Ep 54: Treating Catastrophic Brain Injuries (Part 2 with Dr. Modi)

Welcome to the catastrophic comeback podcast with American Injury Lawyer Clark speaks, helping you find hope, purpose and joy after a catastrophic injury.

Let me ask you this, when when there is a traumatic brain injury, do these symptoms? Are these disease other? These things show up immediately? Or is it some take time to show up? Or, or how does that process work.

So in a traumatic brain injury, all the symptoms would start as soon as the brain is injured. And over time, under the right treatment, it tends to get better. Not always, but there is a tendency towards improvement. Severe or catastrophic brain injuries, they, they recover very differently from mild traumatic brain injuries, because when the injury is catastrophic, there are other organ systems also affected throughout the body. So it's hard to predict the outcome. In mild traumatic brain injury, the symptom starts right from the injury and slowly over time, it gets better in younger patients. And if the brain is not damaged significantly, then they have a tendency to make 100% recovery. But many times they don't make full recovery. And some of these symptoms that they have personality changes, mood changes, they're very hard to detect. So they, they may not be even aware that they are behaving in certain ways because of their brain injury.

And you'd have to spend time with somebody in order to be able to notice this. So the family might notice, hey, there's something different, yes, but it might go undiagnosed, because you don't really, you don't usually get a chance to your doctor didn't see it before. Yeah, he didn't know you before, you know what I mean, he didn't he or she didn't spend time with you, for

many times, we get information from the family as well. And there have been times when patients and the spouse they are in disagreement right in front of being patient, or the victim of brain injury, they may behave abnormal, that can cause problems in the relationship, and they will have a hard time recalling that they behaved that way. So this is a very unique situation where you're not aware of your problems, and you don't recall all the details of how you behaved.

How do you trust, that type of behavioral symptom? I guess, you, you know, you're gonna give them medical treatment that you can give to try to make a person better, right? And what does that course look like?

Yeah, so the most important part is first identifying that there is a problem if we got to spend time with the patient and, and family to actually know that there is some behavioral problem. And then depending on what type of problem is you can use medications you can use behavioral therapy, cognitive behavioral therapy, executing function training, which helps them complete the task with all the efficiently with all the memory and cognitive problems that they have. So so there are there are a number of treatment options, but but the important thing is to identify that they have a problem. And that's where we are the healthcare system in the US is lacking in this like this. Mild traumatic brain injury patients who have these subtle findings that can affect significantly in their personal life. They get missed. What you're

saying is that there are lots and lots of untreated. Yeah, especially mild or moderate brain injuries that just don't don't get treated because historically, we just haven't focused on that people are more focused on the obvious injuries that they can see. broken leg broken arm broken finger, laceration here, laceration there, yes. Something and then so a lot of these brain injuries have historically gone unnoticed. Is that right? Yes,

absolutely. In mild traumatic brain injury, when patients actually go to the hospital in the emergency room, they they may get initial CT scan of the brain and initial evaluation, they may or may not get a diagnosis of concussion, but no one will probe into the details of how it's affecting them. And that's too early on, even later on. For over a month, two months, three months after the injury, usually the system is not is not focused towards identifying this very subtle findings in in patients clinical presentation, so. So that's why they get missed that the system is not designed for that.

So you said earlier you said that the symptoms are fairly immediate after the injury. But what it seems to be now because because I'm thinking about that, and I'm thinking, well shoot, I can think of instances where it wasn't identified. But what you're telling me is that's not because the symptom wasn't present, it just wasn't identified until later in time. Right? Yes. Are there ever any circumstances in which symptoms symptoms might develop more slowly over time after a brain injury? Or that's not usually how it works? No,

that no, that's not how it works. If that happens, and there is a probably a, some kind of secondary complication going on. And that needs a different investigation and treatment. So symptoms getting worse over time is not not typical for brain injuries.

That means something is continuing to cause injury or, or exacerbate an injury is fear.

Yes, things like seizure, brain hemorrhage, mood disorder on untreated depression. Those type of pathologies can can make brain injury patient worse over time.

Okay, so you mentioned some of the things that you can do to treat these kinds of injuries. You mentioned medicines, you mentioned therapies, you mentioned providing patients with certain tools that they might be able to work through themselves. Are those the tools that you have available? Am I leaving anything out? Yes,

the I think you've covered almost all the tools that we have for treatment.

