I read an article in The Toronto Star recently titled “A Blow to the Head is a Big Deal” by Megan Ogilvie (8 April 2011), and I knew I had to read it. It wasn’t long before I was grumbling and had to comment on it. So here are some excerpts with my thoughts.
““The brain goes brrrrrrrrp and is temporarily out of order,” says Richards.
This massive electrical discharge is why people who have suffered a concussion are initially dazed and confused. The hit has obliterated their short-term memory.
“They can’t remember their name, where they are, what day it is, what they are doing,” says Richards. “It’s kind of like the brain has to reboot because the seizure has wiped the slate clean.”
I don’t remember being dazed and confused or even not knowing who I was. What I remember is after impact #1, I froze, raised my hand to protect my neck (as if that would work), and then started thinking again about the book I was in the middle of writing — Lifeliner. After impacts #2/3, I had an extreme emotional reaction. (Two impacts came from the shit drivers who rear-ended us, the third from being pushed into the car stopped ahead of us. I don’t know which rear-ender shoved us into it.) And I didn’t move until I was told to get out of the car. Later, when we were told to move to a side street, I again stayed in the car; I had no interest in what was going on.
But that’s not the same as having no memory or awareness of what happened or what is going on. I don’t know why this myth of memory or awareness loss persists, especially when the injured person remains conscious, or perhaps the loss in me was a nanosecond, but certainly imperceivable to me or anyone else.
I will say though there is definitely diminished perception and awareness to the point that you may see but you don’t really take in what you’re looking at. It was like the day six years after my injury when I stood at Bay and Bloor (an intersection I’m very familiar with and had seen many times in the previous six years) looked around, and suddenly I was seeing it as if for the first time in six years. I just stood there and gawked.
The amount of axon damage is related to the force of a hit and — more significantly, scientists surmise — the direction of the hit to the head. One that catches a person on the side of the head, twisting it sharply to the side, creates greater shearing force than a hit that rocks the skull from front to back.
During impact #1, I was staring straight ahead through the windshield of the car. Because I raised my left hand to cradle my neck, during impact #2, my head was slightly twisted to the left. So I had two directions of force on my brain. Peachy. It’s probably what created more diffuse injuries than would be expected in a straight back-and-forth slamming.
When the brain rattles from a hit to the head, cell membranes open up and a biochemical cascade washes through the tissue and disturbs its precise chemical balance. Specifically, potassium floods out of the cells, while calcium rushes in.
The cells desperately want to restore balance, which requires a huge amount of energy. For a healthy person, this is an easy thing do. But a concussion mucks up a host of other chemical processes that affect how the brain produces energy.
The first problem is that calcium, in high levels, is toxic to brain cells. Normally, the brain would lower calcium levels by drawing on the power of mitochondria— the energy factories found inside all cells. But as the mitochondria work to reduce super-high calcium levels, they clog and don’t produce enough energy.
Let me tell you the fatigue from the brain injury and from treatments to heal it is unreal. Even brushing teeth can require a nap afterwards. (Makes you not want to brush your teeth, aside from just forgetting in the first place.) Everyone in brain injury care knows about the fatigue. But this is the first time I’ve heard a possible scientific explanation, though I had known it was something to do with the mitochondria (university studies come in handy!).
However, I decided to look into this research. So far Dr. David Hovda’s investigative work on the neurochemistry and treatment of concussion seems to focus mostly on rodents or animals. That means this work is in its infant stages. That means he cannot mimic actual injuries that humans sustain in car crashes and sports, but at best approximate them with “controlled cortical impacts.” His work is exciting, but not yet applicable to humans in any real, practical sense.
At the same time, the brain is still seeking energy to restore its chemical balance, so it sends out an emergency signal for more glucose. Usually, glucose — the brain’s primary fuel — is carried to needy areas by an increased flow of blood.
