Saturday, October 1, 2022

POST-CONCUSSIVE SYNDROME /The Brain-Gut Connection (Part 1)

This video is a segment of the 2022 BRAIN HEALTH Educational Series published at the IPHA/Health & Healing 101 Report. The program presents interviews about Post Concussive Syndrome from health professionals and advocates detailing the diagnostic protocols for acute and chronic sports related injuries plus an overview on the current findings about mental disorders associated with head trauma.

By: Dr. Michael Gruttadauria

Most people believe that you need to be knocked unconscious to have a concussion- and that's just not the case.  Even a “small” impact injury, what they call mild traumatic brain injury or mild concussion affects thousands and thousands of people every month.  From falls accidents, sports, assaults-- many different things can cause concussions.

Something called POST-CONCUSSIVE SYNDROME can happen from these mild traumatic brain injuries that may appear to resolve themselves. As far as the symptoms go, most people end up with headaches, blurry vision, dizziness or lightheadedness. After about a week, these symptoms tend to usually go away. But up to 30% of people have persistent symptoms. And those persistent concussion symptoms can be the same things like headaches and dizziness, but it actually can progress into anxiety and depression and changes in personality and so on.

This is really when we need to get involved.

The traditional recommendation and prevailing wisdom for a long time was actually to just take it easy, stay in a dark room and rest-- don't do anything exertional and stay off the computer. Don't watch too much TV and your brain will just heal.   Lately, we find that this is no longer the case. You may want have physiological rest, but then what you really want to do is have ACTIVE rest, which is allowing the brain to work- pushing the brain to work.

There are physiological changes that go on in the brain when you have a trauma. When you have this initial injury (and depending on the extent of the blow to the head), you have changes in the micro environment within the brain. You also can have an actual bruise. You can have changes in blood vessel diameter. You can have torn blood vessels. With concussion, most of these things are invisible.  MRI and CT scans are usually negative- and patients are usually sent home from the ER and told to rest.  No follow ups are assigned from this point, and this is where we need to do better.

Once we get this clear diagnosis that you had a concussion, we need further studies and objective findings such as continued diagnostic imaging. Where the standard imaging protocols of today often leaves people to their own devices, what they don't realize is that this blow to the head causes changes that actually can affect them for the rest of their lives.  Quite often I'll have people who come to see me with anxiety or depression or Dysautonomia or migraine headaches, and upon my consultation with them, I would find that they had a history of being hit in the head years ago- but was not diagnosed with concussion then. They do not realize that something like this blow to the head that didn't really seem to be so overwhelming at the time can actually change so many things about their life down the road.

With high impact sports like boxing and football and soccer, where you have repetitive blows to the head, there are studies that are actually show that repetitive concussive forces can actually be additive. You can have an additive effect. It doesn't have to be one giant impact where you might see a wide receiver going over the middle and catching a soccer ball.

Getting violently laid out by a linebacker may not even be as bad as the offensive and defensive linemen that are banging their heads against each other for 60 plays a game, per se. We we're all differently susceptible to concussion. Somebody could have what would appear to be a more minor concussion and have greater symptoms for a longer period of time, as opposed to a really significant concussion.

I had a 32 year old former professional hockey player see me for ongoing symptoms that he related back to the multiple concussions that he sustained from a game. He had been traveling around the world and had access to the top doctors. Over time, he contracted persistent headaches, balance problems and dizziness that really began affecting his life. It actually forced him out of hockey.

Between his hockey career and his present life, he self-medicated the compounded set of problems that just weren't going away. These symptoms are never really looked at objectively because many physicians are not necessarily equipped to look too deep for dysfunctions, diseases or damage this complex. The patient ended up having a chronic gastrointestinal problem as well as an inner ear problem. And these two things are more functional in nature. These would not appear in an MRI or a CT Scan.  What we realized was that the GUT-BRAIN CONNECTION was so powerful. When we put him on an anti-inflammatory diet and we did eye-based and balance-based rehabilitation within two months, all of his symptoms disappeared.

