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YHM 079 - Post-Concussion & Eye Movements… is there a link?
36 Plays1 year ago
In this episode of Your Health Minute, we dive into the intriguing link between post-concussion symptoms and eye movements with special guest Melissa Biscardi, a leading concussion clinician and educator.
Discover how concussions can disrupt brain function, leading to visual disturbances and other eye-related symptoms. We’ll also explore practical tips for managing concussions and maintaining optimal eye health.
Don’t miss this insightful discussion on the hidden connections between your brain and eyes!
Follow Melissa:
@concussionrehab.ca
concussionrehab.ca
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Transcript
Introduction and Host Welcome
00:00:11
Speaker
Welcome everyone to another episode of Your Health Minute brought to you by Aqua Omega. I'm your host, Max Marion. And with me, as always, is my co-host, Calvin Morrow. Hello, everybody. We also have our moderator today, Alanis, in the studio.
00:00:25
Speaker
We are very excited about
Guest Introduction and Concussions Overview
00:00:27
Speaker
today's show. We have very special guests, clinical concussion clinician, Melissa Biscardi. It's early in the morning. I have not had a full cup of coffee yet, so I'm just tripping over my words a little bit here. But we are excited about today's show. We are going to be talking about the relation between concussion or post-concussions and your eye health. Welcome to the show, Melissa.
Hockey's Shift to Brain Health Awareness
00:00:53
Speaker
Thank you so much. I'm so happy to be here again. We always have a good time and I made sure to pour my coffee before I record. I'm super excited. Yeah, I was a little foggy this morning. I have not had a full cup of coffee yet. I left my coffee downstairs in the office. We're upstairs in the studio here.
00:01:13
Speaker
I feel like the air crusher has, you know, how it's been going up and down or I'm sure it's the same. My allergies are already. I think I had like a 10 sneeze in a row this morning. Crazy sneezes there this morning. I was like, Oh man, it's back. It's bad.
00:01:31
Speaker
Yeah, get my own magazine and shed some of that information. Absolutely. And we'll be good to go, but I am excited about today's show. Thank you. And I'm excited to talk
Research on Eye Movement and Concussions
00:01:43
Speaker
about... I'm excited to talk about a lot of things, like even sports. Like yesterday, I took my kids to a junior hockey game. I hadn't been to a junior hockey game in a really long time.
00:01:53
Speaker
And right away, the first thing I noticed is like, there's, there's not a lot of contact in this sport anymore, or far less than what I used to play outside. Interesting. And I think, and so I was messaging some friends, I'm like, do you guys know about this? Like, you know, like, I'm watching guys dump the puck in the corner, and nobody's getting run over. I'm like, what is happening? Like, what happened? You should not be getting away with them. Yeah, like, why? Like, you should be hearing the boogeyman coming, like, every time the folks in the corner, you know what I mean? Like,
00:02:16
Speaker
And, and it's just not like that. And so I'm messaging some friends during the game. They're like, Oh yeah, it's like, that's the way, you know, hockey Canada, hockey USA wants it to be now. And I can only imagine it's because of brain injuries and concussions. And that's what we're going to be talking about today and the long-term effects of that.
00:02:33
Speaker
and the impact on eye health. So I guess before we dive into that, I'd love for you to tell our listeners more about yourself, why you guys are interested in concussions and traumatic brain injuries and recovery from these.
Underreporting and Mental Health Impact
00:02:50
Speaker
And then we'll dive into the topic of what a concussion is and how it's going to impact your eyes potentially long term.
00:02:56
Speaker
Absolutely. So yes, I'm Melissa Biscardi and I'm a concussion clinician. I'm also a PhD candidate at U of T and my research, which is University of Toronto, my research focuses on eye movement interventions in adults post-concussion. So very interested in the eyes and I maintain a small clinical practice in Toronto and then also
00:03:22
Speaker
teach clinician so it's a really busy life but I do love it and I started to get interested in the brain probably about 10 years ago and then it just naturally kind of evolved into an interest in concussion as this like invisible injury
00:03:39
Speaker
Over maybe the last four or five years. There's been more and more traction It's all over the news more clinicians are focusing on it more research, but when I first started there wasn't so much So it's been really interesting to just see the evolution and even like you said the evolution of sport so all the way from how we treat it to how we behave has evolved and
00:04:07
Speaker
Yeah, that's me in a nutshell. I'm excited. It's funny too, because like concussions have not gone away. If anything, there's like, I don't know, I was talking to a concussion kind of like therapist, just
00:04:20
Speaker
was it last this week? Earlier this week, I don't know the weeks are blending together. But like this week or like, like, I think it was early this week. Anyway, doesn't matter when it was we're talking about and he was just saying, like how many concussions are is and it was like 10s of 1000s just in Canada. Yeah, a lot. That's cute. That's the acute concussions. And then what you don't see him.
Concussion Awareness and Reporting
00:04:40
Speaker
What I learned about is that sometimes these
00:04:43
Speaker
Post concussion syndromes can last like years after the concussion itself. And there's not a lot of therapy or treatment that's available for people that are suffering from this. And there's a lot of direct links that tie into like anxiety, depression, even suicidal tendencies, which is wild.
00:05:00
Speaker
I wonder how many concussions go unnoticed? I was going to say that's the thing about the statistics, too. We see that the stats are going up. There are more concussions than ever, but the problem with that is there's more awareness than ever. There is a just reporting bias.
