HEALTH TECH REPORT: BRAIN HEALTH (PART 1)

INNOVATORS SPOTLIGHT: Concussion Monitoring Headband

July 19, 2022- IPHA NEWS conducted a private interview with the co-developers of NEUROVINE® - a portable headband using EEG (electroencephalogram) technology designed to measure brain waves.  Meet CEO Ashleigh Kennedy, Ph.D., and CMO Matthew Kennedy, MD, MSc (co-founders of Neurovine Inc.) from Ottawa, Ontario, CA. who share their objectives in support of concussion monitoring by measuring brain health as part of optimizing their recovery process. Neurovine is marketed to offer "interactive monitoring program for athletes, students, professionals and anyone undergoing mentally strenuous work by alerting them to take brain breaks before an activity becomes too strenuous”.

IMPROVING CARE OF CONCUSSION VICTIMS   By: Dr. Matthew Kennedy

Seeing a lot of patients come through my family practice in Ottawa, I see numerous patients with disjointed care with concussion, either not having access to missing pieces or just a disjointed lack of communication between practitioners. And then probably the biggest thing that stood out was the cognitive pacing component. We use our brains all the time. You can be in the cognitive rest part of your concussion recovery, and trying to not overdo it. You can even be sitting in a dark room and your mind can be going‐‐ thinking about your taxes or other stressors.  It's really hard to turn the mind off because it's where we live our life and where we experience the world. And so I would see time and time again, patients going back to work, even with half days or we'd have time regulated limitations on how much they'd be able to work and then they would overdo it and have setbacks and they'd be back three weeks, four weeks in the recovery.

We have developed a comfortable, portable EEG guided cognitive pacing tool which monitors how hard the brain is working in real time and gives alerts to patients before they overexert themselves. This allows for data driven cognitive pacing which can be used at home, in the office, or in the classroom. We also have the heart monitor as well as heart rate variability. So that helps to guide subthreshold exercise, which has been shown to speed recovery, as well as giving metrics on concussion status with the heart rate variability. And then on top of that, we have accelerometer, gyroscope, magnetometer --sensors in the head band that allow for measuring head movement. The amazing thing about that is it gives biofeedback for balance retraining, vestibular retraining, as well as even some ocular motor and eye tracking exercises- making for a fairly thorough package of information.

ORIGINS AND CONCEPT EVOLUTION    By: Dr. Ashleigh Kennedy 

My father had played professional football in Canada and he had a lot of friends that were really experiencing some cognitive decline. I also lost a friend to suicide when I was quite young- and that really is what got me interested in how the brain recovers after an injury. This all inspired my studies and has been my mission in life to learn more about how the brain works and how it recovers. I was a postdoctoral fellow at the Toronto Rehab Institute and I found them to be amazing at putting technology in patient's hands and sending them home with it. This idea offered continuous and more intense care as an inpatient- allowing patients to thrive both mentally, as well as physically through the recovery, because they were part of the process. 

I made my first EEG headband during my undergrad at Stanford.  That model was designed for kids with cerebral palsy- to help their understanding of how they're moving through space and also what's going on cognitively. Matt and I actually met in our master's program during a research project to explore and build this type of technology. 15 years later, Matt and I started talking about how we can do this for patients who have sustained a brain injury. The intention of Neurovine was to create a kind of small technology that could support them in the recovery journey. Over the past three years, that's evolved into more of a platform solution where patients take our technology home, and our data analytics really supports them right from the time of their concussion until they've returned back to work or school or sport. 

We're actually launching as a wellness technology in September… we are working with sports teams, delivering the technology to them on a yearly license. We are exploring the opportunity to work with military organizations and employers. We also aim to target post-concussion cases both in the US and Canada, where employees are not getting care for these concussions (and it's keeping them out of work for months- longer than it really should). If they had the proper care after the injury, that's our starting point and that's how we are entering the market. 

*This spotlight segment is part of IPHA MedTech News' innovators feature series.

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 20-DAY IPHA TEST DRIVE
9/1/2022- IPHA NEWS kicks off a 20-day direct demo/test drive and performance challenge of the NEUROVINE® App and Sensor Band- by our Sr. Editor, Lennard Gettz. "I took on the Neurovine experience as any other head patient of a physiatrist or neurologist, whereby I was to undergo an EEG exam. Simulating this has some elevation in stress or anxiety with these brain games, which I was concerned may affect its accuracy and ultimate results."

Given the option of a variety of activities (from the APP), the following 5 images are actual post-activity reports of some of brain exertion.  The uniqueness of each graphic appears to record the major brain wave patterns- reflecting on the brain's real-time reaction to that specific activity. For this review of a COGNITIVE PACING (for head injuries/concussion), one can see the potential benefit of such a personal device during all stages of one's day by helping to identify one's brain health. Extrapolating from the graphic scan, high exertion would indicate elevated strain and struggle for the brain. The PACING element of this wearable device will translate this high exertion by suggesting "it's time to slow down or rest". (See complete report on HealthTech Reporter*)

