Dr. David Clark, DC-Triangle TBI Concussion

[Persistent Post Concussion Symptoms Success Story] Patient completes marathon!

I got this email last month from a patient I've been working with for a while. Before treatment she was suffering with visual processing difficulty and sensitivity, extreme headaches, fatigue that started at 3:00 PM (her "witching hour"), and diffuse hair loss.

My diagnostic work up showed high inflammation markers, and her Comprehensive Lymphocyte Immunophenotyping test (her immune system "fingerprint") showed high CD8, low TH2 and an abnormally high Th1/Th2 ratio.

Fast forward a bit on her treatment plan, and this is what she sent me a couple of weeks ago.

https://triangletbiconcussiondoctor.com

[ More than HALF of Patients with a mTBI and Negative CT Scan are NOT Recovered After 6 Months ]

New research in JAMA Neurology reports that over 50% of patients who suffer a mild TBI (aka Concussion) and have a NEGATIVE CT scan are NOT recovered 6 months after their injury.

Why is this such a big deal?

Previously, the prevailing information was that roughly 75% of patients with concussion would be recovered in 30 days.

This led to a lot of people who will were still suffering symptoms at 1 month, 2 months, or 6 months after their injury being blown off and told they were depressed etc.

Now, the mindset is going to have to change.

The truth is...MOST people with a mtBI/Concussion are NOT recovered 6 months later.

So, calling these suffering people 'depressed' or 'crazy' is no longer acceptable. It's time to do the detective work and figure out why they haven't recovered.

Why are they not recovered?

That's a long answer, but basically it boils down into these two reasons:

• Metabolic Problems (hormones, inflammation, gut function, nutrient deficiencies, HPA Axis)

• Circuit Problems (distinct brain areas and pathways that are UNDER functioning or OVER functioning).

If you want to learn more about those and what I do to treat them and help patients finally recovery, go here:
https://triangletbiconcussiondoctor.com


https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795251

Raleigh Durham Chapel Hill – TBI & Concussion Treatment – Effective non-drug treatment for TBI, mTBI, Post-Concussion Syndrome I have energy now and am able to do regular activities now. I can talk without feeling exhausted.  Light and sound sensitivity and tunnel vision are much improved. I haven't been nauseous in a long time. I can use my iPad and computer without blood pressure spikes....I don't have headaches... My ar...

The eyes are the window to the Brain!

Super excited to be trying out the new Neurolign VOG equipment. It does an AMAZING job of recording and analyzing eye movements that we can use to diagnose treat:
✅ Concussion and Post Concussion syndrome
✅ Vestibular problems like vertigo, dizziness and balance
✅ Vision problems
✅ Cognitive problems
✅ movement disorders like Parkinson’s disease

https://triangletbiconcussiondoctor.com

Dr. David Clark, DC-Triangle TBI Concussion updated their phone number.

Back in Cape Canaveral for another 3 days with Dr. Carrick—learning up to date diagnostic and drug free treatment for traumatic brain injuries and concussions. Can’t wait to use this to help people suffering with these symptoms after concussion:

• Headache
• Dizziness and balance problems
• Vision problems
• Fatigue
• Brain fog and memory problems
• Neck pain

https://triangletbiconcussiondoctor.com

Great turnout at the event tonight!

[Brain Injury Awareness Event in Raleigh on 2/28 ]

I'm sponsoring the Raleigh date for Amy Zellmer's *Not Invisible* Tour.

Amy is launching a two-year, international awareness campaign through the use of photography to visually show that while brain injury may be an invisible injury — the survivors are not!

She is raising awareness of this invisible injury that affects over 3.5 million American’s each year in an effort to help people find resources sooner.

During this event you will hear Amy’s story, learn how to share your own story, and also how to be a part of the campaign through aggressive social media sharing.

All survivors are invited to take part in a research survey that Amy has created in partnership with *CTE Hope*. The objective of this research survey: To identify trends in types, diagnosis, and resources of brain injury.

This event is free to attend, so share it!

-->When: Thursday, February28th, 2019 4-6pm

-->Where: WakeMedRaleigh Campus — Andrews Center
 3024 New Bern Ave, Raleigh, NC

Agenda:

4:00-4:30 meet & greet and photo booth

4:30-5:15 presentation

5:15-6:00 Research survey and photographs



www.triangletbiconcussiondoctor.com

Headed to Cape Canaveral for 3 days of training in Neurorehabilitation of the Basal Ganglia. Can’t wait to get updated and put this into action treating concussion patients.

