You might have suffered a concussion playing football as a high school or college student, and because you felt nauseous and dizzy, you rested for a few days, just as your doctor advised. Those few days passed and you felt like your old self again, ready to return to the field.

Fifty years later, your family is concerned about your memory: you don’t know what month it is, and you can’t recall the conversation you had with your son two hours earlier. Your wife eventually takes you to a neurologist, who diagnosis you with Alzheimer’s disease. You’re surprised. After all, you have no family history of Alzheimer’s, and you’ve worked hard to keep your brain sharp: you’ve been an avid reader and crossword puzzle fanatic for years. The neurologist must be wrong, you think. Or maybe you haven’t considered the concussion you sustained half a century earlier.

A brain injury is a risk factor for Alzheimer’s. It’s possible that all it takes is one concussion. On autopsy, an Alzheimer’s brain reveals beta amyloid deposits – proteins that collect between nerve cells. Tau, tangled fibers of proteins, collects within the cells. As we age, it’s not unusual to expect protein build up within our brains, but in Alzheimer’s, they accrue in greater amounts, impeding communication between nerve cells, causing memory impairment and personality changes.

In autopsy studies of those who have died in the acute phase of a traumatic brain injury, researchers have found amyloid deposits in thirty percent of people, including children, and increased tau levels in the spinal fluid of those who died of a severe traumatic brain injury.

But studies have proven that amyloid is a mysterious protein as it relates to head trauma. Researchers have learned that individuals with mild cognitive deficits, who reported a history of brain trauma, showed brain changes consistent with Alzheimer’s. But those with no cognitive impairment, who also reported a history of brain trauma, did not show any changes.

So, at least there is hope – if you have suffered a brain injury, maybe you’ll be among the lucky and will escape the sticky plaques and fibrous tangles.

http://www.medscape.com/viewarticle/818376 http://depts.washington.edu/adrcweb/research-101/traumatic-brain-injury/

You reach for the bush, grab a cluster of summertime, then pop the handful of nature’s sugar into your mouth. A burst of warmth coats your tongue, meanders down your throat, and you think of homemade jam. You grab another cluster, then another, and eat them all, guilt-free, because you know they are good for you – blueberries.

They may be small, but wrapped inside the sheen of a blueberry skin lies a treasure of health benefits: vitamin C for immunity, manganese for strong bones and for converting fats, proteins and carbohydrates into energy. Blueberries are packed with fiber, which helps reduce cholesterol. Research shows that they even reduce the risk of obesity. Polyphenols – substances that give blueberries their blue-purple color – fight off unstable molecules that put us at risk for heart disease, cancer, and Alzheimer’s disease. Health magazines, Dr. Oz, and likely your own mother, have touted the benefits of eating blueberries. But did you know that these blue jewels, which have been around for more than 13,000 years, might help survivors of traumatic brain injuries recover?

The brain functions normally in the presence of glutamate – a neurotransmitter, or chemical that mediates excitatory signals through the nervous system. But, after a brain injury, glutamate rapidly increases, destroying cells. However, in animal studies, researchers have noted that when extracts from blueberries are added to the cells with glutamate they are actually protected. Though it is not necessarily a good idea to always heed “the more the better,” but “the more berries you eat, the better your brain will be protected if a stroke or traumatic brain injury occurs,” says Dr. John Weber, a researcher at Memorial University’s school of pharmacy. Dr. Weber, and others, is still trying to determine exactly how many blueberries are needed for a specific amount of antioxidants – molecules that combat free radicals, or unstable molecules – to reach the brain, and how long they will remain there.

But Dr. Weber is clear about one thing: those who have suffered a moderate to severe injury might not benefit from eating blueberries. Yet, the extracts in berries might be helpful in the later stages of healing.

