What Concussions Do to Women’s Hormones with Dr. Tatiana Habanova (Part 2) | E19

Dr. Ayla Wolf and Dr. Tatiana Habanova discuss the neuroendocrine changes post-concussion, particularly the impact on thyroid and adrenal function. Dr. Habanova explains that hypothyroidism often results from pituitary dysfunction rather than direct thyroid issues. She emphasizes the importance of assessing hormone levels immediately post-concussion or after a few weeks. They highlight the need for regular re-evaluation of thyroid medication dosage as the brain heals. Dr. Habanova also advocates for annual brain health assessments to monitor cognitive function and overall brain health, stressing the importance of early intervention and comprehensive neurological evaluations.

• New research shows even mild concussions can cause significant hormonal changes
• Pituitary dysfunction creates a downstream effect on thyroid, adrenal, and other systems
• Thyroid medication needs may change frequently during concussion recovery
• Thyroid symptoms often overlap with dysautonomia symptoms, complicating diagnosis
• Cortisol rhythm disruptions explain afternoon energy crashes in concussion patients

• Annual brain health assessments should become as routine as dental checkups
• People with mild cognitive changes often "shrink their world" without realizing it
• Cognitive testing isn't about measuring intelligence but identifying functional changes
• Tracking symptoms and biomarkers empowers patients in their recovery journey
• Addressing toxins and environmental factors that burden the endocrine system is essential

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Chapters

• 0:00 Neuroendocrine Changes After Concussion
• 6:26 Thyroid Dysfunction and Pituitary Impact
• 16:00 Dysautonomia and Medication Considerations
• 23:49 Managing Hormonal Imbalances Post-Concussion
• 31:41 Importance of Annual Brain Health Assessment
• 39:06 Cognitive Changes and Self-Awareness

Transcript

Speaker 1: 1:10

This is part two of my important conversation with Dr Tatiana Habanova, where we discuss neuroendocrine changes that can happen after a concussion that has an impact on thyroid and adrenal function, as well as blood sugar control. We also discuss the importance of more consistent neurocognitive testing and screening for monitoring brain function. I hope you enjoy this conversation. Please subscribe to our show so you don't miss an episode and, as always, you can email us questions at lifeafterimpact at gmailcom or send us a text by clicking on the text us link in the show notes.

Speaker 1: 1:47

Welcome to Life After Impact, the concussion recovery podcast. I'm Dr Ayla Wolf and I will be hosting today's episode where we help you navigate the often confusing, frustrating and overwhelming journey of concussion and brain injury recovery. This podcast is your go-to resource for actionable information, whether you're dealing with a recent concussion, struggling with post-concussion syndrome or just feeling stuck in your healing process. In each episode we dive deep into the symptoms, testing, treatments and neurological insights that can help you move forward with clarity and confidence. We bring you leading experts in the world of brain health, functional neurology and rehabilitation to share their wisdom and strategies. So if you're feeling lost, hopeless or like no one understands what you're going through, know that you are not alone. This podcast can be your guide and partner in recovery, helping you build a better life after impact.

Speaker 1: 2:48

I have certainly had patients that have. After a concussion, they've actually developed thyroid conditions. I've actually seen people go hypothyroid and I've seen people go hyperthyroid. And so why don't you talk a little bit about this research that was published in 2023, where they were looking at pituitary levels and obviously the pituitary then talks to the thyroid, the ovaries, the adrenals. So maybe get a little bit into some of this newer research that is looking at these types of changes.

