Health & Healing from the Pain Healers Alliance: September 2022

Friday, September 30, 2022

Op-Ed: (On Concussion) Miami, We Have a Problem!

9/25/2022 - The Miami Dolphins prized quarterback Tua Tagovailoa sustained what was clearly a concussion. He was dazed and in trying to walk off the field, staggered and nearly collapsed. He was helped off the field and taken into the injury evaluation tent. You didn’t need to be a neurologist to see that he was shaken from hitting his head on the ground.

Watch it here: https://www.youtube.com/watch?v=d5c_zR85ca4

Incredibly, the QB cleared the NFL Concussion Protocol and to everyone’s surprise, was allowed to play in the second half of the game. Many questions were raised about the injury following the game and everyone from the Dolphins coach, to their staff to Tua himself seemed to blame the entire incident on a back injury he said he sustained earlier in the game.

The NFL Player’s Association publicly announced that they were investigating the Dolphins/NFL handling of the entire incident. https://sports.yahoo.com/nflpa-initiates-concussion-investigation-after-wobbly-tua-tagovailoa-continued-playing-vs-bills-235433110.html

Then, the unthinkable happened. The Dolphins were scheduled to play again just four days later and they announced that Tua would be the starter. He came out Thursday night looking great until a play where he was thrown to the ground again. His head bounced off the ground and he immediately went into what appeared to be a decorticate posture. His body flexed as he appeared to lose consciousness and his arms, hands and fingers became stiff and distorted - indicating a severe trauma to the brain.

He was immediately stabilized and taken off the field on a stretcher to be evaluated at a local hospital. Accusations have been flying and denial is the word of the day. What is clear is that we must do better.

With the knowledge that concussions are linked to chronic neuroinflammatory changes and more recently to neurodegenerative disease, we must do better. Tua is a professional athlete in arguably the most violent sport there is. He is tough... a modern day warrior. He is also a very young man competing on the biggest stage in the world with fame and fortune on the line. He must be protected, even if that means from himself.

Watch the progression of the injuries here:

https://www.youtube.com/watch?v=EPbg_KIyUko

Personally, I have a difficult relationship with football. I am a big fan of the sport as I played it from when I was 9 until I was 18 years old and loved every minute of it. I sustained countless blows to the head and who knows how many concussions, but that was a different time. We were always told to shake it off and be tough. I also love watching the games on TV and follow along in my Fantasy League. However, as a clinician, I have seen countless athletes from high school, college and professional sports suffer head injuries that altered the course of their lives to varying degrees. Understanding the neurology and biochemistry of head trauma makes me worry for the players and their futures. I struggle with this dichotomy.

AFTERTHOUGHT:

The NFL generates close to $20 billion annually. They have the resources to facilitate change, but there appears to be conflicts of interest. Who made the final call to allow Tua to play after the first injury? Can a doctor who is employed or contracted by the NFL be truly impartial? Are they personally liable for their decision to let him play and if not, maybe they should be…we need some adults in the room.

DR. MICHAEL GRUTTADAURIA is a Board Certified Chiropractic Neurologist and Professional Biohacker. He manages a private practice in Huntington, NY, treating people with chronic health conditions from early Alzheimer's Disease, IBS, neck/back pain, anxiety/depression, dizziness, vertigo, migraines and concussion/PCS. "Dr. Mike" uses functional neurological examination and advanced testing to evaluate the body, brain and brainstem to develop strategies to rehabilitate most chronic neurological conditions. He applies interventions including functional neuro rehab, balance training, eye movement rehabilitation, chiropractic adjustments and functional nutrition. www.TheOptimumU.com. Additionally, He is the founder of the SameHere Global Functional Doctors Alliance on Mental health. https://samehereglobal.org/docs-alliance-directory/

2022 STUDY OF INTRACRANIAL IMPACT DISORDERS

Concussions are viewed as a mild form of traumatic brain injuries and most frequently occur following an event that involves an acceleration–deceleration mechanism without actual injury to the head, such as whiplash, or the head striking an object. As we study these, researchers and clinicians are learning that these are fairly common, but often underdiagnosed. While the vast majority of people with concussions recover without obvious disability, people can end up with long-term cognitive, emotional and functional issues affecting quality of life – including memory issues and Alzheimer’s disease. Efforts to better predict outcome from head injuries by focusing on the age, sex, type of injury and acute assessments have led to some improvement, but still fail to predict or explain the variation in healing and outcomes. Studies in professional athletes have shown that about 80–90% are sufficiently recovered to return to playing within 7–10 days. But that means that 10-20% are not, and their recovery can take up to 3 times longer. Even taking into account variations in initial injury, this variation is difficult to explain or predict. (see complete feature by Dr. Roberta Kline)

