Health Resource Digest

Friday, October 7, 2022

What's New in Breast Cancer Detection?

NEWS FROM THE FIELD

The DENSE BREAST TISSUE / CANCER CONNECTION is a topic that has finally achieved proper recognition in our community. Thanks to organizations like The 'ARE YOU DENSE?' Foundation, awareness of this health concern has now shed light to the risk to 40+% of the national women's population whereby more clinicians are now recognizing the need to state a patient's dense breast status. Research crusaders like Dr. Noelle Cutter and research associate Alexandra Fiederlein from Molloy University are underway the 2022 National Survey of Dense Breast Studies by bringing ultrasound access to underserved members of the women's community.

In a recent episode of SPOTLIGHT ON AMERICA, Dr. Bard spoke as the clinical expert in the report "Millions of women have this breast cancer risk factors... why aren't they being informed?" -- TND REPORT/Spotlight on America is pressing to ensure women have access to a crucial health fact that could save their lives. According to the Centers for Disease Control and Prevention, 40% of women have dense breast tissue, which is a risk factor for cancer. The TND team first highlighted this issue in October 2021, and more than a year later, we expose how some women are still being left in the dark about their density, and federal health bodies are failing to make sure they’re informed.

Prologue: UNDERSERVED AGE FOR EARLY DETECTION

By Dr. Robert L. Bard and Joe Cappello of AreYouDense.org

Decades into the battle against breast cancer, clinicians and the public are much more educated about EARLY DETECTION, PREVENTION and the current protocols and modalities available to save lives. Recent headlines on DENSE BREAST and the advancements in ULTRASOUND SCANNING supports a major part of this battle.

A major concern is the presence of breast cancer in underserved communities, including those TOO YOUNG FOR A MAMMOGRAM. Whereby the medical community touts the recommended (and legal/billable status) of getting a mammo scan should be between 40-50, what happens to the many women who do not fit this age criteria? How would they even know to get checked without the support of their clinicians or an alarm from family history?

According to Breastcancer.org, "Where mammography is available, ultrasound should be seen as a supplemental test for women with dense breasts who do not meet high-risk criteria for screening [with] MRI and for high-risk women with dense breasts who are unable to tolerate MRI... but if mammography isn’t available, then ultrasound seems to be a good alternative for breast cancer screening."

Doppler Sonography offers clinical accuracy and access
to breast imaging evaluation (www.breastcancernyc.com)

A recent cohort study is underway under a partnership between Molloy College and AreYouDense.org to publish new findings about low BMI patients and younger women about the presence of dense breast tissue. This same review also covers the advantages of ultrasound use where mammography is not available.

Mammography is the current standard for breast cancer early detection for women 40 & older. Recent studies have shown nearly half of all women who get mammograms are found to have dense breasts, exposing this population to the risk that mammograms may miss potentially cancerous tumors concealed by dense breast tissue. Dr. Cutter's initial concepts to target LOW BMI (bet 12-22% body fat) was personally inspired. As an active TRIATHLETE, her own diagnosis sparked her survey and inquiry throughout the athletic community where she uncovered a significant trend that became the basis for this research. She wishes to target younger women, athletes and members of underserved communities. "Younger women may be more likely to have dense breasts... also I find athletes with LOWER BMI (body mass index) or those with less body fat are more likely to have more dense breast tissue compared with women who are obese." (See complete feature article)

VIEWPOINT

WHAT ABOUT IF YOU'RE TOO YOUNG FOR A MAMMOGRAM? I went to my doctor for a lump I felt in my breast and she gave me a response that set off red flags: "don't worry about it". Being a researcher involved in breast density and breast cancer, I knew that I had to take action; I was fortunate enough to have my breast ultrasound training with Dr. Robert Bard (cancer imaging specialist, NYC) upcoming in the next week. Dr. Bard showed me how to use the ultrasound to help me find two benign tumors in my breasts, and it was there that he reported that I have dense breasts. Had I not taken action in getting screened at the young age of 22, I would have never known that I should be getting screened via ultrasound every 6 months (because having dense breasts puts me at a higher risk for breast cancer), nor would I have known that I had benign breast tumors.