One of the things I was going to ask you about and this is something I've read recently is that nutrition can have a can have an impact on brain function and brain health and the recovery. And so I read about, you know, feeding fish and omega threes and these kinds of things, is new nutrition plays a role in the recovery process of a person after a traumatic brain injury.

Yes, so nutrition plays a plays a role in a sense that if the nutritional status is not good to begin with, and then any injury, not just brain injury, any kind of injury will make patients more likely to get worse. They will they will have more symptoms than people with a good nutritional state. There are clear studies that show conditions like obesity and hypertension, which which is usually often from from poor nutritional state. They have a worse outcome from brain injury compared to people who have a good state of nutrition and good health.

Are there any are there any foods in particular that people with brain injury should try to avoid? Or to try to try to consume more of?

Not Not really, we, as long as if they are. If they don't have any nutritional deficiency, then there are no specific foods that will help recover the brain better.

Is technology improving with respect to either diagnosis or treatment of these types of injuries? Do we see do we see improvements that people can can give can give people some hope and some in in some confidence that think their condition might improve in the future or the technology might improve in the future? Yes. So,

technology has been improving one of the recent technological advancement that came in last few years is biomarkers. When the brain is damaged, it releases certain types of protein. Some of the names are G fap. And you see HL Vaughn based on the level of this protein you can in the blood you can you can predict the severity of the injury. And and we are working towards translating that information to prognosis means how they will do over time. Then there are other imaging techniques, especially some MRI brain sequences. DTI is one of the sequences called DTI and that can identify the areas of of the brain that are injured. In many cases, if not all, its predictive value for the prognosis. It's still, it's still being investigated right now.

So So So what you're saying is they have traditional MRI machines? And can you tell me generally how an MRI machine works?

So the MRI machine uses powerful magnet to get the image of inside of the body without

having to cut and explore? Yeah, exactly,

there's no cutting involved, there is no radiation. So it's a quite safe technique. And that gives a really detailed pictures of the brain and any other organ. And the problem with MRI in a in a mild traumatic brain injury is that MRI is a macroscopic picture of the brain. So like how the brain looks like to naked eye, it does not show microscopic structure. So and the milder injuries are usually at a microscopic level. So MRI will not show those findings. You know, just because MRI doesn't show conventional MRI doesn't show that doesn't mean that there is no brain injury, there could still be microscopic injury. More severe injury obviously shows up on the on the MRIs and CT scans. And

I think your your point is that they have there's new equipment that has come out or will be coming out, that will better be able to identify those types of mild and moderate brain injuries. Is that with advanced technology in terms of the MRI equipment, is that true?

Yes, yes. That are so there is a lot of research and literature on on this. And there are some special MRI sequences that we can do and that that are specific, more specific and more sensitive to pick up. Mild traumatic brain injuries in the brain.

as just an ordinary citizen, and especially in my work, I'm noticing that we're learning more and more and more about brain health and brain injuries and how people were affected by trauma and impact and those kinds of things and how it affects a person's brain and brain health. So are you seeing more emphasis on this this area of treatment? Are you seeing more people come to you and ask you, Hey, do I have? Do I have this injury? Do I what do I need to do to treat it?

Yes, I think so there is a there is more awareness now than it was before I if I recall, like a decade ago, concussion and mild traumatic brain injuries were were not clinically investigated. They did not go through imaging patients did not go through imaging. And this patients are not taking that seriously for treatment. But over time, what I'm seeing now is patients are more aware of their condition and they know more about treatment. doctors and other providers are are offering more treatments now than before. Still, a sizeable proportion of these patients are under treated. So we still have a lot of way to work on this.

So I would see this all the time, and especially over the last 2025 years, or whatever it's been, it's, I would see people who have, you know, you see the magnitude of the impact. And you see the cars being totaled, or the fall or the you know, some kind of end. And you and it's even even if it's diagnosed as a concussion or whatever. There are very little there are very few treatment options, historically, at least at least that were available to many of my clients. And the reason, you know is mostly like, Okay, well, you know, lie down and put a cold compress on and turn the lights out and don't overstimulate and take a few days off, or whatever that was the extent of it are. And for years, we were like there's got to be more to this because you see the long term effects of these things. And they're so So now those things are being more readily identified. And the treatment plan is more detailed and effective. Is that fair?