What happened to Miami Quarter back Tua Tagovailoa is likely Second Impact Syndrome, where an athlete receives a second concussion before a previous concussion has totally healed, carrying with it a high risk of permanent brain damage and in exceptional cases can be fatal among adolescents as their brains are not fully myelinated like an adult brain. Tua’s head slammed on the playing surface, he got up, wobbled and appeared disoriented. The Dolphins claimed it was a back injury. This happens under the guise of a minor back or a neck injury to circumvent the NFL concussion protocol. When concussed, playing at full potential both physically and mentally is compromised. Winning obviously meant more to the Dolphins than Tua’s future quality of life as he returned to play already being concussed.

When Tua played the second game, I wasn’t surprised. I expected it. The Dolphins rolled the dice where the wager far exceeded the prize. I have battled Parkinson’s Syndrome and 2nd stage Dementia Pugilistica since I was 41. I’m now 72. I’ve had 58 years to ponder what went wrong. In all probability, I wouldn’t be writing this article if I had addressed my first concussion promptly and properly.

Ray Ciancaglini, The Second Impact
www.thesecondimpact.com

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Friday, September 23, 2022

Restoring Quality of Life with Ultrasound Studies and NeuroProsthetics

ANALYZING PAIN: GETTING TO THE BOTTOM OF THE
"CRIME SCENE" - From an interview with Dr. Robert L. Bard

Russ saw me with a severe scoliotic curve to the spine including lordotic upper spine changes and an abnormal MRI scan report. However, in spite of the markedly abnormal mid and upper disc disease, his pin point pain was in the right hip posterior region which he delineated with his forefinger. Ultrasound imaging is a dynamic and patient inclusive examination. After I did my preliminary scan Russ took the probe and placed the probe over the painful area. The normal gluteus muscle is light gray but the right buttock muscular tissue was dark gray where he held the transducer. As he rotated the hip the bone appeared intact in real time motion without evidence spur or arthritis but the sacroiliac joint at that level was irregular.

Ultrasound uses Doppler blood flow sonography that measures vascular activity that is elevated in inflammatory states. The image showed four times the normal vessels supplying a non inflamed joint and the 3D/4D quantitative image of the hemodynamic activity confirmed moderate neovascularity in the region. This type of inflammation is also called “inflammatory spondylitis” originally described in the radiology journals and rheumatology literature in 2010. This is a critical distinction categorized under the heading of “arteritis” which is a diffuse disorder also affecting the blood vessels including the brain arteries and eye vasculature resembling Rheumatoid Arthritis in progressive clinical course. The 2021 International Inflammatory Skin Conference at the New York Academy of Medicine made the connection of inflammatory disease to heart disease and stroke and also to increased cancer risk. For example, the common skin disease psoriasis of the nail often develops into painful joint swelling and tendinitis. Rosacea of the nose is associated with inflammation of the eye. Gout with a painful toe may foreshadow the beginning of kidney disease or due to the body’s reaction to a high blood pressure medicine.

In Russ’s case, since spondylitis is associated with iritis (inflammatory involvement of the iris), we were able to check his cornea, lens, iris and retina. Russ’s story opens up a global look at medicine because an ophthalmologist will not likely consider back pain as a related issue to eye pathology. A dermatologist may miss the connection of the typicial “butterfly” rash of the collagen disease “lupus” to an increased likelihood of stroke or cancer. A pulmonologist could study the acute shortness of breath in a patient just landing from a long flight whereas the cardiologist will check for pulmonary emboli in a heartbeat.

Ultrasound is non invasive, portable in some cases, real time and shows functional changes as far as abnormal structure (bone fracture vs sprain) and altered hemodynamic such as cancer vessels supplying an aggressive melanoma or breast cancer. Dynamic sonography of the joints is available without an MRI scanner and microcalcium (gout crystals) are visible in seconds that are invisible to most xrays and MRI scans (calcium stones appear black on MRI while showing bright white on sonograms. Point of care ultrasound (POCUS) is now used by the military to bring the diagnostics to the injured patient and at home use of this technology monitors COVID-19 patients avoiding hospitalization.

