March 24, 2025 • 45 mins
Dr. John McClaren shares his journey into specializing in brain injury rehabilitation and explains how autonomic nervous system dysfunction affects many TBI patients, often going undiagnosed despite causing significant symptoms.
• Personal connection to TBI after his father's severe train accident which inspired his specialization
• Conventional autonomic testing (QSART, tilt table) often has 6-month waiting lists, delaying treatment
• Autonomic nervous system functioning requires responsiveness - like a high-performance sports car - needing both acceleration and braking capabilities
• Simple bedside assessments can reveal autonomic dysfunction without lengthy waits
• Pupillary light reflex testing using smartphone apps provides millisecond-precision measurements
• Blood pressure differences between sides and positions offer valuable diagnostic information
• Heart examination with position changes can detect subtle autonomic abnormalities
• White matter connections between brain regions drive proper autonomic function
• Current focus on vagus nerve may miss the bigger picture of central autonomic network dysfunction
• New imaging techniques like DTI now allowing visualization of damaged neural connections
Dr. McClaren can be contacted at Advanced Chiropractic & Neurology in Omaha Nebraska.
Advanced Chiropractic & Neurology Facebook page
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. John McClaren (00:00):
What you're looking at for people who are
getting these reflex tests done.
Those are the things they'regoing to do the QSART testing
and the tilt table test, whichyou know we're going to
orthostatically challenge youand see what happens to your
blood pressure and your heartrate over time.
And do the responses occurnormally, or do I get, you know,
a huge rise in my heart rateand a drop in my blood pressure
(00:20):
when I become upright, which isnot, you know, the response that
you want to have, and it's gotto meet a certain criteria which
they change.
You know they move thegoalposts all the time on this
stuff too.
You know, used to be 30 beats aminute, now some people are
saying 40, you know, becauseit's like one.
Do we have so many people,especially in this post COVID
era, that have autonomic nervoussystem dysfunction?
(00:40):
You know, and you know againwhat we know not function, you
know, and you, you know again,we, you know, not to get ahead
of ourselves on topic there, butyou combine some of these
things, which is the humanexperience, you know, oh boy
right.
Sophia Bouwens (00:58):
Welcome to the Life After Impact podcast, where
we do a deep dive into allthings concussion and brain
injury related.
We talk about all the differentsymptoms that can follow brain
injury, different testingmethods, different types of
specialists out there anddifferent therapies available.
I'm Sophia Bowens, I'm herewith Dr Ayla Wolf and we will be
your guide to living your bestlife after impact.
Dr. Ayla Wolf (01:22):
Welcome to the Life After Impact podcast, where
today we have Dr John McLarenon the show.
And Dr McLaren, you've been inprivate practice since 2002
outside of Omaha, Nebraska,correct?
Dr. John McClaren (01:35):
Correct.
Dr. Ayla Wolf (01:36):
And you have a diplomat in chiropractic
neurology.
You also completed a veryintense program and earned a
fellowship by the American Boardof Brain Injury and
Rehabilitation.
And then, if that wasn't enough, you actually went back to
school.
You already have a doctoratedegree, but you went back to
school.
You got a master's degree inclinical neuroscience, where you
(01:58):
spent a lot of time studyingtraumatic brain injuries as well
as dysautonomia, and then youearned your master's in clinical
neuroscience.
You're on the faculty of theCarrick Institute, You've had
the honor of presenting at theInternational Symposium of
Clinical Neuroscience and youspecialize in your practice in
(02:18):
brain injuries, concussions anddifferent neurological disorders
.
So I'm thrilled to have you onthe show as one of my teachers.
I find you to be just a wealthof information and so generous
in sharing your information.
So thank you so much for beinghere.
Dr. John McClaren (02:36):
That is about the greatest introduction I
could ever ask for.
Thank you so much for the kindwords.
And yeah, I've done.
I've done all that.
I guilty as charged.
My wife would say it's justbecause you're bored or you know
things like that.
But but the thing that is greatabout clinical practice, and
when you get into this stuff,you just, you know, you dip your
(02:57):
toes in a little bit and it'slike, oh, I'll just go to, you
know I even me, you know, it'slike I'll just go to the first
TBI seminar, I'll get someguidelines.
I already kind of know what I'mdoing.
And then I'm like I don't knowwhat I'm doing at all.
So here I am, you know, like Isaid, you know sucking that from
the fire hose, trying to getmore, and you know you're in
over your head and it's it'sdefinitely something you can
(03:18):
never, you can never know enoughin this practice.
Same with you, you're superduper credentialed and you just
keep going and I am so excitedfor your book.
Thank you Personally and for mypatients and anybody else that
I'd refer to.
So put me on the list.
Dr. Ayla Wolf (03:35):
Thank you for that.
And you are so right, I think.
Every single patient comes inand presents with their own
unique challenges.
That forces us to constantly belearning more and it's never
ending.
I mean, even with my book.
I referenced papers that werepublished in January of 2025 in
my book.
Like I mean, it's just theamount of new stuff coming out
(03:58):
is so good it is, and that's thething you go.
Dr. John McClaren (04:03):
One more paper I remember when I did my
long COVID class I found a paperI think it was that week or the
week before that got publishedand it's like hey guys, this is
hot off the press.
I don't even have a citationfor it yet.
So it's the way it goes.
For sure, you find stuff allthe time, and it's kind of nice
when assertions you make in yourresearch get validated kind of
(04:24):
at the last second, like thattoo.
Dr. Ayla Wolf (04:25):
It's really, really fun.
Oh yeah, absolutely.
You know things like patternsthat you were seeing or things
that you observed.
All of a sudden, someonepublishes a research paper on it
and you go okay, so I'm notcrazy, I really am.
You know, seeing this correctly.
Dr. John McClaren (04:38):
Yeah, I'm not the only person that saw this,
or you find stuff that was way,way buried in the weeds and it.
You know, for some reason itwasn't really spoken about a lot
, but then you know a lot withthe olfaction and the long COVID
, that was really really big andit was nice to see that,
because olfaction, you know Ialways said it's kind of like
the redheaded stepchild of our.
(04:59):
You know it's a vestigial sense, it doesn't mean much, and then
COVID happens and everybody'slike well, I guess olfaction is
probably pretty important forcognitive function.
Dr. Ayla Wolf (05:06):
Yes, I mean the amount of anxiety that people
were having when they couldn'tsmell and I think people don't
realize, you know, when youcan't smell, you don't know if
your house is on fire, and thatyou know not knowing can create
tons of anxiety when you aren't,when you lose that sense to
when you lose that sense, oh forsure, yeah.
Dr. John McClaren (05:24):
Or you know even simple things like well,
the baby's got a loaded diaperand you know stuff like that,
you just go, geez, it's like Idon't want to smell it, but you
kind of want to know for the kidright, Right.
You do need to know if thediaper change needs to happen.
Dr. Ayla Wolf (05:47):
Yeah, yeah, exactly, yes.
Well, I did read a study thatsaid that 55% of people, after a
traumatic brain injury, havechanges in their smell that
lasted, for you know, up to ayear afterwards.
I've certainly had patientsthat have experienced a loss of
smell longer than that.
So you know also with braininjuries, that loss of smell can
be a symptom as well.
Why don't you give us some ofyour background in terms of what
led you to not only studychiropractic but then to
(06:08):
specialize in neurologyspecifically?
Dr. John McClaren (06:13):
You got it, yeah.
So how did I get here, so tospeak?
And you know the thing, and inlistening to you guys in the
podcast and in our discussionsfrom before too, we always, you
know, when we kind of choose ourhealthcare profession, we have
kind of a horse in the race, youknow, so to speak, or things
like that.
I was a high school student atCornhusker Boys State.
(06:33):
The Boys and Girls Stateprograms are these legion
programs that they do for likeleadership development and
things like that for high school, like juniors going into senior
year.
I was at Cornhusker Boys State,my you know junior going into
my senior year, and I get a callfrom my mom.
You know, your dad was in anaccident, you know, and I think
(06:54):
you know I had some friends inthe room and we were meeting
with one of my friends who waslike this gubernatorial
candidate and no-transcript.
(07:27):
One train ran into the otherthis wreckage goes everywhere
and my dad was in an oncomingtrain and his conductor jumped
off the train and dad was thrownoff the train as these things
collided, landed on his head,his neck and so on.
Luckily he was not paralyzedWorse, you know.
You know gets up, you know seestars, claws his way up the hill
(07:49):
, this kind of thing, and youknow they run for their lives,
they get away far enough andthey just watch the carnage
happen.
And then you know, ambulancescome in and they transport them
to North Platte, which is, youknow, a central Nebraska town.
That's kind of got the hub foremergency services and things
like that.
And his doctor in North Plattewas our like childhood, my
(08:12):
childhood doctor.
He'd moved on and so it waskind of nice to get a familial
connection.
Nebraska is small like that.
I grew up in Western Nebraskaso then, you know, I became
intimately familiar with theworld of traumatic brain injury.
It took a little while for mydad to get the diagnosis.
He's diagnosed with a traumaticbrain injury, ptsd, which you
know some of the things we'regoing to be talking about today.
You know all these kind ofthings.
(08:34):
He had a neck injury as well,which I have loved the way you
guys have talked about neckinjury on the podcast so far.
I mean, you know, chef's kiss,you guys nail that stuff super
well.
And this is dad.
He ends up having four vertebrafused and, you know, had a
neuropsychologist who got, youknow, the diagnosis correct for
him and you know, and the thingI saw with my dad, as you know,
(08:57):
I went on.