[Stunning Lack of Follow Up Care for Patients with Concussion/ mTBI]

New research has discovered that less than 50% of patients with mild traumatic brain injury (mTBI) seen at an ER receive educational material at hospital discharge... or see a medical practitioner within 3 months of their injury.

These patients had significant POST CONCUSSION symptoms (headaches, dizziness, nausea, cognitive problems, mood, and sleep disturbances)... but weren't being followed up on by ANYONE...and the patients weren't seeking any help.

Why?

One answer is in the name itself, calling it "mild" TBI. So doctors AND patients don't take the injury seriously enough...or the patient thinks that things ought to get better on their own.

I wish I could say this news was surprising. But it's not. Thousands of people who've suffered a concussion (aka mild TBI) are left to wander the healthcare wasteland.

If your concussion symptoms clear up completely within a couple of weeks, count yourself lucky. About 30% of concussion sufferers are NOT better after a couple of months...they are the Miserable Minority.

If you suffer a concussion, make sure you seek help--at least an evaluation if nothing else--from someone who is trained in recognizing, diagnosing AND treating Brain Injuries.

Source:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2681568

http://www.triangletbiconcussiondoctor.com

[What should I do if have Post-Concussion Syndrome?]--Well, at this point, doing nothing…or more resting…will not help.

If your symptoms are still persisting at 3 months after your injury, research says they are likely to be present at 12 months, too--especially if you don't get the right treatment.

But don’t give up.

You need a WHOLE BODY approach to your Post-Concussion Syndrome. Why?

Because your Brain literally influences and controls ALL other body systems…hormones, digestion, immune system—to name a few.

A person with concussion that has turned into Post-Concussion Syndrome is almost GUARANTEED to be suffering with any combination of the following:
• hyper-leaky gut
• malabsorption of nutrients
• gut microbe dysbiosis (bacteria imbalance)
• food sensitivities
• hormone regulation problems
• autoimmune conditions (Hashimoto’s is a common one)
• blood sugar regulation problems

And each of those items on that list WILL negatively affect your Brain function. It’s a vicious cycle.

So your doctor needs to be looking for all of those. And should know how to handle each of them.

--> Here's another reason you need a full body approach to your Post-Concussion Syndrome:

The pre-existing health problems you had BEFORE your head injury will HAUNT you and sabotage your recovery.

So, if you had any of these before your concussion, these problems need to be completely addressed with a WHOLE BODY APPROACH:

• Diabetes
• Autoimmunity such as Hashimoto’s, Rheumatoid Arthritis
• Hypothyroidism
• Menstrual irregularities
• Hormone imbalance
• Leaky gut
• Food sensitivities
• Vitamin and nutrient deficiencies
• Anemia

Look, I know having Post-Concussion Syndrome is tough. It’s lonely. You feel disconnected form the person you used to be.

It’s not your fault. (It’s not fair—just being female increases your risk of PCS.)

Probably no one told you it may take a long time to get better. That person wasn’t lying to you, they probably just didn’t understand concussions, mTBI and PCS.

You need to find a doctor who’s current and trained in both the Neurological circuit problems ad the metabolic problems that plague Post-Concussion Syndrome victims.

Ideally, you’d want a doctor like me who has the credential FABBIR (Fellow American Board of Brain Injury & Rehabilitation) ...and who also has experience and training in Clinical Nutrition and Functional Medicine.

You need a whole body approach and systematic follow-up to get better and stay better. Not “call me when you need me.”

[What’s wrong with me? What’s causing these post-concussion symptoms?] --There are basically 2 sets of factors (suspects) that could be causing your Post-Concussion Syndrome…and BOTH need to be investigated if you’re going to get better and stay better.

1. Brain Circuit Malfunction – Seems obvious, right? Get hit in the head and your brain doesn’t work right. Structures in the MIDLINE of the brain are very likely to be injured.

2. Metabolic Malfunction– these are biochemical problems with hormones, immune system, digestion, inflammation (the list goes on). It's not so obvious at first glance that a concussion could cause this--until you realize that the Brain has a hand in ALL body functions…all of them.

So, if your Brain is injured you will suffer symptoms caused by the specific damaged Brain Circuits. Depending on the area and circuits, this can cause double vision, headaches, dizziness, fatigue, insomnia, anxiety, depression.