Speaker 2: 3:18

Yes, absolutely. So really it's just a trickle down downstream aspect. You know, it's really almost a secondary hypothyroidism as opposed to a primary condition around the thyroid. So I know sometimes language and words that we use to explain things in the medical world can be slightly confusing, so we really have to tease that out. So it's probably not a direct issue at the thyroid, although we obviously want to make sure there's no growth or problems. You know, maybe there's an autoimmune condition at the thyroid. That could certainly happen. So we got to be careful. But it's usually a downstream effect coming from the pituitary. Now we can't really address the hypothalamus per se, so we can assess from the pituitary level and then, of course, downstream from that. So definitely, you know current research is indicating that and this is the interesting thing, that was nice to see it they now say it doesn't matter the level of injury, Like they used to believe. A more severe injury would lead to more severe hypothyroidism. Low um, um or hypopituitary is a low pituitary function, which would then lead to low thyroid function, which would lead to low adrenal function. Right, so it's just a downstream effect. Now actually means it's just showing that it doesn't matter the degree of injury, even mild.

Speaker 2: 4:41

You know, TBIs, which are concussions, can even cause those issues. So, definitely, seeing, what they recommend is to have a. Let me take a step back. Some recommend doing an assessment at the acute phase. Okay, when you first have the concussion, go ahead and just do the hormonal panel at that moment and just sort of document what's going on. Others are like, give it a few weeks, maybe even six weeks, let kind of everything, let the dust settle, so to speak, and then take the assessment at that point and see sort of how has the system kind of rallied back, um, you know, and then from that point, if there's issues, consider moving forward, you know, in care, treatment and continuation of assessing, uh, long term in that management, right, so there's a couple ways to go about that, but definitely, um, you know, seeing changes, those neuroendocrine changes which, of course, for the thyroid, is so important for brain function.

Speaker 2: 5:36

So not only is a person maybe dealing with the concussive symptoms, whatever that profile might look like, now there's an added layer that kind of comes back and nips them.

Speaker 2: 5:47

You know, in the bud, like in kind of a round two, where you know, maybe it's just now new symptoms are showing up or symptoms are getting more manifested, you know, at a greater degree, and the the approach they were doing to manage them isn't working anymore Right? So, like with headaches, for example, you spoke about earlier, maybe they were managing them a certain way and that worked until the shoe dropped because that neuroendocrine change, you know, was affected. It took several weeks to months to do what it's going to do and it didn't rally back. So throughout that time maybe there weren't those thyroid symptoms just yet, but now there are, you know, because it's dropped so much. And here, two, three months, six months later, a new you know a new manifestations occurring, or you know the treatment is not working anymore. That's again when I a new manifestations occurring or you know the treatment is not working anymore. That's again when I talked about that stagnation. We need to go back and evaluate if we haven't initially.

Speaker 1: 6:41

Yeah, and I think there's a really important piece here too where, if you look at, like you mentioned, be great if we could all just get a baseline hormone test, you know, just to know where things are at. But I think a big piece here is that when you have a brain injury at. But I think a big piece here is that when you have a brain injury, as people's brain heals, then also if there's a pituitary dysfunction or imbalance, then that is all. As the brain heals, that can also heal. And so it might be a case too where if somebody does get put on a thyroid medication, we maybe shouldn't wait a year to recheck it, right? Maybe we shouldn't even wait six months to check it because, as the brain heals, they might not need the same dose. And so I think that that's also important too is that, in the context of a brain injury, if somebody is taking medications to manage a thyroid disorder, that might need to actually be like retested every three months instead of every six months or every year.

Speaker 2: 7:33

Absolutely. That's exactly the take home point and you're right Again that thyroid medication may be a needed ingredient to help also the brain heal right, in addition to other things that's going on for the brain to heal, and maybe the brain needed that little bit of thyroid hormone in the brain to be able to do that right. And then it heals up. And now maybe we need to titrate that down or slowly take it away and not become dependent on it. And I think currently in the field of medicine, you know, thyroid is not looked at that way.

Speaker 2: 8:07

It's sort of looked at oh, you go hypo and then you most likely need meds your whole life. And then maybe they're just going to slightly tweak the levels because you know maybe someone's feeling a racing heart or blah, blah, blah, blah, right, so they're going to start to maybe kind of play with the dose, but they never take you off of it right. Or look to maybe wean out completely and again, maybe that is needed, maybe it's not, but I agree with you. I agree with the idea of providing it if necessary and then seeing how the brain develops right and heals.

