As the Old Saying Goes…
…If I had a dime for every time someone with concussion said “my doctor doesn’t listen to me”. Nearly every day in clinical practice patients report to me one way or another this very real concern. While this is true across all areas of specialty at our center, it is far more prevalent in those suffering the effects of concussion and post-concussion syndrome.
There are several theories as to why many doctors don’t take the time to listen. These can be explored at length with a simple internet search. Here, I will briefly explore some of these more accepted views and, more importantly, what I have come to see is the real truth behind why so many are being ignored, and in many cases dismissed, by their ‘trusted’ health care providers.
The Usual Suspects
- Time. Most primary care physicians are pressured by the demands of heavy patient loads and declining insurance reimbursements. That leaves you as the patient at the mercy of a provider that may only give you one minute or less to voice your concerns; which for those of you with concussion are often too many to list.
- Distraction. Electronic records, insurance forms, mobile devices, and excessive patient volume can cause doctors to get caught up in things that are not right in front of them. That is you, the patient. If a doctor is distracted, they will not do a great job at listening.
- Bias. It has been established that many doctors will spend less time with individuals based on race, gender, and other factors such as socio-economic status. Also, patients that come in with recurring complaints are more likely to be dismissed or ignored.
While I believe these are accurate (although unacceptable) reasons for many being short-changed when it comes to their health care provider’s attention; there are more specific reasons doctors don’t listen when it comes to the laundry list of life struggles that can accompany concussion and post-concussion syndrome.
The Real Story Doctors Don’t Listen to Those With Concussion
- Ignorance. This may seem like a harsh term to many (particularly the doctors), although it simply means that most primary care providers lack the knowledge and information necessary to properly question and screen for these types of conditions.
- Invisible. Concussions are not seen on CT scans or found in blood work. They are silent injuries that result in functional problems with balance, vision, cognitive abilities, and more. Conventional medical approaches are not well suited for these conditions; therefore, doctors are less inclined to listen to problems they cannot treat.
- Overwhelming. The number of symptoms and conditions that can result from a hit to the head are staggering (we’ve compiled a list of over 50!). Most doctors when presented with 5, 10, or more complaints may focus only on 1 or 2 as this is what they are accustomed to.
- Unknown. Even with all the attention given to concussion over the past several years in sports, the media, and movies, this is still uncharted territory for most providers in mainstream medicine. This is also true for many of the doctors those with concussion are being referred to.
So, What’s the Answer?
The internet is full of strategies to get your provider to listen better. This, however, is not the focus of this article. And, it will not serve you well to try and get those that don’t understand concussion to listen to you! What you need to do is seek out the services of a qualified functional neurologist who is well versed in the art of listening. And, who understands the multitude of symptoms those with concussion and post-concussion syndrome experience. Only then will you be able to get answers as to what the best method of treatment will be for you. Concussions are real, and so are the symptoms and solutions!
For more information please call us at 828.708.5274, or visit any of the following resources:
Day of Discovery
- Is your brain not working as well as it used to?
- Have you been struggling with a recent or lifelong brain performance issue that you want answers for?
- Or, do you simply want to know how well your brain is working to ensure it is serving you optimally?
- If you knew there was something you could do to tell, would you do it?
…If so, APEX Brain Centers’ comprehensive ‘Day of Discovery’ is just what you’ve been looking for.
What is it?
The Day of Discovery is an extremely valuable and critical investment in your health, longevity and prosperity. Fear of a declining brain is one of the top issues of our time, and this unique opportunity puts the power of informed guidance in your hands to make the best choices possible for your brain and body health. By investigating numerous ‘biomarkers’ of brain health and integrity, we are able to connect the dots between your experience of life and your current state of brain and body function.
Your Day of Discovery will include the following:
- Comprehensive history and review of previous diagnostic testing
- Comprehensive neurological exam looking at functions of the brain, spinal cord and peripheral nervous system
- Quantitative EEG (qEEG) for measurement of brainwave activity
- Cognitive testing to assess memory, attention, executive function and more
- Videonystagmography (VNG) for detailed assessment of eye movements
- Dynamic posturography for investigation of multiple aspects of balance
- Interactive Metronome testing of mental and physical timing capabilities
- Review of all testing with precise recommendations for appropriate intervention
What should I expect and how do I prepare?
