CONCUSSION TESTS

In contrast to what some clinicians and lay persons may believe, there is no such thing as a concussion test. While brain scans are necessary to differentiate between mTBIs and complicated-mild TBIs, they cannot exclusively be relied upon to diagnose mTBI. In other words, neuroimaging is not a concussion test. Similarly, neuropsychological testing and computerized cognitive screening can help clarify the nature and extent of cognitive symptoms experienced following a concussion, but also are not concussion tests. Additional examinations and tests can help inform healthcare professionals and family members about various aspects of the youngster’s condition following a concussion, but none of them is a concussion test per se. Such exams and tests include the following: biomarker assays (e.g., S-100B serum levels; Oris et al. 2018), electroencephalography (EEG), neurological exam, physical exam, postural stability (i.e., balance) testing, graded symptom checklists, and various phone apps. Although these assessment methods are of value in the clinical management of children and teens following concussion, they should not be misinterpreted as concussion tests.

DIAGNOSIS

Bender and Matusewicz (2013) articulated their concerns about the postconcussional syndrome diagnosis. These authors pointed out that the symptoms of postconcussional syndrome (e.g., headache, dizziness, emotional, or cognitive changes) are not specific to concussion and may not actually be a direct result of the concussion, but may flow from other sources, including pre-concussion psychiatric problems or substance abuse. Although not as applicable to young children, this would be important to consider with teenagers diagnosed with postconcussional syndrome. Similarly, neurodevelopmental delays, delivery complications (e.g., anoxia (lack of oxygen) at birth), and pregnancy irregularities (Kaufman et al. 2016) should be considered when trying to draw conclusions about postconcussional syndrome symptomatology. Bender and Matusewicz noted that concussion checklists can lead to overreporting of symptoms and that scores on such checklists predicted worse scoring on performance validity tests, raising questions about the validity of a postconcussional syndrome diagnosis, which is based entirely on self-report. Finally, these authors asserted that “the literature strongly suggests that postconcussional syndrome lacks specificity and that it has questionable diagnostic utility” (p. 114). Failure to appreciate the non-specific nature of postconcussional symptoms can lead to misdiagnosis of postconcussional syndrome and persistent symptomatology (Larrabee 1997; Larrabee 2005).

IATROGENIC EFFECTS

The power of authority commanded by healthcare professionals who diagnose postconcussional syndrome can trigger or fuel psychological mechanisms that contribute to or underlie the postconcussional symptoms. Put plainly, the healthcare professional making this diagnosis [i.e., postconcussional syndrome] can literally bring the diagnosis to life…thereby having an iatrogenic (i.e., harmful) effect on the patient. This phenomenon has been studied as is sometimes called response expectancy (Suhr and Wei 2013), a subtype of which is diagnosis threat (Suhr and Gunstad 2002). Thus, children and teens undergoing neuropsychological assessment in the context of concussion might underperform on the tests because they have come to believe that their symptoms were caused by the concussion. This is more likely if parents fuel such beliefs, which is not uncommon, especially if the parent has been misinformed.

CTE

More research on the long-term sequelae is needed to better understand the incidence and prevalence of CTE [i.e., chronic traumatic encephalopathy] and other neurological conditions among former athletes. The causes of mental health and cognitive problems in former athletes, like the general population, are broad and diverse including genetics, life stress, general medical problems (eg, hypertension, diabetes and heart disease), chronic bodily pain, substance abuse, neurological conditions and disease (eg, cerebrovascular disease) and neurodegenerative diseases (eg, Alzheimer’s disease, Parkinson’s disease and ALS).The extent to which repetitive neurotrauma causes static or progressive changes in brain microstructure and physiology, and contributes to later lifemental health and cognitive problems, is poorly understood and requires further study. (p. 8)

SPORTS CONCUSSION

…high school football is associated with an increased risk of concussion, and yet no causative link has been established between playing high school football and neurodegenerative diseases (e.g., MCI or dementia), is consistent with the most common clinical outcome among youth athletes who experience a concussion. Namely, they generally get better within about 10 days or less. This encouraging theme in the literature was described by Kirkwood et al. (2012) as follows:

…existing prospective controlled studies indicate that most high school and older athletes appear to return to baseline within 7-10 days after a concussion…Some percentage of athletes can be expected to display concussion-related problems beyond 1-2 weeks…

