June 2, 2025 • 55 mins
What really happens when the brain is injured—and why do so many cases go unseen? In this premiere episode of Unseen Impact with Rory Pendergast, Rory sits down with quadruple board-certified neurologist Dr. Amir Bahreman to break down the complexities of traumatic brain injuries (TBI). They explore how even a “mild” TBI—often caused by common events like rear-end collisions—can lead to long-term cognitive, emotional, and psychological challenges. Dr. Bahreman explains why brain injuries are frequently missed in ER settings, how chemical imbalances (not visible on scans) play a critical role, and why early diagnosis and documentation are key.
Whether you’re a victim, caregiver, or just curious about this misunderstood injury, this episode is a powerful resource. Learn what symptoms to watch for in the first 72 hours, how pre-existing conditions like anxiety or ADHD can affect recovery, and what steps you can take to protect your rights and your health. Unseen Impact is presented by Rory Law Firm. To connect, visit RoryLaw.com.
Be sure to follow and subscribe at olasmedia.com
Here are some key moments from this episode:
00:00:00 – What Is a Traumatic Brain Injury?
00:01:16 – Meet Dr. Amir Bahreman: Quadruple Board Certified
00:04:14 – Brain Injuries: The Invisible Epidemic
00:05:26 – Why ‘Mild’ Traumatic Brain Injury Is a Misnomer
00:10:17 – Why Emergency Rooms Often Miss TBIs
00:16:30 – The Science Behind Whiplash Brain Injuries
00:22:47 – Pre-Existing Conditions That Worsen TBIs
00:28:15 – The Full Spectrum of TBI Symptoms
00:30:17 – What TBI Recovery Looks Like
00:37:25 – What Patients Should Bring to a Neurologist
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
S1 (00:23):
Welcome, everyone. My name is Rory Pendergast. I am the
attorney at Rory Law, and today I am very excited.
We have Doctor Berryman here, a a quadruple board certified.
He has a neurologist. He deals with brain injuries. And
so today we're here to talk about brain injuries. Traumatic
brain injuries. Uh, what what they are, how they can
(00:46):
come about and kind of some of the things that
that you as the victim, you as a friend or
family of the victim can, can, can do to help
you one get to a neurologist and then help you
with that process. I know from my own practice, uh, the,
the brain injuries can impact somebody from, you know, a,
a 50 mile an hour car crash, 50 mile an
(01:06):
hour motorcycle crash down to a, you know, a very
low speed rear end, sort of whiplash, sort of, uh,
whiplash injury. And the brain injury can impact everybody. But
we don't want to hear just from me, because what
do I know about it? Right. We want to hear
from the quadruple board certified doctor. Doctor, thank you for
(01:28):
joining us.
S2 (01:29):
Thank you very much. Can you tell.
S1 (01:31):
Us so for not just one, not just two, not
just three, four. What are your board certifications?
S2 (01:38):
Uh, again, thank you so much for having me here. Um, I'm.
I have four board neurology. Number one is, uh, general
neurology and psychiatry. I am board certified in, uh, electro
physiology and neurophysiology. I also am certified in vascular neurology
(02:03):
or a stroke. Neurology. And also, uh, brain injury medicine.
S1 (02:07):
Okay. All right, which I think we're going to spend
a bit of time today talking about. So should we
get to it? Let's get to it, please.
S3 (02:15):
Okay.
S1 (02:16):
All right.
S2 (02:18):
I finished that fellowship program. And, um, I started practicing well.
S1 (02:24):
And I got to think especially around, you know, that 2005, 2007, 2008, 2010,
brain injuries were a big part of of our world.
S2 (02:34):
Absolutely. Uh, especially 2001. Yeah. If I can say when
the September 11th happened, I was in New York. I
was my last year of residency when that disaster happened
to our country. Um, that was a huge, uh, we
(02:55):
saw in New York a huge aftermath, not just because
of that day, because of the following complications and consequences
in terms of PTSD and a lot of lot of
other psychological issues following that.
S1 (03:10):
Well, and then with San Diego being such a huge
military town, you know, up into Pendleton, all of these things,
I think that that that neurology is a really big field,
particularly since, you know, the the we went into the
Middle East, all of those sort of things. You have
the service members coming back and they're having brain injuries. Right.
Or they're, they're, you know, having all of these things
(03:31):
going on.
S2 (03:32):
That is correct.
S1 (03:33):
And so, okay, so can I say, would we be
able to say that your specialty is brain injuries or
as a neurologist, what would you say your specialty or
one of your specialties are?
S2 (03:45):
I have uh, besides the general neurology, I have three
extra fellowships and training. One of them is brain injury. Uh,
I am also trained for vascular neurology or stroke, and
also for neurophysiology. Electrodiagnostic as well.
S1 (04:04):
All right. And then, so, you know, we're here because
talking as a personal injury attorney, you know, I deal
with folks who have brain injuries. And so one of
the things that we wanted to talk about is kind
of what is a brain injury? You know, we see
it all over the place with service members, with football, concussions, with,
you know, I've got a daughter who's in who's playing
(04:25):
soccer and they said they can't head the ball. So
I mean, I think any more in today's age, brain
injuries are, are, are known or at least the words
are known. But what is a brain injury?
S2 (04:37):
That's a great question. Um, while this is one of
the most important topic in medicine, if I tell you
that that's something that we don't see most of the time,
we know it's there, but we don't see it. You
can't believe me. This is one of the major cause
(05:00):
of death in this country.
S1 (05:02):
Brain injuries, brain injury. Okay.
S2 (05:04):
50,000 annual deaths is from the brain injury. Those are
obvious cases. Yeah, but 80 to 90% of the traumatic brain.
Injuries are mild and we don't see anything. It's just
the person with a history of injury and we see
(05:25):
the aftermath.
S1 (05:26):
And so this is one of the things that that, that,
that I deal with is on the attorney side is
we hear mild traumatic brain injury. Right. So if somebody says, oh,
I have a mild ankle sprain to me that says
it's there's not it's not a big deal. So when
somebody says mild traumatic brain injury what does that mean?
S2 (05:49):
First of all, if you go back to the definition
of the brain injury, um, any chemical or structural alteration
to the brain is called traumatic brain injury. So any
chemical or structural alteration caused by any impact or insult
(06:12):
or trauma is called traumatic brain injury. Obvious cases are
having traumatic brain injury with structural changes. We see it
in MRI. We see it in imaging and everything. Obviously
the patient having more problems. There is a type of
traumatic brain injury which is called mild traumatic brain injury.
(06:35):
80 to 90% of the cases are this strange. And
we only see the chemical changes. We are seeing the
evidence or consequences of chemical alteration. We don't see anything else.
They called it mild based on the category and classification
that we have is called GCS score classification. Basically, it's
(06:58):
a misnomer for this. This is unfortunately, after many, many years,
we have not come up with a better classification and
we are still using it based on the presentation, a
clinical presentation at the time of the event.
S1 (07:15):
And so that's the thing. So for instance, for me
as the personal injury attorney that the Glasgow score, that
score that's happened, it's taken immediately. So you have somebody
who's injured and they take some sort of this score
that goes on. And that's kind of what becomes that's
in the records and that's what people are looking at. Right.
S2 (07:34):
Absolutely. Again, unfortunately, we have not come up with a
better way and a way to kind of classify the
impact at the beginning with the outcome. Yeah. So when
you are saying mild.
S3 (07:49):
Yeah.
S2 (07:49):
It's a misnomer in my opinion. 20 to 30% of
the mild cases can have lifetime consequences and complications. So
technically not only there are not mild, actually there are
very disabling. But based on the initial presentation we call
them mild, moderate or severe.
S1 (08:12):
Okay. And and that can have a real that can
have a real consequence, whether it's a personal injury victim
or whether it's somebody that shows up to see you. Right.
So if somebody has what is considered a mild traumatic
brain injury and they show up to see you, they
may not be presenting with these sort of catastrophic issues,
but they have stuff going on. Right.
S2 (08:34):
Absolutely.
S1 (08:34):
And so what are some of the things that you
might do somebody describes for you? Maybe they're in a
rear end car crash, you know, and they describe how, hey,
maybe there's not much property damage, but maybe they felt
a big impact. Maybe their glasses moved on their head,
maybe they had a purse or book bag on their
on their car. And that kind of pushed forward. So
(08:55):
from physically they had an impact. And then they start
having all like funny stuff going on and they, they
eventually get to you. What are some of the first
things that you, as the neurologist, are looking at for
these so-called mild traumatic brain injuries.
S2 (09:10):
My job first is to make a diagnosis. To see
if the patient meets the criteria and guidelines for the
diagnosis of traumatic brain injury. Yeah, that's the first thing
I need to do. I have to look at the impact.
The impact is the most important part of this diagnosis.
S1 (09:33):
So you're talking about from that that the initial sort
of acute trauma, whatever it might have been, that's what
you're concerned with.
S2 (09:40):
Absolutely. Um, no, there is no one symptom, even one
specific for traumatic brain injury. So all of those 20
symptoms or more than 20 symptoms that any patient with
traumatic brain injury can have. There are not specific for
this diagnosis. So without impact and insult we cannot get
(10:04):
to this diagnosis.
S1 (10:06):
So it's kind of like with a traumatic brain injury,
it's more difficult. So, for instance, if I show up
and I've got a broken arm and you're looking at a,
you know, I show up at the ER, I've got this.
I say, oh, I've got this pain in my arm,
this pain in my arm. And they take an x ray.
You can see the break in the, in the x ray,
but you can't necessarily. So that that emergency room doctor
(10:27):
can't see that there's a break in your brain. So
tell me about kind of how often are TBIs missed
at the ER level?
S2 (10:40):
There are multiple studies showing that, um, there is a
big number. It it's from 20 to 30 5 to 40%
of the patients in ER are missed for this diagnosis.
The reason is this because the focus at the emergency
setting is on the trauma and the pain and fractures,
(11:04):
those are the most, uh, A kind of, um. Most
important topics to figure out.
S1 (11:12):
The, ER doctor is there to save life and limb.
S3 (11:15):
That is.
S2 (11:15):
100% correct. So that's the importance that's the significance of
this admission to the ER to rule out those possibilities.
Most of the times, not most of the times, I
would say that about 20 to 30 to 40% of
the cases they miss it in er not necessarily they
(11:37):
want to miss this diagnosis, but because the focus is
somewhere else. And also in the acute phase of the
traumatic brain injury, most of the patients, almost everyone has
a pain component neck pain, back pain and physical pain.
That's why even the patient is focusing on that.