Speaker 1: 8:41

Yeah, and I think you just mentioned a beating heart which made me want to point out the fact too that we in functional neurology we spend so much time assessing for autonomic dysregulation and so it is really important to also see this overlap between thyroid disorders and a lot of the symptoms, kind of overlap with a dysautonomia type presentation too, and so it just like makes it like you said, it's just the ability to understand the functional medicine and the functional neurology at the same time is so huge.

Speaker 2: 9:13

Exactly that makes me think of a case I had about four years ago with a patient who had a history of concussion and previous, and was on thyroid medication for a very long time maybe 30 plus years and constantly spoke about a racing heart, like she used to call it.

Speaker 2: 9:34

Like horses are pounding in my chest, like when horses run near their hooves, you know, they come out beating.

Speaker 2: 9:40

And so she was going to her doctor constantly about the thyroid and they didn't want to change levels because they're going to have the highest she could be and they'd take her too low and then she would have some thyroid crashes because again there's some dependency, a little bit on the meds too, because the system isn't kind of working on its own, it's working on the environment, it's provided with Right, so um.

Speaker 2: 10:02

So again that could be a challenging river to navigate to some degree as well and um, but just never could get it right and I always felt it was the thyroid and had brain fog and all this and you know evaluate her and she had dysautonomia and so treat the dysautonomia and the racing heart went away and was able to lower her thyroid meds to some degree. She still did require some, but not to the degree that she was no more racing hearts and the energy level of brain fog. A lot of things help. But again, was it dysautonomia? Was it over medication of thyroid? You know it's, it's really takes, I think, a practitioner who can peel back multiple layers and look at the person from different perspectives.

Speaker 1: 10:47

Yeah, yeah, I had a patient that was in a lot of pain after her concussion.

Speaker 1: 10:52

She also had a, an injury to her neck, and so being on a lot of pain after her concussion, she also had a, an injury to her neck, and so being on a lot of pain can cause your blood pressure to rise, and so she was placed on a blood pressure medication at some point and I, you know, I think what happened was, you know, maybe the pain levels came down, but she was still on the blood pressure medication and so a lot of the autonomic nervous system, like the dysautonomia piece, wasn't getting better because she had this medication artificially decreasing her blood pressure.

Speaker 1: 11:19

And it was like once she went off of that because she was able to track the blood pressure, say to her doctor, hey, this is consistently low, like I don't think I need to be on this medication. And so they said, yep, you're right, I'm looking at the data here, let's take you off of it. And then, all of a sudden, the dysautonomia improved and instead of plateauing, it's like all of a sudden it's like her progress just shot way up, and so it just really highlights that importance of like in the case of concussion recovery. We've got to be paying attention to all the data, you know, the hormones, the blood pressure, the autonomics. If we've got any medications that are controlling any piece of this, as things improve or if people plateau, we got to step back and say, okay, is all of this stuff still needed at the moment?

Speaker 2: 12:06

Right and I think you hit upon some two really important pieces is allowing patients to take on more responsibility of tracking symptoms. Right so? Like tracking the blood pressure regularly or whatever the case is, and keeping a little journal or log, like really normalizing that, really allowing patients to just take that time to do that and recognize how key that is. That data is so important. Right so, that data collection and then working cooperatively with their primary care physician and being able to say okay, you know, let's work on this where the medication is needed for a time being.

Speaker 1: 13:45

But as the system heals.

Speaker 2: 13:47

Let's work on normalizing and maybe getting off of it if needed or whatnot. Right so that collaborative piece amongst professionals and really to serve the patient at the highest level.

Speaker 1: 13:58

Professionals and really to serve the patient at the highest level. Yeah, yeah, it takes a lot of, you know, awareness of all the moving parts.