00:05:18
Speaker
And then on the other hand, it's like, okay, but what isn't reported. So someone might go to a clinic such as myself or other clinicians that are not in the OHIP system for Ontario or, you know, elsewhere in Canada, just like the system that records data. And so those concussions aren't necessarily recorded in the stats. So there's various skewed
00:05:46
Speaker
you know, markers of concussion for sure. And different grades of concussions as well, right? Like, depending, you know, you can get a slip and fall, you can get a car accident, you can get a sports injury. But I was thinking, like, when you were just talking there, the amount of sports injuries back when I played sports, even before that, because like, even us, like, got our eight, like, it was like, it was like, okay, like, maybe you should miss a game or two. But like, back in the day, it was like, get back in there, kid, tap on the butt, like, you know, it's like,
00:06:12
Speaker
You know, I remember one, one, one time specifically, uh, I was on the ice and I, one of my, one of my teammates got laid, like laid out, like yard
Personal Sports Stories and Concussion Culture
00:06:21
Speaker
sale. Boom. Like, it looks like you gotta look like you got exploded on the ice. And, um, he was back out like two shifts later, but he just skated in a circle for like 30 seconds and then got off. And then they're like, okay, maybe.
00:06:34
Speaker
Is that just skating it off or that was him like having no, it was during the game. Okay. Oh, like the play was going on. He was just like skating in a circle and it was just like, Oh, okay. Maybe back then he was set out like a game, maybe two games, you know, until you felt okay. Like I remember guys throwing up in the locker room and the garbage cans, like, cause they got crushed. Like you can throw up from a concussion. Yeah.
00:06:56
Speaker
Melissa, would you mind maybe for our listeners who don't really know, what is a concussion and how do they most commonly... You've never had a concussion? I don't think so, but maybe I'm going to learn that I've had a free one. I don't know. Yes, so there are some criteria, but you don't have to get hit
Understanding Concussions Mechanically
00:07:11
Speaker
in the head. A concussion happens when either there's an impact to the body, the neck, or the head that causes the brain to shake inside the skull, essentially.
00:07:20
Speaker
And this causes a metabolic cascade and you may have signs and symptoms like vomiting, blurred vision, headache. You can have loss of consciousness, but actually only 10% of people will have a loss of consciousness. So it's definitely not the majority.
00:07:40
Speaker
But it really is that metabolic cascade that is the marker of concussion. So you can get hit by a Nerf ball or a Comm ball, but that's not enough force, like you need enough force to cause this chemical cascade. And then and that
00:07:59
Speaker
those chemical changes kind of happen over, there's the initial insult, and that's where you feel maybe dazed, confused for a moment, and then it settles, and then it's over around two weeks. Depends what literature you're looking at. But the chemical cascade can resolve before you feel better or the reverse. And so that's why
00:08:25
Speaker
quote unquote, like concussion is confusing us all because there are so many things happening at once. Like we said, the eyes can be disrupted, the neck can be disrupted. Just the nervous system is 100% disrupted because it's the brain. Vestibular system, like there are so many different systems that can be thrown off and in everyone it's different. So yeah.
00:08:52
Speaker
the more concussions you get, the worse the symptoms become? I would say there are a couple different details about that. So two concussions in like three months is different than two concussions over three years or over 10 years. And every concussion is different even in the same person. So we think about mechanism of injury.
00:09:18
Speaker
for women, like actually where they are in their cycle matters, even when you're thinking of- Like when the concussion happens, depending on where you're going. Yeah, so if they're, so women who are like in the luteal phase just before getting their period, they're more at risk for sustaining a concussion. And if they get a concussion during that phase, they're more likely to have persistent symptoms or a prolonged recovery.
Gender Differences in Concussion Recovery
00:09:43
Speaker
Wow. So it's really nuanced. And even if your stress levels are already high, you know, like that cortisol inflammation is just raging, and then you get a concussion, you know, that might be different. Or if you just got over COVID, and you get a concussion. So there are just, there are so many nuances that might affect your recovery.
Revisiting Concussion Recovery Advice
00:10:11
Speaker
Yeah, it's interesting because now we know early care is associated with better outcomes. Right. Okay. So like right away, if you suspect, I mean, within 48 hours, you can already be starting. I mean, right away, you can start your recovery in the sense of making sure you're eating well, not drinking, get a, you know, good sleep. And then at 48 hours, many people can start the light aerobic exercise protocol,
00:10:41
Speaker
which generally should be guided by a clinician, but that's not always possible. There are lots of online resources to guide you, but you shouldn't be in a dark room, that's for sure.
00:10:52
Speaker
recovery. They used to tell people stay in a dark room until you feel better. Yeah, I remember some friends like like legit being like, like even like one of my friends like his his NHL career got and like it was like his ninth concussion but like his NHL career was ended by like a really bad hit. And I remember talking to him. He's like, man, I sat in it in like
00:11:14
Speaker
I don't want to see anybody. I sat in my living room with the lights off, the sound down for like a year. Which of course is actually making you feel worse, right? So what makes you feel worse? But that's got to tap into the depression, right? Exactly. The depression and anxiety, right? You just got to feel whole. And the more you, so even when we think about screens, sounds,
00:11:36
Speaker
In the first 48 hours, yes, you shouldn't have more than an hour of screens on each of those days. But after that, we want you to have a little bit of exposure. Otherwise, you will become more sensitive. Just like if a healthy person goes camping for a week and then comes back to the city, you're like, whoa.
00:11:58
Speaker
lights, noises, so you become sensitive to it. So if you stay in a dark room for a year, you're going to have to recover just from being isolated, as well as all the other stuff.
