263 ‒ Concussions and head trauma: symptoms, treatment, and recovery | Micky Collins, Ph.D.

Watch the full episode and view show notes here: bit.ly/3OnrKxW
Become a member to receive exclusive content: peterattiamd.com/subscribe/
Sign up to receive Peter's email newsletter: peterattiamd.com/newsletter/
Michael “Micky” Collins is an internationally renowned expert in sports-related concussions and a consultant for multiple professional sports organizations. In this episode, Mickey first explains the definition and diagnosis of a concussion, as well as the diverse signs and symptoms associated with different types of concussions. He discusses the risk factors that contribute to increased susceptibility and/or severity of concussions in certain individuals, emphasizes the significance of prompt treatment, and uses case studies to illustrate the latest in treatment protocols and recovery process. Additionally, Mickey provides insight into the evolving field of concussion treatments, including the exploration of hyperbaric oxygen and synthetic ketones. He gives advice to parents of kids who play sports and discusses the promising prospects in the realm of concussion management.
We discuss:
0:00:00 - Intro
0:01:15 - Micky’s interest in concussion and how he started the first concussion clinic
0:08:28 - Concussion: definition, pathophysiology, and risk factors making someone more susceptible
0:20:16 - Symptoms of concussion, predictors of severity, and the importance of early and effective treatment
0:26:55 - The six types of concussion, the effectiveness of treatment, and factors that impact recovery
0:31:51 - The importance of seeing a specialist and the prognosis for recovery
0:34:33 - Case study of a racecar driver who suffered a vestibular concussion
0:46:23 - Why vestibular concussions are particularly problematic
0:49:51 - A treatment plan for the racecar driver, possible use of medications, and how to address the root cause
0:56:43 - Exploring alternative treatments: hyperbaric oxygen, synthetic ketones, and more
1:02:47 - The natural history of a concussion if untreated and the effect, if any, of concussion on subsequent risk of brain disease
1:07:57 - Chronic traumatic encephalopathy (CTE)
1:11:21 - Advice for parents of kids who play sports: when and where to seek treatment for a possible concussion
1:17:42 - Is there any evidence that the APOE4 genotype increases susceptibility to concussion or TBI?
1:18:40 - The increased risk of concussions in older adults and a case study of a 90-year-old patient who suffered a head injury in a fall
1:23:36 - Funding for concussion research and fellowship programs to train concussion specialists
--------
About:
The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 60 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more.
Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan.
Learn more: peterattiamd.com
Connect with Peter on:
Facebook: bit.ly/PeterAttiaMDFB
Twitter: bit.ly/PeterAttiaMDTW
Instagram: bit.ly/PeterAttiaMDIG
Subscribe to The Drive:
Apple Podcast: bit.ly/TheDriveApplePodcasts
Overcast: bit.ly/TheDriveOvercast
Spotify: bit.ly/TheDriveSpotify
Google Podcasts: bit.ly/TheDriveGoogle
Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. I take conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit my website where I keep an up-to-date and active list of such companies. For a full list of our registered and unregistered trademarks, trade names, and service marks, please review our Terms of Use: peterattiamd.com/terms-of-use/

[@PeterAttiaMD]

In this episode, we discuss: 0:01:15 - Micky’s interest in concussion and how he started the first concussion clinic 0:08:28 - Concussion: definition, pathophysiology, and risk factors making someone more susceptible 0:20:16 - Symptoms of concussion, predictors of severity, and the importance of early and effective treatment 0:26:55 - The six types of concussion, the effectiveness of treatment, and factors that impact recovery 0:31:51 - The importance of seeing a specialist and the prognosis for recovery 0:34:33 - Case study of a racecar driver who suffered a vestibular concussion 0:46:23 - Why vestibular concussions are particularly problematic 0:49:51 - A treatment plan for the racecar driver, possible use of medications, and how to address the root cause 0:56:43 - Exploring alternative treatments: hyperbaric oxygen, synthetic ketones, and more 1:02:47 - The natural history of a concussion if untreated and the effect, if any, of concussion on subsequent risk of brain disease 1:07:57 - Chronic traumatic encephalopathy (CTE) 1:11:21 - Advice for parents of kids who play sports: when and where to seek treatment for a possible concussion 1:17:42 - Is there any evidence that the APOE4 genotype increases susceptibility to concussion or TBI? 1:18:40 - The increased risk of concussions in older adults and a case study of a 90-year-old patient who suffered a head injury in a fall 1:23:36 - Funding for concussion research and fellowship programs to train concussion specialists

[@BestLifeMD]

Dr. Attia, he doesn't "ring true" for many of us. What do you make of his claims to be able to successfully treat all concussions even years later?

[@matijatatomirovic3351]

I've been working in TBI department for almost 10 years now, this content is priceless to me and my colleagues. Thank you!

[@reallysuraj]

How long does post traumatic amnesia last in severe tbi. My father is very quiet. He cries frequently. He is also behaving like a child.

[@matijatatomirovic3351]

@@reallysuraj I am so sorry to hear this happened to your father. There isn't a simple answer, it can vary a lot. From few weeks, to several months. It is extremely important to get in contact with a specialist in this field. As a first response to the injury, it is important to make sure your father gets good sleep routine, sleeps at least 8 hours, and has well balanced nutrition, and enough calories. He must not be malnourished or lose weight. It is also important not to over stimulate him, or his senses. Take it easy, one step at a time. I wish you greatest of luck!

