Your Symptoms May Trace Back to an Old Concussion - The Hidden Signs of Post-Concussion Syndrome and Traumatic Brain Injury with Dr. Aaron Hartman | Concussion Symptoms | E164

And the thing about a lot of the sleep medications we use to help people sleep slow brain healing down. So using antihistamines like Benadryl, hydroxyzine, using benzos like Valium, or even sleeping medications like Ambien, Lunesta, those all actually, though they help you quote unquote get to sleep, slow brain healing down and can actually make long-term some of the symptoms worse. Most people are told after they have a concussion, rest, avoid screens, take it easy, and you'll be fine in a couple days, maybe a couple weeks. But one study of 100 patients showed that severe symptoms in some patients can last up to 6.9 years after injury. These individuals have a high amount of unemployment, measurable cognitive deficits, anxiety, depression, and some of these symptoms will resi— stay around for a longer time. So longer than like 6.9 years, which is a long time. And why is this? Because they weren't evaluated appropriately and didn't have a full treatment of all their symptoms. And something I want to talk about today is how do you know you, you or someone may have had, may be dealing with some post-concussive syndrome. This is not meant to be all-inclusive, but it's meant to give you an idea of some of the nuances of what can be involved in a post-concussive, post-head injury situation. Before we dive into this, I just, I want to say quickly, just housekeeping. If this information is helpful, please like, share, subscribe. That's how we get this information out there. There. It's also helpful to us. Most of the people listening to this right now actually don't follow us and haven't subscribed. So, if you can do that right now, that'd be super helpful for us to keep this kind of information going. So, with that housekept, let's hop into things. So, when people get concussion, there's the standard checklist. You know, do we think you had concussion? You know, the post-concussive scale system, so to speak. This is like goes under 3 different domains: somatic, cognitive, and emotional. This is the standard way we look at it. I'm going to talk about more nuanced approach here in a second, but this is more like headaches, fatigue, dizziness, nausea, vomiting, light sensitivity, sound sensitivity, sleep disruption, visual symptoms, hearing problems. These are all the typical somatic things you think about when people talk about had, you know, this injury, car accident, got hit in the head and having some symptoms. I just want you to open up your vision a little bit to think about this also, minor injuries, headball, playing with kids, car accident, roller coaster ride. There's a lot of things that can call— anything that causes an acceleration rapidly and a rapid deceleration of your skull. And ultimately your brain is like a big old ball of Jell-O and you get these little micro tears and injuries. So almost anything can do that. Even small acceleration and deceleration injuries. The second domain is cognitive. This is where you have reduced concentration, memory dysfunction. It's harder. You read something, you're like, what did I just read? Slow processing speed. You know, you feel like you're a little slower, like your brain is going through Jell-O. And you have difficulty with complex tasks. This typically is when you, you know, high school athletes that I've dealt with in the past with school, like, hey, take it easy for a week. Students notice it a lot more because you go back to school the next day and you have to think a lot. Adults might not notice these quite as much, particularly if you're already an expert in a field and you've gotten so much into the swing of things that you don't have to think and you're not learning new things. And that's one of the things it's harder to to learn and do new things. Students that are in college and in high school are constantly learning and doing new things, but adults not so much. So sometimes it's harder to see this in adults. Emotional psychiatric, the third domain, anxiety, depression, irritability. PTSD is interesting because this is a severe version and you start getting into some of the chronic traumatic encephalopathy stuff. Most experts will recognize these, but the more subtle ones we'll talk about in a second are commonly overlooked. But the thing to think about, these are not psychological symptoms. These are specific parts of the brain being injured, causing these brain inflammatory symptoms. Now underneath that, you can get a lot more nuanced things, which is where concussion experts kind of come into play. The first one is like vestibular dysfunction. So your vestibular organ is like the little thing and it's like the little snail inside of your, your ear. If that gets disrupted, all of a sudden now you can start developing issues with eye movement. So now you're driving your car and watching things and you get dizzy, lightheaded. You can't drive very far, right? You have issues with eye movement. You're watching your kids play, go back and forth and you feel a little off, or you're same thing with the child. A quick favor.

