BLOG #2: Fundamentals of Concussion, TBI, PTSD, PCS

A concussion is a form of traumatic brain injury (TBI), a wound to the brain. The current medical standard of care for concussions relies on a protocol that essentially recommends rest. It is thought that this resting period will allow the brain to recover. Indeed, it is “common knowledge” that 80-90 percent of concussions “get better” on their own.[i] Not “heal” mind you, merely recover. While it is true that some symptoms will diminish over time, it is equally true that merely waiting for those symptoms to go away – or using drugs to control symptoms — is not our best medicine, nor is this good for the wounded brain, either in the short term but especially over time.

What your doctor probably will NOT discuss, even the Mayo Clinic, your hospital emergency room, the NCAA, the NFL, your local concussion or TBI clinic, let alone high schools, is that a concussion is a wound to the brain that should be treated according to wound healing principles. There is no disputing the fact that in most of the millions of concussion cases experienced every year, the average person will “recover” within a few weeks and symptoms will abate. In a large fraction of cases, however, those symptoms do not go away and in no case will the brain become “healed” unless steps are taken to address the wound. This is true for concussion, Traumatic Brain Injury (TBI), Post Traumatic Stress Disorder (PTSD), or from Post-Concussive Syndrome (PCS).

We are all becoming familiar with the symptoms of head injuries: headaches, confusion, memory loss, nausea, vomiting, dizziness, fatigue, sleeplessness, emotional instability, and many more. PTSD, frequently a result of brain injuries, is accompanied by agitation, irritability, hostility, hypervigilance, self-destructive behavior, social isolation, flashbacks, fear, severe anxiety, or mistrust, loss of interest or pleasure in activities, guilt, loneliness, insomnia or nightmares.

These symptoms are linked to complex pathophysiological processes affecting the brain, induced by chemical and/or biomechanical forces. These forces can lead to brain inflammation and swelling, damage to blood vessels and brain cells, ringing in the ears (tinnitus), visual and balance problems, and a myriad of other overt and/or subtle physical and emotional and functional difficulties.

Some in the worldwide sports community recognize a concussion as an “injury” to the brain, yet nowhere in the gold standard Consensus Statement of the 2017 Concussion in Sport Group (Berlin, 2017) is there mention of a “wound” to the brain. In the eleven major sections of the Statement, only one is devoted to “rehabilitation.” In essence, the Concussion Protocol has virtually nothing to do with medicine.

They note that a sports related concussion “is considered to be among the most complex injuries in sports medicine to diagnose, assess and manage.” Really? Let us look at how we are now changing that paradigm and the long-standing nonchalance about aggressively intervening in the “concussion cascade” to reverse the damage and wounding done to a major organ of the body: the brain.

Critical to understanding the work of integrative medicine doctors trained in wound healing are these facts: medicine knows a lot about how to heal wounds. A physical wound to the brain is like a physical wound to soft tissue and any other organ in the body. Hyperbaric Oxygen Therapy (HBOT) has already been approved by the FDA for certain types of wound healing (air embolism; arterial insufficiencies; compromised skin grafts and flaps; acute thermal burns; crush injuries; and other acute traumatic injuries that lead to oxygen and blood constriction).

Concussion, TBI, PTSD, PCS can lead to inflammation and cerebral ischemia (deficient supply of blood to the brain that is due to obstruction of the inflow of arterial blood). A host of negative chemical processes begin, along with mitochondrial/cell damage, oxidative damage and apoptosis (cell death). There can be a breakdown of the blood-brain-barrier and brain swelling. Numerous animal studies on concussion and blast injuries confirm that blows to the head are just not good for your brain. And not treating them can lead to severe complications over time, up to and including early onset dementia and Chronic Traumatic Encephalopathy (CTE).

Common sense is slowly causing parents and coaches and trainers and even some medical personnel to pay attention to these correlations. The wounded and their care-givers want and need better answers than “be patient.” This is one of the primary reasons that word-of-mouth referrals to HBOT-for-Brain Injury are increasing nationwide. And why the positive scientifically-recorded results are so positive.

Clinics in the TreatNOW Coalition treat wounds to the brain. Hyperbaric oxygen has been proved to enhance several natural processes related to wound healing: it reduces inflammation, inhibits apoptosis (cell death), reduces Intracranial pressure; and promotes neurogenesis and angiogenesis.[ii] This is significant: HBOT promotes growth of new neuronic tissue and new blood vessels. The combination of oxygen (typically 100% O2) and pressure (varying, depending on the diagnosis) leads to the production of more stem cells available for wound healing as well. All this has been proven by rigorous, scientific studies that have explored the role of oxygen and pressure in the brain healing process.[iii] What is not controversial is that HBOT aids tremendously in wound healing, typically 20-40 percent faster healing than the norm.

If brain injury patients (here we are talking primarily of combat veterans, Special Operators, and athletes playing contact sports like football, soccer, hockey, lacrosse and field hockey) can be evaluated and treated over the weekend, we normally find that their symptoms can be resolved because of the wound healing; students can return to school symptom-free on Monday. Much more importantly, however, are the comments from the concussed patients. Time and again, we hear within one or two one-hour treatments that the patient “had no idea how messed up they were.” It is as if the fog has cleared as the symptoms resolve. The patient is wounded and brain function, including judgment, are typically impaired. Naturally, warriors and athletes want to get back into the game and are not always the best judges of their level of recovery and ability to return to battle or play. Objective and subjective tests given to patients worldwide offer much more hard data and insight into the actual functional recovery.

To summarize: We are much smarter in 2020 than we were in the 20th century about the Mechanisms of Action, both stemming from the negative consequences of brain injuries and about the remarkable wound healing actions of hyperbaric oxygen.

Next Up in BLOG #3: How does Hyperbaric Oxygen Help Heal Brain Wounds?

[i] The Center for Disease Control and Prevention keeps track of Traumatic Brain Injury and Concussion at: https://www.cdc.gov/traumaticbraininjury/get_the_facts.html. See also: https://www.brainline.org/article/facts-about-concussion-and-brain-injury. For a more thorough look at those who do not recover so well, see Carmen Hiploylee, et al. Longitudinal Study of Postconcussion Syndrome: Not Everyone Recovers. JOURNAL OF NEUROTRAUMA 34:1511–1523 (April 15, 2017). http://bit.ly/2Cv7VwA
[ii] Amir Hadanny & Shai Efrati (2016): Treatment of persistent post-concussion syndrome due to mild traumatic brain injury: current status and future directions, Expert Review of Neurotherapeutics, DOI: 10.1080/14737175.2016.1205487 To link to this article: http://dx.doi.org/10.1080/14737175.2016.1205487.
[iii] See Philip B. James, MD. Oxygen and the Brain: The Journey of Our Lifetime. Best Publishing: North Palm Beach, FL, 2014. See also Harch PG, Andrews SR, Fogarty EF, Lucarini J, Van Meter KW. Case control study: hyperbaric oxygen treatment of mild traumatic brain injury persistent post-concussion syndrome and post-traumatic stress disorder. Med Gas Res. 2017;7(3):156-174.  http://bit.ly/2zyFrAr;  and HBOT2017, 11th International Symposium. TBI: No Need to Die! A review of HBOT in Acute Severe Traumatic Brain Injury with an Extension to Acute Concussion, and an Update on Chronic Mild TBI. Paul G. Harch, M.D. http://bit.ly/2x4tWUf