I was a powerlifter in college.
I didn't know that I was goingto be a health care guy at that
time when dad got hurt, but Iwas.
You know, stem was kind of mypath.
It was STEM or it was politicsand I'm glad I went to STEM and
not politics.
You know, with the boy statething and I had.
I was a collegiate power lifter.
(09:17):
I had a shoulder injury, had achiropractor.
That I found via this musclemedia you remember Muscle media
magazine back in the day.
Dr. Ayla Wolf (09:27):
I started working in a health food store that was
managed by a bodybuilder when Iwas like 15 years old, so we
probably had it laying around.
Dr. John McClaren (09:34):
Yeah, it's around there.
Bill Phillips would do thechallenge and he'd give his cord
anyway to these guys.
You know.
Yeah, they had an article on onactive release technique at the
time and I'd had the shoulderinjury and the orthos couldn't
figure out what to do and youknow, it's like we can open you
up and go in and I wasnationally ranked as a power
lifter and the shoulder thingkind of took me down a few
places.
So I went to this ARTchiropractor and it's like that
(09:57):
is what I want to do with mylife.
I didn't know at the time howit would tie in with a traumatic
brain injury, until later, youknow.
So I decided chiropracticschool, is it?
I enroll at Parker, my sisterlived in Dallas.
That's why I chose Parker.
You know everybody will say mychiropractic school is the best
because it's because my sisterlived in Dallas and I I wanted
(10:17):
to have family close by forprofessional school, just
because sometimes it's like man,I I'd have a home-cooked steak
or something like that, orsomebody to listen to me cry
when I'm struggling.
Dr. Ayla Wolf (10:28):
Or to quiz you with the note cards.
Dr. John McClaren (10:32):
All that, yeah, here, throw them at her
when I miss.
She got good at dodging them.
So I chose Dallas and I went toParker and my friend Haney
Helmy my first trimester inschool, you know and Haney and
Glenn Zielinski, you know, glenn, you know those guys were like
tri six at the time I was trione and these guys, you know
(10:53):
they.
They were like you got to seethis Professor Carrick guy and
they showed me a couple of theshort shorts videos where he's
running around on the stage, youknow, and he's getting these
people with Parkinson's to getup out of chairs and all these
kinds of things.
And he had a.
He had a patient on one of thecase studies they showed me that
was a traumatic brain injurypatient.
I'm like, tell me more and.
(11:14):
And they did and and they gotme hooked and and you know, we,
we started a, we, they started aneurology club and I just went
and you know, same thing.
It's like, give me all you got.
So so I start to learn somethings.
Go home Maybe some of thisstuff.
My dad had residuals.
This is I went to chiropracticschool in 98, you know.
So I'd go home for breaks, likeyou know, as as these guys kind
(11:37):
of introduced me to some of theprinciples of examination and
treatment.
You know, let's, let's try itwith dad.
You know, dad's balance isterrible, eyes closed.
You know, when he tips his headback, things like that He'd had
, he'd had some fusion in hisneck and things like that too.
So it's, it's one of thosereally complicated cases.
It's like right away I got acool TBI case before I even
leave school whenever I want,you know, and he was, he liked
(11:58):
it because it helped him.
You know, he noticeddifferences right away.
And again, I'm hooked.
They started the diplomate oncampus my seventh trimester at
Parker.
You know, at the time it was anine trimester program.
So you know, my last year theystarted the program on campus.
Again, dr Klotzik and Dr PeterPercoco were there as my
instructors and you know, likemodule one I had like 35 pages
(12:19):
of handwritten notes and ifyou've seen my handwriting,
that's like terrible.
So then I was in.
Dr. Ayla Wolf (12:26):
Yeah.
For sure, and so how do peoplefind you in your community?
And I actually lived in Omahafor about six months, by the way
, when I was an infant.
Dr. John McClaren (12:37):
Oh, how about that?
I didn't know that.
Dr. Ayla Wolf (12:38):
My dad got transferred there for work for
like six months, so obviously Ihave no recollection of it but I
did live in Omaha.
Dr. John McClaren (12:47):
You don't remember the flat plains?
Dr. Ayla Wolf (12:49):
Nope, I just remember that we have home
videos where there's just likereally trippy music playing in
the background.
I was like dad, what were youinto?
Dr. John McClaren (12:57):
That's kind of awesome.
Yeah, yeah, yeah.
What did Omaha introduce him to?
Music?
Wise, right?
That's cool.
That's cool.
Yeah, I've been in practice.
You nailed it.
I've been in practice for 23years now and you know it was
just last month we celebrated,kind of the birthday of the
practice, which is awesome.
In my wildest dreams couldn'thave imagined it going as well
(13:19):
as it has, of course, hiccupsand bumps and bruises and all
sorts of things, but it's just,it's been awesome.
I haven't had to do, we justbrought in some new stuff.
You know, I've got I've gotsome things that I've never
marketed for that I really wantto expose people to a little
more and brought in some newstuff.
But I haven't done anymarketing or or you know those
(13:39):
kinds of outreach things, sincethe yellow pages were like a way
to actually find people youknow, to date myself.
Right, you know, that's you know.
And yellow pages don't workanymore.
Dr. Ayla Wolf (13:50):
It's tough when you're so busy with patients you
don't have the time to thenalso be a marketing executive
for your own companyno-transcript, that kind of
(14:38):
thing or whatever.
Dr. John McClaren (14:39):
So you don't have to, you don't have to
bother them with it, even thoughthey're super great at taking
care of people.
So it's like, yeah, let's,let's get back on.
And I, just today, you know,and so you know, you start
posting things like here, here'sanother hyperbaric treatment,
or here's some pulse EMF thatwe're offering for you know, all
the stuff you would offer thatfor now, like, like my, you know
, and, of course, because I'vebeen dead for four years on
(15:02):
Facebook, nobody, nobody'swatching me anymore or anything
anyway.
And then today I took the wifeand kids to brunch before this
and I posted a food picturebecause I'm like I haven't seen
a food picture since I've beenon Facebook.
More engagement with that thanany of my work stuff.
Dr. Ayla Wolf (15:18):
I totally, I totally know that, like I will
post, you know, a link to a blogthat I think is just so rich
with information and it getslike one like.
And then I post a picture of mydog and it gets like 55 likes
and you're just like all right,the animals win every time.
Dr. John McClaren (15:34):
Everybody's like I want to hug him.
You know that kind of thing.
Yeah, yeah, I know I'm givingyou the like on the post and
you're like well, that that'sgreat, but it doesn't help.
No-transcript my practice,especially early on.
(16:20):
You know, and you see movementdisorder cases and TBI cases and
you do some things.
You know, and there wasn't aFacebook forum for collaboration
like there is now or any thatkind of stuff.
So you know it's like I'd callthe one or two people I knew and
they're like I don't know.
You know, and we just kind oflearned to try.
You know what would anoptokinetic do in this situation
or things like that.
(16:41):
And then you know the TBIfellowship program starts and I
found out how behind I was a lotof other people when I first
got into that, because you knowwe have so many people in this
care trained.
You know variety of disciplinesbetween you know like you know
your acupuncturists, thephysical therapists that are
(17:01):
doing it.
You know the nurse, nurse andnurse practitioner people that
are doing it.
I mean you'll get MelissaBiscardi's work.
You know those kind of things,just amazing and even medical
doctors that really arefascinated with this kind of
work.
So you know, a lot of itoriginally was a lot of doctors
at chiropractic, you know, andthen Professor Carrick built the
bridges and here it is.
(17:23):
It's like, hey, you know, we'renot the only people that can do
this stuff there.
Hey, we're not the only peoplethat can do this stuff.
There's an evidence base for itand I think it's impressed so
many varieties of people and youcan really tie it into whatever
kind of practice you want.
So I just think we have peoplethat are trained really well.
(17:45):
I've gotten to where CarlaMellenbacher made a connection
for me with somebody who's aspeech language pathologist in
our community, you know, in thatthey went out to see her when
she was out in California forTBI Because, again, you know, I
wasn't marketing that, I was inTBI and they live in my
community.
So Carla's like go see Johnwhen you get back home.
And the thing organically grew.
Tammy got me involved with theBrain Injury Alliance, you know,
(18:09):
and I've spoken at their stateannual conference.
I've done a lot of theirsupport group work and things
like that.
So it really kind of got meinto that community.
I've done some collabs at thehospital up there where we've
rounded with each other.
I've rounded with them.
They've come and rounded withme and a lot of times now you
know some of the SLPs that aredoing a lot of the TBI work up
(18:31):
there speech and languagepathologists they get a ton of
this stuff, you know, and theyget a ton of really complex TBIs
.
And sometimes the thing andagain, you know, a lot of people
are doing TBI work now in avariety of professions because
there's so much of it out thereand there's such a need but
people have a tendency to notblend things together because of
(18:52):
, you know, differences intraining and things like that.
And that's the thing ProfessorCarrick has kind of showed us is
we can blend principles fromevery specialty together into
what he calls head-eyevestibular motion therapy or you
know those kinds of things.
So it's like, hey, john, I gotone, I'm I've done X, y, z, can
I send them over?
And of course it's like, well,yeah, please, some of them are
(19:15):
really, really tough, you know,and I get why there there's
struggles there for sure.
So so that's one of the waysI've kind of become known in the
community.
A lot of it is referral, youknow from, from internal
patients.
It's like, hey, my cousin'ssister's brother had a TBI, can
they come see you?
