Surgery Considerations for the Concussed Patient: Is the Brain At Stake?

The advent of general anesthesia completely altered the course of surgery from a barbaric, hazardous, Frankenstein-like horror to a humane and often life-saving intervention. Thanks to general anesthesia, the trauma associated with the surgery to both the medical staff and patients due to horrific screams, pain, terror and death was eliminated.

Some of the first substances attempted to minimize pain associated with surgery were wine and opium. For hundreds of years, various herbs were used. Ether was first synthesized from alcohol in 1540 followed by the discovery of nitrous oxide (laughing gas) in 1722. Both ether and laughing gas were used solely for entertainment purposes and ether follies became a popular gathering. People would gather, sniff ether together and get high. It wasn’t until the mid-19^th century when these entertaining intoxicants were considered for medical use.

William Morton, dentist, was experimenting ways in which he could perform dental procedures pain-free on his patients and first considered laughing gas. At one of the ether follies, Harvard chemist, Charles Jackson, witnessed a man who sustained a significant leg injury while high on ether and he did not show any evidence of pain. He advised Morton to use ether for his procedures.

Morton proceeded with the use of ether in several dental procedures. He then got in contact with surgeon, John Warren, who gave him permission to anesthetize his patient with ether. Together, they proceeded with the first public demonstration of surgery using ether-induced general anesthesia on October 16, 1846, now called Ether Day. In just a few short months following, the world of surgery took a drastic change as ether-induced anesthesia was used in surgeries across the globe.¹ Today, we have various anesthetic agents to choose from for surgery.

As a topic that continues to be brought to light, I felt it best to address it again. Many concussed patients might find themselves in a similar situation – deciding to proceed with a surgery or not. The risks in relation to brain injury recovery and the potential for worsening preoperative symptoms and even causing a prolonging of concussion symptoms are not typically discussed at length prior to proceeding.

Thankfully, with the evolution from literally no sedation or anesthesia, to wine and opium, to laughing gas and ether follies, and now to a wide variety of anesthetic agents, we can undergo surgery without the unspeakable and unfathomable agony experienced in the past. Only, underneath the surface, long-lasting lingering effects of general anesthesia may still continue to haunt patients. With the evidence currently available, can we really blame anesthesia for such outcomes?

I have connected with several people who wanted to gain more insight and discuss moving forward with a surgery during their own respective brain injury recoveries. Faced again with a similar predicament recently, I was reminded of my blog post entailing an elective surgery that occurred within three months of my TBI. While awareness has heightened regarding this very topic, more research is required. I reviewed some of the literature discussed in my previous blog post which will be re-visited but also pose new questions and concerns regarding surgical outcomes in the concussed patient.

I was astounded by the percentage of concussed patients that are faced with this same predicament. Within one year of concussion, typically in the first month, about 8-12% of these patients will present for surgery.²Another study showed 5% of recently concussed patients underwent elective surgeries unrelated to the concussion within one week of injury.³ The significant percentage of concussed patients faced with the prospect of going under the knife could simply be due to the increased risk of musculoskeletal injury they face due to changes in attention, cognition, hand eye coordination, reaction time, etc. In reality, these percentages may be higher due to the fact that there are no concussion screening tests implemented preoperatively. With such a prevalence of concussion patients presenting for surgery, the outcomes should be considered.

There are some questions that come to mind when considering surgery during TBI recovery:

How will surgery itself affect the brain and specifically how will it affect brain recovery?
How will general anesthesia affect the brain and specifically how will it affect brain recovery?
How likely is it that surgery will worsen preoperative concussion symptoms?
Are the effects of general anesthesia on the brain entirely reversible?
How will the inflammation produced from surgery affect the brain?
How will surgery recovery in combination with concussion recovery affect quality of life?
Does the specific surgical site play a part in recovery of the brain?

Here’s what we do know:

Surgery itself is stressful and multifactorial!
General anesthesia can negatively affect the brain.
All surgeries and trauma to any part of the body produces inflammation.
Inflammation can negatively affect the brain.
The general consensus from surveyed anesthesiologists is that elective surgery should be postponed until patient concussion symptoms are stable or have completely abated. Keep in mind, the brain continues to heal long after symptoms disappear. Symptom disappearance does NOT mean the brain is fully healed.

Advice to the concussed patient considering or undergoing surgery:

My best advice to any patient with brain trauma who is in a predicament because they are recommended surgery during brain injury recovery and to those who are unable to postpone the surgery is to read the science and literature that is available. It is best to empower yourself with this information and bring it to your provider for discussion. Consider your current quality of life and think about how the recovery of another part of the body would affect your quality of life which includes your mental health. Consider your current symptoms and the risk involved with worsening of those very symptoms postoperatively.

Discuss these concerns with your surgeon and also ask to discuss these concerns with the anesthesiologist that will be in the surgery with you. There are now intraoperative goals specifically for TBI patients. As this is still an issue on the rise, it is wise to discuss these established goals⁵ with both your surgeon but more importantly, your anesthesiologist:

Cerebral blood flow autoregulation is likely impaired after TBI so even mild hypotension should be avoided to reduce the risk of cerebral hypoperfusion
Maintenance of mean arterial pressure at the patient’s baseline value or higher is therefore appropriate
Hypovolemia should be treated using isotonic normal saline rather than hypotonic fluids, which could cause cerebral edema, or colloids, which have been associated with poor outcomes in TBI
Since hypocarbia (reduced carbon dioxide in the blood) in the face of impaired pressure autoregulation may lead to cerebral ischemia, mechanical ventilation should be adjusted to maintain normocarbia during surgery

In my next post, I will discuss the specific questions posed in this post in detail and review studies available on this front. Is general anesthesia the culprit or are the compounding factors surrounding surgery itself to blame for poor outcomes and worsening of preoperative symptoms?

Sources

1. Ether day: an intriguing history
2. Is a Concussed Brain a Vulnerable Brain? Anesthesia after Concussion
3. Concussion in the Perioperative Period: A Common Condition Requiring More Investigation
4. Anesthesia for the patient with a recently diagnosed concussion: think about the brain!

Brainwear: A Game-Changer for Persistent Concussion Symptoms?

There has been quiet in writing the past few months, though my recovery has been far from quiet. The reserves I was running on ran out, giving me a new meaning to the words “burn out.” I was thinking about the various times I experienced burn out while working many long shifts in the emergency department and none of those times even remotely compared to this. Let’s just say the ebb and flow of this journey to healing has been a test of limits.

Since I last wrote, I traveled to the Mind Eye Institute in Chicago to see world-renowned optometrist and neuroscientist, Dr. Zelinsky. I am grateful to have had my sister there with me. We had some very funny and painful experiences. Laughter really is wonderful medicine. I love you, Quinn!

The trip was a quick 24-hour turnaround, though it felt like months. The day of the appointment was long and grueling. We walked from our hotel about a mile to the practice. We arrived early, beating the whole staff there and anxiously waited on a stoop outside. I sat there with many nerves and thought about how important this day would possibly become. My heart started pounding as we made our way to enter the office for the first time.

The appointment started with testing performed by a vision therapist, fatiguing me almost instantly. Challenging, painful, frustrating, exhausting, are just a few words to describe it. There were many breaks taken in pure darkness in an attempt to calm my nervous system. This initial testing lasted about two hours. We were then taken to another examination room where we waited to see Dr. Zelinsky. She walked into the room and meant pure business. We got to work, with even more testing. This is where it became quite mind blowing.

Dr. Zelinsky first showed me an object, a die attached to the end of a stick, and advised me to then close my eyes and reach my finger out and touch it. I was able to do that fairly well but then we moved onto Dr. Zelinsky’s patented Z-Bell test, which is used to assess and demonstrate the eye-ear connection or how visual processing is integrated with listening. The Z-Bell test is now used around the globe and recognized by scientists and eye experts. Adding the hearing component in addition to the visual component threw me for a spin. During my recovery, I have had my vision and hearing assessed separately and independent of each other countless times. This is the first time hearing and eyesight were fully assessed together to see if they were integrated and working together properly.

A person can have sharp hearing and 20/20 central eyesight, but if the senses are not integrated and the brain is impaired, then the entire neurological system becomes like an orchestra without a conductor. Each musician may be quite talented with his/her learned instrument, but they must play in sync. If they are moving through the composition at different speeds, the result is noise – not music.
Mind Eye Institute

From this test, Dr. Zelinsky was able to identify underlying issues within the circuitry of my brain and quickly showed how we could make it better. The Z-Bell test was very challenging for me and I had started to wonder if anyone could perform it with ease and accuracy. So, Dr. Zelinsky demonstrated the test on my sister who did perform it accurately and with ease. I was amazed to see this in comparison to my personal performance.

With my eyes closed, Dr. Zelinsky rang a small bell in front of me in space. The bell added the hearing component to the testing. I was instructed to reach my finger out and touch the bell where I perceived it to be in space. I tried over and over to touch the bell, though kept missing by a large margin. My sister demonstrated what I looked like, which sort of resembled the arm movements of a zombie, seemingly aimless and random. With my arms flopping in space, I thought, alright you’ll be able to identify where the bell is at the next time and hit it. But this mind over matter mentality did not prove to be the case as I have learned repeatedly throughout this recovery.

The test continued as Dr. Zelinsky put various lenses and filters over my shut eyes, ringing the bell with each lens. How could these lenses have any effect with my eyes closed and allow me to locate the bell? We cycled through various lenses and filters, attempting to find the right combination. Yellow…no change. Blue…no change. Green…there we go! I almost immediately hit the bell with my finger – a direct hit.

It was a moment I won’t forget because I won’t forget the feeling associated with it. It was that whole body electrifying shiver you feel when something amazing happens, when you experience an overwhelming amount of joy, when you score that game-winning goal or when your team wins a championship.

When the right combination of lenses and filters were discovered, altering the way the light reached and dispersed across the retina, I was able to reach out with my eyes closed and touch the bell ringing in the space before me. This was and is so fascinating to me – that changes in light that penetrate closed eyelids can impact an individual’s movement, balance, attention to sound and spatial awareness. And fascinating that just by adding the sound component to the test with the bell produced such a profound difficulty.

In that moment, I opened my eyes, looked at my sister and we both said, “That is magical!” Dr. Zelinsky quickly responded, “It’s not magical; it’s mathemagical!” And that it is. There is so much science put into this technology and over two decades of research. I am very appreciative of her efforts and drive to continue this research stemming way back to the ‘90s when she was looked at as crazy by some doctors she presented this technology to. These were the same doctors who said the eyes and the ears are not connected. Where would we be without pioneers like this who persisted even though it was against the grain?

The eyes are a crucial gateway to the brain, and the retina itself consists of brain tissue. The very simplified science behind the Brainwear (eyeglasses) involves manipulating and altering the way in which light hits the photoreceptors within the retina, leading to changes in the brain’s interpretation and reaction to the environment. By stimulating peripheral areas of the retina, specific pathways in the brain are stimulated. The end goal is new and improved pathways in the brain and a synchronized internal and external environment.

Based on this testing, specialized eyeglasses (Brainwear) were made using just the right combination of lenses and filters. It has been about three weeks since I started transitioning into my new Brainwear. When we think of glasses, we think of how they will magnify words or clear long-distance vision and fine tune central vision. These glasses are not designed to do that. They will not make eyesight any clearer. They are intended to integrate the communication between the eyes and the ears, to balance central and peripheral eyesight, visual processing and positively impact whole body chemistry.

It’s a ‘new age’ in eye testing. The eyeglass prescriptions developed through the Z-Bell Test have been called nothing short of ‘amazing,’ even ‘miraculous’ by patients, because they have brought relief for a range of symptoms, including headaches, dizziness, difficulty reading, learning and behavioral problems, attention deficit disorders, and anxiety. Many patients now being treated successfully suffered for years with the effects of eye-ear imbalances, brain injuries and other neurological issues, because they were told by different health professionals that their eyesight and hearing tested as normal. Unlike 20th century eyeglasses that merely correct central eyesight, Z-Bell-prescribed glasses are therapeutic, intended to bring a person’s inside and outside environments back into synchronization. The common refrain of patients wearing the Z-Bell-prescribed glasses is: ‘I feel like myself again. I feel normal.’
Mind Eye Institute

I didn’t realize that transitioning into these glasses could be so challenging. When I first opened the box containing my new glasses, I was excited to put them on. Only when I put them on, did I immediately feel off and funny. I developed a severe headache and eye pain instantly with associated nausea and the feeling of being out of sorts and off balance. As of today, I can only tolerate wearing them for about twenty seconds, five times a day with my eyes closed. Wearing them with my eyes closed is way more tolerable than with them open but still doing the trick, which is so fascinating to me.

