Traumatic Brain Injuries Explained: Symptoms, Testing & Recovery | Dr. Jonathan Gomez | EP 69

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Oh yeah, no banging on the table.
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Everybody's like, I can't believe, you know, and then it echoes into the mic.
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Sounds good.
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Okay.
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Hey guys, I have Dr.
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Gomez here with Synapse TBI.
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Really excited to have him on the podcast.
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He is a neurologist who focuses a lot of his practice on brain injuries.
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Doc, thanks for being here.
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Happy to be here.
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Cool, thank you.
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Um, so you know, a lot of people right now are super hyper focused on TBIs, traumatic brain injuries, um, post-concussion syndrome, um, especially as it relates to um, you know, sports, car accidents, injury cases, things like that.
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Um, you know, it's it's interesting.
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It's uh a lot of it is coming up now that this is one of the most underdiagnosed type of injuries that hospitals tend to miss.
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And so I'm really excited to have you here because I want to ask you a million questions about that stuff.
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Yep.
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Um before we get into that, can you just tell us, you know, a little bit about you, where you grew up, where you're where you're from originally, and maybe like why you became a doctor and focused on uh your practice on on you know brain injuries.
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Yeah.
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Yeah, thanks for having me.
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So my name's Jonathan Gomez.
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Um grew up in Miami.
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Family is Cuban.
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Um you always got to say what part of Miami, though, because Miami's big and every part has its own little cool niche.
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Like if you're from Brickle or Aventura.
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It's even a more specific niche because if you ask anyone from my neighborhood, it's Miami Lakes, it's not Hayalea.
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Okay, yeah.
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And there's very specific identification.
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There's a beef between the two locations, yeah.
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But it's all Cubans, you know, and and so primarily a Cuban area.
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Uh, but born and raised Miami Lakes area, and then went to high school down here, left for uh stayed stayed here for college, went to Nova Southeastern University.
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Okay.
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Uh left to Ross University.
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Okay.
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I did my clinicals down here, and then I went to residency down in Miami.
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Um, and I was just happy to be back.
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Haven't left since school.
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Yeah, yeah, yeah.
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Did my residency in neurology, then I did it on a subspecialty in interventional pain.
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Okay.
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Um, and primarily noticed a lot of head injuries that were really going underdiagnosed in that um pain space because in pain you deal with a lot of whiplash, you deal with a lot of a lot of pain patients that are post-accident B.
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Um, so I started realizing that I only had time to focus on the pain.
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But, you know, a lot of these, the neurology inside of me was seeing a lot of these post-concussive symptoms like that were just really being overlooked and they weren't really having time to like go through them, the memory aspect, the sleep aspect, and all those things.
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Yeah, it's it's funny.
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Um, I notice when patients go to the doctor, specifically for the pain that they're in, you know, and I'm not talking about a chiropractor, I'm talking about a medical doctor, specialist, um, whether it's interventional pain or like a surgeon.
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A lot of times they're super nervous.
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They got five minutes with the doctor, and you know, the doctor's focused on, like, I guess you would say, triaging.
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What's, you know, one question that I I think is a good question, the doctors will say, like, if I had a magic wand and I could solve one problem, what would it be?
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And they're like, my neck.
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And people are always focused, my neck or my low back or my shoulder.
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Very few people are like, oh, my memory, you know, or every day I have a huge headache.
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Um, what are some of the symptoms that people after um you know, after having a concussion, what are some of the symptoms that you see people most regularly have that they should discuss with their doctor that are important?
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Yeah.
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So all these brain injury patients, I always kind of approach them very similarly from the start.
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You know, you ask about the memory aspect, you ask about the headaches, um, sleep dysfunction.
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Um a lot of people have anxiety or mood complaints, um, and all these symptoms just really go overlooked.
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So I would say it's very important to kind of highlight everything, but I also think it's very important for a physician to understand what can be affected in a brain injury to ask the right questions.
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Um, because when you have a physician who's, you know, treating one thing, and and you're right, you know, um, I typically I typically would approach it the same way.
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I would say, hey, what's bothering you the most?
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Because that's what we'll focus on today.
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Um but with brain injuries, it's just such a complex disorder, you know, and it can have be affected in so many different ways.
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So you really have to go into the nitty-gritty with these patients.
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I sometimes I spend 45 minutes to an hour with these patients, just kind of going over everything just because it it's it's a lot.
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So you really have to see how it's affecting their daily life, and every patient is just so different.
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So I always emphasize like, hey, keep a log of you know what you're noticing, you know, in your day-to-day, like what is being affected by you, what it what is what is actually causing you the most distress and focus on that first.
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Yeah.
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Because if we can focus on that, then you know, some of the anxiety-related components of the mood issues can help, you know, with the other components as well.
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Yeah.
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Some some of these patients it's hard to tell what they had before and after.
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Because like you see the patient and you don't you didn't know them before.
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I know.
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Um is there a way to deal with that?
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Like you just like, you know, sometimes as a lawyer, I feel like I'm their therapist too.
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I'm like, you know, this guy's really got like a whole bunch of issues.
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Is there a way to cleanly figure that out or not?
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From a cleanly, clean perspective, no.
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Um a lot of it is talking to the patient and understanding what they were doing prior and really talk about their activities more than anything and seeing what activities they were doing prior that they cannot do anymore.
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And then obviously collateral information, if you're able to get that, that's great.
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If there's a spouse or family member that can provide some additional insight, that's one of the biggest things that I typically rely on.
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Cause a lot of the times, I mean, I know from my perspective, I will not realize something and my partner will or my family member will.
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Yeah.
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And that's a big, that's a big issue that I'm not very big, I'm I might not be realizing it, but others are.
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So colleagues, um, spouses, family members, always super helpful to kind of get that pre.
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And then, you know, most head injury patients, you're not going to see them before.
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It's not traditional to go to a neurologist from a very young age or or or whatnot.
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So they might have seen a primary care physician, and that primary care physician might be able to highlight some things.
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But from the most for the for the most part, uh, you really don't have that information.
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So it's really clinical perspective how they were performing prior and what they're telling you is affecting their day-to-day.
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Gotcha.
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Gotcha.
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So if they were doing something before and that was a big activity for them and now they can't do it, you're like, hey, this is okay, I get you, I understand.
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Yeah, and I I do it because so one of the other things I also do is I work as a ringside physician for the state of Florida.
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So cool.
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Um for me, it's really important to understand the fighter pre and post, right?
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Okay.
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But the benefit that I have is that I'm able to see the fighter before they go into the fight.
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Okay.
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And then I can see the fighter when they come out of the fight.
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Yeah.
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But a lot of fighters tend to minimize their symptoms a lot more frequently than patients might because they want to compete.
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So there's a difference between a mentality standpoint as well and what you're able to disclose.
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Um, and I find that very interesting because a lot of the times patients are willing to share more information, but a lot of the time they actually don't even know what is wrong with them.
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So it's really important to sort of emphasize that versus fighters, even if you, you know, speak to it, they will minimize it or say it's not a big deal because they want to continue.
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And then you'll hear about the symptoms after because they're willing to talk about it a little bit more.
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Yeah, it sounds like the fighters have an interest in staying in the game.
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Um, I think there wasn't there Tua, didn't he have like an issue with concussions where he was like, No, I'm fine, but they were like, no, you need to sit it out because they were worried about him.
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I think this happens a lot with with uh athletes in general, is they play the system to stay in the game, right?
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That's yeah.
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Yeah, that's part of it.
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Whereas the patients genuinely want to get better, so they're more willing to share with you um what's wrong with them and if they can, I guess, verbalize that, right?
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Um it's interesting.
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I I you just made me remember one of my first clients that he had a real brain injury, was on a motorcycle, he wore a helmet, but he was on a motorcycle, got into an accident on the highway, and he swore that he was, you know, down for like he's I think he said he was conscious the whole time, but his girlfriend was like, No, I was with you for three days in the hospital.
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You were unconscious.
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You like I sat with you and he denied it.
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But um, so all of his medical records with his doctors were like, you know, I was at the hospital, I was like, never lost consciousness.
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Meanwhile, his girlfriend came to an appointment with him and was like, No, you definitely lost consciousness.
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And they got into an argument, and the doctor's like, look, I'm just gonna write down what you know, you're you know, what's going on here.
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So do you find a lot of times that help from because you had mentioned this, a partner, a spouse, a significant other family member, um their perspective of maybe how the person changed or um has been affected is is helpful.
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I think color information is super helpful personally.
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Um I try to understand because they they really have a different perspective than the patient does.
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The patient has their perspective on what they're able to do, but they're again, they're not very aware of their current deficits or their neurodeficits because they had a brain injury and and that's it's a complex network.
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So either you have maybe male patients who are more likely to minimize their symptoms, you know, younger patients who are more likely to minimize their symptoms because they just feel they don't want to be limited by any sort of disorder by any means.
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A lot of people have problems also admitting to a head injury as well.
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They don't want to accept any disability.
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So people are tend to be more reserved in terms of their symptomatology.
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So I do find it super helpful when I can get a uh a family member or someone to sort of speak on their behalf and talk about their issues because they have a completely different perspective.
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And that it really highlights it.
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And then a lot of the times you'll see the patient be like, Yeah, now that you mention it, you're right.
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I do kind of do that.
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Yeah.
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But they're not very aware of it in the beginning.
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Yeah, my wife uh knows me better than myself, and she's like, she knows exactly all of my flaws, so she can point it out if I'm ever if I ever uh have a brain injury.
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Let me ask you um, the rivermead post-concussion uh questionnaire, do you do you utilize something like that?
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And do you like that?
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Or what are you what are your I guess let me ask, what are your thoughts on the Rivermead post-concussion questionnaire that they have out there?
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I think for the most part, it's a great screening tool.
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It standardizes things, it allows for some sort of standardization from from that perspective.
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Um, I don't think it highlights everything.
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I think it's a good tool.
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Um, but there's a difference between a tool and going through an evaluation and really going into the understanding of the issues that the river meet is highlighting, but then getting a little bit more granular on it.
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Okay.
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So I find it to be useful, um, but it doesn't change my way that I approach a patient.
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Every patient is I approach kind of the same way.
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And the deficits and talking about all the things that they they might be complaining about, I kind of approach it because one thing I've also realized is I will get a river mead, and then once I talk to the patient, they answered the rivermead incorrectly because they did not understand what the river mead was mentioning.
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Okay.
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So gotcha.
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And it it's it's understandable.
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These patients have cognitive dysfunction.
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So if you're asking them to process and read a rivermead concussion, you know, test and answer how they're feeling, you know, a lot of the times they might subjectively or put an answer, but they don't really understand what the question is asking.