Virtually all patients with Post-Concussion Syndrome that I see in my office have circuit malfunction in the following areas:

• Vestibular System - dizziness, vision problems, headache
• Cerebellum - dizziness, vision problems, balance and coordination problems
• Midbrain - light sensitivity, sound sensitivity, anxiety, insomnia
• Frontal Lobes - concentration, memory, attention, brain fog, anxiety, irritiability, slow reaction time
• Basal Ganglia - plays a role in ALL of these

How are these circuit problems diagnosed?

A doctor with specialized training can use these specialized diagnostics to find those circuit problems:

• VNG - Video nystagmography/video oculopgraphy. This can measure eye tracking, nystagmus
• Saccadometry - measures quick eye movements called "saccades"
• Gait Analysis
• Balance testing
• Posturography

And, most importantly, the trained doctor can design and deliver a Rehabilitation program to solve those problems...and track your progress objectively, with numbers, not just symptoms.

…You can also suffer METABOLIC problems that are DOWNSTREAM from the damaged Brain Circuits.

A person with concussion that has turned into Post-Concussion Syndrome is almost GUARANTEED to be suffering with any number of the following:
• hyper-leaky gut
• malabsorption of nutrients
• gut microbe dysbiosis (bacteria imbalance)
• food sensitivities
• hormone regulation problems
• autoimmune conditions (Hashimoto’s is a common one)
• blood sugar regulation problems

And each of those items on that list WILL negatively affect your Brain function. It’s a vicious cycle.

So your doctor needs to be looking for all of those and should know what to do about them.

Next in the Concussion Awareness Series: “What should I do if I have Post-Concussion Syndrome?”

[How long does a Concussion last?] —Most research says that 90% of concussions will resolve in 7 to 10 days just with rest alone.

Other researchers have found it can take up to 30 days for 90% of the SYMPTOMS to go away.

**IMPORTANT POINT - just because you FEEL better, doesn’t mean you ARE all better. Headaches might be gone, or insomnia might be gone..but you definitely could have problems with and deficits in, for example, balance and eye movement coordination that are only found with the correct testing.

“What if my concussion symptoms don’t resolve after 30 days?”

You may NOW have Post-Concussion Syndrome (PCS).

“Post-Concussion Syndrome” is a real diagnosis. The ICD 10 lists the criteria:

• Must have at least 3 symptoms present for 4 weeks following the head injury.
• MUST have a loss of consciousness—read that AGAIN. To be diagnosed with PCS you must have had some loss of consciousness. No LOC = no PCS.
• Symptoms in 3 or more of the following symptom categories:
— Headache, dizziness, malaise, fatigue, noise intolerance, Irritability, depression, anxiety, emotional lability (mood swings)
— Concentration, memory, or intellectual difficulties without neuropsychological testing evidence of marked impairment
— Insomnia
— Reduced alcohol tolerance
— Preoccupation with above symptoms and fear of brain damage with hypochondriacal concern and adoption of sick role

The DSM IV uses these criteria for Post-Concussion Syndrome:

1. History of TBI causing ‘significant cerebral concussion’
2. Cognitive impairment in attention or memory
3. At least three of these eight symptoms:
- fatigue
- sleep disturbance
- headache
- dizziness
- irritability
- affective disturbance (mood disturbance)
- personality change
- apathy

About 10 to 20% of all mTBI/Concussions will develop Post-Concussion Syndrome (these are the patients I see in my practice). The are

…the Walking Wounded …the Miserable Minority

…because their concussion symptoms didn't go away after 10 days, or 2 weeks, or 4 weeks.

Of these Post-Concussion Syndrome patients, 25 to 33% of them may develop permanent brain injury!

In my patients--and this matches up with what the research has found--here are the most common symptoms of patients with Post-Concussion Syndrome:
• Fatigue
• Dizziness
• Vision problems
• Headache
• Trouble concentrating
• Anxiety
• Memory loss
• Neck pain
• Insomnia/sleep disturbance

Next in the Concussion Awareness Series: "What's wrong with me? What's causing this Post-Concussion Syndrome?"

[How is a Concussion diagnosed?] - There are no blood tests to diagnose a concussion...and MRI or CT scans almost never show anything wrong…so how IS a concussion diagnosed?