- ALEXANDRA FIEDERLEIN, 22

Cancer Researcher/ Graduate- Molloy Univ.

2022 REVIEW ON WOMEN'S EARLY DETECTION STANDARDS

Excerpt from the 2021 NYCRA Dense Breast Diagnostic Conference By: Dr. Roberta Kline

Breast cancer is still one of the most common cancers in women, and the leading cause of cancer mortality. While mammography is considered the standard imaging for early detection, it falls short for many – including those with dense breasts. Approximately 40% of women have dense breasts, which we now know is associated with an increased risk of breast cancer. On top of this increased risk, mammogram is less sensitive for early detection – up to 50% less for women with the highest breast density. [1] As a result many women are not diagnosed until they have a much later stage cancer – and a worse prognosis. [2]

The State of Connecticut passed legislation requiring notification of breast density in 2009, after having passed legislation requiring insurance coverage for ultrasound for dense breasts in 2005. As an ObGyn physician practicing in CT at the time, I remember the discussions with colleagues and patients around this issue although at the time there were no formal efforts to raise awareness or update guidelines from our national specialty organization, the American College of Obstetricians and Gynecologists (ACOG).

PERSPECTIVE: PERSONAL FINDINGS BY A CLINICAL PROFESSIONAL

I was fortunate to have benefited personally from this effort when I had my first screening mammogram shortly after the law went into effect. The reading radiologist personally informed me of my high breast density immediately after the mammogram, and after recommending a breast ultrasound for further evaluation this was done right then and there. I walked away from my appointment feeling well informed, and any potential anxiety relieved by the prompt additional imaging and results. I also knew that I needed a different approach for my screenings going forward.

Between 2009 and 2019, 37 other states and D.C. passed legislation requiring notification of breast density, one of the last being my new home state of New Mexico. In 2019 a federal law was passed to require both clinician and patient reports contain plain language around the woman’s breast density, and to discuss with her provider. The FDA then created standard language that has now been implemented, requiring reporting on a woman’s individual breast density, and recommendation to discuss with her provider.

There is still much to be learned about what causes dense breasts and why women with dense breasts have an increased risk of breast cancer, and our ongoing study is one of many that are seeking to answer these questions at the molecular and genetic level. But the evidence that supplementing mammograms with other imaging modalities can increase the rate of early detection is substantial, and provides us with tools we can use right now to make a difference. [3,4] Despite this progress, there are still significant hurdles in changing the standard of care. A recent experience with my routine breast cancer screening highlighted the ongoing challenges. When I had asked to schedule an ultrasound with my screening mammogram, I was informed that it was not done this way – I could only get a mammogram. After my mammogram, I had to wait to receive my letter in the mail approximately one week later to be able to take any additional steps. The interpretation included a description of breast density and recommended to discuss any additional care with my physician.

When I called to schedule an ultrasound, I was told that since the radiologist did not recommend it in the report, I could not schedule it. I then had to speak with my primary care provider, educating her on dense breasts and why I needed an ultrasound. Luckily, she agreed to order one. While the radiology facility still questioned the order, eventually I was able to have this done. When the radiologist came in to discuss my results, she too was confused as to why I was having the ultrasound, and was not aware that this should be standard for women with dense breasts.

See 2022 Dense Breast Ultrasound Study

Fortunately all was fine, but had I not been a physician that was fully aware of this issue, I would very likely have had only a mammogram and walked away with a dangerously false sense of security. This experience highlighted for me how much still needed to be done more than 20 years after my first experience. Legislation is only part of the solution. Clinician education and public awareness are the keys to changing how the intention behind these laws gets translated into actual change in health care.

As I experienced, many clinicians are ill-informed about the nature of dense breasts, and options for adjunctive screening including ultrasound or MRI. This means that many of these reports end up being filed away with no further action being taken that could make a significant difference in early detection and saving lives.

EPILOGUE: CURRENT STANDARDS VS NEEDS

ACOG still officially does not recommend any further imaging for women with dense breasts on mammogram, despite the significant body of evidence suggesting that mammogram alone is insufficient and adjunctive imaging with ultrasound or MRI increases rate of early detection. [5] The U.S. Preventive Task Force [6] does not recommend routine adjunctive imaging for screening women with dense breasts. This leaves many healthcare practitioners, from ObGyns to other primary care providers, unprepared to discuss this with their patients or provide sound recommendations.