Russ Allen (R) "reclaiming the best of life"
with family in active travels and sports

The compact size of new devices means that sterilization is fast and battery power assist allows greater portability as has been used in recent building collapses in Florida. Many statewide emergency services have adopted wireless transmission of ultrasound studies to the Trauma Center before the victim enters the hospital. In many cases, such as high school sports, an ankle sprain may be distinguished from a fracture by an experienced coach guided by a remote overreader to verify that the bone is intact and that the pain is due to a bruise type soft tissue injury. We often let the pediatric patients place the examining sonogram probe where they hurt most and copious amounts of ultrasound gel affords virtual non pressure contact on an injured eye that is swollen shut to check for retinal detachment.

A RETROSPECTIVE ON SMART-SENSE RESEARCH

By: Russ Allen (transcript from private interviews)

Thanks to the power of the almighty Google and rusted referrals, I was directed to Dr. Robert Bard in NYC thanks to his countless articles, video seminars and blogs. I was looking for a specialist who is passionate for doing what is least invasive and optimal for the patient. With Dr. Bard, I found a man who devoted his life to expanding his understanding of the latest invasive in medical technologies, always looking for at least invasive modality and is continually sharping as saw as a medical expert.

The imaging that I've used to diagnose my conditions included ultrasound, MRI, and an x-ray, all of which give different insight into what's going on in my body. The benefits of the ultrasound are I'm able to see inflammation within the nerves and muscles of my body. These would not be apparent in the MRI or an x-ray in the same way. The x-ray was able to dramatically show the curvature of my body. And the MRI is able to see the degradation of the ver vertebra in my back. The ultrasound is used on the most sensitive tissues in the most sensitive areas (including little babies inside their mothers).

I've gone over my ultrasounds with Dr. Bard-- specifically looking for solutions and medical treatment options. I found the whole field of ultrasound continues to evolve. We're at a stage now that there are things you can do with ultrasound that historically was not possible, and that will eclipse some more invasive methods to diagnose different conditions. What I love about that unit is any nurse practitioner trained to use. I can take it to the emergency room, a community clinic, a senior center... and get a tremendous amount of usable clinical data right there in the moment that can change that person's life.

FROM THE MEDTECH SIDE
Leadership in the medical community is comprised of an array of difference makers. Many have committed to the noble profession of providing direct patient care while others dedicate their lives to research and exploration. And then there is that special breed of visionary whose best work is in pioneering new ground as technical innovators - reinventing the very future of protocols and clinical strategies. It is this type of healer that holds the unique ability to see beyond the current trends with the creative courage to risk, explore and pave new ventures.

Recent decades have abundantly shown the synergy between technology and medicine, together blazing new trails of problem solving for the human need to heal, recover and restore quality of life- all in the name of life extension. "In the case of Russ Allen, quality of life with chronic pain is greatly affected and it limits the ability to perform normal activities of daily living.

With his new treatment protocol, he is able to improve his wellness, improve his health, and start living his optimal life. And being able to do that with wearable neuro stim allows him to improve in his exercise routine. It also motivated him to improve his nutrition. Wellness technologies like the AxioBionics BioBelt (tm) also allows him to sleep, which we have seen through numerous studies, is essential to recovery. If you're not sleeping, you're not going to recover or reduce pain from your injury", states Josh Schueller, PT.

Tuesday, September 6, 2022

PREPARING ATHLETES FOR RACE DAY: CONDITIONING & PREVENTION

INTRODUCTION

Getting back into full swing of any competitive sports after a lengthy break can be a challenging adjustment, which calls for a re-aligning of the mind-body connection. Let it be the global shut-in of the Covid-19 pandemic or a seasonal hiatus, an athlete who underwent any extended period of inaction from their training routine will require proper help in "getting back in the saddle". As an athlete myself, I chose to specialize in sports medicine to support endurance athletes and active adults to live a long, happy life without extra trips to the doctor.

To restore safe and healthy conditioning for any race, it's all about (first) making sure that they're 100% ready to train to the highest degree without having to take a step back or take a step to the side, because they're either dealing with aches and pains or because they're injured. Whenever somebody's working with me, I always like to make sure that they are getting a full, comprehensive evaluation. More than just reviewing their past medical history or their past wellness history, I also review the past races they've done and the kind of sports they have done in their past. I assess how they move, where they move and if they need some improvement in that ability to function.