[@reallysuraj]

@@matijatatomirovic3351 sir i am the only one to take care for my father. I am unemployed. I can't afford therapy or expensive doctors. The doctors did surgery and now they are asking me and my father to go home. As of now he can't do anything. He understands nothing. He can't standup on his own. He is very quiet. Its been 10 days. Though sometimes, he does answer in yes and no. He remembers his family members name. I am very concerned. His behaviour is childish. How long will it take so that he is able to live on his own independently. I can't afford therapy, so is there anything i can do. Also, what are the chances that this behaviour of him will last permanently and that he will never recover.

[@jenniferhoban8863]

I am hugely grateful for this one. I am three years post concussion/TBI and it has been incredibly frustrating. The resources are getting better but this can be very difficult to navigate. My original PCP didn't know what to do with me, and the reco was 'rest' and I got worse. Neuro didn't know what to do with me, cardiology didn't know what to do with me. I ended up firing my PCP and going the route of Integrative Med to Meridian Acupunture/Cranial Sacral Therapy/ and finding an excellent Vestibular PT. I could go on but I am a poster child for this- at the time of the accident 49 year old professional triathlete/cyclist who literally thought Disability was going to be my fate. I was struggling with suicidal ideation and told to be "patient and rest" again and again. Life is far better now. 95% recovered but its been a tough journey. How can I be a mouthpiece to get people pointed in the right direction?Thank you, thank you, THANK YOU for this.

[@wildhorses6817]

Agree 100% ! Went through same 5 years ago for TBI and same suicidal ideation that I knew was the TBI and no one to treat me. Also had acupuncture, craniosacral therapy, regular PT which knew nothing and never mentioned vestibular physical therapy and later released me to learn to walk and balance at home, it was terrifying. It is criminal to treat people like this. I will share this podcast . This healthcare system is BROKEN and Abusive. Yet, I pay huge health insurance premiums every month.

[@AssyrianKing4ever]

I'm glad to hear you're doing 95% better. I'm on the same boat. 3 years post my head accident and for all these years I thought it was a break up causing these symptoms. I recently found out that I'm dealing with PCS and now seeking help through a concussion clinic. Haven't started treatment yet, but i'm going back to them soon to get treated. They offered vestibular therapy, oculomotor, proprioceptiv, low-level laser, and neurofeedback.

[@electrobass_music]

Can you tell us what your recovery methods were?? I'm 1 year in from 2 major concussions last year in Apri and June. Memory is very bad when I'm had a strong memory... I lost a year so far.

[@jenniferhoban8863]

@@electrobass_music if you are referring to me, I am a little confused by your question. To reiterate, I had meridian acupunctire, cranialsacral therapy, vestibular therapy, and saw my Integrative Physician. In addition to that, I carefully navigated back through the endurance training with HRV, monitored sleep and resting HR too.

[@eugene54547]

Hi Peter and Michael, thank you for finally getting around to doing a podcast on TBI. I learned that the sympathetic nervous system goes into overdrive. That explains a lot for me. I am over 20 years struggling with a mod to severe TBI. I attended Headway in Dublin. Please beware of medically ignorant neuro psychologists. I was treated very badly. On one occasion my partner was called in. They told him I was genuine but that I was a hypochondriac! I was later diagnosed with severe pituitary disruption, neuropathic neurogenic pain, partial hearing loss, tinnitus, left side neglect of the visual fields of both eyes. I phoned them feeling suicidal for support on only one occasion. The Neuropsychologist scoffed at me. They are actually clueless about neurology. I was a specialist PT and I had to inform them about synapses during one of their talks! Of course, this did not go down well with them, and it was shortly after this, they decided to demean me to my partner who is my only support. It nearly destroyed our relationship. I dont know what training is given to neuro psychologists. They admit to having no medical training and yet they are let loose on a very vulnerable population that have basically medical needs. The Neuropsychologists blamed all my symptoms on PTSD, hypochondriasis and malingering. If I wasnt so f...cked tired all the time, I'd have sued them for incompetence!

[@sharonendler1467]

I experienced the same thing from the neuro psychologist as well. Very disheartening and defeating as if I didn't feel defeated enough.

[@SandraRingelstein]

I had post concussion symptoms for 6 months and my PT figured out I had a restriction in the upper spine/neck, which was whiplash. He released the muscle with dry needling and it pretty much cured my symptoms in 2 treatments. I learned so much from this video that I wish I knew in 2018 when I had my concussion. Everything I was told to do was the opposite of what was discussed here. From this video I realized I was experiencing vestibular, anxiety, and brain fog. Also sensitivity to light and sound. The information you presented needs to be common knowledge among physicians today.

[@BestLifeMD]

But you just told us you had a cervical spine issue that was causing your symptoms and your PT figured it out and addressed it. You wouldn't have needed or responded to treatment of the vestibular system.

[@SandraRingelstein]

@@BestLifeMD it doesn’t matter. I still had a concussion and I stayed in the dark and did nothing so I could rest my brain the first week. Which that thinking is flawed according to this video. I was dizzy looking side to side and when I went up and down. I also suffered some anxiety early after the injury. Per this new info I might have decreased the time of recovery. My doctor said there was nothing he could do and sent me home. The cervical spine compression was due to the whiplash I suffered when I hit my head. When the neck muscles were released it increased blood to the brain which helped relieve the dizziness I had when I went out in the sun/heat. LMK if you have anymore questions. 😑

[@tubulartuber]

@@SandraRingelstein name of PT?

