Speaker 1: Oh hey, Hi, it's your brother in law who waves
Speaker 1: his coffee beans, but in a cool way. Ali Ward,
Speaker 1: I'm back with a foggy and groggy and super timely
Speaker 1: episode that I never knew so many of us needed.
Speaker 1: So we'reknock and noggins this week. Neuropathology. Yes I did
Speaker 1: phone up an expert on concussions, but this is a podcast.
Speaker 1: It's not an appointment with your doctor, so of course
Speaker 1: nothing here is intended to diagnose or treat my or
Speaker 1: your head injury. So I'm just putting that up top
Speaker 1: because as a person with a very recent head trauma,
Speaker 1: I know that things can get a little soupy. But
Speaker 1: as I learned this week, over half of folks have
Speaker 1: sustained at least one concussion in their lives, So chances
Speaker 1: are your brains are curious about this, or someone you
Speaker 1: know or love has goose egged their way into concussion town.
Speaker 1: So thank you, by the way, to everyone who has
Speaker 1: been concerned and sent really sweet messages and looked at
Speaker 1: my pictures of me and an an ambulance in the er.
Speaker 1: Thank you also, of course, to patrons for sending in
Speaker 1: great questions on short notice for this episode. You two
Speaker 1: can join for as little as a buck a month.
Speaker 1: It's at patreon dot com slash Ologies, but for free.
Speaker 1: You can also help out the show just by telling
Speaker 1: friends and tweeting and gramming. You can leave a review,
Speaker 1: which I have read all of them, including this fresh
Speaker 1: one from an angel named Angry Undies who wrote that
Speaker 1: Ologies is like a warm hug for your brain. Timely,
Speaker 1: We love you, Angry Undies bunch. So, speaking of brain
Speaker 1: embraces neuropathology, we're going to get into it. So it's
Speaker 1: the study of diseases of the nervous system and neuro
Speaker 1: or neuron are those long, stringy cells that relay our
Speaker 1: brainy messages via chemicals and zip zaps of energy. That
Speaker 1: word neuron comes from the Greek for sinew, chord or
Speaker 1: penis what. Yes, according to ancient Greek scholars, your brain
Speaker 1: just a tangled clod of electric disco dicks, and pathology
Speaker 1: derives from the Greek for passion. Passion gets its route
Speaker 1: from suffering. So I'm going to go into detail about
Speaker 1: my recent head trauma and why I asked for recommendations
Speaker 1: for experts on this later in the episode. But we
Speaker 1: were really lucky that she made room and her schedule
Speaker 1: to record this two days ago, even though I was
Speaker 1: five minutes late. This ologe just went to medical school
Speaker 1: at Georgetown. She did her residency in Physical Medicine and
Speaker 1: Rehabilitation at Harvard Medical School and at Spalding Rehabilitation Hospital,
Speaker 1: where she was chief Resident. She also works with nonprofits
Speaker 1: to assist veterans who are suffering from mild traumatic brain injuries.
Speaker 1: Is the attending physician in the Massachusetts General Hospital for
Speaker 1: their Children's Youth Concussion Program. She's on boards to help
Speaker 1: identify risks in contact sports, and is an instructor in
Speaker 1: the Department of Physical Medicine and Rehabilitation at Harvard Medical School.
Speaker 1: What a feast for brains. But wait, there's more. I
Speaker 1: also talked to doctor Headbutt and in a bonus mini
Speaker 1: episode out this week, we're going to take a brief
Speaker 1: look at concussions in the animal world. So that is
Speaker 1: coming out later this week. But right now, fix your
Speaker 1: head protection and gear up for a chat about everything
Speaker 1: from brain bruises to after school rugby, falling off horses, headaches,
Speaker 1: ADHDC and stars, comorbidities, video games, solitary confinement, convulsions. The
Speaker 1: best time to tumble down some stairs, post concussive syndrome, holds,
Speaker 1: rom coms, and more with head trauma specialist, minor traumatic
Speaker 1: brain injury researcher and concussion coach and neuropathologist, doctor Mary
Speaker 1: Alexis I Karino.
Speaker 2: My name is Mary Alexis Ikrino, and I go buy Alexis.
Speaker 1: She her didn't plan on this episode at all, at all,
Speaker 1: at all, but you fall down some stairs and then
Speaker 1: before you know it, you're like, who knows something about concussion?
Speaker 2: That's usually how people get in touch with me. Nobody
Speaker 2: likes coming to my office. I bet, I bet, yeah,
Speaker 2: So I'm sorry to hear that I did. Think. Well,
Speaker 2: I'll give her an extra ten minutes since she's recovering
Speaker 2: from a concussion.
Speaker 1: I know, you know, I haven't had my phone on
Speaker 1: me much as a clock the last week because I
Speaker 1: have been ordered off screens essentially. But here's the deal.
Speaker 1: Like what happened was, I'll make this quick, but I
Speaker 1: bounded down the stairs to surprise my sister in law.
Speaker 1: We flew in early, and I was like, I'm here
Speaker 1: and absolutely shit on a flight of stairs. But I
Speaker 1: hit the back of my head pretty hard, and I
Speaker 1: was like, oh no, I just really killed the vibe.
Speaker 1: And then I was like I'm fine, I'm fine, and
Speaker 1: I got up and then I passed out and apparently
Speaker 1: I started convulsing. They picked me up, I passed out again,
Speaker 1: and then at that point that all of the gay
Speaker 1: you're here turned into like the ambulances on its way.
Speaker 1: Such a buzz kill. So I have never, to my knowledge,
Speaker 1: had a concussion before. But what is happening when you
Speaker 1: get bonked on the noggin like that?
Speaker 2: Wow, well that sounds like you had a pretty significant injury. Yeah,
Speaker 2: But you know, concussions, even within themselves, can vary, right,
Speaker 2: So there can be these very very mild hits to
Speaker 2: the head and then people who you know might have
Speaker 2: a convulsion or a loss of consciousness or even you know,
Speaker 2: amnesia for some time. But essentially is the brain shaking
Speaker 2: within the skull from some force or impact, right, And
Speaker 2: so that can be a direct blow like I fell
Speaker 2: and I whacked my head or I got hit with something,
Speaker 2: but it can also be a shaking motion like if
Speaker 2: you're in a car accident, you get whiplash and the
Speaker 2: head shakes back and forth, but it never actually hits
Speaker 2: another object. And then the other time we can see
Speaker 2: it is if somebody's around, like an explosion, right, because
Speaker 2: remember the brain sits in fluid, right, since it has
Speaker 2: this yellow like consistency, and it sits in fluid, and
Speaker 2: there's space there for it to move within the skull,
Speaker 2: which is really good because if you know, there's a
Speaker 2: little swelling or something like that, there's some room for
Speaker 2: the brain to expand a little. But that also means
Speaker 2: that it can shake around and hit the sides of
Speaker 2: the skull. So essentially, when you talk about concussion, you're
Speaker 2: talking about some force making the brain shake inside the skull,
Speaker 2: and it usually doesn't produce your classic bruising or bleeding.
Speaker 2: It actually is this more microscopic kind of injury or change.
Speaker 2: And sometimes you can get changes in some of the
Speaker 2: electrical activity in the brain, which is why you can
Speaker 2: get a shaking spell right afterwards. Oh and so that
Speaker 2: you know is something that can happen the' I'll tell
Speaker 2: you it's pretty rare, pretty rare, but possible.
Speaker 1: Okay, So if you're shopping for a minor traumatic brain injury,
Speaker 1: there are three flavors of concussions. It's exciting Grade one.
Speaker 1: There's mild, with symptoms like headache or dizziness or blurred
Speaker 1: vision that last less than fifteen minutes, there's no passing out.
Speaker 1: Grade two moderate those symptoms I mentioned, lasting longer than
Speaker 1: fifteen minutes, still passing out. Then there's Grade three, which
Speaker 1: is severe, in which the person loses consciousness, sometimes for
Speaker 1: just a few seconds. So kind of an overachiever. And
Speaker 1: I went for Grade three, but I don't fully remember it.
Speaker 1: So I fell down the stairs and I got up
Speaker 1: a minute later, and then I walked to the kitchen,
Speaker 1: and the next day I knew I was on the
Speaker 1: floor again, apologizing, and I actually heard my sister in
Speaker 1: law on the phone with nine one one saying that
Speaker 1: I passed out twice, and I was like, no, I didn't.
Speaker 1: But honestly, I was the worst eyewitness in the room
Speaker 1: because I was not conscious twice. But I'm told that
Speaker 1: my limbs seized up and started shaking, and my speech
Speaker 1: was slurred and my eyes rolled back, So it was
Speaker 1: scary for everyone. Was this a seizure though, depends on
Speaker 1: who you ask, But TBI researchers didn't want this post
Speaker 1: concussion brain activity to be confused with seizures caused by epilepsy,
Speaker 1: So the rather musical term concussive convulsions arose to describe
Speaker 1: those benign impact seizures, and as the medic in the
Speaker 1: ambulance explained, it's kind of like your brain shutting down
Speaker 1: and then rebooting. Also, in the bonus episode about headbutting,
Speaker 1: we're going to go into exactly what it takes to
Speaker 1: assess impact damage to neurons. So what they're really looking
Speaker 1: for when you go to the er is the big stuff,
Speaker 1: like visibly bleeding traumas in your head, rather than the
Speaker 1: micro damage, which is probably what I got.