The American College of Radiologists, who also publishes the BIRADS standards for breast cancer screening, acknowledges awareness of breast density detection issues with mammography but stops short of recommending routine adjunctive imaging. Instead, they list ultrasound and MRI as “may be appropriate”. [7] We have enough evidence to know how to better serve women with dense breasts, and we can do better. Now we need to push for better education of all primary health care providers, including ObGyns, and continue to raise awareness for women around current knowledge and best practices.

References

1) Gordon PB. The Impact of Dense Breasts on the Stage of Breast Cancer at Diagnosis: A Review and Options for Supplemental Screening. Curr Oncol. 2022 May 17;29(5):3595-3636.

2) Chiu, S.Y.H.; Duffy, S.; Yen, A.M.F.; Tabár, L.; Smith, R.A.; Chen, H.H. Effect of baseline breast density on breast cancer incidence, stage, mortality, and screening parameters: 25-Year follow-up of a Swedish mammographic screening. Cancer Epidemiol. Biomark. Prev. 2010, 19, 1219–1228

3) Harada-Shoji N, Suzuki A, Ishida T, Zheng YF, Narikawa-Shiono Y, Sato-Tadano A, Ohta R, Ohuchi N. Evaluation of Adjunctive Ultrasonography for Breast Cancer Detection Among Women Aged 40-49 Years With Varying Breast Density Undergoing Screening Mammography: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2021 Aug 2;4(8):e2121505

4) Mann, R.M., Athanasiou, A., Baltzer, P.A.T. et al. Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI). Eur Radiol 32, 4036–4045 (2022).

5) Management of Women With Dense Breasts Diagnosed by Mammography. ACOG Committee Opinion. CO Number 625 March 2015

6) https://uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening

7) American College of Radiology ACR Appropriateness Criteria® Supplemental Breast Cancer Screening Based on Breast Density. 2021

Feature: Diagnostic Tech Review/News:

TRACE4BDENSITY® − THE RADIOLOGISTS’ GUIDED ARTIFICIAL INTELLIGENCE TOOL FOR THE AUTOMATIC DENSITY CLASSIFICATION OF MAMMOGRAMS

One relevant challenge in using mammographic breast density as a driver to supplemental screening with manual or automatic ultrasound, MRI, contrast-enhanced mammography, or other new diagnostic methods is the suboptimal reproducibility of visual classification into the four ACR (Americal College of Radiation) BI-RADS® categories. This is an important problem, especially considering that the last BI-RADS® manual does not base the breast density classification on a pure semiquantitative assessment of the fibrogladular to fatty tissue ratio but takes into consideration the possibility of a masking effect of also limited areas of dense tissue that may obscure underlying cancers. Therefore, artificial intelligence (AI) methods are the best candidate to mimic the qualitative human reading aiming at reducing the risk of a delayed cancer diagnosis, providing an immediate breast density classification with a 100% reproducibility.

DeepTrace Technologies SRL (http://www.deeptracetech.com/), the multi-awarded university spinoff of the IUSS School of Pavia, Italy, developed an AI software for automatic breast density classification using a deep learning approach, i.e., supervised convolutional neural networks: TRACE4BDensity®. The system was trained using the majority breast density category determined by seven board-certified radiologists who independently visually assessed 760 mediolateral oblique images. The model showed an accuracy of 89.3% in distinguishing BI-RADS a or b (nondense breasts) versus c or d (dense breasts) categories, with an agreement of 90.4% and a reliability of 0.807 (Cohen κ) compared with human readers. The clinical study that used TRACE4BDensity has been published in Radiology Artificial Intelligence 2022[1] and recently presented at the European Congress of Radiology in Vienna on July 16, 2022.

From A to D: examples of human readers (HR)–artificial intelligence (AI) agreement. TRACE4BDensity showed a 89.3% agreement and a reliability of 0.807 (Cohen κ) with human readings for the differention of dense breasts (category c or d) versus nondense breasts (category a or b). Radiol Artif Intell 2022 (doi/10.1148/ryai.210199).