CONCUSSION 101: "The Phantom Menace" By: Joshua Schueller, PT In the spirit of public awareness and technical education, the clinical team at IPHA (The Integrative Pain Healers Alliance) recognizes the need to bring resources and information about the latest innovations in diagnostic and therapeutic solutions to the general public.  In addition, IPHA’s support of this public awareness offers the same awareness to the patient-care community with the hopes of adding new options to their expanding possibilities in search of bringing wellness to their patients.   Whether a vicious hit during a football game or an elderly man falling while getting out of the shower, concussions can occur at any time any place to anyone.  Concussions do not discriminate based on age, activity, or location. Nearly a quarter of the population has suffered a concussion. A traumatic brain injury sustained to the head is a concussion.  This number is probably higher due to unreported concussions. [5] Symptoms of concussion can range from mild to severe.  THREE CLASSIFICATIONS OF CONCUSSION: Grade 1 Mild - headache, difficulty focusing, memory loss, dizziness, and nausea. No loss of consciousness Grade 2 Moderate - similar symptoms as Grade 1 but loss of consciousness up to 5 minutes Grade 3 Severe - risk of permanent brain damage and loss of consciousness more than 5 minutes. Symptoms include speech difficulty, amnesia vomiting [6] Currently, concussions are diagnosed by symptoms and mechanism of injury. In severe cases a CT or MRI is used. [7]  The difficulty in concussions is that there is not a universally accepted diagnosis test to determine a concussion or its severity.  Also adding to the challenge with concussions is treatment protocols are symptom reliant. Current treatments include rest, abstain from physical activities, and medications for headaches.  [8].  The complexity of the brain has made diagnosing concussions accurately difficult.  If someone returns too quickly, before the brain is fully healed another more serious concussion can occur.  Repeated concussion especially in short time frames can lead to permanent severe brain damage.  Chronic traumatic encephalopathy (CTE) is brain degeneration caused by repeated head trauma (concussions).  There currently is no treatment and can only be diagnosed through an autopsy.  CTE has been found in athletes such as football players and boxers, but also in military personnel who have been exposed to repeated explosive blast.  Experts do not have a clear understanding of concussions and CTE.  [9] People who suffer from head trauma can display cognitive, behavioral (impulsiveness and aggression), mood disorders (depression, apathy, suicide) and motor symptoms (motor neuron disease and Parkinson’s). (5). Due to the complexity with dealing with brain injury, diagnosis and treatment have fallen significantly behind.  Concussions often go unreported or misdiagnosed as “getting your bell rung”.  Many sufferers will hide their symptoms and keep going on with normal activities despite suffering from symptoms.  Until an accurate test or device is available to accurate classify a concussion and a universally accepted treatment, concussion will continue to grow, and the side effects will be debilitating for the suffers.

2022 TRENDING INTEREST IN BRAIN HEALTH
By: David Dachinger

Within the recent decade, a higher level of focus on brain health has been a trending topic in headlines throughout medical community news.  Public concerns about Alzheimer’s, Dementia, MS, ALS and other neurodegenerative diseases has driven advanced research in their diagnostics, therapeutics and prevention. According to Dr. Jay Lombard, “One of the most exciting opportunities in neuroscience research today is the use of strategies that protect the brain which may potentially prevent, delay or inhibit the progression of neurodegenerative diseases… this opportunity rests on our ability for early diagnosis. Research has shown that the likelihood of success for a given treatment-whether lifestyle changes or pharmacological approaches- is highly dependent upon early intervention, before the disease process has become too severe and potentially irreversible.” [1]

In addition, growing reports on Chronic Traumatic Encephalopathy/CTE (identified from head concussions) has prompted significant attention to this progressive brain condition.  According to the National Health Service (UK), this disorder “is thought to be caused by repeated blows to the head and repeated episodes of concussion. It's particularly associated with contact sports, such as boxing or American football. Most of the available studies are based on ex-athletes”. [2]

More concerns of brain function and performance is widely seen in the current pandemic and post-covid infection sequelae cases, where over 50 prevailing symptoms and disorders (known as LONG HAUL) are now under global review. Clinical researchers state post-acute COVID—affects a multitude of organ systems- including neuropsychiatric issues like BRAIN FOG, a form of cognitive impairment. This may be linked to a wide range of pathologies such as anxiety and depression, post-traumatic stress disorder (PTSD) and recurring headaches and migraines. [3] In a recent meta-analysis study on long term effects of covid-19, Dr. Sonia Villapol (Assistant Professor of Neurosurgery at the Center for Neuroregeneration in the Houston Methodist Research Institute & Asst. Professor at Weill Cornell Medicine) recorded significant long haul cases pertaining to brain health and functions including 44% headaches, 27% attention disorders, 13% anxiety, 12% depression. [4]

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JOSH T. SCHUELLER is a licensed Physical Therapist who dedicated his life's work to supporting and treating chronic pain and disorders with non-invasive, safe and effective treatment solutions. He is the current VP of Clinical Operations and Business Development at AxioBionics LLC. and is formerly the Clinical Director for Orthopedic Physical Therapy Clinics (Rockford, MI).  As an active member of APTA, he holds advanced certification in Physical Therapy treatment techniques including the McKenzie method of patient empowerment.  He has over 20+ years experience in the treatment of neurological conditions such as Spinal Cord Injury, Traumatic Brain Injury, CVA, Cerebral Palsy etc.  In 2021, Josh is elected a clinical advisory role and educational advocacy for IPHA (Integrated Pain Healers Alliance) and has published research articles in pain management for the MedTech Reviews program of therapeutic devices.   Today, Josh continues to support patient suffering from disabilities and has expanded his focus to contribute his expertise in treatment programs for Veterans and first responders. 