Speaker 2: Yeah, so it's not something we can really see. If
Speaker 2: we were to take like a conventional cat scan of
Speaker 2: your brain, right we get a picture or an MRI
Speaker 2: of your brain, or we get a picture, we usually
Speaker 2: wouldn't see anything because it's something happening closer to a
Speaker 2: cellular level. But nonetheless it can be quite impairing and
Speaker 2: can give people a lot of symptoms. It's a tough
Speaker 2: injury that way, because you want to be able to
Speaker 2: see it. Right, if you break a bone, you want
Speaker 2: to look at the X right and see where it's broken. Yeah,
Speaker 2: But with concussion, and we don't really have that nice,
Speaker 2: neat picture to show people where injury happened.
Speaker 1: Yeah, I keep wondering, like, is there a spot on
Speaker 1: the back of my brain where I hit that is
Speaker 1: like a bruised peach. If I could look into my brain,
Speaker 1: would there be kind of some redness there or would
Speaker 1: it really really be microscopic where you're like, I can't
Speaker 1: tell that there's a bunch of like busted oozing cells.
Speaker 1: Like I'm trying to get a mental picture so that
Speaker 1: I take better care of myself.
Speaker 2: So yeah, it is a hard one. It is a
Speaker 2: hard thing to visualize, and it's hard for a lot
Speaker 2: of people too, because it's not like we put a
Speaker 2: band aid on your head or put your head in
Speaker 2: a cast, right, So here you are walking around and
Speaker 2: you look just fine to most people, but you don't
Speaker 2: feel fine. And so that also can make it kind
Speaker 2: of a tough injury in that way for a lot
Speaker 2: of people.
Speaker 1: And from what I understand, a concussion is something that's
Speaker 1: a clinical diagnosis, Right. They can't yeah, like look at
Speaker 1: a scan necessarily, but they can say, based on what
Speaker 1: you told me, sounds like it's like you did have
Speaker 1: a concussion.
Speaker 2: Yes, you are exactly right. So it is a clinical diagnosis,
Speaker 2: meaning we hear about the injury right and you have
Speaker 2: some force that was substantial enough to cause trauma, and
Speaker 2: then we ask people how they looked and felt right afterwards,
Speaker 2: we can do some examination testing like balance testing or
Speaker 2: cognitive testing, where we test things like reaction time or
Speaker 2: memory or attention, and that can show us sometimes that
Speaker 2: people are not doing well in some areas. But there
Speaker 2: is no single diagnostic tests like a blood test or
Speaker 2: a scan that we can do to clearly diagnose concussion
Speaker 2: or to actually say that it's over. So people also
Speaker 2: want to know when am I better? Yes? And could
Speaker 2: you get me a scan or a blood test that
Speaker 2: says this is gone? And we actually don't have that either.
Speaker 1: It's a very gray space in every way, in every way,
Speaker 1: and gray matter space. But let's wedge some terminology into
Speaker 1: our squishy gray matter space. Can you explain the difference
Speaker 1: between a concussion and an mTBI and a TBI.
Speaker 2: I am happy to try to explain that, but I
Speaker 2: will tell you that even among scientists there is some
Speaker 2: debate still between the terms concussion and mTBI. Okay, so
Speaker 2: for most of us and me included concussion and an mTBI,
Speaker 2: the M standing for mild, So a concussion and a
Speaker 2: mild TBI are the same thing.
Speaker 1: Ah.
Speaker 2: Not everybody out there would agree with me, but most
Speaker 2: I think people in this area of medicine, in this
Speaker 2: space would agree.
Speaker 1: Okay. So, as you can imagine, there's all kinds of
Speaker 1: terminology and things change really quickly, and looking it up,
Speaker 1: I felt like your mom in twenty fifteen googling BD
Speaker 1: on Urban Dictionary. But I have also learned that there's
Speaker 1: a ton of debate with concussions and traumatic brain injuries.
Speaker 1: Like so much, there's a ton of shit we do
Speaker 1: not know. There's also a lot of money at stake,
Speaker 1: either via industries that involve occupational hazards or through making
Speaker 1: money on the recovery from them, and some doctors have
Speaker 1: moved to call athletics head injuries srcs sports related concussions
Speaker 1: instead of using the term minor traumatic brain injury. Others
Speaker 1: consider a concussion a subset of mTBIs, which are in
Speaker 1: and of themselves, a subset of more serious conditions that
Speaker 1: may include skull fractures, penetrated penetrated penetrative injuries. I'm not
Speaker 1: going to say that word right, but it means getting
Speaker 1: poked real bad with something and hematomas, which would be
Speaker 1: considered TBIs. So all of those things under the umbrella
Speaker 1: of TBIs. It's confusing, even if you haven't recently blacked
Speaker 1: out on a kitchen floor and then passed out being
Speaker 1: carried to a couch. It's been a wild week, folks.
Speaker 1: I'm not going to say penetrative right now.
Speaker 2: TBI is a broader term, right, Traumatic brain injury encompasses
Speaker 2: everything from concussion through people who have severe trauma to
Speaker 2: the brain and are in coma or have paralysis. Right,
Speaker 2: so it encompasses all trauma to the brain from very
Speaker 2: mild through very severe. And so within this category of
Speaker 2: traumatic brain injury, mTBI, or concussion is the most mild.
Speaker 1: And when should a person get checked out? I feel
Speaker 1: like since the death of Natasha Richardson for what seemed
Speaker 1: like a relatively minor skiing accident, Richardson suffered ahead injury
Speaker 1: Monday while taking a ski lesson in Canada. She was
Speaker 1: pronounced dead Wednesday at a hospital in New York. She
Speaker 1: died two days later. I feel like there's something really
Speaker 1: innately scary about, as my dad would say, thumping your
Speaker 1: pumpkin really hard. When is it time to go to
Speaker 1: urgent care and make sure you don't have like a
Speaker 1: giant hematoma, and when is it just like, if you're
Speaker 1: not passing out, you're probably fine.
Speaker 2: I think it's good for most people to get checked out.
Speaker 2: Not everybody will, and there are certainly some symptoms that
Speaker 2: people get that should make them get checked out more
Speaker 2: than others. For example, if you have a shaking spell
Speaker 2: or seizure, you absolutely need to get checked out. If
Speaker 2: you've been unconscious for any period of time ring, you
Speaker 2: definitely should get checked out. If you have other trauma,
Speaker 2: right like, if you got hit hard enough or you're
Speaker 2: a big enough accent that you broke other stuff, you
Speaker 2: probably should get checked out. If you're somebody who's prone
Speaker 2: to bleeding, right people, sometimes older folks who are on
Speaker 2: blood thinners, those people definitely need to get checked out.
Speaker 2: And then if you're somebody who's thinking about going back
Speaker 2: to do something where you're gonna whack your head again,
Speaker 2: you definitely should get checked out. But really, anybody who
Speaker 2: thinks they've experienced any head trauma, whether you know, you
Speaker 2: can't say with certainty it's just a concussion or it's
Speaker 2: something else, like in the case of Natasha Richardson. So
Speaker 2: it's very reasonable to go get checked out. Most people
Speaker 2: would should feel comfortable doing that. It's not an overreaction
Speaker 2: to go and get checked out and make sure that
Speaker 2: this is really just a concussion versus something like an
Speaker 2: epidural hematoma or fracture or something else. Yeah, that is
Speaker 2: going to require more monitoring or potentially a surgical intervention.
Speaker 1: Okay, So now we understand that within TBIs there are mTBIs,
Speaker 1: and within mTBIs there are concussions, and then within concussions
Speaker 1: there are srcs or sports related concussions. And I promised
Speaker 1: myself when we started this at this episode would be easy,
Speaker 1: but researching it was actually it felt like carving a
Speaker 1: set of Russian nesting dolls out of my own skull
Speaker 1: bones and then painting it with other people's flame wars
Speaker 1: about concussion severities and subsets. But let's take a more
Speaker 1: objective approach. There is the industry standard medical quiz. It's
Speaker 1: called the Glasgow Coma scale, and it goes from a
Speaker 1: fifteen down to a three. Fifteen is doing just fine
Speaker 1: walking away from it unscathed, and three is literally dead.