Speaker 2: 14:06

So it does.

Speaker 1: 14:15

And then when you are seeing these hormonal imbalances and things showing up on labs you know that are cluing you into, say, a pituitary imbalance having downstream consequences, do you want to talk a little bit about your approach to working with those patients?

Speaker 2: 14:25

Sure. So you know, kind of an official kind of meeting, and a lot of times I am in favor of getting some lab tests on the front end. Sometimes patients will already have some recent blood work that they've done, so I always ask them to send that to me if it's within three months, can utilize that data. I find a lot of times they're not very complete or a lot of bits are missing, you know. So we'll have to just go out and get a little bit more testing if we need to fill in a few gaps. But really then you know, upon doing a comprehensive neurological evaluation, I take about three hours to do that comprehensive assessment. So again, information gathering, data gathering and being able to look at what are the primary areas that are needed, depending again on symptomology and what they're presenting with right. So then I like to prioritize for patients sort of how can we best achieve? You know their goals, right, usually most people want to get out of pain, they want to function better than when that brain fog, you know. They want to feel dizzy, headache like, whatever those things are. You know, we'll start to identify their goals and then I'll lay out trajectories or paths and be okay, this is the goal you want to achieve. This is what I feel we need to do to achieve that. And then I'll really ask them what do they want to take on, what makes what gravitates to them the most, what matters to them the most, and what are they willing to take on? Because I think what's also important before I start working with anyone and really getting involved in their care, because I want them to be aware of the things that they're going to have, what hurdles they're going to have to cross, and to also start preparing for some of that. So not all of a sudden, oh okay, here we are, and now you need this. And they're like oh, you know, because many times when you have brain fog, you're not firing off all pistons.

Speaker 2: 16:10

It takes a lot of energy just to do something simple, right? The resources are limited. You're probably not sleeping very well, right? So there's a little bit of that going on. Symptoms, pain all of that can just add to the burden, right?

Speaker 2: 16:25

So I want to try to make it as simple as possible for patients to be able to feel they can be empowered, to feel like they're in control, that I'm guiding them, so that they feel confident in the path that they're taking but that they feel comfortable they're taking on, and the most important part is creating that compassion and safety right. So that's really kind of how I begin leading those cases. They can take a long time, in the sense that it could be a six month to a year process together. We're not just gonna solve some things immediately. Some things may happen quickly, which is great, and some things can take a little longer. So you know what are things we're going to do to manage some of the symptoms in the meantime, what are going to be things that we're going to heal and improve and what does that take. So I think it's really important to have an honest conversation about that so people can make a decision that makes sense for them and the willingness to take that journey on and to do that together.

Speaker 1: 17:19

So I'm not sure if I answered the question where you were leading it, but well, I mean you, you, you bring up that important concept of expectations and I think that when you do all that work on the front end and you spend the three hours, you know, assessing somebody and looking at all the data and then maybe collecting more data, A lot of times what happens is that because you spend all that time on the front end, you can very quickly get to here's what is wrong, here's what the problem is. But then the patient says oh well, they were so quick to figure out what's wrong, so that must mean that they were going to be really quick to fix it too. And, like you said, sometimes it takes a while, and so managing those expectations is huge.

Speaker 2: 18:02

Yes, and even on my end, because trust me, if I could wave that magic wand and make it all go away like this, I would be waving it all day for everybody.

Speaker 2: 18:10

So I tell them, I can only work as fast you know and guide you and support you and coach you and address these things, as I have to respect your body and your body's healing time. I can't push you more than or push your body and brain more than it's capable of. And that's a really important piece. Because if we over fatigue, you know, we end up crashing the system and now we're kind of, you know, putting ourselves behind the eight ball right. That doesn't make sense. So, again, managing those expectations and guiding them, even in their life, because people tend to take on more than you know and sometimes can set back their healing a little bit too.

