EP 53: Treating Catastrophic Brain Injuries (Part 1 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.

Hi, and welcome to catastrophic comeback today. I'm very happy to have my guest, Dr. Sunil Modi. He's a neurologist, and welcome. Thank you for being here.

Yeah. Thank you. Thanks for having me. Clark.

Yeah, we're excited. So so let me tell you talk to you about for a minute. Can you tell me where you're from? And, and kind of the pathway that's led you to, to being a neurologist into treating people who have neurological issues?

Yeah, sure. So, you know, I was I was born and raised in in India, and I went to medical school there. My father was a physician, and that's probably what inspired me. And what kind of physician is he, he was a pediatrician. And then I decided to come to United States for higher education after the medical school, I was, I was always intrigued by the brain and how it works. And so I knew what I wanted to do. And I thought us had a good advanced system for training. And so I came to us like about 2010 2010. And, and I did my internship residency and fellowship in neurology, in, at in Detroit, at Henry Ford Hospital. After that, I, I served as a medical director of a Stroke Program. And, and in 2019, I really decided to move to south in in North Carolina and I had been working with, with Novant Health during the COVID times, and a couple of years after that, and, and later in 2022, I decided to leave the healthcare, big health system and health hospitals and decided to start private practice. And that's how I got involved into treating patients with concussion, traumatic brain injuries, epilepsy, headaches, Parkinson's disease, dementia, stroke, and so many other neurological conditions, what

are your What was your motivation to leave big corporate medicine and start your own practice?

Yeah, once I worked in Novant, health for about three, three and a half years, and, and when you work in a big hospital or a big system, you sometimes you kind of lose the sense of your purpose, and you're just going with the flow and you don't have autonomy. And, and, and that, that was not very satisfying. For me, I didn't go to medical school to, to work in the setting where, where I'm just a cog in the engine.

So I think that's probably one of the reasons why we've connected is because, you know, you're, you're, you're passionate about your mission and your purpose. And, and so that's something that's, that's important to us, too, I want to ask you about your purpose, our purpose is to help people who've been injured in accidents recover physically, financially and emotionally. And we have a lot of things that we do to try to facilitate and achieve that purpose. What do you see your purpose as is?

I want to help patients at at the same time that I want to get satisfaction from the kind of practice I do so. I want to use technology, I want to use evidence based medicine that using those tools. I think I can provide a high quality of service and I take I'm proud of that, and I'm satisfied when I can achieve that.

Yeah, I can understand that. So let me back up to you with you for a minute. You see you have a you have a young child now. And then and that child will grow up in the United States. What are some of the differences do you see with with that child's experience versus with your experience growing up in India? I'm just fascinated by the cultural differences. What do you what do you see those differences to

be? Yeah, so there is a there is a big cultural difference in I would say in In India, especially in, in middle class, which is probably the largest class and upper class, population, there is a lot of emphasis on on education and and child would spend a lot of more hours in education, reading, studying, taking tests and all that. And on the other end, the people who are not privileged, they, they would have problems accessing the educational system. So there's a, there's this big gap between people who can access and who can't. In the United States, I think that gap is narrower. And, and there's more emphasis on other things, sports socialization, and helping to build better communities, and giving a purpose to life. So I think that that would be their difference.

Okay, so let me ask you this, when it comes to treating catastrophic injuries, is that something you've done in the past? What kinds of injuries what kind of catastrophic injuries Have you have you treated? And what is that process? Like?

Yeah, so I have a significant experience for few years, in, in Detroit, and in Winston Salem, Novant, health, treating brain injuries. Some of them were catastrophic, motor vehicle accidents, gunshot wound to the head, acts injury to the head, and falls. And, and it's, it's, it's interesting, this patients are very sick, they are in coma, they are on a ventilator. And they in the in the acute phase, they go through this procedures and surgeries and, and intensive care and whatnot. And oftentimes, at the end of the acute treatment, they are left with this residual disability, most of them won't be able to function back, go back to their occupation, their relationship, so everything is, is affected off the track, when the catastrophic brain injury is concerned, although you put a lot of resources in saving these patients, they are not able to achieve a an independent life at the

end. So So is it fair that sometimes they are and sometimes they aren't? Or is it most of the cases that you see that are catastrophic, they're not able to achieve that level of, of pre accident stability, or