Yeah, that that's a fair assessment. So previously, headaches were being treated for the brain injury, that that's probably the most common treatment that they were offered. But nowadays on top of headaches, we treat cognitive problems. We treat mood swings and personality changes that can be treated using behavioral therapy and and medications, we treat dizziness and vertigo with some vestibular therapy and some balance exercises, VCs retreats, sleep problems, or more aggressively now because it turns out you need a really good, you need a good sleep too for the brain to make a good recovery. So all these components that come along with with traumatic brain injury they are now treated on individually. And that leads to better outcome.

One of the things that I wanted to ask you about is I noticed that so, so my mother is 86, almost 87, she'll be 87 this month, and she's she has dementia, Alzheimer's, and she lived with us for a long time, she doesn't anymore. She lives in a facility where they are they're can can take care of her better. That's only been in the last six, eight months or so. But um, and so I was with her yesterday, and I'm thinking about this anticipation of our conversation. And one of the things that occurs to me is these people, people who get brain injuries, you know, and they make whatever kind of improvements, whether it's a total and complete improvement or whether it's incomplete recovery. I wonder how that impact how that injury will affect them as they get older, you know, as they get to be 70 as they get to be 7580 85 years old. Can you talk about that a little bit.

If the brain is injured, depending on the severity of the injury, at older age, they could have problems because they have less brain reserve less cognitive reserve to begin with. And then you get cognitive impairment in older age, you lose brain cells neurons in older age. So patients who already have pre existing damage, they are obviously more likely to get more pronounced symptoms at an older age.

Is it is it is it is someone more likely to have dementia or Alzheimer's disease if they if they have a concussion or a brain injury at a younger age.

So there's some conflicting information. It's not to say it's not very clear, if someone has a mild traumatic brain injury, if it increases the risk of dementia in the future, I think it will be very hard to test because you know, you have to follow patients for a number of decades. But if you look at the literature, then there are some association and correlation studies. I don't think there is enough data to give a concrete opinion on that. But more severe catastrophic brain injuries, even if they don't develop dementia, that is still significantly significantly impairs their ability to function in older age.

Okay, well, Dr. Modi, I appreciate you being here. Thank you so much. I think the information that you've provided us will be very helpful to a lot of people. So thank you for being here.

Yes. Hi. I hope so. Thanks for having me. Thank you for joining us, and we'll see you next time.

Welcome to the catastrophic comeback podcast with American Injury Lawyer Clark speaks, helping you find hope, purpose and joy after a catastrophic injury.

Let me ask you this, when when there is a traumatic brain injury, do these symptoms? Are these disease other? These things show up immediately? Or is it some take time to show up? Or, or how does that process work.

So in a traumatic brain injury, all the symptoms would start as soon as the brain is injured. And over time, under the right treatment, it tends to get better. Not always, but there is a tendency towards improvement. Severe or catastrophic brain injuries, they, they recover very differently from mild traumatic brain injuries, because when the injury is catastrophic, there are other organ systems also affected throughout the body. So it's hard to predict the outcome. In mild traumatic brain injury, the symptom starts right from the injury and slowly over time, it gets better in younger patients. And if the brain is not damaged significantly, then they have a tendency to make 100% recovery. But many times they don't make full recovery. And some of these symptoms that they have personality changes, mood changes, they're very hard to detect. So they, they may not be even aware that they are behaving in certain ways because of their brain injury.

And you'd have to spend time with somebody in order to be able to notice this. So the family might notice, hey, there's something different, yes, but it might go undiagnosed, because you don't really, you don't usually get a chance to your doctor didn't see it before. Yeah, he didn't know you before, you know what I mean, he didn't he or she didn't spend time with you, for

many times, we get information from the family as well. And there have been times when patients and the spouse they are in disagreement right in front of being patient, or the victim of brain injury, they may behave abnormal, that can cause problems in the relationship, and they will have a hard time recalling that they behaved that way. So this is a very unique situation where you're not aware of your problems, and you don't recall all the details of how you behaved.

How do you trust, that type of behavioral symptom? I guess, you, you know, you're gonna give them medical treatment that you can give to try to make a person better, right? And what does that course look like?