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And then once I ask it to them, it's just a completely different perspective.
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They're able to highlight on it more.
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You know, if I can go into the thinking and memory and talk about word-finding difficulty and recalling conversations and going into a little bit more granular in each subsection, okay, you're able to grab a lot more.
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Um, because that river meat is just really made to highlight the big, the big overall picture.
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Yeah, that's wild because I've always pushed.
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Um, I represent a lot of chiropractors, and I've always pushed on them to use the rivermead and throw it in their intake paperwork.
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I never thought, man, it's probably hard for someone with a brain injury to read it and comprehend it and fill it out.
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Because that most of the times, I don't think doctors actually explain it to them either.
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They're just like, hey, fill this out, have a seat, be with you in 10 minutes or whatever.
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So that's a really interesting perspective.
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I thank you for that.
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I now I feel like an idiot for I'm like, you need to have this in your forms, and then you're right.
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I think no one explains it to them.
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It's like when the patients say they have a five out of 10, and you're like, well, what does that mean?
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You know, five out of 10.
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It's like, yeah, for 10 different people, it's gonna, you're gonna get 10 different numbers.
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Um, so that's that's really interesting.
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I like that.
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Um, so let me ask you a little bit about TBIs and brain injuries.
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Uh, we had spoken a little bit before you got here and uh we turned on the cameras and stuff.
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What got you into being a neurologist, um, focusing your practice on, you know, traumatic brain injuries?
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Yeah, so the path to me to becoming a doctor has been very a windy road, to say the least.
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Um but it all started, I guess, when I was a kid.
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And my mom shows me this paper that I wrote when I was like in kindergarten and asked what you want to be when you grow up, and I would said a doctor.
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I obviously had no idea that I was going to become a doctor.
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I really did want to become a doctor, but I I remember admiring from a young age doctors because I always thought, you know, I always my parents were always about being very respectful.
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And, you know, every time I would go to the doctor, it was just approaching it with a lot of respect.
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So I liked the appreciation and the respect that I would that my family would give the doctor.
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And it wasn't actually until I was a junior in high school I tore my ACL.
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Um I was playing competitive volleyball back then.
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Uh I gotta I gotta mention you're six foot five right now.
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Six six.
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Oh, I'm sorry.
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Uh six six.
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That's a big difference.
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That is a big difference, yeah.
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Especially when you're walking through the door here and you're like hitting your head on stuff.
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Yeah.
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Yeah.
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So um for me, I I tore my ACL and um I'll never forget the day before my surgery, I was on YouTube um watching the surgery.
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Oh and trying and and seeing what was actually going to be done to my knee.
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And my mom and dad were like, what are you doing?
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So I grew a lot of interest um in the medical field after that.
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Okay.
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Um I just started to understand a little bit more um what they do and how the big impact that they can have on someone.
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Um, and if you're in the right provider's hands.
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Um after that injury, um, I had a concussion when I was younger.
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Um, I was actually driving my friend's go-kart and I crashed into a tree.
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Wow.
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Uh and it was a whiplash mechanism, um, you know, classic how you would imagine, uh a whiplash, you know, head forward, back.
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And for about three or four minutes, I couldn't speak.
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My speech was completely gone.
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I couldn't, I literally had no verbs or words coming out of my mouth.
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So I remember someone coming over and trying to check on me, and I I couldn't speak.
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So it was super mind blowing at that moment.
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I was I must have been 13, 14 at that time.
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Wow.
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Um, and then after that, I remember I had about two or three days of headaches.
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You know, I remember going for like a week that I wasn't sleeping well or I was sleeping too much.
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Um, and I didn't until actually I was in medical school realize what I had.
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You know, my parents didn't my parents didn't take me to the to the doctor.
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Actually, at that time I didn't talk about it.
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I just, it just happened.
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And, you know, oh, it's just an injury and you'll get better.
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Yeah.
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It wasn't until later that I realized, hey, wow, I had a concussion and I was experiencing post-concussion symptoms and all these other symptoms.
00:16:33.519 --> 00:16:38.720
So um, during the medical school process, I was open to essentially everything.
00:16:38.879 --> 00:16:43.120
I think I wanted to go in, like doing orthopedics because I I enjoyed sports.
00:16:43.679 --> 00:16:48.159
Um, but then I started to watch, you know, all these concussions.
00:16:48.320 --> 00:16:53.840
And during my time in in med school, head injuries in the NFL became like a huge, large topic.
00:16:54.240 --> 00:16:57.279
Um, the concussion protocol, concussion injuries.
00:16:57.440 --> 00:17:07.680
Um, so I grew really interested in neurology, and then I liked the idea of sports and neurology and and found uh found my niche.
00:17:07.920 --> 00:17:08.559
Okay, cool.
00:17:08.640 --> 00:17:10.000
That's that's a really interesting story.
00:17:10.160 --> 00:17:11.839
You just reminded me of a client I had.
00:17:11.920 --> 00:17:14.480
He was on a golf cart in the villages.
00:17:14.640 --> 00:17:18.720
He went right through the uh, there's no windshield in his golf cart.
00:17:18.799 --> 00:17:22.079
He went right through, hit his head, gigantic bruise.
00:17:22.559 --> 00:17:27.119
And Abo Vadia, after all of these, he had like five different doctors.
00:17:27.359 --> 00:17:30.559
Abo Vadia had to diagnose him with a brain injury.
00:17:30.799 --> 00:17:34.400
I I hired a neuropsychologist for him.
00:17:34.960 --> 00:17:38.880
Uh and the guy goes, he's got a definite brain injury.
00:17:38.960 --> 00:17:43.440
And he met down, you know, he drove down to meet with this guy for part of his lawsuit.
00:17:43.759 --> 00:17:48.160
And uh, one of the craziest things, and I'll never forget, the guy loved drinking alcohol.
00:17:48.240 --> 00:17:53.759
He was like, Hey, let's go have scotch at the house, you know, let's go play golf and then just drink all day.
00:17:54.000 --> 00:17:57.119
And ever since then, he never wanted to drink.
00:17:57.359 --> 00:18:03.519
And his um, his whole personality changed, which obviously, like, you know, not drinking alcohol, a lot of people could go with.
00:18:03.759 --> 00:18:14.319
Um, but he would have this weird situation where he would just start crying hysterically and then laughing hysterically, um, kind of like the Joker.
00:18:14.400 --> 00:18:20.240
Yeah um, and I forget what it's called, but the guy could not regulate his emotions at all.
00:18:20.640 --> 00:18:30.319
And um he just having a normal conversation and just start crying and then laughing and super sad because people look at that guy and they go, Oh, guys, the guy's crazy.
00:18:30.480 --> 00:18:32.000
Yeah, but he's not crazy.
00:18:32.079 --> 00:18:39.279
He's got a brain injury and he was totally normal beforehand, and then it just kind of upended his life.
00:18:39.440 --> 00:18:45.680
And you know, Lucky uh, you know, he had an amazing wife and she supported him through the whole thing, but uh what a trauma.
00:18:45.839 --> 00:18:48.319
And this was you know, a guy who landed on his head.
00:18:48.480 --> 00:18:50.000
Um brings her.
00:18:51.119 --> 00:19:01.039
That frontal lobe is essentially where everything is housed in terms of mood dysfunction and and all these complex um pathways that we that make us who we are.
00:19:01.279 --> 00:19:13.039
Um so obviously in a head injury, just that frontal impact and that bouncing back and forth, you know, especially the older you are, you're more likely to experience worsened injury.
00:19:13.680 --> 00:19:16.960
Um, but yeah, the the presentations are so interesting.
00:19:17.119 --> 00:19:26.160
You know, I've had patients that have had similar how you're explaining, you know, they they're inappropriately laughing when they're ch talking about their symptoms.
00:19:26.319 --> 00:19:26.880
Yeah.
00:19:27.200 --> 00:19:31.359
And it's almost like a defense mechanism to essentially what they're feeling.
00:19:31.839 --> 00:19:37.599
Um so and you you caught me because I'm I know that I know the verbiage, but oh the word for it?
00:19:37.680 --> 00:19:38.319
I know the word for it.
00:19:38.640 --> 00:19:39.680
I forget the word for it.
00:19:39.759 --> 00:19:41.599
It's a really tough word, yeah.
00:19:41.839 --> 00:19:42.160
Yeah.
00:19:42.319 --> 00:19:44.880
There's um there's like a pseudo-ball bar effect.
00:19:45.119 --> 00:19:45.920
I think that's what it's called.
00:19:46.000 --> 00:19:46.480
Is that what it's called?
00:19:46.640 --> 00:19:48.559
Yeah, I'm pretty sure it's a pseudo-ball bar affect.
00:19:48.640 --> 00:19:48.960
Yeah.
00:19:49.119 --> 00:20:01.599
So that's when they like sort of experience this emotional wave of um essentially an emotional wave that you they don't understand and they can't control it.
00:20:01.759 --> 00:20:02.079
Yeah.
00:20:02.240 --> 00:20:03.039
So yeah.
00:20:03.200 --> 00:20:08.240
But it was it was it was interesting because he told me, he's like, Abe, I'm at the doctor's office and he's like, Hey, how's your day going?
00:20:08.400 --> 00:20:11.279
And then he just started crying, and then he just started laughing.
00:20:11.440 --> 00:20:15.200
And the doctor's like, All right, um, we'll see you again in 30 days.
00:20:15.359 --> 00:20:18.480
Your knee looks like it's healing okay, and he was there for his knee.
00:20:18.559 --> 00:20:20.319
And I go, That's that's weird, you know.
00:20:20.400 --> 00:20:26.559
And his his wife would come to him, uh, his wife was always on the phone uh because we were far away, and then they came down and visited me one time.
00:20:26.640 --> 00:20:31.839
She came and she's like, This guy's personality has completely just 180.
00:20:32.079 --> 00:20:35.839
He's not the guy he was before this accident.
00:20:36.400 --> 00:20:41.920
But she was okay because the guy before was like, you know, drinking all day, golfing all day, you know, cards all day.
00:20:42.000 --> 00:20:44.880
And I guess she wanted to hang out with him more, so I don't know.
00:20:45.759 --> 00:20:55.200
But um, yeah, it was it uh brain injuries can pay that I think uh brain injury patients can be probably the most difficult people to treat.
00:20:55.359 --> 00:20:56.400
Would you agree with that?
00:20:56.720 --> 00:21:01.519
What we do at synapse, that's why every doctor's kind of focusing in on what they need to focus on.
00:21:01.680 --> 00:21:10.559
You know, the pain management doctor is gonna focus on their pain, the orthopedics and a fork can focus on their, you know, the orthopedic issues, you know, Cairo, whoever you send.