S1 (11:56):
So you're talking. Sorry to interrupt, but so just just
so I understand this because I think this is a
very important part. Right. So what you're saying is that
it's not it's you're talking about, not physical pain that
their head necessarily is hurting. Is that so? For instance,
you get rear ended right. And so you have that whiplash.
And so maybe your your neck hurts, your back hurts.
And so you have this like this lingering pain. So
(12:17):
you show up to the ER. And like anything in life,
the squeaky wheel gets greased right. And you're, you're squeaky
wheel back neck pain. That's, that's squeaking hard. And so
that's what's getting greased. Is that what what you're saying here.
S3 (12:28):
Absolutely.
S1 (12:29):
Okay. So then eventually, you know, this kind of they, they,
they get to you. And I guess the other thing is,
from what you've described, neurology is complex, right?
S3 (12:42):
Absolutely.
S1 (12:43):
So so you have a lot going on in the ER.
And so somehow it gets missed. But issues keep presenting themselves.
And so somebody comes to you. And so let me
ask you this one. Let's say somebody comes and they say, hey,
you know I've got some issues and we're going to
I'm going to ask you what these, what particular issues,
these 20 whatever else it may be that, that are
symptoms of the brain injury. But somebody describes to say, hey,
(13:06):
I was rear ended and, you know, it was I
got hit and I my head lurched back and then
went forward and they say, hey, you know, I didn't
in that rear end car crash. I didn't lose consciousness.
I saw some stars. But it was weird because my
head didn't hit anything. As a neurologist, what's going through
(13:28):
your mind?
S2 (13:30):
Well, um, loss of consciousness used to be one of
the significant, uh, evidence of having a traumatic brain injury.
But we know that. And it's, uh, for many years now,
there is no need to have a loss of consciousness,
impact or any kind of force or significant force on
(13:55):
the head and neck structure. Again, head and neck structure
can cause the brain injury. So if you have a fall,
if you have a good fall on your back and
the neck, that force can transfer to the brain and
cause this injury.
S1 (14:11):
Now the neck. So the head and neck. This is
because whether you're falling or whether it's a car crash,
we're looking at, it's a, it's it's a whiplash motion.
S3 (14:20):
That right.
S2 (14:21):
In the in the car accident mainly is whiplash.
S3 (14:23):
Motion.
S1 (14:24):
And so some of it if so with the with
the traumatic brain injuries, what you're talking about is because
you have this skull, right? This hard skull. And inside
you got, like, this gelatinous brain that's just kind of
floating there. And so what is it that's connecting that
gelatinous brain to the skull?
S2 (14:41):
So brain is connected to the spinal cord. So spinal
cord basically connect the brain to the spinal column.
S3 (14:53):
Yeah.
S2 (14:54):
And the brain is not connected to the skull, but
there are layers of protection, including a water layer between
the brain and skull. So basically, brain is floating in
this skull.
S1 (15:12):
So here we have our nice hard skull, and we
have our floating little brain just loving life sitting right there.
And you have this sort of energy, as you're saying, right.
And so let's say you get rear ended and the
head goes back and so everything starts to move, right?
But then the head, you know, comes to the end
of the whether it hits the the headrest behind you,
(15:32):
it's the head starts to go forward, but the brain
doesn't move does it. Or it doesn't move at the
same speed. It kind of it kind of scrunches up,
is a little bit slower and then might go forward.
Is that what am right with that sense?
S2 (15:45):
I love the way that you explain. And so actually
the brain moves inside. But it's better to say that.
So we have two different with two different Density. Two
materials to one soft and one hard skull. And these
two are having some normal movements with each other. So
(16:08):
they move with each other in a certain range. If
the force is going to cause one of those materials
moving faster than the other one and hitting the other one,
we're going to see the damage. So basically during the back,
like a rear end accident or whiplash injury or any
(16:29):
kind of head movement, we see the brain moving faster
and hitting a more dense material, which is called skull
inside in different direction. That's why we see the different
consequences on different parts of the brain. And actually it
helps us to see there was an injury in that direction.
S1 (16:53):
Okay. All right. So in some sense the traumatic brain injury.
It's almost like two, two people dancing together. That misstep.
S2 (17:02):
Absolutely.
S1 (17:03):
Okay. And so and so, from what you're saying is,
with the mild traumatic brain injury or the traumatic brain injury,
it doesn't take a huge impact, meaning it doesn't take
a £400, you know, linebacker coming at you at 12
miles an hour and just clobbering you. Right. It can
be something smaller than that.
S2 (17:20):
Absolutely. There was a there was a idea and also
thought in that, um, for instance, the speed. Yeah. The
car speed has to be above a certain limit in
order to cause this. But the researchers and these new studies,
the model reconstruction model showing that, no, you don't need
(17:42):
to have major accident and biomechanic. Um, the event is
not these days. They're not showing that. So you can
have this traumatic brain injury angry with even less speed
and less impact. However, you have to have a significant impact. Yeah,
we don't have exactly a cutoff, but it has to
(18:06):
be significant. So impact is the major part of this diagnosis.
It's very important for us or for people who are
doing the legal work to make sure that the impact
was there before getting to this.
S1 (18:21):
Yeah. And for the word impact, for the impact in
a mild traumatic brain injury. Is it talking about like
something physically hitting the head or are you just saying
that whatever the impact is, some sort of change of force,
change of energy, which then impacts the head and neck movement?
S2 (18:40):
Absolutely. So any kind of force. Yeah. Around the head
and neck.
S1 (18:46):
Okay.
S2 (18:46):
That can cause chemical or structural changes in the brain.
Can cause traumatic brain injury.
S1 (18:54):
And that's your mild traumatic brain injury.
S2 (18:57):
That is that can be mild traumatic brain injury. But
if but that can be mild. It can be any
kind of injury. So any but most of the times
the patient with a mild traumatic brain injury they don't
have a structural injury. They have chemical. That's why the
(19:17):
imaging and the workup especially in the emergency department is negative.
That's why they get discharged home. But later on the
next day, two days, two weeks, then you're going to
see what is happening or what is going on.
S1 (19:32):
So you're saying it from the mild or from the
traumatic brain injury. You're saying you're going to you're going
to see on certain imaging, it might take a couple
of weeks in order for something to show up. That
chemical change might take a couple of weeks. You're saying
that the symptoms are going to present themselves within a
couple of weeks.
S2 (19:47):
So most of the symptoms that we have is a
result of the chemical imbalance.
S1 (19:53):
Okay.
S2 (19:53):
Happens.
S1 (19:55):
And so what does that mean. So because, you know,
some of the stuff is this is so it's it's
it's fascinating for me who did did not have a
medical and does not have a medical background. Right. But
just you know, I have I deal with medical issues
every day as a personal injury attorney. But so it's
fascinating to see what happens, what with the brain, with
the body and then even more so how somebody how
(20:17):
a victim of a personal injury victim, a claimant, a
plaintiff becomes a patient with the right doctor. Right. Because
what you're describing, you know, hey, you break your arm
at the ER easy. Hey, we're going to send you
to an orthopedic doctor. They're going to wrap you up.
You're going to be good within however many weeks or
months you're going to be fine. But how is it
that somebody gets to you? What are the the symptoms
(20:40):
that happen or the symptoms that present itself to where
somebody eventually gets to you as the neurologist?
S2 (20:47):
Sure. Let's just go back again on the classification of
the brain injury. 80 to 90% of the traumatic brain
injuries are mild. What does it mean? There is a classification,
which I don't think is an appropriate classification, but it is.
But when this patient comes to the ER even they
do even they do imaging. We do MRI even in ER.
(21:08):
There is nothing there. The patient has, most of them
have symptoms. Sometimes they don't have anything. The first day
next month we do imaging. The next day we do
imaging next six months we do imaging is still negative
but they are having the symptoms. So for in order
to make a diagnosis of mild traumatic brain injury everything
(21:29):
can be normal. On the diagnostic part okay. So there
is no need to have anything abnormal imaging any bloodwork anything.
So you can have most of the disabling symptoms of
mild traumatic injury. But every workup every single workup is
going to be negative including imaging. So the therefore the
(21:53):
structure is apparently intact with our current technology. Maybe in
ten years from now we're going to see something and
we are getting there. Actually we are. Our system is
definitely is improving. We are having new diagnostic challenge. Findings.
We are having new technologies that are helping us definitely
better than ten years ago. But if the structure is
(22:17):
normal and the patient having those symptoms. So basically we
can say that they are based on chemical disruption. Yeah.
So the symptoms are um, it's about 10 to 20
symptoms that we are dealing with almost for every patients. Um,
(22:38):
some patients have 1 or 2 depending on the severity
of the injury. Some patients have 20 of them. Yeah.
Some patients Donations. In one month, they become symptom free.
Some people in six months and some people never.
S1 (22:54):
Is there is there any sort of kind of commonality
you see with that? Is it that somebody shows up
and you say, oh, that person's going to be a month,
that person's going to be six years, that person's going
to be something else. Or is it just as whatever
however the person shows up is how the person is.
S2 (23:10):
Great question. Um, as a, uh, kind of, um, based
on the numbers and statistics that we have, most of
the patients, 80 to 90% of the patients they recover
in the first three months.
S1 (23:26):
Okay.
S2 (23:26):
That's the data we have.
S1 (23:27):
Okay.
S2 (23:30):
Then the percentage of the patients get to the second
first half of, uh, I mean, like a six months
after the accident and the percentage get to the second year. Okay.
We know that there is no way to predict who
is going to go there? Okay, there is no way
to predict. However, there are 4 or 5, maybe six.
(23:52):
Also factors that we know that if the patient already
carrying one of those, for instance, pre-existing condition.
S1 (24:00):
Okay.
S2 (24:00):
If they get subjected to a traumatic brain injury, they
are having a little bit more chance to go toward there.
S1 (24:10):
So then what what are some of the preexisting conditions?
So if somebody has they suffer an impact. That's enough
to cause the chemical change to cause this traumatic brain injury.
What what would be a preexisting condition? Are you saying
that somebody who had a concussion previously, or is it
somebody who just has a bunch of, you know, some
sort of other orthopedic injury, or what is that preexisting
(24:31):
condition that could cause a kind of compound, the concussion,
the brain injury that you have in the moment.
S2 (24:38):
You just named one of the most important ones, which
is the previous concussion. So the people who are having concussion,
they are having a chance, more chance to have another
concussion or more concussions.
S1 (24:53):
So from from my understanding, when you have a concussion.
One concussion plus one concussion doesn't mean two concussions, right?
It means three four. It could be exponentially worse, right?
The symptoms that come up after more concussions.
S2 (25:09):
Absolutely. We don't know exactly why. What we can say
that as a result of the previous injuries, for some
reason they are prone to develop more because of the
cognitive issues or something. Something is going on. We don't
know exactly. So previous concussion or having a history of
concussion in the past is one of the major ones.