Yeah, so the most important part is first identifying that there is a problem if we got to spend time with the patient and, and family to actually know that there is some behavioral problem. And then depending on what type of problem is you can use medications you can use behavioral therapy, cognitive behavioral therapy, executing function training, which helps them complete the task with all the efficiently with all the memory and cognitive problems that they have. So so there are there are a number of treatment options, but but the important thing is to identify that they have a problem. And that's where we are the healthcare system in the US is lacking in this like this. Mild traumatic brain injury patients who have these subtle findings that can affect significantly in their personal life. They get missed. What you're

saying is that there are lots and lots of untreated. Yeah, especially mild or moderate brain injuries that just don't don't get treated because historically, we just haven't focused on that people are more focused on the obvious injuries that they can see. broken leg broken arm broken finger, laceration here, laceration there, yes. Something and then so a lot of these brain injuries have historically gone unnoticed. Is that right? Yes,

absolutely. In mild traumatic brain injury, when patients actually go to the hospital in the emergency room, they they may get initial CT scan of the brain and initial evaluation, they may or may not get a diagnosis of concussion, but no one will probe into the details of how it's affecting them. And that's too early on, even later on. For over a month, two months, three months after the injury, usually the system is not is not focused towards identifying this very subtle findings in in patients clinical presentation, so. So that's why they get missed that the system is not designed for that.

So you said earlier you said that the symptoms are fairly immediate after the injury. But what it seems to be now because because I'm thinking about that, and I'm thinking, well shoot, I can think of instances where it wasn't identified. But what you're telling me is that's not because the symptom wasn't present, it just wasn't identified until later in time. Right? Yes. Are there ever any circumstances in which symptoms symptoms might develop more slowly over time after a brain injury? Or that's not usually how it works? No,

that no, that's not how it works. If that happens, and there is a probably a, some kind of secondary complication going on. And that needs a different investigation and treatment. So symptoms getting worse over time is not not typical for brain injuries.

That means something is continuing to cause injury or, or exacerbate an injury is fear.

Yes, things like seizure, brain hemorrhage, mood disorder on untreated depression. Those type of pathologies can can make brain injury patient worse over time.

Okay, so you mentioned some of the things that you can do to treat these kinds of injuries. You mentioned medicines, you mentioned therapies, you mentioned providing patients with certain tools that they might be able to work through themselves. Are those the tools that you have available? Am I leaving anything out? Yes,

the I think you've covered almost all the tools that we have for treatment.

One of the things I was going to ask you about and this is something I've read recently is that nutrition can have a can have an impact on brain function and brain health and the recovery. And so I read about, you know, feeding fish and omega threes and these kinds of things, is new nutrition plays a role in the recovery process of a person after a traumatic brain injury.

Yes, so nutrition plays a plays a role in a sense that if the nutritional status is not good to begin with, and then any injury, not just brain injury, any kind of injury will make patients more likely to get worse. They will they will have more symptoms than people with a good nutritional state. There are clear studies that show conditions like obesity and hypertension, which which is usually often from from poor nutritional state. They have a worse outcome from brain injury compared to people who have a good state of nutrition and good health.

Are there any are there any foods in particular that people with brain injury should try to avoid? Or to try to try to consume more of?

Not Not really, we, as long as if they are. If they don't have any nutritional deficiency, then there are no specific foods that will help recover the brain better.

Is technology improving with respect to either diagnosis or treatment of these types of injuries? Do we see do we see improvements that people can can give can give people some hope and some in in some confidence that think their condition might improve in the future or the technology might improve in the future? Yes. So,

technology has been improving one of the recent technological advancement that came in last few years is biomarkers. When the brain is damaged, it releases certain types of protein. Some of the names are G fap. And you see HL Vaughn based on the level of this protein you can in the blood you can you can predict the severity of the injury. And and we are working towards translating that information to prognosis means how they will do over time. Then there are other imaging techniques, especially some MRI brain sequences. DTI is one of the sequences called DTI and that can identify the areas of of the brain that are injured. In many cases, if not all, its predictive value for the prognosis. It's still, it's still being investigated right now.

So So So what you're saying is they have traditional MRI machines? And can you tell me generally how an MRI machine works?

So the MRI machine uses powerful magnet to get the image of inside of the body without

having to cut and explore? Yeah, exactly,

there's no cutting involved, there is no radiation. So it's a quite safe technique. And that gives a really detailed pictures of the brain and any other organ. And the problem with MRI in a in a mild traumatic brain injury is that MRI is a macroscopic picture of the brain. So like how the brain looks like to naked eye, it does not show microscopic structure. So and the milder injuries are usually at a microscopic level. So MRI will not show those findings. You know, just because MRI doesn't show conventional MRI doesn't show that doesn't mean that there is no brain injury, there could still be microscopic injury. More severe injury obviously shows up on the on the MRIs and CT scans. And

I think your your point is that they have there's new equipment that has come out or will be coming out, that will better be able to identify those types of mild and moderate brain injuries. Is that with advanced technology in terms of the MRI equipment, is that true?