00:12:11
Speaker
That's wild. That is wild. Why would he want to be in a dark room for a year? That's what he's told to do. Yeah, and I think he came down to, you know, those initial recommendations in the dinosaur ages were because they didn't want people to overuse their brain, essentially. Yeah, it's like you want the one to let their brain like chill out, but it's like a muscle, right? Your brain's a muscle. If you don't use it, like it's
00:12:35
Speaker
You'll get other issues. It's going to weaken and you're going to get some other issues. It's crazy. What about reading? You were talking about the eyes and the impact on eyes. It's got to cause some issues with reading long-term, right? Because like I said, I was talking about this in the pre
Post-Career Athlete Challenges
00:12:50
Speaker
-show. I remember when we were talking about Dan Carcillo and his advocacy for concussion and treatments. And I remember him posting pictures of himself.
00:12:59
Speaker
and other professional athletes like when they started their careers to when they ended their careers and like like legit like we should post some of these it's crazy like I would love to see like they have like eyes like like you know kind of looks like mine but then when they're done it's like it looks like they're like looking inward you know and it's
00:13:16
Speaker
It's crazy. And he talks, then he talks about, yeah, he go, he went on to talk about the anxiety and depression that was caused post post professional career and you know, how he dealt basically with his concussion syndrome or post concussion syndrome is just by, by being explosive and beating the crap out of guys on the ice. You know, that was like his therapy was to go out and play hockey and beat people up because he had all this anger and
00:13:39
Speaker
and kind of like anxiety built into him that was like his release, but like without the professional sports, how do you deal with that? And a lot of times it falls into like substance abuse or self abuse.
00:13:50
Speaker
And it's like so many things that you just said are interesting. So one is that over 40% of the brain's machinery are involved in eye movements.
Eye Movements in Concussion Assessment
00:14:01
Speaker
So it's not surprising that if you shake your head, get an injury to the head that the eye movements or visual processing can be disrupted.
00:14:13
Speaker
I would say, I mean, we even use the eyes as a marker when we're assessing someone. And so many things can happen. It can be, so your eyes still might be moving, but they're not moving well or they're effortful or they're not accurate. Maybe they are, so Max, what you're describing is when the eyes are converged. So like pointing towards each other,
00:14:39
Speaker
But often we see the opposite. So the eyes actually don't like to come together. And if we think about even just a reptilian brain, something coming towards us is like a threat. So the eyes coming together have this aversion like, oh my God, panic.
00:14:56
Speaker
you know, what's going on. So then you're stuck in like a fight or flight type? Yeah, absolutely. And then we'll see even, you know, the pupil responses will be disrupted. And there is research showing there's this like delay essentially in the pupil response. So that can be contributing even to the light sensitivity, right? If the pupils are not responding just fast enough, you get extra light. And
00:15:24
Speaker
for reading, let's say, so one, we need the eye movements to be accurate, effortless, right, to not get headaches when reading, and also to process what we're reading. The words need to be clear, like all these things we take for granted. And then also, if we're having this trouble with convergence, with our eyes coming together,
00:15:50
Speaker
And then we're trying to read our phone up close or a book up close, that's going to cause so much discomfort, right? You're forcing the eyes to be in the position that they're really not comfortable right now. So definitely, you know, maybe it's going to resolve on its own. But if
00:16:07
Speaker
Those symptoms are- Maybe not, right? Like some of that stuff stays forever. Yeah, and it's better. We know that the earlier you get in, the better. And this is not just a sales pitch, it's reality because our brain is so good at reinforcing things. So it doesn't know that it's reinforcing this negative pattern, it's just getting good at it. So the earlier you get in, the easier, usually a small fire is easier to put out.
00:16:32
Speaker
You break the bad habit early. What kind of therapies would you put in place for that? For me, I'm not an optometrist. I'm looking at it as a holistic clinician. One, I need to make sure the neck is moving because those upper neck muscles are connected to the eye movement.
00:16:52
Speaker
Do you recommend like acupuncture for that and stuff? I'll do manual therapy, I'll do acupuncture right in those suboccipital muscles and the whole neck, right? Because you got to loosen up for the muscle, you got to loosen up the muscles and allow for the blood flow, right? That's what my acupunctur... Absolutely. Yeah.
Neck Mobility and Manual Therapy
00:17:08
Speaker
And then you want those upper muscles like blend right into the Dura and right into that head, eye, neck coordination. So you need that. It's important. Think about when you have a bad sleep and your neck hurts the next day. It's like a week sometimes. Yeah, like I hurt my trap doing some like some some cleans. And like I dealt with that for like six months on injury. And when that would flare up and hurt, my whole brain felt like shit. Like I just like. I was gonna say and sometimes like
00:17:35
Speaker
the neck can be the cause of some of those eye symptoms like the headaches when reading, eye fatigue. So you have to clean up that foundation first for sure. And then looking at, okay, how are these, for me, it's more like eye tracking. How are these eye movements? Are they tracking well? Is it
00:17:54
Speaker
effortful, like lots and lots of blinking, squinting. And then what about the range? Exactly. Exactly. Because so some people have that convergence insufficiency, right? They can't bring their eyes together. But not everyone does. Sometimes people are the way you're describing Dave Carcillo, they have the opposite problem. This whole cookie cutter approach doesn't work, right? You have to look at the patient say, Okay, what
00:18:24
Speaker
how can I help this patient with this pattern? Because the last thing you want to do if they have convergence access is give them convergence exercises. Right. You know, it's like pencil pushups or something like that. So really just seeing, okay, what is not really great and how can we polish it, make it
00:18:46
Speaker
Um, function better. Um, sometimes like maybe we'll talk about dry eye, but that can be happening because of just like the nervous system or the tissues. So we see that a lot
Relieving Eye Fatigue
00:18:59
Speaker
with inflammation, right? Tears as well.
