The Emotional Side of Concussions with Dr. Greig Andrews
Show Notes:
For many people, the journey to researching and treating post-concussion survivors is a personal one. Dr. Greig Andrews is no different, and today he talks about how his experiences treating athletes and his loved ones led him to the field of functional neurology with a special interest in post-concussion syndrome. Tune in to learn about the link between physical brain injuries and mental health, and how TBIs affect a child's brain. We also discuss how neuroendophenotypes might predispose us to certain conditions, what to look out for in subconcussive injuries, and how hormones can influence post-concussion symptoms.
From the biological differences between men and women that predispose women to more severe symptoms, to how toxic masculinity is shaming men into silence about their own struggles, this episode contains a wealth of information. We wrap up with an overview of how other underlying conditions can affect your perception of your symptoms, and how emotions and brain injuries are closely linked. For all this and so much more, tune in today.
Key Points From This Episode:
• An introduction to Dr. Greig Andrews, functional neurology chiropractor.
• How Greig’s personal and professional experiences motivated him to specialize in functional neurology.
• The link between physical brain injuries symptoms and mental health.
• How TBIs can affect a child's brain, and what a neuroendophenotype is.
• Why subconcussive injuries are so common, and what to look out for.
• The biological differences between men and women that result in women suffering from more severe symptoms.
• Bella’s experiment to assess the impact of different hormone levels on her symptoms.
• The links between domestic violence and abuse, and concussions.
• How toxic masculinity is shaming men into suffering in silence.
• The emotional effects concussion survivors might face, and the biology underlying these.
• The feedback cycle of negative emotions and brain injury.
• Why it’s so important to understand how any pre-existing conditions might influence the symptoms of post-concussion syndrome.
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Transcript - Click to Read
[INTRO]
[00:00:05] BP: Hi. I’m your host, Bella Paige. Welcome to the Post Concussion Podcast; all about life after experiencing a concussion. Help us make the invisible injury become visible.
[DISCLAIMER]
The Post Concussion Podcast is strictly an information podcast about concussions and post-concussion syndrome. It does not provide, nor substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician, or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice, or delay in seeking it because of something you have heard on this podcast. The opinions expressed in this podcast are simply intended to spark discussion about concussions and post-concussion syndrome.
If you haven’t joined Concussion Connect yet, I really hope you do as this month’s theme is communication. We understand how hard it can be to communicate with those around you, including medical professionals and friends and family as you’re dealing with something so invisible. Make sure you join concussionconnect.com today and join in on our conversation.
[EPISODE]
[00:01:31] BP: Welcome to today’s episode of the Post Concussion Podcast with myself, Bella Paige, and today’s guest, Dr. Greig Andrews. Dr. Andrews has a master’s degree in transformative studies with a focus on consciousness studies from the California Institute for Integral Studies. Additionally, he has taken extensive post-doctoral course work, he still wants to do more to support his patients to even greater heights of health, healing from recovery from the potentially devastating injuries or illnesses that can impact us and alter our lives. That is what led him to deep study functional neurology and to join the incredible team at Delta S Performance.
In Dr. Andrews own words, “Functional neurology in my humble opinion is the future of chiropractic non-surgical, non-pharmalogical, evidence-based, leading edge scientific healthcare. Delta S Performance is the team that is here to deliver it now. You can really look forward to helping you achieve the superior quality of function end of life that you literally deserve.
[00:02:34] BP: Welcome to the show, Dr. Andrews.
[00:02:36] GA: Thank you.
[00:02:38] BP: Do you want to start by telling everyone a bit about what created your interest in concussions?
[00:02:44] GA: For me, it’s both personal and professional. First, I’ve been a chiropractor for over 25 years. I’ve only been doing functional neurology the last several years. For a long time, I was just practicing mainstream chiropractic. In my first year of practice, when I was an associate, I had a young woman come in as a new patient. She didn’t appear to have anything “wrong with her,” but she had headaches, dizziness, brain fog, a lot of things like that. She was really struggling in her life, but she was young and healthy. I did my spinal assessment, and I told her that it appeared to me based on my exam that there was a lot of stress and tension in her nervous system far more than I would expect on someone so young and so apparently healthy. She immediately burst into tears, and I apologized and she said, “No, it’s the first time in five years that anybody has acknowledged that there’s something wrong with me.” She said, “I can’t tell you how many doctors I’ve been to who just dismissed me saying something like, ‘It’s all in your head.’” I think we’ve all heard that. I said, “Isn’t your head part of your body?”