00:21:11.039 --> 00:21:17.039
A lot of the times they don't have the time to assess a brain injury so detailed.
00:21:17.519 --> 00:21:27.279
So one of the things that I really enjoy that we do at CNFCBI is we really focus and we allocate anywhere from 45 minutes to an hour for every patient.
00:21:27.920 --> 00:21:33.440
And I don't think they're as difficult to treat as we have put it out to be.
00:21:33.599 --> 00:21:40.079
Um, I feel these patients can be very difficult to treat if they're not in the right care.
00:21:40.960 --> 00:21:48.319
Um but similar to any injury, it's about providing the rehab and giving them the the space to recover.
00:21:48.559 --> 00:21:48.799
Okay.
00:21:48.960 --> 00:21:56.799
Um it's no longer what we believed to be, which was hey, sit in a dark room, wait it out, and let's see how you recover.
00:21:57.039 --> 00:21:57.200
Okay.
00:21:57.359 --> 00:21:59.759
You know, now it's about, hey, let's push your limits a little bit.
00:22:00.240 --> 00:22:01.359
More every so often.
00:22:01.440 --> 00:22:03.359
Let's see if you have ocular motor dysfunction.
00:22:03.440 --> 00:22:08.720
Let's see if that ocular motor dysfunction is causing your headaches, is causing your balance dysfunction.
00:22:08.880 --> 00:22:12.559
Um, so I'm I'm not against medications.
00:22:12.720 --> 00:22:16.559
Let's start off with that, but I always try to avoid medications with these patients.
00:22:16.799 --> 00:22:18.720
I think your brain is going through a lot.
00:22:18.880 --> 00:22:29.359
And I think it's imp important to approach these patients from a rehab standpoint, from a functional standpoint, and trying to provide as much functional corrections as we can.
00:22:29.839 --> 00:22:34.640
And I think that's commonly overlooked just because it's a little bit harder to do that.
00:22:34.960 --> 00:22:38.000
But in the long term, that's going to be the best for the patient.
00:22:38.160 --> 00:22:49.119
So we really focus on the rehab component, making sure they're going to speech therapy, they're getting mental health counseling, they're getting, you know, the PTO T V T that they need.
00:22:49.359 --> 00:22:49.839
What is that?
00:22:50.000 --> 00:22:57.519
Uh physical therapy, vestibular therapy, ocular motor or occupational therapy, okay, or ocular motor therapy, whatever sort of therapy they need.
00:22:57.680 --> 00:22:57.920
Okay.
00:22:58.079 --> 00:23:06.559
But that's the important thing of like really going to someone who understands what is going on and getting them into the right place.
00:23:07.279 --> 00:23:07.519
Okay.
00:23:07.680 --> 00:23:11.119
So let me ask you, um, you know, we're talking about therapy right now.
00:23:11.359 --> 00:23:16.720
Um person is, you know, they suffer a traumatic brain injury.
00:23:16.880 --> 00:23:17.680
They come to you.
00:23:17.759 --> 00:23:24.400
You guys do like an hour-long exam, you talk to them, you find out what's going on, what their specific symptoms are.
00:23:24.799 --> 00:23:26.720
What kind of therapies do you guys offer?
00:23:26.880 --> 00:23:32.000
Let's say, let's say a patient's watching this right now and they want to know what therapies are available to them.
00:23:32.240 --> 00:23:37.920
Can you kind of give us just like a 10,000-foot overview of what they might expect?
00:23:38.400 --> 00:23:38.799
Yeah.
00:23:39.119 --> 00:23:44.880
So I oh, every every treatment plan is really personalized to the patient to start off there.
00:23:45.039 --> 00:23:49.279
Um, because no one treatment plan is right for one person.
00:23:49.359 --> 00:23:52.559
Or no one right, oh no one treatment plan is right for everyone.
00:23:52.880 --> 00:23:53.200
Okay.
00:23:53.359 --> 00:23:57.759
Um, you really need to focus and hyper-specialize it to each patient.
00:23:58.079 --> 00:24:09.759
So from a general overview, you know, you can go standard of care, which is understanding that you can do physical therapy, you can do your balance therapies, you can do your eye therapy.
00:24:10.000 --> 00:24:14.400
Um, and I'm simplifying the verbiage to make it easy.
00:24:15.039 --> 00:24:37.200
But once you've sort of exhausted, you know, let's say speech therapy for cognition, um, emotional with mental health, you know, addressing all those options, you know, there's now a bunch of interesting other options that exist that are really being studied now, hyperbarics, hyperbaric oxygen therapy, um, photobiomodulation.
00:24:37.440 --> 00:24:47.039
There's so many different modalities that can be used now that really have not hit standard of care that can be used.
00:24:47.119 --> 00:24:58.240
And from my perspective, I've seen it and used and with some of the fighters and even some of some of the motorbucoxine patients and people who have just experienced head injuries, and I've seen really good results.
00:24:58.400 --> 00:25:04.880
Um but for me, the way I always approach these patients from a treatment perspective is regulating your sleep.
00:25:05.119 --> 00:25:10.400
Sleep is a big issue that's commonly overlooked because it's really hard to treat.
00:25:10.960 --> 00:25:12.799
And then also the mood regulation.
00:25:13.039 --> 00:25:19.039
Once you can get the sleep right and you can get the moods right, you can start to see noticeable improvement in the cognition.
00:25:19.279 --> 00:25:25.440
You can start to see other things as long as you start to participate them in a rehab and and help push them forward.
00:25:25.680 --> 00:25:29.200
But it's it's really hard to say, hey, what is what's a treatment option?
00:25:29.279 --> 00:25:30.480
Because there's just so many.
00:25:30.720 --> 00:25:30.960
Okay.
00:25:31.119 --> 00:25:33.759
And you can't put a patient into every treatment option.
00:25:33.839 --> 00:25:34.799
You got to focus.
00:25:34.960 --> 00:25:40.319
And maybe it's, hey, let's start off with, you know, your balance dysfunction because we don't want you to fall and hit your head again.
00:25:40.559 --> 00:25:40.880
Okay.
00:25:41.200 --> 00:25:45.680
But, you know, maybe next thing will be let's get into some cognitive, you know, improvement.
00:25:45.759 --> 00:25:47.279
You know, let's see where you fall.
00:25:47.359 --> 00:25:52.160
And then we sort we sort of put you into a different into a different pathway, depending on how you sort of progress.
00:25:52.400 --> 00:25:52.720
Okay.
00:25:53.039 --> 00:25:54.160
Um, that's really cool.
00:25:54.319 --> 00:25:56.640
You mentioned I saw hyperbaric therapy.
00:25:56.799 --> 00:26:00.160
Um do you guys offer hyperbaric in your facilities?
00:26:00.319 --> 00:26:00.960
Yeah, you do.
00:26:01.359 --> 00:26:03.039
We offer hyperbaric in our facilities.
00:26:03.200 --> 00:26:03.440
Okay.
00:26:03.599 --> 00:26:10.000
Um, in our Boca office, we have a hyperbaric and we're getting one out in uh Nashville, Missouri, uh, probably Houston as well.
00:26:10.160 --> 00:26:10.480
Okay.
00:26:10.720 --> 00:26:21.599
So um as we start to expand out our facilities, um, we I see hyperbaric as one of the forefronts of this, of this um whole entire treatment process.
00:26:21.839 --> 00:26:22.160
Okay.
00:26:22.480 --> 00:26:26.640
Um, and I'm hopeful that it'll become more standard.
00:26:26.880 --> 00:26:31.119
Uh, but yeah, I I I really appreciate what hyperbarics can do for people.
00:26:31.440 --> 00:26:31.599
Okay.
00:26:31.680 --> 00:26:35.519
Yeah, I know a lot of athletes are doing hyperbarics at their home and stuff like that.
00:26:35.680 --> 00:26:39.920
Um, how many, how many atmospheres do your guys' machines go?
00:26:40.160 --> 00:26:41.039
I guess it's up to.
00:26:41.119 --> 00:26:42.559
I don't know if it's I guess it's not down to.
00:26:42.640 --> 00:26:43.359
It's probably up to.
00:26:43.680 --> 00:26:44.640
They start at 1.3.
00:26:44.960 --> 00:26:47.599
So every patient, you start them the lowest, right?
00:26:47.839 --> 00:26:48.000
Okay.
00:26:48.400 --> 00:26:51.440
Normal is one, and then you sort of start to progress up.
00:26:51.599 --> 00:26:56.079
Are the studies have shown that you don't need to go past two atmospheric pressures?
00:26:56.319 --> 00:26:56.559
Okay.
00:26:56.799 --> 00:27:00.240
So two atmospheric pressures is pretty much your top line.
00:27:00.480 --> 00:27:00.640
Okay.
00:27:00.960 --> 00:27:06.240
Anything above that is more like other sort of medical conditions that we're not really focused on right now.
00:27:06.559 --> 00:27:06.799
Okay.
00:27:06.960 --> 00:27:08.640
Like like burns and stuff like that.
00:27:08.960 --> 00:27:09.119
Okay.
00:27:09.279 --> 00:27:09.920
Or wound care.
00:27:10.319 --> 00:27:10.880
Wound care, yeah.
00:27:11.039 --> 00:27:11.200
Okay.
00:27:11.759 --> 00:27:16.640
So starting up, you know, 1.3, 1.6, 1.8, getting them to that two.
00:27:17.039 --> 00:27:20.240
And the sessions are actually about anywhere from 45 minutes to an hour.
00:27:20.480 --> 00:27:20.720
Okay.
00:27:20.799 --> 00:27:25.920
Um, but studies have shown that you should probably get these patients in for about anywhere from 20 to 40 sessions.
00:27:26.160 --> 00:27:29.519
So it's actually a pretty long, extensive process.
00:27:30.079 --> 00:27:32.960
Um, but you start to see noticeable improvements.
00:27:33.039 --> 00:27:38.640
And it's not something like right after the first, you know, session, you're gonna feel life-changing.
00:27:39.119 --> 00:27:44.160
But it's that gradual buildup that has been the reason why it's been growing so popularly.
00:27:44.480 --> 00:27:44.799
Okay.
00:27:45.119 --> 00:27:45.359
Yeah.
00:27:45.440 --> 00:27:46.559
Um, you know, it's interesting.
00:27:46.640 --> 00:27:55.039
I always I was looking in a hyperbaric for myself because I was like, man, if you know it's good enough for Michael Jordan and Justin Bieber, like I need my own hyperbaric chamber, you know?
00:27:55.279 --> 00:28:05.279
And I guess the higher atmospheres you go, the more complications you could get for um different medical issues, including like, you know, death.