Speaker 1: So I guess there's two, which must be just a
Speaker 1: frustrated ghost. And maybe one is a poltergeist that hides
Speaker 1: your keys and shakes its junk at you. I'm not sure,
Speaker 1: but yeah, fifteen to three Glasgow Coma Scale or GCS
Speaker 1: for TBI. Now one term you may also hear is CTE,
Speaker 1: which is chronic traumatic encephalopathy, which arises from repeated trauma
Speaker 1: to the head and according to last year's second National
Speaker 1: Institute on Neurological Disorders and Stroke and the National Institute
Speaker 1: of Biomedical Imaging and Bioengineering Consensus meeting to define neuropathological
Speaker 1: Criteria for the diagnosis of Chronic traumatic encephalopathy, leading researchers
Speaker 1: there associate CTE with symptoms including aggression and depression, suicidal ideation,
Speaker 1: tendency towards substance abuse, dementia, some motor challenges, even Parkinson's disease,
Speaker 1: cognitive challenges and financial impulsivity, and more. But before any
Speaker 1: armchair quarterbacks start becoming armchair neuropathologists, it is imperative to
Speaker 1: know that CTE can only be diagnosed with an autopsy
Speaker 1: or from three to one on the Glasgow Coma scale,
Speaker 1: So yes, you must be dead to be diagnosed at
Speaker 1: least for now. And the film Concussion with Will Smith
Speaker 1: is a biopic of doctor Bennet Omalu, who is a
Speaker 1: forensic pathologist who's made strides in CTE recognition, but not
Speaker 1: all researchers agree with all of his work. Again, lots
Speaker 1: of debate in this field. And there's Boston Universities doctor
Speaker 1: Anne McKee. She's also a leading researcher in this and
Speaker 1: her website has scans of the TAU proteins is what
Speaker 1: they're called, that appear in individuals with CTE, and she
Speaker 1: writes that CTE has been found in athletes, military veterans,
Speaker 1: victims of domestic violence, and others who experienced multiple falls
Speaker 1: or injuries. And CTE has been known to affect boxers
Speaker 1: since the nineteen twenties. It was initially termed punch drunk syndrome,
Speaker 1: she writes, but more recently it's been found in players
Speaker 1: of American football and ice hockey, be soccer, MMA, pro wrestling,
Speaker 1: and other contact sports. End quote, And we'll have more
Speaker 1: on the diagnosis post mortem in the bonus episode on
Speaker 1: headbedting coming out this week. What a treat. But back
Speaker 1: to concussions and getting those diagnosed when you are just
Speaker 1: a regular, old, alive person. I wonder if, depending on
Speaker 1: the healthcare system your country has, if more people get
Speaker 1: checked out for concussions somewhere with universal healthcare versus you know,
Speaker 1: like I bonked my head, but if I call any
Speaker 1: ambulance that's like two grand.
Speaker 3: I wonder if there's a reluctance in certain like cultures
Speaker 3: or systems to get checked out for things. As soon
Speaker 3: as my assister in law called nine to one one,
Speaker 3: I was like, good idea. I am having a little
Speaker 3: bit of convulsions and a seizure, But also like, ugh,
Speaker 3: it's gonna be so expensive.
Speaker 2: Yeah, I mean that's something that you know, a lot
Speaker 2: of people have to grapple with, Right, Am I really
Speaker 2: going to go get checked out about something that's seemingly,
Speaker 2: you know, mild? And I think, you know, certainly for
Speaker 2: some of the things we just discussed, those things are
Speaker 2: potentially signs that you've had something worse than a concussion,
Speaker 2: and you probably need a scan, right or something bad
Speaker 2: could get missed. For folks who don't have any really
Speaker 2: concerning features at all, they might do okay just going
Speaker 2: to the urgent care by car as opposed to the
Speaker 2: ambulance ride, and that that might be a little bit
Speaker 2: more economical, but yeah, it's certainly you know that the
Speaker 2: ability to access healthcare for a lot of people can
Speaker 2: make you know, my recommendations about getting checked out more
Speaker 2: difficult for.
Speaker 1: Sure really ps a hundred percent the right thing to do.
Speaker 1: I was knocked off my rocker so hardcore, and I
Speaker 1: had this weird combo of like foggy reasoning plus a
Speaker 1: big helping of I wonder what my yearly deductible is
Speaker 1: for a ride in the wu bobile. But given that
Speaker 1: TBIs account for I now no thirty percent of the
Speaker 1: accident deaths in the US every year. Fully, no contest
Speaker 1: warranted and worth it to be in an act brace
Speaker 1: and get a brain scan. But I'm probably not alone here.
Speaker 1: So instead of making this easy, I decided to dig
Speaker 1: up a bunch of research, and I found a twenty
Speaker 1: nineteen Centers for Disease Control, Morbidity and Mortality weekly report
Speaker 1: called Traumatic Brain Injury Related Deaths by Race, Ethnicity, sex, intent,
Speaker 1: and Mechanism of Injury, United States twenty to twenty seventeen,
Speaker 1: plus a more recent CDC article on brain injury trends
Speaker 1: that said, over the last two decades, TBI contributed to
Speaker 1: the death of over a million people, and in that period,
Speaker 1: over four hundred thousand US service members were diagnosed with TBI,
Speaker 1: and other research suggests that forty six percent of people
Speaker 1: in correctional facilities have a history of TBI. Folks who
Speaker 1: experience homelessness are up to four times more likely to
Speaker 1: have had a TBI and up to ten times more
Speaker 1: likely to have had a moderate or severe one like
Speaker 1: I had, and survivors of intimate partner violence who sustain
Speaker 1: traumatic brain injuries also have worse prognoses, and anyone with
Speaker 1: lower incomes or without health insurance, at least in the
Speaker 1: US has far less access to TBI care. Country folks. Also,
Speaker 1: if you live in a rural area, the chance of
Speaker 1: a fatal TBI as higher, as specialized medical care can
Speaker 1: be farther away, harder to get too quickly, and the
Speaker 1: CDC report continued on that Indigenous folks have higher rates
Speaker 1: of TBI hospitalization and death than other groups. People of
Speaker 1: color less likely to receive follow up care and rehabilitation
Speaker 1: following a TBI compared to their white emergency room neighbors,
Speaker 1: so who is granted quality and sufficient care is huge
Speaker 1: as are increased risk factors and resources to cover the
Speaker 1: bill and what kind of bill are we talking in
Speaker 1: the US? According to the twenty nineteen study in Hospital
Speaker 1: Costs after Severe Traumatic Brain Injury, a systematic review and
Speaker 1: quality assessment, in hospital costs per patients were generally pretty
Speaker 1: high and ranged from two thousand dollars to four hundred
Speaker 1: thousand dollars, which is so many dollars. So I have
Speaker 1: health insurance and luckily like six jobs right now, and
Speaker 1: after passing out twice with convulsions before the horror stricken
Speaker 1: faces of my loved ones this week, the thing I
Speaker 1: thought about the most, lying on a gurney in the
Speaker 1: hallway of a crowded er in isolation a day before
Speaker 1: Christmas on the East Coast during an omicron surge. Thing
Speaker 1: on my mind the most the expense, and I have
Speaker 1: it the easiest. So what about doctor Eicherino. Has she
Speaker 1: ever been on the other side of the gurney? Have
Speaker 1: you ever had a concussion?
Speaker 2: But yes, I have had a concussion. At the time,
Speaker 2: I was a kid, and I don't think anybody really
Speaker 2: recognized it for what it was. But now that I live, breathe,
Speaker 2: and work in the space all the time. I can
Speaker 2: absolutely say that I fell off a horse, I hit
Speaker 2: my head and I was helmeted luckily, but I, you know,
Speaker 2: was nauseous, I threw up afterwards. I don't really remember,
Speaker 2: you know, the next couple of hours. So well, So
Speaker 2: I feel like I can stay with certainty that I've
Speaker 2: had a concussion myself.
Speaker 1: Yeah, you're like, I can clinically diagnose myself from the future.
Speaker 1: Did you have any lasting effects from it?
Speaker 2: I don't think so. No. And again, I was a kid,
Speaker 2: and at that time, we weren't looking so closely like
Speaker 2: we do now about concussions in sports, So I don't
Speaker 2: think that I had any lasting effects.
Speaker 1: Now, how do you trace your path to becoming a doctor? Heartrvard,
Speaker 1: who is working on this.
Speaker 2: Yeah, absolutely so. My specialty of medicine is called physiatry. Come.
Speaker 2: I don't know if that's something you've ever heard of,
Speaker 2: a lot of people haven't. My own family sometimes thinks
Speaker 2: I'm a pediatrist. I'm like, Nope, not feet, brains. So
Speaker 2: a physiatrist is someone who specializes in recovery from injury.
Speaker 2: So that could be like a knee injury, or it
Speaker 2: could be something like a brain injury or a stroke
Speaker 2: or a spine injury, so it really runs the gamut.
Speaker 2: I was super interested in neuro rehabilitation, or rehabbing the
Speaker 2: brain and spinal cord after injury. And I'm a huge
Speaker 2: sports person, so I struggled between going into sports medicine
Speaker 2: and going into neurorehabilitation. And this is where I kind
Speaker 2: of found my happy place, if that's even possible to
Speaker 2: have a happy place and concussion. But I I work
Speaker 2: with a lot of young people. I work with a
Speaker 2: lot of athletes. I work with a lot of young
Speaker 2: military service members, so you know, a high functioning group
Speaker 2: of people who've had this neurological disturbance and now are
Speaker 2: trying to recover.