I had another patient when I was just practicing regular chiropractic, a young, strong, healthy woman who was a regular patient just in general. She came in early one morning, and right away I knew her effect was off. She had a really up personality and she was not up at all. She was kind of checked out. I asked her if something happened. She said, “Yeah, I fell on my butt.” I’m like, “What? What do you mean?” She goes, “Well, last night, after work, I was carrying the garbage out to the dumpster and I slipped on some ice and I fell on my butt really hard. My butt and back really hurt.”
I asked her some questions to assess her mental state. I could tell she wasn’t right. I said, “I think you’re concussed” and she immediately said, “I didn’t hit my head.” Again, this is when I was doing mainstream chiropractic years ago when I said, “You don’t have to hit your head to shake your brain up.” She stared at me like, “What? Really?” That was an eye opener. I did it a lot to help her with her spine. I was doing cranial work, which helps, but only so much. I was kind of frustrated that I couldn’t do more.
I had studied a pretty amazing chiropractic technique. It’s known for helping with stress and tension in the spine and spinal cord, in the meninges. I’ve been able to help people with a lot of problems, including neurological problems, but was only so far. I started to get frustrated, why we didn’t do things with the head. I remember asking my teacher, the developer of the approach, who I studied with for years and I taught for him. He said, “We’re chiropractors. We adjust the spine.” I was really not satisfied with that response. I said, “Aren’t we nervous system doctors. Isn’t the brain kind of an important part of the nervous system?” He just didn’t respond. We’re chiropractors, we adjust the spine.
I expanded my approach, did a lot of cranial study and things like that and tat helped. I mean, I worked with people with seizures, and concussions and headaches, but it felt like not enough. I knew I needed to be able to do more. That’s what started to lead me towards functional neurology, but I’m going to mention a couple personal things too if that’s okay. I had a stepson who was diagnosed with ADHD. We tried to do everything to help him because he had a lot of struggles in school. One of the things we found that helped him a lot was physical activity and exercise, which research has shown helps a lot with kids in general, but especially with ADHD and other things like that. He loves playing football, so he started playing a lot.
One summer, he went to football camp, and we got a call that they said he got his bell rung and drove right over there, an hour and a half away. Again, I was not yet trained in functional neurology, but I knew enough basic things from chiropractic college to check his eyes and ask him questions. I knew right away he’d been concussed and wasn’t the only time it happened. I wound up begging him to quit doing it. His biological father and mother wanted him to do it because the exercise was good for him, but I was worried about his brain. He actually listened to me and stopped doing it.
But, I do feel looking back that it happened more than once to him. Again, looking back later on, I realized that after that, he started having more problems. Originally diagnosed with ADHD, then they added mood disorder, ODD, which is oppositional defiant disorder. He started having a lot more trouble sleeping, and a lot more irritability and angry outbursts. I don’t remember those being there before that. It made his adolescence and his trip through puberty a lot more difficult for him than it otherwise would have, because it happened at an early age like when he was like 11.
Then the most personal, as if that’s not personal enough. I was in a relationship with a woman who one day called me from the playground, bawling her eyes out, crying really hard. This was a tough person. She was a lifelong athlete and had delivered children. She didn’t physically cry very easily. She was sobbing. She said she had hit her head on one of the solid steel playground structures. I rushed over and took her to the hospital. Of course, they said she was fine. They did a CT scan. She didn’t have anything obvious, but that’s common. I said, “Well, she doesn’t seem fine to me.” They discharged her, I took her home, but I was really not happy. said, “We may be back.”
Well, sure enough, I woke up in the middle of the night to the sound of vomiting and found her on all fours throwing up on the rug. I started asking her questions like what year it was and who was the president. She was unable to even respond. I took her back to the hospital first thing in the morning, I was kind of raging on them. Of course, they were embarrassed and apologetic. They didn’t really know what to do — “Oh her CT is fine”. I was in this relationship for quite a long time after that.