[@SandraRingelstein]

@@tubulartuber youtube.com/@sternerphysicaltherapy6276?si=iKBR4SBExsWvhZmC

[@allisonfalin8854]

I had the privilege of hearing Dr. Collins speak to a group of athletic trainers and coaches at ETSU back when I was a school nurse and in school for my MSN. I took his information into the school systems and worked closely with the other high school nurses and trainers to ensure our kids were safe and being seen docs we had at the time. I used his articles to write my capstone on why we don’t (or didn’t) have consensus on Primary Care Guidelines on concussions outside of the ICU setting. His knowledge has been of huge help to me in my clinical work and has resulted in getting some pretty seriously impacted patients the care they deserved. Thanks for having him on.

[@emstonestreet]

take “this poor guy has been needlessly suffering” and multiply that by at least 10,000,000 people in the US alone. UPMC publishes clinical guidelines, but those guidelines aren’t followed nationally because the US doesn’t have an executive function to oversee the rollout and adoption of those guidelines. the fact that patients have to travel from all over to see dr. collins is both a badge of honor for him and a mark of shame for our healthcare system. for anyone suffering who’s reading this and can’t access or afford care, remember that this interview starts with describing the problem as an energy crisis. consider taking creatine, which boosts ATP production. consider stopping coffee, which causes vasoconstriction. with the help of an ND, consider taking probiotics. download UPMC’s clinical guidelines. find a local physical or vestibular therapist who is familiar with those guidelines and begin a rehab program. if they look at the guidelines with bewilderment, move on.

[@andreacrouch36]

Thank you. This rocks my son TBI extreme athlete 2015 was not going to make it defied science and research skied 100 days this year. the one thing he would beg for it was more cardio and more PT he intuitively knew what he needed perhaps because he was an athlete in the first place. they paced him Because he had a horrible subdermal hematoma he swears to everybody that cardio heals and the vestibular PT was brilliant still eight years later later he heals himself this way on a daily basis continuing to defy all the odds and research. And way to go for not supporting the meds we refused everything thank God we did He just turned 30 years old. Freaking miracle

[@emstonestreet]

after watching this video, i keep thinking about this: if one of the top MDs in the nation started this interview believing that any patient whose symptoms hadn't resolved in two years was basically a hopeless case, one could presume average MDs think the same thing, and you can imagine how all of those MDs view such patients-as damaged goods with no options. "Sorry, maybe take some antidepressants." What a tragedy this is-the scale of it is astonishing, with millions of people suffering concussions every year, and 10 to 20% of them suffering from this protracted condition for years.

[@eugene54547]

Hi again. Insomnia also results from TBI. It is gruelling. Eventually, 15 years after TBI, I was hospitalised and seen by psychiatrists. I was put on 5mg stillnocht and 5mg brintellix for PTSD/GAD. I take half this dose usually as doctors dont take chemical sensitivity or blood brain barrier issues into consideration when prescribing. If I took the prescribed dose, I would be zombified. So I take a little melatonin too. All at night time and after 15 years of sleep studies and attending a useless sleep expert, I am no longer lying awake, suffering at night time. Thank God I cracked finally and ended up under the care of the psychiatrists. I am now sleeping like a baby. Hope this helps.

[@eugene54547]

One thing doctors never do is consult TBI patients properly. Half their mysteries could be solved by collating info from sufferers. Eg, we are told we are no longer aware of the sensitivities of others. That's precisely because others ignore our needs. We are irritable. Because we still have to tolerate the chaos others bring to us. We snap at partners, etc. That's because for the early years, we feel like a blood vessel is about to explode in our heads. That's a standard symptom. So we cant risk a rise in blood pressure and we snap to establish immediate boundaries. Because of metabolic dysregulation, if we get hungry, we can slide into days of feeling like shit if we go below our ATP threshold. So, we get told to have an ounce of patience and we will all be eating in 5 mins, if we are at family meals. The biggest problem is that all these symptoms are common in TBI. But no one has been highlighting them for decades. Medics who have a duty of care to us have usually failed us. This info has been around for decades. NABIS conferences were very informative, Silversteins book on TBI for psychiatrists at least should make medics feel they should give patients the benefit of the doubt. No, instead it's ok to allow the Vietnam vets and all that come after them to slowly and angrily slide into alcoholism and social oblivion. Addictive substances act as neurotransmitters for us. With our lack of proper HPA axis function, we just cant function in society. Some basic, overdue understanding by experts might help a lot, even at this late stage.

[@Cathy-xi8cb]

Everyone in rehab knows concussion IS brain injury. Not always mild. TBI patients can be the most challenging to rehab. I have treated gunshot victims, CO2 victims, car accident victims, and beatings both adult and pediatric. The ones who deny their deficits due to their brain damage resist therapy and adaptation to deficits, and go on to essentially destroy their lives. Their families can't take it, their jobs are lost, and they persist in making poor choices. Most of the time their families and coworkers do not realize that these people are brain damaged, not jerks.

[@fp2687]

My gosh. Someone who has some true info. Car accident 5 years ago. Still not feeling myself. It was suggested going back to work. Still can't cope. My anxiety levels are high. I get upset very easily and I cry in front of others.

[@bobtaylor170]

Truth. An aunt disinherited me because a cousin, who was a successful fortune hunter, convinced her that I was just a bum.

[@Mau365PP]

This is what covid is causing as long covid 😢

[@sharonendler1467]

@@fp2687 I am definitely one of the people that destroyed my life and the lives of my children from my irritability poor decisions, CPTSD ......