Although noncontrolled studies may be able to provide the number of athletes who display persistent postconcussive problems, they fail to account for the base rate occurrence of common postconcussive symptoms among non-head-inured individuals or account for false positives—that is, the number of nonconcussed athletes who would report ‘postconcussive’ symptoms or would be classified as impaired on objective testing at the time of postinjury measurement. (p. 345)

In other words, while a very small minority of concussed young athletes experience concussion-related symptoms beyond the typical timeframe of 7 to 10 days, the evidence of persisting symptoms is confounded by the fact that youngsters without a history of concussion experience these same symptoms for other reasons that have nothing to do with head injury.

It is important to emphasize that SIS (Second Impact Syndrome) is believed to be very uncommon and that it may even be a mischaracterization of some other neurobiological process. According to McCrory (2001), for example, SIS is more accurately viewed as diffuse cerebral swelling.

Recommendations for Pediatric Neuropsychologists

First, perhaps the most important recommendation is to know what a concussion is, and what it is not. In contrast to what is communicated in the media (Carone 2014), a concussion is not a grave or indelibly harmful injury, so parents, teachers, and other concerned parties should not worry about long-term negative consequences as a result of a concussion. Even though “The expected duration of symptoms in children with [sport-related concussion] is up to 4 weeks…” (McCrory et al. 2017) (p. 7), most children will probably experience a full recovery within 7–10 days. It is, therefore, recommended that pediatric neuropsychologists share this valuable information with those they serve.

Fifth, perhaps counterintuitively, it is recommended that pediatric neuropsychologists encourage a quick return to normal activities (Carroll et al. 2004; Ponsford et al. 2001), following the brief period of rest over the first 24 to 48 h. This does not, however, mean a quick return to activities that carry an increased risk for another concussion, as explained above.

Sixth, because there are no concussion tests, it is recommended that pediatric neuropsychologists disabuse parents and other relevant parties of the belief that such a test exists.

First symptom or sign of Rage to physically hurt others but did not act out thankfully handle it differently. What triggered me I think was the frustrations not getting return calls from doctors and the way they talk to me. Now keep in mind I use my checks and balances system for every good and bad behavior. The story is as follows.

Somewhere around mid-May, my doctor noticed my hemoglobin was elevated and ordered a fresh panel of our posted bloodwork. He then left for vacation. I went to Quest Labs and the technician, while drawing my blood, said she worked at a blood bank and that my blood was like red glue. I could be at risk for a stroke or heart attack and I should contact the doctor first thing in the morning and have them write a prescription to have a pint of red cells taken out. This procedure in my scenario is based off the hemoglobin count. It has been known to help with inflammation pain hand is great for overall health. I took her advice thanked her because she is not supposed to talk to the patients she said. She’s only supposed to take the blood as the test required. Their staff was kind and compassionate. The following morning, I knew my doctor was on vacation, but I left three messages over the course of the day for the nurse’s assistant who works under my doctor to call me back so I can have the description and the procedure done. No one called me back. I repeated the same process leaving polite messages knowing some things fall through the cracks and I do not want to come off as being aggressive or a hypochondriac. The third day I went to the office personally to figure out why I’m not getting return calls and requested the procedure and prescription. They said there was no one in the office at that time that could write the prescription. Then the following day I called and asked for the office manager to let them know that no one’s getting back to me. They told me she left for the day, but the nurse’s assistant is in and they will have her call me back. Finally, the nurse’s assistant called me and said, “how can I help you Paolo”. I didn’t want to go backwards and point out how unprofessional their office is with returning a patient’s call. So, I just addressed the issue and told her what the technician said. I said my lab work is back and can you take a look at my hemoglobin count and tell me if it’s abnormal. Normal from my understanding is a score of 11. She said it’s just slightly elevated and the doctor on call will not write you the prescription that I would have to wait until my doctor got back in town. I am still using my coping strategies and breathing techniques to remain calm. Inside my head, all I can think of is I’m at risk at having only a slight stroke or heart attack. This is a perfect case for malpractice. But I do not have the strength to find another doctor or practice that takes my insurance. I took it on the chin and just waited it out until June 13 where my doctor came in. Now I’m a grown man, but I had my father and best friend come with me, so I didn’t pop off or miscommunicate or not comprehend what they were telling me. The disease is the reason why I use my checks and balances system; I have to always make sure my mind is not playing tricks on me and I am living in reality.  My doctor called me in. I did not even bring up the events prior. I just sat calmly as he read my bloodwork. And he said “oh yeah you should need this prescription for the bloodletting every eight weeks” my hemoglobin counts war 16.5 where they should be 11. I just laughed.