00:19:02
Speaker
So even just in the history, and then maybe we'll have the patient do certain exercises, but maybe also just different eye massages or stretches to, you know, it's all about effective effortless movement. I've never heard of an eye massage before.
00:19:23
Speaker
Oh, yeah. Oh, it's so good. Oh, one on my Instagram. How would you massage your eyes? Right. And so I think I saw you do it. Was it with spoons? You took like two. That's that's like a soothing one. And then you just like you gently press on your eyes. Not too much. Almost just like a toonie. And that's going to, you know, it's going to move your eyes around a little bit. And then you just look left, hold, look right.
00:19:53
Speaker
Look up look down and that's just like a little massage for the eyes and if you've been on it's good for everyone if you've been on the computer or doing like lots of reading my eyes get tired i like to like rub my hands together.
00:20:07
Speaker
Oh yeah. And then I move my eyes around. I'm realizing, yeah, I'm giving myself an eye massage all the time, probably daily with my hands. And so sometimes it's that it's strategies for soothing, right? And sometimes it's strategies for rehab. I tried the spoons after you put it on. Oh yeah. Did you like it? I love it.
00:20:26
Speaker
I love, I love. Oh look, I have one right here. Spoons are always cold. Okay. I wasn't sure if you were putting them in the freezer. No, no, it's actually just cool for whatever reason. Oh, you have a spoon ready. I know. I just happened to have one here. That feels good too. It feels so nice. We'll do that on our story after this. You know, it's interesting when you're talking about like the eyes and stuff like that. I did talk about this all the time because I had a really good experience, but I did one of our, um,
00:20:57
Speaker
Our customers, he bought the master franchise for iCryo for Canada.
00:21:02
Speaker
And we were visiting, yeah, and we were visiting one of his, well, his new head office where they have like the inaugural kind of store. It was really cool. The therapy's unreal. Anyway, and they're like, oh, you want to try it? And I was like, yeah, I want to try it. And I'm like, just being like the person I am, they're like, well, do you want to do like the, the beginner level, mid-level
Cryotherapy Experience and Vision Effects
00:21:21
Speaker
or expert? I was like, turn it up. We're going to be okay. You know, I do lots of calls. Will I die? No, put me out.
00:21:29
Speaker
like a little face mask cover your ears and you wear mittens and socks and so I went in and I did I think it was three and a half minutes or something like that or like the maximum you can do at that it's like it's pretty intense but when you when I came out
00:21:43
Speaker
I definitely felt like the, I don't know if we're gonna talk about the vagus nerve or not, but like, I definitely felt it like up here. And I came out and the lights were just like, whoosh, like so bright. Like, it was crazy. It was so crazy. So I can imagine people that have like, like, traumatic brain injuries, concussions, or they're dealing with some, that's got to be good for them to a certain degree too. Or is that over the cryo you were in a tank? Like, yeah. Okay. Deep freeze. Intense. All my, all my hair's got frozen on my body. Yeah.
00:22:12
Speaker
That's so crazy. Yeah, it's intense. That's pretty cool. Someone was just talking about, I don't know if it's a research device or if it's a device on the market for after someone sustains a concussion. I think they've already looked at cooling caps, but this was a cooling just for around your neck. Oh, cool. I love cold too. To try and decrease that, I guess, initial inflammation.
00:22:43
Speaker
Wow. The thing is, we need some inflammation, right? That's your response to be like, okay, we got to fix this. But you don't want it to live there either, right? You don't want chronic inflammation. That's when you start to get some serious health issues.
00:23:00
Speaker
I don't know, there's a lot of really cool, like cold therapy. I love cold therapy. I take nothing but cold showers. I love, I have, I just, can I show you my new setup with like my steam room and cold bath? Yeah, I got like a new cold bath in my garage gym with like a steam room and stuff. I love, and I love all things cold. So I can imagine, and it makes me feel good. I don't know if it makes everybody feel good, but I feel great. I know a lot of people are addicted. I have not been able to get into it because I don't like the cold, but I like heat.
00:23:28
Speaker
Yeah. Well, there's good therapies for heat too, right? Like there's some great heat therapies that can loosen up those massage, those, those muscles and kind of eliminate some inflammation. It's like, it's oftentimes you're going from like, I like both. I was about to say that too. Like if you, for example, if you're in the cold and then you step out, that's kind of the heat, like you get a contrast either way. It's just biased in one direction. If you go heat and then like, when you step out of a hot shower and you're like, nah, it's cold.
00:23:58
Speaker
I like going maximum polar opposites. All right, let's go. Crank it all the way up and all the way down. All the way up. Yeah, we were at the north. I was going to ask if you go to the spas. Yeah, Janelle and I were at the spa last week, and they were doing, I don't know what it was. It was a Swedish therapy thing. Waffing the heat around and stuff like that. It gets hot in there, man. And I sweat. And then right from there, right to the river bath. Boom. I love that.
00:24:27
Speaker
so much. Love it. It's the best. Everybody else is like, I'm like, man, give me all of this cold. I need all of it. I get created. Yeah. I have to check out that Nordic spa. I haven't. I've seen the ads for it. And it looks amazing. We go to the original one up in Chelsea. Yeah, Chelsea is great. There's one in Toronto now.