Yes, yes. That are so there is a lot of research and literature on on this. And there are some special MRI sequences that we can do and that that are specific, more specific and more sensitive to pick up. Mild traumatic brain injuries in the brain.

as just an ordinary citizen, and especially in my work, I'm noticing that we're learning more and more and more about brain health and brain injuries and how people were affected by trauma and impact and those kinds of things and how it affects a person's brain and brain health. So are you seeing more emphasis on this this area of treatment? Are you seeing more people come to you and ask you, Hey, do I have? Do I have this injury? Do I what do I need to do to treat it?

Yes, I think so there is a there is more awareness now than it was before I if I recall, like a decade ago, concussion and mild traumatic brain injuries were were not clinically investigated. They did not go through imaging patients did not go through imaging. And this patients are not taking that seriously for treatment. But over time, what I'm seeing now is patients are more aware of their condition and they know more about treatment. doctors and other providers are are offering more treatments now than before. Still, a sizeable proportion of these patients are under treated. So we still have a lot of way to work on this.

So I would see this all the time, and especially over the last 2025 years, or whatever it's been, it's, I would see people who have, you know, you see the magnitude of the impact. And you see the cars being totaled, or the fall or the you know, some kind of end. And you and it's even even if it's diagnosed as a concussion or whatever. There are very little there are very few treatment options, historically, at least at least that were available to many of my clients. And the reason, you know is mostly like, Okay, well, you know, lie down and put a cold compress on and turn the lights out and don't overstimulate and take a few days off, or whatever that was the extent of it are. And for years, we were like there's got to be more to this because you see the long term effects of these things. And they're so So now those things are being more readily identified. And the treatment plan is more detailed and effective. Is that fair?

Yeah, that that's a fair assessment. So previously, headaches were being treated for the brain injury, that that's probably the most common treatment that they were offered. But nowadays on top of headaches, we treat cognitive problems. We treat mood swings and personality changes that can be treated using behavioral therapy and and medications, we treat dizziness and vertigo with some vestibular therapy and some balance exercises, VCs retreats, sleep problems, or more aggressively now because it turns out you need a really good, you need a good sleep too for the brain to make a good recovery. So all these components that come along with with traumatic brain injury they are now treated on individually. And that leads to better outcome.

One of the things that I wanted to ask you about is I noticed that so, so my mother is 86, almost 87, she'll be 87 this month, and she's she has dementia, Alzheimer's, and she lived with us for a long time, she doesn't anymore. She lives in a facility where they are they're can can take care of her better. That's only been in the last six, eight months or so. But um, and so I was with her yesterday, and I'm thinking about this anticipation of our conversation. And one of the things that occurs to me is these people, people who get brain injuries, you know, and they make whatever kind of improvements, whether it's a total and complete improvement or whether it's incomplete recovery. I wonder how that impact how that injury will affect them as they get older, you know, as they get to be 70 as they get to be 7580 85 years old. Can you talk about that a little bit.

If the brain is injured, depending on the severity of the injury, at older age, they could have problems because they have less brain reserve less cognitive reserve to begin with. And then you get cognitive impairment in older age, you lose brain cells neurons in older age. So patients who already have pre existing damage, they are obviously more likely to get more pronounced symptoms at an older age.

Is it is it is it is someone more likely to have dementia or Alzheimer's disease if they if they have a concussion or a brain injury at a younger age.

So there's some conflicting information. It's not to say it's not very clear, if someone has a mild traumatic brain injury, if it increases the risk of dementia in the future, I think it will be very hard to test because you know, you have to follow patients for a number of decades. But if you look at the literature, then there are some association and correlation studies. I don't think there is enough data to give a concrete opinion on that. But more severe catastrophic brain injuries, even if they don't develop dementia, that is still significantly significantly impairs their ability to function in older age.

Okay, well, Dr. Modi, I appreciate you being here. Thank you so much. I think the information that you've provided us will be very helpful to a lot of people. So thank you for being here.

Yes. Hi. I hope so. Thanks for having me. Thank you for joining us, and we'll see you next time.