if you consider the catastrophic injuries made it very significant. And I would believe, I would think most of them will not achieve functional independence, as we would say that they are able to function in the society independently without support, or any aid. If you're if you're talking about less severe injuries, like moderate the severe injuries or mild traumatic brain injuries, then they may or may not recover completely. And the symptoms are milder if they don't recover, so they can still function in the society, although not at the level that they were doing before. But they can still perform more simpler tasks than they did before. And, and their relationships and family life and other activities and hobbies they can enjoy to some level. But obviously, there are some unfortunate people that have moderate or mild severe injury where on the long term, the deficits are still persistent, and they still can't come back to their normal self.

So you mentioned that some of these some of these traumatic brain injuries, whether they're catastrophic or moderate or mild, affect a person's ability to work in the future live independently, might affect their relationships. Are there other ways where people might be affected by these traumatic brain injuries?

When someone can try function well, in the society as we know, there are so many things go off track, their income drops, their confidence drops, because the relationships are affected many times, that that can create another set of problems in in their life. And, and the list can go on, like, one thing leads to another, they, they start losing their mental health, mental well being and physical well being. And their life has changed forever. So

when somebody goes through something like that one of the things that I've heard is that traumatic brain injuries can affect someone's personality. And then that's something that a lot of times affects relationships. So is that consistent with your observations? Yeah,

that's, that's absolutely true. The frontal lobe of the brain has control over emotions, it can, it has control over your impulses, you can suppress impulses. And, and so when the damage is in the front part of the brain in the frontal lobe, even if the damage is mild, it causes people to behave more subconsciously, rather than having a total conscious control over their behavior. So we call that falls under the category of personality changes from brain injury, but these personality changes can be can range anything from mood swings, unnecessary laughing, unnecessary crying, and depression, anxiety. And that then affects their relationships and ability to function in the society and that has negative feedback effect of Furthermore, in their in their personality and behavior, so so they do they do experience a significant change in their life.

So personality would be a thing or place where people might be affected by it for dramatic brain injury, I guess memory might be another area where somebody might be affected. Yes,

absolutely. If they injuries generalized throughout the brain, then and especially on the lobes, temporal lobes of the brain, then they have a patient's have problem registering new memory. So the old memories, which is established already, that remains intact, they can recall all the details of things that they did in the past. But from the accident or injury on words, they have, they can't recall those events because those memories didn't register to the, into the memory circuits. So it's hard to learn new information, hard to learn new information, they may hard to stay present minded to complete a task. Like if you don't remember what you did yesterday at work, then it's hard to have that continuity and function efficiently. Sure,

yeah. I imagine it's hard to hard to operate at work is probably hard to operate in, within a family. It's probably hard to do you know, like you say, take care of your own individual responsibilities to yourself to take to take care and live in. Absolutely, yeah. So you mentioned memory, you mentioned emotional control. Are there other specific areas that are impacted by a person traumatic brain injury?

Yes. So depending on the the force, that the direction of the force and the intensity of the force that the brain experience, different parts of the brain can be damaged. Sometimes, there's a large damage that we can see on the scans sometimes, damage is very mild and we cannot see on the scans. But but every patient is different because the pattern of damage throughout the brain is different. So their symptoms can range anything from personality changes, problems with memory problems with language expression. And feeling dizzy, off balance, vertigo. They can get mood disorders.

Can motor control an issue in

a catastrophic brain injury or a moderate brain moderately severe brain injury the depending on the location motor control can get affected they have in coordination, problems walking in a straight line. complex movements of the hands the dexterity is also affected in those patients? Usually not so in the mild traumatic brain injury, are there

is that is that a relatively exhaustive list? Are there other ways people are impacted by these traumatic brain injuries? No,

this is not an exhaustive list. There are a wide number of symptoms. Problem is vision problem with speech problem with hearing problems integrating sensory information getting disoriented easily. And, and there are some patients even get GI symptoms, abdominal symptoms from from injury to the brain, their autonomic nervous system is controlled by the brain to some extent and and you can see changes in the ball movement changes in bladder control, and so so on.

I guess your brain controls almost everything, almost everything. So if it's injured, then you can have it meant those injuries manifests themselves and probably any way you can think of. Yes, yes. 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.