Here’s the checklist most researchers and doctors have agreed on:
✔️ Injury to head (a shaking injury from a direct blow on the head/face/neck, or from forces transmitted TO the head)
✔️ Symptoms - headache, dizziness, ataxia, brain fog, trouble concentrating/remembering, irritability, insomnia, vomiting
✔️ Loss of consciousness — anywhere from 0 to 30 minutes.
✔️ Post-injury amnesia for less than 24 hours
✔️ A Glasgow Coma Scale score of 15

Let me explain that last one…a Glasgow Coma Scale score of 15 would mean the concussed person can do the following:
1. Can open their eyes spontaneously—without being told to open the, or being physically prodded
2. Is able to same their name, the date and place —all three of those
3. Is able to follow a 2 part command - like “touch my finger, then touch your nose.”

Any WORSE performance than those 3 things, would be a score less than 15, which would indicate a MORE severe injury than a MILD TBI/Concussion.

So, using what the observer can see the injured person doing + what the injured person feels = diagnosis of concussion.

==> This is why a Concussion is called “The Invisible Injury.”

Concussion injuries can be further diagnosed and categorized into 3 Grades of severity.

Grade 1 -
• No loss of consciousness.
• Considered a “mild” concussion.
• The symptoms last LESS THAN 15 MINUTES FROM THE TIME OF THE INJURY. The classic “getting your bell rung.”

Grade 2 -
• No loss of consciousness.
• Considered a “moderate” concussion.
• Symptoms last LONGER THAN 15 MINUTES FROM THE TIME OF THE INJURY.

Grade 3 -
• ANY amount of loss of consciousness. Even if only for a few seconds

• Considered a “severe” concussion no matter how long the symptoms last. So, “LOC” is the key for a grade 3 concussion.

If you think someone's had a concussion, GET THEM EVALUATED IMMEDIATELY.

Next in the Concussion Awareness Series:
"How Long Does a Concussion Last?"

[What are the Signs & Symptoms of a Concussion?] — The symptoms of a concussion come on rapidly and may progress over a few hours.

Researchers generally agree that the following are SIGNS of a concussion—in other words, what an observer could see in a person who’s suffering a concussion:

• Vacant stare — "the thousand yard stare", "nobody's home"
• Unresponsive to questions (“Are you okay? Can you hear me?”)
• Wobbly legs, trouble walking or maintaining balance (technically called “ataxia)
• Loss of consciousness — from a few seconds to 30 minutes
Amnesia - loss of memory

This next list is what the person suffering the head injury could FEEL due to a concussion--the symptoms of a Concussion:

• Headache- diffuse, all over
• Vomiting
• Dizziness
• Feeling like you’re in a fog
• Irritability
• Slowed reaction time
• Difficulty concentrating
• Difficulty remembering
• Insomnia

=> PAY CLOSE ATTENTION TO THIS NEXT BIT:
The symptoms of a concussion are NOT necessarily related to STRUCTURAL damage. So, 99% of the time CT scans and MRIs will NOT show anything wrong. But—you can certainly feel terrible and have actual problems even if the imaging is “negative.”

[What is a concussion?] - A low speed (but not always) injury that causes shaking of the brain. This could be a DIRECT hit to the head, face or neck. Or, this “shaking of the brain” could be caused by a blow somewhere on the body, and the FORCE is transmitted to the head.

NAME GAME--A concussion is a kind of MILD TRAUMATIC BRAIN INJURY. So the terms ‘concussion’ and “mTBI” are often used interchangeably.

Obviously, sports are a a common way to suffer a concussion: football, gymnastics, cheerleading, hockey, rugby, lacrosse, wresting, soccer (headers).

Car crashes are also common sources of concussion. There’s of course hitting your head on the steering wheel or the inside of the car. You can also suffer a concussion from a whiplash—violently accelerating and decelerating.

Falls and accidents are another major source of Concussions (stairs, playgrounds, swimming pools).

“How many people suffer concussions each year?” — Recent estimates from 2015 say that about 3,000,000 mild Traumatic Brain Injuries occur each year. This means hundreds of thousands of trips to the ER, urgent care, family doctors.

Sports concussions account for 53% of all head injuries under age 19.

Concussions can have devastating effects on your work and home life. About 50% of patients suffering a mild TBI can NOT return to their pre-injury jobs at 2 weeks after their injury.

At one month after injury, about 26% of patients with a mild TBI can’t return to their pre-injury job. This obviously can be financially catastrophic.

Look for the next post in this series "Concussion Symptoms" and "How Concussions are Diagnosed."

Dr. David Clark, DC-Triangle TBI Concussion's cover photo

Dr. David Clark, DC-Triangle TBI Concussion