Now that I’ve had years of functional neurology training, especially extra level of certification in traumatic brain injury, I can recognize that a lot of the changes that happened to her in her personality were likely related to the concussion. She became unpredictable, irritable, quick to anger, sometimes physically aggressive, really impulsive, risky behavior and crazy risky behavior, skirting laws and ethics that she would never have done before. She had a strong “moral compass” early on. I know people change but this was scary, dramatic change.
[00:09:25] BP: Drastic.
[00:09:27] GA: Yeah. Much later on, I found out she had been diagnosed with bipolar, among other things. I think that the TBI is probably brought that out and potentially made it worse. Between these personal and professional experiences, I just began to feel like chiropractic in and of itself wasn’t enough for what I wanted to do for people. I saw I knew I needed to do a deep dive into study of the brain. Since mental health has always been important to me, I always felt like that should be such a central part of healthcare and I feel like it’s not. I started seeing and the more I studied functional neurology, just how much brain injuries, and brain problems and mental emotional health are completely independent, interdependent. You can’t have one without the other.
[00:10:18] BP: Honestly, I don’t know which one I would pick. If I had to pick between the mental and the physical symptoms and experiences I went through. I don’t know. It’d be a pretty big tossup. They’re pretty even with each other. But it is really important and I agree, I don’t think we really address mental health enough. It’s definitely getting a lot better than it was 20, 10, five years ago, but it definitely is still lacking. Something that we haven’t actually spoken on a lot on the podcast is kids particularly and mental health with kids. I know based on our previous conversation and then as well as your son is a bit of an interest to you. Do you want to talk a little bit about how concussions can affect a young individual’s mental health?
[00:11:05] GA: In addition to my extra level of certification in traumatic brain injury, I also have an extra level of certification in the field of functional neurology in neurodevelopmental disorders, which is helping children and adults but primarily children with ADHD, autism spectrum, OCD, Tourette’s, any number of neurodevelopmental disorders, learning issues and whatnot. I actually feel really fortunate that I studied both much more deeply within the general field of functional neurology, which is already an intense specialization beyond regular chiropractic. Because it helps me understand how both interact so much, and I think that’s what gave me that perspective on mental health and concussion.
For example, with my stepson, I feel like the TBI’s made his mental health issues more of a challenge for him. One of the things we talk about, and I meant to mention this later on, but maybe it’s relevant to mention it now. In functional neurology, we talk about neuroendophenotypes, which is kind of your brain’s individual fingerprint. A way of illustrating that is, say you have a parent. I don’t mean, okay, if your parent was an alcoholic, you’re going to be an alcoholic. I think that’s as much environment as anything else, although I could be wrong. But more like if you had a parent with clinical depression, or if you had a parent with bipolar, if you had a parent with ADHD, anxiety, it’s been found that there are certain expressions that show up to functional neurologist that are similar between you and other members of your family. It doesn’t mean you’ll definitely have it, but you’re more predisposed to having similar or other related neurodevelopmental issues.
One of the things that can trigger turning that neuroendophenotype on and off, almost like, if you’ve heard of the subject of epigenetics, twins can be born and have very different lives because they have different experiences. So different things that happened to them in their lives turned genetic expressions on or off. Well, I think that my stepson, his neurondophenotype included a vulnerability to some of those neurodevelopmental disorders/mental health challenges. The TBI’s turned them on, triggered them, made them worse, just like with his mom. They both had overlapping diagnoses that were made worse. In fact, for her, kind of didn’t show up until her TBI. That’s a big one that I’ve learned to pay attention to.
I think a lot of parents may not even recognize. I’ll see a child for a physical often for a mental health issue. Anxiety is a big one. They’re struggling with learning. I’ll ask, “Did they ever hit their head?” “They play a lot of sports, kids fall, kids bump themselves.” I’m like, “Yeah, but the little kid crawling around can smack their head into a table, and it might mean nothing. But for someone else, it could have been something serious. Or falling down the stairs or falling when they’re learning to walk.” There are some scary things that parents put their kids in. I’m sorry. I can’t remember what they call, but do you know what I’m talking about. Those things that…
[00:14:34] BP: Oh, the bouncers?
[00:14:36] GA: Yeah.