Hi, and welcome to catastrophic comeback today. I'm very happy to have my guest, Dr. Sunil Modi. He's a neurologist, and welcome. Thank you for being here.

Yeah. Thank you. Thanks for having me. Clark.

Yeah, we're excited. So so let me tell you talk to you about for a minute. Can you tell me where you're from? And, and kind of the pathway that's led you to, to being a neurologist into treating people who have neurological issues?

Yeah, sure. So, you know, I was I was born and raised in in India, and I went to medical school there. My father was a physician, and that's probably what inspired me. And what kind of physician is he, he was a pediatrician. And then I decided to come to United States for higher education after the medical school, I was, I was always intrigued by the brain and how it works. And so I knew what I wanted to do. And I thought us had a good advanced system for training. And so I came to us like about 2010 2010. And, and I did my internship residency and fellowship in neurology, in, at in Detroit, at Henry Ford Hospital. After that, I, I served as a medical director of a Stroke Program. And, and in 2019, I really decided to move to south in in North Carolina and I had been working with, with Novant Health during the COVID times, and a couple of years after that, and, and later in 2022, I decided to leave the healthcare, big health system and health hospitals and decided to start private practice. And that's how I got involved into treating patients with concussion, traumatic brain injuries, epilepsy, headaches, Parkinson's disease, dementia, stroke, and so many other neurological conditions, what

are your What was your motivation to leave big corporate medicine and start your own practice?

Yeah, once I worked in Novant, health for about three, three and a half years, and, and when you work in a big hospital or a big system, you sometimes you kind of lose the sense of your purpose, and you're just going with the flow and you don't have autonomy. And, and, and that, that was not very satisfying. For me, I didn't go to medical school to, to work in the setting where, where I'm just a cog in the engine.

So I think that's probably one of the reasons why we've connected is because, you know, you're, you're, you're passionate about your mission and your purpose. And, and so that's something that's, that's important to us, too, I want to ask you about your purpose, our purpose is to help people who've been injured in accidents recover physically, financially and emotionally. And we have a lot of things that we do to try to facilitate and achieve that purpose. What do you see your purpose as is?

I want to help patients at at the same time that I want to get satisfaction from the kind of practice I do so. I want to use technology, I want to use evidence based medicine that using those tools. I think I can provide a high quality of service and I take I'm proud of that, and I'm satisfied when I can achieve that.

Yeah, I can understand that. So let me back up to you with you for a minute. You see you have a you have a young child now. And then and that child will grow up in the United States. What are some of the differences do you see with with that child's experience versus with your experience growing up in India? I'm just fascinated by the cultural differences. What do you what do you see those differences to

be? Yeah, so there is a there is a big cultural difference in I would say in In India, especially in, in middle class, which is probably the largest class and upper class, population, there is a lot of emphasis on on education and and child would spend a lot of more hours in education, reading, studying, taking tests and all that. And on the other end, the people who are not privileged, they, they would have problems accessing the educational system. So there's a, there's this big gap between people who can access and who can't. In the United States, I think that gap is narrower. And, and there's more emphasis on other things, sports socialization, and helping to build better communities, and giving a purpose to life. So I think that that would be their difference.

Okay, so let me ask you this, when it comes to treating catastrophic injuries, is that something you've done in the past? What kinds of injuries what kind of catastrophic injuries Have you have you treated? And what is that process? Like?

Yeah, so I have a significant experience for few years, in, in Detroit, and in Winston Salem, Novant, health, treating brain injuries. Some of them were catastrophic, motor vehicle accidents, gunshot wound to the head, acts injury to the head, and falls. And, and it's, it's, it's interesting, this patients are very sick, they are in coma, they are on a ventilator. And they in the in the acute phase, they go through this procedures and surgeries and, and intensive care and whatnot. And oftentimes, at the end of the acute treatment, they are left with this residual disability, most of them won't be able to function back, go back to their occupation, their relationship, so everything is, is affected off the track, when the catastrophic brain injury is concerned, although you put a lot of resources in saving these patients, they are not able to achieve a an independent life at the

end. So So is it fair that sometimes they are and sometimes they aren't? Or is it most of the cases that you see that are catastrophic, they're not able to achieve that level of, of pre accident stability, or

if you consider the catastrophic injuries made it very significant. And I would believe, I would think most of them will not achieve functional independence, as we would say that they are able to function in the society independently without support, or any aid. If you're if you're talking about less severe injuries, like moderate the severe injuries or mild traumatic brain injuries, then they may or may not recover completely. And the symptoms are milder if they don't recover, so they can still function in the society, although not at the level that they were doing before. But they can still perform more simpler tasks than they did before. And, and their relationships and family life and other activities and hobbies they can enjoy to some level. But obviously, there are some unfortunate people that have moderate or mild severe injury where on the long term, the deficits are still persistent, and they still can't come back to their normal self.