Speaker 1: And doctor Igarino was herself a patient everyhab. She also
Speaker 1: suffered a spine injury as a teenager and was steered
Speaker 1: toward this work helping others recover, which is amazing. And
Speaker 1: now if you're listening to all this and you're like,
Speaker 1: you know what, I'm going to sell my rollerblades to
Speaker 1: my cousin, I'm going to keep up my holiday lights
Speaker 1: until next year. I'm staying off the roof. Let's talk
Speaker 1: about how do people wind up with a minor TBI.
Speaker 1: So studies show that fifty percent of us have had
Speaker 1: a dramatic brain injury in our lifetimes. Dudes, bad news.
Speaker 1: You're twice as likely to be hospitalized three times more
Speaker 1: likely to die. So overall, thirty to fifty million of
Speaker 1: us out in the world will knock our noggins pretty
Speaker 1: hard this year. So hello, welcome to my club. Enjoy
Speaker 1: the sweatpans now. According to the National Center for Injury
Speaker 1: Prevention and Control, the most common causes are falls, that's
Speaker 1: the most popular one. Been there, done that, don't recommend,
Speaker 1: Then motor vehicle accidents, getting struck by objects, including sporty things,
Speaker 1: And then there's violence, assaults and intentional self harm, which
Speaker 1: has the highest mortality rate. But yes, for most of us,
Speaker 1: it's just not paying full attention to safety or physics,
Speaker 1: being an asshole.
Speaker 2: Lots of people have concussions, they fall down the stairs,
Speaker 2: they get in a car accident, they have an injury
Speaker 2: at work, So it's pretty common in a lot of people.
Speaker 2: And many people have probably had a concussion and you know,
Speaker 2: they didn't have a seizure or they didn't feel so
Speaker 2: bad and they never saw a doctor, right, and within
Speaker 2: a few days they were kind of back to their
Speaker 2: usual self. So the reporting on concussion is probably lower
Speaker 2: than the number of concussions that actually happen. I think
Speaker 2: one of the reasons there's a big focus on people
Speaker 2: in sports and the military because these are areas where
Speaker 2: people are at high risk of getting concussions and potentially
Speaker 2: more concussions. Right, So they're doing things that put them
Speaker 2: at risk of a head injury on a pretty regular basis,
Speaker 2: and so that's probably why there's a lot of focus
Speaker 2: on those groups.
Speaker 1: What does recovery entail if you are in physiatry, which
Speaker 1: is a word I now know when you are treating
Speaker 1: someone who has had a concussion or multiple first line
Speaker 1: of defenses that like, get off your iPad. You don't
Speaker 1: need to be scrolling social media now or is it
Speaker 1: cognitive puzzles? I was told to stay off screens and
Speaker 1: literally not to think too much, like not to play
Speaker 1: scrabble or anything. And I'm not sure how long people
Speaker 1: have to be weary that. What's your plan for people?
Speaker 2: Yeah, So it's really interesting because the field of neuro
Speaker 2: recovery and concussion recovery, it has really changed in the
Speaker 2: last ten fifteen years. So we used to tell people
Speaker 2: to rest and not just like hang out on the couch,
Speaker 2: but go in a dark room and pretty much sensory deprivation,
Speaker 2: don't look at anything bright, don't turn on the lights,
Speaker 2: you just leave me alone, don't listen to anything loud.
Speaker 2: And what we found is actually people didn't get all
Speaker 2: that much better doing that, and we didn't really have
Speaker 2: any good science to say why people should do. That
Speaker 2: just seemed like kind of the thing to do. And
Speaker 2: now we've really moved much more to a more sort
Speaker 2: of moderate approach, which is that we don't think people
Speaker 2: need to be sensory deprived or put in dark rooms.
Speaker 2: We actually think that would make it harder for them
Speaker 2: to maybe get better. Oh, just because you're completely removing
Speaker 2: yourself from all your usual validating life activities. Right, putting
Speaker 2: people in solitary confinement makes them depressed, right, and anxious. Right,
Speaker 2: you have nothing else to do but sit there and
Speaker 2: think about how bad you feel. So that doesn't actually
Speaker 2: do a lot of people so much good. But what
Speaker 2: we like to see now is that people do what
Speaker 2: I like to call relative rest. So hang out, don't
Speaker 2: over exert yourself, like go for a big workout or
Speaker 2: certainly don't put yourself in harm's way of getting another
Speaker 2: head injury. So if you're an athlete, don't get back
Speaker 2: out on the field before you're better. But it's okay
Speaker 2: for people to watch a little TV, be on their
Speaker 2: phone or their computer a little bit. You might find
Speaker 2: that being on screens or being in a really loud
Speaker 2: place or a crowded place makes you not feel so well,
Speaker 2: and if that happens, then you kind of back off
Speaker 2: from doing those things. But there's not really great evidence
Speaker 2: to support people staying off screens staying in dark rooms
Speaker 2: just for the sake of it. So we really like
Speaker 2: to go with how people feel and how they are
Speaker 2: responding as an individual to various stimuli, because this is
Speaker 2: a very individualized injury. I'm sure you've talked to other
Speaker 2: people have had concussions, and maybe they haven't experienced the
Speaker 2: same things you have, And that's because it really boils
Speaker 2: down to the person and maybe what their sensitivities are
Speaker 2: and some of the other medical conditions or background. Everybody's
Speaker 2: going to be a little bit different. So we want
Speaker 2: people to have a few days of relative rest, bumming
Speaker 2: around the house, and then actually after about day three,
Speaker 2: We're okay with people getting back to a little bit
Speaker 2: of work, a little bit of school and just seeing
Speaker 2: how they do and kind of using their symptoms as
Speaker 2: a guide. But everybody will be different, and so there's
Speaker 2: no reason to give everybody the same exact prescription on
Speaker 2: how to get better.
Speaker 1: Okay, that's actually great to know because I had posted
Speaker 1: something where I'm like, little concussion fine, you know, catskin
Speaker 1: came back fine, and I got a lot of comments
Speaker 1: on instagramming like watch the fuck out because don't look
Speaker 1: at screens. Someone else, you know, would say I got
Speaker 1: a concussion, I got post concussion syndrome. Be really, really careful,
Speaker 1: And so I was kind of left not sure is
Speaker 1: this going to make something worse? Is it not? I
Speaker 1: hadn't heard of the term post concussion syndrome before this.
Speaker 1: Is that something that is scientific clinical term or is
Speaker 1: that like a catch all?
Speaker 2: So the post concusted in syndrome is a term that
Speaker 2: refers to people who have symptoms for longer than expected,
Speaker 2: and it's actually being phased out. So it used to
Speaker 2: be a clinical diagnosis that was made and we've actually
Speaker 2: phased the term out because of what I just kind
Speaker 2: of talked about that everybody's kind of individualized, and sometimes
Speaker 2: you know, people will have symptoms that last a little longer,
Speaker 2: but they might be related to another condition they have,
Speaker 2: like somebody who already has maybe migraines, or somebody who
Speaker 2: already maybe has light sensitivity or noise sensitivity. So it's
Speaker 2: a term that's getting phased out, and I kind of
Speaker 2: prefer to think of it as persistent symptoms or prolonged
Speaker 2: recovery because I'm also really mindful that when you give
Speaker 2: somebody diagnosis as a doctor, right, you have the post
Speaker 2: concussion syndrome, but I don't have any treatments or really
Speaker 2: great cures for that. It can actually make people feel
Speaker 2: a little worse, right, if you tell them that they've
Speaker 2: got some prolonged syndrome, we can actually maybe kind of
Speaker 2: change the narrative in a bad way. So the term
Speaker 2: has fallen out of favor for a lot of reasons,
Speaker 2: but it still kind of means the same thing, right
Speaker 2: that some people experience symptoms longer than other people.
Speaker 1: Okay, so I'm very lucky to have an end with
Speaker 1: doctor Jane McGonagall from the Ledology episode on video Games,
Speaker 1: who has done a ton of research and even a
Speaker 1: ted talk on her own. mTBI sustained from accidentally slamming
Speaker 1: her cabasa into a cabinet at home, which I do
Speaker 1: not envy. So two days after my own fall data
Speaker 1: fly to stairs, I emailed her asking for advice, and
Speaker 1: she was amazing. She echoed to take it easy, to
Speaker 1: get some rest and fresh air, maybe some walking, watching
Speaker 1: some familiar or comforting movies, perhaps pressuring a loved one
Speaker 1: to give me a foot massage, which I did. And
Speaker 1: she said if something felt like it was off or
Speaker 1: too much, to back off and don't push through it.
Speaker 1: And this part really struck me. Did not intend that
Speaker 1: pun but it mirrors what she said in her Ludology episode,
Speaker 1: So with her permission, I'm going to repeat it here.
Speaker 1: I'm going to read part of the sweet email that
Speaker 1: she sent to me last week. She said, the other
Speaker 1: thing that really helped me was learning that some people
Speaker 1: experience depression as a neurological side effect of a concussion.