Lt. DAVID DACHINGER (Ret) - Northeast F.A.C.E.S. Ambassador /Cancer Advocate

David Dachinger is a retired Fire Lieutenant with over 21 years as a leader in emergency services. He is also a Stage IV cancer survivor. He wrote cancer prevention policies for the Ridgefield CT Fire Department, and introduced physical fitness wellness initiatives. David hosts the video podcast “Responder Resilience”, which is dedicated to improving the mental and physical well-being of police, fire, EMS, and dispatch personnel. In addition to being a Grammy®-nominated engineer, David combined his expertise in multimedia, crisis leadership and major medical challenges to produce calming programs (alongside his wife Tamara) that enhance the lives of first responders & cancer patients though a state of the art APP called "Loving Meditations Mindfulness".

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GENETIC RESEARCH & CONCUSSION RECOVERY  By: Roberta Kline, MD

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.  DNA is the genetic code that is the blueprint for everything that goes on in our bodies. Genomics is the study of how small changes in our DNA affect how our bodies function. [link to genomics article] Research, primarily focused on combat veterans and athletes so far, has shown that these small variations in our DNA may account for at least some of why some people respond to and recover from traumatic brain injury better than others. While the APOE gene is the most widely studied, there are now over a dozen others that have been identified. Because there are hundreds of genes impacting all of these biological systems, it is likely that there are many to still be evaluated, and outcomes are the result of the interaction of multiple genes. (more)

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REFERENCES

1) Research Review: Neurodegenerative Diseases and the Vascular System/ Health Resource Digest:  https://healthresourcedigest.blogspot.com/2022/06/neurodegenerative-diseases-and-vascular.html
2) Chronic traumatic encephalopathy: https://www.nhs.uk/conditions/chronic-traumatic-encephalopathy/#:~:text=Chronic%20traumatic%20encephalopathy%20(CTE)%20is,are%20based%20on%20ex%2Dathletes.
3) COVID long-haulers: Questions patients have about symptoms | AMA:  https://www.ama-assn.org/delivering-care/public-health/covid-long-haulers-questions-patients-have-about-symptoms
4) https://cancerresourcealliance.blogspot.com/2021/06/long-haul-syndrome-post-covid-dilemma.html
5) https://www.npr.org/sections/health-shots/2016/05/31/479750268/poll-nearly-1-in-4-americans-report-having-had-a-concussion
6) https://www.carrushealth.com/2020/02/07/signs-and-symptoms-of-the-3-different-grades-of-concussion/
7) https://www.hopkinsmedicine.org/health/conditions-and-diseases/concussion
8) https://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/symptoms-causes/syc-20370921
9) https://concussionfoundation.org/CTE-resources/what-is-CTE

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THE GLOBAL VIDEO ENCYCLOPEDIA & THE SOCIAL VOICE

Dr. Bard interviewed by CH11 PIX News: 10/8/2021

To gain an understanding of today's digital video messaging is to accept the very basis behind social media and its community.  Video is the trending media for high-speed message delivery, harnessing the major global share- seated within all screen & cell phone users.

In our digital age, the written word continues to suffer a major loss of followers over the impact of VIDEO messaging.  Where book stores and magazine publishers are at a major decline, the cell-phone generation (with a device too small to read a full article) finds a 2-minute video clip to better comply with their Gen-Z attention span.

This concept of bringing awareness and education strongly exists in many areas of the local news community with an expansion in programing to include educational and informative content for social media platforms.  Veteran journalist and lead anchor, Marvin Scott (recipient of 12 Emmy Awards) has been the bedrock of NYC's CH11 News. For over 50 years, he has delivered all areas of local news to millions of homes in the NYC area.  Mr. Scott also pioneered educational and medical segments in his news reporting by covering topics like cancer and other health issues.  He expanded the reach of his reporting beyond the daily TV newscast by producing CH11's Facebook Live and Youtube Channels.  It is this visionary use of our current media trends that shape the distribution of useful, share-worthy information that adds to the intellectual expansion of our web community.

THE VIDEO MESSAGING TREND:
By: Lennard Gettz  (Producers of NYCRA NEWS/TV)

Since the inception of YOUTUBE, the multimedia video platform is vastly conquering the lion share of public info access and distribution- especially throughout social media.  Education and News are materials that we can never get enough of. They provide insight, awareness and a connection to the world at large.  These genres are considered by the social media platforms as useful information and relevant material.  They are preferred content because they suit the SHARE-WORTHY nature of the viral distribution concept.

Search engines (like Google, Bing and Yahoo) helped to forge the discernment between true information vs. commercialized material as part of a conscious effort to not mislead the public.  In social media, publishing (or posting) promotional, marketing and commercial videos are a violation of terms of use and are usually frowned upon by subscribers. The poster is often reported or blocked leading to their accounts to be frozen or even cancelled.  

WHAT IS CREATIVE COMMONS?
The continued expansion of FREE EDUCATION is an industry that aligns with the current social media rules- while offering useful content for sharing. They follow non-commercial behaviors like branding, calls to action or all the marketing actions to buy something.  FREE SHARE content is part of our entire social culture driving information throughout the 'interweb' without charge, cost or commitment. Producers of these videos who legally own the copyrights to their work invite this form of free sharing by offering Creative Commons licenses. This gives everyone from individual creators to large institutions a standardized way to grant the public permission to use their creative work under copyright law.

The production and distribution of industry news, technical education or (How-To) instructional content has confidently carved a major presence in our digital media. Educators and news reporters are flexing their talents in this trending platform while generously sharing their content through moving image and sound. From amateur videos shot with a cell phone, to well-produced prosumer grade educational clips on YouTube (and other video platforms), our current digital media is the next encyclopedia for just about any researcher or student.  As search engines and social platforms like Facebook and YouTube continue to filter out commercial content, this gives educators a fighting chance to support their noble cause of sharing enlightenment and proper science.