And it's like, well, yeah, ofcourse I'm here, and that's the
(19:36):
thing I think people don't want,these cookie cutter approaches.
You know that, that you canfind that, that, you know, just
like any modality on its own,you kind of get that 80, 10, 10
rule.
You know, maybe it works for80% of people, 10% of people it
somewhat works for, and 10% areyour, your non-responders, that
need to move on to somethingelse.
Dr. Ayla Wolf (19:58):
Short answer.
You get a lot of people in thecommunity who know your
specialty and and so one of thethings that I I know you worked
really hard on was thispresentation on long COVID that
you taught for the CarrickInstitute and I know a huge part
of that was a deep dive intoautonomic nervous system
dysfunction, and so I wanted tohave you maybe talk a little bit
(20:22):
about autonomic nervous systemdysfunction that you see, not
only with long COVID, but alsothat is one of the things that
when patients come to me, that Ioften find has been the thing
that's been undiagnosed untilthey come in and I start paying
attention to it, and so a lot of, at least in where I live, I
(20:42):
know there's like a three to sixmonth waiting list for people
when they get referred to theseconventional big hospitals for
their autonomic reflex testing.
So it's great that we have somereally great tools that we can
do bedside that you know don'thave a six-month waiting list or
don't require, you know, somesuper high tech and why don't
(21:02):
you talk a little bit about youknow somebody comes in to see
you A lot of times.
The autonomic assessment isreally the cornerstone or the
foundation of what we're lookingat here.
So maybe talk a little bitabout how frequently you do see
that in people that are havingthese lingering post-concussion
symptoms, and then how you'reassessing it.
Dr. John McClaren (21:22):
There are so many things that we can do.
I mean, you talk about QSARTtesting or tilt table testing
and things like that, you know,and one of the things like you,
you know not to not to make itsound like I'm a super genius
you sent me a list of topicsahead of time so I could kind of
get in there and do a littlebit of research on my own.
And I thought, you know, let'slook at QSART testing, your
(21:48):
qualitative, you know,pseudomotor axon testing, where
you know we're putting somebodyin conditions and seeing what
the sweat response is right, youknow, and I thought let's see
if that actually has a body ofliterature associated with TBI.
I mean, did you go out and lookfor that QSART testing TBI like
Google, scholar, pubmed, that?
Dr. Ayla Wolf (22:04):
kind of thing.
I did not look for a specificlink between those two.
What'd you find?
Dr. John McClaren (22:10):
Well, I wanted to see it.
I wanted to see it because,again, that's the thing what
you're looking at for people whoare getting these reflex tests
done.
Those are the things they'regoing to do the QSART testing
and the tilt table test, which,you know, we're going to
orthostatically challenge youand see what happens to your
blood pressure and your heartrate over time.
And do the responses occurnormally, or do I get, you know,
a huge rise in my heart rateand a drop in my blood pressure
(22:34):
when I become upright, which isnot, you know, the response that
you want to have, and it's gotto meet a certain criteria,
which they change.
You know they move thegoalposts all the time on this
stuff too.
You know, used to be 30 beats aminute, now some people are
saying 40, you know, becauseit's like one.
Do we have so many people,especially in this post COVID
era, that have autonomic nervoussystem dysfunction?
(22:54):
You know, and you, you knowagain what we.
You know not to get ahead ofourselves on topic there, but
you combine some of these things, which is the human experience,
you know, oh boy, right.
But yeah, you know, people goand they get this stuff done and
they get results that maybearen't conclusive or things like
that.
If you know, yeah, I've waitedsix months to get in.
I was going to come see you butI figured I'd wait until I had
(23:17):
a diagnosis before I would.
And you go, that's six monthsof rehab.
We lost.
You know that kind of a thingand and and again.
You know, with traumatic braininjury you can make progress
throughout the lifetime of theperson, right?
You know the old conventionalwisdom of you know, and again,
the goalpost move it's your.
Six months is your recoverywindow.
A year is your recovery window.
(23:37):
Two years is your recoverywindow, right, and now it's like
man.
You know it's a lifetimerecovery process that you can
have as long as you keep workingat it, and some of it is slow
and some of it's long.
But people get frustrated andyou wait six months for a
diagnosis and it just stinks.
So I went out and I looked atthat.
(23:59):
Let's go to PubMed, let's go toGoogle Scholar and let's see if
there aren't a lot of sourcesout there that link the QSART
testing to being significant fordysautonomia associated with
traumatic brain injury.
Same with the tilt table test.
Dr. Ayla Wolf (24:13):
I found it really interesting because I had a
patient who came in and she hada lot of symptoms.
She had had three concussionsand I started working with her
and she had gotten a referral togo do all the autonomic reflex
testing.
But she had a six month waitlist and so she came in with a
lot of symptoms.
Well, I got to treat her forsix months and then by the time
she went to do all of theautonomic reflex testing, it was
(24:37):
everything was normal, exceptfor the QSART.
However, there was a littlenote on the bottom that said
this test can be impacted bycertain medications, and there
was, you know.
I think a certain medication shewas on that might have actually
thrown it off.
And there was, you know, Ithink, a certain medication she
was on that might have actuallythrown it off.
But you know, when we, you knowway back in, like beginning of
clinical neuroscience training,you know we talk about this
(24:59):
concept of sweating, as you know, being increased sympathetic
activity that can sometimes beuneven.
Some people might actually sayI sweat more in my right armpit
than my left armpit, and so,even from a Chinese medicine
perspective, sweating is a veryimportant thing that we pay
attention to, whether it's, youknow, cold clammy hands or hot
(25:20):
clammy hands, or if people havespontaneous sweating.
You know.
So, in from a Chinese medicineperspective, the whole sweating
thing is an important thing thatwe do pay attention to.
But you know, it's only onesmall piece of the autonomic pie
, obviously.
And so you know, I've, I thinkthat a lot of this conventional
(25:42):
testing, like you said,sometimes it's a little, it
leaves people kind of with morequestions than answers, I think.
Dr. John McClaren (25:49):
For sure, yeah, for sure, and that's the
thing.
Or they get an inconclusivetest, or or, yeah, they get some
of those things where it's like, well, it's probably your
medicine, it's not your, it'snot your TBI.
And that's the thing I see alot, especially like if
litigation's involved, they'lltry to blame anything but the
TBI.
You know, I had a guy that waslike, oh, it's diabetic
neuropathy, you know, because hehad like numb hands and feet.
(26:11):
He had a myelopathic injury tohis neck In addition to his TBI.
He had like an A1C of 5.7.
I'm like, thanks for that, youknow, independent medical
examiner for saying that.
But that's the thing.
A lot of these conventionaltests they're waiting on for a
really long time.
I'm so glad your patient camein and got the rehab, you know
it's like, oh, darn you, youpassed your test.
(26:32):
That means you know you highfive and go well, let's just
keep doing what we're doing.
Then you don't need that stuffanymore, right, you don't?
You don't need to wait for thenext test to try to validate how
you feel, you know, becausethat's ultimately what matters,
right?
People are coming in becausethey feel crappy and they want
to feel better and they think,you know, because of whatever,
(26:53):
whatever it is that they got toyou that maybe you can help them
.
So you know, when we're lookingat these things, yeah, how much
do you sweat.
You know and and and thingsthat'll happen to.
You know, if I've got somedysautonomia and I'm doing some
things that I should sweat whenI'm doing, what'll happen is
instead I don't sweat and myhands and my feet and my nose
and all these other things getreally really cold, which, again
(27:13):
you go in Chinese medicine.
That's definitely not good.
And again, in functionalneurology.
We know that's not good and youknow you see these things where
and that's one of the things ina lot of the training that we
get.
You know the autonomic nervoussystem.
Everybody talks about how, likeit's parasympathetic, good,
sympathetic, bad.
Too much sympathetic activityis bad, absolutely.
(27:35):
But a lot of times you knowthat kind of a model you're
going.
You need a sympathetic nervoussystem to take the load of
clothes up the stairs and likenot pass out, or you know things
like that.
Or to run around and chase yourkid or something like that.
You need to dilate some bloodvessels and you need to get the
lungs to expand at a littlehigher rate and you need, you
(27:55):
know, pupillary dilation.
So, as we're talking aboutthese things, people who are
trained like us are alreadygoing.
Yeah, now I know how we'recrafting our examination that
we're going to do at the bedsidefor this.
So you know that that's one ofthe things like what do we do in
our practices for testing.
You know, and when somebodycomes to see me, the first thing
especially, you know you canlook at like a Rivermead
(28:16):
post-concussive score,especially if it's six months or
later after they've had the TBI, because it's valid six months
or later, right, you know, someof these other inventories you
can look at are really good tokind of point you toward well,
we've got some autonomic typesof symptoms.
But before I do any, you know,pursuit or saccade or vestibular
testing or things like that,the first thing I want is a
(28:36):
baseline people test before Icontaminate it with my exam,
right?
So I'm going to come in and Iuse the reflex people app, but
no disclosures.
I have like a hundredth of ahundredth of a thousandth of a
piece of stock on it becausethey offered it when you.
You know it was like you get,you get a free month if you buy
like a share or something.
So I do have a tiny amount ofshare in it, but you know it's
(28:58):
it's more, just because I thinkit's.
It's a fabulous piece oftechnology and and again,
professor Kirk introduced us tothis and we're getting a lot of
data on what should happen withyour people and you can use this
thing.
You know tons of different ways.
The way, the way I use it atthe beginning of my assessment
is you know it'll, it'll come in, it'll flash.
