Why Some Concussions Never Fully Heal | A Neuropsychologist Explains with Dr. Shan Patel

What happens when concussion recovery doesn't follow the timeline everyone promises?

Clinical neuropsychologist Dr. Shan Patel joins Wendy Lurrie to explain why traumatic brain injuries are far more complex than most people realize.

They discuss the psychological effects of concussion, why no two brain injuries are alike, how outdated advice continues to delay recovery, and why individualized treatment is essential for people living with persistent symptoms.

The conversation also explores confidence, identity, behavioral health, and why healing isn't simply about waiting for symptoms to disappear.

If you've ever been told your scans are normal or that it's "just a concussion," this episode is for you.

Watch the full episode on YouTube: https://www.youtube.com/@BestGuessistan

Subscribe to our Substack: https://bestguessistan.substack.com/

Follow us on Instagram: https://www.instagram.com/bestguessistan/

Join the conversation on Facebook: https://www.facebook.com/bestguessistan/

Transcript

SPEAKER_03 0:00

An athlete might want to hear, how do I get better? They keep getting the same advice over and over. This is your new normal. In my book, that's that's the wrong mentality to be taken, especially if you were never referred to a specialist to see what's actually happening. But Burden becomes how do you find them, right?

SPEAKER_00 0:36

Dr. Sean Patel PsyD is a clinical neuropsychologist whose work focuses on concussion and traumatic brain injury. And if you've been following along at home, you know that about 80% of all traumatic brain injuries are concussions. Following advanced training in neuropsychology, he completed a fellowship in clinical neuropsychology and sports neuropsychology at the University of Pittsburgh Medical Center Sports Medicine Concussion Program, one of the country's leading concussion programs. Welcome to Rupture Doc.

SPEAKER_03 1:05

Thank you for having me. Appreciate it.

SPEAKER_00 1:07

Glad you're here. So let's just start at the beginning. Tell us a little bit about how you got to where you are. What was your path into neuropsychology, working with concussions? Like, how did you get here? What was interesting to you?

SPEAKER_03 1:18

Yeah, no, so to keep a long story short, I was always interested in the brain and behavior. So I started off in one path, kind of led me more into psychology, and then brought me right back into brain and behavior. So it it was always headed in that direction, but I never really knew what to put a label on it. And then eventually I found out neuropsychology was that calming. And so ultimately I kind of figured out as I kind of went through my educational journey and some of my interests and passions and kind of combined it all into and landed in me into that field.

SPEAKER_00 1:49

Very cool. Very, very cool. So why brain injury work though? Like, I mean, yes, neurology, I get that, but brain injuries, concussions specifically, like Yeah.

SPEAKER_03 1:59

Yeah. So within our field, you know, as neuropsychologists, we look at both the brain and behavior. And oftentimes, a lot of times with brain injuries, you know, focus often is on the medical nature of the injury and what's actually happening. But there's a huge behavioral component that often gets missed, unfortunately. And I've come to learn over my training and just years of just experience, short few years, that you know, the behavioral side is tremendously important to address in in terms of having a person holistically improve overall from a brain injury standpoint. And so, you know, I it's just misconceptions over the years, even my own, and as I trained in the field, learned more about the field, and you know, saw patients firsthand improve with some of these different modalities, looking at both the behavioral side and neurological side, it kind of fits like a puzzle.

SPEAKER_00 2:48

So when you say, let's just clarify terms, when you say behavioral, are you talking about mental health?

SPEAKER_03 2:53

Yeah, mental health.

SPEAKER_00 2:54

Can you talk more about that? Because most of the clinicians we've had on have we've had a neuro ophthalmologist, uh, an OT who specializes in vision, but we actually haven't had anyone from sort of the neuropsych part. So if you could talk a little bit more about behavioral and what that means and what that represents.

SPEAKER_03 3:12

Yeah, absolutely. So a lot of times, you know, behavioral functioning can be an absolute thing. Anxiety, mood functioning, happy, and any sort of hyper-arousal feeling. So depression, post-traumatic anxiety, PTSD. So these are some terms synonymous with behavioral health and overall functioning and the modalities and ideologies that we kind of address. So that covers, you know, as a psychologist, you know, that that is first and foremost what we are all trained in overall. So we get both the behavioral side of therapy, one-on-one talk therapy, we get diagnostic training and where we evaluate for different types of dementias, cognitive disorders, traumatic brain injury, vascular disorder. So we we kind of look at the whole slew of different medical ideologies, but from what behavioral lens? And so how this impacts the person, not just from all those etiology standpoints, but the behavioral component as well. And so we we kind of come in the crux of everything to kind of tie in and consolidate a pure diagnosis of, you know, what type of specific dementia is this, or what is causing this from a vascular standpoint? Is there any CBI component involved? And so we kind of put together all the pieces and you know, a lot of what we do as neuropsychologists is extensive testing at sometimes. We have to look at various domains of the brain. We have to ask a lot of questions, we do a very deep dive interview into your behavioral functioning, we look into your personality, who you are as a person, and we kind of tie in the holistic picture of what's actually happening from a neuropsychological standpoint. So you get both neuro and psychological both combined into one field.

SPEAKER_00 4:52

So you may have answered this, but one of the questions I was wondering about is like, what what do you see as a neuropsychologist that other clinicians working with the same population might not?