In November, I will return to Chicago for another evaluation and adjustment of the lenses and treatment protocol. The existing lenses may need to be adjusted for new lenses at each visit depending on my progress. Until then, I continue my transition into my glasses and hope to add one second each day! The first four weeks are expected to be the most difficult with a significant amount of agony and discomfort.

This was yet another humbling experience to say the least and one that will hopefully be another tool to get me my life back. I now have two pivotal, brilliant doctors in my corner and I feel blessed to have both Dr. Donaldson and Dr. Zelinsky working hard to piece back together my broken brain.

I have many research articles on the science behind Brainwear stacked up and I very slowly plan on getting through them and will describe the science fully in a future blog post. Will Brainwear be a game-changer for my recovery? Stay tuned. I can’t wait to find out!

A Yearning for the Sound of Silence: Noise Sensitivity After Brain Injury

creative shot of human ears on dark background

The dog is barking at the excitement of the visitors. The front door slams. The kids talk to each other in their naturally higher pitched voices – something that would normally be sweet but unfortunately there is nothing sweet about this. The screaming starts. Now there’s crying. “It’s so loud in here,” I say out loud. I don’t know if it was louder than a whisper to myself but even the sound of my own voice hurts my head. It’s hard to discern how loud I’m talking when there are so many noises in the environment on top of the ringing in my ears.

I walk up to my room, close the bedroom door and turn my white noise machine on, hoping it will somehow cancel out some of the noise. I feel threatened by the noise but in my rational mind I think about how silly this is. The noise machine isn’t doing anything so I go into my closet and close the door. Maybe this will be a safe space. The ringing becomes so loud. I can hear my heartbeat – I picture the ventricles of my heart filling up with blood and pumping it out of the vessels with every loud thump in my head.

There is a vent on the wall in my closet. The air conditioning turns on; I can hear it flowing through the vents so I can pinpoint the exact flow of it just like the flow of my blood with each heartbeat. Systole. Here it comes rushing out next to me through the closet vent, blowing directly onto my body. I’m shivering because I am so cold. The vents make a crinkling and crunching sound as it passes through the house, eventually making its way to my vent where it whooshes out in a fury.

A new sound emerges almost every second it seems, startling me, making my body jolt. The front door slams every five minutes. Even if I can predict when the slamming will occur, it startles me. The voices – the many voices – penetrate directly into my brain. Kids talking normally and kids screaming. Adults talking in normal voices but it sounds like they are shouting. I hear laughter. This should be joyous and happy to hear laughter but instead, it is excruciating. Voices with the inflection of excitement penetrate further. Why are the vents crinkling so much? My noise machine is going in my bedroom but it isn’t actually doing anything except using up electricity. All rational thought has left me.

I’m lying on my closet floor, tears streaming down my face as I hold my ears. My brain is in rebellion as I don’t even consciously make the connection that I am staring with eyes wide open at the wall, not blinking at all. Meanwhile, my ears are zoning into the madness, picking up every little sound. I made a little pillow for my head out of a yoga towel that was laying on the floor in the closet. I am so overwhelmed that attempting to add some sort of comfort is not on my radar. A pillow and a blanket would’ve been nice.

How do I make it stop? I want to rip my ears off. I’m sweating. I must be in fight or flight, and I so desperately want to fly away to a place in silence. I wonder what silence feels like anymore. Every additional sound is hammering my brain. I attempt to meditate and focus on my breathing but every second I am startled and distracted by a noise. The front door slams. A car drives by outside as I hear its engine rev. The deep voices and higher voices in conversation penetrate the walls. It seems as though the walls are made of paper. The ear plugs make the ringing worse, causing me to feel even more insane. Why can’t I just flip the switch to off? The ringing is so intense – it’s system overload.

I want to be normal and want to be a part of it but I can’t. I’m alone again because I can’t handle it and I’m reminded that I’m still not me. And I’m still not like everyone else. Never in my life have I wanted to be so much like everyone else more than I do right now. I’m drowning in noise. I turn to my usual solace – music. But the music mixed with everything else makes it worse so I have to turn it off. The combination of sounds is just too much. How many movements are left in this horrendous, excruciating symphony?

I’m shaking. I’m anxious. I wish for just one second the noise would stop. The air conditioning turned off. Oh, now I hear my noise machine. Why is the ringing getting louder? Someone must be tapping their foot on the wall or on the counter because I hear a repetitive tapping over and over. A pantry door opens. It is so squeaky and feels like someone must be opening the side of my skull like a door, peering into the mess in my brain.

Dishes are being stacked in the pantry. Oh my god, that hurts. It’s like the dishes are being stacked directly onto my brain. My brain is reverberating. I’m faced with the same question I’ve faced in many situations past – can anyone hear this? I feel insane by it because pre-injury I wouldn’t have noticed the many little sounds I’m hearing now or be affected by such normal and innocent sounds. Of course, no one’s noticing the noise. Except me.

Someone’s blasting music in their car – I wonder if it’s a teen with a sub-woofer because I can hear and feel the bass thumping outside the house on the street. The air conditioning is coming back on…only a matter of seconds before the crunching of the vent starts. There it is. I know the burst of freezing cold air on my body is impending and it will bring goosebumps and shivering. But I can’t help but continue to lie here paralyzed.

I picture the air movement. It takes a turn through the vent. It’s coming up. The gush of freezing air has arrived, blowing directly onto my cold, limp body. I just figured it out – it sounds identical to the rain pounding the gutters and windowpane in a really bad storm. That was always something I loved about storms but not anymore and this is a storm in my brain that I don’t want to be a part of.

Having no concept of time, I realize I have been lying on my closet floor for two and a half hours. I wish there were a volume dial for the sounds of the world. For just a moment, I wish I could turn it down and put the world on stop.

I miss the sound of silence.

A Powerful Tool to Stay Afloat When Pulled Under the Waves of Brain Injury Recovery

This journey would not be possible without the support of all of you reading this – my friends, family and strangers alike. I didn’t think my very big family could get any bigger, but it has! This is a community I cherish deeply. I wanted to take a moment to reflect on this. This is for you – a reminder of just how grateful I am for you.

While I wasn’t able to post last week and my next blog post was a different plan, it could not be fulfilled due to physical restrictions. What transpired over the past week led me to write these words here. Experiencing a long stretch of bad days recently, it always helps to focus on what I am grateful for. Gratitude is one of the most powerful tools of brain injury recovery. I’ve written a lot during this recovery as it is cathartic and helps me release some of the keepings in the mosh pit that is my brain.

Not only is it cathartic to write, it has also helped me to maintain focus on my ultimate goal of healing and achieving some sort of normalcy. Starting this blog and sharing the most intimate thoughts and details of my recovery publicly was terrifying and still is at times, but this was one of the best decisions as I had felt like I was doing this alone. This was despite having an amazing support system already because I wasn’t being fully transparent and open about all that I was experiencing.

Since starting this blog, I have received such positive feedback from many people. I have also been able to connect with many others on similar journeys, thanking me for sharing my story as I have helped them feel less alone, helped them receive proper care, and even helped some understand their loved one’s brain injury better. Aside from my writing being my own personal commitment that I will continue fighting until I reach healing, I truly went into this thinking if I could help just one person, my mission will be accomplished. I have done just that and more. That inspires me to keep going.

Many years ago, I read about a study that showed that just by looking at images of nature (when unable to physically be in nature) was enough to lower stress levels. This led me to think that maybe by printing dozens of pictures that bring me back to a very happy and peaceful moment, that it could possibly have the same result.

Last year, I printed pictures of moments and times that transport me to a happy place when I look at them because I could feel myself being pulled into a dark direction in my recovery. I turned the pictures into an art piece which is hanging on a wall in my bedroom that I see every single day. The majority of the pictures are of and with people who I adore and am so grateful for. There are pictures of moments shared with others – a beautiful sunrise, a concert, or a day at the beach. It is helpful to see that every day and remind myself of brighter times. My connections with people, with you, are so important to me and are invaluable.

Unfortunately, in the depths of extremely painful bad days and setbacks, it was and is still so easy to fall back into a hopeless place. I felt like I needed a better strategy to use in those specific moments. I had tried many things and various types of meditation without much help. Despite it almost feeling impossible in those moments, practicing gratitude was the thing that helped in a powerful way.

Just prior to the most recent rough patch I experienced, I was working on strategies with my therapist on how to navigate the really bad days and not feel so consumed, down or lose hope as a result. She recommended making note cards or little reminders of days and moments where I felt good and happy and to describe it in all its glory so that I wouldn’t forget that those moments are possible and that the bad moments are temporary. Before I could complete this task, I spiraled into a migraine that lasted seven days. Each time I thought I was possibly in the clear, it came back with a vengeance.

The progress in this recovery has moved at a sloth’s pace. No offense to sloths because I love them. It’s like living in slow motion. Once I feel I’m picking up speed and on a good path, I am destroyed by a wave, and sometimes pulled under.

Sometimes I can discern what triggered the bad days or setbacks and other times I can’t. I have noticed trends and patterns but there are still many moments where I feel as though I’m completely blindsided by it. This time, I knew the cause but it seemed to linger past what I had anticipated the amount of time it would take to get through. My brain was in major rebellion. Having no concept of when I would be out of the rough spell brought a great deal of stress and despair.

I know the path of this recovery very well at this point. It is not a perfect upward linear trend. It’s filled with ups and downs and setbacks. Somehow, though I know the path is very jagged and rough, I’m never fully prepared for the bad days. It is so easy during a setback or bad day to feel trapped, inundated and the end result being fully succumbing to fear. I think I’m in the clear but then it’s like I’m being dragged back into the torture of the pain. In the moment, it seems like too much pain for one person.

It’s easy to get caught up in the bad days. It feels like I’ve lost ground during the setbacks. It can be very discouraging which is an understatement. It’s human and I don’t fault myself for that but I’m realizing that in those moments I’m not looking at the big picture. Where am I now compared to six months ago? One year ago? Or two years ago?

Reflecting on times of the past where I felt this way, I made it through. That perspective helps. It is so easy to lose track of the big picture in those dark moments but I remind myself that my care up until recently had been majorly hindered by the simple fact that most of my providers were not looking at the big picture. I also need to look at the big picture rather than getting sucked into the familiar tunnel vision.

The days recently took me back to a moment in college. One of my best friends and I spontaneously decided to cross the street from our cottage to a local surf shop, buy boards and go directly to the beach to surf. Neither of us knew what we were doing and didn’t have any tips or guidance. We ran head on into some scary waves with no fear. We were pretty bad. And by pretty bad, I mean awful. At one point, I was destroyed by a wave and it took my surfboard with it. I was dragged under the wave by the surfboard leash attached to my ankle – that is what this recovery feels like.

Despite being destroyed by waves and aspirating quite a bit of salt water, we continued to get back on our boards and try over and over again. It was painful and terrifying at times but man, once we successfully stood up on our boards and caught a wave, all of it was worth it. And while we chose to do that, it is still a reminder of overcoming odds, pushing limits and facing challenges persistently. And that doesn’t just apply to this recovery but life in general which can be so turbulent. The water can be so calm at times but just like that, the waves start to roar and can even pull you under. I’ve realized I am not defined by the days of incapacitation.

Currently, good days are still the exception. I know that I can’t rush my healing, though I’d like to. In due time, the bad days will become the exception. There are no guarantees, I know, but I am holding on to the hope of my happy ending – my success story. Or rather, my happy beginning – of a life filled with new perspectives, wellness and vitality. Hopefully one day in the near future, I will be able to look back on these treacherous days which seem to engulf me like the big ocean waves, and stand up tall realizing that truly living again made the fight worth it.

Transforming the lowest days of my life into something greater, something magnificent, will be the greatest triumph.

The power of connection, community, faith, gratitude and love can never be underestimated. Thanks for being present on this journey. Your support and kindness will never be forgotten.

I have so much love for you.

From the depths of my heart, thank you.

A Trip to Georgia for Intensive Brain Rehabilitation

In February of 2019, four months after sustaining my brain injury, my uncle who lives in Georgia and works in the sports industry called my Mom to tell her about a doctor in Atlanta who was treating concussion with great success, especially with many big-time athletes. My mom and I called the office for a consult. It sounded unlike any treatment I had already tried and seemed promising.

Despite the fact that it sounded promising, I was hesitant and nervous about it. My bills were piling up from all of the treatments I had sought out which had become an additional stressor. I was nervous about traveling and experiencing the busy environment of the airport. I was nervous that the flight would exacerbate my symptoms.

It happened fairly quickly and the next day, with a push from my Mom, we were booking flights to Georgia for a week for an intensive neurorehabilitation program at Innova Brain Rehabilitation, now called Plasticity Centers.