00:28:05.359 --> 00:28:16.079
And so somebody who suffered like a brain injury, you wouldn't want them to go past a certain level, like you were talking about, because it could, you know, it might be more harm than good kind of thing.
00:28:16.319 --> 00:28:16.559
Yeah.
00:28:16.720 --> 00:28:22.400
I mean, I think it's the studies have shown that anything past two atmospheric pressures is not really where we need to go.
00:28:22.640 --> 00:28:22.799
Okay.
00:28:23.039 --> 00:28:25.279
Two atmospheric pressures is is a lot.
00:28:25.440 --> 00:28:29.440
You can still get, you know, the barrow trauma, which is the ear trauma.
00:28:29.920 --> 00:28:32.079
Um, you can get, you know, lung issues.
00:28:32.240 --> 00:28:37.920
There's there's contraindications and things that you need to look at before you start doing hyperbarics.
00:28:38.240 --> 00:28:49.680
But uh, for a standard patient overall that's healthy and is experiencing a brain injury, I'm not too concerned about the actual instance of the hyperbaric pressure itself.
00:28:49.920 --> 00:28:50.240
Okay.
00:28:50.480 --> 00:28:57.039
Um, for me, I think it's it's more likely gonna help them rather than hurt them.
00:28:57.440 --> 00:28:57.680
Okay.
00:28:57.839 --> 00:28:58.480
I got you.
00:28:58.720 --> 00:29:02.160
And then did you say, I don't know the fancy word for it, but like red light therapy?
00:29:02.240 --> 00:29:04.240
Is that photo photobimodulation?
00:29:04.480 --> 00:29:04.640
Okay.
00:29:04.720 --> 00:29:06.720
That's like a super fragile cagualistic kind of thing.
00:29:06.799 --> 00:29:07.039
I don't know.
00:29:07.599 --> 00:29:07.920
I don't know.
00:29:08.400 --> 00:29:12.000
That's why I think that's why everyone goes to red light therapy because it's like hard, but that's the medical term for it.
00:29:12.079 --> 00:29:12.319
Yeah.
00:29:12.559 --> 00:29:14.079
Um, you know, it's it's funny.
00:29:14.240 --> 00:29:23.599
Uh everybody knows like NFL players, UFC fighters, they get hurt, they go, they're like, okay, let's throw them in the hyperbaric, let's do red light therapy, you know.
00:29:23.759 --> 00:29:26.799
And then um they're like, yeah, those guys are athletes, you know.
00:29:26.960 --> 00:29:34.720
And then it's like regular Joe Schmoe, one of us, gets injured, and you know, the health insurance company's like, oh no, that's experimental.
00:29:34.799 --> 00:29:34.960
Yeah.
00:29:35.119 --> 00:29:39.920
And it's like, dude, if I was your family member, you would you would say, hey, let's go for it.
00:29:40.400 --> 00:29:40.960
Let's do everything.
00:29:41.039 --> 00:29:42.799
Yeah, let's let's do hyperbaric.
00:29:42.880 --> 00:29:45.119
Uh uh, let's do red light therapy.
00:29:45.279 --> 00:29:51.920
And uh, I feel like these health insurance companies just want to label everything experimental so that they can avoid paying for stuff.
00:29:52.000 --> 00:29:52.319
Yep.
00:29:52.640 --> 00:29:57.599
And people are okay with it, which is not, you know, like like the average consumer is okay with it.
00:29:57.680 --> 00:29:58.880
They're like, oh yeah, that that makes sense.
00:29:58.960 --> 00:30:01.440
It's experimental, so I got to pay cash or whatever.
00:30:01.599 --> 00:30:05.359
Um, so it's it's really cool that you guys offer these services.
00:30:05.519 --> 00:30:07.359
Um, because they do think they're cutting edge.
00:30:07.440 --> 00:30:14.880
You know, um, 50 years ago, people would say that like surgery on your knee was, you know, experimental.
00:30:14.960 --> 00:30:22.160
Like we don't know, you know, now it's like standard, you know, you're in football, you hurt yourself, you know, you go get a knee surgery and that you feel better.
00:30:22.319 --> 00:30:25.440
Yeah, it's almost that term like you hear like maximum medical improvement.
00:30:25.680 --> 00:30:25.839
Right.
00:30:26.000 --> 00:30:28.640
And it's like maximum medical improvement to what?
00:30:29.359 --> 00:30:41.279
If they haven't gone through everything, you know, if they haven't experienced all the available mentalities that can be used to treat this patient, how do you know what their improvement could be if they would have gotten an additional care?
00:30:41.519 --> 00:30:41.759
Right.
00:30:41.920 --> 00:30:42.160
You know?
00:30:42.319 --> 00:30:42.559
Yeah.
00:30:42.799 --> 00:30:51.759
So I've never really liked that term because, you know, in the traditional setting, you know, it'll be, hey, is this the best I'm gonna get?
00:30:51.920 --> 00:30:58.480
And it's well, based off of standard of care and what you've had available to you, this is probably your cap.
00:30:58.640 --> 00:30:59.680
This is where we're at.
00:30:59.920 --> 00:31:06.000
But are there additional modalities that I think could help you and get you to that next level in combination with some other things?
00:31:06.240 --> 00:31:07.039
A thousand percent.
00:31:07.119 --> 00:31:07.279
Yeah.
00:31:07.440 --> 00:31:10.079
It's just unfortunately, you're right.
00:31:10.319 --> 00:31:14.400
You know, health insurances have limited the options to providers.
00:31:14.640 --> 00:31:24.720
But um, you know, I think what we're hoping to do is sort of be able to provide those options to everyone and really give people the option to be able to participate in things that you wouldn't normally be able to participate in anyway.
00:31:24.960 --> 00:31:25.119
Yeah.
00:31:25.200 --> 00:31:31.839
If I mean, if it was my kid that got injured and I had the financial resources, I would say, we're doing that.
00:31:31.920 --> 00:31:32.960
We're we're gonna try that.
00:31:33.119 --> 00:31:35.200
So I think it's really cool that you guys offer that.
00:31:35.359 --> 00:31:37.519
So um, you know, we're talking about therapy.
00:31:37.599 --> 00:31:38.000
I love it.
00:31:38.079 --> 00:31:45.359
You're telling me every patient gets individualized care based on the different, I guess, tests that you guys perform.
00:31:45.599 --> 00:31:46.720
What are some of those tests?
00:31:46.799 --> 00:31:49.359
Let's say I'm a patient, I'm coming to your office.
00:31:49.519 --> 00:31:54.480
Um, what could I look forward to for testing that that I might experience?
00:31:54.640 --> 00:31:58.559
And, you know, use like words that caveman Abe would understand for me, please.
00:31:58.880 --> 00:32:03.279
But what would I expect as a patient to come into your office and and receive for testing?
00:32:03.359 --> 00:32:08.480
Is it is it like, are you guys gonna be probing my brain with things, or is it more verbal?
00:32:08.640 --> 00:32:09.519
Explain that to me.
00:32:09.839 --> 00:32:10.240
Yeah.
00:32:10.559 --> 00:32:15.920
So again, starting off with just understanding essentially what the patient has been experiencing.
00:32:16.079 --> 00:32:17.440
So you come see me.
00:32:17.599 --> 00:32:29.759
The way that would work is we spent about 45 minutes of an hour together talking about all the symptoms that how they affect your daily life and how that goes about your day and how it affects your work, how it affects your home activities.
00:32:30.000 --> 00:32:35.279
And then from there, we have a suite of testing that typically we do depending on what the patient is feeling, right?
00:32:35.440 --> 00:32:56.240
So we'll test your balance, we'll check out, you know, the different um issues that might be affected with your balance and and your balance systems, whether it's checking your proprioception, your vestibular system, your vision, and those terms essentially just mean all the different balance systems within your brain, essentially, come to produce your balance, right?
00:32:56.799 --> 00:33:01.200
So if one of those are altered, then you might have difficulty in certain in certain issues.
00:33:01.359 --> 00:33:11.279
So if your vision is is poor, then maybe when you're relying solely on your vision for balance, then maybe your vision, you know, needs to be corrected so that we can correct your balance issues.
00:33:11.759 --> 00:33:25.200
Um, then we do brain testing, we do, we check for cognitive dysfunction, we essentially put a fancy cap on your head, and that fancy cap gives us some numbers, and those numbers essentially tell us what it looks like compared to someone else your age.
00:33:25.440 --> 00:33:31.279
And if there is dysfunction, then we can kind of understand that, hey, this is dysfunction.
00:33:31.519 --> 00:33:44.160
And then the second or one of the other tests that we kind of do is vestibular occupant motor testing, just essentially testing the eyes as it goes in the vertical, horizontal, and circular planes and understanding if there is any abnormalities in that.
00:33:44.400 --> 00:33:50.400
Now, the one thing that I always emphasize with patients is that testing is objective and it's very helpful.
00:33:51.119 --> 00:33:56.079
But we always address the patient directly and the symptoms that they're experiencing.
00:33:56.400 --> 00:34:03.759
Because we might do a cognitive test and they might perform amazing, but they're a high performing individual.
00:34:04.079 --> 00:34:06.400
You know, they're super high functioning.
00:34:06.640 --> 00:34:14.639
And though their cognitive dysfunction might be present compared to someone their age, you know, it's not showing on the testing.
00:34:15.039 --> 00:34:16.320
So testing is great.
00:34:16.480 --> 00:34:27.760
And I'm a huge proponent for testing, but it doesn't take away the clinical aspect that the doctor has with the patient to kind of really understand and really go in depth with all these things.
00:34:28.159 --> 00:34:28.480
Okay.
00:34:28.719 --> 00:34:29.199
Gotcha.
00:34:29.440 --> 00:34:38.239
So um, you know, a lot of people have been talking for the last, I would say like two or three years about blood testing for brain injuries.
00:34:38.480 --> 00:34:48.880
Um, can you just give people watching this a little bit of an idea about how that works and how that's I guess maybe the level of accuracy and all that stuff?
00:34:49.679 --> 00:34:49.920
Yeah.
00:34:50.159 --> 00:35:07.599
So essentially what the blood test is doing, it's testing proteins that can essentially secrete when there is some sort of brain injury or some sort of dysfunction, whether it be neurodegenerative from a chronic process, or in this case that we're talking to, it being traumatic brain injury.
00:35:07.840 --> 00:35:22.719
So if you have a tear in your brain, and we'll simplify the terms, you might have secretion of some of these proteins like GFAP, neurofilament, um UHCL1, UHC1, um, essentially that can secrete.
00:35:22.800 --> 00:35:32.800
And then based off of the level of elevation, you can see essentially if there is essentially a brain injury or axonal injury.