SPEAKER_03 5:02

Yeah. Well, it it depends on what fields we're talking about, right? So if we're talking about neurologists, you know, a lot of their focus may be on the medical nature of the injury and what what's happening and timing may be a difference. You know, oftentimes our evaluations can be anywhere from one hour to three hours long. Neurologists may not have that kind of time. Right. And so it's just the nature of what we do, right? They're they're they focus heavily on the structural side of the injury as well. So I rely heavily on our neurologists and neurosurgeons as well to give me the go-head from a structural standpoint. So it is a multidisciplinary approach that you need to take with this injury. It it it you we can't just rely on one aspect or one person to kind of look at everything. I rely on a team, even in the place that I direct my program at currently, where we have everyone from sports med, neurosurgery, neurology, everyone involved in a case, because that's what it takes. It really takes a team effort.

SPEAKER_00 6:00

So, okay, so you work in an integrated model. Absolutely. Yeah. For those people who do not have access to an integrated model, they might start with, I mean, they usually start with the ER, right? And sometimes they'll end up with primary care, sometimes they end up with a neurologist. If if they're going in that route, when would you see them?

SPEAKER_03 6:18

That is the the tough question that's really hard to address. Because oftentimes it's the nature of the injury, how it gets discovered. And so there's various populations. So if I'm working with athletes, they have a lot of personnel behind them looking after them, athletic trainers, coaches, and they want them to succeed and get better, especially if this is a star athlete, you know, and they really want that they need them for the team. They got a big game coming up. And so you will find that the approaches in that pool of population, you know, the athletic, you know, they get access to the care really quickly. Now, when you get into the other pool, the non-sport related civilians, the civilians, right? Right. There's traumatic nature involved to it, right? Where it's an accident or car accident or a slip and fall, the things that are not expected, right? Versus if you're playing a football game, you're about to go tackle someone head to head, you're you're expecting something to happen. What versus this, there's no bracing, there's no nothing. You're it's unexpected oftentimes, and you're left with not just concussion. Oftentimes concussion is missed, one of the most missed injuries, in my opinion, but the main focus becomes back, neck, any rib, any major slew thing going on from a from a medical standpoint, and that's where you kind of get missed from a TBI concussion aspect. And so when you go to the ER, like you mentioned, you know, their focus may not be on, you know, how do I treat your concussion? They may be focused on is this life-threatening? Are you okay? Right.

SPEAKER_00 7:45

If you have a break or a bleed, basically, right?

SPEAKER_03 7:48

They might clear you with imaging, but again, it's it's not necessary to make this diagnosis for concussion. Oftentimes imaging is normal. There's nothing really involved from that standpoint.

SPEAKER_00 8:00

Yeah, but I'm glad you brought that up because that actually points to a large part of the problem here. And there is a problem. Right, there are concussion is difficult to diagnose, the treatments are meh, all the things that that are have been proven to work with an athletic population don't necessarily train, you know, there isn't knowledge transfer to the civilian population. And one of, you know, one of the things that has become clear and as I've talked to more people, is so many times the language is like people are told your scans are clear, it's just a concussion, right? It minimizes the entire thing. I actually had a chat with my mother about this recently because she's obviously much older than me. And she said when she was growing up, a concussion was considered like a really serious thing, whereas now it's kind of minimized. So I did a little research to just try to understand like why did it used to be serious and now it's treated like it's almost dismissed. And a lot of it seems to have to do with the with with imaging. And because imaging became available, when imaging wasn't available, no one could tell if a head injury was uh you could tell obviously by the symptoms, but you couldn't tell to what degree there was really damaged. But now with imaging, most scans for mild TBIs are going to be clear, right? So that leads to like it's just a concussion, which causes a lot of you would call them behavioral. I will say, I would say it causes a lot of psychological problems for people who have them because that minimization leads to guilt and shame. And could you just like talk about in your practice and how you approach things? Like clearly you don't dismiss a concussion as just a concussion, but you're aware that this is in the ether, this is in the environment. How do you do things differently? How do you even deal with this concept of it's just a concussion?

SPEAKER_03 9:42

No, no, absolutely. I mean, that's that's a great topic and great question to bring up. You know, to be honest, every concussion I've seen quite a bit is different. No one is the same. Every treatment plan, every trajectory, every approach I take with each individual is very, very different. Now, I do utilize a lot of the same treatment modalities, but to what extent and what this patient needs is very different. And so it's really hard to kind of group from that perspective. And so kind of going back to, you know, it's is it it's just a concussion, right? Uh oftentimes, yes, it that does make sense because it is a natural injury, it is recoverable. Most people do recover on its own. And I I see where that term comes into play because most people, yes. Like, you know, I I heard a lot of the older generational patients that I see, they, you know, yeah, I definitely got my bell rung a few times, but you know, it's just yes, that language specifically. Exactly. It comes up often in in my practice, and so it it's different sort of generations have different perspectives on this injury, and you can see the evolution over time, like with imaging and a lot of these things that have nothing to do with determining if someone has a concussion, but it's used to kind of kind of temper down anxieties in different ways, but it doesn't necessarily mean the person going through it is actually recovered. It's very different. I I look at them holistically from all aspects, from behavioral aspect, neurological aspect, and personally what's happening in their lives, right? What is perpetuating certain aspects of certain issues that may be concussion related, but over time this injury evolves. It becomes something very different.