[@noracharles9366]

Drop the mic...👏

[@Crepitom]

Took me 3 years to recover from a concussion. Hardest part of my life with a lot of uncertainty and almost no knowledge about it in the medical community. A shame..

[@HallPark]

It’s been 2 years for me how did you recover?

[@faustinam2215]

Been 3 years for me as well since a TBI after being hit by a soccer ball. Just had two tmj arthroscopic surgeries last week (as the tmjs were severely affected by the impact) & my surgeon said the entire joint space on both sides were filled with scar tissue, causing excruciating constant muscle spasms in neck/head/shoulders. It's crazy it took me 3 yrs to see a maxillofacial surgeon. Tbi care has sucked so much in my experience, but I also found a wonderful functional neurologist who assisted in my recovery. Still ongoing symptoms, but hoping to eventually get to the symptom free stage. We can do this ❤

[@AssyrianKing4ever]

​@faustinam2215 please update us. I'm on the same boat. I got a epidural hematoma 3 years ago and I was recently told that I'm suffering from PCS.

[@stefaniebryant3747]

How did you recover

[@Crepitom]

@@stefaniebryant3747 Difficult to answer because I tried so many therapies. But at least: - graded exposure (of sensory input, try to pick up your normal life very! slowly - and yes, that hurts) - graded exercise - functional eye exercises - psychotherapy (you’ll need a positive growth mindset and acceptance) - osteopath for headache - lots of nervous system relaxation, like walking in nature, meditation, some cannabis or CBD oil etc, Tai Chi.

[@bikeski970]

I had my 8th concussion in august. the previous ones lasted a couple of days to two months. this one was the mildest accident and has affected me the most...a year now of having severe concussion symptoms. lost my job, can't do sports really anymore. Doctors were completely useless. so were physical therapists. only thing that helped was vision therapy, which of course isn't covered by any insurance.

[@bellelacroix5938]

Yeah this really pisses me off. Leads to brain atrophy. Correct vision where is absolutely essential.

[@MichaelWu]

health insurance is all about profits. The body need the right nutrition so the brain can function.

[@susiehannan3368]

As a school nurse I appreciate this information SO much! Thank you!

[@dougmajor6724]

One addition from a TBI clinician of 35 years, we DO have a biomarker. With the new eye tracking systems combined with the vestibular-eye reflexes is and will become the new objective standard of brain injury and treatment protocols. The best description of TBI symptoms was written by AI cognitive neuro specialist, Clarke Elliott PhD from DePauw University who gives a first personal analysis in "The Ghost in My Brain" a true must read masterpiece.

[@bellelacroix5938]

AI?

[@TheKitty1952]

Absolutely fascinating....gives hope to so many who suffer from concussion

[@sheldonewagner]

I'm new to this podcast but not new to the work of the Pittsburgh folks in this area of medicine. This is a great retrospective of sorts of modern concussion care. It's really great to have more tools in the toolbox in the way of 'newer' symptom-specific interventions including exercise. This should offer patients, families and practitioners hope that dispositions can improve with proper treatment. At same time, I think we have to keep an eye on the dangers of chronic/repetitive head trauma in the realm of sport but also in cases of domestic violence. CTE is real and there is always a price to be paid for injuring your brain. Education and risk modification is really the cornerstone to moving the needle with this injury. Finally, kudos to Dr. Attia for some of the most probing, insightful questioning I have ever seen in ANY media platform. Really a joy to geek out with this podcast. Cheers!

[@HuiAPH]

Great interview, appreciate your work! Just graduated from primary care sports medicine fellowship and we see tons of concussions on the sidelines/clinics/athletic training rooms. I think a primary care sports medicine physician would be a good first place to start for many lay people. Certainly agree most concussions are treatable. In the future would love to hear perspectives on the changes on the new SCAT 6 as it would offer insight on how the thinking behind concussions has changed.

[@shehahn5768]

Thank you for this deep dive into concussion and head trauma. Watched/listened to this at 2am. Contacted UPMC/Mickey Collins’ team and have an appointment set. My concussive even was 3/09 and I’ve been suffering with significant symptoms. Kudos to you, Peter! You have a new fan/subscriber

[@dwb197]

Great interview Peter and Dr. Collins! As someone who just recovered from a concussion I can’t say enough how important exercise, good sleep, and nutrition played in getting better quickly. Such great information you’ve shared. Cheers

[@rckptt0076]

Was there a specific diet that you were put on?

[@garyseasydiy9572]

Hi Peter, great podcast and from someone who has considered this these questions many times. I am a 55 year old male who has taken up kick boxing 12 months ago. This involves sparring and I have some obvious concerns about head trauma. Great insight gained from this podcast. On balance I feel the gains far outweigh the risks. Cheers Gary

[@thecyclinggreek274]

Such a great podcast subject. A friend of mine went down hard on a training ride where it was determined that she does have a concussion (after the fact). I sent her this video along with a summary I made on my IG account.

[@lisachristinaconfirmed5067]

I think Dr. Collins is a good first stop for sure. I think that Dr. Peter Atia really dives into the complexities of issues that Dr. Collins does not have the education or expertise on.

[@sharonendler1467]

How can Dr. Collins not recognize that HPA hormonal issues are quite common after TBI and those with PCS. Have him watch Dr. Tamara Wexler’s endocrinology presentation on the Concussion Legacy Foundation . Many papers in the subject from well known endocrinologists from Barrows , NYU, U of PA

[@lisachristinaconfirmed5067]

Because he’s not a medical dr, he’s a psychologist.