ZOOM IS LIVE TV... AND RECORDABLE TOO!
By: Roberta Kline, MD

The vast majority of the business community attributes the explosive popularity of ZOOM CONFERENCES to the current Covid-19 Pandemic. To divert our public engagement toward the safer digital & web-based alternative of a web-based video meeting far achieves so many benefits from infection prevention to travel cost reduction to optimal time management.

Meanwhile, the VIDEO RECORD feature of ZOOM is also a powerful instrument for educational video productions for speakers and interviews. Patterning after the movement of 2020 mainstream news and many late night talk show hosts who worked from home (using more advanced broadcast equipment), video producers from all levels have taken on ZOOM recordings as an alternative (or even a replacement) to on-site professional video shoots.  This saves $$ on the significant cost of transporting lighting, camera, audio recording equipment & video crews. 

Of course "Zooming" with your consumer grade 1080dpi webcam will never replace broadcast quality equipment but a new "Pandemic-Grade" video style has exploded throughout the web, casting a massive demand for more webinars, zoom video interviews and productions using Zoom-recorded videos.    This trend may be inspired by the pandemic, but producers and clients alike are enjoying the financial advantages of filming interviews via Zoom will continue its presence in the prosumer video market for social media distribution.

THE KING OF HIGH SPEED DISTRIBUTION AND RETENTION

By: David Dachinger (Producer of Responder Resilience podcast)

Edited by: Graciella Davi (Sr. Editor of The RightWriters Content Group)

As we are now deep in the age of digital media, producing a video on your own has become extremely fast and easy.  One person can take on the role of what used to be a team of union-scale professionals, ie. camera experts, online editors, lighting designers and audio/sound engineers.  With the advent of  the smartphone, which offers satisfactorily high-enough quality optics and recording capabilities, the ECONOMY OF SCALE (of smaller, faster, cheaper) has reshaped the entire multimedia industry to re-think the production and distribution (formerly called BROADCASTING)  to re-scale every area of video work- including its access.  

The effectiveness of video as a multi-sensory messenger matches its function as a personalized and intimate experience.  Where reading a newspaper once dominated the media industry, the GenZ society (that's everyone who owns a cell phone) finds reading to take significantly more work for the audience (to process the read word into relatable content).  Video engages the audience by delivering both a visual and auditory message, capturing the viewer's brain processing with motion and engaging sound and/or voice. 

The average person can read 5-10 words per second, while images can be processed so much more quickly. Over 80 percent of the information processed by our brains is visual and our brains can process images 60,000 times faster than text.  Visuals are also better remembered than audio or text: 80% of us remember what we see, versus 10% remembering what we hear and 20% recalling what we read. A recent survey reported that 95% of business-to-business buyers wanted briefer and extremely visual content. This makes sense as we are seeing a constant uptick in video consumption on social media, with 100 million hours of video being watched on Facebook daily. On social media, compared to text and images combined, videos get 1200% more shares.

Psychologically speaking, video has the power to cause strong emotions, which encourage viewer behavior like commenting, liking, and sharing. In general, increased interaction is influenced by better content. Video content can help you engage your audience and help you get your point across better than virtually any other marketing medium. Video can also be the difference between the customer who’s only interested in your product versus one who’s willing to buy. Video is an excellent tool for creating a deeper connection with viewers and for creating a higher level of engagement.  When it comes to communication and content marketing, video is king. Video plays a crucial role in our podcast, which we use to build community and bring important information to the first responder community. 

INFO REVOLUTION: THANKS TO FAST AND FREE ACCESS

Since the camcorder in 1982, personal, pro-sumer grade quality video became accessible to everyone. Since then, digital video cameras have flooded the market at a small fraction of the VHS era- making it even easier for anyone to pick up a cell phone to shoot and edit a video. Hosting platforms YouTube became global channels for global consumption, driving 24-7 access to any production from just about any electronic device.  Thanks to the digital revolution, fast access to video (both on the production and web access ends) has mostly conquered public communication- where the written content has taken a back seat to a 2-3 minute online video clip. 

GETTING RE-MOTIVATED BACK TO FITNESS (Part 1: Running)

PROLOGUE:
By: Graciella Davi /IPHA Editor

In the thick of the summer, enjoying the outdoors is (yet) another reason to get into, or get back into fitness. Having an ACTIVE LIFESTYLE is #1 in every wellness  how-to article and coaching program- whereby staying in motion positively affects all areas of our health.

Whether you drive through the city or the suburbs, you may get a glimpse of an occasional runner or cyclist at the side of the road, diligently pushing themselves into fantastic shape. The non-active spectator may wonder what it could be like to become that person- and what attracts people to that form of exercise in the first place.  The idea of pounding the pavement for miles and miles appears grueling, painful and often lonely - and yet those who are dedicated to distance exertion truly is the wiser in so many ways.

We asked our own PT JOSH (in-house physical therapist) about the mind-set of a health regimen follower after his own presentation on the love for RUNNING.  IPHA-NEWS hopes to share  PT JOSH's message of getting off the couch, getting in motion and enjoying the running zone.

THE MINDSET OF STAYING IN MOTION:
Written by: "PT JOSH" Schueller

“All body types are beautiful”- Brittney Runs a Marathon. This 2019 films depicts Brittney going through the journey in becoming a runner.  Brittney is an out of shape, party girl who decides to improve her health by training for a marathon.  