SPEAKER_00 11:19

Oh, it does. It is by no means static. It is very a very dynamic condition that changes. But you you just said something really interesting, which is that the language of just concussion can temper anxiety. I think that can also backfire really badly. Because when someone is told that, I mean, because we know, like, and and you and I we we both know this, like no two concussions are alike, right? And there's a wide range of symptoms. Right. Um, there are some that people commonly have, but there's also, I mean, it's a it's it's a whole like universe of symptoms. To be told when you are having sensory issues, pain issues, uh cognit cognitive issues, emotional mood issues, that it's just something can have the opposite of effect of tempering anxiety. I think it just blows up people's sense of first of all, the rage. I can even like feel it in my body at the idea of it. Um but also the guilt that that anxiety is gonna it's gonna cause more anxiety and more depression because it's more it's causing more guilt and shame. Because if it's just something, if it's only a something, then the natural assumption is then I should be able to do all of these things, which suddenly I can't do. So what's wrong with me? The doc the doctors are telling me I'm fine, the scans are clear. Right. So this is, I mean, and and I'm sure you see this in your practice, but uh yeah, I don't know that it tempers anxiety. I wonder if it doesn't do the opposite.

SPEAKER_03 12:40

Oh, for sure. I mean, I I think both have a place to exist. I mean, I when you when I talk with athletes, they're happy to hear me say, like, you're gonna be just fine. I need you to do X, Y, and Z, and you'll be okay. And so, you know, there's various populations that we're talking about. Now, if you're talking about someone who's going through this injury for the past two, three years, they've been through multiple clinics, centers, they've done all these X, Y, Z therapies, and some has improved, but they're still stuck with certain areas that aren't improving, and that's causing issues behaviorally, right? Anxiety, trauma, yeah, you know, relationship issues, financial distress, right? There's all these sort of issues, you know, it's not like concussion, but it's a byproduct of what happened because of your injury that's causing these other issues to kind of slew into different domains, right? And so when we look at a patient, we look at all of those factors and we try to address everything, not just from a neural standpoint, but we're we're doing behavioral therapy, right? We're looking at what made you used to tick before and why aren't you doing it right now? And so we we we get to the bottom of it from that standpoint. But when I say when going back to your your your question of, you know, it does cause that, absolutely, right? If if you've been going through this for three years and you hear someone like me say, hey, I can get you better in XYZ time. I want you to take this approach and just follow me. I, as a, as a clinician, that's my job. I'm going to tell you what I believe in and what I know I'm good at. But at the same time, I also hold your anxieties in a very soft place as well. I understand what you've gone through. I factor in the years that you've been going through this, right? And it's just, I'm just commenting on the term of, you know, I think it has a place to exist on both sides because an athlete might not want to hear the other side. An athlete might want to hear how do I get better quicker, faster. And so both approaches are valid. And it's just my way of kind of saying, like, you know, I understand both aspects and I take different approaches with everybody, right? Like I just said, different populations need different approaches. And so I I highly respect your perspective. Absolutely.

SPEAKER_00 14:39

So there are roughly five million new concussions in the US every year. That's an ish because we also know that a huge number of concussions are never diagnosed or treated, right? People don't think that anything happened. So you actually have this very large population. And then, you know, of the people who have it, half or so. The numbers, I mean, we've seen different different numbers, but about half will get better on their own. Two, three weeks, they're fine. But that remains that leaves a huge population of people who are on year two, three, four. I was in contact with someone recently who's had his for 50 years. Yeah.

SPEAKER_01 15:17

Yeah.

SPEAKER_00 15:17

Right. Uh mine, I I mean, I feel I feel like like a young thing with mine only being about four years, but the fact that you have emotional dysregulation from this, that there's mood dysregulation from this, yeah, and that it goes on year and year and year and year. And I I ran out of options. Like I would love I do want to hear about the treatment modalities because I did a bunch. Something, I mean, nothing for me, nothing helped with the pain. A few things have helped with mood and emotion, but that's that's still something I struggle with. Vision got better through rehab, vestibular got better through rehab, but there's still a lot of deficits and other symptoms that I live with and that I know most other people live with too. So if you talk about like the treatment modalities and like what you find is effective.

SPEAKER_03 16:01

Yeah. So the the way that I was trained in looking at CBI concussion is looking at the clinical profiles approach. So we've now learned there's six different types of concussion that can exist. And so there's different various components without getting too much into weeds, I can spend hours and lectures on each one, but just to get a little weedy. Oh you'll ballpark, there's different profiles, right? And so there's vestibular, ocular, there's anxiety, mood, cervical, sleep, certain modifiers. And so we kind of see which profile is kind of driving what symptoms, right? And then we develop a tailored treatment plan to what you need. But that takes time to extrapolate from clinical interview, really understanding who this patient is, what they're what they're about. You know, I I can't do the same treatment sort of approach with an NFL all-star as I would do with an 80-year-old who just you know slip and fall, right? And so it is very nuanced from that perspective. But each one of those profiles have different treatments, and all of them are evidence-based treatment modalities. And so everything we do has loads and loads of references behind it and evidence-based principles. So, you know, we we do a lot of psychotherapy. There's sometimes vision therapy involved, there's cognitive rehab that could be involved, different sorts of physical therapies can be involved, like some of the ones you mentioned with the ocular, vestibular. And so it really depends on after we diagnose the patient, see what's really happening, both from a behavioral standpoint, neurological standpoint, we can really put together a targeted treatment plan. We don't just throw the whole kitchen sink at everybody. We we need to design a program that's appropriate for what the patient needs and what they have going on, and how quickly and efficiently we can get them back to baseline.