00:35:33.039 --> 00:35:35.519
So happening at the microscopic level.
00:35:35.840 --> 00:35:36.079
Okay.
00:35:36.239 --> 00:35:36.400
Right.
00:35:36.559 --> 00:35:38.320
That might not be seen on an image.
00:35:39.039 --> 00:35:41.920
So I know that you're familiar probably with DTI, right?
00:35:42.079 --> 00:35:42.400
Yeah.
00:35:42.719 --> 00:35:44.480
So testing the tracks.
00:35:44.719 --> 00:35:54.079
And DTIs are great, um, but sometimes it doesn't get it as granular as at the microscopic level, which is what those proteins are essentially testing.
00:35:54.719 --> 00:35:58.239
So it can show it it's a great test.
00:35:58.719 --> 00:36:03.360
The only issue with it is that it's not specific, right?
00:36:03.599 --> 00:36:04.960
It can be sensitive.
00:36:05.119 --> 00:36:18.719
But if you have a patient who has multiple sclerosis and then also has a brain injury, you know, is it possible that their proteins could have been elevated from a previous neurodegenerative condition?
00:36:19.039 --> 00:36:19.519
Maybe.
00:36:19.840 --> 00:36:20.079
Okay.
00:36:20.320 --> 00:36:22.079
You know, is it normal?
00:36:22.400 --> 00:36:22.639
No.
00:36:23.039 --> 00:36:25.840
Should it should it be within normal limits?
00:36:26.079 --> 00:36:26.480
Yes.
00:36:26.800 --> 00:36:29.920
So it's really everything is taken within context, right?
00:36:30.159 --> 00:36:35.360
So it's all about understanding the picture and understanding the patient and being able to plug it in appropriately.
00:36:35.519 --> 00:36:36.880
So I think it's a great test.
00:36:37.119 --> 00:36:45.039
But everything goes back to the patient and understanding the relation of all this testing to when they started with their dysfunction.
00:36:45.440 --> 00:36:45.760
Okay.
00:36:46.079 --> 00:36:53.760
Um, do all of these blood testing companies that, you know, like, hey, our blood test can determine if there's a TBI.
00:36:54.320 --> 00:36:56.559
Does it vary from company to company?
00:36:56.639 --> 00:37:00.800
Is it or would you say it's pretty standardized across the board?
00:37:00.880 --> 00:37:02.719
Aaron Powell, I'd say it's relatively standardized.
00:37:03.039 --> 00:37:03.199
Okay.
00:37:03.440 --> 00:37:09.679
Um I would say it's making bigger waves now in the checking for the chronic aspect of it.
00:37:09.840 --> 00:37:13.840
You know, there's a good test to test for an acute aspect.
00:37:14.239 --> 00:37:22.559
It's essentially testing the same markers, but the bigger companies have already, you know, tackled onto that acute process and checking for the acute process.
00:37:22.639 --> 00:37:25.679
And they can do that at large facilities and large hospital systems.
00:37:25.920 --> 00:37:26.239
Okay.
00:37:26.400 --> 00:37:32.559
Um, but now it's grabbing into the chronic phase and being able to understand the chronic phase a little bit better.
00:37:32.800 --> 00:37:34.800
So again, I think it's a great test.
00:37:34.960 --> 00:37:46.559
I think it's just appropriate in the right patient and understanding how far from their brain injury they are and understanding what those levels mean at that point in time relative to their injury.
00:37:46.960 --> 00:37:58.719
So, so in other words, it's it's one test, it's one like way to show that there's a brain injury, but it's not necessarily a golden standard, end all be all.
00:37:58.800 --> 00:38:04.239
There you gotta, you gotta verify you again, you gotta go back to that hour-long test interviewing the patient.
00:38:04.400 --> 00:38:04.559
Yeah.
00:38:04.719 --> 00:38:10.000
That's probably the most important thing, it sounds like in evaluating someone for a TBI is the one-on-one.
00:38:10.320 --> 00:38:10.639
Correct.
00:38:11.039 --> 00:38:15.760
I mean, uh the standard is so far a clinical diagnosis is the gold standard.
00:38:16.079 --> 00:38:16.239
Okay.
00:38:16.559 --> 00:38:19.840
Understanding that everything else helps support you.
00:38:20.000 --> 00:38:20.159
Okay.
00:38:20.559 --> 00:38:23.519
Helps understand the patient a little bit better.
00:38:23.760 --> 00:38:28.079
And obviously, any physician would love to have all the data, right?
00:38:28.559 --> 00:38:32.800
Get every information they possibly can because it just helps them treat the patient a little bit better.
00:38:32.960 --> 00:38:37.280
It gives them something to track, it gives them something to understand how the patient is progressing.
00:38:37.599 --> 00:39:01.119
So all the testing, whether it be blood biomarkers, whether it be diagnostics that we spoke about earlier with the eye testing, the brain testing, you know, MRIs, I think they're all great to help understand the patient better, but nothing will ever take away truly understanding the patient from a one-to-one level, and you can't replace that.
00:39:01.760 --> 00:39:02.480
You know, who knows?
00:39:02.559 --> 00:39:04.239
Maybe AI will, but not yet.
00:39:04.559 --> 00:39:13.599
Listen, Star Star Trek has already thought up so many different things over the years, and they've already come up with a holographic doctor like 30 years ago.
00:39:13.920 --> 00:39:14.159
I know.
00:39:14.320 --> 00:39:20.000
It was AI, you know, you talk to it like normal and it can do surgery on you, but it's incredible.
00:39:22.320 --> 00:39:22.559
I know.
00:39:22.800 --> 00:39:23.039
I know.
00:39:23.280 --> 00:39:24.639
But AI is not going to be this tall.
00:39:24.800 --> 00:39:26.320
Maybe we can like maybe we can do that.
00:39:26.400 --> 00:39:27.599
We can just make it bigger if we want.
00:39:28.079 --> 00:39:29.840
They're gonna have the robo dog here just talking.
00:39:30.239 --> 00:39:31.039
Yeah, yeah, yeah.
00:39:31.119 --> 00:39:32.000
For sure, for sure.
00:39:32.239 --> 00:39:41.440
Um so um, you know, DTI scans, they're all the rage for the last like, I would say, five years in the personal injury context.
00:39:41.679 --> 00:39:47.039
Um now I think they're generally accepted with health insurance, even before they were like, nah, we're not paying for that.
00:39:47.119 --> 00:39:50.880
Now it's generally accepted in the community DTI scans for health insurance.
00:39:51.360 --> 00:39:56.880
Um can you explain a little bit of the timing of when a DTI is good?
00:39:57.039 --> 00:40:07.840
Because I I see some doctors, um, mostly chiropractors, who will order a DTI the first hint of a car accident.
00:40:08.000 --> 00:40:09.920
They're like, oh, go get a DTI.
00:40:10.159 --> 00:40:13.679
Um, and then I see other people get it like a year later.
00:40:13.840 --> 00:40:20.239
Is there a specific time frame when somebody who thinks they might have a brain injury should go get it?
00:40:20.480 --> 00:40:23.519
And then what are your thoughts in general just about DTI?
00:40:24.320 --> 00:40:30.960
I find imaging so interesting because I think there's a time and place and understanding when to order everything is so important.
00:40:31.760 --> 00:40:36.239
Because in the acute setting, you'll commonly see in the hospital the order of CT.
00:40:36.320 --> 00:40:43.360
And CT is appropriate because they're checking for anything acute bleeds that might be causing that patient to die right there.
00:40:43.599 --> 00:40:43.920
Okay.
00:40:44.079 --> 00:40:57.920
You know, and then I commonly get patients who will be, you know, a month out and they've already got an MRI with a DTI, and I kind of just like, you know, nod my head a little bit because that's not probably when I would order it.
00:40:58.239 --> 00:41:03.360
Studies have shown three to six months is typically the ideal place to order it.
00:41:03.679 --> 00:41:13.039
That being said, they've noticed, you know, deficits that or dysfunction that has been noted, or tract dysfunction that has been noted, you know, a year out.
00:41:13.360 --> 00:41:16.800
Um again, I always say a brain injury is a brain injury, right?
00:41:16.880 --> 00:41:20.639
So if you experience something later on, you're you're gonna find it.
00:41:20.719 --> 00:41:23.760
You know, if you experience something, you're you might find it at later on.
00:41:24.000 --> 00:41:35.039
Um the first three months, there's typically still a lot of recovery, edema, understanding, allowing it to allowing your brain to sort of just like recuperate a little bit.
00:41:35.679 --> 00:41:40.320
Um so you can get false negatives or false positive um no, I'm sorry, false negatives.
00:41:40.719 --> 00:41:41.679
Yeah, false negatives, yeah.
00:41:42.000 --> 00:41:48.800
Essentially that show, hey, there's no tract damage, but it's probably because you ordered it too early on and you're not you're not able to see it.
00:41:48.960 --> 00:41:49.199
Okay.
00:41:49.440 --> 00:41:53.280
So three to six months is typically when I like to order things.
00:41:53.440 --> 00:41:57.679
Um I have ordered it later and seen dysfunction, you know, seen tract dysfunction.
00:41:58.159 --> 00:42:03.119
Um, but I I that's typically the window that has been most supported that three to six months.
00:42:03.280 --> 00:42:17.840
I've seen patients that, you know, they've had it done at a month and they're in this post-concussion syndrome, even though that's not the term that people like to talk about, post-concussion syndrome, but just these post-concussive symptoms essentially.
00:42:18.000 --> 00:42:21.280
And then I reorder it at four or five months and it comes back positive.
00:42:21.840 --> 00:42:26.960
And it's just, you know, what you what you find at a month, you're gonna find something different at four to five.
00:42:27.119 --> 00:42:30.960
And there are people that order it early on and find damage early on.
00:42:31.199 --> 00:42:33.280
But for me, I just I typically wait.
00:42:33.440 --> 00:42:43.360
If the patient had a CT early on, I'm comfortable understanding that there's nothing truly acute that is of high concern unless the patient has like these red flag symptoms that are really concerning.
00:42:43.840 --> 00:42:50.559
And if I were to order an MRI before that three month range, I probably would do an SWI alongside an MRI.
00:42:50.639 --> 00:42:50.880
Okay.
00:42:51.039 --> 00:42:55.039
Just because you're most likely gonna see an SWI is gonna check for these microhemorrhages.
00:42:55.280 --> 00:42:55.599
Okay.
00:42:55.760 --> 00:42:59.280
Um, and you can find that earlier on in the process.
00:42:59.599 --> 00:43:00.559
Okay, very cool.
00:43:00.719 --> 00:43:02.079
Um, it's always interesting to me.
00:43:02.159 --> 00:43:04.960
People are like, no, I had this ET scan at the hospital and I'm fine.