The stereotypical runner is tall, lanky, fit, and attractive striding across the finish line like a gazelle.  In reality, this type of runner is in a very small minority.  As the quote above suggests “all body types are beautiful” runners come in all shapes, sizes and conditions.  Most runners start out in poor shape.  My research shows that the average runner can run less than ½ mile prior to starting their training.  The misconception is you are born a runner, but most people must become a runner.  As cliché as it may sound, taking that first step is the hardest.  

Running is an art and a science. The difference between a good run and a terrible run can be razor thin(1).  In my research, many factors can determine a good run vs a bad run.  Contrary to many beliefs running is 90% mental. A poor mental outlook or self-sabotage can end a training session very quickly (2).  Many people quit a running program before it even starts because they do not think they can do it.

COMMON REASONS WHY PEOPLE QUIT RUNNING:

1. Unrealistic expectations —when I started training for my first race, I bought a book on running programs. I am not a prototypical runner by physique.  This program set unrealistic training regimens.  Running 6 days a week for 5 months was mentally and physically overbearing and I ended up quitting after 3 weeks. Start small. Set achievable goals and expectations.

2. Not enjoying the Journey- make running an escape from your daily life. Just you and the open road or trail.

3. Injuries - to help reduce injuries consult with your doctor, find proper footwear, and listen to your body (4)

4. Weather can affect your runs.  In my experience some of the best runs occur during less-than-ideal conditions.  

5. Unrealistic goals - Many runners set unrealistic expectations.  Running is an individualized journey.  Winning a race is not realistic, but finishing a race is the real accomplishment.

BENEFITS OF RUNNING (some may surprise you)

1. Improve health and wellness- this is a common reason people run. Improved heart health and bone density and weight loss in running, 5 to 10 min/day is associated with reduced risks of death from all causes and cardiovascular disease, even at slower pace (3)

2. Improved socialization-whether training with a group or the camaraderie of race day being around like-minded people who know what you are going through can be a enormous advantage.

3. Improved emotional health-1000s of studies have shown a link between improved mental health and running (5)

4. The Great Outdoors-being outside carries a lot of benefits.  Most of us sit inside all day long. Many benefits of getting outside such as Vitamin D, better breathing, improved sleep can lead to improved health and wellness. (6)

5. Improve memory-In a recent study running has demonstrated to increase in a protein that suggests a correlation between improved memory and running (7)

STAY THE COURSE

In my experience, some helpful tips to overcome the hurdles of running-

1. Type of surface -Vary the areas you run.  Some people prefer treadmills vs outside.  Treadmills have never been my preferred training method.  Always too easy to stop anytime and if you let your mind wander you may end up falling.

2. Sounds of silence-Find what is best for you to listen to while you run.  Many people choose music, podcast, audiobooks, or just silence. Experiment with different ways to entertain yourself   

3. Reward yourself.  Most runners run because they counterbalance the good with the bad lifestyle habits.  Reward yourself after a good run or meeting a goal.

4. A missed run is no biggie.  Somedays life just gets in the way so you might not be able to do a long run or any run at all.  Tomorrow is a new day.  This is your journey.

5. Variety is the spice of life. Varying your distances, speed, surfaces, and locations increases your enjoyment and results. 

6. Embrace the suck—some of the best runs are in the worse weather or didn’t have the best motivation to run that day. 

Whether it is a 5k, 10K or marathon the atmosphere and excitement of race day can be one of the most rewarding days of your life.  The dedication, hard work, perseverance all pays off when you cross the finish line to people cheering you on.  So next time life throws you a challenge  grab the shoes and let the rubber hit the road and forget about life for a while.

One run can change your day, many runs can change your life!

   

1. https://www.runverity.com/blog/running-is-an-art-and-a-science

2. https://runnersconnect.net/mental-aspect-runner/

3. https://www.jacc.org/doi/10.1016/j.jacc.2014.04.058?articleID=1891600

4. https://health.clevelandclinic.org/how-to-prevent-running-injuries-6-expert-tips/

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663387/

6. https://www.healthline.com/health/health-benefits-of-being-outdoors

7. https://www.cell.com/fulltext/S1550-4131(16)30247-9

DERM-NEWS 2022: TOXINS IN THE SKIN

According to the CDC, DERMAL ABSORPTION happens when a chemical goes through the skin and travels into the body. Many chemicals used in the workplace or even from home (ie. pesticides and organic solvents) can wreak havoc on and under the skin, damage internal organs and also the immune system if they penetrate the skin and enter the bloodstream. Most efforts to address chemical hazards have been focused on breathing, digesting or drinking chemicals rather than what's being absorbed through skin. Because of this, there are far fewer methods and campaigns dedicated to assessing skin exposures to toxins - UNTIL NOW.

With the latest evidence of inflammatory skin disease and foreign bodies under the skin, the medical and aesthetics communities are now facing the many new ways that environmental (toxic) influencers can affect the body through skin contact and absorption. This initiative is achieved thanks to our non-invasive diagnostic imaging advancements including Confocal Microscopy and the 3D Doppler Ultrasound. Dr. Robert Bard, presents this critical health topic as part of his 2022 Series on INTRADERMAL IMAGING OF TOXINS in dermatology conferences such as the NIDISKIN Spring Symposium. (See INFLAMMATORY SKIN DISEASE Poster)

SUPPLEMENTAL:
 Toxins and Health: A Personalized Medicine Perspective: By Dr. Roberta Kline

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SENSIBLE ADVANTAGES OF ULTRASOUND IMAGING FOR BURNS AND DERMAL TRAUMAS

Written by: Dr. Robert L. Bard of the Bard Diagnostic Imaging Center

For most emergency responders and physicians, identifying the degree of any burn or dermal trauma cases starts with a visual assessment.  With professional training and enough experience, the professional eye can differentiate between first, second and third degree burns to initiate the proper treatment process. First-degree burns commonly show redness, and swelling only on the outermost skin layer; second-degree burns show surface injury to the underlying layer with blistering and Third-degree burns affect up to the deep layers of the skin.