Speaker 1: So during healing, the brain is trying to put the
Speaker 1: brakes on your normal activity and it wants to avoid
Speaker 1: another impact, so to preserve your precious energy, literally the
Speaker 1: glycogen your brain needs to heal. It depresses you, so
Speaker 1: your brain wants you to stay in bed and feel
Speaker 1: like nothing is worth doing until it heals. And for me,
Speaker 1: she writes, learning that this depression was a natural and
Speaker 1: helpful physiological response to concussion and not a fact of
Speaker 1: my life or a psychological weakness or just an emotional
Speaker 1: response helped me write it out and see it as
Speaker 1: a healing response without suffering as much. Many people don't
Speaker 1: experience depression after a concussion, she writes, so this may
Speaker 1: not come into play for you at all, but it
Speaker 1: is common enough that I always try to tell people
Speaker 1: that if it happens, know that it's just your brain
Speaker 1: trying to keep you RESTful, and it's not a feeling
Speaker 1: that continues after you recover. When a concussion is healed,
Speaker 1: those feelings go away, and she concludes, I hope you
Speaker 1: are one of the many people who recover quickly and
Speaker 1: relatively comfortably. And if like me, you take a little longer,
Speaker 1: just surf it out. Don't fight the waves, go with them,
Speaker 1: give yourself grace, rest, because there's no benefit to fighting
Speaker 1: your own brain. Ugh Doctor Jane McGonagall Freakin Saint so
Speaker 1: her website and her talks are linked at my website
Speaker 1: which is linked to the show notes. You don't have
Speaker 1: to remember anything or write anything down. Also side note serious,
Speaker 1: huge thank you to my sister in law and wedding
Speaker 1: dress designer Samantha Sleeper, who has continued to house Jarrett
Speaker 1: and I for a long, languid two week vacation of
Speaker 1: fireplace hangouts with Chris and Mason while I neural plasticize
Speaker 1: my noggin. What is that word? Neuroplastic Okay? So I
Speaker 1: looked up studies and in the twenty sixteen book Translational
Speaker 1: Research in Traumatic Brain Injury, it explained that neuronal circuits
Speaker 1: can adapt structurally and functionally to injury neuroplasticity, so they
Speaker 1: recruit new cells to replace the damage ones, and then
Speaker 1: your brain uses molecular modifications to reroute and get the
Speaker 1: job done. If you're feeling a little weird or down
Speaker 1: or funky after a concussion, just consider it kind of
Speaker 1: like a renovation, So pardon your own dust. During the remodel,
Speaker 1: you're figuring it out. And what about right afterward. I
Speaker 1: know we talked about you don't have to go into
Speaker 1: solitary confinement necessarily, and I did notice, you know, I
Speaker 1: was fine to do some things. I'm luckily I'm in
Speaker 1: a relatives house and I've just been beaching myself by
Speaker 1: the fireplace. But as soon as I started playing Super
Speaker 1: Smash Brothers with my nephew, I was like, all right,
Speaker 1: this is too much flashing lights and screaming gorillas.
Speaker 2: Yeah. So I often tell people to try to do
Speaker 2: all the good things for their body, you know, so
Speaker 2: stay hydrated, try to eat to relatively balanced diet. There
Speaker 2: are no specific diets that have been shown to make
Speaker 2: concussion go away faster, nor have there really been shown
Speaker 2: to be any supplements that'll do it. There's lots out
Speaker 2: there and people can definitely try them, but nothing that's
Speaker 2: a slam dunk, you know. And then have the ability
Speaker 2: in your day to take it easy if you need to,
Speaker 2: right if you find that you kind of overdid it
Speaker 2: playing video games. Have the ability to say, you know,
Speaker 2: I think I'm just going to step away for a
Speaker 2: little bit, or I'm going to you know, work part
Speaker 2: time for a couple of days and take some breaks
Speaker 2: during the day. We actually used to recommend that people
Speaker 2: not do any exercise until they were all better, and
Speaker 2: now there are some studies that show in they're mostly
Speaker 2: studies in athletes because that's where this tends to be
Speaker 2: a common issue, that some light aerobic exercise that does
Speaker 2: not make your symptoms worse might actually help people feel
Speaker 2: a little better. So this would be like, you know,
Speaker 2: taking a brisk walk or getting on an exercise bike
Speaker 2: or something like that. So it's been interesting that we
Speaker 2: went from people not doing anything right to actually, oh, well,
Speaker 2: maybe you know, getting moving a little bit, you know,
Speaker 2: in a controlled way that doesn't make you feel worse
Speaker 2: be helpful.
Speaker 1: So if your idea of a workout is maybe some
Speaker 1: light cage fighting, perhaps hold off just for a bit
Speaker 1: your usual triple shot quartato, what about that? Yes or no?
Speaker 2: I've heard people say, you know, I cut out all
Speaker 2: my caffeine right, well, how many cups of coffee did
Speaker 2: you used to drink? Well two in the morning, and
Speaker 2: now I have a raging headache and I'm tired, And
Speaker 2: I'm like, okay, just go back to your usual coffee
Speaker 2: in caakee because I think we've actually by eliminating coffee,
Speaker 2: you have actually made yourself feel worse. Right, So we
Speaker 2: want people to be like on their normal routine. We
Speaker 2: don't want them to turn themselves inside out and take
Speaker 2: away all their sort of usual behaviors and activities completely,
Speaker 2: or they can actually make themselves feel a little bit worse.
Speaker 2: I think some of the things that we want to
Speaker 2: stay away from right after concussion are things like alcohol
Speaker 2: and stuff that can make you feel hungover and be
Speaker 2: kind of mind altering, right, because that usually doesn't make
Speaker 2: people feel better.
Speaker 1: What about glycogen? I read somewhere that your brain needs
Speaker 1: a lot of glicogen to heal.
Speaker 2: Your brain needs a lot of glucose, right, which is sugar.
Speaker 2: Actually that's the only thing your brain survives on. So
Speaker 2: you know, fasting is probably not a great idea when
Speaker 2: you have a concussion or being extremely restricted in what
Speaker 2: you eat. But otherwise there's not a lot of dietary
Speaker 2: stuff that might really make a big a big impact
Speaker 2: for most people, and so we don't tend to really
Speaker 2: recommend it.
Speaker 1: Okay, Okay, So that being said, side note, there is
Speaker 1: emerging research on very low carbohydrate or keutogenic diets and
Speaker 1: brain function after injury, and the journal Frontiers in Neuroscience
Speaker 1: published a twenty nineteen study from the University of Connecticut
Speaker 1: that showed a high fat diet reduced aggression in males,
Speaker 1: they say after concussions. Has explained some evidence that concussions
Speaker 1: might cause some brain cells to die off by over
Speaker 1: exciting them during a trauma, and then that causes the
Speaker 1: cells to use up all their glucose all at once,
Speaker 1: all too fast, and die now. Brain cells usually run
Speaker 1: on glucose right, stored mostly in the form of glycogen.
Speaker 1: In non neuronal glial cells, they're called astrocytes. Doesn't really
Speaker 1: matter good to know, but the brain can also use
Speaker 1: ketone bodies or fat metabolites in a pinch if you
Speaker 1: have no more glycogen left. So many past neurological studies
Speaker 1: point to ketogenic dites as a way to keep brain
Speaker 1: cells kind of out of that excitotoxicity zone, which can
Speaker 1: prevent things like seizures. So it's possible that this twenty
Speaker 1: nineteen research into ketogenic fuel and concussions could help prevent
Speaker 1: mTBI damage in folks who are prone to concussions, like
Speaker 1: pro athletes, which could be huge in this field. Shoot.
Speaker 1: I forgot to mention all the research was done with fruitflies,
Speaker 1: so animals who don't have to work on spreadsheets or
Speaker 1: navigate society and whose brains are the size of a
Speaker 1: poppy seed. But listen, before you scoff at fruitfly research,
Speaker 1: let's remember with our big meat brains that their fly
Speaker 1: brains do have one hundred thousand neurons and tens of
Speaker 1: millions of connections. So yes, they are a small model,
Speaker 1: but they're a mighty model nonetheless, But we do have
Speaker 1: a long ass way to go. So ask your own doctor,
Speaker 1: because opinions on brain trauma recovery and prevention are, like
Speaker 1: your own brain, pretty split down the middle. I myself
Speaker 1: have been eating lots and lots of holiday cookies, and
Speaker 1: right now I'm pondering how much of my sluggishness is
Speaker 1: fully the result of a brain injury versus just some
Speaker 1: good old fashioned pancreatic overwhelm in January. So just be
Speaker 1: kind to your construction zones, is all i'ms now. What
Speaker 1: about just firing up your bomb or buying some Goop
Speaker 1: certified White Lady cannabis. So I asked another neuroscientist pal,
Speaker 1: who said that CBD is definitely being researched and used
Speaker 1: in TBI recovery. So I found a study called Review
Speaker 1: of the Neurological benefits of phytocannabinoids neuroprotective, anti inflammatory, and
Speaker 1: immunomodulatory benefits, and I was like, okay. But then all
Speaker 1: the way at the bottom in the conflicts of intersection,
Speaker 1: there was a disclosure that the leading researcher was a
Speaker 1: shareholder in a CBD gummy startup. But maybe he just
Speaker 1: really believes in it, which is totally fine too. Once again,
Speaker 1: a lot of research is emerging, a lot of it
Speaker 1: has merit. But I'm not your doctor. I'm just a
Speaker 1: lady with a brain injury googling her way out of
Speaker 1: confusion and then back into deeper confusion. As I record
Speaker 1: this at two pm the same day that it's getting released,
Speaker 1: and I'm still wearing jamas I put on thirty six
Speaker 1: hours ago, a question remains, you know important question how
Speaker 1: long can I milk this? And I fell down some stairs,
Speaker 1: like when do I have to start returning emails?