00:43:05.039 --> 00:43:05.679
There's no injury.
00:43:05.760 --> 00:43:07.679
And I'm like, that doesn't mean there's you're fine.
00:43:07.760 --> 00:43:14.000
That just means that you're not gonna die on in the hospital um or within 24 hours of leaving the hospital.
00:43:14.159 --> 00:43:28.320
Um, you know, it's it's one of one of the cases we had was a young 18-year-old girl, uh, I think it was in Polk County, she was in a head-on collision, she had a bruise on her head, and uh the it was it was gonna go to trial.
00:43:28.559 --> 00:43:33.760
And the expert that the insurance company hired said, no, no, no, no, that's just a smudge on the image.
00:43:33.840 --> 00:43:35.920
This was before they had digital, and it was like the actual image.
00:43:36.079 --> 00:43:37.039
He goes, No, that's a smudge.
00:43:37.119 --> 00:43:39.360
It's somebody put their finger or something on there.
00:43:39.599 --> 00:43:42.880
And our expert radiologist was like, it's not a smudge, that's blood.
00:43:42.960 --> 00:43:59.280
It's just not the the radiologists at the hospital, they're just like normal, normal, unremarkable, unremarkable, just banging out reads for the five dollars they get, you know, per read, and totally missed what our doctor said was blood on our on our frontal lobe.
00:43:59.360 --> 00:44:07.599
And the Their doctor, of course, who got, you know, I think he got like five million dollars that year from one insurance company for testifying, said, no, no, no.
00:44:07.679 --> 00:44:10.480
It's just it somebody smudged it with their hand or something crazy.
00:44:10.639 --> 00:44:17.920
I'm like, what a, what a ugh, made me sick to my stomach that there's people out there like that that will just lie through their teeth.
00:44:18.079 --> 00:44:21.519
Um uh and she had all sorts of corresponding issues.
00:44:21.679 --> 00:44:22.880
It wasn't just that.
00:44:23.360 --> 00:44:29.679
Um, and you know, it's interesting that doctor, I forget his name, but he was one of the pioneers in Florida for DTI.
00:44:29.840 --> 00:44:31.199
Um, he was up in Port St.
00:44:31.280 --> 00:44:32.960
Lucie Beaches MRI.
00:44:33.039 --> 00:44:34.480
Uh, I forget his name right now.
00:44:34.719 --> 00:44:37.199
But um, people from around the country would go to Port St.
00:44:37.360 --> 00:44:39.840
Lucie of all places to get scanned on a scanner.
00:44:39.920 --> 00:44:47.119
And he said something like, you know, I miss X percentage of brain injuries.
00:44:47.199 --> 00:44:55.760
Just because I say I don't see a brain injury, you know, you still have to correlate the patient with the symptoms they're having to see because this is just one test.
00:44:56.320 --> 00:44:59.679
It's not um the end all be all test.
00:45:00.320 --> 00:45:01.199
It's not diagnostic.
00:45:01.360 --> 00:45:01.599
Yeah.
00:45:02.320 --> 00:45:07.360
It's supportive, it's very supportive and it helps the clinician understand the patient better.
00:45:07.519 --> 00:45:18.800
But yeah, kind of like what we spoke about, you know, it's all about understanding the patient because a patient could test-wise look great, clinically it looked terrible.
00:45:19.119 --> 00:45:19.440
Okay.
00:45:19.760 --> 00:45:23.679
So I always really focus on what the patient is telling me.
00:45:24.159 --> 00:45:28.719
And sometimes they might show cognitive dysfunction, but that's okay for them.
00:45:28.800 --> 00:45:29.760
That's their baseline.
00:45:29.920 --> 00:45:30.079
Okay.
00:45:30.320 --> 00:45:35.519
I'll tell them, hey, you know, it came back a little poor, you know, we can talk about that.
00:45:35.840 --> 00:45:42.159
But, you know, if you're not feeling the dysfunction, we can focus on the other things first.
00:45:42.800 --> 00:45:50.800
You know, so it's about really approaching the patient directly and understanding the patient and using all those other tools to really understand it.
00:45:50.960 --> 00:45:58.639
And it's I find imaging super interesting because imaging will show dysfunction or tract symptoms in certain areas.
00:45:58.719 --> 00:46:03.920
And if you can correlate it back to the patient, I always find it super interesting because it just connects the dots so well.
00:46:04.239 --> 00:46:10.800
You know, if you're able to see the frontal lobe has, you know, six or seven tracks that are just abnormal.
00:46:10.960 --> 00:46:14.159
And then the patient's experiencing all these symptoms that are mood related.
00:46:14.239 --> 00:46:19.599
And it's just so interesting to it's so powerful when you're able to tie it together that I just find it really interesting.
00:46:19.840 --> 00:46:20.400
Yeah.
00:46:20.719 --> 00:46:25.119
Um, you know, neuroquant is another thing that I keep hearing about.
00:46:25.280 --> 00:46:29.599
I guess it measures the volume of the brain.
00:46:29.760 --> 00:46:38.719
You know, what I was told, correct me if I'm wrong, was after a trauma to the brain, uh, there's going to be atrophy at a much faster rate.
00:46:38.880 --> 00:46:40.159
Everybody's brain atrophies.
00:46:40.239 --> 00:46:42.559
Everybody's brain shrinks as we get older.
00:46:42.800 --> 00:46:46.400
But after a trauma, it kind of accelerates that to a certain degree.
00:46:46.639 --> 00:46:48.000
Um, I like neuroquan.
00:46:48.400 --> 00:46:48.480
Okay.
00:46:48.719 --> 00:46:50.320
It goes back to the same things with the other things.
00:46:50.400 --> 00:46:52.159
Like DCI, I find it super interesting.
00:46:52.320 --> 00:46:52.480
Okay.
00:46:52.719 --> 00:46:56.000
Neuroquant, I also find very interesting because you're right.
00:46:56.239 --> 00:47:00.000
It's exactly how you said there's certain brains, certain parts of the brain that you'll see atrophy.
00:47:00.239 --> 00:47:01.599
And that's those are the things that I like to see.
00:47:02.079 --> 00:47:03.280
I feel good when you tell me I'm right.
00:47:03.519 --> 00:47:04.320
Like, I don't know what it is.
00:47:04.480 --> 00:47:06.159
Like inside, I'm like, yeah, it is great.
00:47:06.320 --> 00:47:06.960
So go on, go on.
00:47:07.119 --> 00:47:07.440
It's great.
00:47:07.519 --> 00:47:07.840
It's great.
00:47:08.079 --> 00:47:12.000
But you can see, like, let's say hypothetically you have hippocampal atrophy.
00:47:12.079 --> 00:47:12.239
Okay.
00:47:12.400 --> 00:47:12.639
Okay.
00:47:12.800 --> 00:47:16.880
Hippocampus is where memory function, memory storage, whatnot.
00:47:17.119 --> 00:47:17.360
Okay.
00:47:17.519 --> 00:47:20.960
And then you see it line up with a patient who's complaining about memory dysfunction.
00:47:21.119 --> 00:47:21.280
Okay.
00:47:21.519 --> 00:47:24.000
So it's it's it's interesting to see those things line up.
00:47:24.480 --> 00:47:26.400
Again, it's not the end all be all, right?
00:47:26.559 --> 00:47:26.880
Okay.
00:47:27.039 --> 00:47:31.119
Um, you can experience a TBI and you can have a relatively normal neuroquant.
00:47:31.280 --> 00:47:34.239
So at the end of the day, it's addressing the patient.
00:47:34.320 --> 00:47:36.559
But yeah, I think neuroquant is super interesting.
00:47:36.639 --> 00:47:47.039
I think alongside DTI, it's really helpful from a clinical standpoint to really understand at a more granular granular level what's happening with the patient.
00:47:47.519 --> 00:47:53.840
And then really being able to apply all these testing that we get and then go into a treatment modality.
00:47:54.000 --> 00:48:03.360
And obviously, the more testing you have, the more you know, detailed you can get with your treatment process because you understand the patient so much better.
00:48:03.679 --> 00:48:04.000
Okay.
00:48:04.320 --> 00:48:04.800
Gotcha.
00:48:05.199 --> 00:48:08.400
And uh just a last question about the neuroquant.
00:48:08.559 --> 00:48:18.000
Um, I'm deferring to you here, but is it does it make sense to do a follow-up neuroquant read?
00:48:18.239 --> 00:48:37.360
I don't know, six months, a year, two years later, some kind of period of time to see to kind of measure that that rate after the first neuroquant to get it again later, or do you think that's kind of so I'm not against retesting in in all in all of the testing, essentially.
00:48:37.519 --> 00:48:49.599
You could theoretically retest and see what that essentially level of atrophy, the rate of s of atrophy is slowing relative to where it was, how it was prior.
00:48:50.000 --> 00:48:54.559
The problem with a lot of this is that you don't understand the your their baseline a lot of the times.
00:48:54.719 --> 00:48:56.159
You don't have a pre, right?
00:48:56.480 --> 00:48:56.719
Okay.
00:48:56.880 --> 00:49:07.199
So it's I find it useful to get testing if the patient is continuing to really go get worse, right?
00:49:07.519 --> 00:49:08.000
Okay, gotcha.
00:49:08.719 --> 00:49:13.920
Continually getting worse, regardless of all the treatment modalities you've essentially thrown at them.
00:49:14.719 --> 00:49:18.320
Are they continually progressing downward?
00:49:18.719 --> 00:49:27.280
That for me, that really justifies retesting to really get understand the picture to see if maybe there's something that we're not addressing.
00:49:27.440 --> 00:49:36.079
You know, if there's been any changes relative to where they were before or relative to that testing compared to maybe a year down the road.
00:49:36.400 --> 00:49:36.800
Gotcha.
00:49:36.960 --> 00:49:37.280
Gotcha.
00:49:37.440 --> 00:49:38.880
I see this all the time with patients.
00:49:38.960 --> 00:49:40.000
Uh, well, let me represent.
00:49:40.159 --> 00:49:41.360
I see this all the time with some of my clients.
00:49:41.440 --> 00:49:47.199
They they come to me and they say, Abe, you know, I didn't hit my head on anything, but I feel like I have a concussion.
00:49:47.280 --> 00:49:51.760
Like I'm sensitive to light, I'm sensitive to noise, um, my memory sucks.
00:49:51.920 --> 00:49:52.880
Like something's off.
00:49:52.960 --> 00:49:54.079
I can't get words out.
00:49:54.159 --> 00:49:57.280
Uh, there's like a word on the tip of my tongue that I just can't get out.
00:49:57.519 --> 00:50:01.360
Do people need to hit their head in order to have a TBI?