If I would’ve took out my anger on my doctor, then I would’ve lost a vital piece of my support team to get my medications. So that was probably trigger one.

 Triggered 2:

I get a call and I usually don’t pick up numbers that I don’t recognize, and my personal number is not listed on the site, but I picked it up and it was a kid asking, “Is this CPMHA”? I was little rough because I thought it was somebody soliciting something. So, I asked who this is and what is it regarding. He said his Name was X, that he’s a high school football player and he thinks has CTE and was crying on the phone. I told him to calm down take a deep breath. Then told him, first, if you read or got our information from the website, we have disclaimers everywhere. I am not a doctor or a licensed therapist. I am strictly Sharing my story. The good, the bad and the ugly with complete transparency. So those who are following us might identify with one of my symptoms on CPMHA.COM  whether it be TBI/ CTE, chronic pain or mental illness that I suffered from and learn coping skills/ techniques that have worked for others and see if they can apply for some relief or be motivated to help others. He then said I’m sorry to bother you. but I just want to kill myself right now and I wanted to learn more about CTE.

After hearing that, I went into protective Paolo mode, one of my core values/Life codes. I remembered when I spoke about this topic(suicide) with Dr. Russell Bourne. He said, when someone brings up suicide, it’s healthy to talk about it, the worst thing you could do it Is to shut that person out.

So I said to X, “it’s okay bro”, first thing I want do is give you a phone number to call someone whose professional so I don’t give you the wrong advice so I gave him the suicide hotline phone number. Then I said after I get done talking to you, you must promise to call that number and he said okay.

Now I was in a position that I did not want to be in giving advice because I am not a professional.

So, I asked him, what are the symptoms making you want to commit suicide. He said he had a concussion two years ago and now he is gay, and his parents hate him, and he hates himself for being gay. I took a deep breath and reiterated I’m not a doctor, but regarding the concussion, you should get an MRI of the brain and see a neurologist and tell him all your symptoms and history. Be completely honest, even if you’re smoking weed or taken any other medications. He jumped in right away and says he doesn’t drink or do drugs. I said cool, good for you, you’re a better man than I am already then I proceeded to say, “From my personal experience and research I have done on my own, CTE is not caused by a single concussion. And I might be wrong, but I’m pretty sure that a concussion cannot make you gay. I have heard a crazy story, I don’t know if it’s true, but during my research I found a story of a woman that had traumatic brain injury from England started speaking with a Chinese accent out of nowhere.

That said, if you are truly gay and that’s what makes you happy, what’s wrong with that. The world is changing every day, people are more open now. If you are gay, it’s not something you should be ashamed of. I have plenty of gay friends even though I’m straight and some of my gay friends were professional athletes. One in particular was a hard-core Navy seal who served our country proudly and is hero in my eyes.

Then I asked him, if he had anything around him that could harm himself. He said yes. I have my gun in my hand and I want the pain to stop. I said strongly X, if you want to talk to me anymore, which I’m willing to do. I want you to take the bullets out of the gun while you’re on the phone with me and put the gun under your bed. He said okay, and I actually heard him following my directions. He then thanked me for talking to him. I replied, “Good man Now we both need to take a deep breath and chill for a second. because I’m freaked out X.” He then let out a little laugh. Which made me relax a little bit.

Then I started the conversation back up and said I have a policy I don’t talk about politics or religion because everyone has the right to believe what they believe and from my experience. If you’re not on the same page talking about those sensitive subjects, there can be conflict and I’m not about conflict. That said, I told him I was in a lot of pain, physically, emotionally and mentally; I wanted to end it. Anything to make the pain stop.