But a concussion affects this process, too. After a hit, blood vessels constrict, making it difficult for blood to carry glucose to where it is needed most.
Oh my God! My desire for sugar — for things like pop, which I hate, or cookies — gets extreme whenever I do mental work or undergo treatments. (Otherwise my desire for sweets has dropped.) This connection became very clear to me when I began brain biofeedback treatments. After each session, I had this overwhelming desire to drink a can of ginger ale with sugar in it, not artificial sweetener. I could not resist it, and the fast downing of sugar always made me feel better. It was the only time I ever wanted to drink pop. Even today, if I’m more tired than usual (and I am always, always tired), and even if not hungry or needing food for my body, eating something will perk me up rather obviously. And, on a side note, doing things that increase blood flow helps too.
I have tried to discuss this with family, friends, health care people, anyone who can help me figure out how to feed my brain without feeding my fat because it is definitely not an empty craving but one that comes from my brain’s real need and because responding to my brain’s demands results in weight gain. This is also on top of the fact that brain injury does throw your internal functioning out of whack, something doctors simply don’t recognize.
I haven’t had much success.
I think someone has to come up with a way to get the body to send the glucose straight to the brain and bypass the fat stores — because the rest of the body doesn’t need it, it will snag the glucose and stuff it into the fat cells. The brain has to compete with the body for that glucose.
Dr. Hovda is on the right track perhaps with his ketogenic diet study, but again it’s in rats. No one seems to have studied this in humans, and certainly the medical community doesn’t even discuss diet in relation to brain injury, never mind the kind that can feed the brain sans feeding the body.
People who have a concussion will describe being overwhelmingly tired. This weariness is actually a neural fatigue, brought on when the brain doesn’t get enough fuel and must struggle to perform. Pushing through the fatigue is one of the worst things somebody with concussion can do.
“During this energy crisis, the brain wants to shut down and be very, very quiet,” says Hovda. “If you exercise the brain, or if you experience another brain injury (during this time), you will prolong the symptoms associated with concussion and extend the period of vulnerability.”
Well, I don’t know if we really know what the cause of the fatigue is. We understand its symptoms, have a visual concept of how it must be, but the mechanism details for fatigue in humans is not known. His statement that “pushing through the fatigue is one of the worst things” is theoretical, based on rat studies. How can he possibly know for sure?
If you don’t push through the fatigue, you’ll (a) be criticized and (b) won’t get the help you need. They talk about the energy crisis in this article as if it’s short term. It isn’t. It lasts years, decades. Sure, it gets better. But it doesn’t take much to land you on the couch and in front of the TV again.
Ironically, the one thing that caused a massive energy drain in me — the brain biofeedback — gave me way more energy in the end than the do-nothing approach had for the previous five and a half years.
Also, we know that basal metabolic rate consumes the vast percentage of our energy. In other words, we consume most of our energy needs just by living. Exercise adds very little to our energy consumption. Have you ever checked out how much effort you have to make before exercise makes any sort of indent into increasing your energy consumption — aka calories burned? Five minutes a day ain’t going to do it. Thirty minutes will. So why would the brain be any different? It’s already consuming vast gobs of glucose just to run your heart, lungs, digestive system, hormonal system, eyeballs, hearing, touch, taste, smell, etc. etc. How much extra energy does it take to think? To read? To write? Is it the same as exercise, that is, five minutes of reading isn’t going to make much diff but thirty minutes will?
I know from experience that in the beginning, five minutes of reading was like studying university texts for five hours. But does that mean in order for your brain to heal, you should do nothing? Isn’t it more likely that it means you need to start slow, build incrementally, be patient with yourself until you do reach normal levels of metabolic, hormonal, and cognitive functioning in areas like attention and memory. It seems strange to say that you’ll perpetuate the potassium-calcium cascade as long as you do anything but stay in bed because if that’s true, your brain will probably die in no time. That makes no sense.