Speaker 3: Yeah?
Speaker 2: I mean everybody is different. You don't have to be
Speaker 2: one hundred percent better to start re engaging in a
Speaker 2: little bit of you know, school or work. Right, you
Speaker 2: want to go buy your symptoms, but it's also very
Speaker 2: reasonable to not just jump back in to everything right away.
Speaker 2: And you know, work a eighteen hour day with you know,
Speaker 2: dinner and drinks at the end of the day to sleep,
Speaker 2: and then do it again the next day and the
Speaker 2: next day. Right, So the people who do best are
Speaker 2: somewhere in the middle. Right You don't just rest for
Speaker 2: days and days and days, and they don't go full
Speaker 2: tilt on their daily schedule. Right there, They're doing this
Speaker 2: sort of middle of the road, working my way back
Speaker 2: in a controlled fashion. So easing back into it is
Speaker 2: probably good. And you know, that's hard for a lot
Speaker 2: of people. If you're a busy person like I imagine
Speaker 2: you are very challenging. But that's usually how people get
Speaker 2: better fastest average times for recovery. Again, this is really
Speaker 2: quite broad, so I hesitate to even throw numbers out there,
Speaker 2: but anything from a week to honestly like ten to
Speaker 2: twelve weeks is considered normal. Oh like, it's considered kind
Speaker 2: of within normal range for feeling all the way better.
Speaker 1: Okay, that's good to know.
Speaker 2: Those like one week people are you know, kind of
Speaker 2: at one end of the spectrum, and the people take
Speaker 2: a couple of months might be a little bit at
Speaker 2: the other end of the spectrum. And then unfortunately there
Speaker 2: is a group of people who take longer. There is
Speaker 2: kind of mixed reporting on this kind of data, like
Speaker 2: who has prolonged symptoms.
Speaker 1: And again, alonged symptoms is how most doctors refer to it.
Speaker 1: But it was once commonly called post concussive syndrome. And
Speaker 1: I'll be honest, as soon as I heard the term
Speaker 1: post concussive syndrome, I personally kind of freaked out. So
Speaker 1: I understand from my own perspective how it's helpful to
Speaker 1: frame it as something less scary and less permanent. That
Speaker 1: being said, that prolonged recovery does happen, but to how
Speaker 1: many folks who actually get seen by doctors.
Speaker 2: Estimated anywhere from five percent to some studies like closer
Speaker 2: to like twenty five to thirty percent of people that
Speaker 2: you know have at least a symptom longer than that. Now, again,
Speaker 2: I think it depends on what population you study, Right,
Speaker 2: if you're studying a group of people who are really
Speaker 2: interested in concussion and have prolonged symptoms, you're going to
Speaker 2: get a higher number. Where if you study those people
Speaker 2: who don't even go to the doctor, right, those people
Speaker 2: probably got better pretty fast. So I think it depends
Speaker 2: on the population you study, but there are this group
Speaker 2: of unfortunate folks who do have symptoms even longer than that.
Speaker 1: If you get a concussion, should you go enroll yourself
Speaker 1: in a study, because I imagine it's really hard to
Speaker 1: study because you're like, who out there has concussions? You
Speaker 1: can't bonk someone and then do experiments on them. That's
Speaker 1: not ethical.
Speaker 2: Yeah, Nope, not ethical at all. And the human brain
Speaker 2: is really different than other brains. So even a lot
Speaker 2: of the data that we have that comes from like
Speaker 2: animal models, you know, you still at the end of
Speaker 2: the day are like, well, okay, but it's not the
Speaker 2: human brain, right, which is an extremely complex organ I
Speaker 2: think if you're somebody who gets a concussion and you
Speaker 2: are willing to help science better understand that injury, then
Speaker 2: you are an awesome person.
Speaker 1: So if you're concussed, maybe you can give your time.
Speaker 1: I looked into studies I could participate in as long
Speaker 1: as I had a messed up brain, but most of
Speaker 1: them were either looking for former NFL players between the
Speaker 1: ages of forty five and seventy four, or they only
Speaker 1: needed my brain between one to three on the Glasgow
Speaker 1: Coma scale. If you know what I mean, so there
Speaker 1: are folks doing really great research under the thirty million
Speaker 1: dollar Care Consortium, which is the world's largest investigation into
Speaker 1: traumatic brain injuries, and it's funded by the NCAA, the
Speaker 1: National Collegiate Athletic Association aka College Football, and the US
Speaker 1: Department of Defense. Have I mentioned you should follow the
Speaker 1: money with this stuff.
Speaker 4: You should.
Speaker 1: In this case, let's aim our own money hoses towards
Speaker 1: some causes of the ologists choosing. So this week, doctor
Speaker 1: Ikarino asked that it go to home Base, which is
Speaker 1: a Red Sox Foundation and Massachusetts General Hospital program and
Speaker 1: it's dedicated to healing the invisible wounds for veterans of
Speaker 1: all eras, service members, military families, and families of the
Speaker 1: fallen through world class clinical care and wellness education and research,
Speaker 1: and home Base operates the first and largest private sector
Speaker 1: clinic in the nation devoted to providing life saving clinical
Speaker 1: care and support for the treatment of the invisible wounds
Speaker 1: to include post traumatic stress, traumatic brain injury, anxiety, depression,
Speaker 1: co occurring substance use disorder, family relationship challenges, and other
Speaker 1: issues associated with military service. So you can learn more
Speaker 1: about the great work they're doing at Homebase dot Org,
Speaker 1: and that donation was made possible by some sponsors of
Speaker 1: the show.
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Speaker 4: I think so.
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Speaker 1: So a lot of you had repeated questions, so let's
Speaker 1: hit it. It's about getting hit repeated times or multiple concussions.
Speaker 1: I'm looking at your noggins, patrons. Scott Duncan, Lea Ludovico,
Speaker 1: Marissa Holtzman Allen Lee, Palmgren, Alia Myers, Timothy Wong, Chelsea Ravel,
Speaker 1: Ross Boulou, heather More, Cumulus, cloud Tower, Ali Vessels, Peyfe Dong,
Speaker 1: Lulu Hall, Karen Zeidler, Claudia Data, Beverly so Wolman, Jessica
Speaker 1: beckwith specs Owl, and Julius split Orf, whose life highlights
Speaker 1: include running face first into a brick wall to meet
Speaker 1: Harry Potter, then getting kicked in the head by mule,
Speaker 1: and getting whacked in the head by a baseball bat
Speaker 1: by someone trying to break open a pinata at their
Speaker 1: birthday party, which landed them in a helicopter to the
Speaker 1: hospital for a few weeks. Julius question, how am I alive?
Speaker 1: In functioning? Let's ask a doctor. Olivia Schaeffer says, how
Speaker 1: many is too many? A lot of people are like
Speaker 1: I play hockey, I was in roller derby, I played football.
Speaker 1: The repeated concussions. What's the deal that? What is with that?
Speaker 2: Yes, this is a hard question, but one that I
Speaker 2: feel a couple of days a week.
Speaker 1: Okay, So.
Speaker 2: The answer is that there is no number. There's no
Speaker 2: specific number where we say, okay, hang up your roller skates,
Speaker 2: turn in your you know, your varsity letter jacket.
Speaker 1: It's over yea.
Speaker 2: And this really goes back to that every person is different, right,
Speaker 2: Every person is different. How they respond to the injury
Speaker 2: is different, how long it takes them to get better
Speaker 2: is different, and what they're going back to in their
Speaker 2: life is different. If you're a person who's had three
Speaker 2: concussions because you're in car accidents, we're not going to
Speaker 2: tell you to never get in the car again. That
Speaker 2: makes no sense, right, But where we get a little
Speaker 2: bit concer learned about folks is if they're in a
Speaker 2: recreational activity like sports or job where they are pretty
Speaker 2: much guaranteed to get repeated head injuries. Right. Those are
Speaker 2: people that we want to start talking and thinking about
Speaker 2: how much do you want to expose yourself to a
Speaker 2: head strike or how much risk do you want to take? Right,
Speaker 2: so we talk about repeated injuries. Those are the groups
Speaker 2: that we start to get a little bit worried about
Speaker 2: because we know that they've signed up for more events
Speaker 2: where they could take another hit. And we do think
Speaker 2: that many hits over time could in some people, not everybody,
Speaker 2: but in some people could lead to either symptoms that
Speaker 2: never go away. Right, So you don't actually get all
Speaker 2: the way better, or that as you get older you
Speaker 2: start to maybe experience cognitive difficulties, meaning like thinking and
Speaker 2: remembering things and paying attention or other symptoms, and that
Speaker 2: those may be related to all those hits to the head.