[00:14:36] BP: Yeah, or the jelly jumpers or…
[00:14:38] GA: Yeah, the jelly jumpers. The kids don’t have the spinal integrity to hold their head up sometimes. I mean, really little kids. I’ve seen videos on YouTube with some kid bouncing up and down and their heads kind of flopping around. I’m like, “Oh my God!
[00:14:50] BP: They look like a bobblehead.
[00:14:51] GA: Yeah, like a bobblehead. That’s almost like they’re creating their own Shaken Baby Syndrome. Then, I realized that I’m teasing out overlapping co-occurring conditions or what — I hate to use this word because it sounds so negative, but comorbidities. I’m actually dealing with a child with potential concussion or subconcussive forces, which functional neurology research has shown and you probably already know this. A person doesn’t have to have a severe head injury to have a concussion, or more than one. Subconcussive forces can add up to compromising the brains’ function. That’s been shown by research on things like working memory, and reflexes and things like that, that are not so obvious, but show the difference between a normal neuroendophenotype and a compromised neuroendophenotype.
[00:15:40] BP: For sure. Subconcussive injuries happen a lot, especially with athletes because they’re not realizing that they’re not getting a concussion every time. But they’re hitting their head enough that their brain is sustaining enough stretch or enough damage on the micro level. That doing that over, and over, and over again, they end up with the same result the same amount of damage as receiving a concussion or more because of all those smaller hits or jolts to the head. Gymnasts often deal with this. They don’t really realize, “Oh! I never got a concussion” “Well, yes, but you’ve been spinning and doing all of these things in the air, and over, and over and over again. Maybe you’ve hit the mat, or you’ve messed up and you fall. You still got hurt, just not to the same extent as a concussion.” Those subconcussive hits results with the same symptoms as concussion or mild traumatic brain injury.
[00:16:37] GA: Yeah, that’s a huge point, Bella. Thank you for saying that. All through my career, I’ve worked with a lot of gymnasts and dancers. Like you said, “I didn’t get knocked out. I wasn’t unconscious. I couldn’t have gotten a concussion”. But how many gymnasts, either fliers who fallen or the poor base who’s someone fell in there and someone else’s elbow or knee bump them, classic. They would have problems that they wouldn’t understand beyond the physical. That’s a really good point. It’s interesting for me, because these two interests that I didn’t consider that connected are completely connected for me. Absolutely, 100% agree with everything you said about that. There’s a lot of under recognition of that.
[00:17:25] BP: Yeah. Speaking of under recognition, one thing that often gets missed, and something that we tend to recognize, we do. Definitely men experience concussion symptoms, post-concussion syndrome and mental health, which is often missed for what is also missed is that a women can often deal with more side effects than men. Do you want to speak a little bit on why that is?
[00:17:53] GA: Yeah, I’d love to. That’s a big one. I’m seeing that a lot in my practice, and also in my research. Because in addition to my day-to-day practice, I’m constantly researching this field so that I can serve people better. Also, I feel like educating the public about this because it’s a public health issue. It’s not just an individual issue. It’s a public health issue. That’s what people like you are doing and it’s such a great service. You’re educating the public about, this is a problem that people don’t understand. I bet there are people who listen to your podcasts and go, “Oh my God! I wonder if that time.” Boom, and they start to connect the dots.
Let’s get the more obvious things out of the way as far as that. Everyone says, “Well, women are more vulnerable because their necks are smaller and their skulls are thinner”. Same with children. Yes, that makes women and children more vulnerable to TBI potentially than men. But there’s a lot of subtle nuances to that. Start with the fact that some medical professionals still look at a concussion as a bump on the noggin. We notice even those more fortunate cases of TBI that don’t lead to PCS, men “typically,” recover in 10 to 14 days. Whereas women, often have symptoms like headaches for three or four weeks or longer, and neurocognitive impairments to memory and focus for even longer that men don’t report. In sport, percentage wise, to the population participating, women suffer far more concussions in games and practices than men.
The other big thing that’s only getting recognized very recently by female researchers, interestingly is a woman’s hormonal cycle, her monthly cycle. This great research that I read recently by a team led by a woman found specifically the late luteal phase is when women are apparently the most vulnerable to the most neurological sequelae. This one researcher, I loved where she went with it. A lot more research needs to be done, but she basically said that the neuroprotective aspect of hormones, in particular progesterone plays a significant role in this. When a woman sustains a TBI is important, not just how. She wants to do more research on determining when in a woman’s cycle she has experienced a TBI, when she actually got the injury and finding out as quickly as possible so that it can be pretreated with progesterone to potentially help minimize the impact.