SPEAKER_00 17:48

That's helpful. Okay, so look, what are the most common symptoms you see across this population? Since you know, people get injured in a ton of different ways and absolutely.

SPEAKER_03 17:56

So, you know, some of the big ones like headaches, uh, migraine sort of presentation with ocular, sort of, you know, frontal sort of headaches, you get dizziness, kind of like a slow wavy, like you're on a boat sort of feeling. Nausea at times, light sensitivities, noise sensitivities. You also get a lot of fatigue, brain fog, kind of feeling slower than usual, blurry vision, double vision is always usually big factors, especially not treated over time. You do adapt to a lot of these issues, but these are some persisting symptoms for sure. And then you have other issues that you wouldn't really think could be developed, but you get anxiety, you get sort of this panic feeling at times, especially when you're driving, other people driving past you, kind of get this slow boat wavy feeling coming on. A lot of my patients kind of endorse a lot of those symptoms very often, especially the ones that I've seen two, three years since their injury. These are some of the common presentations I'll get from them.

unknown 18:54

Yeah.

SPEAKER_00 18:54

No, I'm just checking it off in my head because I've got I've got a bunch of them.

SPEAKER_02 18:58

Yeah.

SPEAKER_00 19:01

There's a huge basket of available symptoms, and a lot of us have many of them. And but it is, I I I do think that the variability of the condition makes it uniquely hard to treat that, plus just the difficulty of actually what's understanding what's going on in the brain. Yeah. I find this a difficult thing to explain to people. This is a uniquely unrelatable condition, which also I think leads to the anxiety. I think the fact that you can't, unless someone's had this, if you're going through it and you are trying to the people you're trying to help the people in your orbit understand, they can't. No. And I think the un the unrelatability leads to isolation, which I think leads to anxiety. Yeah, absolutely. Absolutely.

SPEAKER_03 19:43

And especially when, you know, and it's not to the detriment of any other provider. It's just if you go to just a regular provider and they see concussion, you know, they they they have to take the standard approach that they've been trained on, right? These aren't individuals who have extensive training or background or updated literature or knowledge. And it's it's not that you know we have to hold on to it, but they're they're trying to limit any sort of discomfort and pain. And so when you go to an ER and you have a concussion, they're gonna advise you oftentimes to rest, avoid things, don't go to school until you feel better and go see your primary care doctor. Oftentimes, that is not always feasible or the right sort of approach or appropriate for that person, but it it's the current nature of the field, unfortunately. And it's just we haven't evolved yet with the current literature, which is evolving every day, but especially in the past 10 to 15 years.

SPEAKER_00 20:34

Well, and that and that's part that's one of the really frustrating things that that I hear about and and that comes up a lot in conversations, which is the science has changed. There is new data that strongly suggests that the old guidance of no screens, cognitive rest, da-da-da, newly fine a few days is wrong. And that actually people who don't disengage in that way do better, but that doesn't make it into the training materials. It does make it into the way professional athletes are treated. Right. I know from now having talked to people who do that, but it doesn't make it into the civilian population. And so people I know who have gone to neurologists after a head injury at well-regarded institutions at major medical centers. So I'm not talking about like, you know, backwaters, are told you lie in a dark room for a few days, you'll be fine, you know, stay away from screens, go back to work in a week. And it seems like the gap there is is the in the newer information not having made it into the training materials. Right. Which is like a you you it's mind blowing that that's the thing that's preventing a lot of clinicians from having better options in terms of how they treat, and all of these patients who now who might have the opportunity to actually get better instead of being where a lot of us are, which is just sort of stuck just because the information hasn't made it into the educ in into the way they're being trained. That's kind of like you were trained in a specific concussion program, right? Not everyone has access to that. Yeah. Not every clinician has access to that.

SPEAKER_03 22:00

No, and a lot of times, and that becomes the issue, right? You know, as a medical doctor, you know, there's a lot on their plate, they gotta know about everything, right? And so, like, it to become really sub-specialized in every field, it's really hard unless you're dealing with that sort of injury on a consistent basis. And those are then the visuals that I'm referring to, right? Like updating certain protocols. And I'm not saying everyone does this. There are people who mean well and say, like, hey, I need you to get active after the first 48 hours and you know, build up some tolerance. So they do get good advice often as well. It's just this injury, oftentimes when it doesn't naturally recover on its own, and there's certain targeted modalities that haven't been looked at or addressed or had the proper lens behind them to really address an extrapulator treatment plan. I think that's where patients kind of get hung up. Because it's not like they're getting bad advice by any means. It's just they need some targeted treatment modalities. And I'm referring to the patients that you're saying and are in that pool who don't get better, right?

SPEAKER_00 22:55

Yeah, I mean, people will get better on their own. They don't need any of this.

SPEAKER_03 22:58

Right. For for them, I think making the appropriate referral to a specialty concussion clinic is necessary because oftentimes it's not just what happens after the injury. We're looking at factors that were pre-injury, meaning I'm looking at risk factors that this patient has, right? People who have a history of motion sickness have a longer time recovering from this injury. People who have a history of anxiety have a longer time recovering from this injury, ADHD, learning disabilities. There's a whole slew of different factors that we not only evaluate that's post-injury, we look at your background. We we factor all those components in to determine how long your recovery actually may take. And we're really honest with you about, you know, why that takes that long. We present you with literature, research, backing that, you know, determination and kind of gives you a kind of a heads up on what to expect during the recovery period. But you know, it's really hard to do that when you're just looking at it from a secular perspective, like, hey, you have a head injury, go rest, go home, come see me feel better, I'll clear you. You know, oftentimes that that does the trick. I'm not gonna discount that, but oftentimes it doesn't.

