 281 00:17:33.359 --> 00:17:37.160 about concussion severities and subsets. But let's take a more 282 00:17:37.200 --> 00:17:41.400 objective approach. There is the industry standard medical quiz. It's 283 00:17:41.440 --> 00:17:44.400 called the Glasgow Coma scale, and it goes from a 284 00:17:44.440 --> 00:17:49.119 fifteen down to a three. Fifteen is doing just fine 285 00:17:49.319 --> 00:17:53.359 walking away from it unscathed, and three is literally dead. 286 00:17:53.759 --> 00:17:57.000 So I guess there's two, which must be just a 287 00:17:57.039 --> 00:18:00.680 frustrated ghost. And maybe one is a poltergeist that hides 288 00:18:00.720 --> 00:18:03.759 your keys and shakes its junk at you. I'm not sure, 289 00:18:03.920 --> 00:18:08.000 but yeah, fifteen to three Glasgow Coma Scale or GCS 290 00:18:08.160 --> 00:18:11.680 for TBI. Now one term you may also hear is CTE, 291 00:18:12.000 --> 00:18:17.079 which is chronic traumatic encephalopathy, which arises from repeated trauma 292 00:18:17.119 --> 00:18:20.960 to the head and according to last year's second National 293 00:18:21.000 --> 00:18:25.119 Institute on Neurological Disorders and Stroke and the National Institute 294 00:18:25.160 --> 00:18:29.880 of Biomedical Imaging and Bioengineering Consensus meeting to define neuropathological 295 00:18:29.880 --> 00:18:34.480 Criteria for the diagnosis of Chronic traumatic encephalopathy, leading researchers 296 00:18:34.519 --> 00:18:41.160 there associate CTE with symptoms including aggression and depression, suicidal ideation, 297 00:18:41.920 --> 00:18:47.000 tendency towards substance abuse, dementia, some motor challenges, even Parkinson's disease, 298 00:18:47.799 --> 00:18:54.240 cognitive challenges and financial impulsivity, and more. But before any 299 00:18:54.359 --> 00:19:00.839 armchair quarterbacks start becoming armchair neuropathologists, it is imperative to 300 00:19:00.920 --> 00:19:05.079 know that CTE can only be diagnosed with an autopsy 301 00:19:05.559 --> 00:19:09.160 or from three to one on the Glasgow Coma scale, 302 00:19:09.319 --> 00:19:12.200 So yes, you must be dead to be diagnosed at 303 00:19:12.279 --> 00:19:15.119 least for now. And the film Concussion with Will Smith 304 00:19:15.200 --> 00:19:17.799 is a biopic of doctor Bennet Omalu, who is a 305 00:19:17.839 --> 00:19:22.359 forensic pathologist who's made strides in CTE recognition, but not 306 00:19:22.519 --> 00:19:26.160 all researchers agree with all of his work. Again, lots 307 00:19:26.200 --> 00:19:29.119 of debate in this field. And there's Boston Universities doctor 308 00:19:29.119 --> 00:19:32.000 Anne McKee. She's also a leading researcher in this and 309 00:19:32.039 --> 00:19:35.400 her website has scans of the TAU proteins is what 310 00:19:35.400 --> 00:19:39.240 they're called, that appear in individuals with CTE, and she 311 00:19:39.319 --> 00:19:43.079 writes that CTE has been found in athletes, military veterans, 312 00:19:43.400 --> 00:19:47.440 victims of domestic violence, and others who experienced multiple falls 313 00:19:47.519 --> 00:19:51.160 or injuries. And CTE has been known to affect boxers 314 00:19:51.160 --> 00:19:55.160 since the nineteen twenties. It was initially termed punch drunk syndrome, 315 00:19:55.240 --> 00:19:58.119 she writes, but more recently it's been found in players 316 00:19:58.119 --> 00:20:02.839 of American football and ice hockey, be soccer, MMA, pro wrestling, 317 00:20:03.000 --> 00:20:06.119 and other contact sports. End quote, And we'll have more 318 00:20:06.240 --> 00:20:10.559 on the diagnosis post mortem in the