Your Day of Discovery will take anywhere from 4-6 hours depending on physical ability, level of fatigue, technical factors and any unforeseen circumstances. You will spend the duration of the day in our office and should pack a healthy lunch/snack depending on time of day. You should do your best to obtain quality sleep prior to your Day of Discovery, refrain from alcohol/recreational drug/cigarette intake, maintain adequate hydration, eat a healthy breakfast the morning of testing, bring copies of any pertinent diagnostic tests with you, be on time to ensure the smoothest of transitions throughout the day, not wear any skin care products/make-up/hair gel, and bring a positive and proactive attitude with you as this day is designed to empower you with critical information to help you create positive change in your life; not to point out flaws in your performance!
Call us today at 828.708.5274 to set up your Day of Discovery, or email us at [email protected] for more information.
As the buzz surrounding the release of the projected Christmas blockbuster movie Concussion grows; the evidence continues to mount in support of the seemingly insurmountable challenges posed by this ‘silent epidemic’.
Continued reporting from one of America’s most trusted public television investigative news sources, PBS’s FRONTLINE, demonstrates the urgency of the matter at hand; and the extremes to which it can lead… Dementia and, in severe cases, death!
The most recent FRONTLINE update from September 18, 2015, based on research from the Department of Veterans Affairs and Boston University, can be viewed in their article entitled New: 87 Deceased NFL Players Test Positive for Brain Disease. The most shocking part of this reporting is that the disease, chronic traumatic encephalopathy (CTE), was found in 87 of 91 player’s brains tested. Let that soak in for a moment… That is 96% of the brains tested in this particular ongoing study showing signs of a potentially avoidable killer disease. We will come back to this in a moment.
Some definitions, facts, and stats to ponder:
- Concussion is a traumatic brain injury that alters the way your brain functions
- Most sport-related concussions (almost 90%) occur with NO loss of consciousness (LOC)
- A median 2.7 million TBIs occur in the US each year (think about how many go unreported), at a cost of nearly $50 billion annually
- Symptoms of concussion include: headache, dizziness, balance and speech problems, nausea, light and noise sensitivities, memory and concentration difficulties, behavioral and emotional struggles, and anything out of the ordinary observed that was not an issue prior to the event/s
- Risk factors for concussion include: prior concussion, vertigo/dizziness, alcohol/drugs, high-risk behaviors and sports (e.g. football, hockey, soccer, etc.), military conflict, abusive relationships, driving, and high-risk occupations (e.g. construction, utility work, etc.)
- Mild traumatic brain injury (mTBI) is another word for concussion; even though, in my opinion, there is no such thing as a ‘mild’ brain injury
- Chronic traumatic encephalopathy (CTE) is a progressive degenerative disorder of the brain found in those with a history of repetitive brain trauma
- Symptoms of CTE include: memory and executive function decline, depression, irritability, impulsivity, aggressiveness, suicidal behavior, eventual progression to dementia
(All facts and figures presented are courtesy of the Centers for Disease Control and Prevention and The Mayo Clinic)
***Did you know??? Those with ADHD are significantly more likely to experience worse outcomes with a concussion than their non-ADHD peers. This is of extremely important note as many children are placed in sports to control problematic behavioral and academic challenges. Read the abstract from a paper on this topic presented in the Journal of Neurosurgery: Pediatrics***
Back to the FRONTLINE reporting of 96% of the NFL players’ brains containing direct indications of CTE. What is being revealed in this ongoing study is one of, if not the most, statistically significant findings of our times. Consider for a moment if you will… If there were an outbreak of any communicable disease in a family, school, small town, cruise ship, or some similar controlled group separate from our general U.S. population; it would take, in most cases, less than 1% of the population being affected to mobilize critical resources to control and eliminate such an outbreak. Why is nothing being done to prevent and treat this largely controllable epidemic that has been unfolding before our very eyes for some time now?
While there is an extraordinary amount of activity and funding being directed towards this catastrophe, we are still largely no further along in the detection, advocacy, and treatment for this ‘silent epidemic’. As a clinician who has been in the trenches working with concussion and TBI for over 15 years, the stark reality is that the vast majority of patients that have walked through the doors of our Center have been given the same advice: “Wait and see”. That is, to go without treatment in hopes of symptoms subsiding; which, in rough estimates from various sources, will not happen in approximately 25% of cases! In other words, at least one in 4 will continue with any or all of the debilitating symptoms listed above long after a blow to the head.
Why “wait and see”? The primary tests utilized after one has sustained a hit to the head and suspected brain injury are structural in nature. What this means is if you have nothing that shows up on a CT scan or MRI, you are structurally ‘OK’ and sent on your own to wait out the symptoms – possibly with the assistance of medications for pain, dizziness, nausea, etc.