SPEAKER_00 24:06

And for those about half the time, right, right.

SPEAKER_03 24:09

And for the other pool of patients, right? And but honestly, rest completely is probably just purely bad advice. After the first 48 hours, I we need some regulation. That's just common CDC guidelines as well. Now it's just needs to be implemented, common nature everywhere. But to completely shut someone down until they see their primary care doctor, which could be weeks, months, you know, it's it's really not a feasible way to go about mouth BI.

SPEAKER_00 24:34

It's not. It's not um you some of the things that I had heard that were predictors of made someone likelier to have this long-term problem, right? People who don't who will get better in two, three weeks. It was interesting the ones that you mentioned in terms of the pre-existing anxiety and some of the other things and learning disorders. The ones I was told were a previous history of concussion, which makes sense, and a history of migraine.

SPEAKER_03 24:56

Yeah, history of migraine as well. There's a whole other list. Female gender is another one. If you had this at the time of injury, pronounced at the time, that also leads to protracted recovery. How soon you get into a clinic also determines how how long it may take for you as well, from protracted recovery standpoint.

SPEAKER_00 25:15

Okay, so that's a big question I have because not everyone has access to UPMC or your your clinic in Florida. And a lot of people live in specialist deserts. What are what should they do?

SPEAKER_03 25:28

Yeah, so absolutely. So there is a network of providers who are fellowship trained at Pittsburgh, who are all across the country. I currently see patients in person in Florida, just at various different local. We have 13 different hospitals across the state and that I currently direct this TBI program. So if you're if the person's in Florida, they do have access to one of these sites. I do also provide, and this is very new that our field kind of allows us to do to get access to patients who, you know, for instance, live in Oklahoma or Midwest somewhere who really don't have access to a lot of these treatment modalities. Not to say New York or anywhere else is better in certain places and just picking a random place to kind of pick on for a second. But yeah, for those patients, I I currently operate in SciPAC. So I can see patients in 41 other states. Yeah, SciPAC. So it allows me to see patients in 41 different states with my license.

SPEAKER_00 26:19

And so within Okay, so you can do them remotely. I could do them licensed in the exactly.

SPEAKER_03 26:24

And so what and we it it's through my own practice, patelci.com. And we basically it's fully telemed. And what we do is we get in touch with you. You would get my full evaluation via telemed. You get all your assessments since you completed. And then what happens is I get you connected with specialists that are nearby, or we come up with a game plan to get you what you need to get going, whether it requires traveling to a clinic just to learn a program and go back home and following up with those providers. So we really customize and tailor specific to what your needs are. And so it's a kind of a new concept I've created because you know, I I see patients in Florida for sure, but I there this need exists all across the country. Um, and so uh not just here, you know, I'm also looking at efforts in in my where my parents were born in India, uh, you know, from my own background as well, trying to see how I can implement Ybril Health and TBI in a different country where, you know, not accustomed to any sort of you know, Western sort of ideologies. And so I'm not only looking at here, but finding ways to get access to care everywhere. And so uh what I'm trying to do is building a network of providers who are kind of have that like-minded training and evidence-based approach. So I'm working on that gap that you are talking about right now.

SPEAKER_00 27:37

That's great. That's good to hear because I haven't actually heard that many proactive efforts to make this easier. But I mean, neurologists, neurologists I've spoken to have said there are not enough neurologists, which is true. Very true. And even among the neurologists, they're not they don't all specialize. I mean, I I had a uh I had a long history of migraine. Yeah, uh, I had a headache doc. Uh, he was the one who insisted that I go, you know, get the CT scan to make sure there's no bleed or no fracture. Uh and he treated me for a while and he was great, but then at a certain point he was like, you know what? I'm not a concussion specialist. Like I'm at I'm and he's like, I'm at the end of my knowledge of how to deal with this. Like, you need to get to a concussion center. And I will say it was difficult. I could not get in through the front door, even though I was in New York, I had access, I had relationships, I had all this stuff. I needed people to pull favors for me, which was the only way I got in. Yeah. Not everybody even has that ability to like have a fate, you know, have a you know, a card to play and to find someone. Yeah. And and people are getting are still getting old, discredited guidance. They are.

SPEAKER_03 28:43

Yeah, yeah. It's it's unfortunate, you know, because you you it it's it's really hard to you know maintain knowledge in a whole field holistically, you know, and I'm especially looking at MDs when you when you're looking at neurologists specifically. But you know, that I I commend that person to say, like, hey, like you should go to a specialist who literally just deals with this, will spend an hour with you understanding what is going on and and develop a treatment plan for what you need. And you know, it's really hard to get that with just every single provider from whether you look at emergency department, PCPs, neurology, you know, just because they fit that title, does it mean that you're gonna be able to get certain other specialized therapies that you need or a lens that is more appropriate for what you need? And not saying that they they biarmians are not competent, absolutely not. It it it has more to do with the other bucket of patients that we're talking about who don't get better and they keep getting the same advice over and over, and then they're told this is your new normal. And that that is the one of the worst things I hear because you know, to me, I have to do a lot of rebuilding with that patient because it is oftentimes not true. And a lot of things that I haven't looked under the hood, you know, we need to look at. And so we until we do that, until we make that determination, you know, in my book, absolutely not. That's that's the wrong mentality to be taken, especially if you were never referred to a specialist to to see what's actually happening. But the burden becomes how do you find them, right? And so it's a two-way street for sure.