bonus episode on 319 00:20:10.680 --> 00:20:14.400 headbedting coming out this week. What a treat. But back 320 00:20:14.440 --> 00:20:17.359 to concussions and getting those diagnosed when you are just 321 00:20:17.400 --> 00:20:21.519 a regular, old, alive person. I wonder if, depending on 322 00:20:21.559 --> 00:20:24.200 the healthcare system your country has, if more people get 323 00:20:24.279 --> 00:20:28.519 checked out for concussions somewhere with universal healthcare versus you know, 324 00:20:28.599 --> 00:20:30.839 like I bonked my head, but if I call any 325 00:20:30.839 --> 00:20:32.599 ambulance that's like two grand. 326 00:20:32.559 --> 00:20:36.119 I wonder if there's a reluctance in certain like cultures 327 00:20:36.240 --> 00:20:39.160 or systems to get checked out for things. As soon 328 00:20:39.200 --> 00:20:40.519 as my assister in law called nine to one one, 329 00:20:40.559 --> 00:20:42.720 I was like, good idea. I am having a little 330 00:20:42.720 --> 00:20:45.559 bit of convulsions and a seizure, But also like, ugh, 331 00:20:46.119 --> 00:20:47.319 it's gonna be so expensive. 332 00:20:48.920 --> 00:20:52.240 Yeah, I mean that's something that you know, a lot 333 00:20:52.319 --> 00:20:54.599 of people have to grapple with, Right, Am I really 334 00:20:54.599 --> 00:20:58.519 going to go get checked out about something that's seemingly, 335 00:20:59.039 --> 00:21:04.559 you know, mild? And I think, you know, certainly for 336 00:21:04.640 --> 00:21:08.519 some of the things we just discussed, those things are 337 00:21:08.559 --> 00:21:11.599 potentially signs that you've had something worse than a concussion, 338 00:21:12.559 --> 00:21:16.880 and you probably need a scan, right or something bad 339 00:21:16.960 --> 00:21:21.799 could get missed. For folks who don't have any really 340 00:21:21.839 --> 00:21:26.359 concerning features at all, they might do okay just going 341 00:21:26.359 --> 00:21:29.640 to the urgent care by car as opposed to the 342 00:21:29.680 --> 00:21:32.119 ambulance ride, and that that might be a little bit 343 00:21:32.160 --> 00:21:35.960 more economical, but yeah, it's certainly you know that the 344 00:21:35.960 --> 00:21:38.960 ability to access healthcare for a lot of people can 345 00:21:39.000 --> 00:21:41.640 make you know, my recommendations about getting checked out more 346 00:21:41.680 --> 00:21:42.480 difficult for. 347 00:21:42.480 --> 00:21:45.960 Sure really ps a hundred percent the right thing to do. 348 00:21:46.119 --> 00:21:49.680 I was knocked off my rocker so hardcore, and I 349 00:21:49.720 --> 00:21:53.359 had this weird combo of like foggy reasoning plus a 350 00:21:53.400 --> 00:21:56.279 big helping of I wonder what my yearly deductible is 351 00:21:56.680 --> 00:22:00.200 for a ride in the wu bobile. But given that 352 00:22:00.319 --> 00:22:04.240 TBIs account for I now no thirty percent of the 353 00:22:04.319 --> 00:22:08.440 accident deaths in the US every year. Fully, no contest 354 00:22:08.720 --> 00:22:11.519 warranted and worth it to be in an act brace 355 00:22:11.599 --> 00:22:14.759 and get a brain scan. But I'm probably not alone here. 356 00:22:14.960 --> 00:22:17.559 So instead of making this easy, I decided to dig 357 00:22:17.640 --> 00:22:19.559 up a bunch of research, and I found a twenty 358 00:22:19.640 --> 00:22:23.920 nineteen Centers for Disease Control, Morbidity and Mortality weekly report 359 00:22:24.400 --> 00:22:29.759 called Traumatic Brain Injury Related Deaths by Race, Ethnicity, sex, intent, 360 00:22:29.920 --> 00:22:33.960 and Mechanism of Injury, United States