The software can be directly applied to the PACS of radiology centers providing the breast density category in a few seconds with 100% reproducibility, allowing breast radiologists to overcome the limitations of human reading that unfortunately may give different answers to the crucial question: Are you dense? In addition, this approach can be considered more fitting with the aim of avoiding delayed cancer diagnoses than methods purely based on quantitative assessment of fibroglandular and fatty breast tissue that may underestimate the masking effect of localized high- density areas. Such an accurate tool, proposing a standardized density classification, represents a valid help in the decision-making process and in proposing a more personalized breast cancer screening. «TRACE4BDensity can help us to provide advice to women with dense breasts about the possibility of having, after a negative mammogram, additional screening with ultrasound, MRI, or contrast-enhanced mammography − explains Professor Francesco Sardanelli, head of the Diagnostic Imaging Service at the IRCCS Policlinico San Donato, coordinator of the Gruppo San Donato Breast Imaging Joint Research Unit, and full professor at the University of Milan, principal investigator of the study − This software, therefore, proves useful for radiologists as well as for women and patients».

References:

1) Development and Validation of an AI-driven Mammographic Breast Density Classification Tool Based on Radiologist Consensus, https://pubs.rsna.org/doi/10.1148/ryai.210199

CONTRIBUTORS:

DR. ROBERT L. BARD has paved the way for the diagnostic study of various cancers both clinically and academically. He runs an active NYC practice (Bard Diagnostic Imaging) using the latest in digital Imaging technology which has been also used to help guide biopsies and, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered Sonograms, Spectral Doppler, sonofluoroscopy, 3D/4D Image Reconstruction and the Spectral Doppler are safe, noninvasive, and does not use ionizing radiation. His commitment to lead the community of cancer imaging and diagnostic experts has led to the establishment of the "Get Checked Now!" campaign.

JOSEPH J. CAPPELLO married Nancy Marcucci, in 1974 and the story began. Joe is the co-founder and executive director of Are You Dense, and Are You Dense Advocacy- in January of 2019 after Nancy’s passing from treatment related bone marrow cancer (MDS). His passion is to continue Nancy’s legacy by pursuing the goal that they set in 2004; that not one woman would die from a late stage breast cancer due to dense breast tissue. In 2009, Joe and Nancy championed the first in the nation breast density inform law in the State of Connecticut (and now, 36 States have breast density legislation).

ROBERTA KLINE, MD (Educational Dir. /Women's Diagnostic Group) is a board-certified ObGyn physician, Integrative Personalized Medicine expert, consultant, author, and educator whose mission is to change how we approach health and deliver healthcare. She helped to create the Integrative & Functional Medicine program for a family practice residency, has consulted with Sodexo to implement the first personalized nutrition menu for healthcare facilities, and serves as Education Director for several organizations including the Women’s Diagnostic Health Network, Mommies on a Mission.

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Monday, October 3, 2022

Sports-Related Concussion (Part 2): BRAIN-GUT CONNECTION

Have You Heard of the Term "YOUR SECOND BRAIN"?

Gut-Brain Axis: By Leslie Valle, MD

To heal from chronic conditions, it is essential to approach the gut-brain axis as an integral system. Some of us don’t know that most of the symptoms we suffer can be reversed by resetting our gut. Brain fog, fatigue, mental health issues, mood swings, inflammation, short-term memory loss, neurodegenerative diseases, and cognition can result from an imbalance in our gut microbiome (gut bacteria).

The two-way biochemical communication that takes place between the gastrointestinal tract and the central nervous system, the gut-brain axis (GBA), is influenced by microbiota. For example, during a stressful event or exciting short-term event one might experience cramping, nausea, or even diarrhea.

This second brain (our gut), composed by immune, endocrine, and neuronal components, will alert when an imbalance (dysbiosis) in the gut microbiome has been identified. Constant microbiota fluctuations change our gastro intestinal terrain, and influence our judgment and well-being. For example, when our good bacteria are out of proportion with the bad bacteria in our gut, there is no production of anti-inflammatory antioxidants to help the body get over trauma. Thus, bad bacteria begin to flourish, releasing toxins and increasing inflammatory responses in our body which can circulate back through our blood and back to our brains.