SPEAKER_00 30:19

Well, there's an awareness problem. I mean, you I we talk I've talked about this with a a lot, this comes up a lot, right? You know, and I'm I'm a marketer first, so like if you look at this as a marketing problem, and by the way, in a lot of ways, this is a marketing problem. Yeah. And and I I did a post recently that said concussion needs better branding and a commons plan because while people think that it's just a concussion, they don't realize the severity of this, the scale and the scope of this, and what people who don't get better in two weeks live with. Right. Everything starts with a problem with a problem of people aren't aware of all of how you know how many symptoms there are, how long lasting that they they can be, and that a concussion isn't back to where we started from like like just a concussion. Your confidence is one of the first things to go because the concussion strips away the things that made you you. That's just how it feels, right? And the sort of the psychological impact, the load you carry when you feel like you aren't the person you were before. Right. Because I don't care what anybody says. Yeah. Once you're past a certain point, if if you're in the two to three weeks and you recover, great, you're fine. Right. But once you've gotten past that, some of these things are going to be with you to varying degrees. You will never be exactly the person you were before. You just won't. It's just that's just the nature of this kind of injury. But your confidence was based on being that person. Like, what is you're looking at this from a neuropsych point of view. I mean, what are the implications for people and and how they deal with this emotionally and psychologically?

SPEAKER_03 31:47

No, that's just a great question. It actually reminds me of my mentor who I trained under for my fellowship, Dr. Michael Collins. He's actually a pioneer in the field, developed a lot of these assessment tools that I use that major institutions use everywhere. But one of the things that, you know, really sticks out is when he cleared athletes, and I'm talking about, you know, professional NFL guys, you know, at the highest level, you know, one of the things that stuck out to me from him was, you know, these athletes, they want to get back to play. They're gonna tell you everything's good, you know, everything's fine, but we got to do our job to make sure if it is good or not. A lot of times, anxiety is a big hurdle for a lot of athletes when it comes to confidence, right? Getting back to play. Like, am I gonna be the same person? Believe it or not, they'll pass all these exertion tests, they'll pass every sort of nook and cranny we have from clearance perspective, and they'll pass with flying colors. But one thing that stuck out that Dr. Collins always usually asked athletes is zero to ten, how confident are you that you can go back to play? And if it was anything shy of 10 out of 10, you're not gonna get cleared. And that was the importance of that. You could feel completely fine, you could be completely normal. But if you get back on the field and you're anxious, you're probably gonna get another concussion because you're not gonna be the right, you're not gonna play the right way, your reaction's gonna be off, you're gonna be hesitant. And so we really provide that psychoeducation you need to make you understand, like, look, this injury is recoverable. It's kind of a reset when you go through the proper channels and you get back to baseline and we test you appropriately to make sure you're at that level. Once we clear you, we want you to understand, like, hey, go out there, do your thing, be confident. And so if you don't implore that, we want to spend some time to make sure you gain that confidence back. And so that may require some strength and conditioning or overtraining some certain time doesn't make your sure you're comfortable. But that is probably the biggest red flag for patients who actually want to get back to play, right? And it brings up that that statement that you said it's the confidence, right? And it's it's so important that that could have been the one thing that prevented an NFL guy to get back to an important game is endorsing his confidence level to be low. And that's how important it can be. It could be the matter of clearance or not, or it shouldn't be, right? As well. Like you want to be confident when you get back. Right, right.

SPEAKER_00 34:07

And you know people just saying they're confident because they want to get back on the field. Right. But you know, all this talk about the sports medicine is it you know, and and I was I listened to a podcast recently, and they had a sports medicine neurologist who was talking about like, you know, the the you know, people are they're the athletes are screened right away. How they they get better faster from this, right? Fine. There's a lot of really good medicine and science being done on the sports medicine side with professional athletes or college athletes. Why is that information not getting transferred to the civilian population? I mean, the civilian population is much larger than the professional athletic population. I don't understand why we're not seeing that knowledge transfer so that it's applied to a civilian population.

