Diane speaks with Dr. Roger Kligler who is living with advanced stage cancer on why he's suing the state of Massachusetts for the 'Right to Die' and with Dr Jessica Vitter, and intensive care and palliative care specialist on why better communication is so needed between doctors and patients facing end-of-life issues.
Clark Elliott’s world collapsed after his car was rear-ended 16 years ago. He suffered a concussion and often had severe cognitive problems, from seizures to short-term memory loss that sometimes left him unable to even name his children. Dozens of doctors told him there was nothing they could do. Then, the DePaul University professor began working with specialists who were using new treatments based on recent brain research. He worked on brain teasers and puzzles and was given special eye glasses. Within months, his symptoms were gone. We look at new treatments for concussions and what they could mean for patients.
- Dr. Gregory O'Shanick president and medical director, Center for Neurorehabilitation Services in Richmond, Virginia. He is also medical director emeritus at the Brain Injury Association of America.
- Clark Elliott author of "The Ghost in My Brain: How a Concussion Stole My Life and How the New Science of Brain Plasticity Helped Me Get It Back." He is a professor of artificial intelligence at DePaul University.
- Dr. Korin Hudson associate professor, Georgetown University School of Medicine. She practices sports medicine and emergency medicine with MedStar Health.
Read A Featured Excerpt
From The Ghost in My Brain: How a Concussion Stole My Life and How the New Science of Brain Plasticity Helped Me Get It Back, on sale now. Reprinted by arrangement with Viking, an imprint of Penguin Publishing Group, a division of Penguin Random House LLC. Copyright © 2015 by Clark Elliott.
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Your Questions Answered: Concussions And New Treatment With Georgetown's Dr. Kori Hudson - The Diane Rehm Show
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MS. DIANE REHMThanks for joining us. I'm Diane Rehm. Concussions are debilitating for millions of Americans. Many patients with brain injuries report suffering memory and cognitive problems. Traditionally, most doctors have said long term symptoms are untreatable, but a variety of new treatments involving puzzles and even special eyeglasses are now being used to help people with brain injuries.
MS. DIANE REHMHere in the studio to talk about these new therapies, Dr. Gregory O'Shanick of the Center For Neuro Rehabilitation Services of Richmond, Virginia, Dr. Korin Hudson with the Georgetown University and author, Clark ELLIOTT at DePaul University. His new book is titled, "The Ghost In My Brain." I'm sure many of you will want to join us. Give us a call at 800-433-8850. Send us an email to email@example.com. Follow us on Facebook or you can send us a tweet.
MS. DIANE REHMAnd thank you all for joining us.
DR. KORIN HUDSONThank you.
DR. GREGORY O'SHANICKThank you very much.
DR. CLARK ELLIOTTThank you, Diane.
REHMGood to see you. Clark ELLIOTT, I'll start with you. I know you suffered a concussion in your car several years ago. It changed your life. Tell us what happened.
ELLIOTTThank you, Diane. Yes, in 1999, I was rear-ended while waiting at stoplight in Chicago and, you know, the police came, an ambulance came and I seemed okay at the time and I ignored the advice of the EMTs to go get checked out at the hospital because I thought, well, you know, I seem fine. So I drove to my class and I taught my three-hour lecture out at DePaul University, but strange things began happening, even from the moment of the car accident.
ELLIOTTI remember having a pile of five papers in my hand as the police officer was asking for my insurance card and I couldn't figure out how to get the insurance card out of the stack. After class, I couldn't stand up. I had to have a student help me through the doorway because I couldn't get out into the hallway. I couldn't walk down the stairs. When I got to the parking lot, I couldn't find my car and I had no memory of having driven to school.
ELLIOTTYou know, my DePaul students are a delightful crowd and we just joked about my loopiness from the crash. Nobody took it seriously. But that began my eight year odyssey with quite severe symptoms from this concussion.
REHMSo Dr. O'Shanick, how common are the symptoms about which he's just spoken?
O'SHANICKWhat Clark experienced, every 16 seconds in the United States, somebody sustains a traumatic brain injury.
REHMEvery 16 seconds.
O'SHANICKCorrect. It ranges from mild traumatic brain injuries, IE concussions, to moderate to severe. But the vast majority, over 80 percent, relate to what Clark's had. So it's an extremely common difficulty that is largely unrecognized. Many physicians, many coaches, individuals, do not recognize that they are having these difficulties. It's actually an impairment of the brain's ability to take that step back and critically analyze what is going on.
