Concussion: Executive Summary

Despite all that has been learned in the last 30 years by Hyperbaric Oxygen Treatment (HBOT) practitioners, the standard of care for concussions around the world remains “watchful waiting”. Whether in the military, professional sports, emergency rooms or sports in general, medicine generally takes a passive approach to concussions, with the exception that drugs are prescribed for a myriad of accompanying sequelae/afflictions. Most often, the patient recovers to a point where physical therapy is possible. The patient invariably regains some measure of movement though quality of life may never be regained.

In what follows, culled from numerous web sites for general and specific information, from some of the most prestigious organizations and International Conferences in the world, the accepted protocol for concussions is observation, sometimes aided by brain scans, interviews or questionnaires and/or mental-physical tests to aid in diagnosis. There is little to no mention of any intervention to treat and heal the underlying injury to the brain, unless it has caused brain bleeding and/or swelling, in which case emergency interventions and surgery may be called for. Patients are told that almost all concussions eventually resolve themselves after some time. Pain medication is recommended where warranted.

There is no mention of even basic nutrition or brain foods and supplements, much less any discussion of the one intervention that can have an immediate impact.  In multiple peer-reviewed journals and articles worldwide, Hyperbaric Oxygen Therapy can help in the healing of underlying brain injury typically suffered in mild to moderate traumatic brain injuries, of which concussion is a sub-set.

Current standard-of-care “Rehabilitation” after a significant brain injury can include such interventions as rest, physical and cognitive therapy, brain training, visual and auditory help, occupational therapy, talk therapy and preparation for return to a diminished lifestyle, typically on drugs to control pain, headaches and mood swings. It is common to hear that “70-80% or more fully recover before three months.” Fully recover? Nonsense. Multiple concussions are additive in the context of acceleration of damage.
Run your own test: ask a neurologist or the athletic trainer at your children’s school what their protocol is for a concussion. Read the Army and the NFL Guidelines below and notice the similarities across the board. The common standard of care is little more than bed rest and hoping for the best.

Preliminary Note:

We are a coalition of largely veterans working pro bono to help heal service members suffering from “invisible wounds” of TBI/PTSD. We are helping stanch the suicide epidemic one warrior at a time; we have been successful with over 340 to date. Our work with brain-injured service members unavoidably puts us in contact with brain-injured civilians and victims of all kinds of head injuries. People with concussions approach us continually with requests for help with healing. They want an end to the headaches, the sleeplessness, depression and the myriad symptoms resulting from blows to the head. Plus, they want to get back to normal. They’re the unlucky ones whose concussions didn’t resolve themselves with time. Sadly, too many of them don’t ever hear about HBOT from their doctors, or they have heard negative comments from doctors who turn out to know next to nothing about HBOT: they weren’t taught it in medical school and they have never read the worldwide literature or assessed the evidence.

Time after time, in hundreds of cases where we’ve contacted Veteran Call Centers, Veteran Service Organizations, major orgs like VFW, IAVA, AL, VVA, DAV, Navy League, the NFL, the NHL, colleges and high schools, they all accede to the need to DO SOMETHING. Mostly the commentary focuses on academic theory, high level strategy, admonitions about “we don’t know enough about the brain”, and 19-point plans for cleaning up and focusing and measuring and demanding accountability. No one — not one — talks simply and directly about CLINICAL MEDICINE. All take the passive approach: rest and watchful waiting. Many talk about “evidence-based medicine” but ignore evidence that runs counter to what they “know.” And they don’t tackle the simple fact: an epidemic of ANY kind demands URGENCY and treatment.  Think Ebola.  The epidemics of concussions and military suicides demand no less intense focus on immediacy and proactive intervention.

Former Army Secretary Marty Hoffmann insisted on accountability and the need-for-speed. “Take a risk for the veteran” he would demand. Use battlefield medicine rules — whatever it takes, bar none, always within parameters set by the doctor. It still astonishes when people learn how many off-label drugs and treatments the Warrior Transition Units use for palliative care — symptom suppression, not healing. The NBIRR Coalition has 100s of testimonials from patients who have passed through Warrior Transition Units. To a person, they attest to the predilection toward: drugs, talk therapy, gadgets/apps, palliative care. Luckily, some benefit somewhat. BUT — the overwhelming majority lose hope, get mustered out, and go on to fight with the VA until they reach a “new normal”, with or without VA care, and always with an expanding list of prescription drugs. And they hunker down with a welfare check.

And “research” continues into “What is a concussion?” and “How can we tell if the patient has PTSD or TBI?” or “Is there a drug/biomarker/brain image that will tell us how hurt the patient is?” And always the search for a new magic drug that will “fix” the injury. And now a cottage industry in mouth guards, accelerometers, softer helmets, etc. Capitalism is a good thing, but the mechanics of a 30-150G force hit can’t be finessed with memory foam.

Imagine the following: all ballplayers after a game have a ritual about how they treat their injuries/pain/aches. Physical trainers and doctors prescribe protocols for different injuries: backs, necks, ankles, muscles, etc etc. Ice-baths, saunas, massages, electrical stimulation, analgesics, pain pills, diet, etc. And for a concussion? Never HBOT. Even cursory research could turn up what HBOT practitioners already know: expecting a severe brain injury to “heal” without treating the underlying swelling and damage to the brain tissue is a bit like throwing a dumbbell to an athlete with a broken arm — before setting the broken bone — and saying “let’s rehab that arm now!” An equivalent with concussions to warriors from IEDs is all the cognitive- and neuro-psych — even language/job/physical-therapies — all while waiting for natural healing and the “tincture of time” and palliative care to somehow heal the brain.