As standard practices continue to evolve, diagnosing any advanced burns are now calling for new considerations for the prevention of burn-related complications.  As more and more after-effects from high degree burns have left patients with lasting (and sometimes fatal) results, it may no longer be enough to drive a treatment protocol based on surface topical healing. 

BURN SCANNING TECHNOLOGY: ASSURANCE AGAINST COMPLICATIONS

Second and third-degree burns may show blisters and red skin but with today’s many non-invasive subdermal technologies, you can now identify the depth of the burn and what the injury truly means under the skin. Identifying the exact DEPTH of the internal injury as well as monitoring (visually) its internal impact/effect on the body may uncover and predict other potential health issues such as:

-        Scarring and unrecoverable dead tissues

-        Damage to Nerve endings /neuropathy

-        Inflammation

-        Temporary to permanent loss of skin

-        Damage to underlying bones, muscles and tendons

-        Bacterial infections (from the broken skin) like tetanus

-        Internal Shock

-        Hypovolemia (low blood volume/ unusual blood loss from a burn)

According to Image 1A, high resolution sonogram used a standard probe for skin imaging showing the black area, which is just below the white line of the surface and the black fluid corresponds to the blister seen on the specimen of the burned area. Now below it you see the skin with the first vertical blue dotted line and it goes to the fascial plain white line, which shows swelling of the tissues. The normal skin measures 1.3 millimeters or thin as a dime and the depth of the burn itself measured is twice that, 2.6 millimeters. So we have a way of seeing the fluid. We have a way of checking the depth of the burn, which is clinically difficult because the eyes cannot see below the skin.   You can see the blister is basically gone because that's the tiny black area above the tissue line- showing almost no fluid left (represented In the blackish area)

Upon review of Day 9 diagram, see "burn healing" on the left side of this diagram where it says dermis on day 9, you can see the bottom white line under the lettering dermis, which shows the bottom of the skin, which last time was 1.3 millimeters. Then to the right of that the dermis tissue is starting to have the red and blue healing blood vessels that's coming in marked by the red arrow. And then to the right of that where it says decreased vascularity, the larger blood vessels have not yet come in, but at least we know the skin has viable feeding blood flow. So it's more likely than not to heal.

** These images are scanned with the GE Ultrasound Voluson E8.  Any machine over 15 megahertz can be used on burns- however, devices with higher the resolution improves the scan experience to get the best data.

REVIEW OF THE BLOOD FLOW INNOVATION

Today’s imaging devices cover a wide range of functions on the market carrying specific features to fit their many users specific needs.  This scan was generated by the General Electric Voluson E8 system which uses an 18 mhz probe outputting 1/10 of a millimeter of resolution.  The benefit of using this GE 3D Doppler system enables the ability to measure the depth of the burn as well as identify and record the exact amount of fluid in the surface of the burn, which is the blister. 

For many diagnostic applications, the real-time scanning ability of VASCULAR ULTRASOUND has greatly advanced the way injuries are read, identified and managed.  Vascular ultrasound uses sound waves to evaluate the body's circulatory system.  It also helps identify blockages in the arteries and veins and detect blood clots.  This innovation is not radiation based, leaving no harmful side effects and out-performs many of today’s current counterparts including accuracy in scanning soft tissues that does not appear in x-rays. 

BLOOD FLOW technology is the “diagnostician’s storyteller”.  It allows you to see which part of the skin is alive by the indication of active blood flow through the area- versus the skin that is dead or dying with no blood flow. In cases of burns, the margin of injury can extend once the burn has been completely cooled down. Since vascular ultrasound is safe sound waves, you can conduct frequent scans to monitor healing and progress every hour/every day until resolution.

The paradigm of studying blood flow allows any diagnostician to review whether the tissue is curing or not.  In the case of performing a possible skin graft, the blood flow around an injury gives more data as far as the behavior of the burn or injury as well as the condition of healthy tissue to attach to the burn.

Any inflammatory skin disease is caused by inflammatory blood vessels, which is not evident by the naked eye. This scanning modality allows you to quantify the degree of inflammation and the response to all the new treatments available. Where widely accepted optical technologies work well,  they are limited to 1/2 of a millimeter depth, so they are surface only.

SKIN LIFE VS. SCARS 

If the tissue doesn't heal with normal skin, it will scar. The scar tissue appears as black in ultrasound imaging, almost like the fluid- but with zero blood flow.  Any kind of trauma can result in healing tissue or dead tissue, which will either get infected or scar down. Imaging can also show if the area is getting inflamed as it indicates irregular volume of the blood vessels resulting in cellulitis or the inflamed skin.

Scar tissue is dead skin.  Doppler Imaging can be useful as it shows the thickness of the scar to determine if it can be treated, either with steroids, laser or any of a number of current scar treatment technologies.  The depth and the hardness of the scar determines which option to use and all these can be resolved by the various ultrasound technologies. Ultrasound is the new ‘weapon of choice’ to show depth, thickness of the scar, type of scar, how hard or elastic it is  (also see elastography).  It also allows the surgeon to clearly identify the margins you wish to attach the graph to.  