twenty to twenty seventeen, 361 00:22:34.400 --> 00:22:38.119 plus a more recent CDC article on brain injury trends 362 00:22:38.319 --> 00:22:41.640 that said, over the last two decades, TBI contributed to 363 00:22:41.720 --> 00:22:44.680 the death of over a million people, and in that period, 364 00:22:45.079 --> 00:22:48.880 over four hundred thousand US service members were diagnosed with TBI, 365 00:22:49.319 --> 00:22:53.319 and other research suggests that forty six percent of people 366 00:22:53.400 --> 00:22:56.920 in correctional facilities have a history of TBI. Folks who 367 00:22:57.160 --> 00:23:00.359 experience homelessness are up to four times more likely to 368 00:23:00.400 --> 00:23:03.720 have had a TBI and up to ten times more 369 00:23:03.839 --> 00:23:06.279 likely to have had a moderate or severe one like 370 00:23:06.319 --> 00:23:10.480 I had, and survivors of intimate partner violence who sustain 371 00:23:10.559 --> 00:23:14.799 traumatic brain injuries also have worse prognoses, and anyone with 372 00:23:14.960 --> 00:23:17.839 lower incomes or without health insurance, at least in the 373 00:23:17.960 --> 00:23:22.559 US has far less access to TBI care. Country folks. Also, 374 00:23:22.759 --> 00:23:25.400 if you live in a rural area, the chance of 375 00:23:25.440 --> 00:23:29.799 a fatal TBI as higher, as specialized medical care can 376 00:23:29.839 --> 00:23:33.279 be farther away, harder to get too quickly, and the 377 00:23:33.319 --> 00:23:37.680 CDC report continued on that Indigenous folks have higher rates 378 00:23:37.720 --> 00:23:41.880 of TBI hospitalization and death than other groups. People of 379 00:23:41.920 --> 00:23:45.759 color less likely to receive follow up care and rehabilitation 380 00:23:46.160 --> 00:23:50.000 following a TBI compared to their white emergency room neighbors, 381 00:23:50.359 --> 00:23:54.240 so who is granted quality and sufficient care is huge 382 00:23:54.279 --> 00:23:58.119 as are increased risk factors and resources to cover the 383 00:23:58.160 --> 00:24:00.480 bill and what kind of bill are we talking in 384 00:24:00.519 --> 00:24:05.640 the US? According to the twenty nineteen study in Hospital 385 00:24:05.720 --> 00:24:10.319 Costs after Severe Traumatic Brain Injury, a systematic review and 386 00:24:10.440 --> 00:24:15.400 quality assessment, in hospital costs per patients were generally pretty 387 00:24:15.480 --> 00:24:19.559 high and ranged from two thousand dollars to four hundred 388 00:24:19.599 --> 00:24:24.200 thousand dollars, which is so many dollars. So I have 389 00:24:24.279 --> 00:24:27.920 health insurance and luckily like six jobs right now, and 390 00:24:28.000 --> 00:24:33.480 after passing out twice with convulsions before the horror stricken 391 00:24:33.519 --> 00:24:35.960 faces of my loved ones this week, the thing I 392 00:24:36.039 --> 00:24:39.039 thought about the most, lying on a gurney in the 393 00:24:39.039 --> 00:24:42.880 hallway of a crowded er in isolation a day before 394 00:24:42.960 --> 00:24:47.039 Christmas on the East Coast during an omicron surge. Thing 395 00:24:47.079 --> 00:24:49.839 on my mind the most the expense, and I have 396 00:24:49.920 --> 00:24:54.200 it the easiest. So what about doctor Eicherino. Has she 397 00:24:54.400 --> 00:24:57.480 ever been on the other side of the gurney? Have 398 00:24:57.559 --> 00:24:58.519 you ever had a concussion? 399 00:25:00.000 --> 00:25:03.680 But yes, I have had a concussion. At the time, 400 00:25:03.720 --> 00:25:06.880 I was a kid, and I don't think anybody really 401 00:25:06.920 --> 00:25:11.119