I had looked into the treatment further which had received a lot of press over the past several years after Sidney Crosby of the Pittsburgh Penguins credited his concussion recovery success to Dr. Carrick, the founder of the Carrick Institute, which trains providers in clinical neuroscience and rehabilitation such as the doctors I would work with at Innova. Crosby had suffered several concussions and missed nearly a year of hockey as a result and in that time period, he had received treatment with Dr. Carrick who founded the field of functional neurology, also referred to as chiropractic neurology. Many other NHL players and professional athletes have had success with this treatment for their concussions.

What Is Functional Neurology?

Viewed by some as controversial or unorthodox, functional neurology combines neurology with chiropractic care. Functional neurology is a holistic approach, focused on the rehabilitation of the nervous system by identifying specific areas of miscommunication and dysfunction in the brain and treating those areas with a rehabilitation program. This treatment is deeply rooted in the process of neuroplasticity.

Neuroplasticity is the brain’s ability to reconnect dysfunctional communication systems or form new neural networks. This involves an in depth evaluation of the various systems of the brain. By using repetition exercises of the dysfunctional areas, the goal is to either strengthen or grow new networks within the brain. This is similar to exercise and using repetition to increase the strength of a muscle. In order to get bigger muscles, you must use and train them. The same concept flows into neuroplasticity and with repetition and exercises, the areas in the brain that may be weak or not communicating properly can strengthen connections and begin to work effectively again. This is the same concept used in neuro-optometric rehab.

The Carrick Institute is a postdoctoral education program where Dr. Carrick’s method of brain rehabilitation is taught. This is an additional three years of studies beyond chiropractic school completion. While many chiropractors go through this program, it is available for other providers too. This extra specialization allows a deeper understanding of the nervous system and how to treat problems that may arise. The goal of this treatment is to get the systems working together again. This involves waking up the deficient parts of the brain and also strengthening the communicating parts of the brain to make them more efficient, increasing endurance and then getting them to work in harmony again.

Using various tools and types of stimuli, these areas of the brain are strengthened. These tools include but are not limited to: whole-body gyroscope (GyroStim), which is a rotating chair that spins in various directions to stimulate the brain (picture and video of this later), electrical stimuli, laser therapies, light therapies, visual input, proprioceptive therapy, balance exercises and multi-tasking.

Touch Down in Atlanta

After an exhausting and symptom-provoking airport and flight experience, we made it to Georgia. I knew day one was going to be long and draining. I caught up with family which was wonderful. I was and am still so grateful I had a very welcoming place to stay. I got to bed early in anticipation of day one. It was nerve-wracking.

The familiar questions before new treatments scattered through my mind. Could they help? What if this is another dead end? Would it be worth the expense? At the end of the day, I was so desperate for something, anything, to work. The smallest chance that this could help was enough to propel me forward.

Innova Brain Rehabilitation

From the start, we were met with open arms. Literally. I received a big hug from Leslie, the care coordinator. She definitely made up for my lack of energy, in a good way. I then met Dr. Duffy and Dr. Patterson. I knew we would have a special bond and this group would soon feel like family.

I had to fill out forms including a symptom checklist with a scoring system of 0 (none) to 6 with 5-6 being severe. My severe symptoms included: headaches, pressure in head, dizziness, sensitivity to light, feeling slowed down, feeling in a fog, don’t feel right, fatigue or low energy, more emotional, sadness, trouble staying asleep, eye pressure, tinnitus, jaw pain. Moderate symptoms included: neck pain, nausea or vomiting, blurred vision, difficulty concentrating, irritability.

We wasted no time and got to work. I sat down with Dr. Duffy in an exam room where we went over my injury, symptoms, imaging results and treatment modalities tried up until that point. This was the first time the reality of the situation started to settle in. He was the first provider to tell me that I absolutely could not afford even one more hit to my brain. I think somewhere within me I knew this was the case but I wasn’t willing to accept it just yet.

The reality was hard for me to accept but I was somewhat relieved to hear a strong perspective on the issue that was tormenting my mind. At this point, I was still holding on to the thought that somehow it would be worth it for me to play hockey again. The truth is, I really wanted one of my providers to make the decision for me so I could be done with it. I wanted them to make it for me because I wanted to be reckless. And really, I had been reckless for the majority of my hockey career. It was as if I needed protection from myself. This was a start, though I continued living in denial for quite a bit longer. It still seems silly in retrospect that I held on to that idea for so long even though I was never even close to having the opportunity to play again.

I have come to realize that sometimes the idea of something is so much more appealing than the reality. I had come to love the idea but not the reality. And this was a hard truth I had to grow to recognize on my own. I wrote this in my journal during my recovery:

When will reality become better than my dreams?

I took the recommendation from Dr. Duffy where it would marinate for quite some time and we moved along.

Comprehensive Testing and Results

The exam was long and grueling. While I summarize a lot of it here, there was so much more conducted and assessed that I have not included. We first started with my vital signs – blood pressure and heart rate. My gait was then assessed. I walked down a long hallway and then making things a bit more complicated, he had me complete random tasks such as saying the alphabet, then saying the alphabet backwards while walking. I didn’t realize this could be such a difficult task.

My gait demonstrated no left arm swing. Arm swing during normal walking can indicate how well the brain is functioning. By adding dual tasking or asking me to say the alphabet while walking, the doctor assesses for any change in arm swing. This is a useful assessment for persons with neurological disease.

Luria’s test is a test that assesses frontal lobe damage or dysfunction. It involves the performance of three different hand motions. My result showed the movements were decomposed on both sides, suggesting I suffered frontal lobe damage of my brain.

Perfusion index is a measure of blood flow to peripheral tissues and can give a look into the autonomic nervous system. This is measured with a sensor on the fingertip similar to that of a pulse oximeter which measures heart rate and blood oxygen levels. It is supposed to be between the ranges 1.5-4. My PI was 0.32, suggesting dysautonomia, along with many other findings. As a reminder, dysautonomia is a dysfunction of the autonomic nervous system.

A bruit is a vascular sound heard through a stethoscope that is a result of turbulent blood flow. Bruits were present over the left subclavian and both carotid arteries, suggesting dysautonomia.

The pupillary reflex is a look into the function of cranial nerve III. The findings suggested decreased brain function. My left pupil was fast to fire and fail. The right pupil demonstrated hippus, which means the pupil constricts and dilates back and forth. Interestingly, this term is rooted in Greek origins from the word hippos which means horse so it has been suggested the name was given as the fluctuating movements of the pupil resemble that of a galloping horse. This fluctuation in the pupil reflects varying signals from the nerves responsible for autonomic functions. Again, this points to dysautonomia and an imbalance of the sympathetic and parasympathetic nervous systems.

Several movements were performed and assessed which evaluated fine motor skills and function of the cerebellum. Rapid alternating movements of the arms were slower on the right, suggesting decreased cerebellar function on the left. Finger-thumb tapping showed sluggish action on both sides.

The Maddox rod test is a test used to evaluate the diplopic function of the eyes, or the eyes functioning together on a target. One eye visualizes a line while the other visualizes a light. In normal functioning of the eyes, the line and light should overlap. When I did this test, the line was many inches away from the light. What they found on exam was exodeviation or the deviation of the eye outward. They also found hypotropia which means one eye drifts downward. The result of this is each eye is seeing a target at different points in space which can lead to double vision and other visual symptoms.

Convergence testing which measures how the eyes come together to focus on a target at near showed failure at 9 inches with both eyes shifting to the right. For reference, normal convergence in healthy eyes should be around 3 inches.

Further assessment of the cranial nerves showed a low hanging palate on the right, representing dysfunction of cranial nerves IX and X. My balance was tested which actually wasn’t too bad.

Then things started getting complicated. By complicated, I mean exceptionally difficult and draining. Visual eye tracking via video-oculography was performed, assessing eye reflexes and movements. Sitting in the chair not focusing on any target in pure darkness, my eyes demonstrated right beating nystagmus. Nystagmus is an involuntary, quick rhythmic movement of the eyes.

Focusing on a stable, non-moving target in various gaze positions, my eyes showed square wave jerks. These jerks are also involuntary movements of the eyes but consist of an initial sudden movement from the intended fixed target followed by a second quick movement in the opposite direction. On the video and graph result of my eyes, it looked like tiny, spastic movements that I named tiny eye earthquakes.

Pursuits were assessed, which are large fluid movements of the eyes to track a moving object. Again, with these movements, I experienced the tiny eye earthquakes. This threw off my tracking of the object and I was left feeling dizzy, nauseous, off balance and with an increased headache.

Quick eye movements between targets called saccades showed a prolonged latency, which is the measure of time it takes for the nervous system to trigger this movement. My latency was prolonged, which is a typical finding after brain trauma or neurological conditions.

The hardest part of the testing was when we got to the optokinetic reflex (OPK). The OPK is the reflex that allows us to follow objects in motion while our heads remain stable. An example of this is when you are driving down a tree-lined street or a construction zone with orange cone after cone. As you pass each tree or cone, this reflex allows you to stabilize the image and still allow you to recognize where you are at in space by the quick adjustment of the eye as the tree or cone moves out of your field of vision. In a healthy pair of eyes, they will quickly jump back to the original location of target. My OPK was egregiously off as shown by my results but also the test itself left me so dizzy, nauseated and almost to the point of vomiting. This would explain my issues with tracking moving objects, sickness in the car and inability to scroll on my phone.

The vestibular ocular reflex (VOR) was also deficient. This reflex is used to stabilize your gaze while moving the head due to activation of the vestibular system which allows you to maintain balance and equilibrium if working properly. This gives you an idea of how the visual system is working with the vestibular system. As a matter of demonstrating why the OPK and VOR can give such an indication of brain function is how many areas it takes to stimulate these reflexes. Both reflexes are stimulated by neurons located diffusely in the brain.

The results I received made me feel validated. Having no objective data of my deficits leading up to this point was difficult for me to understand. I struggled to understand my brain and body and having nothing to show why I was feeling the way I did left me feeling invisible.

In short, my results showed major short circuiting in various areas of my brain. My eyes were the most troubling. My autonomic nervous system was in a state of fight or flight. I could not hold a stable gaze on a target that was not moving and my eyes were spastic even when not focusing on any target. How would we get all of this to start functioning properly again?

Rehabilitation/Treatment

My rehab was intense and grueling, with each day being eat, sleep, rehab, repeat. Rehab consisted of starting with the basics and fundamentals which was gaze stabilization and getting the eyes to be able to focus on a non-moving target. As time went on, we added movement of my body while my eyes continued to focus on the target.

Chiropractic manipulation was used to not only get my body in balance but to also give my brain good positive reinforcement and feedback. Proprioceptive feedback is important for the brain and body because it allows you to sense your position in space. My brain needed repeated positive feedback because it was constantly out of equilibrium. It was determined that my first left rib was stuck which improved with manipulation. Interestingly, my left jaw had begun popping and clicking since my injury and this was the first time it was suggested that the neck should be looked at more closely as that was most likely where it was originating from. My shoulder was a mess from my surgery just two months prior due to failure of rehab, so manipulation of the shoulder was also done.

Electrical stimulation was used to stimulate the second branch of cranial nerve V. This would stimulate the nuclei located in the pons, the largest part of the brainstem that houses a group of nerves. This is important for sensory and motor communication in the brain.

The GyroStim machine became my best friend. I felt like I was preparing for a NASA takeoff to outer space. The GyroStim is a multi-axis rotational chair, invented by an engineer in his basement, desperate to find a way to help his daughter who had suffered from cerebral palsy. The movements of the chair were theorized to stimulate the vestibular system, motor control areas in the brain and wake up dormant neural networks. When he noticed major improvements in his daughter, this device slowly made it into the medical community. Interestingly, the first sale of this chair was to the Air Force Academy.

The chair even does flips! No flips for me, though. Flips did eventually occur later that year when I completed another intensive rehab program in functional neurology, but that’s another story. During this treatment at Innova, I moved slowly left to right in the machine as I fixated my eyes on a little smiley face sticker. It was difficult for my eyes at first but became easier each time and my autonomic nervous system seemed to love it too. My perfusion index which again is supposed to fall between 1.5-4 improved to 1.8 from a whopping 0.32. It continued to rise the more we did it, maxing out at 2.3. Attached at the end is a video showing this futuristic device.

Passive figure 8 movements called complex proximal joint movements of the right leg and arm were done in opposite directions to stimulate the left cerebellum. Attached at the end is a video showing this.

The last day consisted of repeat testing, one last hoorah in the GyroStim and education on my home exercise program.