REHMAnd to you, Dr. Hudson, explain what happens when a concussion occurs. What happens to the brain?
HUDSONSo a concussion is an injury to brain that results from a temporary loss of the normal brain function. I often liken this to a power surge to your computer or to your TV where something gets jolted all of a sudden. It shuts down temporarily and then it takes an amount of time to reboot. That rebooting time might be variable for each patient and things might not quite work the same way when it's back up and running as it did before the initial injury.
REHMBut what is the physical process of a concussion?
HUDSONSo concussions happen on a microscopic scale, this is a shift in ions across cell membranes in the neurons. This isn't a large scale injury. It's not a macro injury of bleeding or bruising or swelling in the brain. Those are different types of injuries. This is something that's really happening on the neuronal level in millions and billions of neurons in the brain simultaneously that causes a collection of symptoms which will vary from patient to patient.
REHMSo it may be a shaking of the brain or could it, in fact, be a hitting of the brain against the skull itself?
HUDSONIt could be any of those. We sometimes see concussions that happen from a direct blow to the head, say someone is struck in the head with a baseball. It could be a secondary injury, they're hit in the head with a baseball then they fall to the ground and hit their head on the ground. It could be a tertiary injury where then the brain is actually moving inside the skull and shifts from one side of the skull to the other.
HUDSONAny one of those impacts or all of them together could result in a concussion.
REHMAnd as you practice sports medicine, I'm sure you've seen a lot of those.
REHMClark, what do you mean by "The Ghost in My Brain," the title of your new book?
ELLIOTTYes. And I want to thank you, Dr. O'Shanick, for mentioning every 16 seconds. That's between this time right now and the same time tomorrow, we're gonna have 5,000 of these brain injuries reported, 5,000 a day. So in "The Ghost in My Brain," I'm trying to capture this experience. You know, for the first eight years after this initial injury, I was told by every practitioner I had seen -- I went for MRIs, CT scan.
ELLIOTTAnd, of course, Dr. Hudson, as you comment, they didn't find anything, other than maybe a few shady areas because it was microscopic damage and yet on a massive scale. I was told, Clark ELLIOTT, you will never get better. This kind of brain injury is permanent. Learn to live with your symptoms. And yet, at the end of eight years, it was at the point where I was going to lose my job. I was going to lose my house and custodianship of my children.
REHMHow come? What was going on at the end of eight years?
ELLIOTTDiane, I gave myself a test in the mornings there. You know, I was a single parent and I'm working through this whole period. I was struggling as a busy adult, like many of us. And I would give myself a test in the morning to name my children. And on good days, in the normal way, I could name them in six seconds and I knew I could take on some challenges that day.
ELLIOTTBut on bad days, it might take me three minutes and even at the end of that three minutes, I couldn't be sure that I'd gotten them all right.
REHMWhat about physical symptoms? Were you falling, for example?
ELLIOTTWell, you know, as long as I didn't think I was fine. I was perfectly normal. But as soon as I used my brain to create the visual spatial images of reasoning, you know, the kind of reasoning that makes us human, I would lose my balance because that visual spatial reasoning is vision-based. It's the part of our brain, the 50 to 80 percent of our brain, that gets involved in visual spatial reasoning at some point.
ELLIOTTAnd when I needed those visual resources to think in that way, well, these vision resources could not take over the double duty of making up for my damaged vestibular system and I would get dizzy and start to fall over and I would lose my balance. So yes, I was fine as long as I didn't have to think. But as soon as I started to think, within five minutes, I'd start to experience nausea. I'd have to hold onto the wall. I'd have to be careful if I'm sitting in a lecture because if it went too far, I couldn't stand up to get out of the classroom or out of the lecture hall, so.
REHMDid you begin using a cane?
ELLIOTTNo. I did, though, however get...
REHMYou were too proud.
ELLIOTTI was very crafty at making sure not to get in those sticky situations. There was a tricky moment at the DePaul graduation with all the colorful environment that was bombarding my senses. Here I was a scholarly learned professor on stage behind the president of DePaul giving a commencement speech. And as we were to progress gracefully off the stage, I couldn't walk.
ELLIOTTSo fortunately, I had a colleague that managed to push me off the stage. Otherwise, I looked like a drunk person out there.
REHMSo Dr. O'Shanick, explain to us a little more what it is that's going on in the brain creating this conflict between thinking and moving.
O'SHANICKThe issue might be best illustrated by if I ask you to shake my hand and I put my hand out and automatically almost reflexively you put yours out. That is not something that entails a lot of thought. If, on the other hand, I ask you to put your hand out and move it up and down, you, all of a sudden, have to recruit certain parts of your brain to initiate that activity.