SPEAKER_03 34:52

So, like I this the same treatments I use with the athletes is the same thing I do with the non the non-athletes as well. So they they get the same treatment when you go to a specialty clinic. It's just getting access to care and how quickly you get it. Now that determines a lot on the school's program. Like there's certain schools that I deal with, like a lot a lot of public schools I deal with, they don't have a lot of these athletic trainers. They don't have these spotters on the field, they don't have medical personnel on the field to guide them, right? And so when we work with certain programs, like we'll do baselines for the whole high school. So we'll get, we'll see how each athlete's brain is working before the season even starts, meaning we'll get an imprint of where everyone's supposed to be. And then during the season, you know, usually during a game, there's usually a concussion that usually happens. And so when we see when we have that athlete and we have their baseline, our protocol is within three days, we see them. It's something I picked up from UPMC where I was trained, which they implemented, you know, statewide with colleges and high schools everywhere. And I kind of want to do that in the state of Florida, you know, where there is no legal guidance on baselines or having to do any of that. So that needs lobbying, that needs a whole slew of other things. But, you know, a lot of those factors, you know, tend to play, right? Where you determine, you know, this person had an injury, if I get them in sooner, they're gonna recover faster, quicker. And so I have an athletic trainer who's trained on what to look for, what to see, looks at the athlete, pulls the athlete out of the game because you shouldn't go back after you have a concussion back into a game. So there's so many different trainings that are involved. And a lot of these programs are well equipped to do that. And so when you going back to your question, why doesn't it translate over? Well, we can't have an emergency department everywhere, have all these spotters, you know, on the road if an accident happens, right? There's EMS, there's trauma involved, there's a whole bunch of emotions involved. The last thing, and this is based on reality, anyone's looking for is concussion, right? They're just like, hey, you don't have you don't have any issues with your brand, your imaging's good, go home, sleep it off, go see your PCP. But you know, they don't have that follow-up through with athletic trainer, coach, everyone on the side. And so in order to do that, you need a whole shift in the whole medical approach when it comes to TBR. And that's hard to do, especially when you have institutions that operate a certain way, they have personnel who see this injury a certain way. It's really hard to evolve over time. And so it it's it's a tough issue to nail down.

SPEAKER_00 37:21

It is. And and and you know, one of the things that I write about a lot are systems. And systems, systems are the prime directive of the system is to perpetuate itself. Systems are not about change, systems are about continuity. And when you challenge a system, it's very, very difficult to do, right? The the entrenchment, the sort of embedded way of thinking. But that's what needs to happen is some of these systems have to change. I mean, one of the things I've been thinking about a lot, and again, I do come back come at this from a marketing point of view because that's my background. For sure. Concussion needs a campaign, the way the stroke awareness campaign has worked. And it's that that campaign has been running for decades, continues to run, and has actually worked, right? People now know the signs of a stroke, and people also know that if you can catch stroke early, the damage could be stopped or or reversed, even, right? People know that because of this campaign. That was so I I was like, okay, who paid for that campaign? How do we find out how to do something with that for concussion? The American Heart Association paid for that. Great. There is no equivalent organization. And until we can get, I mean, because again, until we make people aware that a concussion can be serious, yeah, that it is treatable. Because a lot, a lot of people don't even think it's treatable. I mean, you know, I've gone through tons of treatments and at a certain point I just decided.

SPEAKER_01 38:40

Right? It's it feels like discouraging. Absolutely.

SPEAKER_00 38:42

I understand. Which leads to the behavioral, I'll call them the mental health, but you'll call the behavior. It's very discouraging. Like I I've described my sort of experience with this in like multiple phases. As soon as this happened, my only goal was to keep my job because I had been in, I'd only been in a job for under three weeks. Okay. And it was a big deal job, and I didn't want them to think that they'd made a mistake, even though they didn't make a mistake, but the person they hired wasn't the same person as the one who showed up three weeks later with a brain injury. But year one was just treatments and therapies and one foot in front of the other. And then the next phase was none of this stuff is working.

SPEAKER_01 39:17

Yeah.

SPEAKER_00 39:18

And I can spend the I get I didn't know what to do. So it was just very sad and dark.

SPEAKER_01 39:22

Yeah.

SPEAKER_00 39:23

And then I started to write and do world building and do other things because that became the therapy that got me out of it. But in terms of the symptoms, like I reached a point where I was like, you know what, I'm gonna stop chasing treatment because I can spend the rest of my life doing that.

SPEAKER_01 39:36

Yeah.

unknown 39:37

Yeah.

SPEAKER_00 39:37

And decide to live with it.

SPEAKER_01 39:39

Yeah.

SPEAKER_03 39:40

And it's unfortunate because it it's it's kind of like a normalization that you're kind of describing, right? Where you kind of learn how to live with a lot of these symptoms. And, you know, it's unfortunate, right? Because the information is out there and it's evolving, and it's it's really hard to just get it integrated with everybody, right? There's information out there, it's just how do you find it? How do you get there? And when you get there, are they able to see me?

SPEAKER_00 40:04

Right. You can do all that stuff, and then like, can I get an appointment? Right, right.

SPEAKER_03 40:08

Yeah. There's a lot of work to be done. I I agree, campaigning in a in a really strategic way where you get the right information to the right people to really just trickle it out onwards. And I think it will happen. You know, I I think in in the near future it will happen. I mean, in the past 20 years, you know, we've learned so much about this injury that we didn't know before the 2000s, right? And so in in the past 20 years, the amount we've learned is tremendous about this injury, how to treat it, how to look at it. And so I have no doubt the next generation of coming on is gonna make strides to kind of reverse this trend. They have to at this point.

SPEAKER_00 40:44

I I I I hope so. I do. I I I really do for so many people, I hope so. You had said something when we were talking the other day about buy-in. Remember we were talking about could you talk a little bit about what you meant about buy-in?