[@rayleo8333]

He also said neck concussions are "not very common" when in my experience the neck is the most overlooked piece of concussion recovery. It can be argued that whiplash occurs in 100% of concussions.

[@lorimannella8297]

I am about a year and a half out from my concussion and although I appreciate all of this information, I have a request. Please be mindful of people with post concussion syndrome and maybe think about subtitles and perhaps talking more slowly and repeating key points. It has taken me hours to listen to only 20 minutes of information because I am constantly rewinding to try to assimilate all of the information. Thank you for posting this…I really do appreciate the information and hope to find answers.

[@BestLifeMD]

I'm an MD who specializes in Physical Medicine and Rehabilitation and he raises a lot of red flags...promising his treatments work and that brain rest is bunk. In my experience, these "Concussion clinics" are bogus and provide many unnecessary and unproven therapies at a high cost.

[@derekthephysio]

As a physio, it's a great sales pitch to claim we 'know what to do', but in reality, we're more often than not stumbling in the dark with navigating the comexities of each individuals presentation, history and resources. We can work to help 'find' the path that ends up with a successful resolution for the client; but I continue to be humbled by what that ends up being for each individual client.

[@BestLifeMD]

@@derekthephysio well said. His overpromising is too good to be true! We know from experience!!

[@suburamaa]

Agree. This is one of the not so good ones who came on Peter Attia program. Usually Doctors are happy to talk about treatments, whereas Micky was cagey even when pressed by Peter.

[@suburamaa]

Could you recommend some good clinics/therapsts in Dallas area?

[@lisachristinaconfirmed5067]

@BestLifeMD- what or where do you suggest to go or do if you have a pediatric severe concussion or moderate tbi

[@gailbyrne3839]

Great podcast! Hyperbaric oxygen does work well with concussions. Have several family members who have used it very successfully to accelerate the recovery from concussions. Perhaps a patient might end up ruminating too much in the chamber or perhaps someone doesn't have the time for HBOT, and certainly, most insurances don't pay for it, but if you look at the breadth of research out there, there is certainly room to interpret a positive use of HBOT for concussions and because I've seen it myself more than once, I'm sold. Don't rule out HBOT. In addition to reducing inflammation, HBOT also increases energy, often decreases anxiety, and it's used extensively by professional athletes because it works.

[@emstonestreet]

It depends on the type of concussion. With some of the 6 types outlined here, HBOT can actually be harmful, so it isn't a treatment you can recommend to everyone. It helps some and hurts others.

[@AssyrianKing4ever]

Concussion maybe but PCS? I kinda doubt it.

[@emstonestreet]

it’s really useful to think about the way TBI impacts your most adapted or superhuman abilities and takes them away (including adaptations to things like lazy eye, and superhuman abilities to do things like ski or play hockey). i wouldn’t be surprised if the race car driver you mentioned could easily ace a bog-standard balance test and be told he’s “normal” but to his brain it’s a massive decrement that makes him dizzy constantly. with progressive exercise training, there’s a formula and framework for how the progression should unfold. you generally want to provoke symptoms, but not at an 8/10 or 10/10 level, which isn’t helpful. the answer isn’t “rest” or “activity” but progressively increasing the activity to steadily raise the ceiling over weeks, months, years. i think if people are told they’re working toward re-establishing their most adapted or superhuman abilities, that would really reframe it in a positive way.

[@Cathy-xi8cb]

The driver is unable to work. I think that says a lot.

[@emstonestreet]

@@Cathy-xi8cb Yes, and yet he would probably be denied disability because he presents within the "normal" range. Worse, he would probably be told that his feeling of dizziness is just subjective. A neurologist or sports medicine doctor might tell him, "You're having a subjective feeling of dizziness." And with that word, subjective, everything he's going through is mocked, it isn't an objective reality, it's all in his head. If he's lost, say, 80% of his capacity, and his brain is reeling, but 20% for him is an average capacity for someone else, he gets no help, and is even sneered at by neurotypical people.

[@BestLifeMD]

@@emstonestreet he would be considered disabled from his job as a race car driver.

[@emstonestreet]

@@BestLifeMD Yes, but he would probably still be considered able-bodied and therefore not eligible for disability. My point here is that people are evaluated based on crude averages that have no bearing on what's happened to the individual. The intake evaluations performed at UPMC a very different. They are aimed at evaluating this particular person's specific deficiencies, not whether they're "able-bodied" based on averages. This is one of many ways that TBI patients are disserved or abused by medical professionals who have no idea what's happening or how to measure it. They might ask someone to walk in a straight line, and if they do that, call it a day.

[@eugene54547]

When I sustained a moderate to severe TBI with severe fatigue, 20% drop in cortisol levels, etc. The doctors and neuro people were so inept at dealing with my issues that the pituitary damage was never even addressed for over fifteen years. So I couldnt work at all. The medical social worker called to my home at 2pm in the afternoon in june one year. There I was, still in bed with chronic fatigue, headaches etc and the xmas tree still up, decayed in the kitchen complete with its baubles. I was at pains to try to get thro to this person that I needed social welfare, that I was a specialist PT, had done my advanced masters in NY and my basic training in Dublin. I am anything but lazy. All this expertise and over 20 years of working in sports medicine was lost overnight. I had zero financial security for the rest of my life, had chronic earache, lost all my friends, treated with disdain by my mother. No wonder we ruminate. It would be foolish not to. We lose everything and especially our identity in this world, usually overnight. Anyway, the social workers response was " we can make you make sandwiches!".