[00:20:29] BP: It’s interesting because we’ve talked on hormones before on this show and I’ve talked about it before. Actually, before there was a lot of research on it. I came up with it myself with doctors based on just tracking my symptoms and things. This was a couple of years ago. We used different birth controls, and then I would assess whether or not they would change my symptoms. They actually did. It took quite a few trial and errors, but it did actually significantly help my symptoms. When I had them and all those types of things with the use of hormones. It’s interesting to also use it on more of the diagnostic side of things rather than just the treatment side.
[00:21:12] GA: Yeah. Thank you for saying that, because that researcher also mentioned that, in her research, women on birth control of different kinds of birth control had different outcomes than women who are not because of how it affects your hormones. That makes me remember something I did want to mention about children. Because I said when a woman sustains a TBI is important, that’s also important with children because there are certain periods in their neural development when they’re much more vulnerable to injury. That’s important to pay attention to.
Other part of that is, at least with a lot of kids, neuroplasticity is kind of at its peak. Even though I see young athletes with concussions, their potential for full recovery is generally really high. That’s the good part about that. I know that doesn’t relate to women, but you reminded me by mentoring that that I wanted to say that about children. I also want to — tell me if this isn’t the right time, but kind of tying those together, the differences between men, women and children is the role played by domestic abuse. I was going to talk about that now or I could talk about it later.
[00:22:22] BP: You can talk on that right now. We haven’t actually talked a ton on domestic abuse, so it is a significant reason for concussion.
[00:22:31] GA: I have general information, not exact statistics. I apologize if that’s something that you or your listeners are hungry for is statistics. One really stark difference between men, and women and children and their experience of concussion is the role played by domestic violence, domestic abuse. Women and children suffer hugely greater numbers of brain injuries than men inflicted by a domestic partner, or a caregiver, guardian, parent. To me, this is tragically under recognized and under addressed. It’s even worse now, since the pandemic, because a lot of people are home, they’re stressed, and a lot of people are drinking more than they even usually do. Again, removing a filter.
There are some specific points that need to be addressed as far as the differences between men and women in TBI. A man is much more likely than a woman to exhibit aggressive behavior following a brain injury. You take the example of a football player, someone who’s 200 or 300 pounds, big and strong, trained and wired to be violent, to be aggressive to hit people gets a brain injury. Besides the tragedies of the public reports of suicides of famous and beloved football players, there’s also the tragedies of potentially violent people who have their filter removed. Then you hear about some big, huge, strong, dangerous person knocking out their much smaller, usually wife or girlfriend, but sometimes beating a child, beating one of their own children. That’s a double tragedy.
A woman is much more likely than a man to die from a head injury, and she’s more likely to die from a head injury by assault, by violence, whether at work, in healthcare and police work. My God! These days, I think it’s more dangerous to work at Target than it used to be in certain areas, and especially in intimate partner violence and domestic violence. Something that I’ve been seeing a lot of in my own practice is how many more older adults who suffer brain injuries are women, and how much more severe are the neurological, cognitive, behavioral and mental health sequelae.
[00:24:49] BP: Yeah. No, it’s really interesting that you say you see a lot of women. I have a tough time, because I think there’s two sides to it. I haven’t done a lot of research on it myself, but one is, women have, as we discussed, hormones and things like that that affect them and so they might experience more symptoms and there is some biological factors there as well. There’s also the factor that men are raised and taught to not have symptoms, to not be weak, to not struggle, to not struggle with mental health. I wonder if that does skew results in some of the ways, because men aren’t supposed to feel according to general North American and societal norms and we’re working on changing that. But I do believe that would prevent a lot of men from showing up.
As sad as it is, when we talk about things like suicide and mental health, it very often is men who we always say we didn’t see it coming. They have a family, they’re so strong, everything is so well. Who saw it coming? I think that big problem is, is men who do have head injuries and just men in general are very taught to downplay it exactly how they feel compared to women.