O'SHANICKThat type of initiation, that type of sequencing and prioritization are things that generally are felt to be in our frontal lobes and require, among other things, chemicals such as dopamine to initiate that activity. When somebody has had a concussion, those types of chemicals are depleted and are not functioning at the same level resulting in initiation difficulties. It's not that you can't do it. It's that your starter switch isn't working.
O'SHANICKSo you can have a Maserati engine, but if the ignition switch doesn't work, it doesn't go anywhere.
REHMDr. Hudson, can you see a concussion on a brain scan?
HUDSONNot on conventional scanning and that's one of the most challenging things we see. When I'm the emergency department half of my practice working in the ER, seeing patients with brain injuries, that's often a question we see. Can we get a CAT scan? Can we get an MRI? Can we see it? And the answer is no, typically, we can't on our routine imaging.
REHMSo how do you know a concussion has occurred?
HUDSONWell, it's typically a clinical diagnosis. It's a collection of symptoms. We can see it with a physical exam. We can find these subtle things in the history of patient's self reported symptoms as well as balance and visual deficits that we can tease out of a very careful neurologic exam in the office.
REHMSo that means you're gonna have to do more talking than looking.
HUDSONIndeed. A routine new patient appointment in a concussion clinic could last anywhere from 90 minutes to four hours.
REHMDr. Korin Hudson, she's associate professor at Georgetown University School of Medicine. When we come back, we're going to talk about some of the ways Dr. ELLIOTT found to deal with concussion.
REHMAnd welcome back. In this hour, we're talking about concussions, diagnosis, treatment, frustration at no treatment. I also want to let you know that we'll be doing a live Q-and-A with Dr. Korin Hudson on Facebook. You can post your questions at Facebook.com/thedianerehmshow. And we'll begin when this program ends at the top of the hour. Here in the studio: Dr. Korin Hudson of Georgetown University. Clark ELLIOTT, he's the author of a new book, "The Ghost in My Brain: How a Concussion Stole My Life and How the New Science of Brain Plasticity Helped Me Put it Back." He's professor of artificial intelligence at DePaul University.
REHMAnd Dr. Gregory O'Shanick. He's president and medical director of the Center for Neurorehabilitation Services in Richmond, Va., also medical director emeritus at the Brain Injury Association of America. Clark ELLIOTT, I gather you saw dozens of doctors to begin with and they couldn't help you. But eight years ago, you started working with two specialists. Tell us what there was about their approach that helped you so much.
ELLIOTTYes. I had read a book, at the end of this very difficult eight years living with all of these symptoms I described, and by Norman Doidge, called, "The Brain that Changes Itself." And using the key word, brain plasticity, I looked for clinicians that emphasized this in their practice. Almost purely by luck, I came up with the name of Donalee Markus, a cognitive restructuring specialist in Chicago, and her colleague, the optometrist, Deborah Zelinsky. Both of them emphasized that these brain plasticity techniques, wherein healthy brain tissue can take over functioning for parts of the brain that have been permanently damaged.
ELLIOTTNow, you'd think, after eight years with these very skilled people, dedicated to their work -- how could an optometrist that uses prescription eyeglasses and a restructuring specialist that uses paper-and-pencil puzzles, drawing -- connecting dots on paper -- how could they rebuild my brain? And yet, within three weeks of beginning treatment with these two -- during that period I was experiencing my body reawakening to itself. I could walk down the hallways and feel them next to me. It was like being a six-month-old baby rediscovering the world and my place in it and my mind's place in my body.
ELLIOTTAnd this strange experience -- this is the reference to the ghost in my brain -- started happening where I had a sense of someone following me around about 30 feet off my right shoulder. And then, after a week, it was maybe 20 feet away. In two weeks, now, it was 10 feet away. And finally, it was three feet away. I was a little worried. Is this, you know, am I stepping into some kind of, you know, delusions here? But then I realized one night outside my office as I had just finished class about nine o'clock, that's me.
ELLIOTTYou know, this is the boy that had so loved mathematics that he used to ride his bicycle up at 11 years old to study math and physics at the University of California there at Berkeley and sailed his, you know, sailed his boats around the San Francisco Bay and loved music so passionately his whole life.
REHMSo it all began coming back.
ELLIOTTThat guy came home. I just went in my office...
ELLIOTT...with tears flowing down my face. And the next morning, he had moved inside and I was back again.