[@Heatherdm]

Would love info on training for concussion rehab professionals. Thank you. Great info!!!

[@rayleo8333]

Check out Complete Concussion Management.

[@nadiasohawon9614]

I skipped to the racing driver who gained vestibular concussion. Which was what I had. Is the vagus nerve spoken about at all in this pod and it’s link to concussion? As the parasympathetic system was spoken about. It seems to be the key to my issue and I am recovering well. Will watch the rest, just rushing to work! Had roughly the same symptoms as the driver. My alignment from my head and neck was looked at along with my vestibular system. Thanks Peter 🙏🏽

[@anitachaperon]

This was one of the most significant conversations for me to listen to, as it put a lot of perspective on my personal experience with a neck injury that I've had to navigate on my own, because of lack of experience in my local medical 'pool'. A somewhat niche question for both of you - are you aware if an injury (during concussion) of a specific brain part/area, can negatively affect deep sleep duration?

[@bellelacroix5938]

I suffered an m t bi after a car accident. Severe sideways whiplash and I smashed my head. Or the kid who ran the stop sign did. I developed a vestibular disorder. Several different diagnosis but it mal disembarkment to my mind. Before I got a handle on it and it took me years REM sleep would make me dizzy and wake me up. It's been a 20-year ride trying to be comfortable and has really limited my life I've adapted. It is what it is as they say. I hope you can find some help after listening to this podcast.

[@cliffe691]

Hi Peter, big fan of your work. I started recently following after seeing you on Limitless with Chris Hemsworth and it really changed the way I thought about longevity. If it's within the scope of your expertise, can you speak to longevity when it comes to gut health and gastrointestinal issues? Thank you so much.

[@cozos]

I got concussion while snowboarding (fell flat on my face) and completely lost my short term memory for a period of maybe 2-3 hours. But the funny thing is I got up and kept on snowboarding down, and even went back up on the chairlift. I don't remember any of this, and only because my friend noticed that I had asked the same questions 5 times that he took me to an ambulance. Imagine if I kept going and got another concussion!

[@Cathy-xi8cb]

Not sure you did not. Every bump, every hockey stop, shook your damaged brain a little.

[@resistapathy]

Brett Favre, Hall of Famer, Super Bowl winner and numerous football record holder, has a message for parents: Don't let your kids play tackle football until they're 14. Age at which to begin play was not addressed unfortunately. Parents who only have Medicaid type health insurance for their children might want to steer clear of those sports for their children altogether,

[@iamkamsai]

wish they would start talking about Chiari Malformation from head traumas.

[@Cathy-xi8cb]

Because that is not technically brain trauma. It would be considered cervical trauma as the ligaments allow the brainstem to descend.

[@iamkamsai]

@@Cathy-xi8cb traditionally no, but as it turns out it modern studies found can be acquired from a brain trauma. I got hit in the head by a jet ski (helmet on) mine is 6mm.

[@rosek1892]

Ive had no help at all and feel worse than ever....feel like nobody cares and its scary to live with this impossible when people look at u with no understanding

[@lgingermcdonaldfrederiksen7437]

So sad....our 17 yo son is 1 y post concussion still w symptoms...the concussion specialists including U of Colorado pediactric neuropsyche. The opposite recs from Dr Collins. Very little rehab or true neuro eval. I hope we can get to see Dr Collins for help in recovery! But hesitate to say that his impression of specialists doing the right thing may be quite overoptimistuc.

[@lgingermcdonaldfrederiksen7437]

Over optimistic

[@ColeCorkran-li6mi]

How is your son now? Hope he’s better

[@oglelaura]

I love that Peter asked about ketones. I was in ketosis when i hit my head and wondered if ot hurts or helps. I'm supplementing with mct oil hoping it aids in my recovery.

[@juliepena3440]

This is amazing, I stumbled upon this video because I’m searching for answers. I’m currently in bed suffering from a blow to my head from a freak accident that lead me to have a concussion, whiplash, and two herniated disks (one in upper neck & lower back L5. I was hospitalized for 1 week and discharged as Ok. Coming home I realized im not ok. Have migraines, brain lasers, eye blurry, paranoia, fight or flight, dizzy, and get stuck in rumination, can’t sleep, and anxiety. I Have an appointment with a neurologist Monday. My question is what happens when you can’t move much because of other issues Besides concussion that can’t get PT? Right away? This accident happened October 7th, I’m so nervous how do I get up & going with all these symptoms??? Where is this doctor located? I would love to see him!!?

[@eileenkast4982]

That was terrific. As a physical therapist, I came away with that a little confused as I get conflicting information from different education programs . I took one certification course that said the person should rest completely and keep symptoms no higher than 3/10 and another pushing aerobic activity. Does anyone out there recommend a good concussion program for a physical therapist?

[@nadiasohawon9614]

Great question. My concussion happened 15 yrs ago and I didn’t rehab it. Some back to haunt me this year. Have recently found out physical therapy is so important.

[@sharonendler1467]

Cameron Marshall, DC - Concussion management offers a certificate program for PT, We sure need more that understand those of us who have been destroyed by them

[@user-fe2cx1bp7s]

Anyone know how Collins and UPMC rehabs audio issues? Both audio proccessing and hyperacusis? The gradual exposure model hasn't fully resolved the issue. Thank you!