[00:26:06] GA: Absolutely. Thank you for mentioning that. That’s a huge point. Several years ago, before I went deep in my dive into functional neurology, I was getting more and more interested in the impacts of concussions on people’s health. I was covering another practice for another chiropractor and a patient that I had known for a long time over the years asked me if she could bring her young son to me. I think he was about 19. She was really, really worried about him. She said he had shared that he was having suicidal thoughts, and she brought him in the next day. I assessed him, I started talking to him, and he seemed in really good shape. I asked him, I said, “Have you had a concussion?” His mom said, “Yeah, remember that time.” She specifically talked about a particular incident. He goes, “Oh, yeah.” I said, “How long ago was that?” “It was like a year.” I’m like, “How long have you been having suicidal thoughts?” “About 9, 10 months.” I was like, “Do you know how high the correlation is between brain injury and suicidal thoughts?”
They’re actually relieved to have that information because he was literally afraid he was losing his mind and she was a little concerned for that as well. That was an eye opener for me, because that was early in my awareness of that connection. Thank you very much for bringing that up, Bella.
[00:27:22] BP: Yeah. It’s interesting that you say he felt like he was losing his mind because it’s actually really common. A lot of survivors feel like something’s wrong. They don’t know what’s wrong, especially if they don’t put that concussion, and emotional connection or loss of mental health state together. We are going to talk more about the emotional effects of survivors, but you can learn more about Dr. Andrew’s work and connect with him at deltasperformance.com. With that, let’s take a quick break.
[BREAK]
[00:27:59] BP: Support the podcast. If you truly love the podcast, please consider supporting us through our tip jar. Find the support the podcast link in our episode description. All tips are greatly appreciated.
[INTERVIEW CONTINUES]
[00:28:16] BP: Welcome back to the Post Concussion Podcast with myself, Bella Paige, and today’s guest, Dr. Greig Andrews. Often, we see a big list of concussion symptoms, like dizziness, fatigue, headache. But unless you start researching into post concussion syndrome, prolonged concussion syndrome, all these different things, we don’t often see the emotional side effects listed anywhere. It’s really missed and the emotional side of things are just as important as we talk about a lot on the show. If you want to talk a little bit more about what type of emotional effects concussion survivors might face.
[00:28:55] GA: Yes. First, I’ll mention depression. So, rates of TBI are on the rise, especially among women with that qualification that you mentioned, which is huge. At the same time, rates of depression are on the rise. That’s only one symptom, we’ll talk about more. But again, it’s higher among women compared to men. Women with traumatic brain injury report more mental, emotional problems. Now, we’re going to overlap cognitive with mental behavioral, so I’m not ignoring the emotional if I mentioned the cognitive. But in areas like goal setting, and follow through, organization and independent work, initiative, self-expression, and articulation and confidence, obviously. Not only can you already have depression from a traumatic brain injury, but these problems contribute to greater anxiety, and stress and depression.
If it’s alright with you, I want to tie it into what we know in functional neurology about some of the brain pathways. Is that okay?
[00:29:51] BP: For sure. Yeah.
[00:29:52] GA: One area of the brain that we in the functional neurology world pay a lot of attention to in relation to TBI is what we call the DLPFC, the dorsal lateral prefrontal cortex. More specifically, the dorsal lateral prefrontal thalamic track. This male just sounds like a Greek sorority, but when you think about frontal, everybody knows that frontal is pretty much your higher function, your executive function. There are specific pathways related to frontal. When you talk about the thalamus, the thalamus is a big gateway for sensation and emotion. You couple the frontal and thalamic pathways, you can kind of understand even without training in functional neurology, where we’re going with this. Frontal is your thought, your organization, your higher thought and thalamus gates a lot of the emotional and sensory inputs and expressions.
I was really impressed with some of the research I found with this more recently. One in particular that really jumped out to me was this paper that calls out the tendency to treat cognitive issues as separate from emotional and behavioral problems following brain injury. We know that brain structures and pathways serve multiple overlapping functions. I’d really like to quote this paper if I could. Is that okay?
[00:31:07] BP: Go ahead.