Major Improvements and Home Assignments

By the end of the week, I was feeling improvement which was amazing. I remember being so happy to feel some relief, I couldn’t help but cry. While I was still far from “normal,” I was sleeping better, my pain had decreased and many of my other symptoms had improved too. The initial symptom checklist I had filled out showed many of my symptoms decreasing to the mild or moderate range rather than severe.

Home assignments were given. With the repetition of the exercises, this was supposed to stimulate my brain to make new connections. This was also supposed to help stabilize my vision which was so terribly wrecked at this point. The improvements and gains I made in Georgia came home with me.

Very religiously each morning, my Mom or Dad would assist me with my home exercise program. Two of the exercises were called sinusoidal pitch movements which were to mimic the same movements in the GyroStim. My parents would push me in a rocking chair, slowly forward and back as I stared at a sticker on the wall to stabilize my gaze. We would then move over to an office chair, where I would be rotated slowly side to side as I stared at a sticker on the wall.

We were to continue the complex proximal joint movements or figure 8 movements at home. Lastly, I was also given breathing exercises and stretching exercises to open up my chest. All of these exercises would be repeated and done twice a day.

The Inevitable Decline

As I continued the home exercise program, I was feeling hopeful but after about two weeks of being home, things started to reverse. Despite religiously doing the assigned exercises, all of my symptoms came flooding back to the intensity they were prior to my trip. I was disheartened, devastated, hopeless, and again could feel myself being drawn back into the dark place I had become so familiar with.

It was hard for me because I again took it as a reflection of me. I was trying my hardest with the exercises and it still wasn’t good enough. Why couldn’t I make it stick? I decided maybe if I just increased the exercises and did them three times a day instead, the gains would come back. They didn’t. I lost them. I could not understand why.

I understand now. While they did a deep investigation of identifying the areas of my brain that were not functioning properly and assigned the rehab exercises for those specific areas, it was not sustainable. It was not sustainable because of the underlying problem of rampant inflammation and neurosteroid imbalance. My brain could not hold on to the gains because it was simply not prepared to receive or keep them.

I’ve discussed previously that maybe the timing of a treatment is just as important as the treatment itself. I truly believe there is major benefit to functional neurology, but I don’t believe I was at a point where my brain was ready to receive it and hold on to it. How could those improvements thrive in a brain riddled with inflammation? And one without the proper levels of neurosteroids, potent regulators of neuroinflammation.

It was a safe space for my brain that made it feel good. But once I left that space, my brain faced that familiar reality – the perception that everything was a threat and inundated with inflammation. The intensive positive input I received day in and day out from rehab was gone and so those connections became weak and lax, falling victim to the diffuse inflammation throughout my brain. There was nothing to combat it.

While at Innova, I thought, this is the missing puzzle piece. This is the thing that will get me better. While it didn’t turn out to be that, it did bring me a little hope to keep going and it brought me a reprieve from my symptoms for even a brief moment, which was more valuable to me than anything leading up to that point. It also opened my eyes to the deeper issues within my brain and my vision, which ultimately led me to find a neuro-optometrist which has been a huge, much needed resource. It also led me to explore the role of my neck in my recovery which had been neglected up until that point. I truly believe functional neurology can help patients whose brains are ready to receive the benefits and hold on to them.

By the end of day one, the Innova staff felt like they were family. We still keep in touch to this day. They treated me with kindness and care and brought me much needed hope. That is something that I will be forever grateful for.

Sources

Chiropractic Functional Neurology: An Introduction, 2017. PMID: 30881237.

Traumatic Brain Injury Treatment Everyone Should Know About: Success at the Regenerative Medicine Center

A few months ago, I started a new treatment protocol for traumatic brain injury (TBI) at the Regenerative Medicine Center in Pittsburgh. I faced many obstacles leading up to this treatment that had prevented me from exploring it much sooner in my recovery. I was told I couldn’t get better, to accept that this is the best I’ll ever get. This is a similar tune heard by many TBI sufferers and it shouldn’t be that way. I hope that my experience can bring some much needed light and perspective to both brain injury sufferers and medical providers alike.

To the medical providers: There is a way to help these patients get better. To the TBI sufferers: There is a light at the end of the tunnel.

In this post, you will learn the medical explanation of this treatment, my flawed experience with conventional medicine for treatment of TBI, my progress and reflection of all that has transpired since starting this new protocol just a few short months ago.

This post is a culmination of months and a huge feat for me as I have spent a lot of time listening, slowly writing, slowly reading, and re-reading in order to gain a deeper understanding of the science behind the treatment. I still have so much to learn! I knew more layers would be revealed as time went on and that there are still many layers to come, but I feel it is important to share this and spread this information. I was initially hesitant because I had this residual feeling from many other treatments in the past that had failed. I thought that maybe this was too good to be true. It turns out, this treatment is good and true! It has been an extremely humbling process.

Flashback to my first post about my initial trip to Pittsburgh, I first learned of the use of neurosteroids to treat TBI while listening to a few podcasts.

After hearing about this treatment in a podcast one year into my recovery, I posed the idea to several of my doctors which was essentially shunned. One doctor said to me, “I’m not sure hormones really play a role in brain injury recovery.” This had led me to suppress the idea that this could help me and was a real option. I brushed it aside as the reaction from my providers led me to feel like this was a crazy idea and one simply out of desperation.

Another year had passed and again, I heard another podcast about neuroendocrinology and this treatment. At that point, I felt so desperate and didn’t care what any of my current doctors thought about seeking this treatment. I discovered Dr. Valerie Donaldson who had completed a certification process in Neuroendocrinology TBI treatment protocols led by Dr. Mark Gordon, who developed them. Dr. Donaldson is also an expert in regenerative medicine and functional medicine so I attribute my success to all of her knowledge in many areas as well as the TBI protocols.

The Neurosteroid TBI Connection

Neuroendocrinology is the study of medicine that relates to the interaction between the endocrine system and nervous system. This focuses on the hormonal activity throughout the body that is regulated by the brain. Neurosteroids are hormones synthesized by the brain, regulating the growth of neurons as well as the connections and communicating system between the neurons. Neurosteroids act in target glands throughout the body such as the thyroid, adrenal glands and gonads (ovaries and testes).

There is primary and secondary injury following brain trauma. The primary injury leads to cellular damages, vascular damages, ischemia (restricted blood flow) and metabolic crisis. The secondary phase is riddled with complex processes, a toxic symphony leading to the fostering of a highly inflammatory state in the brain. The secondary effects from this process can present as symptoms even decades later, and by that point the association between the symptoms and the brain injury may have been lost, resulting in long-term suffering. Without identifying the underlying cause, healing potential is limited and inflammation continues.

The pituitary gland and hypothalamus are both key players in hormonal regulation. These two areas are easily impacted and highly vulnerable to brain injury. The hypothalamus resides between the pituitary gland and the inner brain, connecting the endocrine and nervous systems. Living at the base of the brain is the pituitary gland. It plays such a central role in the endocrine system that it gained the reputation of the “master gland.”

The hypothalamic-pituitary axis is the system that intertwines the central nervous system with the endocrine system. It has been found that TBI can lead to dysfunction of this axis, causing various hormonal abnormalities. In research, it is estimated that about 50-76% of TBI patients show some loss of pituitary neurosteroid function and suggests that 58% of these patients will recover within a year but the other 52% carry on to develop new deficiencies a year after the initial injury.^1-3

Through research and working with thousands of TBI patients, Dr. Gordon found that neurosteroid hormone deficiency or insufficiency (low “normal” range) is often found in brain injury patients and the underlying cause of prolonged symptoms, with growth hormone abnormality being the most common. By properly addressing chronic inflammation, identifying the deficiencies and treating them, there has been great success getting brain trauma patients better with reproducible results. I had wondered if I could be one of those patients.

Neurosteroid deficiencies could mean reductions in any of the following: growth hormone, estrogen, pregnenolone, DHEA, progesterone, testosterone. While all of these play a huge role, growth hormone is of high importance because it is essentially the quarterback of so many functions in the body. If the level declines, the functions of the body start to decline too. Growth hormone is responsible for overseeing these functions: mood, stress, energy, memory, sleep, immune system, sex, circulation, bones, joints, weight, skin and hair.

Interestingly, the symptomatology that is a result of neuroendocrine dysfunction is the same symptomatology of that which is labeled post concussion syndrome. The symptoms include but are not limited to, memory loss, attention difficulties, insomnia, impaired cognition, fatigue, depression, anxiety, mood swings, personality changes. Instead of screening for and identifying such dysfunction, a patient may be labeled with post concussion syndrome and continue to suffer with many debilitating symptoms for years.

Dr. Gordon has had great success helping many veterans who have been diagnosed with PTSD by using these protocols and has found the root of that diagnosis is most often chronic inflammation and this dysfunction secondary to brain trauma. The issue is that these patients, such as myself, are treated with pharmaceutical medications for the symptoms but these pharmaceuticals do not address the underlying cause of inflammation and do not replenish the deficient neurosteroids.

This is not typically taught in medical studies. I wish I had known about this prior to my injury. Suggestions from Dr. Gordon and others about screening for this have come to light. Dr. Gordon recommends screening as soon as possible after TBI as a baseline, followed by hormone panels at 3, 6 and 12 months from the initial testing. Another suggestion is to order a hormone panel at 3 months post-injury if symptoms suggest neuroendocrine dysfunction or if there are delayed symptoms at any point up to 3 years post-injury.^4-5

Despite the thousands of articles available demonstrating the connection between TBI and hormonal dysfunction for more than a decade, this is still a very under-diagnosed consequence of brain injury that is not typically screened for in patients. It’s hard to ignore such research and statistics and say that this would play no role in brain injury recovery.

Conventional Medicine Failures

I want to preface this section by saying, I do believe conventional medicine has a place and I also did have positive experiences with a select few providers in conventional medicine. This is a reflection of my own personal experience and failures of conventional medicine for the treatment of my traumatic brain injury. My frustrations and disappointments are valid and I feel it is important to share them as I felt I didn’t have a voice in this process for so long and I know many others have felt similarly. I am a prime example of a patient with chronic ailments that fell through the cracks of conventional medicine and I hope this can save another from this major fallout.

At some point during my recovery, my treatment started to feel redundant, like the same things were recommended over and over again. The end result was the same – I still felt miserable or even more miserable. It felt as if I were banging my head against a wall. It reminded me of Albert Einstein’s quote about insanity. I feel like that accurately sums up the treatment I received for over two years with the exception of a select few practitioners that provided meaningful benefit.

The definition of insanity is doing the same thing over and over again, and expecting different results.
Albert Einstein

Throughout my recovery, I found that I, as a person, wasn’t being treated but rather my symptoms were being treated and, in the end, this helped foster the identity crisis I was already experiencing.

Unfortunately, I became faceless. The 13-year-old girl who had been seen for a head injury before my appointment was given the same treatment as me, just as the 40-year-old male who was seen after me. We were all the same. I know this after connecting with other TBI sufferers and hearing their experiences. It was as if the “individual” was taken out of the treatment plans.

I had seen dozens of specialists, each dissecting me to only peer inside one system. It reminds me of my days in the cadaver lab, as we dissected each system. Soon after the injury I was seeing 20 different providers for each symptom I was experiencing, none communicating with each other and so instead of a whole being I became this long list of symptoms. They were so zoomed in on one tiny part but never zoomed back out to look at the big picture, to look at how important it is for all of the intricate systems to work together again. The big picture was me as a person, but the big picture was also seeing that an underlying cause led to all of my residual ailments.

In my darkest moments, I was desperate for help. I was desperate to be heard. I was desperate to just be seen.

When I wasn’t making progress and wasn’t getting better, I was usually told a variety of things: “Try this new medication. Just give it more time. It’s all in your head. There is nothing more to offer you.” It felt like I was fending for myself because my providers gave up on me and my healing. This was so detrimental to my mental health to know that the very people who were supposed to help me gave up on me. The very people who were supposed to see me looked past me. I was crying out for help but couldn’t be heard.

I didn’t want to give up but this made me feel like maybe I should.

I’m one of the fortunate ones who did not give up. I thank my friends and family who helped carry me when I couldn’t carry myself. I continued to research more options and continued to present them to my doctors. Unfortunately, almost all of them did not believe the treatment options I was presenting to them were worth exploring. So, not only did it feel like they gave up on me and stopped offering me options, they also told me to stop exploring options too.

My providers who I was supposed to trust stopped problem-solving and advocating for me. They left that to me – the person working with an ineffective and dysfunctional brain, running on almost no energy like a car with its gas light on about to stall. I was fending for myself, working tirelessly with poor vision and depleted energy to get better.