REHMDr. Hudson, these treatments, as Clark ELLIOTT said, stem from what is called brain plasticity. Explain that for us.
HUDSONQuite simply put, the idea of plasticity is that we can retrain neural pathways in our brain. We can bypass the pathways that are broken and we can train new pathways to take over and can teach them to perform the functions that our brain needs to get through our daily life.
REHMNow give me an example of the kinds of treatments you would prescribe.
HUDSONSo I work more in the acute setting, where I'm seeing patients in the days, weeks and months, initially after their injury. And we try to initiate therapy very quickly, in the hopes that we can avoid patients months and years down the road...
HUDSON...still struggling. We use a combination of physical therapy, occupational therapy and speech therapy: simple exercises such as relearning to balance, relearning to balance on one foot. I'll have my patients put Post-it Notes on the wall in the shape of a diamond. And they practice just shifting their eyes back and forth, their gaze between the Post-it Notes, side-to-side, up and down. When they can do that, then they can do it standing up. When they can do it standing up, they can do it standing on one foot. As Clark pointed out, the idea of multi-tasking, asking the brain to do more than one task at a time, is often most challenging. So when we can get the vision system working, then we'll try to engage the vision and the vestibular system simultaneously.
REHMDr. O'Shanick, are the kinds of things that Clark ELLIOTT was talking about now part of a larger approach to treating concussions?
O'SHANICKUnfortunately not. Much of the system is still very fragmented. And because of issues regarding payer sources and things of that nature, many of these things are not covered by insurance companies. It becomes an issue of needing to identify, for many folks, kind of their own independent pieces of the puzzle, which at the very time they're the least able to organize and plan and synthesize all of these different providers, that's exactly what they're being asked to do. So fortunately, there are some centers around that can provide that.
O'SHANICKOne of the other points that I want to make sure doesn't get lost is, part of what helped Clark get better is what I call, you know, basic health -- brain health basics, which is: You've got to be getting good sleep. You've got to be getting good nutrition, hydration and exercise. If you think about brain plasticity in terms of our children going to school, we don't send our kids to school to learn if they're not sleeping well, if they haven't eaten, if they're -- if there's some other kind of pain issue going on. It's the same thing. It's their neuroplasticity at appropriate ages that is allowing them to learn. It is brain neuroplasticity in adults and others that allow us to relearn those areas and reestablish areas as Clark experienced.
REHMNow, Clark, tell us more about the line drawings and the geometric puzzles you were doing.
ELLIOTTWell, I did have the prescription eyeglasses. And using those, we bent the light to different parts of my retinas. And this channeled the input from the retinas to different parts of my brain. And in tandem with that, I worked with these puzzles. And we started out literally with three dots, this is a triangle. Four dots, this is a square. And I would do pages and pages of learning just those simple shapes, rebuilding the visual spatial reasoning in my brain. Then we would put the triangle on top of the square.
ELLIOTTAnd then we would get three-dimensional triangles. And ultimately, as I show in the book, I worked my way up, over the course of six months, to a page full of maybe 100 or 120 dots. And I would have to tease out from those dots 15 different three-dimensional geometric shapes. So the puzzles, you know, were designed for someone who is a professor of artificial intelligence, ultimately, you know, would -- this is the kind of spatial reasoning that I needed for my work.
REHMDr. Hudson, you're shaking your head.
HUDSONI think that it's important to note that those tasks were exactly what Clark needed as a professor of artificial intelligence, that concussions are very individualized. Patients with visual spatial symptoms, we need to focus on visual spatial therapy. Patients with vestibular symptoms need vestibular therapy. In the acute setting, we see a number of patients who, in addition to their head injury, also have some degree of whiplash or cervical spine muscle spasm. We find physical therapy, manual therapy, massage therapy -- those kind of treatments are very beneficial, both in terms of relieving symptoms and in terms of helping patients get on with their daily lives. So we really cater therapy to the individual patient.
REHMI want to go back to these special glasses, Clark. Because I gather, if I were to put them on, how would I see differently?
ELLIOTTWell, interestingly, these are just prescription eyeglasses. You could buy them at LensCrafters, you know? It's all in the prescription. It's possible that some labs maybe couldn't build in the prisms or they might have a little trouble with particular occlusions. But there's nothing technologically unusual about these. But I can give you an example. Imagine that someone, as a result of brain injury -- and this is very common, that the visual centers of the brain are disturbed in this way from these impact concussions -- that they're having trouble with near-far focus in their left eye. That there's a slight lag as they look up close and then they refocus when they look in the distance, something we do hundreds of times in an hour.