[IMAGE 2] In this image, we have a burn that came from a charcoal grill. This burn leaves a white coating (surface singe) to the red skin. (A) This white surface outline with the black arrows is the ash from the grill or the burning surface. The small yellow circle is the blister that immediately broke from the heat. So the blister burst and opened up causing the teardrop-shaped opening in the skin, which could get infected. 

Diagram B shows the two yellow arrows pointing to the white area, it's got a top white, a medium dark, and a bottom white area.  That's the appearing ash visible only on the surface but not penetrating deep (thus it is not a third-degree burn). Upon further interactive review of the burn, it was only surface ash from the surface of the charcoal grill which was easily removable. On the same image (B), we are also looking at external tendon, 1 mm wide. 

Diagram C indicates the blood vessels and the normal tissue on the side of the burn. Though the burn goes deep into the skin, it is not a complete third-degree burn in the whole area (B). Comparing B and C, the injury to the burned tissue is marked by the red arrow on top and also the tendon that raises the finger pushes 1 mm wide is completely unaffected by the dark burn area. Now below that since we weren't sure if it was a third-degree burn or we wanted to see if there was viable skin next to it, we did the blood flow technology which shows the micro vessels or the capillaries that are in the adjacent skin, so if you ever needed to graft it you'd have normal skin and also the fact that you have normal skin in the red area means that the burn in that area is a first degree or not really burned at all.

“IT’S ALL ABOUT THE PROBES”

The GE Doppler scanner can go deeper under the skin - at an estimated 5x the resolution than the average ultrasound probe (at 1/10mm resolution). The higher the megahertz, the deeper and sharper the image (like 70mhz has 1/50 of a millimeter resolution).  Such a probe is much better for imaging tendons and skin and the regular 18 or 20 megahertz (such as the GE) that we use routinely use has 1/10 of a millimeter resolution. You have better detail for seeing tendons and blood vessels.

Overall, each probe determines a specific depth, the width & range of the scan, the level of blood flow while the hardware & diagnostic software itself communicates with the probe to translate all data into recognizable images in real time.

PRE-OPERATIVE (AND RISK REDUCTION) PROTOCOL

Among its many uses, cosmetic surgeons can benefit from dermal imaging by mapping the nerves and the arteries before cutting. Also, you can find the dead skin as compared to the normal skin for doing reconstructive surgery. 

Emergency departments can more easily treat nerve trauma, burns, tendon injuries with the help of visual analysis of any affected area.  As an example,  you can see if the tendon is partly or completely torn with ultrasound more easily and effectively. you are able to move the finger because it won't be any movement of the torn part. If you move the tendon when you open up the finger from a closed fist position.

ABOUT THE AUTHOR-

ROBERT L. BARD, MD, PC, DABR, FASLMS - Advanced Imaging & Diagnostic Specialist
Having paved the way for the study of various cancers both clinically and academically, Dr. Robert Bard co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- www.CancerScan.com) uses the latest in digital Imaging technology has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered Sonograms, Spectral Doppler, sonofluoroscopy, 3D/4D Image Reconstruction and the Spectral Doppler are safe, noninvasive, and does not use ionizing radiation. It is used as a complement to find anomalies and help diagnose the causes of pain, swelling and infection in the body’s internal organs while allowing the diagnostician the ability to zoom and ‘travel’ deep into the body for maximum exploration.

References

https://www.cdc.gov/masstrauma/factsheets/public/burns.pdf’’

https://stanfordhealthcare.org/medical-conditions/skin-hair-and-nails/burns/stages.html

https://www.intechopen.com/books/hot-topics-in-burn-injuries/burn-etiology-and-pathogenesis

  

https://www.healthline.com/health/burns#complications

https://www.radiologyinfo.org/en/info.cfm?pg=vascularus

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HERXHEIMER'S REACTION: REVIEWING THE HEALING CRISIS

"HERX IS NOT A SIDE EFFECT!"

By: Josh Schueller, PT

As non-invasive treatments such as electromagnetic and neuro-stimulation devices have shown significant evidence as a safe and effective option for wellness and pain relief within recent decades, one possible bodily reaction may occur that can feel adversely as pain or discomfort- possibly being misunderstood as a side effect of the treatment.  This physiological reaction is called Herxheimer Reaction. This can occur when dead microbes or bacteria release endotoxins into your body at an accelerating rate.   This accelerated release is quicker than the body can eliminate.  The body then initiates an immune response which can bring on an inflammatory response.  Otherwise known as "Herk reactions", this reaction is commonly a temporary and short term (normally only last a couple hours to days) detoxification reaction in your body.  Common symptoms can resemble the flu- headache, joint and muscle ache, malaise, chills, nausea, sore throat etc.   This reaction is caused by the detoxification of the body.  Staying hydrated is one way to help flush your body and decrease the symptoms.   

A TEMPORARY REACTION TO DETOXING

The buildup of toxins in the cells can decrease your health and wellness.  Cell phones, computers, TV, air quality, improper hydration, and poor-quality foods can all lead to poor cellular health.  When treatments that help detoxify, the body initially occurs occasionally this is when the Herx Reaction occurs. Herx reaction is not common but can occur.  Education and communicating to the user on the possibility will improve outcomes and the persons reaction.  These symptoms peaks eight hours after treatment and disappears normally within 24-36 hours. 