Now what you call pain and I call pain could be to different things. But pain is pain and it sucks, and I hate to see anyone suffer. But, thankfully, I spoke to an amazing man; who is now my cognitive psychologist. He didn’t try to talk me out of committing suicide, but rather he just listened and did not judge me. Then he proceeded to calmly and with compassion educate me on suicide.  Telling me that suicide is usually a mental health impulsive behavior obviously once you make a final decision there’s no coming back.  Then he said from my experience anything impulsive: sex, buying something, etc. Is not a good or healthy thing. Then he gave me a tool that I use all the time, called three-day rule. I explained it to him and told him that it will be

posted on the website soon. Then I proceeded to tell him that if your feelings are true and your gay so what?

Let’s paint a different picture then tonight Its dark thought you did a good thing you reached out to a complete stranger for some answers that’s pretty brave and you have my respect.  So, you go off to college, besides getting an education and degree. You grow as a human and find yourself. Then say you are gay, and you come to terms with it. You find a partner and fall in love and are happy. But if you kill yourself right now. You will never get to experience that amazing feeling of falling in love. But I can give you this advice don’t get married until you’re at least 30 Play the field and be safe. He laughed and said wow I feel a lot better and thank me. I replied don’t thank me you were the one brave enough to fight through the darkness and pain and reach out for help. So, I said are we cool X can I sleep well tonight knowing that you’ll call and speak to a professional and get different advice that will help you. He said yes sir. I say good because I have a crazy migraine and I need to rest, and we hung up the phone. 45 minutes pass approximately my head is pounding I am icing every joint in my body just about to fall asleep.

The phone rings again but it’s a different number. I pick up there’s a woman on the other end of the phone, angry saying who is this. I said you called me who are you. She said I just got done talking to my son. He said you spoke to him and told him it’s okay to be gay. Who are you to tell my son it’s okay to be a sinner? Now I’m a little pissed off, I said ma am your son called me, I was just trying to help him did he tell you that he has a gun in his room, and he wants to end it. She said well that’s not your business, are you at doctor. I said no ma’am, I’m not. She responds with, let me ask you this do you believe Jesus Christ is your savior. I said what the fuck are you talking about. She said that means no, I guess. You’re going to burn in hell. If you ever contact my son again, I’m going to send the police after you and sue your ass then she hung up. I was so confused/Troubled then anger ensued.

Trigger 3

My partner/ girlfriend is a good Christian woman and a southern woman. We are polar opposites except I am extremely stubborn so is she. I am street-smart New Yorker and self-taught entrepreneur. She is not and everything has to be by the book. She was screwed over by her ex-husband and I have trust issues. So, I think I’m being pretty fair and transparent. I do not want to be throwing her under the bus at all.  Because not too many women would stand by their partner who is dealing with my situation/ illness.

Last week my Little brother Andrew and ambassador to CPMHA, Alex, were over my house and helped me to pick up my dog, Jackson, from physical therapy because I was too dizzy to drive.

He is recovering from an ACL surgery. Prior to the surgery, I went up to talk to the vet who was going to perform the surgery on Jackson.

In the past, I sent a lot of my former athletes to a specialist and I have a little bit of knowledge on ACL surgery and recovery. I talked about it to the veterinarian how about the process in the cost. I made her aware of my financial situation as well as my medical condition and told everyone in the staff about CPMHA and ask them to spread the word and support us. The veterinarian told me the cost would be $ 2300 for the ACL surgery, $170 for the physical therapy consult. Then it’s $150 a physical therapy session.

So, the New York Street hustler in me came out, and I said listen, I am a former professional sports performance coach. I would never have anyone I care for just have surgery and no physical therapy it’s a waste of time. Can you work with me on the price? She said yes if I sign off today it will be $4700. That would include unlimited physical therapy and the surgery but not the medication. I said that’s fair let’s proceed. Three weeks go by and I take Jackson for his second physical therapy session. And they tell me that the veterinarian, Dr. Evans, was fired and is no longer working with them. But it’s okay, I will be working with the main the veterinary who owns the practice and he’s a better Vet and I will be in good hands. So, Jackson’s physical therapy session was scheduled twice a week approximately 10 days ago, with Alex staying in the car, I walk inside to pick up Jackson from Physical therapy. The physical therapist tech brings Jackson outside and says he is doing great. We are going to cut back his physical therapy to once a week. I said why as soon after surgery he still can’t put pressure on the leg. The tech is giving me all this roundabout talk. Finally, he says when someone’s package is coming to an end, we try to stretch it out and cut back to once a week. I said package coming close to an end, what are you talking about? He tells me that I had a package of 10 that cost $800. I said fine, so where did the rest of the money go? I paid $4700. The surgery cost $2300 now you’re telling me physical therapy package of 10 which we have not even used yet is $800. If you add those together, that is only $3100, we are missing $1600, where did that money go. The tech goes back in the room and calls a bunch of the staff wait a half hour comes out and says we will have to go through the receipts and get back to you, I only do the scheduling and do the physical therapy with dogs under Dr. Chang. I said fine, mistakes happen, as long as Jackson is taking care of, we are all good.