ELLIOTTWell, if the left eye is lagging behind in the focus compared to the right eye which is working correctly, that means that this brain has to put these two different worlds together in this massive computation that takes place. And it gets fatigued. And ultimately, part of the brain may just say, I'm turning off the signal from the left eye altogether. Now, interestingly -- because it can't keep up with the computations. Now, ultimately, the experience of that from inside is very subtle but could be quite profound also, in that, since we also think as visual-spatial beings, it means then someone's trying to study physics or they're trying to understand a complex novel they're reading and they can't see in three dimensions anymore because the signal's being turned off.
REHMDid you wear glasses prior to the concussion?
ELLIOTTYes. But for a very minor vision correction.
REHM...vision correction. And how is it that you see through these glasses? What changes?
ELLIOTTWell, there's something very important to understand about our retinal inputs. If you go to see a usual optometrist, they will pick that dime-sized focus area and say, can you see the E on the far wall? What they're leaving out is this huge area around, which is our peripheral processing, that sets the context, the meaning for that thing we're seeing. So if you see the letter E, well, that might be, in the real world, an E in the word theory and you're reading about dialectical materialism. And that's different from seeing the E on a pizza truck that's just skipped the curb and about to run you over. So we also have to treat the peripheral vision, which is never done in the traditional optometry.
ELLIOTTThen, there's a third pathway, which is critically important to who we are as beings, and places us in the world and sets the context for that peripheral vision and that's this collection of non-image-forming retinal pathways. And Dr. Deborah Zelinsky treated those and measured those using something called the Z-Bell Test, where I would close my eyes, she'd ring a bell and I'd have to reach out and find the bell with my eyes closed. And when the prescription was correct, and this is all with my eyes closed, I would reach out and touch the bell every time in every coordinate location. So without treating these non-image-forming retinal pathways and without treating the peripheral vision with these glasses, the whole brain can sometimes be completely out of whack.
REHMDr. O'Shanick, what do you make of these approaches?
O'SHANICKThese approaches are tailor-made to the individual patient. A friend of mine says, if you've seen one brain injury, you've seen one brain injury. Everybody's brain is different, just like our fingerprints.
REHMSo what you're saying is that Clark ELLIOTT's particular type of concussion and particular type of remedies will not apply to everyone.
O'SHANICKNot universally. The issue is having a good, comprehensive evaluation that looks at visual-spatial issues, auditory processing issues, vestibular issues, balance issue, proprioceptive issues -- all of those different things integrated. Because if we don't have the full picture of what the individual's strengths and deficits are, we can't help them maximize their strengths.
REHMAnd you're listening to "The Diane Rehm Show." Interesting to me, Dr. Hudson, that Hillary Clinton wore similar lenses after she fell and hurt her head, which at least indicates to me that retraining that visual process as it bounces off the brain must have some value.
HUDSONOh, I think there's a great deal of value. I think anybody who deals with brain-injury patients recognizes that patients who have complex visual-spatial issues will benefit from some degree of retraining. It's not always easy to find a specialist who can do this assessment and who can prescribe the right type of lenses in all parts of the country. Finding somebody who really understands brain injury and can do this comprehensive evaluation, as Dr. O'Shanick mentions, is critically important to getting on the right course towards therapy.
REHMWell, who is doing the kinds of assessments that we're talking about? A dear friend of mine is currently undergoing something with oxygen treatment. I wonder, Clark ELLIOTT, if that was something you ever did? And what's it called, Dr. O'Shanick?
ELLIOTTI had heard of it and the -- by the time we reached the point of my considering it, I just couldn't manage the scheduling of anything like that, as Dr. O'Shanick had commented on. It was beyond me to try and pursue that path. You know, it can be quite complex to try and find these practitioners. And that was beyond me.
REHMAnd I gather it's quite extensive and quite expensive.
O'SHANICKCorrect. And there is controversy in terms of how efficacious it is. There is a recent study done by the VA that looked very critically at that question and found that unfortunately it did not provide sustained benefit for individuals.
REHMWell, of course, the VA was also looking at the money involved.
O'SHANICKI'm not going to argue that point. (laugh)
REHMYeah. Have you ever seen or been with patients, Dr. Hudson, who've used that form of treatment?
HUDSONI've not worked with any patients who've used hyperbaric oxygen for this specific indication. Hyperbaric oxygen therapy is used for a number of different indications, including diving injuries, the bends. It's used for wound care and wound healing. And it's trying to gain some traction for brain injuries. Again, we're scientists. We like data. We'd love to see a giant study with 20,000 patients randomized into two arms where half of them get the therapy and half of them don't.