00:50:01.920 --> 00:50:02.239
No.
00:50:02.559 --> 00:50:07.840
And I think people think head injury, and it doesn't need to be a head injury.
00:50:07.920 --> 00:50:08.960
It could be a neck injury.
00:50:09.119 --> 00:50:09.280
Okay.
00:50:09.599 --> 00:50:25.280
If you're if your essentially neck is going into that acceleration, deceleration, which is what we understand as a whiplash, a lot of these patients that I see, they experience significant brain injuries, and they never hit their head.
00:50:25.519 --> 00:50:33.840
They just had that acceleration, deceleration, and they have this neck pain, and then now they're experiencing these all these symptoms that you're speaking about.
00:50:34.159 --> 00:50:37.199
So I think it's really important to understand you don't need to hit your head.
00:50:38.079 --> 00:50:47.920
Just the movement of your head alone is enough to produce the force to cause brain injury or shearing, as we understand, in the brain that can cause these symptoms.
00:50:48.320 --> 00:50:48.639
Yeah.
00:50:48.960 --> 00:50:49.679
Okay, thanks.
00:50:50.000 --> 00:50:53.599
Um I think one of the things that might be good for you to ask.
00:50:53.840 --> 00:50:54.320
Yeah, sure.
00:50:54.559 --> 00:51:05.119
Um, is because I do get this question, is so you know, these pro athletes, they come back so quick, right?
00:51:05.920 --> 00:51:09.760
And we understand them to just like all of a sudden they just come back so quickly.
00:51:10.000 --> 00:51:10.320
Okay.
00:51:10.480 --> 00:51:14.079
So why do patients have these like prolonged concussion symptoms?
00:51:14.239 --> 00:51:20.480
Or why is the force that these patients, you know, you see an NFL player or these boxers, they take so many hits to the head.
00:51:20.559 --> 00:51:20.880
Yeah.
00:51:21.039 --> 00:51:23.679
And they're able to not experience a concussion.
00:51:23.920 --> 00:51:30.480
But a patient who just had a simple whiplash, you know, why do they have a head injury?
00:51:30.719 --> 00:51:30.880
Okay.
00:51:31.119 --> 00:51:33.119
So let me let me let me ask it for the clip.
00:51:33.280 --> 00:51:33.519
Yeah.
00:51:33.760 --> 00:51:41.199
So um, you know, I have a random question for you here that I don't know where I got this from, but um, so I have a question for you.
00:51:41.360 --> 00:51:47.280
Um, you know, we see a lot of these athletes, they have a concussion, they're out for a game, they're back in.
00:51:47.360 --> 00:51:50.719
Um, boxers, MMA fighters are getting hit in the head a lot.
00:51:50.960 --> 00:51:57.360
They kind of appear to us to bounce back and they're back in the ring, you know, very shortly thereafter.
00:51:57.440 --> 00:52:00.960
But then you have someone who's maybe in a car accident or some type of injury.
00:52:01.119 --> 00:52:09.840
Um, maybe they fell down the stairs and they're just out for weeks, months, a year, even their whole life is affected permanently.
00:52:10.000 --> 00:52:13.039
Um, can you kind of explain that and maybe give us some rationale?
00:52:13.360 --> 00:52:14.559
That's a great question, by the way.
00:52:14.800 --> 00:52:15.119
Thank you.
00:52:15.280 --> 00:52:16.000
Thank you.
00:52:16.480 --> 00:52:18.320
Um, to to that, yeah.
00:52:18.400 --> 00:52:31.280
So I find this super interesting because I I get this question a good amount in terms of understanding a head injury of an athlete to a head injury of just the day-to-day patient involved in a motor vehicle accident.
00:52:31.519 --> 00:52:37.760
The difference between an athlete, let's just say a boxer, they're constantly in this defense position.
00:52:37.920 --> 00:52:40.480
They're ready, they're ready to absorb a hit.
00:52:40.639 --> 00:52:44.239
They're per they're in a protective mechanism, they're protecting themselves.
00:52:44.559 --> 00:52:49.599
So you'll and if I don't know if you've seen these boxers and these athletes, they have giant necks.
00:52:49.840 --> 00:52:51.440
Like they have very wide necks.
00:52:51.760 --> 00:52:55.199
They essentially are training for a head injury.
00:52:55.519 --> 00:52:55.599
Okay.
00:52:56.159 --> 00:53:11.599
So if you have someone who's training for a head injury and understands what is going to take them out of the game, they do everything to avoid, you know, going, you know, they do everything to avoid getting that head injury.
00:53:11.760 --> 00:53:14.000
So with Tua, you brought that up earlier.
00:53:14.159 --> 00:53:16.480
Um, what did he do after a head injury?
00:53:16.639 --> 00:53:23.840
He went and he started working out with these wrestlers and these athletes that are boxers because he wanted to increase his neck width.
00:53:24.159 --> 00:53:24.400
Okay.
00:53:24.639 --> 00:53:33.280
So with patients, you know, it's for example, a motor vehicle accident patients that just sitting at a red light and they get rear-ended, they're not expecting it.
00:53:33.440 --> 00:53:37.679
They don't have the time to brace, you know, that that moment to protect themselves.
00:53:37.760 --> 00:53:46.000
It's completely un unpredicted and un they had no idea it was essentially going to happen.
00:53:46.559 --> 00:53:50.880
That lack of defense mechanism really didn't allow them to prepare for the impact.
00:53:51.039 --> 00:53:59.679
So their lack of preparing for the impact is the force that they're able to create with that that whiplash is very significant.
00:54:00.239 --> 00:54:09.039
Again, it also goes back to athletes who the moment they get diagnosed, they are entered into a concussion protocol.
00:54:10.079 --> 00:54:20.239
The UFC, they have their fights on Saturday, on Monday, all these fighters are getting evaluated and going straight into a concussion protocol.
00:54:20.320 --> 00:54:27.760
From the moment I see them in the back tent, they're going into a concussion protocol if we believe them to have a concussion protocol.
00:54:28.000 --> 00:54:33.199
And that can involve diet, that can involve um rehab right away.
00:54:33.360 --> 00:54:45.039
It it's it's essentially they're they're getting dedicated care right away versus a patient might go two, three, four, five weeks, months without ever getting diagnosed.
00:54:45.519 --> 00:54:55.360
So even in in kids, you know, athletes who are who are children, you see it significantly higher and their recovery time is a lot less, but they also want to play.
00:54:55.519 --> 00:55:08.079
They want to go back to the injury, but you see these prolonged, you know, discovery of a concussion and a delayed treatment, which really plays a huge difference on their recovery timeline.
00:55:08.400 --> 00:55:09.199
Wow, that's interesting.
00:55:09.360 --> 00:55:10.000
I never thought of that.
00:55:10.159 --> 00:55:20.480
So you're saying that, you know, these fighters, these athletes, they go straight into concussion therapy after they've been diagnosed and they get everything they need.
00:55:20.639 --> 00:55:30.639
Meanwhile, like the regular Joe Schmoe is out here fighting for their life, trying to one, locate a doctor like you and two, um, get the care that they need.
00:55:30.800 --> 00:55:32.400
So that's that's a pretty interesting.
00:55:32.480 --> 00:55:33.679
I I never thought of it that way.
00:55:33.760 --> 00:55:34.480
That's that's crazy.
00:55:34.719 --> 00:55:37.280
Same thing, I guess, goes for like someone with a knee injury, right?
00:55:37.360 --> 00:55:45.280
Like if they if they putz around for four months before they go in for therapy, it's gonna be a really uphill battle versus if they go straight in for therapy.
00:55:45.599 --> 00:55:47.440
Yeah, it's the same thing with like a knee injury, right?
00:55:47.519 --> 00:55:47.679
Yeah.
00:55:48.000 --> 00:55:53.199
If a patient has a knee injury, and I also find compensatory mechanisms to be so interesting.
00:55:53.360 --> 00:55:53.519
Okay.
00:55:53.760 --> 00:56:00.400
So let's say an athlete has a knee injury, they're they're getting that knee injury fixed probably within that week, right?
00:56:01.199 --> 00:56:23.599
Versus a patient might have to wait a couple months for either one, they go into PT and then then they, you know, decide to go through with therapy or a surgery, but they're compensating, you know, maybe their glutes start activating more, their hips start to weaken because they're compensating, and then they start developing these secondary injuries that they're not expecting.
00:56:23.840 --> 00:56:25.599
So it's the same thing with head injuries.
00:56:25.760 --> 00:56:29.039
You know, your brain wants to get better.
00:56:29.679 --> 00:56:37.199
It's that's we understand neuroplasticity to be one of the big things, you know, in terms of recovering for a brain injury.
00:56:37.360 --> 00:56:45.599
So your brain wants to get better, but if you put the process for it to get better in front of it, it's gonna do you're gonna have a better trajectory.
00:56:45.840 --> 00:56:54.960
Versus if you don't, you're gonna fall down the rabbit hole of compensatory mechanisms, which they might get a little bit of improvement because your brain wants to get better, but they're not gonna have that full improvement.
00:56:55.679 --> 00:56:56.000
Okay.
00:56:56.159 --> 00:56:57.199
Okay, that's really interesting.
00:56:57.360 --> 00:56:57.679
Thank you.
00:56:57.920 --> 00:57:10.239
If there was any symptoms after a traumatic brain injury or someone suspects they have a traumatic brain injury, what would some of your top symptoms be that they should definitely go get checked out after suffering a trauma of some type?
00:57:10.559 --> 00:57:18.400
I think that's one of the hardest questions to answer because every patient is going to prioritize something differently.
00:57:19.039 --> 00:57:19.440
Right.
00:57:19.760 --> 00:57:37.039
So your sedentary person who is not really participating in a day-to-day activity and maybe memory is important, but they can, you know, have cognitive aids to help them sort of get through their day might not be as big of an issue in terms of their cognitive dysfunction and how it's impacting their day.
00:57:37.280 --> 00:57:50.719
But yourself, if you have a memory issue and you had a head injury and you're, you know, you're not performing the way that you are used to performing, that you need to perform at a high level, that's gonna be a huge impact, you know?
00:57:50.800 --> 00:57:50.960
Yeah.
00:57:51.199 --> 00:58:01.599
So I would say the most important thing is really just taking a retrospective look at yourself and seeing what's affecting you the most, whether it be you're just not sleeping well.
00:58:01.760 --> 00:58:04.960
If you're not sleeping well, for me, that's a good enough reason to go see a doctor.
00:58:05.280 --> 00:58:25.280
You know, if you're not sleeping well, if you're having mood dysfunction, if you're having cognitive dysfunction, if you're having balance dysfunction, everything is so important, at least the way that I see it, everything is so important because if you have balance dysfunction, I need to work on that because who's to say you're not gonna fall and have another head injury and make this even worse?