(25:30):
Having a history of migraines. Having history of ADHD.
S1 (25:36):
Really ADHD.
S2 (25:38):
ADHD, having history of depression and anxiety, or PTSD in
the past.
S1 (25:44):
These can make the the symptoms from the. From the concussion.
From the traumatic brain injury worse.
S2 (25:51):
Absolutely. And they. So if you're asking you were asking
what are the factors that we can predict this patient. Possibly.
We don't know. Still we don't know. There is no
way to predict. But if these are existing there. It
there is a chance that patient is going to have
a prolonged course.
S1 (26:09):
So a person who suffered a brain injury, a traumatic
brain injury, a mild traumatic brain injury, a concussion. Some
of the things that they and their family might want
to look at is what has happened to them before.
Have they had depression? Have they have PTSD? Have they
had another concussion? These are the kind of things that
when a patient or a, a, a plaintiff shows up
(26:33):
to you. This is probably some of the stuff that
you want to know.
S2 (26:37):
That is so important to know about the preexisting pre-existing
conditions and an already important thing. Is this a lot
of family, especially if this happens to children and the kids, um,
they kind of the new injury. They're going to think
this is from the previous history of previous condition, so
(26:59):
they don't pay as much attention. They think that, oh,
attention deficit is now flaring up or depression is a
little bit flaring up or anxiety is a little flaring
or headaches are worse because of that. No, it's not
just that.
S1 (27:14):
So it's not just the pre-existing condition.
S2 (27:15):
It's not just the pre-existing. Actually, these patients needs to
have a faster and sooner evaluation and treatment because they
have a chance a more I mean, they have more
chance to have a prolonged course. So recovery.
S1 (27:28):
Would you say then from from what I'm hearing, if,
if you have, if you or a loved one you
think had a traumatic brain injury and that you know
that you or that loved one has had these histories
in the past. You want to get to a neurologist
as soon as you can?
S2 (27:43):
Absolutely.
S1 (27:44):
Okay. And then is there is there some sort of
aggressive approach that somebody with the, with the preexisting condition,
who then has a TBI as a traumatic brain injury
that if they get to the neurologist, can you can
you kind of attack it stronger and hopefully have a
better outcome long term?
S2 (27:58):
So the sooner you start the treatment and evaluation and
diagnostic whatever is needed, the better outcome for sure for
those patients. And again, there are patients with preexisting conditions.
And they in terms of the treatment and any kind
of treatment or therapy, they have to be started sooner
(28:22):
because we know that these are not going to have
the same chance of recovery with other people who don't
have preexisting.
S1 (28:30):
It's it's they're in a they're, they're they're in a
weaker state that they need a little bit of extra,
extra protection.
S2 (28:37):
Absolutely.
S1 (28:38):
Now, so here's one of the things that I know
with the traumatic brain injury. It's not just cognitive, right.
It's there's an emotional aspect to it. And so, you know,
for you as the neurologist, you're it seems that you're
not looking at one narrow lane. You're as a neurologist,
you have to look at kind of the whole person.
S2 (28:55):
Absolutely. So we have three categories of or classifications classes
of symptoms and symptomatology. Basically one of them is physical symptoms. Headache. Nausea.
Blurry vision dizziness. Balance issues. We have a we have
(29:16):
a series of cognitive issues okay. Brain slowness difficulty in concentration,
difficulty in multitasking. Uh forgetfulness. And then we have a
sense of the psychological issues and symptoms such as anxiety, stress, PTSD.
the typical one. Lack of sleep, irritability, mood disorders. So
(29:41):
basically when we are looking at a patient, we like
to see all of those, or at least 1 or
2 symptoms of each of those classes. And based on
the severity, we have to focus in terms of the treatment.
S1 (29:57):
So what I'm hearing is that for those who have
a traumatic brain injury or those who suspect they have
a traumatic brain injury, they really need to look at
their whole background and kind of document things before they
show up to the neurologist, so that when they show
up to the neurologist, they can give the neurologist, like you,
the full picture of what's going on.
S2 (30:15):
Absolutely.
S1 (30:16):
Okay. All right. And then so what are some of
the things that you can do. So somebody shows up
and they have two two areas perhaps three areas. You
know you have some forgetfulness. You have some emotional aspects.
You have, you know, kind of lack of sleep which
is causing some other things. What are some of the
kind of the healing processes, the Processes, the healing procedures. Who?
Who are other? Do you bring in other doctors? What
(30:38):
do you do from a treatment perspective?
S2 (30:40):
Great question. First of all, there is no one magic
pill for this. This is not an infectious issue. So
you've got to get antibiotic amoxicillin. And you're going to
get better in ten days. No we have to see
what the problems are. Again we have 20 symptoms or
20 and three different classes of issues. We're going to
(31:01):
go each one with each one is more prominent problem. Yeah.
Pain in the acute setting either headache or spinal pain
such as neck or back pain are the major issues
that need to be addressed after the first acute phase.
I mean, the acute phase, which is around first month
(31:21):
when we are dealing with the pain issues, then we're
going to see the real face of the cognitive issues
and other physical issues such as dizziness and balance.
S1 (31:30):
So the so it's so this is not something that
just presents itself. This is something that takes time. So
you're saying in essence there's layers of it. So you
have this physical pain with that that's associated with the
event that caused the traumatic brain injury. And then as
that starts to kind of dissipate, as that starts to heal,
there's other gophers that pop up out of the ground,
(31:52):
is what you're saying.
S2 (31:53):
Uh, that is very true statement. That's what you said. However, however, um.
We need to have symptoms based on the guidelines and
diagnostic criteria, even in the first 72 hours.
S1 (32:12):
Okay.
S2 (32:13):
So they might not be the prominent symptoms, such as
neck pain, back pain, headache. However, we need to have symptoms.
S1 (32:21):
So can you give me an example of so you're
saying with the traumatic brain injury, in order to be
able to diagnose it down the road, you need to
see within the first 72 hours that there was some
sort of symptom where you've got your big ones, your neck,
your back. What are some of the other symptoms that
you would look at in your everyday practice?
S2 (32:38):
Absolutely. Uh, basically, headaches are one of the major things.
S1 (32:42):
Okay.
S2 (32:44):
After that dizziness and balance issue.
S1 (32:47):
And would that, could that present itself within that first
72 hour phase?
S2 (32:52):
Absolutely. Okay. One of the major things that I am
asking patients is that actually having dizziness or not having
dizziness or balance issues is going to be a question
for me. That is a real dizziness. This is a
real TBI or a just the headache. So there are
a lot of issues uh, or diagnoses. Other diagnoses can
(33:15):
mimic TBI at the acute phase, including post-traumatic headaches. So
post-traumatic headaches are not TBI. Okay. But most of the
patients with TBI having post-traumatic headaches. So it's very important
for us to separate this diagnosis because that can have
a lot of consequences and also stigma in the future
(33:37):
for the patient and the diagnosis again. And but so
there are a few things we need to really know.
So anxiety and mood changes and sleep disorders are very common.
S1 (33:51):
And when does.
S2 (33:52):
That.
S1 (33:52):
Present itself. When can it present itself with the TBI.
When can the sleep disorder, the anxiety, these sort of
kind of serious issues present themselves.
S2 (34:00):
For in order to make a diagnosis? Again, we are
sticking to the guideline. Yes. As I mentioned before, there
is no specific symptom for traumatic brain injury. So if
we don't put them together in when there is in
the in the right context, and it's specifically very important
in a real impact, you cannot make this diagnosis. So
(34:23):
basically in order to make this diagnosis you have to
have two symptoms.
S1 (34:28):
Terms, okay.
S2 (34:28):
Two symptoms, at least in the first 72 hours or
at the time of the accident. So you cannot have
just a neck pain or just one headache, nothing else.
And then three months, four months, you're going to refer
to a neurologist for having other issues. And you're going
(34:49):
to say, oh, did I have brain injury at that
time or not? It's hard to say. Cognitive issues in
my experience, that you are seeing it. That's the last
thing comes up. Okay. The patients are blaming their brain slowness,
their forgetfulness, everything in the first 2 or 3 months,
even six months because of the pain, suffering, anxiety, they're
(35:11):
not working. They just blame God. And after that, when
everything else is settled, then they see, wow, this is
not the cognitive function that I had before this accident.
S1 (35:24):
So, you know, there's two big things I see right here.
One is that. Well, I should say three. One major
one and two kind of subtopics. Right? It's very complicated. Right.
And so on the first hand, it's got to be
very complicated for the patient, for the personal injury victim
who's dealing with or potentially dealing with the traumatic brain injury,
(35:46):
knowing what is going on, having that self-awareness, having friends
and family around you who are there. And then secondarily,
for you as the doctor, to peel away all of
these layers and really get down to it. This isn't
something that you can do in a 15 minute, 15 minute, uh, encounter.
Can you?
S2 (36:05):
Absolutely. And you just said exactly the fact, um, let
me tell you that, um, I'm an expert. I'm certified,
board certified in brain injury, and I'm seeing a lot
of patients. Yeah. Still, there are cases. I'm scratching my head, hair.
I don't know. It's a real case or not. So
(36:28):
that's why we are sticking to the guideline. Otherwise, we're
going to be distracted. If you have ten neurologists, no
matter they are certified or not, or board certified or
trained in brain injury. If you give them a case
to ten of them, you're not going to see a answer.
(36:48):
A kind of a unique I mean, unified answer. Yeah.
You're going to see different opinion and different diagnosis. So
even for us. Yeah, it's hard to make a diagnosis
after many, many years dealing with the traumatic brain injury
and having a lot of science about it.
S1 (37:08):
Yeah. So I think my kind of final question here
has to do with, I mean, if it's this hard
for smart, educated, board certified neurologist, what what is your advice?
What is your suggestions that potential patients, uh, personal injury
(37:29):
victims who think maybe I've got a traumatic brain injury
or something associated with that. What is it that they
can do to one? Get to a neurologist, and then
once they do get the appointment with the neurologist, what
is it they can bring to you? What story can
they tell you to better help you make that diagnosis?
S2 (37:48):
So for us, again, we don't see 80 to 90%
of the cases. There's everything is every testing is normal.
So this is a diagnosis we make with the patient
in the room okay. So they have to give us
a as much as possible information.
S1 (38:08):
About their history.
S2 (38:09):
History everything and then impact. It's so important for us
to see the mechanism of action. What happened in the impact.
Is it a compatible. Is this impact compatible with? The
patient can have a brain injury or not because every
impact they're not the same. Even it's a rear end
(38:29):
that for instance a car accident, but they're not the same.
We know that and you know that.