HUDSONAnd we'd like to see a great benefit.
HUDSONUnfortunately, with brain injuries, none of our therapies have that kind of large-scale, randomized trial and may never have that.
REHMWhat do you think of the kinds of glasses that Clark is wearing and how helpful they might be to perhaps a broad spectrum of patients?
HUDSONI think they're probably very effective for patients who find that they're having these visual-spatial symptoms. I see a number of college students...
REHMHow many of your patients have those kinds of visual-spatial symptoms?
HUDSONSo it's a complicated question, because when we look at concussion patients broadly, perhaps as many as 80 percent of concussion patients will be symptom free within a month. It's that other 20 percent...
HUDSON...where it's not a bell-shaped curve. It's not like they get better immediately. We're looking at a very small percentage with ongoing symptoms.
REHMDr. Korin Hudson of Georgetown University. When we come back, we'll open the phones, take your calls. I look forward to speaking with you.
REHMWelcome back. Time to open the phones now as we talk about concussion, some treatments that work, how difficult it is to really diagnose concussion and the various symptoms one might have. Let's go first to Monica in Baltimore, Maryland. Hi, you're on the air.
MONICAHi, thank you. It's an honor to be able to speak to you today.
MONICAYou're welcome. 35 years ago, I sustained by first concussion in a horseback riding accident. And the year following, I was hit by a minivan in September, so that was about 14 months later. I've since completed junior high, high school, college, it took me 10 years, so, and I, but I still have -- will occasionally lose balance and I'm very nervous. I'm sorry. And even though my father was a doctor, and my mother had studied nursing and such, I still feel it's not -- people don't know what to do with an injury that, you know, they don't know how to handle.
MONICAWhen they look at me, you know, everything's normal. I can speak another language, I understand other languages as well. And I've done a lot of travelling and such. But it's still hard to get the respect...
REHMYeah. I gather you're losing your balance, is that correct, Monica?
MONICAI occasionally still do lose my balance and it will be just something, you know, just going up a pair of stairs. Or a set of stairs. Or just moving.
MONICAAnd somehow, I just lose my balance, and usually, I seem to fall to my right and I've never had vision problems. I was 20/20 eye vision all the time, and I just seem to have gotten all the recessive genes in my family, so I don't know if this is a factor, mentioned, that you.
REHMRight. Right. Well, Monica, I'm so sorry about the injuries you've suffered. I mean, this seems so common, and Clark, I see you writing. Comment, please.
ELLIOTTMonica, my heart goes out to you with this injury. And to the six million other Americans, just like you, and like me, who have suffered these injuries. What I'm hearing from the early feedback, from early readers of the book, is exactly this message that you are giving on the air here. Which is a version of thank you, Dr. ELLIOTT, you are the first person who believes me. I am taking my book to my family members, I am storming into my doctor's office and saying, this is what happened to me.
ELLIOTTThis is my life. I wasn't lying. I'm not, you know, I'm not a crazy person. That, inside me, I have been changed in this way, and outside, I look fine. And I, to the extent that happens in your life, you know, I'm sorry, but you are not alone. And there was one other thing you commented on. You said your vision is 20/20 tested, but as I commented before, 20/20 vision is that centerpiece of the vision and so much of who you are as a human being, and that also can be measured through testing the retinas with these neurodevelopmental optometric tests.
ELLIOTTYou know, they are scientific tests that have been around for over 20 years.
REHMDr. O'Shanick, do you want to comment?
O'SHANICKAgain, I think that, as Clark said, she is not alone in terms of this. And if I've heard it once, I've heard it a thousand times, after I've examined a patient, thank God. I thought I was crazy. And the issue is, these things are going on internally. You know that there's something amiss. And yet, other people around you don't validate that.
REHMAll right, let's go to Detroit, Michigan. Mark, you're on the air.
MARKThank you for taking my call and I'll try to stay focused. I have the same similar as the doctor there. Two years ago, I was rear ended. It was a very, what I thought was a very minute accident. Fortunately, I did go to the hospital. But the brain trauma that I'm experiencing is long term and one of the experiences I've had is I was sitting down in -- I was taking my daughter for vacation down in Florida, what a wonderful place, and I'm sitting across from the table, and I can't even remember her name. And I just start crying, you know, just because it affects you in that way.