[00:31:07] GA: I love this paper. I think everybody that has any interest in brain injury. It’s a 2017 paper by Wood and Worthington in Frontiers in Behavioral Neuroscience. “Executive skills are critical for integrating and appraising environmental events in terms of cognitive, emotional and social significance.” Think about that. “This is undertaken through multiple frontal subcortical pathways within which it is possible to identify a predominantly dorsal lateral network that sub serves executive control of attention and cognition. The so called cold executive processes. If you think cold, you think analytical side, and orbital frontal ventromedial pathways. You don’t even have to understand what that means when you know that those underpin the hot executive skills that drive much of behavior in daily life. The hot skills are the ones related more two emotions. These overlap and interact with each other. TBI frequently involves disruption to both sets of executive functions, but research is increasingly demonstrating the role of hot executive deficits underpinning a wide range of neuro behavioral disorders that compromise relationships, functional independence and mental capacity in daily life.” With my little parenthetical explanation of hot and cold.
What this means in plain English is that cognition and social emotional behavioral function are not separate, and in fact, inform and influence each other significantly. That’s why in my clinic, I pay attention to everything and account for everything in my work with people, I see brain health and mental, emotional, social, spiritual health and wellbeing as inextricably linked and interdependent. If I have a patient come in who not only struggles with answering certain questions, but like maybe one day yells at me, or maybe one day bursts out crying. To me, that’s more information about how their brain injury is affecting them and I have to pay attention to that, because I want to see that change as well as everything else.
The good thing is, we know how to work with all those pathways and how they interact with the limbic system and the amygdala, which are related to emotion and learning. It’s not like we fix your emotions. We help your brain pathways work like they’re supposed to, so you can experience, and express your emotions and your cognitive function more efficiently for you. It doesn’t take away from a person being who they are. It actually supports them and getting the stuff out of the way, so they can be more who they really are.
[00:33:35] BP: For sure. That mental and physical aspect that you mentioned being connected, it really is connected. I’ve talked before about how my mental health suffered significantly when my physical health suffered. A lot of it because of those physical symptoms also led on to a lot of isolating things that also encouraged mental health and mental illness. It’s kind of like a vicious cycle. You have these physical symptoms, your brain can’t calm down, and you call it, your filter is gone. Filtering out emotions that you don’t want isn’t there. Then all of that creates isolation and things that also bring on even more mental health symptoms. It really is tough, because you have so many factors. Kind of the odds are against you. As always, my logic and thought process for it.
It isn’t in a way of healthcare, and we are getting better at helping things. But in the grand scheme of things, everything is fighting for you to not be doing well. What you have to do is just take it one day at a time, and you will get better and I know you’ll get better because it’s definitely possible because I am an example of that.
[00:34:43] GA: Yes, you sure are.
[00:34:44] BP: Do you want to touch a little bit more on the emotional side effects that people can suffer? You touched on depression. How that physical and mental effect really is connected with survivors?
[00:34:57] GA: Yes. They’re overlapping, but we see a lot of anxiety, a lot of stress, a lot of depression. We have people who might have anger issues, because again, the filter is removed. Then they have guilt, or shame or embarrassment or as you mentioned, isolation. I had an 80-year-old woman who kind of had a double brain injury and she had something explode. There was a blast injury and it threw her and knocked at the back of her head against the house. She was really in rough shape. When she first called me, her speech was completely flat. Her effect, her facial expression was completely flat. You could tell she felt isolated. Her husband didn’t know how to relate to her. Being senior himself, he didn’t really know how to adapt her situation. She felt even more isolated because she couldn’t communicate with him.
She lost to a couple of our greatest joys in life, which were reading, and knitting, and walking and socializing. She’s a very social engaging person beforehand, but you wouldn’t know it from meeting her. Over the course of care, as we got her basic cognitive and things like her balance on line, so she wouldn’t fall again, especially in these Berkshire winters where is everywhere for like four or five months. She started to be able to read again, and she started to be able to knit again and she learned to communicate to her husband again.
The day she came in and started explaining her Herman Melville, and the subtlety and brilliance of how his prose is like poetry, I was blown away. I mean, the person I met who could barely speak for herself, a few months later, she could have been a college professor, and it was the same person. She was joking, she was teasing me, she was smiling and laughing. You could say, yes, she was able to function again, so she’s happy again. But it wasn’t just that, that’s part of it. Yes.