S1 (38:34):
Absolutely.
S2 (38:34):
So it's we have the more information we have at
the time of interview, the better chance to come up
with the right diagnosis.
S1 (38:43):
And then whether there is a traumatic brain injury or
there isn't a traumatic traumatic brain injury. What I'm hearing
from you is that if, if a if a victim
thinks that they may have a traumatic brain injury, they
need to come prepared with being able to describe the impact,
what happened, what was the forces? They have to be
able to tell you how they felt within the first
72 hours, and they have to have some sort of documentation,
(39:06):
some sort of history that they can explain to you
about what they were like beforehand. Do they have a
pre-existing issue, and then what has happened to them in
the weeks and months since then?
S2 (39:17):
Uh, as a physician For me. Just having those information enough. Yeah.
If they are going to have a medical legal case documentation,
it's a significant it's a significant issue. Yeah. So it
they have to know that first of all the they
(39:39):
don't they should not leave this alone.
S1 (39:42):
Yeah.
S2 (39:43):
The brain injury is can be disabling if they don't
get treated correctly. And um as soon as possible. However
med legal cases are different in med legal cases. Documentation
is the major thing. Yeah. They have to take care
of it.
S1 (40:01):
Well, and for for for me, as a personal injury attorney,
one of my biggest concerns is not just like I
take a two pronged approach to it. I want to
get them justice and but then I want them to
get better. And so, doctor, I want to thank you
so much for your time today. This has been fantastic.
I think, you know, this is a very, very huge iceberg, right?
And we have seen just the tip of it. But
(40:21):
I look forward to hopefully someday we can have this
conversation again and continue on.
S2 (40:25):
Looking forward to it. Thank you so much for the opportunity.
Thank you. Thank you very much.
S4 (40:32):
Now's a good time for a short break. Stay with us.
There's more ahead on unseen impact.
S5 (40:42):
Hey, it's Daniel from Beyond the Doors. We're super excited
to be a part of the Ola's media network, recording
right here in San Diego, alongside some amazing podcasts. There's
a host of wonderful shows from all types of genres,
basically like real estate. There's a little something for all
walks of life. You won't want to miss it. So
(41:03):
head over to Ola's media or wherever you get your podcasts.
Don't forget to follow or subscribe while you're there. Now
let's get back to the show.
S4 (41:14):
Welcome back. Let's continue the conversation.
S1 (41:19):
Well, that was fantastic. Talking with a quadruple board certified neurologist.
And I guess the biggest thing that I hope people
take away from this is brain injuries are really, really complicated.
And not just at the beginning, not just at the middle,
not just at the end from start to finish. They
(41:39):
are complicated from the mechanism of injury, meaning how it
happened to the to the symptoms that you suffer in
the first 72 hours in the first weeks and the
first months. It's very complicated. So what I want listeners
to take away from here is if you sense something
in yourself or in a loved one, start having that self-awareness.
(42:04):
Start taking notes. Start really thinking about, well, could this
be related? What is going on? Is it just the pain?
Once the pain gets over, what else is going on?
And so kind of some of the tips that I
have for you is document, document, document. And it can
be something as simple on your iPhone where you're just
saying or you're on your phone with the messages, you're
saying da da da da, or your notes just writing
(42:25):
down if it's once a day, if it's once a week,
if it's once a month, just take a moment and
have some self-reflection and think, hey, what's going on with me?
How am I doing? What are some of the issues
that I have? Is this headache that, you know, maybe
I used to have headaches, but now this one is
a little bit worse than it was before. So recognizing
that maybe you had some symptoms before, but now that's
(42:48):
just a little bit worse. That counts. Have it documented?
One of the biggest things is if you think anything
is going on, whether with you or a friend, call us,
message us. Go to the website. Engage with the website.
Sign up for us. One of my biggest jobs is
(43:08):
just to talk with people so I can. You can
tell me your stories. I see a bunch of these things.
So I start to recognize the similarities. I can cut
right to the heart of what you need to look at,
and together we can kind of figure out what's going on.
And so part of that is I get questions right.
Whether it's at the intake, whether it's throughout the, throughout
(43:30):
it all, uh, of the of the litigation, the pre-litigation
process or it's just, you know, folks engaging with us
on social media. I get questions, so what I want
to do is answer a few of them. So first off,
and this is a good one, right? Can I file
a lawsuit for a mild traumatic brain injury? And the
(43:52):
answer is absolutely. I can file a lawsuit for a
what they call mild traumatic brain injury. I think one
of the things that we learned today is that mild,
the term mild is a misnomer just because it's deemed
mild or by the guidelines, as Doctor Bowerman said, is mild.
It doesn't mean that the impact on your ability to
(44:13):
function is mild. It just means that the way that
they have classified it, that it's mild with respect to
the brain injuries. Still, it can keep you up at night.
It can cause anxiety. It can cause debilitating headaches, it
can make your life debilitating. And all of those are damages, right?
Damages are what really drive lawsuits. Okay, a great question
(44:39):
that we get a lot that I love to answer
is what damages can I recover in a brain injury lawsuit?
In a brain injury lawsuit, you can recover medical bills
past and future loss of income, loss of earnings, capacity,
meaning your ability to do what you did before the
the pain and suffering and emotional distress. And this is
(45:02):
what is really huge in this area. Basically, it comes
down to a quality of life. You know, this country
was founded on the idea that we get to pursue
our happiness and the pursuit of our happiness comes down
to our quality of life. And when the quality of
life is diminished, it's cut back or it's just fully
taken from you. Those are the actual damages that you get. Now,
(45:25):
when it comes to brain injuries, typically unfortunately it's longer term.
So you're looking at the cost of that longer term right.
When we when we do the damages analysis, when we
look at this, we're not just looking at, hey, what's
it going to be like in the first week and
the first month we're talking about what is it going
to be like from the date that this happened to
you until the end of your life? And this is
(45:48):
important stuff. One question I get often is how long
do I have to file a brain injury claim? Now what?
I like to back up and say, hey, any claim?
So this isn't just specific to brain injuries, but typically
in California you have two years to bring a lawsuit.
Now however, if there is a government entity like the city,
(46:12):
a county, Caltrans, you know, some sort of government body.
You only have six months to file what they call
a government tort claim. And so what that is, is
you have to go to the actual web page or
communicate with the actual agency and say, hey, what form
do I have to do? You have so I can
fill out? You have to fill out that form. And
(46:32):
this is a hard date six months. Then they have
45 days in which they have to deny or accept it.
They're going to deny it. And then once you get
the denial, you have only six months to file the lawsuit.
So how much time do I have to file a
brain injury case? Typically two years. If it's a government entity.
You got six months. And I know six months might
(46:55):
seem like a long time. It's not. It goes very,
very quickly. Another big question that I get are how
do attorneys prove a brain injury in court? Now When explaining,
how do you prove anything in court? There's a lot
of similarities with this, right? And there's a lot of
sort of the process that we do that's particular to
(47:16):
us in, you know, really digging into the to the,
our plaintiff's life, our, our client's life, their friends, their family,
the brain injury is a little bit more difficult because
what you have to do, as we heard from Doctor Bahman,
he's looking at what was the impact like not necessarily
(47:37):
saying impact to the brain. Right. But impact that caused
the sort of movement in the body that caused this
traumatic brain injury. What was the impact? Like, you have
to say, what happened to you? What symptoms were you
having in the first 72 hours? First 72 hours? That's
really tough because most of the time you're in shock.
(47:57):
You have physical pain, you don't necessarily know what's going
on there. And then kind of for the next, for
the following weeks and for the following months, you have
to kind of document what are your what are your injuries.
So in looking at what do you have to prove
brain injury and court. What was the impact. What happened
in the first 72 hours. What has what are your
(48:19):
symptoms that have been since the impact. And a big
thing for the neurologist, which of course is for us
is did you have any pre-existing conditions before? Did you
have a previous concussion or concussions. Did you have depression?
Did you have PTSD? These are all items that are
necessary for proving a traumatic brain injury in court. Another
(48:42):
big question that we get is my loved one has
a brain injury and can't make decisions. Can I act
on their behalf? And the answer is yes. If your
loved one has a brain injury in which that person
is incapacitated. You can either. You can absolutely act on
their behalf. It happens a couple ways usually. Typically, if
(49:05):
you have an estate plan set before this happens and
you have designated somebody to make these health decisions on
your behalf, that person automatically gets to do it. Secondarily,
you can have either a legal guardian, which usually is
a spouse, a family member. If there are none, you
can have one appointed or a conservator of some some respect,
(49:26):
and those folks can make those decisions on your behalf.
This is a great one that I do get as
an attorney at Rory Law. What types of accidents do
I most often see leading to brain injuries? And and really,
especially those that go unseen are rear end auto crashes
(49:50):
where you have that whiplash, that whiplash motion. And it
doesn't have to be huge property damage. I've got one
right now. Very wonderful lady who she felt a big impact, right?
She had that impact and that whiplash. As we talked
about before, you have that hard skull, that hard cranium
(50:11):
and the kind of different density, that gelatinous brain. And
when they start to kind of not dance with each other,
as we talked about with Doctor Barnett, you can have
this sort of brain injury. And so it's, it's that
it's the it's the motor vehicle rear end crashes where
I see this most often, at least with respect to
(50:33):
those that are unseen. Um, you know, for instance, I've
had a number of motorcycle crashes that were significant and
they were bad and they were nasty. And you just
know that it happened right? When you have a banged
up helmet, a scraped up helmet, somebody's thrown 25, 30ft,
you know that it's big. Where I'm looking at is
(50:55):
where I most see this unseen brain injury, as are
these rear end or kind of side impacts. And it
doesn't have to be a big property damage, big damage
to the vehicle. Now this question is what I get
the most and I should how much does it cost
(51:16):
to hire Rory Law? Hire an attorney for a brain
injury case? Well, first off, there's no separation between any
injury and a brain injury case. Attorneys like me, attorneys
at Rory Law, we are what's called contingency fee attorneys.
And what a contingency fee means is that I get
(51:38):
nothing until and unless I produce for you. What I
love about that is it means one. I have to
get to know you, right? Is. And I have to
believe in this case is am I going to spend
potentially thousands of hours and potentially tens of thousands or
hundreds of thousands of my dollars to fight this case, Right?
(52:00):
So there's a real sort of fire behind it for
me to get behind it and to go for it.
I do not get paid by the hour. And if
we lose, if something bad happens, you don't pay me anything.
What the contingency fee means is that whether it's a
contingency fee on a brain injury, a contingency fee on
(52:21):
any sort of other injury, it means I only get
paid if I produce. Thank you all for listening to
Unseen Impact. I am Rory Pendergast, your host, the attorney
at Rory Law. If anyone has any questions about anything
wondering about our services, please visit us at WW that
(52:42):
is WW. Also, we have all sorts of social media accounts.