Speaker 2: We do worry in some groups about how many, but
Speaker 2: there's not a specific number. And then the other thing
Speaker 2: we worry about is is also how frequent, So like
Speaker 2: a boxer takes twenty blows in a fight, whereas a
Speaker 2: gymnast and I'm not saying all gymnasts, but let's just
Speaker 2: say a different sport where you can hit your head,
Speaker 2: and you probably do from time to time, but that's
Speaker 2: not the goal, right, The goal is not to hit someone.
Speaker 1: In the head. Yeah, right.
Speaker 2: Those are different things, and so we worry about how many,
Speaker 2: and then we worry about how frequent they are, how
Speaker 2: close together, did the brain get time to recover sufficiently
Speaker 2: or do you think you took more hits when the
Speaker 2: brain wasn't fully recovered. Read, those are factors we care about,
Speaker 2: so number matters, and then frequency and time to recover
Speaker 2: also probably really matter. But I would say if a
Speaker 2: person is concerned that they've had a lot of concussions
Speaker 2: and they are worried that they've signed themselves up for more, right,
Speaker 2: like I'm going to continue to do my sport or
Speaker 2: I'm going to continue in this field of work. It
Speaker 2: is very reasonable to try to see somebody who's a
Speaker 2: physiatrist like me, or a neurologist or someone who has
Speaker 2: experienced and concussion to sort of talk about what might
Speaker 2: be the threshold for stopping that activity. But I think
Speaker 2: it's reasonable for people who've had a lot of injuries
Speaker 2: or work in fields where they know they're going to
Speaker 2: have a lot of head injuries to have these sort
Speaker 2: of discussions and know what their options are.
Speaker 1: If you see someone riding a bike without a helmet,
Speaker 1: do you ever scream out? You wind do? Like Iver
Speaker 1: got a helmet on.
Speaker 2: So I've screamed with my windows up and then occasionally
Speaker 2: if it's like kids in my neighborhood, yes, but but
Speaker 2: I try, I try to keep it on the inside.
Speaker 2: But you know, concussions can be tough injuries for some people,
Speaker 2: and as we said, there are you know, some people
Speaker 2: who take a long time to get better. But let
Speaker 2: me assure you that it is still the mildest form
Speaker 2: of a head injury, and if you are unhelmeted, you
Speaker 2: are much more likely to get a skull fracture or
Speaker 2: a brain bleed or something way way way word worse
Speaker 2: than a concussion.
Speaker 1: So helmet up.
Speaker 2: Yeah, helmet up, because when I see bikers who are
Speaker 2: helmeted and come to me with concussion, you know they're
Speaker 2: obviously upset they have a concussion. But what is missing
Speaker 2: from the discussion is, well, thank goodness you had a
Speaker 2: helmet on, or else you might not be walking into
Speaker 2: my office to talk about your concuss I might be
Speaker 2: seeing you over in the neurological icee you because you
Speaker 2: had a huge brain plead. So everybody helmet up, and
Speaker 2: I'll just say I'm up here in you know, Boston skiers, sledters.
Speaker 2: I know you might not feel cool if you go
Speaker 2: sledding with your helmet on, but you know, sledding is
Speaker 2: job security for me because people hit their heads. Spledding,
Speaker 2: somobiling activities on wheels where a helmet will save your life.
Speaker 2: And then you can just come to a concussion clinic
Speaker 2: to talk about that. So yes, I am, I'm a huge,
Speaker 2: huge helmet person.
Speaker 1: So big applause to helmeted ologites out there, Kelly Ulig,
Speaker 1: rob La, Tony Vessel's Cycling Tiger, and motorcyclist Doug Stewart
Speaker 1: who said, don't worry dad word, I act gat. I
Speaker 1: had to google it all the gear all the time.
Speaker 1: And for anyone who has had multiple concussions, remember that
Speaker 1: neuroplasticity that re routes and compensates for injured areas well.
Speaker 1: Do that many many, many many times, and that's more
Speaker 1: of a rerouting burden on the brain. And some scientists
Speaker 1: call this suboptimal signaling pathways in your brain. So protect
Speaker 1: that coconut. You only get one and it's resilient. Don't
Speaker 1: push your luck. Wear a helmet. Also, when it comes
Speaker 1: to safety gear, definitely consider it a wise investment and
Speaker 1: do your research to get the best and the safest
Speaker 1: you can for your budget. And if you can buy
Speaker 1: in person, it's best to get fitted for a helmet
Speaker 1: so that you're not seeing phosphines aka experiencing photopsia aka
Speaker 1: seeing stars, which side note is your brain playing tricks
Speaker 1: on you from sudden changes in oxygenation and pressure, especially
Speaker 1: from a bonk that affects the vision system in your
Speaker 1: occipital lobe in the back, which brings me to the
Speaker 1: next question. Is your skull like real estate? Many of
Speaker 1: you such as Anthony Steffi, John Worster, Karen Burnham, Jesswan
Speaker 1: and Morgan one of whom asked about hitting someone with
Speaker 1: a rock to incite a concussion and will remain anonymous. Sephie.
Speaker 1: What wants to know essentially is it location, location, location?
Speaker 1: Some folks wanted to know is it worse to bonk
Speaker 1: different areas of your head like I hit the back
Speaker 1: of my head? Is that not as bad as hitting
Speaker 1: the front?
Speaker 2: No? I would say that's probably a bit of a myth, okay,
Speaker 2: because remember in the beginning I said to you you
Speaker 2: actually don't have to directly strike your head. Yeah, you
Speaker 2: could just shake, shaken or like an explosion with a
Speaker 2: blast wave or somethings. So no, not necessarily.
Speaker 1: Last listener question Michael said Inboga, Dylan manthl Rosaria, Nehra,
Speaker 1: Sarah Crowder, Megan Ramirez, Greg Wallack, Rachel Selby, Nathan Ogden,
Speaker 1: first time question asker, Kyle Pollock, Heather Dykes. All of
Speaker 1: these people want us to know about drowsiness and sleepiness
Speaker 1: with a concussion and can you not go to sleep
Speaker 1: after a concussion? Will you die in your sleep if
Speaker 1: you go to sleep after a concussion.
Speaker 2: So the concept that somebody would be awake and then
Speaker 2: die in their sleep actually more closely ties back to
Speaker 2: injuries that are not concussion but something more severe. Right,
Speaker 2: So like Natasha Richardson right, who hit her head, was
Speaker 2: kind of walky talkie and then went to you know,
Speaker 2: she didn't go to sleep. She probably collapsed, but you
Speaker 2: could imagine if it was evening, you'd go to sleep
Speaker 2: and never wake up, right, Yeah, And that wasn't necessarily
Speaker 2: do concussion. She had a hemorrhage. But if you go
Speaker 2: get checked out and you just have a concussion, you
Speaker 2: can go to sleep. So where people get more concerned
Speaker 2: about not letting people fall asleep is if people are
Speaker 2: so drowsy they can't stay awake. Right. So I'm sitting
Speaker 2: next to you, You've just say, hit your head and
Speaker 2: it's broad daylight and you literally can't keep your eyes open, right, Well,
Speaker 2: then I'm worried about you because your brain is not
Speaker 2: able to maintain concientiousness, right, And that's actually a reason
Speaker 2: to go get checked out, maybe get a scan, because
Speaker 2: we're worried about something maybe more severe than just concussion.
Speaker 2: But if you have a concussion not a more severe
Speaker 2: brain injury, you should be safe to go to sleep.
Speaker 2: If somebody is so concerned about somebody being sleepy right
Speaker 2: after head injury, that person should go get seen at
Speaker 2: a hospital.
Speaker 1: Okay, that's good to know. I was yawning a lot afterward,
Speaker 1: and I was like, why is this happening? But I
Speaker 1: think that there's this myth that you have to stay
Speaker 1: awake for twenty four hours like a telethon in order
Speaker 1: to prevent dying in your sleep. I don't know what
Speaker 1: movie it came from, but I feel like we all
Speaker 1: saw a movie in the nineties where that happened or something.
Speaker 2: I'm sure. I'm sure we did. And it's very common
Speaker 2: to be tired after concussion or want to sleep more.
Speaker 2: That's actually a common thing, and that is okay to
Speaker 2: do as long as you actually have a concussion and
Speaker 2: not a more severe brain trauma.
Speaker 1: M hmm, okay. I looked for at least an hour,
Speaker 1: maybe two hours. I have no idea what movie made
Speaker 1: us all believe that you can't sleep after concussion. But
Speaker 1: if you have been checked out and had a scan
Speaker 1: and you don't have a brain bleed or severe trauma.
Speaker 1: The doc will give you the okay to snooze. And
Speaker 1: if you know what movie is lodged in our heads,
Speaker 1: please tweeting me, because it is just frying my ganglia.
Speaker 1: I cannot figure it out. I'm so tired. Any responses
Speaker 1: in general to concussions in the media or the movie concussion,
Speaker 1: or just in general anything in pop culture that gets
Speaker 1: it right or gets it early wrong.