The field of medicine is amazing and astounds me because it is ever-evolving and ever-changing. I became frustrated that my providers closed their minds off and stopped seeking new options and solutions. Aren’t we as medical providers supposed to be detectives of the human body? When did this change?

My treatment plan had been focused on symptomatic relief, and not full healing. This was because the thought process was that there was no room for improvement, no potential for full healing, and the only thing left to offer me was relieving the long list of symptoms I was left with. Unfortunately, most conventional medicine practices involve dishing out more and more medications. This typically leads to more medications being prescribed to combat the side effects from a medication initially prescribed.

Throughout my recovery, I had been on nearly 30 different medications, all with deleterious side effects. How does someone go from being on no medications to this? I was embarrassed to sit down every week to fill up my pill boxes because I couldn’t remember when to take the many pills I was on. These “treatments” only masked the symptoms and caused worsened effects. None of these different medications could have replenished my deficient levels of hormones!

The Start of Getting My Life Back

I did not expect my world to change when I walked into Dr. Donaldson’s office that day in February, but it did. That day is one I will never forget. It was the start of getting my life back.

The positive effects since then have been abundant. This visit started with a comprehensive lab work-up, a detailed history of treatments leading up to that point, my symptoms and my goals. The lab tests assessed how well the hypothalamic-pituitary axis was functioning and how the peripheral glands of the endocrine system were functioning. The treatment is individualized as no person is the same, just as no brain injury is the same.

How refreshing it was and is to be treated like a person and to not be placed in a bucket with every other patient and receive the same exact treatment. I am finally receiving an individualized treatment plan, and one that focuses on me as a whole. How refreshing to know that my doctor believes I can heal.

Dr. Donaldson’s lab work-up showed various significant and impressive hormonal deficiencies, more than I had anticipated. Instead of masking the symptoms with many pharmaceuticals, she works hard to identify the underlying cause and then treats accordingly by addressing inflammation, replenishing deficient hormones and providing additional support with nutraceuticals. Not only does she work hard to identify the underlying issues but works hard to put everything back together, to function in harmony as the body is supposed to.

This treatment protocol is multifaceted and ever-evolving. At each appointment, we go over everything in detail, determining if anything needs to be added or subtracted from the treatment protocol. Dr. Donaldson described it like a game of chess – a well thought out process, determining the next move to healing. I deeply appreciated this thought because where many providers would say there is nothing left that they can do for me or try the same thing on repeat to no avail, I know that Dr. Donaldson will not give up on me and is always thinking of what else can provide further benefit.

Shortly after I started a secretagogue to increase growth hormone production, I had the first glimmer of what quality sleep felt like again. I slept through the night for the first time in years. It felt like I had gone into a coma. I woke up and felt so strange that I had slept through the night that I moved my limbs to ensure I was in fact, alive. While my sleep is still a work in progress, I am deeply grateful for the spontaneous nights of sleep I have experienced since starting treatment.

Similarly, after starting testosterone replacement therapy, I had so much energy that I again felt strange. I felt like I could run a marathon. For the record, I would rather do any other activity than go running so that shows how exceptionally strange I felt. While I still experience fatigue, it has been refreshing to feel moments of energy again. I also noticed an improvement in mental clarity as well as a reduction in my nerve-related head and neck pain as testosterone helps to heal ligaments and joints.

One day recently, I started to develop an all too familiar migraine, one that would typically go on to last seven days straight and would not respond to any medications. It seemed like a miracle that the right dose of progesterone that Dr. Donaldson advised me to take rid the migraine completely within just a couple hours. After that, she said to me, “You are in control!” No provider has ever said that to me and that was one of the best and most empowering things to hear. For so long, I had felt like nothing was in my control.

I recently experienced the Light Portal at my last visit which I am now in love with based on my extremely positive and enlightening experience. This is an apparatus that uses light, color and sound, producing a profound and relaxing energy through the body. It is magical. I describe my full experience here. I look forward to future Light Portal sessions.

During my most recent visit, we also initiated exosome therapy. I am interested to see what benefits I may have. Derived from stem cells, exosomes are extracellular vesicles or tiny bubbles carrying genetic material and proteins. All living cells communicate with other cells and these are the messengers. They are like little envelopes, carrying important information that is released to promote cell repair, regeneration and healing.

Since beginning this treatment a few months ago, I have experienced the most progress I have since my injury, just over 2.5 years ago. Just the other day, I went on my first successful drive after countless failed attempts over the course of my recovery. And since then, I have gone on several more successful drives! Liberated just doesn’t cut it.

While I am still a work in progress, the newfound hope instilled in me brings me to tears. I know my recovery will continue to ebb and flow, but I now have a new perspective on what is possible. And I’m not letting anyone take that from me again.

An Evolution in Mindset

Aside from addressing my hormonal imbalances, chronic inflammation and the physical aspects, Dr. Donaldson has challenged me to change and evolve my perceptions about my limits. I didn’t realize until recently just how many limiting beliefs were instilled in me from this brain injury. It was a culmination of the injury and doctors telling me there wasn’t potential for improvement which then led to my own self-destructive thoughts and beliefs. The result was a lie that I convinced myself was true – an enormous lie that I couldn’t get better, that life as I once knew it was gone, that I would potentially never be able to work in medicine again.

“There is one grand lie – that we are limited. The only limits we have are the limits we believe.”
Wayne Dyer

I was convinced I couldn’t get better because that’s what I was told. I tried so very hard to repel this belief but eventually, after hearing it over and over, I believed it and stored it within me. Even if my conscious mind said I will get better, the subconscious was holding onto that limiting belief, restricting me from my healing potential.

I’ve thought I’m not good enough or I’m not capable. Retaining new information is nearly impossible. The judgment of other people matters. My eyes are stuck like this. I can’t get better, therefore I am a failure. My brain is stuck like this. This is my new normal. This is the best I’ll ever get. These were messages sent to myself, restricting my potential. I hadn’t realized I was really doing this.

This evolution of mindset, in motion with other treatment modalities such as using neurosteroids where I am deficient, regenerative therapies, nutraceuticals and Light Portal has been a power force. While I still have a lot of progress to make, this has been a major kickstart to my healing.

A Reflection in Gratitude

How often do you walk into a doctor’s office and think, this person is going to change my life? How often do you walk into a doctor’s office and think, this person will end up feeling like family? For me, that’s rare. Truthfully, even as a medical provider myself, I had grown to hate going to appointments because they had become filled with despair and negativity. I left the appointments with immense anxiety and hopelessness. All of this changed at the Regenerative Medicine Center.

Throughout my career in the emergency department, I would receive a seemingly random positive experience review from a patient, describing how meaningful I was to them in that moment. It would often come as a surprise that I deeply affected that person and that I had left such a lasting impression. The effect you have on someone is more valuable than you may think.

You never know when someone will alter the course of your life for the better. And a lot of the time, you may not know just how great the impact or lasting impression you left on someone. It’s amazing and miraculous really that one interaction with someone has the power to change the course of your life. Think about how many people you may have touched deeply in your life but don’t ever know about it. Think about all the people who, in one moment or another, you felt so grateful for or still do and they don’t know it. This might have been a cashier at the grocery store, a nurse, someone you simply lost touch with but still think about, or even a stranger you struck up a brief conversation with. A simple, “Hello,” could be the start of an impression of a lifetime.

Sometimes we stop and express our gratitude but often we don’t because we might feel we don’t have time or, for me on various occasions, fear that it may be perceived as creepy to someone you don’t know deeply or just met. During so many moments of reflection about myself, life, love and the world, I think we should proclaim how we feel in those moments. Just that small expression may very well make the person’s day. We never know what burdens someone else may be carrying and that simple message could also be the thing that lifts their spirits and keeps them going.

I recently read a time capsule that I wrote in grade school when I was 9 years old. The time capsule included little prompts with a blank line after each one. We put them in an envelope addressed to ourselves to open five years later. I revisit it from time to time. One prompt read: Before I die, I hope __________. I wrote on the line: I say I love everybody. From a young age, I had this deep desire for everyone to feel love. I think it is so important, now more than ever, to share our gratitude and love and put it out into the world.

As I walked into the Regenerative Medicine Center that cold day in February, I was hopeless and desperate. To be completely honest, I didn’t have many expectations at that point in my recovery. I was desperate for help, to be heard, to be seen. It was in my darkest moment that I needed a lifeline and I got one.

I received help. I was heard. I was seen.

Dr. Donaldson altered the course of my life for the better. She is now associated with hope, light and all that is good. A lifeline. A connection I will never forget. She was a stranger, became my doctor and then became family. It’s amazing to think about how many people we may have touched deeply in our lives but don’t ever fully know about, so I wanted to take a moment to say, Dr. Donaldson has deeply touched mine and left a lasting mark on my heart and soul. She is a bright light, reminding me that healing is in fact, possible.

This is someone you want in your corner. This is someone who can get you your life back.

Someone asked me, “So, Dr. Donaldson is alternative medicine?” I replied, “Dr. Donaldson is an alternative to bad medicine.”

Sources

1. High Risk of Hypopituitarism after Traumatic Brain Injury: A Prospective Investigation of Anterior Pituitary Function in the Acute Phase and 12 Months after Trauma, 2006, DOI: 10.1210/jc.2005-2476

2. Neuroendocrine dysfunction in the acute phase of traumatic brain injury, 2004, DOI: 10.1111/j.1365-2265.2004.02023.x

3. Acute and long-term pituitary insufficiency in traumatic brain injury: a prospective single-centre study, 2007, DOI: 10.1111/j.1365-2265.2007.02931.x

4. Neuroendocrine dysfunction following mild TBI: When to screen for it, 2014.

5. Traumatic Brain Injury, A Clinical Approach to Diagnosis and Treatment, 2016.

6. Neuropsychology and clinical neuroscience of persistent post-concussive syndrome, 2008, DOI: 10.10170S135561770808017X

7. Hypopituitarism After Multiple Concussions: A Retrospective Case Study in an Adolescent Male, 2007, PMID: 18060001

8. Pituitary function in subjects with mild traumatic brain injury: a review of literature and proposal of a screening strategy, 2010, DOI: 10.1007/s11102-009-0215-x

9. Neurobehavioral and quality of life changes associated with growth hormone insufficiency after complicated mild, moderate, or severe traumatic brain injury, 2006, DOI: 10.1089/neu.2006.23.928

10. GH deficiency as the most common pituitary defect after TBI: clinical implications, 2005, DOI: 10.1007/s11102-006-6047-z

11. Neuroendocrine Dysfunction in a Young Athlete With Concussion A Case Report, 2017, DOI: 10.1097/JSM.0000000000000408

A Beautiful Day for a Drive: A Huge Victory

You know how people joke that they need to turn down the volume of the radio in the car to see better? I have truly felt that over the past two and a half years. It has been exceptionally difficult for me to focus or comprehend something if there’s background chatter or noise. Even without any background noise, my driving attempts since the beginning of my recovery have been failed attempts.

I woke up today and felt this overwhelming momentum. I felt like this would be a good day to attempt driving again. I am unable to exercise at my Mom’s gym as it is too busy and overwhelming for me inside. So, I go to a recreation center that is calm inside, about one mile up the road. I rode in the car with my Mom to her gym and got into the driver’s seat to drive myself to the rec center. This was a big moment.

Today was a beautiful day of warmth and sunshine. I sat in the driver’s seat for a moment, closed my eyes, grabbed the steering wheel and took a big breath, purely feeling everything as to ground myself. I opened my eyes, then the windows and felt ready. I drove through the parking lot towards the street in silence. I then had this urge and turned on some music and started making my way to the rec center just up the road. I put my hand out the window and felt the sun and warm breeze flowing through my fingers. It was electric.

About two minutes into the drive, I felt it in my being that this time was different. It felt like my eyes would cooperate and that the intricate systems of my brain would communicate. I didn’t feel cross-eyed, dizzy or have a headache like the countless attempts over the past two and a half years.

Pure bliss.

I couldn’t help but smile big and out of nowhere, tears started streaming down my face. The warmth from the sun and the breeze through my hand felt like it penetrated my soul. I made it to the rec center and started sobbing while simultaneously smiling so big until my face hurt.

I sat there in the parking lot and cried so many happy tears. At that point, I would have already developed a migraine based on my previous driving attempts. Rolling with this energy, I went into the rec center where I completed my PT exercises.

Still smiling, I got back into the car, turned on the music and rolled down the windows. I closed my eyes, again breathing it all in. I started my drive back to my Mom. The entire drive back, I had the biggest smile on my face and again the tears started to flow.

My Mom asked, “So, how did it go?” I looked at her and started sobbing. Naturally, she immediately thought it went very badly. She said, “Oh my gosh, what happened? What’s wrong?” I said, “It was so good and I am so happy. I forgot what that felt like.” That is a moment that will stick with me for a very long time.