All of them are at Rory Law firm. So again
at Rory. Firm. We are here to answer any questions.
Talk about your case. Whatever you need. Rory Law at
(53:05):
Unseen Impact. We're here for you.
S4 (53:13):
Thanks for tuning in to Unseen Impact with Rory Pendergast.
Please follow, subscribe, and maybe share this episode with someone
who's walking their own path to recovery or justice. You
can find us on Instagram, Facebook, YouTube, and LinkedIn at
Rory Law Firm. To learn more about legal services or
get in touch, visit Rory Law.com. Unseen impact is recorded
(53:38):
in San Diego, California, and proudly produced by Olas Media,
an IVC media company.
S6 (53:55):
Alas media.
Welcome, everyone. My name is Rory Pendergast. I am the
attorney at Rory Law, and today I am very excited.
We have Doctor Berryman here, a a quadruple board certified.
He has a neurologist. He deals with brain injuries. And
so today we're here to talk about brain injuries. Traumatic
brain injuries. Uh, what what they are, how they can
(00:46):
come about and kind of some of the things that
that you as the victim, you as a friend or
family of the victim can, can, can do to help
you one get to a neurologist and then help you
with that process. I know from my own practice, uh, the,
the brain injuries can impact somebody from, you know, a,
a 50 mile an hour car crash, 50 mile an
(01:06):
hour motorcycle crash down to a, you know, a very
low speed rear end, sort of whiplash, sort of, uh,
whiplash injury. And the brain injury can impact everybody. But
we don't want to hear just from me, because what
do I know about it? Right. We want to hear
from the quadruple board certified doctor. Doctor, thank you for
(01:28):
joining us.
S2 (01:29):
Thank you very much. Can you tell.
S1 (01:31):
Us so for not just one, not just two, not
just three, four. What are your board certifications?
S2 (01:38):
Uh, again, thank you so much for having me here. Um, I'm.
I have four board neurology. Number one is, uh, general
neurology and psychiatry. I am board certified in, uh, electro
physiology and neurophysiology. I also am certified in vascular neurology
(02:03):
or a stroke. Neurology. And also, uh, brain injury medicine.
S1 (02:07):
Okay. All right, which I think we're going to spend
a bit of time today talking about. So should we
get to it? Let's get to it, please.
S3 (02:15):
Okay.
S1 (02:16):
All right.
S2 (02:18):
I finished that fellowship program. And, um, I started practicing well.
S1 (02:24):
And I got to think especially around, you know, that 2005, 2007, 2008, 2010,
brain injuries were a big part of of our world.
S2 (02:34):
Absolutely. Uh, especially 2001. Yeah. If I can say when
the September 11th happened, I was in New York. I
was my last year of residency when that disaster happened
to our country. Um, that was a huge, uh, we
(02:55):
saw in New York a huge aftermath, not just because
of that day, because of the following complications and consequences
in terms of PTSD and a lot of lot of
other psychological issues following that.
S1 (03:10):
Well, and then with San Diego being such a huge
military town, you know, up into Pendleton, all of these things,
I think that that that neurology is a really big field,
particularly since, you know, the the we went into the
Middle East, all of those sort of things. You have
the service members coming back and they're having brain injuries. Right.
Or they're, they're, you know, having all of these things
(03:31):
going on.
S2 (03:32):
That is correct.
S1 (03:33):
And so, okay, so can I say, would we be
able to say that your specialty is brain injuries or
as a neurologist, what would you say your specialty or
one of your specialties are?
S2 (03:45):
I have uh, besides the general neurology, I have three
extra fellowships and training. One of them is brain injury. Uh,
I am also trained for vascular neurology or stroke, and
also for neurophysiology. Electrodiagnostic as well.
S1 (04:04):
All right. And then, so, you know, we're here because
talking as a personal injury attorney, you know, I deal
with folks who have brain injuries. And so one of
the things that we wanted to talk about is kind
of what is a brain injury? You know, we see
it all over the place with service members, with football, concussions, with,
you know, I've got a daughter who's in who's playing
(04:25):
soccer and they said they can't head the ball. So
I mean, I think any more in today's age, brain
injuries are, are, are known or at least the words
are known. But what is a brain injury?
S2 (04:37):
That's a great question. Um, while this is one of
the most important topic in medicine, if I tell you
that that's something that we don't see most of the time,
we know it's there, but we don't see it. You
can't believe me. This is one of the major cause
(05:00):
of death in this country.
S1 (05:02):
Brain injuries, brain injury. Okay.
S2 (05:04):
50,000 annual deaths is from the brain injury. Those are
obvious cases. Yeah, but 80 to 90% of the traumatic brain.
Injuries are mild and we don't see anything. It's just
the person with a history of injury and we see
(05:25):
the aftermath.
S1 (05:26):
And so this is one of the things that that, that,
that I deal with is on the attorney side is
we hear mild traumatic brain injury. Right. So if somebody says, oh,
I have a mild ankle sprain to me that says
it's there's not it's not a big deal. So when
somebody says mild traumatic brain injury what does that mean?
S2 (05:49):
First of all, if you go back to the definition
of the brain injury, um, any chemical or structural alteration
to the brain is called traumatic brain injury. So any
chemical or structural alteration caused by any impact or insult
(06:12):
or trauma is called traumatic brain injury. Obvious cases are
having traumatic brain injury with structural changes. We see it
in MRI. We see it in imaging and everything. Obviously
the patient having more problems. There is a type of
traumatic brain injury which is called mild traumatic brain injury.
(06:35):
80 to 90% of the cases are this strange. And
we only see the chemical changes. We are seeing the
evidence or consequences of chemical alteration. We don't see anything else.
They called it mild based on the category and classification
that we have is called GCS score classification. Basically, it's
(06:58):
a misnomer for this. This is unfortunately, after many, many years,
we have not come up with a better classification and
we are still using it based on the presentation, a
clinical presentation at the time of the event.
S1 (07:15):
And so that's the thing. So for instance, for me
as the personal injury attorney that the Glasgow score, that
score that's happened, it's taken immediately. So you have somebody
who's injured and they take some sort of this score
that goes on. And that's kind of what becomes that's
in the records and that's what people are looking at. Right.
S2 (07:34):
Absolutely. Again, unfortunately, we have not come up with a
better way and a way to kind of classify the
impact at the beginning with the outcome. Yeah. So when
you are saying mild.
S3 (07:49):
Yeah.
S2 (07:49):
It's a misnomer in my opinion. 20 to 30% of
the mild cases can have lifetime consequences and complications. So
technically not only there are not mild, actually there are
very disabling. But based on the initial presentation we call
them mild, moderate or severe.
S1 (08:12):
Okay. And and that can have a real that can
have a real consequence, whether it's a personal injury victim
or whether it's somebody that shows up to see you. Right.
So if somebody has what is considered a mild traumatic
brain injury and they show up to see you, they
may not be presenting with these sort of catastrophic issues,
but they have stuff going on. Right.
S2 (08:34):
Absolutely.
S1 (08:34):
And so what are some of the things that you
might do somebody describes for you? Maybe they're in a
rear end car crash, you know, and they describe how, hey,
maybe there's not much property damage, but maybe they felt
a big impact. Maybe their glasses moved on their head,
maybe they had a purse or book bag on their
on their car. And that kind of pushed forward. So
(08:55):
from physically they had an impact. And then they start
having all like funny stuff going on and they, they
eventually get to you. What are some of the first
things that you, as the neurologist, are looking at for
these so-called mild traumatic brain injuries.
S2 (09:10):
My job first is to make a diagnosis. To see
if the patient meets the criteria and guidelines for the
diagnosis of traumatic brain injury. Yeah, that's the first thing
I need to do. I have to look at the impact.
The impact is the most important part of this diagnosis.
S1 (09:33):
So you're talking about from that that the initial sort
of acute trauma, whatever it might have been, that's what
you're concerned with.
S2 (09:40):
Absolutely. Um, no, there is no one symptom, even one
specific for traumatic brain injury. So all of those 20
symptoms or more than 20 symptoms that any patient with
traumatic brain injury can have. There are not specific for
this diagnosis. So without impact and insult we cannot get
(10:04):
to this diagnosis.
S1 (10:06):
So it's kind of like with a traumatic brain injury,
it's more difficult. So, for instance, if I show up
and I've got a broken arm and you're looking at a,
you know, I show up at the ER, I've got this.
I say, oh, I've got this pain in my arm,
this pain in my arm. And they take an x ray.
You can see the break in the, in the x ray,
but you can't necessarily. So that that emergency room doctor
(10:27):
can't see that there's a break in your brain. So
tell me about kind of how often are TBIs missed
at the ER level?
S2 (10:40):
There are multiple studies showing that, um, there is a
big number. It it's from 20 to 30 5 to 40%
of the patients in ER are missed for this diagnosis.
The reason is this because the focus at the emergency
setting is on the trauma and the pain and fractures,
(11:04):
those are the most, uh, A kind of, um. Most
important topics to figure out.
S1 (11:12):
The, ER doctor is there to save life and limb.
S3 (11:15):
That is.
S2 (11:15):
100% correct. So that's the importance that's the significance of
this admission to the ER to rule out those possibilities.
Most of the times, not most of the times, I
would say that about 20 to 30 to 40% of
the cases they miss it in er not necessarily they
(11:37):
want to miss this diagnosis, but because the focus is
somewhere else. And also in the acute phase of the
traumatic brain injury, most of the patients, almost everyone has
a pain component neck pain, back pain and physical pain.
That's why even the patient is focusing on that.
S1 (11:56):
So you're talking. Sorry to interrupt, but so just just
so I understand this because I think this is a
very important part. Right. So what you're saying is that
it's not it's you're talking about, not physical pain that
their head necessarily is hurting. Is that so? For instance,
you get rear ended right. And so you have that whiplash.
And so maybe your your neck hurts, your back hurts.
And so you have this like this lingering pain. So
(12:17):
you show up to the ER. And like anything in life,
the squeaky wheel gets greased right. And you're, you're squeaky
wheel back neck pain. That's, that's squeaking hard. And so
that's what's getting greased. Is that what what you're saying here.
S3 (12:28):
Absolutely.
S1 (12:29):
Okay. So then eventually, you know, this kind of they, they,
they get to you. And I guess the other thing is,
from what you've described, neurology is complex, right?
S3 (12:42):
Absolutely.
S1 (12:43):
So so you have a lot going on in the ER.
And so somehow it gets missed. But issues keep presenting themselves.