Speaker 2: 18:46

So yeah really supporting him in that. But definitely if I seeing some issues, you know, on the thyroid side because I don't prescribe medications, you know that is something where I'll refer them to their primary or another physician if that support is needed. Many times we'll also work on supplementations and other things to kind of support the the need for the body to work better, just support cellular function. So, you know, with the endocrine system particularly, you know looking at endocrine burdens, right? So what are things that are affecting the hormonal system from working as well? And I'm talking about now receptor sites. So are we dealing with toxicities and things of where we can do some liver support and maybe you know, clear out some things, some toxins and burdens that will allow your hormonal system to actually function better, right? So it's almost like I say you have a knapsack with a bunch of rocks in it or boulders and you're trying to run up a hill. That's really darn hard. But why don't we take that knapsack off? Boy, you can sprint up no problemo, right? So let's deal and look at sometimes, instead of always working from a mindset of let's just improve, improve, improve, improve, why don't we stop and take a look and go behind our shoulder and kind of look what are some of the burdens that are occurring to the system. What's going on dietarily? Are the things that we may be consuming, you know, that have pesticides in them or we're exposed to environmental toxins, you know? Maybe we should do a panel and see if there is mold or, you know, various infections or other things that are maybe burdening and pulling the system down. So I think that's an important thing as well, instead of saying, oh, let's just always try to create peak performance for these hormones. So again, another mindset of consideration. Their history will dictate some of this, of course, right, women that are in their perimenopausal and menopausal. We now need to be thinking a little bit on hormones and what's going on there. So definitely, I start to see changes in progesterone as women are in their perimenopausal phases, whereas progesterone is starting to decrease. So that is going to not be as much of a neuroprotective effect and create a little bit of a heightened anxiety around things as well. So, in terms of managing patients that might have these neuroendocrine changes perhaps due to a concussion, perhaps just neuroendocrine changes that are happening in life to also support them from that perspective as well. So the literature doesn't speak per se to any of the sex hormone changes. They're really talking more about that pituitary and the thyroid and the adrenal, the cortical. They do also now mention growth hormone and insulin growth factor starting to be influenced. So that is going to now link back up to sugar handling.

Speaker 2: 21:49

Okay, so that's important from an energetics perspective. So, energy metabolism. So how else do I manage neuroendocrine changes? Is I look at bioenergetics? Um, I know you've talked a lot on your podcast about red light therapy. I also like to do a lot of pemf pulse, electromagnetic um stimulation as well, um, so, other ways to provide energy to the system, supplementation, herbs there's a variety of things, lifestyle changes to support those processes too. So I think we've got to look at it from a practitioner's perspective, a few different angles, and for patients to realize oh, there's a lot of choices and options that I can maybe explore when I'm trying to stabilize a system or improve upon a system. What are some rocks that I haven't unturned, turned over yet, to explore Again, those neuroendocrine disruptors right, there are several that we are, know in the food and just you know chemicals and water and things like that.

Speaker 2: 22:50

Should I get a you know water purifier? Should I just you know, shop slightly differently, eat slightly differently. That goes a long way, that really goes a long way. And then, you know, looking at some energetics as well, so I kind of again looking at the case really guides me. But these are all the things that I have at my disposal that I'm kind of considering, as I kind of have this imaginary whiteboard in front of me, as I, you know, have all the dots for the patient and you know, all that information I'm kind of holding in my mind. But these are the things that I'm thinking about as well. You know, there's nothing really we can do for the pituitary specifically. We can only do, like the downstream.

Speaker 1: 23:31

Yeah.

Speaker 2: 23:33

And then stress, right. So cortisol, the other component, we haven't discussed if you want to approach that or not, but looking at cortisol, elevation of cortisol and dysregulation of the circadian rhythm and just stress, overall right and the influence that has on neuroendocrine effects.

Speaker 1: 23:51

Yeah, when you do the Dutch test, are you typically ordering the one that includes the cortisol awakening response to look at that cortisol activity first thing in the morning within that first hour?