When you can’t function, you’re scared, and depressed and anxious. But also, when your brain can’t function, you’re scared, and depressed and anxious. She not only got her cognitive abilities back, she got her ability to experience emotions back. Because even when I first saw her, I would make little jokes to her to try and cheer her up and she didn’t even get them. Even if she did, it didn’t matter, because she doesn’t have the capacity to laugh and enjoy them.
[00:37:15] BP: I think it’s amazing to hear. I always love uplifting stories. You actually mentioned something really important was her lack of ability to read. We talk about that a lot, because it’s always people’s first recommendation, “Well, I can’t leave the house. I have a headache. I don’t feel good. I’m really tired all the time.” “Well, why don’t you just read.” I always laugh, because I always used to tell people “I can’t read”. But it would have been really helpful, because reading would have kind of taken me out of my bubble that I was isolated to and that allowed me to kind of explore things in my own thoughts. I do encourage survivors to get audiobooks, because they can help. It’s not the same feeling as a book, but it definitely can help. You’ve given lots of good insights so far, and is there anything else you’d like to add before we end today’s episode?
[00:38:00] GA: Yeah. This is something that I think is important and related to what we’re talking about. To me, another invisible aspect to what we call the invisible epidemic, which is what is termed by social workers and psychologists as co-occurring conditions. It’s my experience, personally, professionally, and in my research, it seems to me that when a person suffers prolonged PCS, post-concussion syndrome, that there are often other health challenges. There’s recent research that finds that these major complications can severely impede someone’s recovering from Lyme disease, whether it’s multiple TBI or other co-occurring conditions.
One example of those is Lyme disease. There’s a great paper that talks about how under address Lyme disease is when you add the neurological complications. To me, there’s like a secondary invisible aspect to the invisible epidemic of concussions, which is what are termed by social workers and psychologists as co-occurring conditions. It’s not unusual when a person suffers prolonged post-concussion syndrome, that there are other health challenges that may be impeding their recovery. They often include Lyme disease, and there’s a recent paper written by one of the leaders in the functional neurology field that he’s been discovering how often people have undiagnosed, untreated Lyme or multiple Lyme vectors, because we know there’s multiple and often people are only looking for Lyme Borreliosis, but there’s a lot of others like Bartonella. These can be missed, and these can complicate what’s already a complicated recovery.
Then when you add that some people have had COVID and don’t know it, and there are often neurological complications post-COVID. So, you can have a multipronged drawn-out struggle and not know fully why. To me, it’s really important, it behooves the health care clinicians to be really diligent in their assessment and testing of people that they see because a person in front of them who they think got a dinger may have not only one concussion. They may have multiple concussions, but they also may have co-occurring conditions of Lyme and or COVID.
[00:39:58] BP: I actually really liked that you pointed that out, because I don’t know if you’ve ever been on them, but there’s support groups on Facebook and things like that. They’re kind of wild, which is why we have Concussion Connect, which is more of a softer, more close-knit community than those. But in those, people often comment, “Well, did you have this health issue after your concussion, and this health issue and this health issue?” One of the biggest problems is a lot of these people never got their health checked before or didn’t understand that they had pre-existing conditions before their head injuries. Now, they’re coming about all these things, and sometimes we’re over relating them to our head injury, like your head injury cause this. Where a lot of the time, individuals were suffering from these things before, and then their concussion just heightened it.
For example, I’m anemic and my anemia became very apparent with my extreme fatigue of my brain injury, and getting blood checked all the time for that. I always knew I was anemic, but I didn’t realize I was anemic. I really was struggling. When I had my brain injury, it kind of heightened it all. I think it’s important to be aware that we can have pre-existing conditions and those pre-existing conditions definitely can be heightened by our concussions and all of our symptoms, as we know that our brain is connected to our whole entire body.
I just want to thank you so much for joining today. We touched on a lot of important facts and sharing your insights in post-concussion. I’m sure will help very many today.
[00:41:30] GA: Thank you. Thank you very much, Bella. I’ve really enjoyed talking to you and I look forward to hearing more pf your podcast.
[END OF EPISODE]
[00:41:40] BP: Has your life been affected by concussions? Join our podcast by getting in touch. Thank you so much for listening to the Post Concussion Podcast and be sure to help us educate the world about the reality of concussions by giving us a share. To learn more, don’t forget to subscribe.
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