[@TrollsAreFunny]

Does anyone know where Dr. Attia got this button up shirt from?

[@katkuratko7046]

Are there any clinics in western Canada?

[@funwithayoyo]

I don't know if anyone here knows or is compelled to comment but while concussion was defined does that include events like diffuse axonal injuries and such? Would optimism be high for this as well in terms of meaningful recovery in one day to day?

[@tidesmaniandevil]

@42:52 - Dr. Mickey said: “I’ll see upwards of 75 to 100 patients a week.” I’m thinking: How much time is he spending with each patient? 40 hrs in a work week with Fridays off leaves not much time for doctor-patient contact.

[@SilentRunningRedux]

No one works 40 hours a week who is deeply involved in a career like this… no digs at those who manage great things on 14 hours a week. But I AGREE, even w/ an 80+ hour a week schedule, seeing that many patients, researching AND keeping up with other researchers work, it would seem impossible to give “enough” time to those patients he claims to see.

[@firstlast-em2yq]

Too bad, this interview, completly missed this: Concussions cause traumatic injury to blood vessels and extracellular matrix in the brain, which are comprised of collagen and HA. This leads to dysregulation of their normal metabolism. Emerging research points to both collagen and HA dysfunction as key targets for treatments to improve concussion recovery and reduce secondary injuries. Chronic collagen and HA abnormalities can impair blood flow, increase neuroinflammation, disrupt waste clearance, and alter neuronal connectivity in the concussed brain. The available data so far does suggest concussion pathology involves disruption of both collagen and hyaluronic acid homeostasis in the brain's extracellular matrix. Targeting their dysregulation shows therapeutic promise.

[@sharonendler1467]

what is HA- I have had such a rapid increase in aging . People I knew just a couple of years ago don’t recognize me. My skin, muscle atrophy despite exercise. What is HA? thank you (or bringing this up

[@firstlast-em2yq]

Hyaluronic acid@@sharonendler1467

[@KTravRuNEr]

Multiple concussion experts in this country. UCLA has Brain Sport, Harvard, etc etc. this guy is awesome, great podcast. He did miss why he won’t get everyone well and anyone who sees WC, PI or patients with secondary gain issues - probably will have poorer outcomes.

[@lisachristinaconfirmed5067]

What is WC,PI, secondary gain??

[@adriennepsychic7014]

On the positive side of having a concussion, if there is any… I had a concussion when I was around 7 or 8. My mom wasn’t home and I hit my head on the wall jumping on the bed. Had amnesia for about 30 minutes. I thought my sitter was my mom and had no idea who I was, etc. Not sure of the exact duration the amnesia occurred. The sitter never told my mom. She was scared she would get in trouble. Since then I’ve been psychic. I’m clairvoyant and clairaudient. I guess I hit just the right spot.

[@thomaswipf7986]

My friend who reminded me where I was when being falsely accused by MN state trooper Haugen(POS!), (multiple multiple witnesses) is having trouble with a concussion in ND. Who does Micky Collins work with in ND please? 🙏

[@kmholmes2187]

Is there a concussion clinic in Atlanta?

[@jackschitt6235]

I know of a guy who was a Taekwondo superstar who developed dementia at 61 and died at 64. Is it likely that getting hit in the head hard regularly caused it? I crossed paths with him after starting in it at 15 and he was one of the top guys for the 8th degree black belt master from Korea. I did not remain involved long term.

[@mgray3130]

My God this could be me in your office. It's been years sense I had a hit to a concrete pole around a gas pump, and not long after a 47 min grand mal, I don't know myself and have lost all past memories. Not sure about which happened first. it's been years. How would I get in touch with Dr. Collins. Not sure if it's too late or not.

[@SilentRunningRedux]

More experts on this, please. This is not something people want to face… but more discussion AND THEY WILL. It matters, little is understood, others have new perspectives in addition to your guest Micky Collins. Please MORE perspectives from ppl who don’t regard the research/recommendations FROZEN. AND… Thanks to Peter Attia for releasing the entire podcast rather than a teaser (teaser or summary of a podcast is generally a fine business model these days, however this topic is so very important it’s like Attia doing critical PSA/pro bono - with caveats by him and his guest to viewers not to rely (duh) on what’s heard as “medical advice” for individuals they’ve not examined personally). I used to chuckle but perhaps you need to make that caveat (alas).

[@ikewoodroof5179]

My wife is 8 weeks out from a mild concussion, but still suffering from daily headaches. We have introduced mild levels of exercise and creatine. Is a sauna helpful?

[@MichaelWu]

creatine isnt healthy at all. The body need a high quality enzymes to break down proteins.

[@user-zy9ui3wt9b]

Hi, Dr.Peter what's up!! Help me out🙏 I am a high school student from MIT and my friends, and I were playing a world's craziest game involving rapidly whipping our heads back and forth. I aggressively accelerated and decelerated my head, forcefully in whiplash like manner, lashing it around in an attempt to win. Afterwards, I experienced an intense and unfamiliar headache, almost like the sensation from a wound or cut. I also felt confused mentally. Feeling awkward to ask others about the question? Did I possibly suffer a concussion from this self-inflicted head trauma? And if so, is it likely I lost some neurons due to stretching and tearing?

[@MichaelWu]

the body needs the right nutrition to break down the proteins. Chronic inflammation which is protein tau.