Speaker 2: 24:02

I do absolutely, and there's always disruptions, you know, in that circadian rhythm. And then also I look at the drop that occurs around the lunchtime hour, Because that is when the adrenals need to kick in to provide the cortisol, for as the circadian rhythm will naturally decline that's a natural circadian rhythm it should drop and then kind of level out around 5pm, Right, so it should start to rise in the morning. We do want cortisol first in the morning.

Speaker 2: 24:32

That is a very good thing that creates an awakening response. So you know, sometimes people are alarmed that their cortisol is so high in the morning. It's like, well, relatively right so. But then I look at the peak and then look at that drop and generally that's where people have an afternoon lull, right. Sometimes it could be kind of eating food. Maybe they have some, you know, glucose intolerance, so they're eating lunch and then they get sleepy, tired, drowsy 15 to 30 minutes after a meal. Well, you know, that's a glucose metabolism issue, right.

Speaker 2: 25:05

But assuming it's not that they just kind of feel like drop in energy and then they kind of get better later in the day, those adrenals are not kicking in and supporting the chain, the dropping of the cortisol, and the adrenals are supposed to, are supposed to bring it in and to kind of level you out slowly, right, not crash. So there is herbs that can be used to support that process, to help kind of bring you down more comfortably, and I find that very, very effective for people to manage their energy so they don't crash. They can be productive all day. Keep going. You know, we know movement, brain function, thinking, body movement is so important for brain health and brain healing, absolutely. So, again, managing and supporting those effects.

Speaker 1: 25:50

Well, you have shared a wealth of information. Do you want to talk a little bit? You said at one point, summer, you're on a mission to provide annual brain health assessments to everybody. So tell me a little bit about what that looks like, because I think that this is something that I would love to see this happen. If we were in charge of healthcare, right, this is what we would implement.

Speaker 2: 26:13

I think, to some level there might be bigger powers in motion. There's some amazing women already on, I think, moving this torch forward as well. So I'm happy to be one of those voices to continue to create that movement, and not just particularly for women, but definitely for everyone. For everyone In terms of. You know, we go to the eye doctor once a year. We go to the dentist maybe once or twice a year. We get an a yearly physical. These are normal.

Speaker 2: 26:47

You know, little moments of assessments that we do in our health, right, it's just norm, it is what we do. But we don't do that for our brain. And why not? We're living longer. You know. We want longevity, health. You know.

Speaker 2: 27:03

I think it becomes a more of a due diligence that you take it upon yourself to say, hey, if your practitioner is not recommending this, which most of them aren't at this moment. But trust me, time will come, they will be and this will be a norm. You know how that looks like. I'm trying to develop a model right now of what should be included because, as you know, we could do so many elements to neurological assessments and we don't want it to be taxing and and too comprehensive in the sense, where it takes so many hours and it's difficult to implement into a practice and for people to come in and maybe get in a one hour visit, right. So keep it doable, to keep it the right information and things like that. So I'm trying to create a model and a standard or beginnings of something that we can do.

Speaker 2: 27:49

But the idea of that yearly is so critical because it's going to pick up on anything that maybe you need to work on that you don't realize, right? It's just sort of like you get a dental and you realize, oh, you have a little cavity, well, you better deal with it, you better do something. You're not going to just let it go, you're going to treat it right. Or your eye prescription maybe needs to change slightly, right? So you go ahead and change your prescription, get new contacts or glasses. It's just what happens. So why not here and why not move forward in life with the best brain that you possibly can have? Right? Because should something happen like a concussion or some brain injury, you know going into the concussion is so important that you go. You never want to have a concussion, I don't want for anybody, but should that happen, you want to go into it with the best brain possible, and the only way you can do that is you keep tabs on. If you don't measure it, you don't know what's going on. So I think that idea of just doing that yearly and then checking again the next year and everything's the same, awesome. You know, if things have altered a little bit, let's fix that and again, it's always better to it'll only be a quick little fix, it won't be major right Now. If there's something that we need to work on, let's work on it. Let's get that sorted out and then you're good again, let's move forward, right? So so that's kind of the mission there and just that, the stigma around the cognitive aspects of it.