Blueberries store well in the freezer –they don’t suffer damage to their fragile polyphenol skins. So, at only 80 calories per cup, stock up, and eat up!

http://www.naturalnews.com/032219_polyphenols_blueberries.html

http://www.blueberrycouncil.org

http://www.whfoods.com/genpage.php?tname=foodspice&dbid=8

http://www.thetelegram.com/News/Local/2014-08-05/article-3823293/Blueberries-could-help-heal-brain-injuries/1

You might think of war veterans when you hear, or see, the words post-traumatic stress disorder – an anxiety disorder recognized after the Vietnam War, when soldiers returned home with symptoms of mental illness. You might also think of victims of tragic accidents, rape victims, or those who have endured any kind of abuse. What about health care workers, such as nurses? We tend to think of nurses as in control, emotionally strong, even in the face of gore and death. Still, nurses often hear others ask them, “How do you do what you do? How do you manage watching people die all the time?” But nurses suffer from PTSD too, also referred to as compassion fatigue, vicarious trauma, or empathic strain. PTSD is an occupational hazard for nurses. Fourteen percent of nurses experience PTSD symptoms – compare that statistic to the 3.5 percent of the general adult population.

Critical care, emergency room, and labor and delivery nurses are particularly at risk for PTSD, as well as those who work on rescue transport teams. For long shifts – twelve, sixteen, hours they witness an unending stream of trauma: shooting and stabbing victims, an attempted suicide victim, the deaths of newborns – the list goes one. Nurses cannot simply walk away from patients who are bleeding or not breathing. Their duty is to be wholly present – physical and emotionally – at patients’ bedsides. And since nurses are perfectionists (I’m a nurse, so I know the feeling), they might view their own PTSD as a sign of weakness. It’s easier for them to see symptoms of PTSD in others, because that’s what nurses are supposed to do – assess patients, then intervene on their behalf. Nurses, unfortunately, don’t take care of themselves.

Treatment is simpler than you might think: stretches and meditation. Researchers at the National Institutes of Health followed 22 nurses with PTSD symptoms. Led by someone trained in exercise science and martial arts, the nurses participated in a twice a week mind-body class that involved stretching, deep breathing, meditation, and balancing techniques. After eight weeks, half of the nurses experienced a 41 percent decrease in symptoms; the other half experienced only a four percent decrease. The exercises were simplified so that the nurses could easily engage in them anywhere at anytime, even during a quick bathroom break.

For more information see The Endocrine Society’s Journal of Endocrinology and Metabolism, Volume 98 Issue 7 – July 1, 2013.

http://nursing.advanceweb.com/Features/Articles/PTSD-in-Nurses.aspx

http://www.uic.edu/orgs/convening/vicariou.htm

http://psychcentral.com/news/2013/05/30/mind-body-techniques-reduce-ptsd-in-nurses/55418.html

http://press.endocrine.org/doi/full/10.1210/jc.2012-3742

Because traumatic brain injuries are the result of a trauma, it’s common for TBI survivors to also suffer from PTSD. But differentiating the cause of symptoms can be challenging. Depression, anxiety, cognitive difficulties, and fatigue are common to both. But PTSD is a mental condition, whereas TBI is a neurological condition.

In TBIs, individuals may experience retrograde amnesia: memory loss of events – usually recent ones – that occurred prior to the injury. Before the elderly driver ran into me at the Santa Monica Farmers’ Market, I recall holding a peach, then nothing else, until I woke up in the emergency room more than an hour later. Even then, my memory is spotty. In PTSD, people are haunted by intrusive thoughts and memories of the trauma. Even though I do not remember the accident, I have been haunted by thoughts of the gruesome scene. Imagination is powerful.

Fatigue is a hallmark feature of TBIs. The brain tires easily, and therefore must work harder to process information. When I’m exposed to too much stimuli – chatter, whining children, and bright lights – I feel as if my head is stuffed with cotton. In PTSD, hyper-vigilance keeps people awake (see Post-Traumatic Stress Disorder: A Re-Wired Brain). In anticipation of nightmares, they may be afraid to fall asleep. So my TBI causes my brain to work over-time, and the nightmares I still experience startle me awake, keep me awake, draining what little fuel is remaining in my brain.