00:24:50
Speaker
It's pretty cool. It's the same maker. Yeah, except it's not, well, it's in Toronto, but like on the outskirts. So I have to figure out how to get there. Yeah, I was worth it. I love that. You sleep like a baby after you're done. Yeah, I bet. Your nervous system is just happy as heck, right? It's just so good. Such good stuff. So what kind of therapies, aside from like the eye massage and things like that, are you working with people? Like I've seen things like,
00:25:19
Speaker
You know, it was at the Cochran Institute. They're doing like, they put people in like this, looks like a giant spinner. Like it looks like... Oh, the gyro spins probably. Yeah, like that man. It looks like one of those things you would be preparing. Like a multi-axis chair. Yeah, like you'd be using that if you were going out into space, like the... Yes. In your shed. Okay, so it's a chair that rotates in different... Yeah, but like... Yes. It's people.
00:25:43
Speaker
And they do that for concussion? Yeah. I don't have one of those. My colleague in Toronto has them. They're becoming more popular. I mean, they're like $150,000 at least. So I don't think they'll ever be widespread. But the idea is, at least of
00:26:03
Speaker
understand it correctly is let's say you have an area that is hypo or like need some encouragement you're gonna spin on the access to bring stimulation to that area but you don't need a giant chair to do that you can do it on a rotating stool for example although you don't really you can't get the vertical but there are other ways to stimulate
00:26:28
Speaker
So, yeah, I would be using the more accessible versions of that. That's good too, right? Like, I think the accessible version is nothing wrong with that because I think you go home and you can continue some of that therapy when you're at home. For sure. You know, that's nice. I mean, even when we think of those things, I don't know if I'd want to. Like, even like, no. Actually, I do think a lot of patients find them fun. Yeah, it does sound like a right, just hearing you say it. It's like... Are you serious? Pull it up, Elena. Like, that, like...
00:26:56
Speaker
It's like you tell them you would get sick. I think you would get sick. It sounds like a carnival ride almost. I've seen them like sometimes they'll put them on like the edge of a mountain, you know, so you get this like impression that you're going to fall off, right? I have not seen that.
00:27:12
Speaker
But accessibility is important because even when we think of aerobic exercise, which is like gold standard to start that after concussion, not everyone has a treadmill,
Exercise and Sleep in Recovery
00:27:22
Speaker
right? Maybe we need to do it on I prefer exercise bike, honestly, because it takes out that, you know, movement that might be aggravating, especially if they're having eye movement issues. But maybe the patient will have to start with walking. So we need to work with what is available. Is that aerobic exercise to drive blood flow?
00:27:41
Speaker
Yes. And for like nervous system support. Right.
00:27:46
Speaker
you want that good kind of energy. And even when you think about it, so if people have not been doing the exercise and they come into my office, that alone is a game changer. Yeah, so let's say they didn't know better and they just spent a few days in a dark room or a week or we're doing nothing, like right away we need to get them moving. And that's gonna help with mood, right? And even locus of control, like now they're like, oh my gosh, good, there's something I can do.
00:28:16
Speaker
the endorphins and also the sleep drive. So we know that there are sleep disturbances often after concussion, but you also need to, you need to get that sleep drive. And if you're just laying around all day, that's not going to everybody's experienced that before. Like Ray, you get like, just have like a lazy, lazy Saturday or Sunday or something like that. And then try to go to bed at night. You're not going to sleep and sleep becomes so important. So you got to burn some of those. Yeah. That.
00:28:45
Speaker
energy to be able to effectively sleep well, you know, go for a walk in nature. Like think the difference that you do that you just sleep so great. I think we call it sleep drive. I don't know if that's what it's called. But yes, yes, it is what it's called. Okay, that's great sleep drive. Yeah, just doing things through the day to make sure you have a good night's sleep.
00:29:02
Speaker
Yeah, I saw there was I was at a conference last Friday, and a professor, I think she's from York, she did a little presentation on sleep. And it was great. And just simple, simplified that fact, like during the day, we are creating that sleep drive. And as we sleep, we're removing it essentially, and then we wake up, and then we spend the day, you know, refilling that sleep drive. And then that's, that's the cycle.
00:29:32
Speaker
You got to load it up, but not too much. Too much will spike the cortisol. If you load it up too much and too late, you'll spike your cortisol and you will not sleep well. It's a cycle. Is there a time of day you recommend for them to do their exercise? Is it the first thing in the morning? Get up. I like it first thing in the morning.
00:29:52
Speaker
You know, definitely concussion recovery is such a special day naturally. And some people can only do a minute of exercise. And I say, Okay, well, do that in the morning, get the blood flow going, you know, get some nutrients oxygen to the brain, and start your day.
00:30:10
Speaker
Oh, great diet. Is there any kind of diet that you're recommending as well? Yeah, I mean, I do ask people, okay, well, we know there's not a concussion diet, but we know the Western diet is not good.
Dietary Advice for Concussion Recovery
00:30:22
Speaker
Right? So what's that doesn't work for anything. No, it doesn't work for anything. So my
00:30:29
Speaker
My one thing is I really like people to cut the gluten if they can. I find out of everything that is the one people notice the most. So dairy is like, here or there. But I definitely ask people, you know, you have rice instead of pasta, sourdough bread, and if you have to have bread.
00:30:53
Speaker
so that oh yeah no alcohol or like jube jubes or anything like that but only the omega chewables that's the only jube jube you can have um you know that fruits and vegetables just like the healthy diet yeah most people know what is healthy for the most yes no it's true because so now i ask people i used to say how's your diet now i say what do you eat right because
00:31:23
Speaker
you know, exactly a healthy diet means different things to different people. Right. But I try not to be too restrictive, because it can be too overwhelming for people. So something pretty traumatic, right? Yes, exactly. And then their life is already being thrown upside down.