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Also things that change direction. You start having problems if you're like going up and going down, turning left and right, things that affect the semicircular canals, which are little loop-de-loops in your inner ear. You can start having these like dizziness kind of things. The thing about it is this can also be triggered. You can have a movement that triggers dizziness. And so it can be unexplained dizziness. This is not psychiatric. It's actually a vestibular response that affects your autonomic nervous system, which is your, one of your basic neurological control systems, super subtle and commonly overlooked. So you got the standard stuff, vestibular, visual dysfunction is a very common thing. All of a sudden your eyes don't track quite as well and you might fatigue reading. You might have a harder time reading. It takes a lot of brain to use your eyes. If you look at these little brain maps, there's so much of your brain that correlates with eye movement, processing vision, and it requires a complexity that can be easily disrupted with a small brain issue. And then all of a sudden what happens is converging or looking at things coming close becomes more difficult. It's hard for your eyes to track. And this can look like a whole lot of different issues in people and sometimes requires a, a neuro-ophthalmologist to do an evaluation. And it's interesting when you look at the experts in concussion, you'll see neurologists, you'll see physical therapists, But you'll see specialized ophthalmologists that focus on eye training exercises to really help treat post-concussive syndromes because you lose the connection between your eyes, your organ imbalance, and all of a sudden anything that has to do with eye movement, which is more humans, we move our eyes all the time. These are small subtle things that only a neuro-ophthalmologist or someone who trained it can actually pick up. And it can look like a whole lot of things, light sensitivity, Anytime your eyes move, we already mentioned that. Cognitive symptoms, the brain fog is real and the brain thinking through mud is a real thing. This can look like, I've already mentioned the slow processing speed. What happens all of a sudden is now when you switch, you have a harder problem multitasking or, you know, called dual task failure where you kind of go from one thing to another, to another. You know, when your brain's sharp, you can actually quote unquote multitask. Multitasking is not actually multitasking. It's the ability to switch quickly. Between tasks, go from task 1, 2, 3, 4, 5, go back to task 1. That ability to switch, which we call multitasking, is not quite there. And so people that, particularly women who are unusually better than men, that's just kind of the way things are, they don't multitask quite as well. And it's interesting as we get older, that's a natural thing. You know, I'm 53 now. I don't multitask as well as I did when I was 33. But this happens overnight, literally, with a brain injury. The other thing that can be, that can be affected is hormonal dysfunction. One of the things that's interesting with the way your brain works is your pituitary, your hypothalamic-pituitary axis gets disrupted and all of a sudden you have issues with pituitary function. One study after, it was interesting looking at 80 adults after a TBI showed 80% of people had growth hormone deficiencies and about 16% had problems with their ACTH going to cortisol. It is really interesting. It can be bad enough you can actually develop a type of diabetes called diabetes insipidus where you're thirsty, you drink, and water goes right through you. The point is, is some of these can turn into long-term things like growth hormone deficiencies, like testosterone issues, like thyroid issues, like adrenal insufficiency. So, when you go to like your functional expert, functional medicine doctor, and they start doing the 4-point cortisol testing, they do prolactin levels because your hormone's off. They don't realize that some of those discrepancies or issues actually go back to a brain, a brain injury issue. And then your autonomic nervous system is something that I've gotten a lot into more with recently with POTS and dysautonomia. You can have small brain injuries actually cause a certain amount of autonomic dysregulation. So what does that mean? The regulation of your body's regulation gets dysregulated, which I know sounds kind of weird, but the gist is anything that has a regulatory impact. Hunger, satiety, sleep, hormones, even your drive. Your brain has to be in a really good state for you to have like your drive and focus, like the dopamine part of your brain. Sometimes people will lose that. And I've actually seen individuals get like ADHD after brain injuries. They lose the ability to focus. I had actually one individual, it was really interesting. He actually had anesthesia in his 50s. He was a psychologist. And after that, he didn't quite have the same amount of cognitive ability. So there's a lot of overlap between different kind of brain issues with this. But the point is that your ability to regulate your body becomes dysregulated and that can have a whole bunch of different symptoms. And then sleep disturbance is a big thing that so many people deal with sleep problems, you know, whether it's sleep initiation, wake up in the middle of night, heart racing, waking up with poor quality sleep. You have issues with sleep initiation, sleep maintenance, and then ultimately the quality, wake up feeling refreshed. That can be a side effect of the concussion or injury. And the problem is this is a crisis within a crisis, because when does your brain heal?