What are often overlooked, or not acted upon if they are in fact implemented, are tests of brain function. There are a great number of ‘biomarkers’ of brain function that can be measured with great precision – that is, tests that tell us what’s going on in the body as a result of commands from the brain; and what might not be working well after a particular region of the brain area has been injured. What follows are some examples of these biomarkers that can be measured and improved in most cases of concussion and TBI:
- Eye movements
- Physical timing
- Cognitive abilities (e.g. memory, focus, attention)
- Vital signs (e.g. heart rate, blood pressure, breathing)
- Blood sugar, hormone regulation, and other metabolic functions
Once functional deficits are identified; a host of neurological, cognitive, and metabolic rehabilitative interventions and processes can be employed to normalize these functions as best possible – and, in many cases, entirely! Examples of such would include: eye movement therapies, gait training, neurofeedback, physiotherapeutic modalities such as electrical stimulation and vibration, nutritional therapies, aromatherapy, visual and auditory training, meditation, lifestyle changes, and more.
While the quest continues to identify the best, evidence-based practices to combat this growing epidemic with little to no therapeutic intervention being rendered in most cases; there are a small number of progressive centers that strive to provide highly effective functional clinical interventions, as opposed to “wait and see” that has failed so many. Given the apparent lack of immediate shifts in the cultural circumstances that are causing brain injuries, and the inability or lack of desire of many to abstain from behaviors that are causing them, it is imperative that intervention with any head injury be focused largely on the therapeutic aspects once adequate healing time has passed.
One parting thought: There remains a sentiment in opposition to studies of the nature of the one referenced in FRONTLINE; dismissing the evidence as an overreaction to, and sensationalizing of, data from a highly specific group of individuals (i.e. football players get head injuries). My question to you is: If just one person in your family, community, etc. were to contract a disease like polio; do you think there would be any discussion of overreaction to the impending action that would be taken to remediate the cause of this potentially crippling disease?
If you knew there was something you could do, then why “wait and see”?
Whether they are running, cycling, swimming, auto racing, playing ball sports, or participating in weekend warrior contests; athletes of all shapes, sizes, and abilities have one thing in common. They all want to WIN!
The road to excellence in sports has changed quite a bit over the past several decades. The vehicles that bring athletes to their peak today look nothing like the horse and buggies that used to get them there. Sports performance is a high-tech, fast-paced, ultra-competitive industry where new advances in training the human body are popping up around every corner, in every discipline.
Today you may commonly choose to enhance your athletic performance through strength, agility, and endurance training specific to your sport, metabolic therapies, and possibly indulge in cross training and sports psychology therapy. But something is missing from this list. Something BIG. Something that could make all the difference in the world. Brain Training can help you achieve peak athletic performance. Training your brain to perform at a peak level is shaping up to be the biggest, and likely most important, aspect of training for ANY athlete. Brain Training can also amplify the effects of other training methods.
If you answer yes to any of the following questions, then you are ready to take the next step in your athletic training program:
1) Do I want to be faster?
Most sports require speed and endurance, and training your brain to be faster can be a game changer. Balance, coordination of movement, core stabilization (shunt muscles) and voluntary movement (spurt muscles), all controlled by your brain, are key factors in determining how fast your muscles will move your body. The more “tuned-up” these systems are, the faster you will be.
2) Do I want to increase my reaction time?
Advanced applications like the Interactive Metronome were designed to improve timing abilities in key areas of the frontal lobes of your brain that govern your ability to react appropriately to stimulation coming from your environment (i.e. sight, sound, etc.). Training your brain’s ability to react to various types of stimulation, and to block other types out, can significantly speed up your reaction time and overall accuracy of thought and movement.
3) Do I want to improve my focus?
Focus, Flow, Concentration, The Zone… whatever you prefer to call it… is one of the most complicated of all brain abilities, and very likely the most crucial brain function when it comes to success at sports. Many abilities come together to create focus, most notably vision combined with your brain’s attention network. These abilities CAN be trained to achieve higher levels of concentration and attention. This is what creates the effortless focus on the task at hand – The Zone – that most athletes crave.
4) Do I want to outsmart my competition?
Training various aspects of memory, essentially increasing your intelligence, will provide invaluable assistance when stacking up against your competition. Working and procedural memory can be improved through intensive Brain Training programs that combine “brain games” and metal tasks with physical exercises and various types of sensory input shown to improve cognitive abilities.
5) Do I want to decrease my risk of injury?
The brain controls your muscles as well as the tone of your tendons and ligaments. Muscles, tendons and ligaments that are controlled by a well-functioning brain are more resilient, faster to respond, and less likely to be injured. In turn, if something has been injured it tends to send “faulty” feedback to the brain, further increasing risk of injury. Training brain-body connections is critical for any high performance athlete that wants to stay off the sidelines.