00:31:43
Speaker
So also giving alternatives like, okay, try not to have pasta instead have rice instead of like, don't eat these 10 things. Yeah. I like that. Water like, you know, some people just, they still don't drink water. So we need to get that even just for the tissue, but concussion, we need to flush out the inflammation. The most, the most water Calvin gets is in his coffee. I used to be like that. I used to just live off Red Bull.
00:32:13
Speaker
That's great. That's high school Calvin, right? Nobody's shocked. I don't know. I was never a big energy drink. I invented a few times and like, I'm super sensitive to all that stuff. So I think one day I had like two Red Bulls and like, like in a short amount of time. And I started like, like, oh my gosh, dating. And I was like, Oh, fuck, we're done with these. Like, you know, give me the jitters. That's for sure. It feels like your heart's gonna blow out of your chest. You're like, okay, we're
00:32:38
Speaker
I remember those little five minute energy things or five hour energy shots. And then it was like eight hours, 12 hours energy. It's like, these are not good. Your sleep drive is not there for like a week. Yeah. Yeah. Don't need any of that. The other thing with diet is like really making sure people are getting enough fat. Like if anyone was alive in the eighties, then fat is like this bad thing, but actually it's such a good thing that we need. And especially
00:33:06
Speaker
thinking of sleep and before bed, it's those high fat like avocado, maybe nuts or coconut.
00:33:15
Speaker
high fat before bed is going to be some Greek yogurt, some things like that. Why before bed? Or like for your last meal, because if you're having something high carb or like crackers or bread or something like that, it's the sugar like the your glucose sometimes it will make your insulin. Yeah, exactly. Your body isn't working optimally. And then you wake up at two or three
00:33:43
Speaker
So the fat burns slow and it creates like, like satiety, so you're not as hungry. You don't get the, and it regulates your blood sugar. You're not getting these crazy ups and downs, but your brain hates. It must be so important. How, what's, is there a correlation between like diabetes and concussions? Like do like, like, because the brain, yeah, always what? I'm sure it throws off the blood sugar because it throws it off even in non-diabetic. Right. That's what I mean. Your brain hates, your brain hates like,
00:34:13
Speaker
inconsistent like sugar, like control, it loves like steady glucose levels, lots of oxygen, lots of blood flow. And if this if there's a correlation between like a brain injury or you're like your your blood sugar is being thrown off, your brain's gonna hate that.
00:34:29
Speaker
And I call the concussion or a concussion the great amplifier. So anything that was already there or under the radar, all of a sudden, it's a bigger problem because your brain is using energy to heal from the concussion, but it's producing less energy.
Concussions and Pre-existing Conditions
00:34:47
Speaker
So as a result, everything is kind of compromised. It's interesting you say that too before bed, like the bedtime snacks, because like, yeah, you could get up.
00:34:57
Speaker
You know, it's not, it's really bad to start your day off with like a high sugar breakfast and mostly you want protein. There's like this thing where there's like these cereals that have like these crazy carcinogens in them. And like some of the Asian and like European countries have started to ban them. Yeah. Oh wow. The one I know about is like red dye 31 or whatever it's called. It's supposed to be really bad for ADHD, I think. Yeah.
00:35:22
Speaker
Yeah, like where did that even come from? Like bowls of sugar for breakfast. I love Captain Crunch. I don't know what it tastes like now, but I remember like I could have all walks of it. I talked about that the other day. I saw an ad and I sent it to Calvin and Andre here. I was like, yo, Captain Crunch or Corn Pops?
00:35:42
Speaker
But it's crazy that I know all of these cereals. I was like, normally you wake up, you have both. Let me just spike my, let me just spike my insulin to start the day. And then just have constant sugar cravings the whole rest of the day. And you got moody and cranky. Not know why cereal. I am nutritious. I got all my grains in this morning. Yeah, that's what it says on the back. All my grains was even some omega threes. I think in that last one I ate.
00:36:11
Speaker
No, there wasn't. Oh, it's so interesting because I was just listening to a podcast this morning. I don't even know which one. It just showed up in my ears and it was talking about and I think
00:36:24
Speaker
you will be well versed in this, but the fact that the soils don't have the minerals anymore. And so then we fortify, which I don't often think about this, but the foods are fortified, but the fortified foods is not complete nutrients because
00:36:46
Speaker
I guess there are the nuances on the, you know, minerals. I'm definitely not giving this the appropriate language. It wouldn't be like in its natural state, right? It wouldn't be like it's fortified in its natural state or have its natural kind of like nutritional profile that you would expect. And the problem is with a lot of foods is like the nutritional profiles that they did on these foods were done 50 years ago.
00:37:07
Speaker
Hmm. Yeah, right. Because the soils have been depleted, they've been overgrown, like so that you don't get the same nutritional values as you would, which is why we see a lot of vitamin and mineral deficiencies. People they have all these like, yeah, and health issues from that, like, and the vilification of things too, right? Like the vilified salts, like Walter created equal, like obviously, there's some that are very synthetic, basically, you know,
00:37:33
Speaker
pool salt is not that different than like table salt or like the white table salt and you can convert your pool salt into chlorine pretty easily. So I've been wondering even about my Himalayan salt.
00:37:43
Speaker
Yeah. Is it good? I like gray salt, Celtic salt, which is basically the same thing. They have a great mineral profile, which is very, very good. I think it's gray salt and Celtic salt. They're the same thing. You just get it for cheaper when you buy the gray salts.
00:38:08
Speaker
Um, you know, the Celtic salts come from like a very specific area. And I think the other, the gray salts come from like France or something like that. Oh, fancy. Basically the same thing, but like you, same type of profile, you just get it for a lot less money. Um, but yeah, the vilification of the, the salts and like they're, they're necessary. It's like, Oh, don't touch salt. Your blood pressure is like, man, you need these electrolytes for your body to drive, drive properly. Right. That's why there's like some great supplements. Like Rob Wolf came out with that, uh, what's it called element?