SPEAKER_03 41:01

Yeah, no, absolutely. You know, a lot of times, you know, going back to you the comment you made, right? Where you you go through all these treatments and you go through all these therapies and modalities, and you know, some things get better, but you don't feel quite right and you kind of just accept it. But when you go to like a specialty clinic or someone who who's trained and looking at it from a different perspective, I I think it's it's good to kind of take a fresh slate, meaning kind of ignoring what you've heard, what you've learned, what you've known about, and taking a fresh perspective. I think if you're able to do that and separate away from am I doomed, and take that different approach, I think it it's beneficial. And so buying into understanding like, hey, like I don't think I've done all these other things that this clinic is talking about, and it doesn't involve, you know, crazy bells and whistles and all these different little toys and everything that I see, you know, that's not empirically researched or any of that stuff, right? What we're doing is evidence-based literature where you, me, anyone can go look up and try to implement in the practice. But how do you do that? How do you get a person to actually, you know, do a lot of the treatment recommendations that I give them, right? They're gonna look at me like, what's wrong with you? Why would I do that? But it's an approach you have to take to get them to understand why they need to do it. Psychoeducation, the amount of time I spend with the patient to help them understand, you know, what a ranger is, what's currently happening to them in their situation, to relate it to their experience and get them to understand why I need them to do these treatment recommendations in order to get better. And that requires a level of buy-in. And so meaning from the patient. Exactly. So you have to understand you're seeing me for a reason. You want to make an attempt to try to get better. My job is to give you everything that I've learned through my knowledge, education, recommendation-wise, to get you up and running. And so as long as you do your part, meaning buy in to what you're doing there in the first place, and I'm doing my job and evaluating you, diagnosing you, and properly giving you the recommendations that you need, it's a two-way road, right? If you go to a doctor and you're not trying to listen to them, what's the point of going to them? You you you need to understand you're there for a reason, you want to get better. I oftentimes relate this sort of parallel with patients, like, you know, if you're if your leg was shattered and you couldn't walk, right? And the only thing that ever made you walk was six months of excruciating physical therapy every single day. Are you gonna miss a day? And the answer is always no. No. I'm gonna have to go every single day, no matter how painful it is, because I want to walk again. And then I bring up the same point. So I was like, you know, these treatment recommendations, they're really simplistic, right? But but you've given me all these different excuses for why you can't do this, this, this, and this. And they have no response. Because they don't view the brain as a similar thing, because the brain is really resilient, it pushes through issues, it will adapt whatever you need to do to get the job done, but at your expense with symptoms. So you're gonna feel it for sure. All right. And that over time is discouraging. Behaviorally, it changes you over time as well. And you deal with a whole slew of psychological issues. And so it it it does take a level of buy-in understanding because there's a lot that we discuss and go over to really make you confident going back to that term as well, in what we're doing and what you need to do to get better.

SPEAKER_00 44:21

Is there that makes total sense? Is there required buy-in on the clinician side too?

SPEAKER_03 44:27

Yeah, absolutely. I mean, I to be honest, I picked this up from Dr. Collins, who trained me, is I'm not afraid of this injury. You know, like I I've seen various versions of it. I've been trained that way. And I look at it uh as a monster I've tackled many times. And, you know, I I enjoy it. You know, every concussion is different. For me, it's not the same, it never gets old. Some of the mechanisms of injury are also very interesting as well, you know. And so this injury can happen in a whole slew of different ways. And but the symptoms are very alike, the the perspectives are very alike, but the treatment modality and the approach that is needed is really nuanced per patient.

SPEAKER_00 45:03

That's great. Okay, thank you. All right, we're gonna wrap up in a minute, but so you you've looked at some of my work. So you know I've I've created this imaginary country. It's only it's it's only imaginary because if the real world provided what what people like me needed, we wouldn't need that, we wouldn't need a country like Best Guestistan. But you know, there are clinics like yours, but for a lot of us, we when we talk about rupture, TBI is one form of rupture. Rupture comes in many flavors, right? But it's it's anything that wrenches someone's life into before and after. And my and the country, Best Guestistan, is for people who can't go back to who they were before, don't know who they're becoming, but in the meantime need to live in a world that isn't saying, aren't you better yet? Why aren't you better yet? Right. Because we do have we do have a culture of toxic positivity, which I think is makes it even harder on people with this kind of intractable problem who are already feeling guilt and shame, and then have then to have society saying, Well, if you did my five things, take these three supplements, my ten steps. If you didn't do that, you didn't do it right. That's sort of what we all live with. So in the country of Best Gastistan, we have a governmental system and we're mostly ministries. We have some bureaus and offices and other things, but mostly ministries. And every guest guest gets a ministry. And I'm going to offer you the ministry of buy-in. Because it sounds like that's really the thing that's needed on both sides to activate. Absolutely. Yeah. Absolutely. All right. So you accept the role? I'll claim it.

unknown 46:32

All right.

SPEAKER_00 46:33

I will I will I tell everybody this. I will send the paperwork. It will be confounding, it won't matter because in in best guess to stand there are no wrong answers. Um, my final question though, because this has been super interesting. Where can people learn more about you and your clinic and your approach and your work?

SPEAKER_03 46:48

Absolutely. So if you want to see me in person, I I currently operate out of University Orthopedic Care in Florida. They have multiple hospitals throughout the state, so you can find one throughout the coastlines. If you're out of the state of Florida, my my other uh personal website is patelci.com and it's fully telemed, operate nationwide, mostly at a majority of states, 41 states total. You can find the whole list online there as well. But yeah, patelci.com, you can find resources there, information there. If you want to come in person, you do have access to our facilities, our specialist within Florida. I mean, you can get access to the whole gambit of treatments there. But if you don't have access to that, you can always come search at patelci.com. And we can certainly get in contact with specialists near you and get you the care you need.

SPEAKER_00 47:37

Thank you. Thank you for sharing that. And thank you for joining us. This is this has been really, really interesting and useful. Thank you. No, I appreciate this. Uh thank you for inviting me. This was great.