So you mentioned that some of these some of these traumatic brain injuries, whether they're catastrophic or moderate or mild, affect a person's ability to work in the future live independently, might affect their relationships. Are there other ways where people might be affected by these traumatic brain injuries?

When someone can try function well, in the society as we know, there are so many things go off track, their income drops, their confidence drops, because the relationships are affected many times, that that can create another set of problems in in their life. And, and the list can go on, like, one thing leads to another, they, they start losing their mental health, mental well being and physical well being. And their life has changed forever. So

when somebody goes through something like that one of the things that I've heard is that traumatic brain injuries can affect someone's personality. And then that's something that a lot of times affects relationships. So is that consistent with your observations? Yeah,

that's, that's absolutely true. The frontal lobe of the brain has control over emotions, it can, it has control over your impulses, you can suppress impulses. And, and so when the damage is in the front part of the brain in the frontal lobe, even if the damage is mild, it causes people to behave more subconsciously, rather than having a total conscious control over their behavior. So we call that falls under the category of personality changes from brain injury, but these personality changes can be can range anything from mood swings, unnecessary laughing, unnecessary crying, and depression, anxiety. And that then affects their relationships and ability to function in the society and that has negative feedback effect of Furthermore, in their in their personality and behavior, so so they do they do experience a significant change in their life.

So personality would be a thing or place where people might be affected by it for dramatic brain injury, I guess memory might be another area where somebody might be affected. Yes,

absolutely. If they injuries generalized throughout the brain, then and especially on the lobes, temporal lobes of the brain, then they have a patient's have problem registering new memory. So the old memories, which is established already, that remains intact, they can recall all the details of things that they did in the past. But from the accident or injury on words, they have, they can't recall those events because those memories didn't register to the, into the memory circuits. So it's hard to learn new information, hard to learn new information, they may hard to stay present minded to complete a task. Like if you don't remember what you did yesterday at work, then it's hard to have that continuity and function efficiently. Sure,

yeah. I imagine it's hard to hard to operate at work is probably hard to operate in, within a family. It's probably hard to do you know, like you say, take care of your own individual responsibilities to yourself to take to take care and live in. Absolutely, yeah. So you mentioned memory, you mentioned emotional control. Are there other specific areas that are impacted by a person traumatic brain injury?

Yes. So depending on the the force, that the direction of the force and the intensity of the force that the brain experience, different parts of the brain can be damaged. Sometimes, there's a large damage that we can see on the scans sometimes, damage is very mild and we cannot see on the scans. But but every patient is different because the pattern of damage throughout the brain is different. So their symptoms can range anything from personality changes, problems with memory problems with language expression. And feeling dizzy, off balance, vertigo. They can get mood disorders.

Can motor control an issue in

a catastrophic brain injury or a moderate brain moderately severe brain injury the depending on the location motor control can get affected they have in coordination, problems walking in a straight line. complex movements of the hands the dexterity is also affected in those patients? Usually not so in the mild traumatic brain injury, are there

is that is that a relatively exhaustive list? Are there other ways people are impacted by these traumatic brain injuries? No,

this is not an exhaustive list. There are a wide number of symptoms. Problem is vision problem with speech problem with hearing problems integrating sensory information getting disoriented easily. And, and there are some patients even get GI symptoms, abdominal symptoms from from injury to the brain, their autonomic nervous system is controlled by the brain to some extent and and you can see changes in the ball movement changes in bladder control, and so so on.

I guess your brain controls almost everything, almost everything. So if it's injured, then you can have it meant those injuries manifests themselves and probably any way you can think of. Yes, yes. Thank you for joining us, and we'll see you next time.