You should see a pupilconstrict when it's exposed to
light.
You should see it dilate, youknow, to 75% of its original
(29:22):
size relatively quickly, and youshould see it maintain.
And the app gives you, you know, constriction speed metrics,
dilation speed metrics, latencymetrics, things that with my pen
light I am not as good at.
You know you can pick a lot ofstuff up.
Dr. Ayla Wolf (29:36):
I mean it's taking 30 frames a second when
it does that.
We can't do that with the nakedeye.
Dr. John McClaren (29:42):
These guys aren't doing 30 frames a second,
that's for sure.
Or maybe they're doing it, butit sure ain't processing up here
.
You know I wish, yeah, so it it.
It gives you a lot ofinformation and you can kind of
segregate that into.
You know some left brain versusright brain types of aspects in
regard to autonomic.
You know activations and so onand so forth.
(30:04):
But you know those are thingsyou should see.
You get a pupillogram.
How smooth is it?
You know how much does itconstrict, dilate?
Do they maintain thatthroughout the process?
That's the first thing I'mdoing before I do really
anything else other than maybegabbing with somebody a little
bit.
Dr. Ayla Wolf (30:19):
So we'll get some pupils, we'll get some blood
pressures bilaterally, metricsare actually very narrow as far
as, like, what's considered anormal latency between the light
flashing and the pupilconstricting, you know, and so,
though, again like those windowsof time that are measured in
milliseconds, very hard to seewith the naked eye if you just
(30:41):
shine a pen light in someone'seye.
so I also love that that appthat pupillary light reflex for
that reason, is to be able tocapture a latency down to a
certain millisecond.
You know, and knowing that thenormal reference range is so
narrow, you do start to be ableto see.
You know, this orchestrabetween the parasympathetic and
(31:03):
sympathetic nervous systems inthis test that takes 15 seconds
to do.
Dr. John McClaren (31:09):
That's beautiful.
The orchestra word is exactlywhat it is.
It's this fine waltz betweenthe systems right when, if they
work appropriately, odds aregood.
You know that patient's notgoing to have as big of a
symptom load, or they're maybenot even going to come see you
because they feel pretty good ifit works like it's supposed to.
You know.
And then, yeah, you get in andyou grab your sphygmometer and
(31:31):
your your stethoscope and youtake your blood pressures.
You know what happens on theleft side versus the right side.
Then you compare it.
You know, and that's the greatthing about this, you go, I've
got different metrics that I cancompare.
And then you start to go doesthis make sense?
Do we have medications on boardthat can maybe contaminate some
of our data, which?
You go, well, there are somemedications that can influence
(31:53):
pupillary reactions.
There are others that caninfluence your blood pressure
findings, but it's really hardto find medications that
influence everything equally.
So you can go, well, I've gotand again, even if they're on
medications, these systemsshould adapt relatively well.
Sometimes that's why they'retaking the medication is to get
the system to adapt well, and ifit's why they're taking the
medication is to get the systemto adapt.
Well, and if it's still notworking, then you know,
(32:16):
depending on your scope ofpractice and your relationship
with your patient and yourproviders, you can give them
that data.
You can go, hey, you know,maybe the dose or the medicine
isn't appropriate for thispatient because we're still
seeing XYZ and it could beruining or contaminating or
(32:36):
causing a problem with ourrehabilitation coefficients and
so on.
Just communicating with otherproviders, which, again, when
you ask, how do people find youand how do you build this kind
of practice, that's one of thebest ways because they go.
Well, you're not just, you know, you're not just banging away
on people willy nilly, you'reactually collecting some data
and there's some care.
(32:57):
You know these primary practicepeople.
They're really busy and a lotof times they don't have the
time to do this stuff.
If they, if they know how to doit Sometimes they're, again,
not trained like this, but theyappreciate it and they go wow,
that's a nice, you know, that'sa nice approach that you take.
I've got five others that arejust like this patient who had a
traumatic brain injury.
They were, they were maybe onthe same bridge or you know
(33:18):
something like that, where themulti-car pileup happens and you
know they do.
They become impressed with theway you know people, especially
that are care trained, reallystart to approach these kinds of
things and they go.
I never referred to anacupuncturist before, but I'm so
glad I did.
Or I never referred to a doctoror chiropractic before.
I always thought you guys were,you know, weirdos or whatever.
And you know it turns out I wasthe weirdo for not doing it all
(33:41):
this time.
I you know, and it helps.
Dr. Ayla Wolf (33:43):
Well, and I see a lot of patients, you know, when
they have things like posturalorthostatic tachycardia syndrome
, a lot of times they end uptaking themselves off the
medications they're givenbecause of the side effects that
they experience.
And a lot of doctors are veryupfront and saying listen, you
know, we don't have a greatpharmaceutical solution to fix
(34:03):
this and so let's just try this.
And a lot of doctors are alsokind of humbly approaching it
and saying you know what, likewe're not so good at treating
this, and we know that.
But here it.
And saying you know what, like,we're not so good at treating
this, and we know that.
But here, try this, and if ithelps, great, but if it doesn't,
like, then you know, don't takeit.
Basically, and so well they knowthat you know a lot of their
(34:23):
medical.
You know approaches are kind ofa trial and error and you know
the way that I.
I think the autonomic nervoussystem is so complex and when
you try to control one small armof it with a drug it usually
doesn't equate to a good outcome.
And I think you know that'swhat I see play out quite often
(34:45):
and I you know, like you said,you know people kind of demonize
the sympathetic nervous systemand say parasympathetic good,
sympathetic bad.
But the way that I like todescribe it is like like your
autonomic nervous system turnsyou into a high performance
sports car and so when you wantto, you know, slam on the brakes
(35:05):
and come to a screeching halt,you can.
Or if you want to go zero to 60in 0.5 seconds, you hit the gas
pedal and your system can dothat.
And so it's like it's thatability to modulate for
whatever's appropriate in themoment.
And in some cases, if you'repower lifting, you got to have
that sympathetic output,otherwise you're not going to be
(35:27):
a good power lifter.
Dr. John McClaren (35:29):
Yeah, or you're snorting all these salts
and doing all these other thingsto try to get it to activate.
And and know, I had a buddy man, he would.
He would just literally havehis training partner hit him
with a two by four just to getthat sympathetic.
You know, and I'm like you know, and some of them, you hear it,
it's like, oh my God, I'm likeI'm out of the gym.
I'm like I'm like if you guysslap me like that, I'm gonna
slap you back.
(35:50):
And I'm like if you guys slapme like that, I'm going to slap
you back and I'm out.
These kind of things.
I'm like don't smack me.
I'm like, tell me nice things,give me some validation.
You're a really good lifter,john, you're going to lift.
I'm not the tough love guy withthat.
Don't corporately punish mebefore my lift.
But yeah, you see people do thisstuff all the time and it's
(36:14):
just fascinating.
And yeah, you know, that's thegreat thing is we've got these
tools that are relativelyinexpensive to assess it in a
very thorough fashion.
You know, this orthostatictesting is really a great thing
to do.
You can, you can check bloodpressures in those different
positions, you know, and if alot of this to people kind of go
how do I save time?
You know, and I think the thingtoo, if you really want to do a
(36:35):
service in this autonomicnervous system in your TBI
community, you've got to bewilling to spend a little bit of
time and it's okay.
Maybe you don't do your wholeexam in one visit, or something
like that with people, becauseif you're trying to fit a TBI
exam into a 30-minute window, Ican't do it.
Dr. Ayla Wolf (36:53):
It doesn't work.
Dr. John McClaren (36:56):
I mean, professor Carrick can probably
do it in two minutes because hehas it when he looks at you walk
.
But you know, I mean for meit's like, especially with some
of this, yeah, you get, you know, the pupillometry is pretty
quick, blood pressures arepretty quick, but you could.
You got to spend some time andand you've got to try some
different therapies and kind ofsee what happens as well so you
can do a pull.
I mean you've got to pull socks.
If you don't have a bloodpressure cuff and a stethoscope
(37:21):
and a pull socks, don't do thiskind of work, right, I mean?
And we should all have thosethings, probably after a
professional school or thingslike that.
The pull socks, you know, get agood one.
Don't buy the $20 junkie oneoff Amazon or from Walgreens
nothing against Walgreens butget a good one like a non or you
know something like that.
My brother was a critical carenurse for a really long time and
(37:43):
he's like, don't you know, andthey, these are guys, those
measurements, you know theirlife and death for for the
things that they're doing.
You know he was a flight nurse.
He's a nurse, anesthetist nowand he's like you really want
good equipment if you're goingto do that stuff.
And again, professor Carrickwould say the same thing Get a
good pulse ox, you know.
Get a good stethoscope andauscultate the heart too.
You know.
(38:03):
You can find so much withregards to the autonomic nervous
system by what happens withheart sounds.
You know not only you know.
Is there a murmur or somethinglike that which you should find?
If they have autonomic nervoussystems, do they have a primary
cardiovascular issue?
But you can listen to your S1and S2 sounds.
Have them turn the head justlike we would in a
post-geographic exam.
(38:24):
You go.
Well, if I turn the head to theleft and I've got differences
in S2 splitting or you know somemuffling of an S1 sound or
things like that, then I knowthose are things that aren't
supposed to normally happen.
A whole lot with physiology.
Right Now I've got a deviationfrom what and that's the thing
like we get normal physiology inour schooling.
What is a deviation from that?
(38:44):
Is that related to how I getblood and oxygen to my body?
That's what your autonomicnervous system does.