There are no words that can fully describe the experience of driving with the windows down, hand out the window, feeling the warm breeze through your fingers while listening to good music. It was so liberating. I didn’t realize just how freeing until I lost the ability to experience that. This was one of the many things in life I took for granted before this injury – a simple drive. Next time you go for a drive, take a moment to really feel it. All of it.

I was on cloud nine and I still am! It made me feel whole. Even though it was a short drive, it was something I haven’t tolerated on many attempts leading up to this point. I will never take even the shortest drive for granted again. One might call this a small victory but I call this a huge victory.

In this moment, I am rolling with the wave of good energy and momentum and hope there are more positive advancements to come! Little by little, I hope to get back to full driving. My goal is to eventually be able to drive myself to future trips out to Pittsburgh. That is a big goal but I am set out to do that. And when that happens, the drive itself will be all the celebration I need.

The Psychedelic Light Portal: Another Pittsburgh Adventure

I just returned home with my Mom from another trip to Pittsburgh to visit my family and awesome team at the Regenerative Medicine Center. Right on topic with my most recent posts about mental health and well-being, I had the privilege of experiencing the Light Portal and its profound benefits.

The Light Portal, an unsuspecting wooden apparatus with psychedelic lights, amazing acoustics, sound and vibration in harmony, took me to a different realm. I wasn’t entirely sure what to expect. I am so grateful that I not only experienced it but that I had a beautiful experience. I joked that I was stepping inside a time capsule. It turned out that I really had no concept of time. It is difficult to fully articulate the experience but I am going to attempt to describe it.

As I am writing this, after three Light Portal sessions, I am experiencing the most energy I have in a very, very long time. It has been such a long time that I can’t even remember when I had such energy.

I have written quite a bit about how I have incorporated a meditative practice into my life to help with my recovery in which I have used many different modalities to reach a meditative state. Even with the help of these devices and apps, it can still be extremely difficult to reach a calming state.

After a stressful morning, I went into my first Light Portal session with a lot of stress and tension. It didn’t help that I was also running on one hour of sleep. I didn’t know if I’d truly be able to relax. I went into it with no expectations, but was hoping that it would help me in some way. I entered the Light Portal and laid down. Looking up, I could see the colorful lights with many light bulbs producing a trippy scene. The music cued and the grand experience commenced.

I closed my eyes and started focusing on my breathing. I was initially overcome with so many thoughts that it was overwhelming. My mind scattered all over to various moments and places in my life. I started reflecting on not just my most recent TBI but the many before, spanning my entire hockey career. Tears began streaming down my face and I didn’t know why. I then started picturing myself laughing, smiling and in full health. I reconnected with my youthfulness which I had felt so disconnected from.

As time went on, which again I had no concept of, my scattered brain and thoughts became calm. I felt as though I was transported to a different dimension, to a very spiritual place in which I had no pain. My body became so calm to the point that my limbs felt extremely heavy yet I also felt extremely light at the same time. My headache, neck pain and tension melted as I was transported. It felt strange having no head pain as I have been living with some form of head pain every day for the past two and a half years. I reached an entirely different level of calm and peace that I had never experienced before.

After the first two sessions, I slept through the night with only a few interruptions. This was a huge win for me as I still struggle with intense insomnia, waking up dozens of times through the night and sometimes not sleeping at all. The best part was that I woke up the next morning with energy and a new sense of well-being. I thought, this is going to be a good day. The energy was so bizarre to wake up to. I had wondered what was going on. What is this feeling? This is strange. I had completely forgotten what that felt like.

It made me realize that my energy for so long had just been going towards survival. Just surviving isn’t truly living. As I have come to fully realize over the past several months, spiritual healing is just as important as physical healing and maybe even more important. How can we possibly fully heal our bodies if our spirit is broken?

My last session in the Light Portal was even more moving than the first two sessions. The fog had lifted. It was a new level of peace I hadn’t experienced. Physically, after the session, I had no pain at all. I anticipated if I received a benefit that it would have been all spiritual and emotional but it turns out that the physical benefits were also astonishing.

I had seen my physical therapist after my sessions. He usually comments on how my neck feels like cement. This was the first appointment in over a year since starting PT that my neck and head had felt great. My physical therapist said to me, it was the softest my neck had ever felt. It’s quite amazing that the manual work on my neck couldn’t produce such a result but the Light Portal could.

More realizations had surfaced. I had lost touch with many things that still make me, me. None of the meditation apps or devices I have tried during the past two and a half years could have given me the same experience as the Light Portal. Transformative is an understatement.

I had been focusing on maintaining positive thoughts for so long but finally realized that my subconscious was holding onto negative beliefs and negative thoughts. It feels like a barrier deep within had been broken open, granting me a fresh and new perspective.

I have a different perspective on life and I look forward to what is to come. I realized that my healing does not fit into a box, ironically as I laid in the Light Portal apparatus that resembles a large wooden box. What I mean is, I’ve come to realize that the labels we use in our society restrict us and place limits on our potential. Everyone’s healing is different. I had been told many different things by various doctors through this time period, telling me there was no room for improvement, that this was the best I would ever get. I needed to accept that this was my “new normal.”

These are all restricting thoughts and they just aren’t true. I had been acting on seeds planted in my mind, on limiting beliefs, that weren’t true. I had started saying the same things to myself, beating me down further. What this left me with was a low belief in myself, in my worth and what is possible. The faulty program that I had become accustomed to in my brain was not efficient and was restricting me from my goals and my well-being.

A quote by Albert Camus came to my mind: “And never have I felt so deeply at one and the same time so detached from myself and so present in the world.” It was as if all that I thought about myself and my recovery, the preconceived ideas, the negative core beliefs and blocks to healing were released. I was released from those thoughts and ideas as they didn’t fit anymore. A block within me had lifted. There was no question about my identity or who I am. My heart and soul were at once the harmonious frequency that is me.

Finally, I could breathe in contentedness and be present in the world. I could just comfortably be. During my last session, I began to smile. For a long time, I thought that being content was a negative thing because if we become content, we will stop striving for growth and become stuck in a robotic routine even if it doesn’t suit our desires and dreams. The definition of content is “a state of peaceful happiness.” Finally at peace and finally content, I realized this feeling was a positive achievement and could not have felt more freeing.

Being alone with my thoughts during this recovery has been scary at times. I have been living in a hypervigilant state for so long where typical, harmless every day occurrences are perceived as threats. Negative thoughts and ideas were also threats. I was alone with my thoughts in the Light Portal and something I felt to my core that recurred over and over in my sessions was: I am safe.

I realize and fully know now that healing is possible, that I am enough, that my former self isn’t lost, that deep within I am radiant with health and youthfulness, that my spirit is intact, that those restricting thoughts and inputs can be repelled. What is light and good can penetrate and that is what is necessary to live a meaningful life filled with love, happiness and purpose.

I am so grateful for the momentum provided by the Light Portal.

Here’s to light, love and healing!

Apps, Gadgets and Tools for TBI Recovery

This is a list of various devices, tools and apps I have tried during my recovery for reducing and improving residual symptoms. Some have provided meaningful benefit while others fell short. I’m going to put the particular apps and gadgets I have found most helpful at the beginning of the list. You can check them out at their respective websites by clicking on the title of each app or device. As I try new things, I will update this post and add them here.

Speechify

This is an app I just recently discovered. It is great for me because of my vision troubles. It is an app similar to audiobook but it reads anything you want. I like to read books, medical articles, and much more but have been limited and it takes me a very long time to get through anything these days. I open the app, take a picture of what I want it to read on my phone, scan it in and it’s ready to go! You can play what you scanned in at any time. It’s free with a caveat. If you want a better or more natural sounding reader, you have to upgrade to the premium version which in my opinion is worth it. Otherwise, it is very distracting having a robot-y voice reading to you.

F.lux

This is a free app that I have on my home page of my site because I have used this for a long time now and have found it extremely helpful especially for light sensitivity and eye strain. Research has shown that various levels of bright light before bed at night can disrupt sleep and melatonin production, especially with blue light that is emitted by all of our screens. This app is great for screens as it adjusts the frequency of light emitted to your eyes. You can change the settings to your waking time and bedtime and it adjust the light in a natural cycle following a natural circadian rhythm. So, if you are staring at a computer screen all day, the light emitted naturally fluctuates and towards the end of the day and pre-bedtime the blue light will be reduced automatically. If you are an android user, I believe there is a similar app called Twilight, however I can’t speak to that because I haven’t used it.

Bonsai Occipital Release Tool 2.0

This is a great device and one that exceeded all expectations because quite frankly, I had none. How could this little block actually relieve any of the terrible neck pain and headaches I’ve been experiencing for so long? I was shocked after using it for just 10 minutes that my headache and neck pain were significantly reduced. It works by providing gentle pressure to the suboccipital (just below the base of the skull) muscle trigger points, resulting in less stiffness which then leads to less head pain.

TrueLight Luna Red Sunset Sleep Light

This lightbulb has been amazing. I truly love it. Similar to how f.lux changes the light frequencies emitted from your screens throughout the day, this lightbulb does the same. It comes with a remote control so you can adjust the light setting. This lightbulb is low blue light emitting at all times and has the ability to emit just red light. I put the red light on at night about 1-2 hours before bed as red light does not interfere with our circadian rhythms. It has helped me fall asleep faster and when I wake up in the middle of the night I can switch that on instead of causing further disruption with bright lights or the light of my phone. I’d highly recommend it.

Sensate

This is a meditation device that I have used for about 6 months now. I’ve used many meditation apps and a couple devices and this seems to be the best one. It looks like a large pebble that you rest on your sternum (chest bone). You turn it on and sync it to the app on your phone. It vibrates on your chest and synchronizes to the music from the app. The vagus nerve which is involved in activating the parasympathetic nervous system (rest, relaxation) is stimulated by sound and vibration. This device combines sound and vibration to help tone the vagus nerve, leading to a sense of calm. It is pricey compared to other products but in my opinion, it is worth a try if you are experiencing stress, anxiety or sleeping troubles.

Insight Timer

This is a free app for meditation. It is great because there are so many meditation options to choose from based on what type and the duration. Also, there are so many different voice options. Finding a voice to meditate to can be difficult but with the hundreds and thousands of options on this app, you will definitely be able to find a voice you like that is calming. I’ve used this one a lot and highly recommend it.

Swanwick Glasses

These blue light blocker glasses are great for evening and before bedtime. I guess the cool kids call these “Swannies.” They are supposed to help block the blue light that could harm your natural circadian rhythm and melatonin production. They help with light sensitivity as well. I find them particularly helpful when riding in the car at night as they reduce glare and decrease the blinding headlights of cars.

Omax Cryofreeze CBD Pain Relief Roll-On

This roll on is made from CBD, menthol and some other herbal extracts that aid in relieving muscle stiffness and pain. This has been helpful for temporary numbing of pain and stiffness. It is similar to the icy hot feel due to the menthol and peppermint oil in it. It isn’t a long-lasting solution but does help provide some temporary relief.

Dohm Noise Machine

This is a white noise machine which has been amazing for helping to drown out the ringing in my ears a bit. I never travel without it now. It has helped my insomnia a little bit as the tinnitus can get very loud at night. They now make different versions that play different sounds. Mine is straight up white noise. I love my Dohm!

Heart Math InnerBalance

This is another meditation device. You attach a sensor clip to your ear which plugs into your phone and then open the app. As you breathe, it senses your pulse through the blood flow from your ear and shows you what zone you are in. You aim to be in the “green,” so it gives you real time feedback on how you are performing and you can adjust your breathing accordingly. It tracks your coherence level and heart rate variability (HRV). HRV is a measurement of beat to beat activity of the heart and how it fluctuates. The normal variability in HR is due to the synergistic effects of the parasympathetic and sympathetic nervous systems. The app gives you real time data on HRV, giving you a small window into how balanced these branches are. Physiological coherence means how well the heart and brain are united and the measurement given shows how well your mind and body are in harmony. Interestingly, if I am feeling very anxious and I do a session, I can tell based on the graph because of how it is jagged and all over the place. Usually by the end of the session, I can get it to be a nice fluid wave pattern and feel more relaxed. I have found it to be helpful and the graphs giving real time feedback is nice for comparison after sessions.

Bose QuietComfort Noise Canceling Earbuds

These noise canceling earbuds worked wonderfully. I am still very sensitive to noises and with the intense ringing in the ears it is nice to drown that out. It also really enhanced focus. I ended up returning them because while I loved the sound, my ear canals hurt with all sizes of the ear buds. They have over the ear noise canceling headphones too but I have not tried those. If you are noise sensitive or need to increase focus, I’d recommend trying these out.