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When does it repair? When does your brain neurons take the trash out? During high-quality deep sleep. And you actually form new memories better during REM sleep. So, if your sleep becomes disrupted because of an injury, all of a sudden you might notice now I'm not sleeping as well. And it's often overlooked. And the thing about a lot of the sleep medications we use to help people sleep slow brain healing down. So, using antihistamines like Benadryl, hydroxyzine, using benzos like Valium or even, you know, sleeping medications like Ambien, Lunesta. Those all actually, though they help you quote unquote get to sleep, slow brain healing down and can actually make long-term some of the symptoms worse. And then the emotional psychiatric symptoms, again, we tend to overlook these a lot because, oh, you're just emotional or whatnot. And we tend to do this more with women than men, which is just part of, you know, I've talked about medical gaslighting before., but all of a sudden the depression and the anxiety, the inability to deal with stress, emotional dysregulation that might be worse around cycles. Oh, it's your premenstrual dysphoric disorder. Maybe, but maybe it's related to some brain injuries in the past. So all of a sudden these symptoms that appear unrelated actually are related. And the frontal lobe, which is one of the places that gets particularly impacted, particularly in younger people, it's just where you, when you have a called a coup-contrecoup injury, what happens is your jello in your brain moves back and forth and it tends to affect The back part and the front part. Front, the front part is where you do a lot of your hierarchical thinking stuff that's in your brain. All of a sudden you lose the ability to do that. You might notice more depression, anxiety, irritability, less ability to actually focus. And your limbic system, which is your emotional generator, gets dysregulated. And so now all of a sudden small things might cause big emotional responses. Point being is like, these are all things to think about symptom-wise. Do you think you're dealing with some kind of post-concussive syndrome issue? So hopefully this episode's helped you all think a little better about What symptoms could be associated with that? And we're going to keep on going forward and talking about now what. So maybe you think your loved one has a brain injury. What's the next steps? What can you do now? I want to keep on talking about that. This whole series will come together at the end. You know, the big question is, so what? Okay, great. You said a lot of things about this.

Hmm.

You know, how many, you know, it's really interesting myself personally. This is anecdotal, of course, but when I was in second grade, I ran headlong into a pole and Got concussion and my mom did what you're not supposed to do is brought me home from school and put me to sleep. But it was interesting, I developed migraines after that. But also an interesting thing was even today I have issues with, I have really bad handwriting and I have normal hearing, I've had normal hearing testing, but I have a hard time hearing words in Latin spaces. There was a lot of background noise and poor handwriting. Well, that actually goes more with a parietal lobe issue, which I didn't have before that. Head injury. And so you can have some, some things older, later in adulthood that could be from a previous injury as well. So having a big picture view of this is important. If this information is helpful, please, please let us know. This is a part of a series we put together based on individuals asking us through social media and through our podcast, "Hey, could you talk about this topic?" Ultimately, the reason we do the podcast, we do what we do is to help educate individuals, encourage them, empower them to take charge of their health. So this information is helpful. Please follow us. That's how we get this information out there. And we'll keep on going forward with this Friday series. Short series on concussions, traumatic brain injuries. Take care. We'll talk to you soon.

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