MARKYou know, one of the things that I do have, I do have the prism glasses. And there's a facility here, just north of Detroit, Michigan, that's a miracle, and they do work tremendously, when I remember to wear them. When I feel nauseous, I do put them on and it does help tremendously. I wasn't a glass person before and I'm also working with a doctor Randall Benson, that I believe discovered a -- or was working with his, a new MRI, a way to read it. And if I'm not mistaken, I believe he testified before Congress with the head injuries for football players.
MARKSo, but, the biggest issue is trying to get somebody to understand what's happened inside.
MARKAnd this is what's been echoing throughout the program. And it's like, the insurance company, with my understanding, will fight a brain injury harder and put more money into it, not to set precedents, to brain injuries.
REHMInteresting. Did you run into that, Clark?
ELLIOTTWell, you know, this is not to beat up on insurance companies. They have investors and, you know, you want to root out people that are trying to cheat, but brain injuries are an easy target. You know, you can look at someone and say, well, why wouldn't we go to court? You look fine. You know, you seem to walk. At least there's a chance that we'll go in front of a jury and say look at them. There's nothing wrong with them.
REHMHave you run into this?
HUDSONI think we can see and concussions is somewhat of an invisible injury. Unlike a broken arm or a broken leg.
HUDSONThere's no crutches, there's no wheelchair. Again, these patients, to the outside, may look normal. They may function through a portion of their day or, in fact, entire days, completely normally, and yet, you can't see the struggle they're having inside to do simple tasks like brushing their teeth or remembering their children's names.
REHMHave you prescribed these prism glasses to any of your patients?
HUDSONIn my practice, what I tend to do is work closely with some neuro-optometrists, so I'll refer a patient to a neuro-optometrist similar to Dr. Zalinsky, who can do this complex exam, which I'm not really equipped to do in my own office. So, we work very closely with these specialists. It's sort of a multi-disciplinary approach to try and work with patients. So, yes.
REHMAnd tell me what kind of difference you've seen when a patient uses these prism glasses.
HUDSONThe description, as Clark put it is very eloquent and maybe many patients can't find such eloquent words to describe, they feel like they get their life back. It may not just be their vision that's coming back. It's their hearing that comes back. They found they couldn't spend 20 minutes in a grocery store without feeling overwhelmed by the inputs and the noise and the lights and the people. And now they can do their grocery shopping.
REHMWhat about contact lenses? Can they -- you're smiling. Why, Dr. O'Shanick?
O'SHANICKWell, contact lenses, again, part of the difficulty relates to keeping the prisms fixed. And yes, there are weighted contact lenses for certain situations.
O'SHANICKBut the larger issue is, sometimes you need a series of glasses. So, you're not going to pop in and out your contact lenses multiple times during the day, depending on what the distance is from your object. Whether you're reading close, looking at a computer screen, varying kinds of lengths of vision.
REHMI've got a big long email here. I do want to read to you, if I can find it. But in, here it is. It's an email from Ann in Chester, Maryland. A little over six years ago, we lost our youngest son to suicide. A year before he died by suicide, he had a very bad snowboarding accident. He was wearing a helmet, but he had a concussion right after the accident. He didn't know where he was. He kept speaking in loops. Our son was a very normal, happy talented young man. He was known as easy going and a wonderful friend. So difficult to understand his suicide.
REHMIs it possible that a concussion can be much worse than anyone knows, and can lead to suicide? Clark?
ELLIOTTI have a couple of comments about that, Diane. First, this is so sad, and I have heard it many times as I'm sure you have, as well.
ELLIOTTThe first thing is I'm thinking of my neighbor down the street. And this is a woman who had cancer and she was losing limbs from diabetes. And she had a heart problem. And she had also slipped on the snow and had a concussion and we would joke about this. You know, this theme again of being non-human. She would say, diabetes, the losing my limbs and the cancer, I can deal with that. But this head injury is so troublesome. It's a feeling for so many of us that we have left the human race.
ELLIOTTThese hundreds of ways we've been changed inside, in small, simple ways. You know, we might say, oh, could you get me the blue big box over there, instead of saying, the big blue box. Well, it's just a tiny linguistic change, but when it happens thousands of times a day, you just feel, I'm not here anymore.
REHMNow, what about suicide, Dr. Hudson?
HUDSONIt's hard to attribute any one case directly back to a head injury, but this is certainly tragic, and we certainly hear way too many of these cases. I think that there, for many patients, is a degree of depression that comes from separation from the activities that they enjoy. We see it in our student athlete populations, when they can't go to class and they can't go to sports and they can't participate with their teammates. They lose somewhat of their identity and what made them them. And when you take that away, depression often follows.