00:58:25.440 --> 00:58:25.679
Right.
00:58:25.840 --> 00:58:27.679
So it's really addressing everything.
00:58:27.920 --> 00:58:35.519
And I really don't look at anything in terms of like one single symptom because they're all so important.
00:58:35.599 --> 00:58:35.840
Yeah.
00:58:36.000 --> 00:58:44.320
And they're all so important to address that we commonly overlook certain symptoms just because maybe it's not a priority at the moment.
00:58:44.719 --> 00:58:49.760
But at least from my perspective, I'm gonna come back to it because they're all important.
00:58:50.400 --> 00:58:52.239
So, what do you like to do for fun?
00:58:54.000 --> 00:58:57.119
So I typically I'm a big walker.
00:58:57.280 --> 00:58:57.599
Okay.
00:58:57.760 --> 00:58:59.440
I love walking, you know.
00:58:59.599 --> 00:59:03.039
So if my That is like the least sexy answer I've ever gotten on a bike.
00:59:03.440 --> 00:59:04.480
It's not fun at all.
00:59:04.639 --> 00:59:08.880
But you know, the reason why I was going to this is that I just got knee surgeries with my knees.
00:59:09.119 --> 00:59:09.519
Oh, wow.
00:59:09.679 --> 00:59:12.480
So I got knee surgery on one knee and then another knee surgery.
00:59:12.880 --> 00:59:13.360
Yeah, wow.
00:59:13.599 --> 00:59:14.400
Three months later.
00:59:14.559 --> 00:59:14.880
Wow.
00:59:15.199 --> 00:59:22.159
So it's uh now I'm finding hobbies that are that are different, uh just because I'm not walking as much.
00:59:22.480 --> 00:59:23.039
Legos.
00:59:23.280 --> 00:59:23.679
Legos.
00:59:23.920 --> 00:59:24.239
Legos.
00:59:24.639 --> 00:59:24.880
That's good.
00:59:25.199 --> 00:59:26.400
My nephews would love to hear those.
00:59:26.559 --> 00:59:26.800
Yeah, yeah.
00:59:26.880 --> 00:59:27.920
I got I got a bunch back here.
00:59:28.079 --> 00:59:30.000
My uh, you know, my kid, I built that one.
00:59:30.159 --> 00:59:31.519
I built that one with my son.
00:59:31.599 --> 00:59:37.119
Uh some of these uh my kid built those when he was like six or seven years old, those two spaceship ones, the Star Wars ones.
00:59:37.599 --> 00:59:37.840
Yeah.
00:59:38.159 --> 00:59:39.519
I like the Captain America.
00:59:39.760 --> 00:59:41.679
Yeah, oh I uh he built I couldn't build that one.
00:59:41.760 --> 00:59:42.960
It was just too mundane for me.
00:59:43.039 --> 00:59:43.760
He built it, my son.
00:59:43.920 --> 00:59:45.920
I built the Avengers Tower, but he built the shield.
00:59:46.159 --> 00:59:48.079
Um so yeah, this is pretty cool.
00:59:48.159 --> 00:59:50.400
Um, but Lagos is like fun if you can't move.
00:59:51.440 --> 00:59:52.639
I haven't been able to move that much.
00:59:52.719 --> 00:59:55.039
So um I'm a really active person.
00:59:55.199 --> 00:59:56.559
That's what I was sort of getting to.
00:59:57.039 --> 00:59:58.639
Um I love doing something active.
00:59:58.800 --> 01:00:02.960
I love going on a hike if I'm outside, you know, if I'm somewhere in the mountains or something like that.
01:00:03.280 --> 01:00:04.480
Where's your favorite place to go hiking?
01:00:04.559 --> 01:00:06.320
Have you like national park-wise?
01:00:06.719 --> 01:00:09.920
No, honestly, I out in Colorado and Utah.
01:00:10.159 --> 01:00:12.639
I just love like hiking those areas, like walking around.
01:00:12.719 --> 01:00:20.559
I I I love it, the change of weather, you know, that like winter going fall or fall winter, I guess.
01:00:20.639 --> 01:00:20.800
Yeah.
01:00:20.960 --> 01:00:23.039
I always find those super that's the most peaceful.
01:00:23.280 --> 01:00:23.840
I'm from Florida.
01:00:23.920 --> 01:00:31.840
I love the heat, but I will tell you, we just got back like a couple weeks ago from Yellowstone, um, uh Glacier National Park, Grand Tetons.
01:00:32.559 --> 01:00:33.840
Amazing experience.
01:00:34.000 --> 01:00:38.480
If you haven't been to Yellowstone or the Grand Tetons, Glacier National Park was cool too.
01:00:38.639 --> 01:00:42.559
Um, it was like another planet uh for hiking and stuff like that.
01:00:42.639 --> 01:00:43.920
We had such a good time.
01:00:44.079 --> 01:00:46.239
Um when your knees are better, you should definitely go.
01:00:46.639 --> 01:00:50.000
We had a we had a blast, and uh don't go skiing.
01:00:50.079 --> 01:00:52.079
I'm terrified of skiing because of the knees.
01:00:52.159 --> 01:00:53.599
Um, so I feel you.
01:00:53.760 --> 01:00:58.880
Uh, but uh beautiful scenery out there if you've ever been to Yellowstone and we we had a blast.
01:00:58.960 --> 01:01:01.519
We went the my my family and it was phenomenal.
01:01:01.599 --> 01:01:03.760
So I used to be a big lawnboarder, actually.
01:01:04.239 --> 01:01:06.000
I used to like skateboarding, lawnboarding, okay.
01:01:06.239 --> 01:01:07.440
Even without all I am.
01:01:07.599 --> 01:01:07.760
Yeah.
01:01:07.920 --> 01:01:08.719
I used to love it.
01:01:08.960 --> 01:01:13.360
But yeah, I stay away from anything that has to do with pivoting emotions at this point.
01:01:13.519 --> 01:01:14.639
Yeah, I'm I'm terrified.
01:01:14.719 --> 01:01:20.239
I I I went skiing for the first time in uh just like six months ago in January or whenever that was.
01:01:20.400 --> 01:01:25.840
Um, and I was terrified I was gonna like tear my knee or something from all the you know people that I've known over the years.
01:01:25.920 --> 01:01:27.360
So, you know, God bless them.
01:01:27.440 --> 01:01:31.840
But I was like, I'll stay on the little um, it was like this this big of a slope, you know.
01:01:31.920 --> 01:01:33.280
Yeah, the money slopes, yeah.
01:01:33.760 --> 01:01:35.039
Um, so cool.
01:01:35.199 --> 01:01:37.679
Um, okay, and then I always ask everybody this one question.
01:01:37.840 --> 01:01:48.559
I was like, you can have a drink with anybody, dead or alive, any kind of drink, anybody on anybody, uh, who would it be and what would the drink be?
01:01:49.360 --> 01:01:50.320
And why, of course.
01:01:50.480 --> 01:01:51.599
The drink is usually the easiest.
01:01:52.000 --> 01:01:52.639
Drink is the easiest.
01:01:52.719 --> 01:01:53.679
I'm gonna go with whiskey.
01:01:54.000 --> 01:01:54.159
Okay.
01:01:54.559 --> 01:01:56.719
I'll do a nice whiskey with a big ice cube.
01:01:57.039 --> 01:01:57.199
Okay.
01:01:57.760 --> 01:01:59.280
My drink of choice.
01:01:59.599 --> 01:01:59.760
Okay.
01:02:00.159 --> 01:02:00.880
Typically.
01:02:01.360 --> 01:02:09.280
Honestly, as a Dolphins fan, uh, this is not particularly the answer that I think most Dolphins fan would want to hear.
01:02:09.360 --> 01:02:11.199
I'm a huge Tom Brady fan.
01:02:11.599 --> 01:02:11.920
Oh.
01:02:12.079 --> 01:02:12.320
Yeah.
01:02:12.480 --> 01:02:12.800
Okay.
01:02:13.280 --> 01:02:13.599
Okay.
01:02:13.760 --> 01:02:18.800
The reason is um he's just a very dedicated person.
01:02:18.960 --> 01:02:25.679
And he's came from, you know, being the last pick in the draft to probably the greatest quarterback of all time.
01:02:26.400 --> 01:02:39.199
And having to go through all those obstacles and challenges that he sort of went through, I always appreciate those like underdog stories that were never really, you know, they never expected that person to achieve what they achieved.
01:02:39.599 --> 01:02:41.199
And he did it at such a high level.
01:02:41.360 --> 01:02:45.760
You can't talk about many quarterbacks that have experienced the level of success success that he had.
01:02:46.320 --> 01:02:56.000
So for me, though it's controversial as a Dolphins fan, and people say, you know, I um liked, I enjoyed torture, you know, for 20 plus years.
01:02:56.159 --> 01:03:02.320
Uh I just find it really interesting because he he's he he essentially went from all the way from the bottom all the way to the top.
01:03:02.559 --> 01:03:02.719
Yeah.
01:03:02.880 --> 01:03:05.440
I'll say I would I would ask him about uh Giselle, but hey.
01:03:05.760 --> 01:03:06.800
I have those questions as well.
01:03:07.199 --> 01:03:07.599
That's all good.
01:03:07.760 --> 01:03:09.360
You know, though that'll be after drink number two.
01:03:09.519 --> 01:03:10.000
Yeah, yeah, yeah.
01:03:10.239 --> 01:03:15.119
So if people want to get a hold of you, ask you some questions about you know how do people get a hold of you?
01:03:15.360 --> 01:03:18.239
Yeah, so I'm I'm very approachable, easy to reach.
01:03:18.320 --> 01:03:19.360
Uh you can find me.
01:03:19.519 --> 01:03:25.760
My Instagram handle is jgomez.md, or our company is synapse.tbi on Instagram.
01:03:26.079 --> 01:03:33.119
So feel free to reach out to us there and and we're happy to sort of uh help you and navigate your traumatic brain injury.
01:03:33.360 --> 01:03:33.920
Awesome, doc.
01:03:34.159 --> 01:03:34.960
We had a great time.
01:03:35.119 --> 01:03:38.320
Appreciate getting to know you and understanding more about TBI.
01:03:38.559 --> 01:03:40.000
So thanks for have thanks for being on here.
01:03:40.079 --> 01:03:40.639
Yeah, thank you.
01:03:41.440 --> 01:03:43.440
Thanks for tuning in to Legally Exhausted.
01:03:43.599 --> 01:03:45.679
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01:03:45.840 --> 01:03:53.280
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