We know that within 12 hours of having a concussion, you end up with a leaky blood brain barrier. And as a result, the, the same proteins and the same chemistry that holds the blood brain barrier together also holds together another barrier- the intestinal lining. So if you have an inflammatory diet and many of these young athletes do (they don't eat so well) all of a sudden you have foods like gluten and dairy and sugar and alcohol that we know to be inflammatory in nature. They are now easily passed through the gastrointestinal, lining into the bloodstream and are able to cross into the blood brain barrier. And now what we end up was a chronic inflammatory irritation of the brain. That's really more chemical than it is as a result of the initial trauma. And if we don't work on fixing the gastrointestinal dysfunction, the brain trauma never truly resolves. (see expanded article on Brain-Gut connection by Dr. Robert L. Bard)

In other patients, we look at the neurology, the biochemistry, the inflammation, the gut and the microbiome.  By fixing the microbiome and changing their diet, experience has shown that all of their concussion symptoms go away. So if we're not looking at the gastrointestinal system, we're literally missing 50% of the problem.

10/1/2022- In collaboration the Bard Diagnostic Imaging (NYC), diagnostic imaging specialists, neurologists and neuropsychologists are now in the process of assembling a comprehensive set of mutli-modality diagnostic protocols and specific physiological scan points for the study of POST-CONCUSSIVE SYNDROME.  This review covers the establishment of imaging base line studies and a formal analysis of hemodynamics that offer quantifiable evidence from non-invasive modalities. 

One of the primary studies is the use of ultrasound technologies including the Transcranial Doppler for the Basilar Artery, the Extracranial Doppler for the Temporal Artery and the Transorbital Doppler for  the ophthalmic and central retinal vessels.  These areas of the head provide essential blood flow readings for the detection of abnormality from latent effects of potential impact.  

“Looking at the arterial-venous ratio and getting baseline is a great tool. Then, doing functional neuro interventions to enhance frontal lobe function (like cerebellar stimulation with complex upper body movements or specific vestibular canal stimulation) can create changes in the AV ratio and show positive correlation with symptom reduction”, states Dr. Mike Gruttadauria in an earlier interview

Dr. Robert Bard explains his prime strategy for scanning with ultrasound. "We need to position the probe to the lower/back of head- where the basilar artery is available. This blood vessel supplies oxygen-rich blood to areas of the brain and the autonomic/central nervous system.  Next, we position the TCD probe to the temporal region, where temporal artery is available. This is located just anterior to the ear, and is a guideline that is used by most practitioners to examine blood flow to the brain & measurement of cardiac cycle. We identify the heart rate or the pulse also shows that the extracranial blood flow is intact as it goes towards the eye. Afterwards, we position a LINEAR probe to the OPTIC REGION- specifically to study the optic nerve to show the paucity of the vessels in the central retinal artery and choroidal vessels."

Clinical Spotlight: Concussion Management

10/16/2022- In a recent collaborative study of sports-related brain injuries, Dr. Alex Gometz (NYC) Founder Concussion Management of New York recently joined Dr. Robert Bard to conduct an investigative study about new imaging protocols recording pathologies of brain trauma.  During this study, Dr. Gometz shared his clinical insights on concussion management with The Integrative Pain Healers Alliance (IPHA).

Meet Dr. Alex Gometz: Review on Athletic & Pediatric Concussion
Dr. Gometz' practice is focused on the diagnostics and management of concussion in the athletic population and the pediatric community.  During an exclusive interview, he reflected on the current guidelines covering patient analysis and the heavy pressure on professional athletes to return to play. "Obviously the league and fans want players to play. (I feel that) they need to have clearer guidelines based on better facts for the sake of the well-being of the player. I find that the current protocols may not be adequate, given the new research that shows recovery time may take longer. Studies show that protocols should be more sensitive to each player’s individual vulnerabilities. This is new research that should be taken into consideration and used to adapt the current protocols".

As an avid student of therapeutic advancements, Dr. Gometz is committed to staying on top of the latest clinical innovations and treatment modalities.  On the care of MSK issues, regenerative therapies like PRP & EXOSOMES as well as non-invasive energy treatments like SHOCKWAVE, PEMF (Electromagnetic Field therapy), COLD LASER among others are well established in the market.  But due to the fast paced progress of this industry, Dr. Gometz finds that not all practitioners are able to keep up with the latest innovations - especially when it comes to technologies that offer new ground in the resolution of concussion symptoms. 

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