HUDSONI think you add to that this invisible injury concept, the fact that many people aren't believing. Many concussion patients are accused of malingering, or making up their symptoms so that they don't have to work. Those things added together with a sense of isolation, I think it's reasonable to assume that may lead some people to consider such tragic ends.
REHMDr. O'Shanick, what about medication as part of the treatment?
O'SHANICKMedications make a difference. Again, the brain, basically, is a linkage of chemicals and ion channels and fluxes. And managing or assisting with neurotransmitters can be helpful.
REHMWhat kinds of medications?
O'SHANICKThere are medications that increase dopamine. Certainly one of the medications that gets used frequently is called Amantadine, which was originally an anti-viral medication, but it helps with initiation, helps with fatigue in some issues. Occasionally, there's a need for certain types of stimulant medications. There's also a need for anti-seizure type of medications because you're not necessarily having grand mal seizures, convulsions, but you're having partial seizures. Funny smells, funny tastes, visual distortions, things of that nature.
REHMAll right. Let's go to Roanoke, Virginia. Hi Rob.
ROBHi Diane. It is always an honor and a pleasure to talk to you.
ROBAnd Dr. Clark, Dr. Hudson and Dr. I'm not sure of his name.
ROBMy daughter's 46. She had a concussion about two weeks ago and won't actually see the neurologist for another week and a half. Although she had a CT scan. She also, as a young girl, as a horseback rider, had a couple of concussions 25 years ago. My questions are she's been advised, in effect, to not use her computer, to try to stay in a dark room. And that seems to go along with the stimulation issues that are being talked about that would be so irritating. I'm just curious how long should she sort of maintain this? As long as she has sort of has some disorientation?
ROBThe other thing is she's also got fibromyalgia diagnosed about 16 years ago, which complicates the diagnostic process.
ROBAnd the last question, if it could be addressed is she actually lives outside of Annapolis, in the Baltimore/Washington area. Is there any particular place that might be recommended for the neurological workup?
REHMAll right. Thanks. Dr. O'Shanick, the no computer and a dark room.
O'SHANICKCertainly you want a period of reduction, in terms of stimulation. If you have anybody be too isolated for too long a period, be it auditorally, visually, sensorally, that kind of sensory deprivation can create difficulties in and of itself. So, it's a matter of kind of driving a standard kind of clutch and gas. And periodically trying to see how they do with increased activities.
REHMAnd you're listening to The Diane Rehm Show. As to my -- his comment about fibromyalgia, I don't think we can get into that today. I'm sure there are many doctors around and you, Dr. O'Shanick, I'm sure, know many.
O'SHANICKOne of the resources is biausa.org as an assistance.
REHMAll right, and I'm gonna take one last call here from Kris in Cleveland Heights. You're on the air.
KRISOh, good. Well, thank you for taking my call.
KRISLest we forget, well, not forget, but we need to pay attention to the fact that brain surgery produces the similar, horrible cognitive results. I've been through it and I can speak firsthand. The suicide question I can also answer. It was terribly confusing. I couldn't understand my two children. I couldn't tell them apart. I couldn't tell them whether I had zero memory for about, almost 20 some years. Short term memory. And it was all too much. After two years after the surgery, I did try to overdose.
KRISAnd fortunately, in very scrambled words, I told my oldest, if I'm not here, and he immediately deduced what I had done. Even though he was in high school.
REHMYeah. And there is a perfect example of someone who is suffering to such a degree that the end seems better than going on. I'm glad you didn't carry that out, Kris. I wish we had more time, but there is a call here from Karen. She had a concussion nine years ago. Prior to it, she was a school counselor. She lost her job because she could no longer process what was being said. She found her own way of getting better using coloring and puzzles. What do you think of that, Clark?
ELLIOTTWell, when we talk about following what people say, let me give an example.
REHMVery quickly, please.
ELLIOTTOkay. If I ring, tap a wine glass behind your right shoulder, not only can you hear the sounds, but you will know where it is in the space around you and also, what it is and retrieve wine glassness. You'll know that somebody could drink that wine. And this is basic reasoning that helps you to interpret the sounds you hear.
REHMAll right. Clark ELLIOTT. He is the author of a new book titled, "The Ghost In My Brain." Dr. Korin Hudson at Georgetown University, Dr. Gregory O'Shanick, President of the Center for Neurorehabilitation Services in Richmond, Virginia. Thanks for listening, all. I'm Diane Rehm.
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