The next day Sherry gets a call from Dr. Chang, the physical therapist, saying the whole staff was afraid of me and they know I have a mental illness and they feel uncomfortable if I come up to the office anymore. I was blown away completely speechless over the phone.

Sherry was at work and I could tell she was all stressed out. So, I decided we talk about it later. I proceeded with my day of doctor’s appointments and made sure the house is clean so that she was not in a stressful environment when she came home. She walks through the door looking stressed and out energy and I ask her just to give me 10 minutes of peace and leave me alone so I can compose myself because I’m hypersensitive. She doesn’t give me more than two minutes before she rants to me about something stupid and I pop I yell and say you can’t give me 10 minutes after I busted my ass all day. Now no matter how sick, I will never put my hands on a woman or child. I could feel this rage inside of me that I used to feel when I was a fighter and I did not like that feeling. I just walked away and went in my room to decompress.

She comes in calmly in about 45 minutes and I can feel myself still in that bad place she says can we talk. I said no I really need to gather myself will talk tomorrow, thinking I was doing the right thing. She then proceeded to say, well look, I spoke to the doctor’s office. It is what it is, Jackson only has three more sessions left they’re afraid of you and I feel very uncomfortable. I explode, I said you’re going to take their side over me. She said well you’re always doing the street hustle deals now veterinarian who you made that deal with is no longer working there and it’s your word against theirs and obviously you opened your mouth about your CTE, so you have no credibility.

My hands were shaking, I said are you kidding me we have receipts, it’s simple math. She said she cannot deal with the stress or confrontation; it is what it is. I said no, it’s not that’s not how I work. When I make a deal, I stand by mine part and I made sure the other people standby theirs. I’m sure as hell not going to let somebody steal a dollar from me. Then I said something cruel and I regret. I said I’m not like you; you make stupid mistakes and let people walk over you. You payed a contractor upfront in cash to do work on the house then they never come back and finish the job and you lose the money and you just take it. She starts to cry. Leaves the room says she’s never had anybody ever talk to her this way or be so mean.

I know I am far from being saint when it comes to dealing with men you do not want to mess with me. But when it comes to women children or animals. I know I’m not perfect, but I know I’m a good man. Yes, I’m a passionate, loud, Italian New Yorker when it comes to confrontation or disagreements. Especially now, with what I’m going through not that it’s a good excuse for anything but every day the smallest thing I work hard to make myself meet one main goal: be a better person to myself and to others. I thought I was doing a good job. I told her not to worry, I love her, but I might need to go a hotel for the night to gather myself and I think I don’t know if it is healthy for me to be living under the same roof with her. If I am hurting her in any way or making her life any more difficult and stressful. I knew this disease would be a strain on my relationship, but I didn’t think it would happen until I physically started to breakdown like an Alzheimer’s patient where I’m not even close to being in that category yet.

So, I drove to the beach I meditated ended up breathing exercises for about an hour. Unfortunately, Dr. Bourne was on vacation, so I did not want to cross the boundary and call him for direction. But I couldn’t get rid of this rage also the feeling that I was going crazy that I was not in reality, and I felt betrayed by Sherry. That she didn’t have my back, so I feel like trust was broken. But using my checks and balance system. I reached out to my mother and father to run the story by them to get and impartial reaction. I explained it to them my energy was intense my mother said I’m looking at you right now and I’m afraid of you. My heart broke. My father said you can’t blame Sherry she does not come from our world. You should kiss that woman feet for sticking by you when you’re this sick. So, what, if the veterinarian’s office ripped you off the $1600. I know you telling the truth because I remember you telling me everything as it was going along. But is $1600 Worth hurting Sherry? I took a deep breath and said no but I just can’t handle somebody take advantage of me, and then on top of that They played a mental illness card.