00:38:37
Speaker
Okay. Yeah, it's really good. Yeah, drink element like I've taken that product before it's great makes you feel great. Yeah, it's really, really good. The Villa to that I appreciate that we talked about in a previous episode is like the quality, because for omegas, you were the one who educated me on this, but poor quality can actually go rancid. And you source like the best quality.
00:39:07
Speaker
There's lots of bad things with omega syndrome. The potency, the type, the form that it's in, the sourcing of it, if it's not gone through proper independent third party testing for like those dioxins, PCBs. It's bad. You do need to make sure you get that.
00:39:26
Speaker
Like you were mentioning before, like the best thing you can eat before bed is healthy fats. And that's not necessarily always omega, but like, you know, have some avocado, have some yogurt, have some healthy and fat. And that will be slow burning instead of creating these insulin spikes. But there was this whole vilification of fats that you mentioned like in the seventies.
00:39:44
Speaker
It's really interesting when you look at that because there's a direct correlation to like this huge spike in obesity and disease Yes Yeah, it's not good for your brain there's correlation with that and they say was it this thing I was listening to somebody talk and he was saying that a lot of like Alzheimer's and dementia and again I then these can tie into like like concussion you're risking go up like the more concussions you have and the more I
00:40:11
Speaker
brain injuries you have, you can increase your risk of Alzheimer's dementia. But I was asking about the blood sugar and the correlation there because in some of the countries, they're starting to call these, these types of disease, they call them type three diabetes. Yeah, you've seen that. It's poor insulin, insulin control in the brain. Hmm. That's wild. That's interesting. That's fascinating.
00:40:33
Speaker
And it's scary, right? Like you think about that. You start telling people like actually, you know, it's like you're, you run a way higher risk of developing Alzheimer's diabetes. If this type three diabetes, you got type one, type two, type three, type one, you're born with type two, you develop type three is like, listen, like if you've had like a lot of insulin resistance throughout your whole life, you can develop type three diabetes inside your brain.
Brain Insulin Control and Health Risks
00:40:54
Speaker
And you know, you may lose your short term memory, essentially. And it's like,
00:41:00
Speaker
That's scary. Okay. I don't want to live without my brain. I know. It's super scary. I recently saw the movie Still Alice. I don't know if either of you have seen it. It's about a lady who develops early onset Alzheimer's. I think she's 50. And usually that type is more genetic. But watching that
00:41:21
Speaker
because my biggest fear is losing my memory. Like I'm terrified of it. And I saw that movie and oh, that's what I was like, Oh my God, I got to get back on my supplements. Right. It was a kick in the butt. Where did you stream that? I'm going to throw it on the watch list. I feel like it's on Netflix. I'm for sure either watched it on Netflix or like Amazon prime or something like that.
00:41:44
Speaker
and then it's also a book but I watched it and as the movie it was good and you know it was really interesting because and I do find this it resonates for concussion as well you know she was experiencing memory
Invisible Injury Challenges
00:42:01
Speaker
changes that she noticed, but she looked fine for the longest time to the world, you know, to everybody else. And that's what happens with concussion, which is one of the reasons I'm so passionate about it. It's this invisible injury. You know, something is wrong and you're not right. And so you really do need advocates and the right support around you because people won't, if they haven't had a concussion before, sometimes it's hard for your friends, your family to actually understand.
00:42:30
Speaker
There's no empathy for it, right? Because you can't see that it's not like.
00:42:35
Speaker
We're looking at someone with a broken arm or a broken leg and they're like, oh my God, you have this injury, but it's like... And it's actually more debilitating in a lot of ways. Yeah, it's your brain. It's like your computer for your everything. It runs everything, yeah. And then for people to be like, it's on your head. I just want to jump in. There was one thing I forgot to say earlier about the whole Dave Carcillo, what you were saying, the anxiety or anger, irritability, and those are frontal lobe.
Frontal Lobe and Emotional Control
00:43:03
Speaker
you know, huge part of that is controlled frontal lobe. And the frontal lobe is also where certain eye movements are generated. And this is a really interesting thing about the eyes is there are phenotypes like eye patterns that are reflective of certain disease states. So there actually are certain things in the eyes that we can pick up with. So
00:43:25
Speaker
I use objective eye tracking in my office. I've seen an eye with MS and once you see it,
00:43:35
Speaker
You can't unsee it. I know someone with MS, or at least their eyes, you can identify it. Same thing with concussion. There are certain things like biomarkers with Alzheimer's. You can pick up on Alzheimer's just looking in someone's eyes. Yeah. Or you can get earlier. I want to say Alzheimer's. Which makes sense too, because it's great. Right? It's interesting.
00:44:02
Speaker
And then the other side of it is though, so let's just say, you know, that you're talking about there that I just want to, the, have you seen the Aaron Hernandez documentary? Oh, I've seen it. I've seen it. It was big a few years ago. Yeah. You saw it. You know, I'm going with this. Yeah. Well.