PERSONALIZED ASSESSMENT

We start with a preliminary evaluation and getting a full breakdown on how the athlete currently moves. With a series of test activities, I observe and record their strength level for the sport they wish to compete. This includes their stability and power to perform and endure specific activities within that type of race or a sport. For example, if I'm working with a soccer player, it's different than working with a triathlete. Everybody needs a different amount of power output, speed or mechanics- depending on what kind of activity or even the distance of race that they're doing.

EVERYBODY NEEDS DIFFERENT KIND OF TRAINING

Coming into the season, it is not uncommon to find athletes to lack strength to safely endure a full race. Whether you're doing a sprint triathlon and olympic triathlon, or even the half and full iron man distances, I make sure that I'm assessing an athlete to THEIR specific individual needs. Race training and conditioning is about PERSONALIZATION; gauge their BMI and regard their specific physiology to match their training. Athletes want to get faster and be able to push harder- but depending on their body type or specific shape, there are different gaps in how they perform. It is the body type that appears congruent to how they produce power output and speed.

I find that a lot of things break down either in one or two categories; there's either something lacking in their feet or their hips where they're either having decreased stability or they're having inadequate activation in their foot. And because of that, it's altering the way they're pushing off when they're running or the way that they're putting appropriate power into their pedal (when they're cycling). This creates an inefficiency and therefore decreasing the power output and an overall decrease in speed over the course of a race. If you're ever thinking about how many steps that you're taking during a 5k or 10K half marathon, and how many cycles you're going through every minute in cycling races, you're missing a lot of things that could be cleaned up by just seeing a physical therapist that is specializing in what you personally do.

PREPARATION AND PREVENTION, NOT JUST REPAIR!

Seeing a physical therapist is so much more than just healing you from pain. A PT that specializes in endurance athletes, triathletes, runners, cyclists or swimmers can help improve your performance overall while you're still trying to compete and trying to work towards your new goals. The benefit of seeing a physical therapist in addition to having a coach can help with your training. We often work together with coaches to make sure you have the best of both worlds. For those aches and pains or injuries, we're there as the athlete's pit crew (just like NASCAR) to "change your tires and change your oil". We're here to make sure that they stay healthy while we're working on improving performance.

SPOTTING GAPS IN PERFORMANCE

From amateurs to elite athletes, my work is in trying to find those little gaps in their performance. I observe their running form (oftentimes using video to monitor this). I'm always looking at all views- from the front view, side view and back view- to see if there's anything that could be breaking down your form that could lead to a potential injury or an issue with your performance. I'm always looking afterwards with the video. Observing what's going on the knee for anything that could be affecting your from the time that you make contact with the ground all the way up to the top of your shoulders in the top of your head. From here, we create a personalized and comprehensive plan for race day.

For cyclists, I observe their cycling form and I assess areas that need work- including gaps in their stability, their strength or their power. We work on specific activities like a lateral bear walk with the weight pull through, or we can do a walking lens with the weight overhead to work a little bit on leg strength while working on core stability. And then we can also work a little bit more on power by doing these accelerations of power jumps while going off of a step in order to make sure that you are getting those gaps filled and making sure that you're getting to the maximum performance that you possibly can.

THE RIGHT TIME FOR TRAINING

Some of my clients train ahead of time during the winter season is going to be enough for them when they go on for their first race. Others begin training shortly before their next race or even in the middle of racing season. Breakdown can happen any time. I usually have my athletes train as much as possible without irritating anything that's still irritated. Also, continuing to work with them in order to improve their performance and improve that achiness or pain that they're dealing with so that they can continue racing and they continue training without having to stop.

AND THEN THERE'S SLEEP

I'm always a big believer in not stopping unless we absolutely have to. At the same time, I always like to redirect what your training is, so that you're able to continue getting some benefit from what you're doing without having to completely shut down. When prepping for your races, make sure that you're not only consulting your trusted specialist for your endurance training, but also making sure that you're getting enough SLEEP. That means the recommended six to eight hours- making sure you're keeping your stress level in check; making sure that you're not forgetting your strength and getting in your flexibility and mobility on top of your training. I know that can be very difficult, but it is very necessary for all of those things. And if you are getting ready for race day, make sure that you're doing the appropriate (and enough) training. And if you're not sure, make sure you ask me.