Speaker 2: 29:14

Most people are pretty comfortable having their vestibular system evaluated or the cervical, the neck and various things, but sometimes it comes to the cognitive people.

Speaker 2: 29:24

People don't sometimes really want to take those cognitive tests because they don't want to know, because I think they're afraid that maybe the test is going to show that they have some you know a cognitive decline and they feel at this moment still in society again there's people who are doing amazing work of altering that stigma and helping people realize that even with mild cognitive impairment there are things that we can do to turn that boat around and improve brain health.

Speaker 2: 29:56

You know, having an evaluation that shows that there's some mild cognitive impairment is not a death sentence or a sentence to alter ice home. You know there isn't that, but we don't want. You know, if we leave it unattended, maybe it might lead to that. So why? Why be risky like that? Why not take care of it? I personally would rather learn about something sooner than later, so there's still a few things to kind of help people in terms of navigating that and learning and education, and you do just such an amazing job on your podcast, sharing this information, helping listeners, you know, really get to the truth behind things, and so you know, I just support you. A thousand different ways.

Speaker 1: 30:39

Thank you.

Speaker 2: 30:40

And all your pursuits as well and the work that you do in the world and in your clinic and personally with patients. So but yeah, the yearly brain health assessment, I think is something that should be normalized. I'd love to see more practitioners do it. I think they're not sure just how to, not not how people know what tests to do, just how well to structure. So I'm working on a doable model that people can just cookie cutter, tweak it to obviously your patient appropriately, but something easy to implement. And there you go, there's the blueprint. You know, go have at it and let's get this going.

Speaker 1: 31:13

And, like you said, I think a lot of people are. They're okay being assessed, other things being assessed, but as soon as you say let's assess your brain, it's almost like people have reminiscence of like high school math test. Right, they're all of a sudden having like test anxiety or they, you know, they are reminiscent of this whole grading system in school and it's like, oh, you're gonna make me do a test, and so I think that the that's a little bit, like you said, of a hesitancy, where people are like I'm fine, I don't want you to look at my brain, I don't want to be tested, you know, and it's. It's like we're not. We're not testing your intelligence, we're just assessing different cognitive functions. It's not an intelligence test.

Speaker 2: 31:51

Exactly, and that's a key point there. And also I find, like some people like honestly, don't want to know, they're in denial. So there's that. But also what I find is, if there are cognitive changes, right, mild cognitive changes, so it's not like drastic, right, sometimes after a concussion you can have significant cognitive changes like this, right, and it is clear, I, that was a little bit my experience, I think, maybe your experience to some degree as well, right, but the mild cognitive changes, people start to shrink their world so they could operate in a way that that they can tolerate to their brain function. So they don't realize that their world is shrinking to some degree so they could keep managing within that. Well, because we all want to do well, we want to feel well and good and successful, right, it's very important, so, so, but they don't realize they're shrinking their world. And then when you expose them to some standardized cognitive tests, and again, not not to make them feel bad, but just to say, hey, here's a benchmark of really the level you should be functioning at, Right, and that's where we want to get you to and we can make that happen, right, if possible. Right, so again, don't make a conversation, but again, let's say realistically. I think that really helps.

Speaker 2: 33:10

Sometimes people realize like, oh, wow, because they feel I'm fine, I can drive, I can go to work, I can do this and this and this, my life's okay, I don't need that right. And it's like, well, okay, let's just kind of measure you to some standards, you know, is your world shrinking or not? Um, Because the smaller it gets, the smaller it gets. The smaller it gets, the less of an existence we have and there's so much to enjoy in this world and we don't want to limit our potential, our abilities and our experiences. So I find also that has been the case for many people too, where they're thankful afterwards and they're like, wow, I had no idea that that was happening, because I felt, you know, you put them in a new environment, you put them a little bit outside their world and now can you navigate things if you're not in the familiarity of your own little space.