[@user-zy9ui3wt9b]

@@MichaelWu Ah, I see! You pinpointed right, chronic inflammation , thanks a lot

[@MichaelWu]

@@user-zy9ui3wt9b your welcome anytime. I had retired football player with head trauma and concussions feeling better now.

[@keziapaws1876]

not trying to be annoying, but curious if anyone can elaborate.. is it that the neurons stretch, causing the cells to send a signal to microvasculature to constrict? (potentially like the chicken/egg situation w/ migraine -- as someone that has them i think migraine's gotta start neuronal bc i've gotten them from concentrating too hard, looking at a strobe light, etc.. but who knows). or is it that the microvasculature is disturbed along with the neurons, causing for them to have the calcium influx as well (causing vasoconstriction at the same time the neurons are under increased metabolic stress also from the stretching?). very interesting tho, also i really agree w/ emphasising the ability of the brain to recover from injury! people will think they have no hope but it is very adaptable!

[@Cathy-xi8cb]

The answer is all of those things happen, and more. And you forgot the initial inflammation and the effects of fatigue on the brain as the person post-concussion tries to power through. The idea that there is no benefit for resting the brain goes against the research. It is only in the amount of time for rest, and the type and amount of activity done as they recover that is in question. This guy is both ignoring the research and overly optimistic about recovery. Anyone who is over 50, drinks to excess, had a previous brain issue like ASD or ADHD, or mental illness, is always going to have a worse outcome. They didn't START with the healthiest brain possible.

[@keziapaws1876]

@@Cathy-xi8cb thank you!

[@joshtenborg4299]

SPARCC in Tucson, AZ

[@sharonendler1467]

Well, since you know that this is happening much more often to older people " that no one is really doing anything about it". Perhaps someone at UPMC can.

[@AidenMcCubbins-zv6cz]

I am a football player and I have a headache tired and lights hurt my eyes. Do you think I have a concussion

[@lisachristinaconfirmed5067]

Yes

[@jimkragelund7517]

How about lack of treatment period!

[@MichaelWu]

its not breaking down the proteins at all which is chronic inflammation.

[@Cikflipp180]

I’m not a doctor but this guy seems to generalize way too much - it just doesn’t make sense that you can basically guarantee recovery.

[@oglelaura]

Saying SSRIs are preferable to Trazodone is irresponsible.

[@toddsutton5672]

There is no treatment and no recovery. 54 years since my tbi at 8, had 3 or 4 concussions since. I still cant do what i cant do. never gotten any better.

[@MichaelWu]

sorry to hear that. I can help you since i helping couple retired nfl player.

[@toddsutton5672]

@@MichaelWu How so how can you possibly fixed a brain injury. NP is pure bs. oh and i have no money. thats what life with a tbi does.

[@toddsutton5672]

@@MichaelWu oh i was hit by a 4000lb car going 35 mph directly in the left side of my head. fracture skull, swallowed my tongue and choked to death for several minutes.

[@MichaelWu]

@@toddsutton5672 that sucks. Health insurance is a scam.

[@MichaelWu]

@@toddsutton5672 i can help your pain level go down. You can eat still or drink water?

[@Mau365PP]

I wonder if he could treat long covid... 55:08

[@dahVEEDBBone]

Would exogenous ketones help for brain repair?

[@keziapaws1876]

not sure about brain repair, but i've had sometimes consistent success taking exogenous ketones right at the start of a migraine (when i first notice a visual aura, or preferably before the visual aura if i'm feeling sort of "migrainey"). for a few months it seemed to really arrest the headache sensation every time, but after more time it is a bit hit or miss for me (or there's some other factor i'm missing).

[@AssyrianKing4ever]

55:00

[@therealcfiddy592]

I sleepwalk and have night terrors and right now I am suffering from my 2nd time concussingnmyself in my sleep This is the stupidest ailment that I could imagine. I fell off a dirt bike at 30mph and broke my hip. No concussion symptoms despite having been knocked out for a short time Go to sleep? Concussed for a month Fuck that

[@tonykearney3806]

Why am I not buying this?

[@BestLifeMD]

Ditto.

[@Cathy-xi8cb]

You are not buying it because it doesn't make logical sense.

[@tonykearney3806]

@@Cathy-xi8cb Also, he doesn't act like a real doctor or scientist.

[@BestLifeMD]

@@tonykearney3806 and it's weird to hear him talk about all of these people he treats as he's a PhD.

[@tommyellison]

You keep calling him out - what should the alternative be? Do you have answers or can you lead someone in the right direction if they are dealing with this?

[@IamMichelle88]

Me and my families stolen identities used here

[@fp2687]

What about a brain scan, according to Daniel amen

[@Cathy-xi8cb]

Oh my, nobody in brain rehab respects his stuff. We turn the sound off and say not-nice things.

[@SilentRunningRedux]

@@Cathy-xi8cb“Amen.” Not a pun.

[@HamadHamad-dd6wf]

Is it me, or did this speaker come off as arrogant ?

[@lisachristinaconfirmed5067]

People do say this. Seem you either are a fan or not.

[@garyseasydiy9572]

Hi Peter, great podcast and from someone who has considered this these questions many times. I am a 55 year old male who has taken up kick boxing 12 months ago. This involves sparring and I have some obvious concerns about head trauma. Great insight gained from this podcast. On balance I feel the gains far outweigh the risks. Cheers Gary

[@Cathy-xi8cb]

You are minimizing the risks of sparring. Reconsider that aspect of your new exercise routine. Your age adds to the risk. Brain plasticity is far less for you than the 20 year old in the ring. Far, far less.