Polar H10 Heart Rate Sensor

While this gadget doesn’t necessarily provide pain relief or healing, it is a useful tool to monitor and track heart rate during recovery as there can be a threshold where you become symptomatic. It is a chest strap that has the heart rate sensor attached to the front of it. This specific device has been studied extensively in research which I like. The app for the sensor is great because you can set it to notify you when you reach a certain heart rate and can back down your activity level if you need to. I love this device for PT and training. The app allows you to track your heart rate data by providing you with graphs and statistics.

Motion Guidance Visual Feedback Rehab Laser

This comes as a kit with a tracking target that sort of resembles a tapestry and a headband with a laser on the front. You put the headband laser on and slowly outline the design on the target (mine is shaped like a butterfly) by gently moving your head. It also has a circle with numbers on it that I can track with the laser. This has been helpful to re-train and re-educate the smaller, stabilizing muscles of the neck as well as tone my fine motor skills. It also helps train proprioceptive awareness or where your brain thinks you are at in space. Lack of proprioceptive awareness following TBI and whiplash is quite common. With practice, some of these exercises have become easier and I have improved proprioceptive awareness.

Optix 55 Heated Eye Patch

This is an eye mask that produces moist heat after you warm it up in the microwave. It is actually marketed for dry eyes but it is soothing to put it on when there is a bad headache or migraine.

Joovv

This device is a red light therapy device using red and near-infrared light. Red light has been shown in studies to promote healing by reducing inflammation and providing energy to your cells. This specific light has been shown in studies to promote improved mental well-being, healthy skin, inflammation, improved blood flow and sleep. It is soothing to use while meditating. I haven’t noticed any huge improvements in pain but while using, it does feel soothing and relaxing on the affected areas. I like to believe there is healing going on at the cellular level. This is a very expensive device. Shout out to my friend who gifted this to me!

Echo Sidekick Tool

This is a muscle scraping device used to stretch and ease muscle tension and aid in recovery. It is a stainless steel tool that you scrape along your muscles to stretch the muscle fibers and increase blood flow to the area to promote healing. While it does work great for many areas of the body, I haven’t found it to be helpful where I need it the most, my neck.

Power Dot Smart Muscle Stimulator

This is a TENS unit which sends electrical pulses through the skin. The theory behind TENS units is to stop pain signals from being sent to the brain and to naturally produce endorphins. I haven’t been entirely convinced in my whole athletic career that TENS units have really done anything for my muscle recovery and related pain but I wanted to give this a shot as there was a lot of rage over this device. Compared to the cheap TENS unit I bought on Amazon a few years ago, I think it does the exact same thing. To me, it just looks fancy and has an app to go with it but if it works for you that’s great! Personally, it wasn’t worth the expense for me.

Hyperice Hypervolt Percussion Massager

This is a massage gun. I was really hoping for relief from tension and pain in my neck and traps which would then hopefully help the headaches. Unfortunately, I think the power of this device is more in tune with the size of an NFL linebacker’s neck because it destroyed my bony neck. It worked great on the quads and hamstrings though! Unfortunately, that’s not what I need.

TrueDark Twilights Classics

This is another pair of glasses used to block certain wavelengths of light. These have dark red lenses that signal your body that it’s bedtime. They are supposed to be used 30 minutes to 2 hours before bed to prevent melanopsin from detecting wavelengths of light that could disrupt sleep if sensed before bed. Melanopsin is a protein in the eye that sends signals directly to the brain as it absorbs light, regulating circadian rhythm and sleep through the production of melatonin. These do not only block blue light but also block green and violet. I could not get used to these as everything is dark red. The concept is great but they didn’t work out for me. It has nothing to do with how absurd they look either. They sort of make you look like one of the animated characters in The Incredibles, which could be kind of cool for a superhero costume.

Aculief Wearable Acupressure Headache Relief Device

This is an acupressure device that you put around your thumb and it applies pressure to a specific pressure point on the hand which has been used to treat headaches for thousands of years. Unfortunately, it did not help with my headaches. The good thing is it is cheap and can be worn anytime and anywhere. I think it is worth a shot. Shout out to my brother and sister-in-law for gifting this to me!

Yogu Acupressure Mat

This is a mat that has many plastic points that press into your back and neck to serve as acupressure points along meridian lines of the body. The goal is similar to acupuncture – improve the energy of the body, reduce pain and tension. The pillow worsened my head pain but the mat itself did provide some mild relaxation. It wasn’t a meaningful change in symptoms for me. Shout out to my Mom for the gift!

Cervical Neck Traction Collar Device

This one sort of looks like a flotation device that goes around your neck. You blow it up similar to the same way you would blow up a blood pressure cuff. As it blows up, it provides traction to your neck to stretch out the space between the vertebrae. I tried this and it didn’t work for me. In fact, it did make my headache a bit worse. I also tried it out on 4 different family members who all thought it worked great and alleviated some sort of pain in the neck and head. I am the anomaly. In this small group, it helped 4 out of 5 people. I’d say it is worth a try for the price.

Lazarus Naturals CBD Balm

This is a muscle balm made from CBD and essential oils to aid in pain, tension and stiffness. Unfortunately, it did not relieve pain or stiffness. Truly, my favorite part was the smell.

Neck Hammock

This is another neck traction device that you hook to a door knob. It is supposed to apply gentle traction to the neck to stretch out the space between the vertebrae which may be pinching nerves. It hangs from the door knob and you lay on your back with your neck in the cradle or hammock and float for a little bit. I found no relief but it also didn’t worsen anything either. For the price, I think it could be worth a try.

Rest Cloud Neck and Shoulder Relaxer

I can’t give a fair review of this one as I have only used it a couple times. In the two times I have used it, it was relaxing to lay on but I didn’t notice any significant reduction in neck pain or headache. It is a similar concept to the Bonsai Occipital Release Tool above but seems milder and doesn’t have the various bumps for pressure points. As I use it more, I will update this.

Ice Beanie

I haven’t received this yet but I am excited to try it once it arrives. This is a hat that provides cold compression to the head, reducing pain signals to the brain and ultimately reducing headache and migraine pain. Hope it makes it to the top of the list. Shout out to my brother for this gift!

When 20/20 Vision Isn’t Enough

As you are reading this, over 50% of the surface of your brain is being used to process the visual information coming in through your eyes. Each eye is constructed of over 2 million working parts and of those, the optic nerve contains between 770,000 to 1.7 million nerve fibers. Nearly 80% of sensory information coming into your body is the input to your eyes! We have more neurons dedicated to vision than our four other senses combined. Interestingly, if you receive conflicting information from your senses, your brain will use vision to over-ride the other sense almost every time (video showing this phenomenon at the end).

This recovery has led me to realize just how much I took for granted, especially my vision. How often do you stop and think, I am seeing this image perfectly in space because of the intricacies of the brain that created it? What happens behind the scenes is the subconscious system of the brain, allowing us to experience where we are at in space and our perception of the world around us. This information is a culmination of so many factors working together in the brain which then forms the 3D road map for us. The human body is amazing.

We see with our brains, not with our eyes.
Norman Doidge, MD

20/20 is looking at one visual function of the eyes, that being visual acuity. What about all of the other components that contribute to the visual system? The systems that make up our vision are so complex and involve various areas of the brain to produce the images and our perceptive abilities. After TBI, disruption and damage at different areas of the brain can occur. With so many areas of the brain contributing to our visual system, you can imagine if there is damage to any single part of the system, it can lead to visual dysfunction.

Following TBI, up to 90% of patients experience at least one oculomotor dysfunction (scanning and tracking) and up to 40% experience visual dysfunction (focusing and eye teaming) persisting beyond three months. Despite the prevalence, this is still often overlooked in patients.

I mentioned briefly in an earlier post that I had a quick referral to an optometrist for my visual deficits that became prominent immediately after the injury but continued to worsen as days and months passed. In the immediate days following my brain injury, I developed blurry and double vision. I couldn’t scroll on my phone or drive in the car without feeling dizzy and nauseous. I couldn’t track moving objects nor could I move my eyes without pain or move them quickly from one target to another without feeling off balance and experiencing double vision.

About two weeks following the injury I was seen by an optometrist who did two things on examination – checked my visual acuity and near point convergence (NPC). When your eyes come in to focus on a close target, that is called convergence (your eyes are converging). NPC is a measurement of the distance where maximum effort of convergence occurs, measured by a doctor moving a fixation stick from far to near and stopping when you no longer see one stick (it becomes double) or when one eye subtly deviates outward. The distance from the nose to that point is the NPC.

You can try this by holding a pen at arm’s length and slowly bringing it closer and closer to your nose. Wherever you start to see two pens or when one eye subtly deviates (if you have an observer), this is your NPC. This is commonly abnormal in patients following TBI. From these two tests, I was diagnosed with convergence insufficiency and accommodative insufficiency. I will explain these diagnoses later in this post. I was prescribed reading glasses (+ 0.50) to aid in focusing. The glasses had a tint to them to block blue light and help with light sensitivity.

I was advised to follow up again in one month to determine if I required vision therapy which we did end up starting one month later. Therapy occurred every two weeks consisting of a ten-minute appointment with the optometrist who observed me perform certain tasks. There was no objective data to show improvement and really no time to properly assess for improvement in a ten-minute appointment anyway.

My eyes continued to hurt, headaches persisted, blurry and double vision seemed to worsen. This carried on for 3-4 months with no notable progress at all. I thought that maybe there just wasn’t room for improvement of my eyes. We kept doing the same exercises over and over to no avail. It felt like I was banging my head against the wall over and over. It also felt like this therapy was a blanket approach – the same therapy used on every single concussion patient.

After stopping vision therapy, I traveled to Georgia where I stayed for one week and completed a brain rehabilitation program. That was the first time I had real, objective data of just how poorly my eyes were functioning. I’m going to explain this trip in detail in a later post. I returned from brain rehab with home exercises and felt better initially but as weeks went by, I could feel my body and eyes reversing back to the state I was in prior to the trip. I thought maybe I just needed more comprehensive care in person for my vision but I didn’t know where to look.

Like every other helpful treatment I’ve discovered, I was listening to a TBI podcast and one of the topics discussed was neuro-optometric rehabilitation. I wasn’t very familiar with this. The doctor in the podcast proceeded to talk about how important it is following a brain injury to find a provider who is specialized in neuro-optometric rehab and a great resource to find one is through the NORA (neuro-optometric rehabilitation association) database. A neuro-optometrist has special training in the neurological aspects of the visual system. The importance of a neuro-optometric examination as quickly as possible after brain injury was stressed.

This was in April of 2019, six months after my injury. I looked in the NORA database and found there was a center very close to home, The Vision Development Team. I looked into it – another treatment that would be solely out of pocket. Could this be worth a shot? I decided it was definitely worth it. Unfortunately, the optometrist I had been seeing for months prior had no experience in neuro-optometric rehabilitation. Vision therapy with that optometrist was solely focused on the eyes, and not how the eyes and brain were working together.

I called and scheduled the first available appointment at The Vision Development Team, about two months away. The appointment was scheduled for June 13, 2019. My hospitalization with the pneumothorax happened the day before this appointment. I cried because I was so upset that I would miss the appointment I had been waiting so long to go to. I begged to be released from the hospital temporarily to make the appointment (this was ridiculous). I was desperate to get my vision better and felt like waiting was wasting more time.

The Appointment at The Vision Development Team

My appointment included a thorough history of the injury and symptoms followed by a complex sensorimotor examination and neurovisual assessment. The exam didn’t just look at the eyes, it assessed how the eyes and systems of the brain work together. The best part other than giving me objective data showing my visual deficits was that they weren’t just addressing my eyes at this appointment – they were addressing all of the systems that construct me.

The exam started with the basic visual acuity test. Surprise, I have 20/20 vision. Oh, how I wish that meant everything were perfect. We then carried on to the more complex sensorimotor and neurovisual assessments.

This exam was comprehensive and included evaluation of oculomotor function, accommodation, binocular function, peripheral awareness, depth perception and spatial processing, visual-vestibular testing, balance and primitive reflex testing. In short, this is testing: how your eyes work together (eye teaming), your ability to track objects in space, your ability to sustain and shift focus, function of spatial processing (where things are at in space, our 3D road map), how the inner ear and balance system is functioning (vestibular system), if any primitive reflexes have re-emerged, and how the peripheral system is working.

The Results

I knew there was a lot wrong but what I discovered after all the testing was a lot to take in. I felt overwhelmed and defeated at first because so much was wrong but that turned into hope because we finally identified the target areas that needed to be rehabbed.

