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