Yeah, you know.
And, like I said, I just gotback on social media.
I mean, I go down my feed andeverybody's got a way to
activate the vagus, right, it'sthe new hypoglycemia, right.
You know it's like everybody'sfiring that vagus up, you know,
(39:05):
due to the cold plunge, andbreathe this way and eat these
foods and all these kind ofthings.
And you know that's great thatpeople are talking about it.
You know, I I see like NateKaiser's post he did the
dysautonomia program for theCarrick Institute.
You know he's like.
You know he kind of takes someof these things and he's like,
yeah, but Right.
Dr. Ayla Wolf (39:25):
Well, and you know when I've taught different
classes, because you know youhave the auricular branch of the
vagus nerve, so a lot ofacupuncturists are really into
auricular acupuncture for thatreason, and so a lot of times I
kind of have to say like heyguys, the vagus nerve does not
have a brain of its own, likeit's not making its own
decisions here, and so what youreally need to understand is the
(39:47):
connections of the vagus nerveinto all these different parts
of the central autonomic network, and that you actually need to
be paying maybe a little bitmore attention to what's
happening above the vagus nerve.
Dr. John McClaren (39:58):
It's ideal, right?
Yeah, you know it's like don'tlook at me down here, look at me
up here.
Right, it matters, right, itreally does.
And sometimes it's okay.
You have to with some of thesepeople where they've got this
phenotype that sympatheticnervous system is really really
overactive.
Those pupils are, you know,constricting and then dilating,
like really really big andreally really fast.
(40:19):
The heart rate's really high,the blood pressure is a little
high.
You've got a, you know, a hugediscrepancy between left side
and right side blood pressures.
Again, these are all things,like you know.
The primary question was how dowe examine these?
As people are listening, theycan go.
So I'm checking blood pressureson both sides.
I'm checking blood pressurelying down versus seated, versus
standing.
You can go ahead and checkblood pressure in dual task
(40:43):
settings if you really want to.
Again, how much time do youwant to spend on it?
But you should do some of theseaspects for sure.
What does the heart rate dowhen I change positions?
And you know those are things.
When people see that thosethings break down, you know,
here they go.
They may need some vagal nervestimulation until you get those
connections, those drivers ofthe vagal activity, to work the
way that they're supposed to,which, when they've got a
(41:05):
traumatic brain injury.
That's what they're telling youis.
Hey, you know I've got someissues.
A lot of that really is rootedin those white matter
connections.
Right, you get this whitematter connectivity.
I'm really excited there's aclinic in town now, an MRI and
imaging center.
They do DTI.
It's commercially available,yeah, so it's like I am going to
(41:27):
be sending you more than youprobably want to deal with,
right, just because the workthey're doing with that.
We're looking at theseconnections between the cerebral
they're doing with that.
We're looking at theseconnections between the cerebral
cortex and the brainstem.
We're looking at theconnections between the
cerebellum and the brainstem.
How does the cerebellum driveinto these centers?
How does the cortex drive in?
Because you should get someactivation of inhibition, of
(41:49):
inhibition and so on and soforth, so that that orchestra
plays the way that it's supposedto.
Yeah, inhibition and so on andso forth, so that that orchestra
plays the way that it'ssupposed to.
Yeah, I want to be the Ferrarithat you're talking about.
I want to be able to rest anddigest when I want and somebody
breaks in I've had the big steakand somebody breaks into my
house.
I want to be ready right away.
I want to go.
I'll come back in 20 minutesonce this thing's digested.
I've got to get slapped in theback by my buddy with the two by
(42:11):
four so I can fight you out ofmy house.
You know those kind of things,so you know that's.
That's the thing.
I want that system to be primedand ready to go.
And of course I mean there's alot of ways for, for athletic
optimization.
I think a lot of the strategiesthey're doing may be
unknowingly helping to harnessthese aspects, or knowingly, you
know, to get them to work likethey're supposed to, or
(42:33):
knowingly, you know, to get themto work like they're supposed
to.
Dr. Ayla Wolf (42:35):
This was part one of my interview with Dr John
McLaren.
The second half of ourconversation will be available
next week.
If you have a specific topicyou would like to learn more
about, please leave us a message, either by clicking the send us
a text link in the show notesor emailing us at
lifeafterimpact at gmailcom.
You can also follow us onInstagram at lifeafterimpact,
(43:00):
and sign up for our latest newsand announcements by going to
lifeafterimpactcom.
Thanks so much for listening totoday's show.
Medical Disclaimer.
This video or podcast is forgeneral informational purposes
only.
Thank you.
The use of this information andmaterials included is at the
(43:22):
user's own risk.
The content of this video orpodcast is not intended to be a
substitute for medical advice,diagnosis or treatment, and
consumers of this informationshould seek the advice of a
(43:45):
medical professional for any andall health-related issues.
A link to our full medicaldisclaimer is available in the
notes.
What you're looking at for people who are
getting these reflex tests done.
Those are the things they'regoing to do the QSART testing
and the tilt table test, whichyou know we're going to
orthostatically challenge youand see what happens to your
blood pressure and your heartrate over time.
And do the responses occurnormally, or do I get, you know,
a huge rise in my heart rateand a drop in my blood pressure
(00:20):
when I become upright, which isnot, you know, the response that
you want to have, and it's gotto meet a certain criteria which
they change.
You know they move thegoalposts all the time on this
stuff too.
You know, used to be 30 beats aminute, now some people are
saying 40, you know, becauseit's like one.
Do we have so many people,especially in this post COVID
era, that have autonomic nervoussystem dysfunction?
(00:40):
You know, and you know againwhat we know not function, you
know, and you, you know again,we, you know, not to get ahead
of ourselves on topic there, butyou combine some of these
things, which is the humanexperience, you know, oh boy
right.
Sophia Bouwens (00:58):
Welcome to the Life After Impact podcast, where
we do a deep dive into allthings concussion and brain
injury related.
We talk about all the differentsymptoms that can follow brain
injury, different testingmethods, different types of
specialists out there anddifferent therapies available.
I'm Sophia Bowens, I'm herewith Dr Ayla Wolf and we will be
your guide to living your bestlife after impact.
Dr. Ayla Wolf (01:22):
Welcome to the Life After Impact podcast, where
today we have Dr John McLarenon the show.
And Dr McLaren, you've been inprivate practice since 2002
outside of Omaha, Nebraska,correct?
Dr. John McClaren (01:35):
Correct.
Dr. Ayla Wolf (01:36):
And you have a diplomat in chiropractic
neurology.
You also completed a veryintense program and earned a
fellowship by the American Boardof Brain Injury and
Rehabilitation.
And then, if that wasn't enough, you actually went back to
school.
You already have a doctoratedegree, but you went back to
school.
You got a master's degree inclinical neuroscience, where you
(01:58):
spent a lot of time studyingtraumatic brain injuries as well
as dysautonomia, and then youearned your master's in clinical
neuroscience.
You're on the faculty of theCarrick Institute, You've had
the honor of presenting at theInternational Symposium of
Clinical Neuroscience and youspecialize in your practice in
(02:18):
brain injuries, concussions anddifferent neurological disorders
.
So I'm thrilled to have you onthe show as one of my teachers.
I find you to be just a wealthof information and so generous
in sharing your information.
So thank you so much for beinghere.
Dr. John McClaren (02:36):
That is about the greatest introduction I
could ever ask for.
Thank you so much for the kindwords.
And yeah, I've done.
I've done all that.
I guilty as charged.
My wife would say it's justbecause you're bored or you know
things like that.
But but the thing that is greatabout clinical practice, and
when you get into this stuff,you just, you know, you dip your
(02:57):
toes in a little bit and it'slike, oh, I'll just go to, you
know I even me, you know, it'slike I'll just go to the first
TBI seminar, I'll get someguidelines.
I already kind of know what I'mdoing.
And then I'm like I don't knowwhat I'm doing at all.
So here I am, you know, like Isaid, you know sucking that from
the fire hose, trying to getmore, and you know you're in
over your head and it's it'sdefinitely something you can
(03:18):
never, you can never know enoughin this practice.
Same with you, you're superduper credentialed and you just
keep going and I am so excitedfor your book.
Thank you Personally and for mypatients and anybody else that
I'd refer to.
So put me on the list.
Dr. Ayla Wolf (03:35):
Thank you for that.
And you are so right, I think.
Every single patient comes inand presents with their own
unique challenges.
That forces us to constantly belearning more and it's never
ending.
I mean, even with my book.
I referenced papers that werepublished in January of 2025 in
my book.
Like I mean, it's just theamount of new stuff coming out
(03:58):
is so good it is, and that's thething you go.
Dr. John McClaren (04:03):
One more paper I remember when I did my
long COVID class I found a paperI think it was that week or the
week before that got publishedand it's like hey guys, this is
hot off the press.
I don't even have a citationfor it yet.
So it's the way it goes.
For sure, you find stuff allthe time, and it's kind of nice
when assertions you make in yourresearch get validated kind of
(04:24):
at the last second, like thattoo.
Dr. Ayla Wolf (04:25):
It's really, really fun.
Oh yeah, absolutely.
You know things like patternsthat you were seeing or things
that you observed.
All of a sudden, someonepublishes a research paper on it
and you go okay, so I'm notcrazy, I really am.
You know, seeing this correctly.
Dr. John McClaren (04:38):
Yeah, I'm not the only person that saw this,
or you find stuff that was way,way buried in the weeds and it.