And so somebody comes to you. And so let me
ask you this one. Let's say somebody comes and they say, hey,
you know I've got some issues and we're going to
I'm going to ask you what these, what particular issues,
these 20 whatever else it may be that, that are
symptoms of the brain injury. But somebody describes to say, hey,
(13:06):
I was rear ended and, you know, it was I
got hit and I my head lurched back and then
went forward and they say, hey, you know, I didn't
in that rear end car crash. I didn't lose consciousness.
I saw some stars. But it was weird because my
head didn't hit anything. As a neurologist, what's going through
(13:28):
your mind?
S2 (13:30):
Well, um, loss of consciousness used to be one of
the significant, uh, evidence of having a traumatic brain injury.
But we know that. And it's, uh, for many years now,
there is no need to have a loss of consciousness,
impact or any kind of force or significant force on
(13:55):
the head and neck structure. Again, head and neck structure
can cause the brain injury. So if you have a fall,
if you have a good fall on your back and
the neck, that force can transfer to the brain and
cause this injury.
S1 (14:11):
Now the neck. So the head and neck. This is
because whether you're falling or whether it's a car crash,
we're looking at, it's a, it's it's a whiplash motion.
S3 (14:20):
That right.
S2 (14:21):
In the in the car accident mainly is whiplash.
S3 (14:23):
Motion.
S1 (14:24):
And so some of it if so with the with
the traumatic brain injuries, what you're talking about is because
you have this skull, right? This hard skull. And inside
you got, like, this gelatinous brain that's just kind of
floating there. And so what is it that's connecting that
gelatinous brain to the skull?
S2 (14:41):
So brain is connected to the spinal cord. So spinal
cord basically connect the brain to the spinal column.
S3 (14:53):
Yeah.
S2 (14:54):
And the brain is not connected to the skull, but
there are layers of protection, including a water layer between
the brain and skull. So basically, brain is floating in
this skull.
S1 (15:12):
So here we have our nice hard skull, and we
have our floating little brain just loving life sitting right there.
And you have this sort of energy, as you're saying, right.
And so let's say you get rear ended and the
head goes back and so everything starts to move, right?
But then the head, you know, comes to the end
of the whether it hits the the headrest behind you,
(15:32):
it's the head starts to go forward, but the brain
doesn't move does it. Or it doesn't move at the
same speed. It kind of it kind of scrunches up,
is a little bit slower and then might go forward.
Is that what am right with that sense?
S2 (15:45):
I love the way that you explain. And so actually
the brain moves inside. But it's better to say that.
So we have two different with two different Density. Two
materials to one soft and one hard skull. And these
two are having some normal movements with each other. So
(16:08):
they move with each other in a certain range. If
the force is going to cause one of those materials
moving faster than the other one and hitting the other one,
we're going to see the damage. So basically during the back,
like a rear end accident or whiplash injury or any
(16:29):
kind of head movement, we see the brain moving faster
and hitting a more dense material, which is called skull
inside in different direction. That's why we see the different
consequences on different parts of the brain. And actually it
helps us to see there was an injury in that direction.
S1 (16:53):
Okay. All right. So in some sense the traumatic brain injury.
It's almost like two, two people dancing together. That misstep.
S2 (17:02):
Absolutely.
S1 (17:03):
Okay. And so and so, from what you're saying is,
with the mild traumatic brain injury or the traumatic brain injury,
it doesn't take a huge impact, meaning it doesn't take
a £400, you know, linebacker coming at you at 12
miles an hour and just clobbering you. Right. It can
be something smaller than that.
S2 (17:20):
Absolutely. There was a there was a idea and also
thought in that, um, for instance, the speed. Yeah. The
car speed has to be above a certain limit in
order to cause this. But the researchers and these new studies,
the model reconstruction model showing that, no, you don't need
(17:42):
to have major accident and biomechanic. Um, the event is
not these days. They're not showing that. So you can
have this traumatic brain injury angry with even less speed
and less impact. However, you have to have a significant impact. Yeah,
we don't have exactly a cutoff, but it has to
(18:06):
be significant. So impact is the major part of this diagnosis.
It's very important for us or for people who are
doing the legal work to make sure that the impact
was there before getting to this.
S1 (18:21):
Yeah. And for the word impact, for the impact in
a mild traumatic brain injury. Is it talking about like
something physically hitting the head or are you just saying
that whatever the impact is, some sort of change of force,
change of energy, which then impacts the head and neck movement?
S2 (18:40):
Absolutely. So any kind of force. Yeah. Around the head
and neck.
S1 (18:46):
Okay.
S2 (18:46):
That can cause chemical or structural changes in the brain.
Can cause traumatic brain injury.
S1 (18:54):
And that's your mild traumatic brain injury.
S2 (18:57):
That is that can be mild traumatic brain injury. But
if but that can be mild. It can be any
kind of injury. So any but most of the times
the patient with a mild traumatic brain injury they don't
have a structural injury. They have chemical. That's why the
(19:17):
imaging and the workup especially in the emergency department is negative.
That's why they get discharged home. But later on the
next day, two days, two weeks, then you're going to
see what is happening or what is going on.
S1 (19:32):
So you're saying it from the mild or from the
traumatic brain injury. You're saying you're going to you're going
to see on certain imaging, it might take a couple
of weeks in order for something to show up. That
chemical change might take a couple of weeks. You're saying
that the symptoms are going to present themselves within a
couple of weeks.
S2 (19:47):
So most of the symptoms that we have is a
result of the chemical imbalance.
S1 (19:53):
Okay.
S2 (19:53):
Happens.
S1 (19:55):
And so what does that mean. So because, you know,
some of the stuff is this is so it's it's
it's fascinating for me who did did not have a
medical and does not have a medical background. Right. But
just you know, I have I deal with medical issues
every day as a personal injury attorney. But so it's
fascinating to see what happens, what with the brain, with
the body and then even more so how somebody how
(20:17):
a victim of a personal injury victim, a claimant, a
plaintiff becomes a patient with the right doctor. Right. Because
what you're describing, you know, hey, you break your arm
at the ER easy. Hey, we're going to send you
to an orthopedic doctor. They're going to wrap you up.
You're going to be good within however many weeks or
months you're going to be fine. But how is it
that somebody gets to you? What are the the symptoms
(20:40):
that happen or the symptoms that present itself to where
somebody eventually gets to you as the neurologist?
S2 (20:47):
Sure. Let's just go back again on the classification of
the brain injury. 80 to 90% of the traumatic brain
injuries are mild. What does it mean? There is a classification,
which I don't think is an appropriate classification, but it is.
But when this patient comes to the ER even they
do even they do imaging. We do MRI even in ER.
(21:08):
There is nothing there. The patient has, most of them
have symptoms. Sometimes they don't have anything. The first day
next month we do imaging. The next day we do
imaging next six months we do imaging is still negative
but they are having the symptoms. So for in order
to make a diagnosis of mild traumatic brain injury everything
(21:29):
can be normal. On the diagnostic part okay. So there
is no need to have anything abnormal imaging any bloodwork anything.
So you can have most of the disabling symptoms of
mild traumatic injury. But every workup every single workup is
going to be negative including imaging. So the therefore the
(21:53):
structure is apparently intact with our current technology. Maybe in
ten years from now we're going to see something and
we are getting there. Actually we are. Our system is
definitely is improving. We are having new diagnostic challenge. Findings.
We are having new technologies that are helping us definitely
better than ten years ago. But if the structure is
(22:17):
normal and the patient having those symptoms. So basically we
can say that they are based on chemical disruption. Yeah.
So the symptoms are um, it's about 10 to 20
symptoms that we are dealing with almost for every patients. Um,
(22:38):
some patients have 1 or 2 depending on the severity
of the injury. Some patients have 20 of them. Yeah.
Some patients Donations. In one month, they become symptom free.
Some people in six months and some people never.
S1 (22:54):
Is there is there any sort of kind of commonality
you see with that? Is it that somebody shows up
and you say, oh, that person's going to be a month,
that person's going to be six years, that person's going
to be something else. Or is it just as whatever
however the person shows up is how the person is.
S2 (23:10):
Great question. Um, as a, uh, kind of, um, based
on the numbers and statistics that we have, most of
the patients, 80 to 90% of the patients they recover
in the first three months.
S1 (23:26):
Okay.
S2 (23:26):
That's the data we have.
S1 (23:27):
Okay.
S2 (23:30):
Then the percentage of the patients get to the second
first half of, uh, I mean, like a six months
after the accident and the percentage get to the second year. Okay.
We know that there is no way to predict who
is going to go there? Okay, there is no way
to predict. However, there are 4 or 5, maybe six.
(23:52):
Also factors that we know that if the patient already
carrying one of those, for instance, pre-existing condition.
S1 (24:00):
Okay.
S2 (24:00):
If they get subjected to a traumatic brain injury, they
are having a little bit more chance to go toward there.
S1 (24:10):
So then what what are some of the preexisting conditions?
So if somebody has they suffer an impact. That's enough
to cause the chemical change to cause this traumatic brain injury.
What what would be a preexisting condition? Are you saying
that somebody who had a concussion previously, or is it
somebody who just has a bunch of, you know, some
sort of other orthopedic injury, or what is that preexisting
(24:31):
condition that could cause a kind of compound, the concussion,
the brain injury that you have in the moment.
S2 (24:38):
You just named one of the most important ones, which
is the previous concussion. So the people who are having concussion,
they are having a chance, more chance to have another
concussion or more concussions.
S1 (24:53):
So from from my understanding, when you have a concussion.
One concussion plus one concussion doesn't mean two concussions, right?
It means three four. It could be exponentially worse, right?
The symptoms that come up after more concussions.
S2 (25:09):
Absolutely. We don't know exactly why. What we can say
that as a result of the previous injuries, for some
reason they are prone to develop more because of the
cognitive issues or something. Something is going on. We don't
know exactly. So previous concussion or having a history of
concussion in the past is one of the major ones.
(25:30):
Having a history of migraines. Having history of ADHD.
S1 (25:36):
Really ADHD.
S2 (25:38):
ADHD, having history of depression and anxiety, or PTSD in
the past.
S1 (25:44):
These can make the the symptoms from the. From the concussion.
From the traumatic brain injury worse.
S2 (25:51):
Absolutely. And they. So if you're asking you were asking
what are the factors that we can predict this patient. Possibly.
We don't know. Still we don't know. There is no
way to predict. But if these are existing there. It
there is a chance that patient is going to have
a prolonged course.
S1 (26:09):
So a person who suffered a brain injury, a traumatic
brain injury, a mild traumatic brain injury, a concussion. Some
of the things that they and their family might want
to look at is what has happened to them before.