Consequent gastrointestinal dysbiosis results in chronic inflammation that leads to brain degeneration.

CONTRIBUTOR:
LESLIE VALLE, MD - Founder of Biomed Life/ Santa Barbara Longevity Center
After medical school, Dr. Valle focused on managing chronic disease starting with its links to poor nutrition and then introducing them into the world of energy frequencies. She explores and includes non-invasive modalities such as: frequency therapies (including biofeedback), PEMF, proper detoxification, nutritional guidance and binaural beats as needed. - visit: www.biomedlifesb.com

MENTAL ISSUES FROM POST CONCUSSIVE DISORDER

Pre-existing mental conditions make the diagnosis and treatment more delicate. The underlying condition can challenge the client and healthcare provider to meticulously investigate the efficacy of each component of testing and treatment choices, timing, and tolerance. Certain preexisting mental health conditions can be characterized by similar dysfunctions caused by brain injury. On the side of treatment, some of those same conditions and understanding response to treatment can vary, fostering inaccurate expectations when it comes to recovery time. Another issue is the possibility of medications side effects that can also be similar to symptoms of a concussion, adding complication to the prognosis or discharge. Lastly, the availability of treatment choices can be greatly limited as some can be contraindicated- perhaps due to an abundance of precautions affecting clinical decision making.

Source: Health Resource Digest: 10/16/2022- Clinical Spotlight: Concussion Management

Introduction

Part 1 of this Brain-Gut Connection was launched by Dr. Michael Gruttadauria's review on sports related concussions and his findings that link the health condition of the GUT with the symptomatology of the head impact injury (see part 1). To continue, imaging diagnostic specialist Dr. Robert Bard concurs with Dr. Gruttadauria's science by presenting current expanded studies on this very connection. This is recorded by the use of non-invasive imaging called elastography as well as the 3D doppler blood flow ultrasound. Recognizing the holistic and integrative physiology that comprises our very wellness confirms the link between latency symptoms of past concussions and other culprits to related illnesses that are prompted by metabolic reactions and biological data including antigens, antibodies, electrolytes, enzymes, inhibitors etc.

GUT IN HEALTH

By: Dr. Robert L. Bard

The intestinal system is now recognized as a major factor in the immune system. New ultrasound imaging advances allow imaging of the gut wall layers, internal vasculature and areas of inflammation and post inflammatory fibrosis with structure formation. High resolution probes visualize the various segments of digestion for scar formation and the shear wave elastography quantifies the degree of fibrosis. This exam may be performed endoscopically or by transabdominal probes depending on the location of the organ and type of pathologic process. Certain areas, such as the appendix, are quickly evaluated for appendicitis with high accuracy on CT studies.

Other organs like the pancreas are examined with endoscopic MRI for silent cancers. Inflammatory markers of active disease are studied with Doppler flow hemodynamics including 3D measurements of the inflammatory arteries attacking the swollen bowel wall. Disease such as Crohn’s disease, irritable bowel syndrome (IBS) and diverticulitis are accompanied by an influx of feeding vessels. The more arterial flow in the affected area signifies the likelihood of greater bowel infection leading to exterior wall adhesions which may obstruct or strangulate adjacent healthy small bowel loops. Fistulae, abscess and cancers may be observed with real time sonographic evaluation in quick non invasive scanning sessions.

ELASTOGRAPHY: ADVANCING ULTRASOUND TO SCAN THE GUT:

Developed in Europe and Japan 20 years ago sonography of the GI tract was slow to be adopted in the US. As of 2 years ago, only one center in New York City was performing outpatient elastography for colitis, IBS and Crohn’s disorder. There are many levels of sophistication in Doppler flow imaging as well as elasticity measurement and the clinical subtype will guide the probe application. Wide usage in cancer detection of the thyroid, breast, prostate and skin has made screening popular worldwide. Often a biopsy will be avoided by a negative elastogram report. Cancers are hard and inflammation is soft which are readily observable endpoints on elastographic studies. Elastography is applicable to examining the pediatric brain as sound easily penetrates the younger skull tissue.