I started to get heated up again thinking about it. You’re telling me you would let somebody rip you off. That’s why I can’t come to you guys and I must use Dr. Bourne. Then my mother chimed in she said she was bought up on the straight narrow my father always hustled for everything and at the drop of a dime he could become very scary people. It took a long time in our relationship for me to adjust to the way he conducts business. And you’re just like him but the major point your father said is $1600 Worth hurting Sherry for all that she is done for you and been there for you.

That’s the big picture. It struck a chord with me. At my age, I have to re-create myself, so I took this it on the chin and I apologize to Sherry. And I told her, if she wants to handle the vet from now on and that’s what makes her comfortable, that’s what I’ll do. My feelings and energy towards her have changed to be honest I feel a little betrayed but I’m hoping I will get over it. Just like she tries to be patient with my garbage.

Hopefully I can use this is a learning lesson to control any anger or frustration in the future to breathe walk away from a problem discuss with the support System and turn the negative into a positive and be productive.

Latest Trigger/ Two sides to every story (Week of February 15th):

I almost let the beast out but I try to bury those feelings and never break my code of putting my hands on someone that’s weaker than me physically or emotionally whether it be a woman, or a child or an animal no matter what the situation. There is no excuse. Thankfully I haven’t acted out physically and I have myself under control.

I have the house to myself, just me and my two dogs and there is complete peace and great energy. Pain and migraines are pretty bad as expected, but my neck and joints are feeling a little relief. There has been no ringing or sounds in my brain or senses. I’m extremely upbeat, motivated by the support of my small team of Andrew and Sarah and I am calm and have no anger working on coping skills for dealing with frustration and I think is working. My memory, concentration and vision have all seen a decrease. I went through my old workouts reaching back to 2015 when I started the CTE symptoms on a very small scale. I decided to push through the pain and do a very small-scale nonfunctioning strength test today. I could barely do three sets hope 20 push-ups. Back in 2015 I was bench pressing 395lbs one set of five. One set of three in the last set of one at 400lbs again this was not a functional or suggested training technique.

If you are concerned that you or someone you care about has CTE, you are not alone. There is help. Many symptoms of CTE are treatable, and resources are available to help you find support and live a full life. It is also important to know that people who appeared to have CTE while alive have been found not to have CTE upon post-mortem examination of their brain.

CTE can pose challenges, but they are challenges that you have tools to fight. If you are concerned you have CTE, there is much you can do to help maintain a healthy and enjoyable life. 

If you are struggling to cope and would like some emotional support, call the National Suicide Prevention Lifeline at 1-800-273-8255 to connect with a trained counselor. It’s free, confidential, and available to everyone in the United States. You do not have to be suicidal to call.

WRITE THINGS DOWN:

If you have concerns about your memory, writing things down can help you be more productive and maintain a sense of control over your life. Whether you keep a notebook, use voice memos or put in calendar reminders on your phone, a system can help.

DEVELOP A ROUTINE:

Creating structured environment, planning tasks to complete and goals to accomplish can help with creating sense of stability. Whether it’s sleep, cooking breakfast, or going for a nature walk, approaching one task can make life more manageable.

CONTROL IMPULSIVE BEHAVIORS:

Studies show CTE can damage parts of the brain that regulate impulsive behaviors. Be cognizant of unhealthy habits like gambling, overspending money, using alcohol, drugs, or other addictive substances to cope with problems. Avoid activities as needed or seek professional help.

SELF-REGULATION:

Managing emotion, anxiety, and stress is an important and learned skill. Practice relaxation techniques like deep breathing, meditation, or counting to 10 to help ensure your emotions don’t get the best of you. Seek professional help to find the right techniques for you.

BUILD A SUPPORT SYSTEM:

Reaching out to people you trust can help get you through moments of stress. Friends, family, colleagues, a church community, a hobby or sport club, or a crisis hotline like the Lifeline can all serve as sources of support. If you are concerned about your safety in a moment of crisis, you can make a safety plan to guide you through those especially difficult moments.