Have they had depression? Have they have PTSD? Have they
had another concussion? These are the kind of things that
when a patient or a, a, a plaintiff shows up
(26:33):
to you. This is probably some of the stuff that
you want to know.
S2 (26:37):
That is so important to know about the preexisting pre-existing
conditions and an already important thing. Is this a lot
of family, especially if this happens to children and the kids, um,
they kind of the new injury. They're going to think
this is from the previous history of previous condition, so
(26:59):
they don't pay as much attention. They think that, oh,
attention deficit is now flaring up or depression is a
little bit flaring up or anxiety is a little flaring
or headaches are worse because of that. No, it's not
just that.
S1 (27:14):
So it's not just the pre-existing condition.
S2 (27:15):
It's not just the pre-existing. Actually, these patients needs to
have a faster and sooner evaluation and treatment because they
have a chance a more I mean, they have more
chance to have a prolonged course. So recovery.
S1 (27:28):
Would you say then from from what I'm hearing, if,
if you have, if you or a loved one you
think had a traumatic brain injury and that you know
that you or that loved one has had these histories
in the past. You want to get to a neurologist
as soon as you can?
S2 (27:43):
Absolutely.
S1 (27:44):
Okay. And then is there is there some sort of
aggressive approach that somebody with the, with the preexisting condition,
who then has a TBI as a traumatic brain injury
that if they get to the neurologist, can you can
you kind of attack it stronger and hopefully have a
better outcome long term?
S2 (27:58):
So the sooner you start the treatment and evaluation and
diagnostic whatever is needed, the better outcome for sure for
those patients. And again, there are patients with preexisting conditions.
And they in terms of the treatment and any kind
of treatment or therapy, they have to be started sooner
(28:22):
because we know that these are not going to have
the same chance of recovery with other people who don't
have preexisting.
S1 (28:30):
It's it's they're in a they're, they're they're in a
weaker state that they need a little bit of extra,
extra protection.
S2 (28:37):
Absolutely.
S1 (28:38):
Now, so here's one of the things that I know
with the traumatic brain injury. It's not just cognitive, right.
It's there's an emotional aspect to it. And so, you know,
for you as the neurologist, you're it seems that you're
not looking at one narrow lane. You're as a neurologist,
you have to look at kind of the whole person.
S2 (28:55):
Absolutely. So we have three categories of or classifications classes
of symptoms and symptomatology. Basically one of them is physical symptoms. Headache. Nausea.
Blurry vision dizziness. Balance issues. We have a we have
(29:16):
a series of cognitive issues okay. Brain slowness difficulty in concentration,
difficulty in multitasking. Uh forgetfulness. And then we have a
sense of the psychological issues and symptoms such as anxiety, stress, PTSD.
the typical one. Lack of sleep, irritability, mood disorders. So
(29:41):
basically when we are looking at a patient, we like
to see all of those, or at least 1 or
2 symptoms of each of those classes. And based on
the severity, we have to focus in terms of the treatment.
S1 (29:57):
So what I'm hearing is that for those who have
a traumatic brain injury or those who suspect they have
a traumatic brain injury, they really need to look at
their whole background and kind of document things before they
show up to the neurologist, so that when they show
up to the neurologist, they can give the neurologist, like you,
the full picture of what's going on.
S2 (30:15):
Absolutely.
S1 (30:16):
Okay. All right. And then so what are some of
the things that you can do. So somebody shows up
and they have two two areas perhaps three areas. You
know you have some forgetfulness. You have some emotional aspects.
You have, you know, kind of lack of sleep which
is causing some other things. What are some of the
kind of the healing processes, the Processes, the healing procedures. Who?
Who are other? Do you bring in other doctors? What
(30:38):
do you do from a treatment perspective?
S2 (30:40):
Great question. First of all, there is no one magic
pill for this. This is not an infectious issue. So
you've got to get antibiotic amoxicillin. And you're going to
get better in ten days. No we have to see
what the problems are. Again we have 20 symptoms or
20 and three different classes of issues. We're going to
(31:01):
go each one with each one is more prominent problem. Yeah.
Pain in the acute setting either headache or spinal pain
such as neck or back pain are the major issues
that need to be addressed after the first acute phase.
I mean, the acute phase, which is around first month
(31:21):
when we are dealing with the pain issues, then we're
going to see the real face of the cognitive issues
and other physical issues such as dizziness and balance.
S1 (31:30):
So the so it's so this is not something that
just presents itself. This is something that takes time. So
you're saying in essence there's layers of it. So you
have this physical pain with that that's associated with the
event that caused the traumatic brain injury. And then as
that starts to kind of dissipate, as that starts to heal,
there's other gophers that pop up out of the ground,
(31:52):
is what you're saying.
S2 (31:53):
Uh, that is very true statement. That's what you said. However, however, um.
We need to have symptoms based on the guidelines and
diagnostic criteria, even in the first 72 hours.
S1 (32:12):
Okay.
S2 (32:13):
So they might not be the prominent symptoms, such as
neck pain, back pain, headache. However, we need to have symptoms.
S1 (32:21):
So can you give me an example of so you're
saying with the traumatic brain injury, in order to be
able to diagnose it down the road, you need to
see within the first 72 hours that there was some
sort of symptom where you've got your big ones, your neck,
your back. What are some of the other symptoms that
you would look at in your everyday practice?
S2 (32:38):
Absolutely. Uh, basically, headaches are one of the major things.
S1 (32:42):
Okay.
S2 (32:44):
After that dizziness and balance issue.
S1 (32:47):
And would that, could that present itself within that first
72 hour phase?
S2 (32:52):
Absolutely. Okay. One of the major things that I am
asking patients is that actually having dizziness or not having
dizziness or balance issues is going to be a question
for me. That is a real dizziness. This is a
real TBI or a just the headache. So there are
a lot of issues uh, or diagnoses. Other diagnoses can
(33:15):
mimic TBI at the acute phase, including post-traumatic headaches. So
post-traumatic headaches are not TBI. Okay. But most of the
patients with TBI having post-traumatic headaches. So it's very important
for us to separate this diagnosis because that can have
a lot of consequences and also stigma in the future
(33:37):
for the patient and the diagnosis again. And but so
there are a few things we need to really know.
So anxiety and mood changes and sleep disorders are very common.
S1 (33:51):
And when does.
S2 (33:52):
That.
S1 (33:52):
Present itself. When can it present itself with the TBI.
When can the sleep disorder, the anxiety, these sort of
kind of serious issues present themselves.
S2 (34:00):
For in order to make a diagnosis? Again, we are
sticking to the guideline. Yes. As I mentioned before, there
is no specific symptom for traumatic brain injury. So if
we don't put them together in when there is in
the in the right context, and it's specifically very important
in a real impact, you cannot make this diagnosis. So
(34:23):
basically in order to make this diagnosis you have to
have two symptoms.
S1 (34:28):
Terms, okay.
S2 (34:28):
Two symptoms, at least in the first 72 hours or
at the time of the accident. So you cannot have
just a neck pain or just one headache, nothing else.
And then three months, four months, you're going to refer
to a neurologist for having other issues. And you're going
(34:49):
to say, oh, did I have brain injury at that
time or not? It's hard to say. Cognitive issues in
my experience, that you are seeing it. That's the last
thing comes up. Okay. The patients are blaming their brain slowness,
their forgetfulness, everything in the first 2 or 3 months,
even six months because of the pain, suffering, anxiety, they're
(35:11):
not working. They just blame God. And after that, when
everything else is settled, then they see, wow, this is
not the cognitive function that I had before this accident.
S1 (35:24):
So, you know, there's two big things I see right here.
One is that. Well, I should say three. One major
one and two kind of subtopics. Right? It's very complicated. Right.
And so on the first hand, it's got to be
very complicated for the patient, for the personal injury victim
who's dealing with or potentially dealing with the traumatic brain injury,
(35:46):
knowing what is going on, having that self-awareness, having friends
and family around you who are there. And then secondarily,
for you as the doctor, to peel away all of
these layers and really get down to it. This isn't
something that you can do in a 15 minute, 15 minute, uh, encounter.
Can you?
S2 (36:05):
Absolutely. And you just said exactly the fact, um, let
me tell you that, um, I'm an expert. I'm certified,
board certified in brain injury, and I'm seeing a lot
of patients. Yeah. Still, there are cases. I'm scratching my head, hair.
I don't know. It's a real case or not. So
(36:28):
that's why we are sticking to the guideline. Otherwise, we're
going to be distracted. If you have ten neurologists, no
matter they are certified or not, or board certified or
trained in brain injury. If you give them a case
to ten of them, you're not going to see a answer.
(36:48):
A kind of a unique I mean, unified answer. Yeah.
You're going to see different opinion and different diagnosis. So
even for us. Yeah, it's hard to make a diagnosis
after many, many years dealing with the traumatic brain injury
and having a lot of science about it.
S1 (37:08):
Yeah. So I think my kind of final question here
has to do with, I mean, if it's this hard
for smart, educated, board certified neurologist, what what is your advice?
What is your suggestions that potential patients, uh, personal injury
(37:29):
victims who think maybe I've got a traumatic brain injury
or something associated with that. What is it that they
can do to one? Get to a neurologist, and then
once they do get the appointment with the neurologist, what
is it they can bring to you? What story can
they tell you to better help you make that diagnosis?
S2 (37:48):
So for us, again, we don't see 80 to 90%
of the cases. There's everything is every testing is normal.
So this is a diagnosis we make with the patient
in the room okay. So they have to give us
a as much as possible information.
S1 (38:08):
About their history.
S2 (38:09):
History everything and then impact. It's so important for us
to see the mechanism of action. What happened in the impact.
Is it a compatible. Is this impact compatible with? The
patient can have a brain injury or not because every
impact they're not the same. Even it's a rear end
(38:29):
that for instance a car accident, but they're not the same.
We know that and you know that.
S1 (38:34):
Absolutely.
S2 (38:34):
So it's we have the more information we have at
the time of interview, the better chance to come up
with the right diagnosis.
S1 (38:43):
And then whether there is a traumatic brain injury or
there isn't a traumatic traumatic brain injury. What I'm hearing
from you is that if, if a if a victim
thinks that they may have a traumatic brain injury, they
need to come prepared with being able to describe the impact,
what happened, what was the forces? They have to be
able to tell you how they felt within the first
72 hours, and they have to have some sort of documentation,
(39:06):
some sort of history that they can explain to you
about what they were like beforehand. Do they have a
pre-existing issue, and then what has happened to them in
the weeks and months since then?
S2 (39:17):
Uh, as a physician For me. Just having those information enough. Yeah.
If they are going to have a medical legal case documentation,
it's a significant it's a significant issue. Yeah. So it
they have to know that first of all the they
(39:39):
don't they should not leave this alone.