ON POST-CONCUSSION SYMPTOMS

The underreported of bowel permeability to toxins in concussion is likewise mostly anecdotal. The possibility of scanning the gut for increased blood flow following brain trauma may be easily performed as followed as a guideline for evaluation of concussion chronicity. As the bowel activity is regulated by the autonomic nervous system we may apply the same diagnostic endpoints as other physiologic norms. The response of the microvasculature in the retina provides a functional guideline as to the progression of brain trauma and concussion as measured by blood flow. The application of optical devices and sensors for physical (temperature, respiration, heart rate, blood pressure) chemical (pH, pO2, glucose, lipids, oximetry) and biological (antigens, antibodies, electrolytes, enzymes, inhibitors, metabolites, proteins) data with imaging (endoscopy, optical tomography, confocal microscopy) adds new classifications of metabolism in the altered state. The addition of wearable sensors and portable laser powered LED tools currently used by athletes are applicable to non invasive monitoring of the effect on the body by concussion indirectly. Surrogate markers are widely used such as analyzing the white blood cells to verify the infection is bacterial rather than viral. Similarly, there exists alternate options with high accuracy to move forward the immediate and long term effects of concussive injury.

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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.

POST-CONCUSSIVE SYNDROME 101
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.

HEAD IMPACT IN SPORTS

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.

SYMPTOMATOLOGY: The GUT-BRAIN CONNECTION

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.

FROM THE LAB: RESEARCH ON CONCUSSION IMAGING

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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Friday, September 2, 2022

MEDTECH REVIEW (PT3) WEARABLE MEDITATION DEVICE

EXPLORING A NEW HOPE IN WELLNESS & BRAIN HEALTH
Written by Josh Schueller, PT / Edited by: Graciella Davi

As a practicing Physical Therapist, I adhere to the philosophy of 'treating the whole person'. This means that when a patient undergoes some form of therapy, it is common to uncover a variety of facets to their injury or condition. The term “PHYSICAL therapy” can sometimes be conflicting as it suggests that the therapist only looks at the physical aspects. Many injuries are comprised of multiple layers and all of them need to be considered to restore normal functions.

Sufferers of ACL injuries (as an example) recover physically long before they are confident to run, jump, or cut without reservations. People who suffer injuries in a car accident may have a psychological component that ultimately limits full recovery. Traditional Physical Therapy does not usually have the means or time to focus diagnosing or treating the emotional or psychological components that can lead to chronic pain or dysfunction. This can lead to people suffering for years with chronic pain despite being healed physically.

I recently received a demo model for reviewing of a wearable device marketed as a brain fitness app and meditation aid (called BrainTap®). According to its literature and white papers, the engineers employ a confluence of BINAURAL BEATS, ISOCHRONIC TONES, HOLOGRAPHIC MUSIC and RED/BLUE LIGHT to affect the user’s focus, enhance sleep, and improve mental health. Through a “symphony of brainwave activity”, the various physical reactions lead to holistic healing, improved learning and productivity. The audio guide describes benefits like improved balance to the alpha (relaxed, intuitive and creative), beta (awake and alert), delta (deep sleep and recovery), gamma (peak concentration and cognition) and theta (healing).

BREAKDOWN OF THE ACTIVE FUNCTIONS
Based on my experience with this device, I took apart the featured integrated effects that make up this meditational program.

1. BINAURAL BEATS: essentially, it’s a form of sound wave therapy. It has two varying frequencies, one in each ear. The brain identifies the difference between the two and the science of this apparently leads you to experience a deep relaxed state.

2. GUIDED VISUALIZATION: Imagine getting a coach to train you on how to see with your mind, and to lift yourself into a positive mode. During the period of relaxation, the narrator/guide (Dr. Patrick Porter, the developer) helps you contemplate and explore the kind of mental images that helps you transcend ‘away from your current self’. I recognize the theory that visualization can improve mental, physical, sports performance, and even assist in body healing. Therapists use this tool with their patients often as a way to help them imagine an idea to manifest into reality.

3. 10-CYCLE HOLOGRAPHIC MUSIC- the quality headphones produces a 360 degree sound environment. This allows the visualization to become real in your mind creating an improved learning state.