Speaker 1: 34:01

Yeah, right, and the other thing that I see is that when people have had a concussion, if their executive functioning is affected to some degree, part of executive functioning is internal self-monitoring and self-awareness, and so some people are not able to have that self-awareness of when they're making mistakes, and so they might actually not even understand the degree to which the concussion has been affecting them cognitively, until somebody comes in and says let's just look at these functions, let's assess them, and then maybe shine a light on where you're struggling.

Speaker 2: 34:36

Absolutely. I think that's a good point and that main times, that's what I do. I just shine a light on people as well. They may not want to pursue this or that if something showed up. Sometimes they do, sometimes they don't, but I said, hey, at least we have data.

Speaker 2: 34:48

And this was a case actually with a patient of mine. Four years ago. We did a little mini evaluation. She's an equestrian athlete and left for season, so they go up north and then back, so working together, and this season, actually just a few months ago, I was like you know what? We haven't done an assessment for a while. Why don't we just run that real quick, right? I mean, we didn't do anything about it before, but we gathered some data, which is why not just take a few minutes? Let's just run a few tests, right?

Speaker 2: 35:20

Well, she was significantly worse at this current moment than she was four years ago and that opened her eyes. I was just like, oh, wow. And I was like I have a concussion in these last four years. Now, of course, she had a little history prior to that, but she felt she was functioning fine. It happens, life happens. But she's like, oh yeah, I did fill up a horse in September. Oh wow, I didn't really think that that affected me in any way. And here we are in February March I believe it was when we did it. So, again, many months after that incident, she got right back on the horse and she said I felt a little off for a couple of days, but whatever and carried on.

Speaker 2: 36:02

And so, wow, now that we did our comparison, she was like she just said thank God, we did that for you. She goes, tom, I really didn't want to do it, but I did it because you kind of did it.

Speaker 1: 36:11

I did it to make you happy, but now I'm glad I did it.

Speaker 2: 36:13

Yeah, she kind of did she kind of did I bless her, but I'm good and grateful that we just did that. Now we did some neuro rehab and cleaned that all up and a few months later now she's left for season again and she's doing a whole lot better.

Speaker 1: 36:30

Amazing. Yeah, what a great example.

Speaker 2: 36:33

Exactly so, even if you think it doesn't really matter. I think this is why it should just be a part of an annual. You don't think there's a problem. But hey, let's just take a look, let's document it, let's just keep some tabs. Same with the hormonal changes, you know. Women should definitely be managing and tracking their menstrual phases, even postmenopausal or perimenopausals and things like that or any type that someone has a concussion. I think they should just get a little notebook out, you know, and start writing down and tracking some of those symptoms as well, so that a physician can maybe then look at it and piece it together.

Speaker 1: 37:06

Yeah, yeah, Awesome. Well, you have shared such a wealth of information that I think a lot of people are going to be. It's gonna be eye opening and fascinating for a lot of people to be able to to listen to this. So thank you so much for for coming on the show. Why don't you tell us where people can find you?

Speaker 2: 37:22

Absolutely. You can just reach out to Palm Beach Brain Center. I'm actually not heavily on social media, as I once was in the past trying to do a little bit of detoxing in terms of mental health and well-being. So you can just go to the website palmbeachbraincentercom, or the phone number and email is there. You could always reach out that way if you have any questions.

Speaker 1: 37:46

Wonderful, amazing. Thank you so much, dr Tatiana.

Speaker 2: 37:50

Thank you so much for having me on your podcast and to share this time with your listeners. I'm really appreciative and grateful for our time together. Thank you.

Speaker 1: 38:02

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