This reminds me of the old adage that after surgery or when injured, you should stay in bed and rest. But we know now that the best thing to do with post-op patients is to get them up and at em practically as soon as they come out of the anesthesia. We know that moving the operated on or injured part — wisely of course and incrementally — accelerates healing. So why not the same for the brain? It is part of our body after all.
Currently, the only treatment for concussion is physical and cognitive rest. Doctors rely on standard neuropsychology tests to help determine the severity of an injury and whether a concussed brain has healed.
That’s old knowledge. Scientists in the US have already learned that progesterone has a positive effect, at least in severe brain injuries. They also know there are hormonal imbalances, like cortisol, for instance. Plus naturopaths already know that omega-3 fatty acids help the brain function better, as does physical exercise. Smart resting is good, but doing something to help the brain recover is better. Why do they not consider studying progesterone in concussions? Why not consider increasing omega-3 fatty acids in the diet because we know those are important in brain function? What about suggesting temporary increase in cholesterol in the diet to help regrow damaged myelin sheathes or research ways to regrow neurons such as what Dr. Michel Rathbone is doing? Or how about prescribing an exercise plan that takes into account the fatigue and sympathetic-nervous system issues?
But that would require some thinking, spending time with patients, and talking to psychologists on physicians’ part, and God forbid they do that.
As for standard neuropsych tests — pffft is what I say. All those tests said I was hunkey dorey. Yet I had to be reminded to brush teeth, feed the dog, make lunch before my stomach started screaming, make phone calls, what to say when I called people. Yet I slept for 12 hours. Yet I found crowds and groups overwhelming and would hide in the bathroom. Yet I couldn’t follow or remember what I was reading. And so on. There was way more dysfunctionality than that. And I’d get stupid comments from friends like “I never remember what I read either” — oh, so that’s why you cannot learn anything and why you cannot build on your professional knowledge, eh? Not.
It’s easy to ace those tests, not so easy to function in the real world. It’s even easier to ace those tests when they’re given to you repeatedly, as psychologists well know, as was done with me. Seven times in seven years. Those tests will never tell you if the concussion is fully healed. Idiots.
While the majority of those who suffer a concussion will get better in one to three weeks, about 15 to 20 per cent of patients will have symptoms that linger for months and sometimes years. Scientists suspect these patients may have a genetic predisposition that makes their brain more vulnerable to concussion.
The specialist who diagnosed my mild traumatic brain injury (mild! Such a misnomer!), got a complete history of my past. Although it had been nine years since a previous car crash and I had not had any clinical signs of a concussion, he said the long-term ramifications of that impact predisposed me to a brain injury.
So I’m not so sure about a genetic link.
I’m much more sure of all those little bumps on the head, those back-and-forths in fender benders or sports hits, setting you up for greater injury when you’re hit hard. But we don’t remember all those little ones, and when your memory is screwed, even less likely to remember and tell the docs.
If I’m ever hit again, my chance of severe brain injury is now much, much higher because of my previous injuries. Yet I wonder if all those brain biofeedback treatments and my regular use of audiovisual entrainment as well as acupuncture treatments has put me back into normal risk territory? I hope so, and I pray I never find out.
Researchers are also trying to figure out why only some people are affected by an accumulation of concussions by teasing out the link between repetitive injuries and chronic traumatic encephalopathy, a progressive degenerative disease that seems to mirror the biology and symptoms of Alzheimer’s. Connections have also been made between accumulated head trauma and devastating diseases such as Lou Gehrig’s and Parkinson’s.
This probably has a lot to do with what kind of treatments they had received or not for each injury, whether they had support or not, what their bad habits are, what kind of diet they had before and after injury, if they were given an exercise routine appropriate to their injury, if their metabolic and internal functioning issues were recognized never mind addressed. There’s an awful lot of stuff that affects long-term outcomes, stuff that the medical and research community are ignoring, stuff that’s right in front of their eyeballs if only they’d open their lids.