00:44:15
Speaker
Let's hear it. Yeah You had no frontal lobe left when they like when they oh, yeah Yeah, like basically like after you had the get no frontal lobe left at all, which is where like all your rational You're talking about I didn't know that's where the eye movement a lot of the eye movement came from as well But like that is you know
00:44:44
Speaker
that's crazy. And that's just got to be from like, repetitive, repetitive, repetitive, like concussions, and not being able to deal with those, right. And when I so when I'm thinking about the eyes, again, like I'm not an optometrist, so I'm thinking about the eyes and okay, where, what pattern
00:45:04
Speaker
does this eye movement light up in the brain? Or what part of the brain does it bias? Our whole brain lights up, but for example, the jump eye movements, so like reading, those are very frontal lobe. So I can look at these jump eye movements and think, oh, wow, okay, this is, I want this to look better. So then we'll use the eyes to rehab, and it's not necessarily vision. It's we're just using the eyes as a lever.
00:45:32
Speaker
And even for, you know, sometimes I'll use eye movements when someone is having a lot of anxiety. Just as, yeah, it just does a lever into the brain or soothing. It's really, really cool.
00:45:45
Speaker
I know when a police officer suspects someone's driving drunk, they'll do the eye movement? Yeah, absolutely. What are their eyes doing? That is usually cerebellum though. So cerebellum, the movement coordinator is really responsive, or what would it be? Like an affinity to alcohol, or alcohol will really disrupt that movement coordinator.
00:46:07
Speaker
Sometimes it's tracking the eyes, which are movement and like how disruptive, can they even follow an instruction? I guess that's part of it. But all those like nose tests, walking tests, that's cerebellum. Okay. Yeah. With the eye, when I had heard that, like, if your eye like jumps, if it almost like skips, right? Where it shouldn't, right? Yeah. And that can happen in a concussion too. Interesting.
00:46:32
Speaker
So similar concussions to being drunk as having a concussion. Some of the tests are essentially the same or similar because we're looking at the same parts of the brain. Yeah. I've only, I think it's interesting cause I don't think police officers think of themselves as doing a neurological exam, but they are. Yeah. I've only had like one or two like concussions. And I said, like, like, if you know there were concussions when you had them. Yeah. I mean, fuck, I got rocked. Like, yeah. Like they were obvious, but like, uh, it was like, uh,
00:47:03
Speaker
It's what it feels like. It feels like you're half drunk all the time. Just kind of like, ugh. And the brain fog, right? Maybe it's annoying, right? And you're in that state of halfway in, halfway out, kind of like, ugh. What is this? You're not in a bliss of, you know? Yeah. Except, unlike being, when you're drunk, you know it's going to end soon. Right. Right. Except what it is, it's like, get me off this fucking ride. I'm done with this shit. I can see that being incredibly frustrating. Oh my gosh.
00:47:34
Speaker
Huh. So how quickly should someone go see someone like, like two days within the first week, you're supposed to, there's a lot of benefit within that first week. If you started getting, and if it's been a long time to get you on the right track, right? So some of the diet stuff, cause some people come in to me and you know, their usual diet is pizza. So we need to just like refine or maybe they will need some supplement support. I do recommend high dose omegas or suggest,
00:48:01
Speaker
about magnesium. It's good for the brain too. Yeah, I do. Usually, I mean, there are the different types, but usually I
00:48:11
Speaker
suggest the biz glycinate 30 minutes or an hour before bed, because it will also help with the sleep. Other people sometimes say, Oh, the three and eight for the brain, but I find, you know, after concussion, there's just so much. You don't want to create too much stimulation, right? Yeah. So I'm more concerned about people sleeping and staying calm as much as possible. And then moving, but not moving too much. What about the waking up? Is that like, is that
00:48:39
Speaker
That's not recommended anymore, right? No, exactly. I mean, we want to keep an eye on someone, but we're more looking out for like projectile vomiting, tremors, like real red flags. But if you wake someone up every hour, they're going to feel like crap the next day. So, right. Thank you so much for interrupting my sleep every three times.
00:49:00
Speaker
I'm done with that shit. My kid, my kids like been sleeping through the night for a long time. I don't need to go back. You know, it's true, man. Like think about, think about when, when Leo was like, you know, when you're getting working up every couple hours, it's like, you just zombie, you just like working off that, like adrenaline for like show up to work. Like, thank God it's Friday. You're like, bro, it is Tuesday.
00:49:25
Speaker
Sometimes people need help around return to school, return to work, return to sport. There are multiple parts to why you might want to see a clinician.
00:49:38
Speaker
100%. And if someone wanted to see you specifically, what's what's the best way? Oh, they would find me my website is concussion rehab.ca. So it's super easy. That's also my Instagram. And you've got a great app too.
00:49:52
Speaker
Oh, yeah, my app brain toolkit. I use that quite a bit. I'd say definitely in my assessment and in my quote unquote homework exercises for either eye movements or concentration. It's also great for other clinicians to you can be creative how you use that essentially movement. The sky is kind of the limit there. That's very cool.
00:50:18
Speaker
Very, very cool. So if you're, and you're in the GTA? Yeah, I'm in the GTA. I also do virtual. So I have people across Canada for sure, who will either consult with me, sometimes like I have a couple patients in Ottawa. And, you know, sometimes you, you like the clinician, right? So you don't want a referral in your area. So sometimes that happens. Okay, that's amazing. So my dentist ever moves, I'm moving with him.
00:50:46
Speaker
just my yearly dental visit to Hawaii. Exactly. But yeah, people can go to my Instagram, my website, or shoot me an email. And I'd be happy to help. Perfect. And we'll have all that information in the description of this podcast. And if you made it this far, I want to remind everyone that if you like the podcast, be sure to like the podcast, share it with your friends and family. Melissa, I want to thank you again so much for being on the show. It's been so great having you on here and teaching us all
00:51:15
Speaker
more about concussions and how our eye health can be related to that. Thank you so much. This was a blast, as always. It's always a pleasure. We'll have to get you on next season. Absolutely.