As with any new exercise keeping your cells hydrated and healthy is the best remedy.  Other helpful ways to lessen the effects is to get plenty of sunshine, minimize exercise during this time, keeping your diet pure (avoiding alcohol) and using a sauna or sea salt bath. Herx Reactions more commonly occur if during the first few treatments the intensity and/or duration is too high for the treatment.  As with any new activity, starting low and slow and incrementally increasing intensity and duration is essential to avoiding any unwanted effects.  Some indications for a possible Herz reaction are how long the person has suffered from the condition.  Chronic conditions can demonstrate more likely increase in the amount of toxins in the system and poor cell health.  If a Herx reaction occurs- decreasing the intensity and duration for a couple of treatments is the most appropriate action needed.  

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PART 2: THE HEALING CRISIS
By: Dr. Roberta Kline

Introduction
In health care, it is common for physicians to witness manifestations of what is commonly referred to as a “healing crisis”.  This experience can appear in many different ways, including physical, emotional and spiritual symptoms that are then followed by a greater sense of well-being. While many “healing crises” have been in response to treatment of Lyme disease and Candida, nutritional changes also occur - from “detox” programs and energetic healing.  There may be lower rates of healing crises within less aggressive and more personalized interventions, but the condition seems to exist here too. 

This phenomenon is not widely recognized within the conventional medical community. Even among complementary and alternative medicine (CAM) practitioners, where there is more recognition of this phenomenon, it is still poorly understood.  Through the course of scientific evolution, we hope to find an answer to whether it is possible to better predict predisposition to experiencing a healing crisis or Jarisch-Herxheimer Reaction.  If so, perhaps we can develop personalized treatments to minimize these symptoms while still creating an effective healing response.

THE JARISCH-HERXHEIMER REACTION

First described in relation to treatment of a syphilis patient by the Austrian dermatologist Adolf Jarisch in the late 1800’s (and similarly reported by German dermatologist Karl Herxheimer), the Jarisch-Herxheimer Reaction (JHR)  has been reported with treatment of other spirochete infections, including leptospirosis, Lyme disease, and relapsing fever, as well as with some fungal, protozoan and bacterial infections. Abridged as the Herxheimer's (or Herx) Reaction, it is today's best-known example of a healing crisis.  This transient phenomenon occurs within 24 hours of antibiotic or antifungal treatment, and often includes fever, chills, headache, nausea and vomiting, tachycardia, hypotension, myalgia and exacerbation of skin lesions. It is not a rare reaction, occurring in over 50% of patients in some studies. While supportive care is indicated, it is rarely life-threatening. 

While efforts to understand the underlying mechanisms have focused on scientific studies related to spirochete infections, the exact pathophysiology still remains elusive. Theories have mostly focused on the concept of “die-off” – that a sudden burden of dead spirochetes releases toxins and induces an inflammatory reaction. (1)

More recent research has expanded to include B. Burgdorferi, the spirochete associated with Lyme disease, and better technology has shed some additional light on the process underlying this phenomenon. No longer is the theory of spirochete “die-off” considered a primary trigger, as the symptoms appear long before the antibiotics actually result in death of the organisms.

It appears to be mediated by a multifactorial inflammatory process, potentially provoked by the uptake of the spirochete into the polymorphic neutrophils. This complex inflammatory response likely also includes nonendotoxin pyrogen and organism-specific lipoproteins, that then trigger an inflammatory cascade driven by tumor necrosis factor alpha (TNF-alpha), and downstream cytokines including interleukin 6 (IL-6) and interleukin 8 (IL-8). But it is still not clear how much of this inflammatory response is causal, and how much is the result of the Jarisch-Herxheimer reaction, and further research is needed. (2)

Interestingly, reports of a condition known as cytokine release syndrome are emerging as a result of treatment with CAR T-cell therapy, which is a form of immunotherapy for cancer. The symptoms occur within hours to days, and are very similar and can include fever, tachycardia, hypotension, and rash. The syndrome is thought to be caused by a large and rapid influx of cytokines – very similar to the findings from studies on the JHR. (3)

CROSSROADS BETWEEN PAIN AND WELLNESS

Various other healing modalities have also reported responses to treatment called “healing crises” that appear to be similar to JHR. Although many people refer to them generically as Herxheimer reactions (“herxing” for short), they do have some differences. Often pain, including reactivation of “old” pain, is seen in addition to changes in heart rate, respiration, more frequent urination and bowel movements, fatigue, fever, headaches, skin rashes and/or disrupted sleep. It is believed that many of these symptoms are the body’s way of eliminating accumulated waste products and toxins that are now being released as a result of the therapy. (4)

Even the reactivation of pain in locations that had not bothered the person for years is seen as part of this process. Oftentimes the healing crisis is followed by improvement in emotional and spiritual wellbeing, in addition to physical health. But while this phenomenon is recognized by many CAM practitioners, there is very limited research available and most of our understanding is anecdotal. Much more is needed to enhance our knowledge so we can educate both healthcare professionals as well as their patients. 

References:

[1] Aayush Dhakal and Evelyn Sbar. Jarisch Herxheimer Reaction. StatPearls April 28, 2022.

[2] Thomas Butler. The Jarisch–Herxheimer Reaction After Antibiotic Treatment of Spirochetal Infections: A Review of Recent Cases and Our Understanding of Pathogenesis Am J Trop Med Hyg 2017 Jan 11; 96(1): 46-52

[3] Noelle Frey and David Porter. Cytokine Release Syndrome with Chimeric Antigen Receptor T Cell Therapy. Biol Blood Marrow Transplant. 2019 Apr;25(4):e123-e127

[4]  Thora Jenny Gunnarsdottir and Helga Jonsdottir. Healing crisis in reflexology: Becoming worse before becoming better. Complementary Therapies in Clinical Practice 16 (2010);239-243