You know, for some reason itwasn't really spoken about a lot
, but then you know a lot withthe olfaction and the long COVID
, that was really really big andit was nice to see that,
because olfaction, you know Ialways said it's kind of like
the redheaded stepchild of our.
(04:59):
You know it's a vestigial sense, it doesn't mean much, and then
COVID happens and everybody'slike well, I guess olfaction is
probably pretty important forcognitive function.
Dr. Ayla Wolf (05:06):
Yes, I mean the amount of anxiety that people
were having when they couldn'tsmell and I think people don't
realize, you know, when youcan't smell, you don't know if
your house is on fire, and thatyou know not knowing can create
tons of anxiety when you aren't,when you lose that sense to
when you lose that sense, oh forsure, yeah.
Dr. John McClaren (05:24):
Or you know even simple things like well,
the baby's got a loaded diaperand you know stuff like that,
you just go, geez, it's like Idon't want to smell it, but you
kind of want to know for the kidright, Right.
You do need to know if thediaper change needs to happen.
Dr. Ayla Wolf (05:47):
Yeah, yeah, exactly, yes.
Well, I did read a study thatsaid that 55% of people, after a
traumatic brain injury, havechanges in their smell that
lasted, for you know, up to ayear afterwards.
I've certainly had patientsthat have experienced a loss of
smell longer than that.
So you know also with braininjuries, that loss of smell can
be a symptom as well.
Why don't you give us some ofyour background in terms of what
led you to not only studychiropractic but then to
(06:08):
specialize in neurologyspecifically?
Dr. John McClaren (06:13):
You got it, yeah.
So how did I get here, so tospeak?
And you know the thing, and inlistening to you guys in the
podcast and in our discussionsfrom before too, we always, you
know, when we kind of choose ourhealthcare profession, we have
kind of a horse in the race, youknow, so to speak, or things
like that.
I was a high school student atCornhusker Boys State.
(06:33):
The Boys and Girls Stateprograms are these legion
programs that they do for likeleadership development and
things like that for high school, like juniors going into senior
year.
I was at Cornhusker Boys State,my you know junior going into
my senior year, and I get a callfrom my mom.
You know, your dad was in anaccident, you know, and I think
(06:54):
you know I had some friends inthe room and we were meeting
with one of my friends who waslike this gubernatorial
candidate and no-transcript.
(07:27):
One train ran into the otherthis wreckage goes everywhere
and my dad was in an oncomingtrain and his conductor jumped
off the train and dad was thrownoff the train as these things
collided, landed on his head,his neck and so on.
Luckily he was not paralyzedWorse, you know.
You know gets up, you know seestars, claws his way up the hill
(07:49):
, this kind of thing, and youknow they run for their lives,
they get away far enough andthey just watch the carnage
happen.
And then you know, ambulancescome in and they transport them
to North Platte, which is, youknow, a central Nebraska town.
That's kind of got the hub foremergency services and things
like that.
And his doctor in North Plattewas our like childhood, my
(08:12):
childhood doctor.
He'd moved on and so it waskind of nice to get a familial
connection.
Nebraska is small like that.
I grew up in Western Nebraskaso then, you know, I became
intimately familiar with theworld of traumatic brain injury.
It took a little while for mydad to get the diagnosis.
He's diagnosed with a traumaticbrain injury, ptsd, which you
know some of the things we'regoing to be talking about today.
You know all these kind ofthings.
(08:34):
He had a neck injury as well,which I have loved the way you
guys have talked about neckinjury on the podcast so far.
I mean, you know, chef's kiss,you guys nail that stuff super
well.
And this is dad.
He ends up having four vertebrafused and, you know, had a
neuropsychologist who got, youknow, the diagnosis correct for
him and you know, and the thingI saw with my dad, as you know,
(08:57):
I went on.
I was a powerlifter in college.
I didn't know that I was goingto be a health care guy at that
time when dad got hurt, but Iwas.
You know, stem was kind of mypath.
It was STEM or it was politicsand I'm glad I went to STEM and
not politics.
You know, with the boy statething and I had.
I was a collegiate power lifter.
(09:17):
I had a shoulder injury, had achiropractor.
That I found via this musclemedia you remember Muscle media
magazine back in the day.
Dr. Ayla Wolf (09:27):
I started working in a health food store that was
managed by a bodybuilder when Iwas like 15 years old, so we
probably had it laying around.
Dr. John McClaren (09:34):
Yeah, it's around there.
Bill Phillips would do thechallenge and he'd give his cord
anyway to these guys.
You know.
Yeah, they had an article on onactive release technique at the
time and I'd had the shoulderinjury and the orthos couldn't
figure out what to do and youknow, it's like we can open you
up and go in and I wasnationally ranked as a power
lifter and the shoulder thingkind of took me down a few
places.
So I went to this ARTchiropractor and it's like that
(09:57):
is what I want to do with mylife.
I didn't know at the time howit would tie in with a traumatic
brain injury, until later, youknow.
So I decided chiropracticschool, is it?
I enroll at Parker, my sisterlived in Dallas.
That's why I chose Parker.
You know everybody will say mychiropractic school is the best
because it's because my sisterlived in Dallas and I I wanted
(10:17):
to have family close by forprofessional school, just
because sometimes it's like man,I I'd have a home-cooked steak
or something like that, orsomebody to listen to me cry
when I'm struggling.
Dr. Ayla Wolf (10:28):
Or to quiz you with the note cards.
Dr. John McClaren (10:32):
All that, yeah, here, throw them at her
when I miss.
She got good at dodging them.
So I chose Dallas and I went toParker and my friend Haney
Helmy my first trimester inschool, you know and Haney and
Glenn Zielinski, you know, glenn, you know those guys were like
tri six at the time I was trione and these guys, you know
(10:53):
they.
They were like you got to seethis Professor Carrick guy and
they showed me a couple of theshort shorts videos where he's
running around on the stage, youknow, and he's getting these
people with Parkinson's to getup out of chairs and all these
kinds of things.
And he had a.
He had a patient on one of thecase studies they showed me that
was a traumatic brain injurypatient.
I'm like, tell me more and.
(11:14):
And they did and and they gotme hooked and and you know, we,
we started a, we, they started aneurology club and I just went
and you know, same thing.
It's like, give me all you got.
So so I start to learn somethings.
Go home Maybe some of thisstuff.
My dad had residuals.
This is I went to chiropracticschool in 98, you know.
So I'd go home for breaks, likeyou know, as as these guys kind
(11:37):
of introduced me to some of theprinciples of examination and
treatment.
You know, let's, let's try itwith dad.
You know, dad's balance isterrible, eyes closed.
You know, when he tips his headback, things like that He'd had
, he'd had some fusion in hisneck and things like that too.
So it's, it's one of thosereally complicated cases.
It's like right away I got acool TBI case before I even
leave school whenever I want,you know, and he was, he liked
(11:58):
it because it helped him.
You know, he noticeddifferences right away.
And again, I'm hooked.
They started the diplomate oncampus my seventh trimester at
Parker.
You know, at the time it was anine trimester program.
So you know, my last year theystarted the program on campus.
Again, dr Klotzik and Dr PeterPercoco were there as my
instructors and you know, likemodule one I had like 35 pages
(12:19):
of handwritten notes and ifyou've seen my handwriting,
that's like terrible.
So then I was in.
Dr. Ayla Wolf (12:26):
Yeah.
For sure, and so how do peoplefind you in your community?
And I actually lived in Omahafor about six months, by the way
, when I was an infant.
Dr. John McClaren (12:37):
Oh, how about that?
I didn't know that.
Dr. Ayla Wolf (12:38):
My dad got transferred there for work for
like six months, so obviously Ihave no recollection of it but I
did live in Omaha.
Dr. John McClaren (12:47):
You don't remember the flat plains?
Dr. Ayla Wolf (12:49):
Nope, I just remember that we have home
videos where there's just likereally trippy music playing in
the background.
I was like dad, what were youinto?
Dr. John McClaren (12:57):
That's kind of awesome.
Yeah, yeah, yeah.
What did Omaha introduce him to?
Music?
Wise, right?
That's cool.
That's cool.
Yeah, I've been in practice.
You nailed it.
I've been in practice for 23years now and you know it was
just last month we celebrated,kind of the birthday of the
practice, which is awesome.
In my wildest dreams couldn'thave imagined it going as well
(13:19):
as it has, of course, hiccupsand bumps and bruises and all
sorts of things, but it's just,it's been awesome.
I haven't had to do, we justbrought in some new stuff.
You know, I've got I've gotsome things that I've never
marketed for that I really wantto expose people to a little
more and brought in some newstuff.
But I haven't done anymarketing or or you know those
(13:39):
kinds of outreach things, sincethe yellow pages were like a way
to actually find people youknow, to date myself.
Right, you know, that's you know.
And yellow pages don't workanymore.
Dr. Ayla Wolf (13:50):
It's tough when you're so busy with patients you
don't have the time to thenalso be a marketing executive
for your own companyno-transcript, that kind of
(14:38):
thing or whatever.
Dr. John McClaren (14:39):
So you don't have to, you don't have to
bother them with it, even thoughthey're super great at taking
care of people.
So it's like, yeah, let's,let's get back on.
And I, just today, you know,and so you know, you start
posting things like here, here'sanother hyperbaric treatment,
or here's some pulse EMF thatwe're offering for you know, all
the stuff you would offer thatfor now, like, like my, you know
, and, of course, because I'vebeen dead for four years on
(15:02):
Facebook, nobody, nobody'swatching me anymore or anything
anyway.