Speaker 2: I don't know that. I'm going to go on the record.
Speaker 1: Yeah, yeah, that's fine.
Speaker 2: Just like any other medical condition. There are tremendous myths
Speaker 2: about concussion that that probably get perpetuated through the media
Speaker 2: and of course, you know, very non scientific entities and
Speaker 2: some aspects of social media. I do think it's a
Speaker 2: it's a serious condition that if you experience it again,
Speaker 2: you should go get checked out. But for an overwhelming
Speaker 2: majority of people, they're going to get better and feel
Speaker 2: just fine and probably forget that it happened to them.
Speaker 2: So again, not true for everybody. And the things you're
Speaker 2: going to read on the internet are probably those folks
Speaker 2: who are struggling, for sure, and trying to caution others.
Speaker 2: But there's many, many people out there who had a
Speaker 2: concussion and are doing just fine.
Speaker 1: That's such good news and that's very hopeful, because I
Speaker 1: think I got a little bit more scared the more
Speaker 1: I read about it, and I did find myself kind
Speaker 1: of tiptoeing. And it's been really great to rest and
Speaker 1: I've definitely noticed like, Okay, my eyes feel a little
Speaker 1: bit tired, I'm done for today. But this tiptoeing that
Speaker 1: you'll make get worse if you resume normal activities was
Speaker 1: kind of freaked me out a little bit, to be honest,
Speaker 1: you know.
Speaker 2: Yeah, no, and I talk to people every day who
Speaker 2: are just so actually the worry and the anxiety about
Speaker 2: can I do this, shouldn't I do that? Did I
Speaker 2: injure myself more? It can become its own beast. There
Speaker 2: are good resources. The CDC is a great resource. The
Speaker 2: Brain in Jury Association of America is a great resource,
Speaker 2: and there are you know, a number of good resources
Speaker 2: out there. But also if you're somebody who is you know,
Speaker 2: not getting better. You know, it's been a few weeks,
Speaker 2: I'm not getting better, you know, and you're able to
Speaker 2: and in a position too, it's it's always very reasonable
Speaker 2: to reach out to a person like me to get
Speaker 2: some more focused guidance.
Speaker 1: What about the most troubling thing or the hardest thing
Speaker 1: about your job?
Speaker 2: HM, the hardest thing about my job? Well, I think
Speaker 2: one of the hardest things about my job is talking
Speaker 2: to those folks where we think that their brain has
Speaker 2: had enough and you know, it might be time to
Speaker 2: think about no longer engaging in combat or collision sport,
Speaker 2: or thinking about you know, a career change. Those are
Speaker 2: hard discussions and I don't have them that often, you know, overwhelmingly,
Speaker 2: I think people being active and in sports has so
Speaker 2: many benefits to their mood, to their health. You know,
Speaker 2: we want to keep people doing what they love. But
Speaker 2: there are times when a person is just not recovering,
Speaker 2: showing too many symptoms, or has had too many injuries,
Speaker 2: or is you know, plays a sport a certain way
Speaker 2: or works in a certain way that they are just
Speaker 2: very very high risk. And so those are those are
Speaker 2: hard discussions. I you know, rode horses for many, many years.
Speaker 2: I can't imagine if somebody told me, like, look, you've
Speaker 2: hit your head too many times. You have to hang
Speaker 2: it up. You know, I would be beside myself. You know,
Speaker 2: it's such a passion, and many people are passionate about
Speaker 2: their careers and their sports, so I think those are
Speaker 2: those are the hard ones.
Speaker 1: What about the best days of your job or research
Speaker 1: or clinical work? What do you love about this?
Speaker 2: Getting people better?
Speaker 1: What do you love about head trauma?
Speaker 2: Yeah? What do I love about head trauma? People get better?
Speaker 1: Yeah?
Speaker 2: The brain is an amazingly resilient organ We think of
Speaker 2: it as very fragile, and in some respects it can be,
Speaker 2: but overwhelmingly is quite resilient. Many, many people can have
Speaker 2: head injuries, some more severe cold than concussion, and they
Speaker 2: get better. It can take time, you know, and they
Speaker 2: need the right rehabilitation, but they really do get better
Speaker 2: and people go back to doing what they love, and
Speaker 2: that is those are the best best days.
Speaker 1: Well, thank you so much for doing this on such
Speaker 1: short notice. Definitely did not have this on the schedule
Speaker 1: for this week, but I appreciate you fitting me in
Speaker 1: to let my brain ask your brain questions about my brain.
Speaker 1: Absolutely absolutely so ask smart brain people all of your
Speaker 1: simple brain questions or your complicated ones. If you are
Speaker 1: lucky enough to just have one, that you could ring
Speaker 1: up or have a podcast, because that's one way to
Speaker 1: do it. You can find doctor Mary Alexis Ikarino on
Speaker 1: Twitter at Ikarino MD. She is wonderful. Also, stay tuned
Speaker 1: for a bonus episode coming out this week on Headbutting
Speaker 1: in Animals. I recorded it, I was going to put
Speaker 1: it in this one, decided to make it a bonus
Speaker 1: episode that's coming out in a few days. Cross your fingers.
Speaker 1: You can find us at Ologies on Instagram and on Twitter.
Speaker 1: I'm at Ali Ward with one L. On both. You
Speaker 1: will find a link in the show notes to this
Speaker 1: episode page, where there are tons more links and research
Speaker 1: all kinds of good stuff. Also a link to home
Speaker 1: based dot org, which is where we send a donation.
Speaker 1: Links to sponsors are also linked in the show notes.
Speaker 1: Thank you to Aaron Telbert, who admins the wonderful Facebook
Speaker 1: group full of Ologies listeners. Hello out there, Hello to
Speaker 1: the subreddit. Hi. Thank you to Shannon and Bonnie who
Speaker 1: helped with merch. Thank you to Susan Hale and Noel
Speaker 1: Dilworth who do so much Ologies business behind the scenes.
Speaker 1: Thank you to Kelly Dwyer who makes our website. She
Speaker 1: can make yours as well her links in the show notes.
Speaker 1: Thank you to Emily White of the Wardery, who makes
Speaker 1: professional transcripts available. Those are for free on our website
Speaker 1: to anyone who needs them for any reason at aliward
Speaker 1: dot com slash Ologies, dash extras. We also have bleeped episodes.
Speaker 1: Thank you Caleb Patten for leaping those. If you have
Speaker 1: seen smologies episodes in the feed heads up, those are short,
Speaker 1: small episodes for Smologites. They are classrooms safe, they're everybody safe,
Speaker 1: a little bit less saucy, but they get right to
Speaker 1: the point. Thank you Zeke Rodriguez Thomas for working on
Speaker 1: those with some help from Stephen Ray Morris. Thank you
Speaker 1: also to Nick Thorburn who wrote and performed the theme music.
Speaker 1: And thank you to lead editor, primary husband and person
Speaker 1: who carried me to the couch while I passed out,
Speaker 1: Jared Sleeper, who has been taking excellent care of me,
Speaker 1: including some foot messages and literally like waiting on me
Speaker 1: as I am just beached on the couch in front
Speaker 1: of a fireplace. Thanks Jar, I love you. If you
Speaker 1: listen through the very very end of the episode, you
Speaker 1: know I tell you a secret. One secret is that
Speaker 1: when they loaded me to the gurney, they have like
Speaker 1: a picture on the side of the ambulance that shows
Speaker 1: like how the gurney is to be lifted, and I
Speaker 1: swear it looks just like a cricket or a grasshopper,
Speaker 1: and they were loading me into it, and I was like,
Speaker 1: doesn't that look like a cricket or a grasshopper? And
Speaker 1: I think they probably thought like, oh, but I remember
Speaker 1: thinking at the time, like a shoot. That probably sounded weird,
Speaker 1: but I would have said that on any normal given day,
Speaker 1: just because crickets are cool. My other my other secret
Speaker 1: is that I was trying to make new calendar sheets
Speaker 1: for my little planner binder and I was in bed
Speaker 1: trying to use my nephew's Swiss army knife to poke
Speaker 1: holes in the pages for the binder, and then I
Speaker 1: fell asleep doing it and I woke up in the
Speaker 1: morning to just like open Swiss army knife in the bed,
Speaker 1: dangerously close to my baby Gomley, which is a dog.
Speaker 1: But I closed it really quick, and sure it was like,
Speaker 1: is that a knife? Did you just close the Swiss
Speaker 1: army knife? Was that in the bed? Did you sleep
Speaker 1: with that opened in the bed after you were punching holes?
Speaker 1: And I was like, I've maybe, So it's been great
Speaker 1: to blame a lot of those on a concussion, but
Speaker 1: I think a lot of this is probably would have
Speaker 1: happened anyway. Sorry, Jar, we survived, Okay, protect your huggins.
Speaker 1: Thanks for listening to the It's a very long episode
Speaker 1: with a lot of asides. There was so much more
Speaker 1: research than I thought. I hope it helps someone out
Speaker 1: there all right by my I love you back there
Speaker 1: by the way, I just realized I left you hanging
Speaker 1: with that I have a brain injury.