CKNW Health Series: Are we learning more about concussions?
February 23, 2017, 1:04 pm
It’s a word that we all know, but few of us really understand. In fact, the medical community itself is very aware of the fact that they do not fully understand traumatic brain injuries.
Here’s what we know for sure: We don’t know enough. And there are a number of reasons for that.
This might also come as a shock as well: British Columbia lags behind other provinces and many states in the knowledge of how to treat a concussion.
LISTEN: Are we learning more about concussions?
Dr. Cirelle Rosenblatt runs the only concussion clinic in British Columbia and explains just some of the difficulties they face.
“When Rowan’s law passed everyone turned around to [Health Minister] Terry Lake and asked him ‘what about B.C?’ And his response, if you look back on that day, that fateful day, was ‘we’re going to look into it.’ As if, as if this is a new problem that’s just crossed someone’s desk,” she says.
She’s referring to a piece of Ontario legislation passed in the wake of a 17-year-old Ottawa teen’s death following a pair of rugby concussions.
“And it’s just shocking to me.”
“Part of the reason I started a clinic was because since 2011 I was talking about doing something about this. And I spent two years with major foundations and organizations one after another after another, every one of them interested, every one of them saying they were going to start a clinic, every one of them asking for help and support, and asking for knowledge that to that point I had been able to achieve through some collaborations. And not one of them followed through,” she says.
“We don’t have one concussion program that is available in this region that can treat people and get them better from this injury. Not one. So this is the one dedicated concussion clinic in the entire province… And we’re private! But there is nothing publicly available, to support these patients, and no platform upon which to apply the knowledge that’s being researched and developed right here in our own back yard. There’s no funding, no service.”
So the one concussion clinic in the Province has its difficulties, but what about researchers and doctors in B.C.’s universities?
Dr. Paul Zehr is a professor of kinesiology and neuroscience, and echos some of Dr. Rosenblatt’s thoughts.
"I would agree that B.C. could certainly improve our standing and strength for sure,” he says.
Zehr says that Toronto has made itself a major centre in Canada for studying brain injury, investing significantly in infrastructure and creating the right research environment to drill down into the issue.
He says in B.C. that’s not the case.
“What I would say is that there are a lot of folks distributed across the province who are doing a lot of things related to concussions on the research side. I think what we really need is a way to knit these things all together with a theme, and taking an institute view. Something to coalesce all these efforts. I would say right now there are a lot of labs doing a lot of things in a kind of disconnected way."
But getting there requires one key resource. Money.
Zehr says it can be a tough competition for researchers to get their hands on scarce health care dollars.
“The truth is, I think a lot of that gets spent on the things that are more acute, that have the higher risk of death or significant burden,” he says.
“And I think a lot of times we still don’t view concussion in that light, despite the fact that we’re talking about things that can fundamentally change a person’s brain activity. With chronic concussion syndrome, you have the idea of effects on memory, the effects on memory on a person’s personality, all these things that affect who they are which is a fundamental part of being a human being.”
Believe it or not Ontario is the only province in Canada that has any type of law around concussion, and Dr. Rosenblatt says that law stipulates just one thing:
"That we need more education, and we need to be doing more about the problem. It doesn’t actually translate into what needs to be done so we’re still kind of debating the issue here rather than acting on it,"she says.
So how does this translate to the actual people who have suffered concussions? How has the disconnected research and single clinic in the province worked for the people that really need proper concussion treatment?
Miranda Podovinnikoff was in the U.S. playing soccer for a couple of schools when she suffered what turned out to be a concussion.
She says at first she thought it was heat stroke and didn’t seek treatment, instead flying home with her father.
Michael, Miranda’s father, explains what he saw happening to his daughter.
"She was just disoriented. The way she was walking and running, it was just different from her normal. And she had a really short temper. She started getting really mad really quick at everything, and normally she is so mild-mannered, that was kind of the clue."
So Miranda says they made the decision to visit a doctor.
"I had seen a neurologist at the Children’s Hospital and she said that nothing was actually physically wrong with me so she sent me to a psychiatrist who just came up with a whole bunch of stuff that turns out it didn’t help. He sent me to another therapist. She said that I had all this stuff but nothing, none of the treatments or anything actually worked. Because that wasn’t the actual problem."
This situation illustrates what both Dr. Rosenblatt and Dr. Zehr are talking about. Not only was a concussion not diagnosed, Miranda was being referred to the wrong people in the wrong fields.
She was unable to do many of the regular everyday things that we take for granted, all because her brain wasn’t getting the proper treatment.
Miranda finally started at Dr. Rosenblatt’s concussion clinic in June of 2016, more than 2 years after her initial concussion.
Since then, she says, it’s changed her life.
“I was at like the darkest you could ever imagine mental health wise. I wasn’t able to do anything, I was barely able to take my dogs for like a five-minute walk without getting dizzy by the cars, or even just having to turn in a circle because their leashes got caught up or whatever,” she says.
“Now, I just started going back to the gym… been able to work out and do some cardio and weightlifting, and I’m going to be going back to school this next semester going into University. That’s something I didn’t think I’d be able to do. Everything is definitely improved hugely now, I’m doing things I didn’t think I’d ever be able to do again."
Concussions, if left untreated properly can be physically, emotionally, and mentally debilitating. They can have a major impact on everyday life from the simplest of tasks to even just getting out of bed in the morning.
But if diagnosed and treated correctly they don’t have to become a burden. They can be overcome and managed.
To do that, Dr. Zehr says we all need to remember just how complex and important our brain really is.
‘The brain is fundamentally unlike other organs in the sense that if you didn’t know anything about how the heart works but somebody showed you a heart, or a model of a heart, and said okay squeeze on this put some fluid in there and you squeeze on stuff… you’d actually be able to work out how the heart works just from its anatomy,” he says.
“When it comes to the brain, it’s not just the anatomy you can see.”
He says there are tens of thousands of connections going on in the brain millisecond to millisecond, invisible in terms of simple anatomy – and it’s changing all the time.
“You can only see that when it’s functionally active. And this is one of the big barriers for people trying to understand ‘well how come you can [do anything?]’ It’s because your brain is so fluid and useful and adaptable that you’re actually able to ask those questions. A real famous scientist named Lau Watson from South Africa said if the brain were so simple we could easily understand it, we’d be so simple we could not.”