S1 (39:42):
Yeah.
S2 (39:43):
The brain injury is can be disabling if they don't
get treated correctly. And um as soon as possible. However
med legal cases are different in med legal cases. Documentation
is the major thing. Yeah. They have to take care
of it.
S1 (40:01):
Well, and for for for me, as a personal injury attorney,
one of my biggest concerns is not just like I
take a two pronged approach to it. I want to
get them justice and but then I want them to
get better. And so, doctor, I want to thank you
so much for your time today. This has been fantastic.
I think, you know, this is a very, very huge iceberg, right?
And we have seen just the tip of it. But
(40:21):
I look forward to hopefully someday we can have this
conversation again and continue on.
S2 (40:25):
Looking forward to it. Thank you so much for the opportunity.
Thank you. Thank you very much.
S4 (40:32):
Now's a good time for a short break. Stay with us.
There's more ahead on unseen impact.
S5 (40:42):
Hey, it's Daniel from Beyond the Doors. We're super excited
to be a part of the Ola's media network, recording
right here in San Diego, alongside some amazing podcasts. There's
a host of wonderful shows from all types of genres,
basically like real estate. There's a little something for all
walks of life. You won't want to miss it. So
(41:03):
head over to Ola's media or wherever you get your podcasts.
Don't forget to follow or subscribe while you're there. Now
let's get back to the show.
S4 (41:14):
Welcome back. Let's continue the conversation.
S1 (41:19):
Well, that was fantastic. Talking with a quadruple board certified neurologist.
And I guess the biggest thing that I hope people
take away from this is brain injuries are really, really complicated.
And not just at the beginning, not just at the middle,
not just at the end from start to finish. They
(41:39):
are complicated from the mechanism of injury, meaning how it
happened to the to the symptoms that you suffer in
the first 72 hours in the first weeks and the
first months. It's very complicated. So what I want listeners
to take away from here is if you sense something
in yourself or in a loved one, start having that self-awareness.
(42:04):
Start taking notes. Start really thinking about, well, could this
be related? What is going on? Is it just the pain?
Once the pain gets over, what else is going on?
And so kind of some of the tips that I
have for you is document, document, document. And it can
be something as simple on your iPhone where you're just
saying or you're on your phone with the messages, you're
saying da da da da, or your notes just writing
(42:25):
down if it's once a day, if it's once a week,
if it's once a month, just take a moment and
have some self-reflection and think, hey, what's going on with me?
How am I doing? What are some of the issues
that I have? Is this headache that, you know, maybe
I used to have headaches, but now this one is
a little bit worse than it was before. So recognizing
that maybe you had some symptoms before, but now that's
(42:48):
just a little bit worse. That counts. Have it documented?
One of the biggest things is if you think anything
is going on, whether with you or a friend, call us,
message us. Go to the website. Engage with the website.
Sign up for us. One of my biggest jobs is
(43:08):
just to talk with people so I can. You can
tell me your stories. I see a bunch of these things.
So I start to recognize the similarities. I can cut
right to the heart of what you need to look at,
and together we can kind of figure out what's going on.
And so part of that is I get questions right.
Whether it's at the intake, whether it's throughout the, throughout
(43:30):
it all, uh, of the of the litigation, the pre-litigation
process or it's just, you know, folks engaging with us
on social media. I get questions, so what I want
to do is answer a few of them. So first off,
and this is a good one, right? Can I file
a lawsuit for a mild traumatic brain injury? And the
(43:52):
answer is absolutely. I can file a lawsuit for a
what they call mild traumatic brain injury. I think one
of the things that we learned today is that mild,
the term mild is a misnomer just because it's deemed
mild or by the guidelines, as Doctor Bowerman said, is mild.
It doesn't mean that the impact on your ability to
(44:13):
function is mild. It just means that the way that
they have classified it, that it's mild with respect to
the brain injuries. Still, it can keep you up at night.
It can cause anxiety. It can cause debilitating headaches, it
can make your life debilitating. And all of those are damages, right?
Damages are what really drive lawsuits. Okay, a great question
(44:39):
that we get a lot that I love to answer
is what damages can I recover in a brain injury lawsuit?
In a brain injury lawsuit, you can recover medical bills
past and future loss of income, loss of earnings, capacity,
meaning your ability to do what you did before the
the pain and suffering and emotional distress. And this is
(45:02):
what is really huge in this area. Basically, it comes
down to a quality of life. You know, this country
was founded on the idea that we get to pursue
our happiness and the pursuit of our happiness comes down
to our quality of life. And when the quality of
life is diminished, it's cut back or it's just fully
taken from you. Those are the actual damages that you get. Now,
(45:25):
when it comes to brain injuries, typically unfortunately it's longer term.
So you're looking at the cost of that longer term right.
When we when we do the damages analysis, when we
look at this, we're not just looking at, hey, what's
it going to be like in the first week and
the first month we're talking about what is it going
to be like from the date that this happened to
you until the end of your life? And this is
(45:48):
important stuff. One question I get often is how long
do I have to file a brain injury claim? Now what?
I like to back up and say, hey, any claim?
So this isn't just specific to brain injuries, but typically
in California you have two years to bring a lawsuit.
Now however, if there is a government entity like the city,
(46:12):
a county, Caltrans, you know, some sort of government body.
You only have six months to file what they call
a government tort claim. And so what that is, is
you have to go to the actual web page or
communicate with the actual agency and say, hey, what form
do I have to do? You have so I can
fill out? You have to fill out that form. And
(46:32):
this is a hard date six months. Then they have
45 days in which they have to deny or accept it.
They're going to deny it. And then once you get
the denial, you have only six months to file the lawsuit.
So how much time do I have to file a
brain injury case? Typically two years. If it's a government entity.
You got six months. And I know six months might
(46:55):
seem like a long time. It's not. It goes very,
very quickly. Another big question that I get are how
do attorneys prove a brain injury in court? Now When explaining,
how do you prove anything in court? There's a lot
of similarities with this, right? And there's a lot of
sort of the process that we do that's particular to
(47:16):
us in, you know, really digging into the to the,
our plaintiff's life, our, our client's life, their friends, their family,
the brain injury is a little bit more difficult because
what you have to do, as we heard from Doctor Bahman,
he's looking at what was the impact like not necessarily
(47:37):
saying impact to the brain. Right. But impact that caused
the sort of movement in the body that caused this
traumatic brain injury. What was the impact? Like, you have
to say, what happened to you? What symptoms were you
having in the first 72 hours? First 72 hours? That's
really tough because most of the time you're in shock.
(47:57):
You have physical pain, you don't necessarily know what's going
on there. And then kind of for the next, for
the following weeks and for the following months, you have
to kind of document what are your what are your injuries.
So in looking at what do you have to prove
brain injury and court. What was the impact. What happened
in the first 72 hours. What has what are your
(48:19):
symptoms that have been since the impact. And a big
thing for the neurologist, which of course is for us
is did you have any pre-existing conditions before? Did you
have a previous concussion or concussions. Did you have depression?
Did you have PTSD? These are all items that are
necessary for proving a traumatic brain injury in court. Another
(48:42):
big question that we get is my loved one has
a brain injury and can't make decisions. Can I act
on their behalf? And the answer is yes. If your
loved one has a brain injury in which that person
is incapacitated. You can either. You can absolutely act on
their behalf. It happens a couple ways usually. Typically, if
(49:05):
you have an estate plan set before this happens and
you have designated somebody to make these health decisions on
your behalf, that person automatically gets to do it. Secondarily,
you can have either a legal guardian, which usually is
a spouse, a family member. If there are none, you
can have one appointed or a conservator of some some respect,
(49:26):
and those folks can make those decisions on your behalf.
This is a great one that I do get as
an attorney at Rory Law. What types of accidents do
I most often see leading to brain injuries? And and really,
especially those that go unseen are rear end auto crashes
(49:50):
where you have that whiplash, that whiplash motion. And it
doesn't have to be huge property damage. I've got one
right now. Very wonderful lady who she felt a big impact, right?
She had that impact and that whiplash. As we talked
about before, you have that hard skull, that hard cranium
(50:11):
and the kind of different density, that gelatinous brain. And
when they start to kind of not dance with each other,
as we talked about with Doctor Barnett, you can have
this sort of brain injury. And so it's, it's that
it's the it's the motor vehicle rear end crashes where
I see this most often, at least with respect to
(50:33):
those that are unseen. Um, you know, for instance, I've
had a number of motorcycle crashes that were significant and
they were bad and they were nasty. And you just
know that it happened right? When you have a banged
up helmet, a scraped up helmet, somebody's thrown 25, 30ft,
you know that it's big. Where I'm looking at is
(50:55):
where I most see this unseen brain injury, as are
these rear end or kind of side impacts. And it
doesn't have to be a big property damage, big damage
to the vehicle. Now this question is what I get
the most and I should how much does it cost
(51:16):
to hire Rory Law? Hire an attorney for a brain
injury case? Well, first off, there's no separation between any
injury and a brain injury case. Attorneys like me, attorneys
at Rory Law, we are what's called contingency fee attorneys.
And what a contingency fee means is that I get
(51:38):
nothing until and unless I produce for you. What I
love about that is it means one. I have to
get to know you, right? Is. And I have to
believe in this case is am I going to spend
potentially thousands of hours and potentially tens of thousands or
hundreds of thousands of my dollars to fight this case, Right?
(52:00):
So there's a real sort of fire behind it for
me to get behind it and to go for it.
I do not get paid by the hour. And if
we lose, if something bad happens, you don't pay me anything.
What the contingency fee means is that whether it's a
contingency fee on a brain injury, a contingency fee on
(52:21):
any sort of other injury, it means I only get
paid if I produce. Thank you all for listening to
Unseen Impact. I am Rory Pendergast, your host, the attorney
at Rory Law. If anyone has any questions about anything
wondering about our services, please visit us at WW that
(52:42):
is WW. Also, we have all sorts of social media accounts.
All of them are at Rory Law firm. So again
at Rory. Firm. We are here to answer any questions.
Talk about your case. Whatever you need. Rory Law at
(53:05):
Unseen Impact. We're here for you.
S4 (53:13):
Thanks for tuning in to Unseen Impact with Rory Pendergast.
Please follow, subscribe, and maybe share this episode with someone
who's walking their own path to recovery or justice. You
can find us on Instagram, Facebook, YouTube, and LinkedIn at
Rory Law Firm. To learn more about legal services or
get in touch, visit Rory Law.com. Unseen impact is recorded
(53:38):
in San Diego, California, and proudly produced by Olas Media,
an IVC media company.
S6 (53:55):
Alas media.
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