4. ISOCHRONIC TONES- This is comprised of equal intensity pulses of sound separated by intervals of silence. Upon review, these tones are often used in other relaxation products because it is easy for the brain to follow.

5. LIGHT THERAPY- the device delivers light pulses that travel through the retina and ear medians. This sends direct signal to the brain. This concept appears in other energy therapies and has been recognized to increase serotonin and endorphin levels, linked to the improvement of mood, positive outlook and optimistic thinking.

FIRST IMPRESSIONS
There are a variety of wearable devices on the market to help you relax, clear your mind- and even sleep better. I took on the BrainTap review for several weeks and started assessing a random list of programs that the app offers. These where guided meditation that can take you through different modalities. The headset and visor deliver light therapy while the soothing, “Barry White-quality voice” brings you through the entire catalog of programs including sleep improvement, life mastery, weight wellness, optimal health, stress free-me, paleo lifestyle and many more. Each category one more inviting than the next.

In the middle of a work day, relaxing your mind takes effort. Perhaps by the very act of scheduling a specific part of my day to do this helped me adjust more easily. Unlike many headphones that are flimsy and not fitting right, I appreciated the solid weight of the unit because this felt substantial to firmly hug my head, eyes and ears and place me into that zone. The headset and visor are surprisingly comfortable and easy to wear. With the right sounds in my ears, I am able to create the proper environment, let it be improving your focus, your retention or relaxation. Once the program is chosen, you can relax as Dr. Porter takes you on your journey. I have taken on the advice of various YouTube testimonials who advise lying down in a relaxed physical position for best results. Each session takes around 20 minutes or so. Having listened to this uniquely composed music, the different beats and frequencies inspire thoughts and reactions throughout. It truly is a journey that brings up a visceral response.

I assess the experience like going through two different layers of consciousness and relaxation. As you travel through your mind, you become focused on one thing- which is the concentrated relaxation while your brain has a chance to wander through different parts of your inner self. That is not something we can usually do throughout our work day when we're surrounded by computers and phone calls.

RECOGNIZABLE EFFECTS / BEFORE & AFTER STUDY

The overall experience left me relaxed initially as I used the preliminary programs. Once the focus shifted to specific groups, I noticed some differences in outcomes. Because this is geared as personalized wellness, I chose to use the device during the afternoons when I normally experience the “hitting the wall “period of the day. I often start the use of the device (BEFORE) when I am distracted (too much on my mind), losing focus and decreased concentration- what I consider to align with poor mental performance. AFTER completing a session, I find myself to feel refreshed, focused, and relived of stress. Initially, the light through the visor was distracting but as my brain synchronized, I acclimated within a few uses and hardly notice it.

I observed that each BrainTap session is comprised of 3 phases:
- Initial relaxation- where the tension leaves your body
- Deep, relaxed sleep
- Focused and precise concentration

The time spent in the deep relaxed sleep decreases and the focused awareness increased the more sessions I completed. Overall, my sessions appear to affect the mind-body connection positively. Logic (and everything we know about personal balance and wellness) dictates that when the mind and body are not connected, increased stress and poor focus can occur. I can only imagine this is the sound logic that Dr. Porter pursued in his blueprints.

EPILOGUE:
The health of our mind can be a leading factor in our life. In my experience if you do not have proper brain synchronization your workout can be torpedoed before it even begins. This is the same with work. Other sessions including ‘weight wellness’ also provided surprising effects. I found myself to go several hours into the evening without craving food. The more sessions I completed, the more benefits I recognized. Over the last several weeks, I logged improvements in sleep, concentration and decreased stress and found the changes to be significant, noticeable and consistent.

This device review has been as much a positive experience about the technology, as it has been a profound reflection on our human condition. As many people spend endless hours on social media and media in general, the connection between mind and body suffers. The negativity and doomsday predictions can leave someone “uncalibrated”. This imbalance can increase stress and cause the body to suffer (pain). If the body is out of equilibrium, it becomes more susceptible to sickness, pain, and dysfunction. This BrainTap device may actually hold the answer (or at least a portion of it) in synchronizing the brain into a calibrated state. When the mind and body gets in sync, healing and recovery becomes possible. As the health and wellness model evolves, having the capability to promote brain and body health becomes vital to obtaining optimal results.