In TBIs, there may be damage to the frontal lobe – the area of the brain that controls emotions and personality, so emotional swings are not uncommon. In the few years after my injury, I found that I was more irritable and cried for no apparent reason: when washing the dishes, or standing in line at the bank. Emotional numbness is more common in PTSD. People may no longer be interested activities they once enjoyed. I recall days when it took a Herculean effort just to get out of bed and dressed for the day – sometimes it still does.

About fifty percent of those with TBIs suffer from depression. Compare that to the approximately seven percent among the general adult population. Depression is also common in those with PTSD, particularly war veterans, but since they want to avoid the stigma of mental illness, they hesitate to report symptoms and refrain from talking about the trauma at all.

Since PTSD is an anxiety disorder it’s natural for people to experience heightened stress, especially when reminded of the trauma. But in TBIs, people appear unmotivated when the truth is they lack the ability to initiate activities. I may seem lazy because I don’t cook and rarely food shop, but that’s because my TBI presents with the inability to make decisions – which kind of pasta to buy, or what to cook for dinner.

Given the overlapping of symptoms between a TBI and PTSD, neither one fits squarely on its own shelf. But I suppose that’s the way it goes with most things.

http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml

http://www.brainlinemilitary.org/content/2013/03/tbi-and-ptsd-navigating-the-perfect-storm_pageall.html

Ten months before I suffered my traumatic brain injury, I started learning how to play the fiddle. But, distracted by pain, fatigue and medical appointments during the first months of my recovery, I thought I’d never play it again. And the few times I tried, the notes sounded either too flat or too sharp. I’d put it back in it’s case, then set it in the corner of the living room, somber and angry at the same time.

Through the persistent support of friends, I eventually practiced again, every day. I started practicing for ten minutes at a time, but quickly increased my sessions to twenty minutes, a half hour, then an hour. I needed the music – immersing myself in the sounds of each note and the melodic phrases of Irish jigs and reels helped me to focus. But I did not know what effect playing the fiddle, or learning any instrument, had on the brains of TBI survivors.

Scientists used to believe that changes in the brain could occur up until only childhood. But modern research has shown that the brain can create new pathways and alter existing damaged ones to form new memories and learn new information. The process, called neuroplasticity (brain remapping) can take months, or even years. But neuroplasticity can also occur through active learning, called structural plasticity. Researchers have found, through music training, areas of the brain involved in cognition such as memory, speech, attention, and language are strengthened. For instance, children who are musically trained have stronger vocabularies and reading skills than those who are not musically trained. Similar patterns have been observed in adults.

So I continue to push the bow across the fiddle’s strings. I call these sessions my brain workout.

http://neurosciencenews.com/neuroscience-music-enchances-learning-neuroplasticity/

Neuropsychologists are not medical physicians; they are psychologists who study the relationship between behavior and the brain. They first interview the individual: work and medical history, family dynamics, and school performance. The neuropsychologist gathers this information in order to compare level of functioning prior to a traumatic brain injury with post-injury functioning. The testing covers a broad range of areas: concentration, attention span, basic and abstract thinking, memory, mathematical reasoning, motor skills, problem-solving skills, judgment, and emotional character.

In May 2006, when I believed there had to be more than PTSD to blame for my difficulties in the workplace, I saw a neuropsychologist. I spent eight hours filling out self-evaluation forms and undergoing testing. Separately, my husband and I scored (one being the best, ten the worst) my level of irritability and depression, and my ability to remember things, concentrate, multitask, recall words, and think quickly. Our scores were nearly identical, with most of them ranging between five and eight. I spent the remainder of the day filling in dots on questionnaires, naming faces in photos, sticking pegs in tiny holes in less than fifty seconds, drawing figures from memory, naming as many items as I could think of that started with the letter T in less than one minute.

A few weeks later, the results came in the mail: the tests suggested I had sustained a traumatic brain injury when I was hit by a car three years earlier.

Finally, I had answers as to why I had trouble following conversations, learning new information, or performing most tasks in a timely manner. Finally, I had a reason as to why I could not retrieve the word from my brain when the neuropsychologist asked me to name the photo of two vertically connected glass bulbs with sand trickling from the top bulb to the bottom bulb.

Hourglass.

Emblematic of the passage of time, the hourglass also marks new beginnings.