And then today I took the wifeand kids to brunch before this
and I posted a food picturebecause I'm like I haven't seen
a food picture since I've beenon Facebook.
More engagement with that thanany of my work stuff.
Dr. Ayla Wolf (15:18):
I totally, I totally know that, like I will
post, you know, a link to a blogthat I think is just so rich
with information and it getslike one like.
And then I post a picture of mydog and it gets like 55 likes
and you're just like all right,the animals win every time.
Dr. John McClaren (15:34):
Everybody's like I want to hug him.
You know that kind of thing.
Yeah, yeah, I know I'm givingyou the like on the post and
you're like well, that that'sgreat, but it doesn't help.
No-transcript my practice,especially early on.
(16:20):
You know, and you see movementdisorder cases and TBI cases and
you do some things.
You know, and there wasn't aFacebook forum for collaboration
like there is now or any thatkind of stuff.
So you know it's like I'd callthe one or two people I knew and
they're like I don't know.
You know, and we just kind oflearned to try.
You know what would anoptokinetic do in this situation
or things like that.
(16:41):
And then you know the TBIfellowship program starts and I
found out how behind I was a lotof other people when I first
got into that, because you knowwe have so many people in this
care trained.
You know variety of disciplinesbetween you know like you know
your acupuncturists, thephysical therapists that are
(17:01):
doing it.
You know the nurse, nurse andnurse practitioner people that
are doing it.
I mean you'll get MelissaBiscardi's work.
You know those kind of things,just amazing and even medical
doctors that really arefascinated with this kind of
work.
So you know, a lot of itoriginally was a lot of doctors
at chiropractic, you know, andthen Professor Carrick built the
bridges and here it is.
(17:23):
It's like, hey, you know, we'renot the only people that can do
this stuff there.
Hey, we're not the only peoplethat can do this stuff.
There's an evidence base for itand I think it's impressed so
many varieties of people and youcan really tie it into whatever
kind of practice you want.
So I just think we have peoplethat are trained really well.
(17:45):
I've gotten to where CarlaMellenbacher made a connection
for me with somebody who's aspeech language pathologist in
our community, you know, in thatthey went out to see her when
she was out in California forTBI Because, again, you know, I
wasn't marketing that, I was inTBI and they live in my
community.
So Carla's like go see Johnwhen you get back home.
And the thing organically grew.
Tammy got me involved with theBrain Injury Alliance, you know,
(18:09):
and I've spoken at their stateannual conference.
I've done a lot of theirsupport group work and things
like that.
So it really kind of got meinto that community.
I've done some collabs at thehospital up there where we've
rounded with each other.
I've rounded with them.
They've come and rounded withme and a lot of times now you
know some of the SLPs that aredoing a lot of the TBI work up
(18:31):
there speech and languagepathologists they get a ton of
this stuff, you know, and theyget a ton of really complex TBIs
.
And sometimes the thing andagain, you know, a lot of people
are doing TBI work now in avariety of professions because
there's so much of it out thereand there's such a need but
people have a tendency to notblend things together because of
(18:52):
, you know, differences intraining and things like that.
And that's the thing ProfessorCarrick has kind of showed us is
we can blend principles fromevery specialty together into
what he calls head-eyevestibular motion therapy or you
know those kinds of things.
So it's like, hey, john, I gotone, I'm I've done X, y, z, can
I send them over?
And of course it's like, well,yeah, please, some of them are
(19:15):
really, really tough, you know,and I get why there there's
struggles there for sure.
So so that's one of the waysI've kind of become known in the
community.
A lot of it is referral, youknow from, from internal
patients.
It's like, hey, my cousin'ssister's brother had a TBI, can
they come see you?
And it's like, well, yeah, ofcourse I'm here, and that's the
(19:36):
thing I think people don't want,these cookie cutter approaches.
You know that, that you canfind that, that, you know, just
like any modality on its own,you kind of get that 80, 10, 10
rule.
You know, maybe it works for80% of people, 10% of people it
somewhat works for, and 10% areyour, your non-responders, that
need to move on to somethingelse.
Dr. Ayla Wolf (19:58):
Short answer.
You get a lot of people in thecommunity who know your
specialty and and so one of thethings that I I know you worked
really hard on was thispresentation on long COVID that
you taught for the CarrickInstitute and I know a huge part
of that was a deep dive intoautonomic nervous system
dysfunction, and so I wanted tohave you maybe talk a little bit
(20:22):
about autonomic nervous systemdysfunction that you see, not
only with long COVID, but alsothat is one of the things that
when patients come to me, that Ioften find has been the thing
that's been undiagnosed untilthey come in and I start paying
attention to it, and so a lot of, at least in where I live, I
(20:42):
know there's like a three to sixmonth waiting list for people
when they get referred to theseconventional big hospitals for
their autonomic reflex testing.
So it's great that we have somereally great tools that we can
do bedside that you know don'thave a six-month waiting list or
don't require, you know, somesuper high tech and why don't
(21:02):
you talk a little bit about youknow somebody comes in to see
you A lot of times.
The autonomic assessment isreally the cornerstone or the
foundation of what we're lookingat here.
So maybe talk a little bitabout how frequently you do see
that in people that are havingthese lingering post-concussion
symptoms, and then how you'reassessing it.
Dr. John McClaren (21:22):
There are so many things that we can do.
I mean, you talk about QSARTtesting or tilt table testing
and things like that, you know,and one of the things like you,
you know not to not to make itsound like I'm a super genius
you sent me a list of topicsahead of time so I could kind of
get in there and do a littlebit of research on my own.
And I thought, you know, let'slook at QSART testing, your
(21:48):
qualitative, you know,pseudomotor axon testing, where
you know we're putting somebodyin conditions and seeing what
the sweat response is right, youknow, and I thought let's see
if that actually has a body ofliterature associated with TBI.
I mean, did you go out and lookfor that QSART testing TBI like
Google, scholar, pubmed, that?
Dr. Ayla Wolf (22:04):
kind of thing.
I did not look for a specificlink between those two.
What'd you find?
Dr. John McClaren (22:10):
Well, I wanted to see it.
I wanted to see it because,again, that's the thing what
you're looking at for people whoare getting these reflex tests
done.
Those are the things they'regoing to do the QSART testing
and the tilt table test, which,you know, we're going to
orthostatically challenge youand see what happens to your
blood pressure and your heartrate over time.
And do the responses occurnormally, or do I get, you know,
a huge rise in my heart rateand a drop in my blood pressure
(22:34):
when I become upright, which isnot, you know, the response that
you want to have, and it's gotto meet a certain criteria,
which they change.
You know they move thegoalposts all the time on this
stuff too.
You know, used to be 30 beats aminute, now some people are
saying 40, you know, becauseit's like one.
Do we have so many people,especially in this post COVID
era, that have autonomic nervoussystem dysfunction?
(22:54):
You know, and you, you knowagain what we.
You know not to get ahead ofourselves on topic there, but
you combine some of these things, which is the human experience,
you know, oh boy, right.
But yeah, you know, people goand they get this stuff done and
they get results that maybearen't conclusive or things like
that.
If you know, yeah, I've waitedsix months to get in.
I was going to come see you butI figured I'd wait until I had
(23:17):
a diagnosis before I would.
And you go, that's six monthsof rehab.
We lost.
You know that kind of a thingand and and again.
You know, with traumatic braininjury you can make progress
throughout the lifetime of theperson, right?
You know the old conventionalwisdom of you know, and again,
the goalpost move it's your.
Six months is your recoverywindow.
A year is your recovery window.
(23:37):
Two years is your recoverywindow, right, and now it's like
man.
You know it's a lifetimerecovery process that you can
have as long as you keep workingat it, and some of it is slow
and some of it's long.
But people get frustrated andyou wait six months for a
diagnosis and it just stinks.
So I went out and I looked atthat.
(23:59):
Let's go to PubMed, let's go toGoogle Scholar and let's see if
there aren't a lot of sourcesout there that link the QSART
testing to being significant fordysautonomia associated with
traumatic brain injury.
Same with the tilt table test.
Dr. Ayla Wolf (24:13):
I found it really interesting because I had a
patient who came in and she hada lot of symptoms.
She had had three concussionsand I started working with her
and she had gotten a referral togo do all the autonomic reflex
testing.
But she had a six month waitlist and so she came in with a
lot of symptoms.
Well, I got to treat her forsix months and then by the time
she went to do all of theautonomic reflex testing, it was
(24:37):
everything was normal, exceptfor the QSART.
However, there was a littlenote on the bottom that said
this test can be impacted bycertain medications, and there
was, you know.
I think a certain medication shewas on that might have actually
thrown it off.
And there was, you know, Ithink, a certain medication she
was on that might have actuallythrown it off.
But you know, when we, you knowway back in, like beginning of
clinical neuroscience training,you know we talk about this
(24:59):
concept of sweating, as you know, being increased sympathetic
activity that can sometimes beuneven.
Some people might actually sayI sweat more in my right armpit
than my left armpit, and so,even from a Chinese medicine
perspective, sweating is a veryimportant thing that we pay
attention to, whether it's, youknow, cold clammy hands or hot
(25:20):
clammy hands, or if people havespontaneous sweating.
You know.
So, in from a Chinese medicineperspective, the whole sweating
thing is an important thing thatwe do pay attention to.
But you know, it's only onesmall piece of the autonomic pie
, obviously.
And so you know, I've, I thinkthat a lot of this conventional
(25:42):
testing, like you said,sometimes it's a little, it
leaves people kind of with morequestions than answers, I think.