The eyes are supposed to work as a team. Just as other parts of the human body are not intended to operate independently of each other, the same applies to the eyes. It is necessary for the eyes to work in tandem and when this doesn’t happen as in my case, a multitude of issues surface. While each eye may individually be considered “healthy,” they are unhealthy in that they do not coordinate with each other and the communication system to the brain is impaired.

The exam showed I have binocular dysfunction or impaired eye teaming. I was diagnosed with convergence insufficiency (CI). This diagnosis means the eyes are not working together to focus on a target up close. Together, the eyes must turn inwards to view objects at near under normal circumstances. CI results when the eyes aren’t in sync and don’t move at the same time to focus on a target. This can result in the words appearing to move while reading as well as lead to blurred/double vision, impaired concentration, eyestrain, drowsiness, and headaches.

Another diagnosis is accommodative insufficiency (AI). AI involves the inability of the eyes to focus properly on an object and switching between looking at an object afar to an object near. An example of your eyes needing to accommodate is looking at the speedometer of your car and quickly looking out at a traffic light in the distance. If there is an insufficiency, when you make that quick movement of focus, there could be a lot of blurriness, double vision or motion intolerance.

I was found to have vestibular dysfunction. The visual system works very closely with the vestibular system of the inner ear that provides equilibrium and balance. When your head moves, your eyes need to adjust to the movement quickly in order to still be able to focus. Dysfunction in the two systems leads to motion intolerance, feeling off balance, dizzy and blurred/double vision.

Aside from the above issues, I had impaired peripheral awareness as well as impaired spatial processing seen with diminished hand eye coordination, depth perception and delayed reaction time.

A neurological phenomenon that I wasn’t aware of was present – suppression of one or both eyes alternating suppression. Most prevalent, however, is suppression of my left eye. This is a natural protective mechanism of the brain in an attempt to make sense of the visual information that is coming in. If you experience double vision, the brain adapts by disregarding or ignoring the visual signal provided by one eye or suppressing it. My eye suppression is a compensatory mechanism of my brain from prolonged periods of double vision.

For example, a healthy pair of eyes align and point towards the same object in space and see an equally clear image. The brain then uses small cues to determine the size, shape and depth of the object. The two images of each eye then combine to produce what you see in space. In a pair of eyes that have poor teaming, one eye may produce a blurry or double image so the brain struggles to combine the blurry image of one eye with the clear image from the other eye. The brain becomes confused and to compensate, it uses the good input from the healthy eye only and ignores the input from the blurry eye. This creates a strain on the muscles in the eye due to the overcompensation which can lead to headache, dizziness, nausea and unsteadiness.

Primitive reflex testing was also something I wasn’t familiar with prior to this appointment and the rehab that followed. Our primitive reflexes are automated responses to a stimulus, sensed by our neurons which then produce a response which is our involuntary action. We have many reflexes, some that are acquired throughout our lives and others that we are born with (innate, primitive). These primitive reflexes we exhibit as babies are a survival response and are integrated into our nervous system within the first year of life. As we hit each developmental milestone, a sense of safety is reached and different reflexes are inhibited by the developed higher brain areas.

Once the primitive reflexes are integrated into our nervous system or disappear, their purpose has been served and they are then stored. Brain injury threatens survival resulting in the reflexes that were once stored to be triggered to reappear. The brain reverts back to that primitive state. Re-integrating the reflex is important as it helps re-connect the sensory systems and regain normal visual functions.

The moro reflex in infancy is stimulated by any sudden movement of the neck. This results in the “startle response.” This survival instinct helps the baby cling to the mother. It is developed at about 28 weeks gestation and typically integrates and disappears around 4 months of age. If the moro reflex is activated in adult life it can lead to dysregulation of the autonomic system, hypersensitivity to external sensory stimuli, anxiety, visual perception and oculomotor dysfunction, and vestibular problems. Through testing, it was found that my moro reflex became active again due to the brain injury.

Neuro-optometric rehab was prescribed, which I continue to this day. A customized plan tailored to me was made – not a blanket approach used on every concussion patient. This is so important because no two concussions are the same.

Neuro-Optometric Rehab: A Work in Progress

It can be difficult for the brain to unlearn some of these behaviors but the good news is the brain exhibits neuroplasticity which means it has the ability to form new connections and heal. Did you know your hippocampus generates at least 700 new neurons a day? That’s pretty cool.

Neuro-optometric rehab focuses on plasticity by using prisms, filters, lenses and more to help stimulate various parts of the brain. This is unlike routine eye care or refractive care that can be fixed with glasses. The therapy I first received following my injury was focusing solely on the eyes and not how the eyes and brain worked together.

Walking into vision rehab often feels like walking into a jungle gym or a playground. Most appointments I am there in the big therapy room with little kids. Every rehab appointment feels like I’m channeling my inner child, which is what makes it so enjoyable.

Though painful at times, and I mean very painful, going to vision rehab can be a fun experience. My doctor works with the vision therapist to tailor a plan for me and adjust it through time as my progress is tracked. My vision therapist knows how competitive I am and incorporated many activities where you can set records. Not only was this motivating for me but it was a great way to track progress and see if I could beat my own scores each week.

We have done so many different vision exercises that I can’t possibly explain all of them here. My initial vision exercises were single eye exercises as I patched one eye. As I progressed, we slowly added in movements and eventually no patch.

To re-integrate the moro reflex we have done a lot of breathing techniques and relaxation exercises. This ties into the autonomic dysfunction that occurs following brain injury leading to a heightened and prolonged fight or flight state. The breathing techniques seemed a little silly at first and were sort of embarrassing with someone watching but it actually works. The breathing techniques used are called hisses and hums. Take a deep breath in, breathe out slowly and as you breathe out, you make a hum or hissing noise. This allows stimulation of the vagus nerve which in turn stimulates the parasympathetic nervous system (relaxation). We were able to reintegrate this reflex to the point where it was no longer present for about a year but unfortunately it re-surfaced after a recent traumatic day of testing.

Another helpful tool not only for the moro reflex but also easing the eyes after difficult rehab sessions is Syntonic phototherapy. When light travels through the eye it reaches the brain, specifically the hypothalamus and pineal gland. These areas are important for regulating various functions and studies have shown that by stimulating them with specific frequencies of light, it can have positive effects. I have done a lot of work with Upsilon Omega (a blue shade) that is supposed to help stimulate the parasympathetic system and restore balance of the autonomic nervous system.

To help with the vestibular system, we have done exercises with head movements which are still extremely challenging. As of late, we have had to put a hold on those more advanced exercises but hopefully I will progress to that point again soon.

Through time, we have also incorporated auditory processing through a program called the Integrated Listening System. I have done this while performing vision exercises to integrate the senses which has been a major area of disconnect. This is extremely challenging as I still have many issues in conversations with side noises, busy environments and becoming startled by unexpected noises and sounds. The intense tinnitus continues to be an issue.

It turns out that the glasses initially prescribed by the first optometrist I saw were not what I needed. After the neurovisual exam, I was prescribed prism glasses with binasal occlusion. Binasal occlusion is a partial covering of the visual field of both eyes to reduce the amount of visual stimuli that my brain has to process that is coming in. Prisms take into account how the brain and eyes are working together and can help stimulate those affected areas and improve vision, balance and spatial processing. Prisms are used for when the eyes aren’t working together to focus on a target which can lead to double vision. The prisms bend light that travels into the retina, allowing the eyes to remove the double vision and perceive it as one image.

Prisms have also been incorporated into rehab. We have worked on balance and spatial processing at vision rehab using various prisms as I have to balance and walk on a walking rail. It feels as if my body is being pulled to one side or the room is slanted. We have made some progress in that I am not constantly falling off of the rail. The goal is to help the eyes and brain to learn to work together again.

Vision rehab has been quite the journey, with many setbacks but also many small victories. It’s easy to feel defeated and stuck during the setbacks but I’m learning to feel all of my emotions and get it all out and then start focusing on how I’ll get out of it and move forward. While I still have a lot of progress to make, I am extremely grateful for the small victories made along the way. My biggest goals of vision rehab have not been achieved yet but I am keeping the faith and hope these goals will be reached and when that day happens, I will probably cry first and then celebrate by going for a drive while listening to good music. This is something I dream about!

Find a NORA Provider Here:

If you experience vision issues following a concussion and are told you’re fine because your vision is 20/20, find a different provider and find one that understands the neurological aspects of vision!

Find a NORA provider here.

To see my amazing group of people at The Vision Development Team, go here.

To All My Healthcare Provider Friends:

It’s important to note that visual dysfunction following brain trauma is due to damage in the brain at the axonal level. The visual dysfunction is not an eye issue – it is a global connection issue and disruption at various levels of the brain.

Despite the prevalence following TBI, vision problems are still frequently overlooked in the concussed patient. Always check near point convergence when evaluating concussion patients. This should be done at the first assessment. Failure to recognize this issue early on can lead to worsened and prolonged outcomes. This is a good predictor of outcomes including the development of post concussion syndrome.

Research suggests abnormal near point convergence contributes to many other post concussion symptoms as well as cognitive impairment. In this study, patients with convergence insufficiency performed worse on reaction time, processing speed, verbal memory as well as post concussion symptom scores as compared to the normal group. Early recognition is key to getting the patient the proper help they need with a neuro-optometrist. It is good to have a resource who deals with concussions and is trained in neuro-optometric rehabilitation. I would check the NORA database for providers near you so you have a good referral system ready.

The systems of the brain work so intricately and it’s important to recognize these problems early on. If you refer your patient for vestibular rehab and they have undiagnosed visual dysfunction, they will likely not progress or will initially progress and then plateau because it requires proper function of the visual system to be successful. Your patient may have auditory processing deficits which could also affect the visual system. This is why it’s important to look at all systems and have a comprehensive neurovisual assessment prior to starting other therapy modalities. The systems are so tightly connected so why are we constantly isolating them from each other and never putting them back together?

Lastly, medications will not solve the visual dysfunction. It seems we are always searching for the quick fix for our patients in the form of various pharmaceuticals which don’t address the underlying problem. Treating visual dysfunction requires time, repetition and rigorous exercises in vision rehab – something a pill will not touch. Remember, 20/20 isn’t enough and doesn’t reveal the whole story.

The McGurk Effect

As I mentioned earlier, if there is conflicting information from your senses, your brain will use vision to over-ride the other sense almost every time. The McGurk Effect is this perceptive illusion that occurs if there is a conflict between what you hear and what you see as someone moves their mouth and lips. I find it fascinating. It just shows you how important vision is in processing information. This video is really neat and shows you what this exact effect is.

Thanks for reading. Till next time earthlings!

Sources

Oculomotor Treatment in Traumatic Brain Injury Rehabilitation: A Randomized Controlled Pilot Trial, 2019, DOI: 10.5014%2Fajot.2020.026880
Vision Diagnoses Are Common After Concussion in Adolescents, 2015, DOI: 10.1177/0009922815594367
Vision Therapy for Post-Concussion Vision Disorders, 2016, DOI: OPX.0000000000000935
Vision Disturbances Following Traumatic Brain Injury, 2002, s11940-002-0027-z
Near Point of Convergence After a Sport-Related Concussion: Measurement Reliability and Relationship to Neurocognitive Impairment and Symptoms, 2015, DOI: 10.1177/0363546515606430
Organization of Visual Areas in Macaque and Human Cerebral Cortex, 2002
Task-dependent representations of stimulus and choice in mouse parietal cortex, 2018, DOI: 10.1038/s41467-018-05012-y
Study guide: brain injury rehabilitation, pain rehabilitation, 1998
Dynamics of hippocampal neurogenesis in adult humans, 2013, DOI: 10.1016/j.cell.2013.05.002

Tag: traumatic brain injury

Surgery Considerations for the Concussed Patient: Is the Brain At Stake?

There are some questions that come to mind when considering surgery during TBI recovery:

Here’s what we do know:

Advice to the concussed patient considering or undergoing surgery:

Sources

Brainwear: A Game-Changer for Persistent Concussion Symptoms?

A Yearning for the Sound of Silence: Noise Sensitivity After Brain Injury

A Powerful Tool to Stay Afloat When Pulled Under the Waves of Brain Injury Recovery

A Trip to Georgia for Intensive Brain Rehabilitation

What Is Functional Neurology?

Touch Down in Atlanta

Innova Brain Rehabilitation

Comprehensive Testing and Results

Rehabilitation/Treatment

Major Improvements and Home Assignments

The Inevitable Decline

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A Reflection in Gratitude

Sources

A Beautiful Day for a Drive: A Huge Victory

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Apps, Gadgets and Tools for TBI Recovery

When 20/20 Vision Isn’t Enough