The multi-systemic nature of TBI
How neurovascular uncoupling affects the brain, gut, hormones, and heart
With the end of my season in Vancouver comes the end of hyperbaric oxygen and neuro-rehabilitation. One might think, at this point in the N=1 experiment, that if the problem was primarily one involving the healing of tissues or cells, we might be a little further along. I've done nearly 30 hyperbaric sessions, and almost 10 neuroplasticity sessions. At the request of Dr. Jalili, I also did some NAD IV therapy to support the production of brain energy while I undergo my last couple sessions.
Yet a number of problems remain, and in fact some seem to be getting worse—vein and artery health, heart health, and hormone health. Little did I know, until all of this work in Vancouver, that these are common problems in the long-term management of a traumatic brain injury.
TBI is a multi-systemic disorder: neurovascular uncoupling
In recent conversation with Dr. Jalili, CogniveFX, and the good folks at Concussion Doc, long-term TBI symptoms are known to be the result of “neurovascular uncoupling,” or the disconnection between neurons and blood vessels in the brain. During the initial phase of injury, the neuron is stretched from the axon, causing the blood vessel to pull away and also damaging the cell’s transfer ports where calcium and potassium are exchanged. Signals fail to move as seamlessly as they ought to. This creates an energy deficit, leading to hyperexcitability of sensory input but also a reduction in ATP—the cellular fuel of the brain.
The reduction in signalling potential eventually leads to issues with the heart and the body’s metabolic system. Messages that are supposed to come from the body fail to reach the right parts of the brain, so there is no “off” signal to be transmitted either through nerve fibres or the body’s various hormone systems.
Dr. Jalili also discovered that I have developed POTS, Postural Orthopedic Tachycardia Syndrome, where the heart begins to race and then fails to stop because the “off switch” doesn’t work. Blood pressure is also dysregulated. I have felt something like this for years, but recently realized that it's been getting worse. And I knew it wasn’t a problem primarily involving my thoughts or mental health. During one set of therapies, the heart would shoot up and then down in a state of rest depending on what angle my body was tilted at. This was the result of my brain simply trying to find itself in space. Neurovascular decoupling would explain why this happens.
Tongue stimulation and eye movement would then be applied to bring the heart back to a normal resting rate, at least for an hour or two. Otherwise, the brain fires indiscriminately to make up for the fact that signals can't be precisely targeted. If the body is in “fight-flight-freeze” mode, the brain can stay indiscriminately alert, at least before catastrophically hitting the bed in a lump of pure exhaustion. It’s like running a marathon for several hours a day, and that’s not an exaggeration.
Inverted heart behaviour and brain network function
One of the other paradoxes uncovered is that the only time I achieve an acceptable resting heart rate is when I’m doing mentally stimulating or high-focus activities—like the gyrostim (where I’m spun around, tilted upside down, and asked to hit a bunch of targets in my field of vision). Under those circumstances, the heart rate should go up.
Dr. Jalili’s theory about this inversion is that somehow in the process of trying to forge ahead over these last few years, I used my prefrontal cortex to overcome default-mode brain energy dysregulation. So when I’m attempting to “rest,” one of the only ways to achieve a regulated body and heart is to simultaneously work, count, or analyze something. If I was a workaholic before, now it’s an unfortunately ridiculous survival strategy. The only way to confirm this theory would be with a scan that isn’t offered in Canada.
The role of the pituitary gland and HPA axis
Other hormone tests have also revealed bizarre new systemic problems that one would not assume are caused by a TBI. The pituitary gland in the brain is known to be compromised after years of misfiring, which eventually causes a problem with many of the body’s hormonal systems: growth hormone, insulin, aldosterone, cortisol, and testosterone. These are all out-of-whack now, leading to problems with veins, arteries, the gut, and the heart. In long-term TBI, the gut fails to work during waking hours but then overcompensates at night as all the blood is redirected from the brain and limbs to the stomach and intestines; the process reverses with the first hit of cortisol in the morning.
While some of this can be compensated for with medication or natural compounds, it's obviously a bit of a bandaid for a complex set of problems. It’s better to target the repair of the pituitary gland, HPA axis, and vascular system.
So, how do we do that?
The main effort now has to be to recouple the brain's veins and neurons with the hope that it will also improve the body’s hormonal and nerve signalling. While some doctors have previously discouraged physical activity because it seems to lead to a serious increase in symptoms for a day or two, this cohort of doctors encourage as much physical exertion as possible under the circumstances.
I know myself to have been a pretty active fellow previously, so it's been pretty hard to accept this state of relative immobility. It doesn't help that this all spiralled during the pandemic when working out in public was not much of a thing. The best time to have started with activity would have been around about the time we were all locked down.
Diagnostic scans and more precision medicine?
Beyond that, the only way to get more precise and see where the blood is not moving would be to get a mult-thousand-dollar diagnostic scan. The easiest place to do that would be at CognitiveFX in Utah, which offered me an appointment next week. In an earlier post, I expressed a great deal of interest in the idea of getting a SPECT scan. Both an fMRI and SPECT can identify precise areas with a lack of blood flow.
When confronting this plateau, the spectre of declining heart and hormone health, and the possibility of neurodegeneration in the future, precision medicine at this juncture seems like the best shot. I’ve also re-engaged the folks at the Mind-Eye Institute in Chicago, which I visited last year, because eye tracking tests have uncovered a need for further visual therapy. I wasn’t convinced with my first appointment there, but it’s clearly an important target point going forward.
There is, however, one other option: the IV doc I was working with today also suggested that I might be able to get an fMRI, neurorehab, and a series of infusions if I were to go to a place like Turkey, Mexico, or the Philippines for a few weeks. This is not something I would have previously contemplated, but with all of this new information, I’m not sure how else to target all of the many systems that need attention if I’m to have any quality of life going forward. She'll recommend a clinic to get this done all in one place. Regardless of what she finds, I might just be on my way to Utah next week.