Dr. John McClaren (25:49):
For sure, yeah, for sure, and that's the
thing.
Or they get an inconclusivetest, or or, yeah, they get some
of those things where it's like, well, it's probably your
medicine, it's not your, it'snot your TBI.
And that's the thing I see alot, especially like if
litigation's involved, they'lltry to blame anything but the
TBI.
You know, I had a guy that waslike, oh, it's diabetic
neuropathy, you know, because hehad like numb hands and feet.
(26:11):
He had a myelopathic injury tohis neck In addition to his TBI.
He had like an A1C of 5.7.
I'm like, thanks for that, youknow, independent medical
examiner for saying that.
But that's the thing.
A lot of these conventionaltests they're waiting on for a
really long time.
I'm so glad your patient camein and got the rehab, you know
it's like, oh, darn you, youpassed your test.
(26:32):
That means you know you highfive and go well, let's just
keep doing what we're doing.
Then you don't need that stuffanymore, right, you don't?
You don't need to wait for thenext test to try to validate how
you feel, you know, becausethat's ultimately what matters,
right?
People are coming in becausethey feel crappy and they want
to feel better and they think,you know, because of whatever,
(26:53):
whatever it is that they got toyou that maybe you can help them
.
So you know, when we're lookingat these things, yeah, how much
do you sweat.
You know and and and thingsthat'll happen to.
You know, if I've got somedysautonomia and I'm doing some
things that I should sweat whenI'm doing, what'll happen is
instead I don't sweat and myhands and my feet and my nose
and all these other things getreally really cold, which, again
(27:13):
you go in Chinese medicine.
That's definitely not good.
And again, in functionalneurology.
We know that's not good and youknow you see these things where
and that's one of the things ina lot of the training that we
get.
You know the autonomic nervoussystem.
Everybody talks about how, likeit's parasympathetic, good,
sympathetic, bad.
Too much sympathetic activityis bad, absolutely.
(27:35):
But a lot of times you knowthat kind of a model you're
going.
You need a sympathetic nervoussystem to take the load of
clothes up the stairs and likenot pass out, or you know things
like that.
Or to run around and chase yourkid or something like that.
You need to dilate some bloodvessels and you need to get the
lungs to expand at a littlehigher rate and you need, you
(27:55):
know, pupillary dilation.
So, as we're talking aboutthese things, people who are
trained like us are alreadygoing.
Yeah, now I know how we'recrafting our examination that
we're going to do at the bedsidefor this.
So you know that that's one ofthe things like what do we do in
our practices for testing.
You know, and when somebodycomes to see me, the first thing
especially, you know you canlook at like a Rivermead
(28:16):
post-concussive score,especially if it's six months or
later after they've had the TBI, because it's valid six months
or later, right, you know, someof these other inventories you
can look at are really good tokind of point you toward well,
we've got some autonomic typesof symptoms.
But before I do any, you know,pursuit or saccade or vestibular
testing or things like that,the first thing I want is a
(28:36):
baseline people test before Icontaminate it with my exam,
right?
So I'm going to come in and Iuse the reflex people app, but
no disclosures.
I have like a hundredth of ahundredth of a thousandth of a
piece of stock on it becausethey offered it when you.
You know it was like you get,you get a free month if you buy
like a share or something.
So I do have a tiny amount ofshare in it, but you know it's
(28:58):
it's more, just because I thinkit's.
It's a fabulous piece oftechnology and and again,
professor Kirk introduced us tothis and we're getting a lot of
data on what should happen withyour people and you can use this
thing.
You know tons of different ways.
The way, the way I use it atthe beginning of my assessment
is you know it'll, it'll come in, it'll flash.
You should see a pupilconstrict when it's exposed to
light.
You should see it dilate, youknow, to 75% of its original
(29:22):
size relatively quickly, and youshould see it maintain.
And the app gives you, you know, constriction speed metrics,
dilation speed metrics, latencymetrics, things that with my pen
light I am not as good at.
You know you can pick a lot ofstuff up.
Dr. Ayla Wolf (29:36):
I mean it's taking 30 frames a second when
it does that.
We can't do that with the nakedeye.
Dr. John McClaren (29:42):
These guys aren't doing 30 frames a second,
that's for sure.
Or maybe they're doing it, butit sure ain't processing up here
.
You know I wish, yeah, so it it.
It gives you a lot ofinformation and you can kind of
segregate that into.
You know some left brain versusright brain types of aspects in
regard to autonomic.
You know activations and so onand so forth.
(30:04):
But you know those are thingsyou should see.
You get a pupillogram.
How smooth is it?
You know how much does itconstrict, dilate?
Do they maintain thatthroughout the process?
That's the first thing I'mdoing before I do really
anything else other than maybegabbing with somebody a little
bit.
Dr. Ayla Wolf (30:19):
So we'll get some pupils, we'll get some blood
pressures bilaterally, metricsare actually very narrow as far
as, like, what's considered anormal latency between the light
flashing and the pupilconstricting, you know, and so,
though, again like those windowsof time that are measured in
milliseconds, very hard to seewith the naked eye if you just
(30:41):
shine a pen light in someone'seye.
so I also love that that appthat pupillary light reflex for
that reason, is to be able tocapture a latency down to a
certain millisecond.
You know, and knowing that thenormal reference range is so
narrow, you do start to be ableto see.
You know, this orchestrabetween the parasympathetic and
(31:03):
sympathetic nervous systems inthis test that takes 15 seconds
to do.
Dr. John McClaren (31:09):
That's beautiful.
The orchestra word is exactlywhat it is.
It's this fine waltz betweenthe systems right when, if they
work appropriately, odds aregood.
You know that patient's notgoing to have as big of a
symptom load, or they're maybenot even going to come see you
because they feel pretty good ifit works like it's supposed to.
You know.
And then, yeah, you get in andyou grab your sphygmometer and
(31:31):
your your stethoscope and youtake your blood pressures.
You know what happens on theleft side versus the right side.
Then you compare it.
You know, and that's the greatthing about this, you go, I've
got different metrics that I cancompare.
And then you start to go doesthis make sense?
Do we have medications on boardthat can maybe contaminate some
of our data, which?
You go, well, there are somemedications that can influence
(31:53):
pupillary reactions.
There are others that caninfluence your blood pressure
findings, but it's really hardto find medications that
influence everything equally.
So you can go, well, I've gotand again, even if they're on
medications, these systemsshould adapt relatively well.
Sometimes that's why they'retaking the medication is to get
the system to adapt well, and ifit's why they're taking the
medication is to get the systemto adapt.
Well, and if it's still notworking, then you know,
(32:16):
depending on your scope ofpractice and your relationship
with your patient and yourproviders, you can give them
that data.
You can go, hey, you know,maybe the dose or the medicine
isn't appropriate for thispatient because we're still
seeing XYZ and it could beruining or contaminating or
(32:36):
causing a problem with ourrehabilitation coefficients and
so on.
Just communicating with otherproviders, which, again, when
you ask, how do people find youand how do you build this kind
of practice, that's one of thebest ways because they go.
Well, you're not just, you know, you're not just banging away
on people willy nilly, you'reactually collecting some data
and there's some care.
(32:57):
You know these primary practicepeople.
They're really busy and a lotof times they don't have the
time to do this stuff.
If they, if they know how to doit Sometimes they're, again,
not trained like this, but theyappreciate it and they go wow,
that's a nice, you know, that'sa nice approach that you take.
I've got five others that arejust like this patient who had a
traumatic brain injury.
They were, they were maybe onthe same bridge or you know
(33:18):
something like that, where themulti-car pileup happens and you
know they do.
They become impressed with theway you know people, especially
that are care trained, reallystart to approach these kinds of
things and they go.
I never referred to anacupuncturist before, but I'm so
glad I did.
Or I never referred to a doctoror chiropractic before.
I always thought you guys were,you know, weirdos or whatever.
And you know it turns out I wasthe weirdo for not doing it all
(33:41):
this time.
I you know, and it helps.
Dr. Ayla Wolf (33:43):
Well, and I see a lot of patients, you know, when
they have things like posturalorthostatic tachycardia syndrome
, a lot of times they end uptaking themselves off the
medications they're givenbecause of the side effects that
they experience.
And a lot of doctors are veryupfront and saying listen, you
know, we don't have a greatpharmaceutical solution to fix
(34:03):
this and so let's just try this.
And a lot of doctors are alsokind of humbly approaching it
and saying you know what, likewe're not so good at treating
this, and we know that.
But here it.
And saying you know what, like,we're not so good at treating
this, and we know that.
But here, try this, and if ithelps, great, but if it doesn't,
like, then you know, don't takeit.
Basically, and so well they knowthat you know a lot of their
(34:23):
medical.
You know approaches are kind ofa trial and error and you know
the way that I.
I think the autonomic nervoussystem is so complex and when
you try to control one small armof it with a drug it usually
doesn't equate to a good outcome.
And I think you know that'swhat I see play out quite often
(34:45):
and I you know, like you said,you know people kind of demonize
the sympathetic nervous systemand say parasympathetic good,
sympathetic bad.
But the way that I like todescribe it is like like your
autonomic nervous system turnsyou into a high performance
sports car and so when you wantto, you know, slam on the brakes
(35:05):
and come to a screeching halt,you can.
Or if you want to go zero to 60in 0.5 seconds, you hit the gas
pedal and your system can dothat.
And so it's like it's thatability to modulate for
whatever's appropriate in themoment.
And in some cases, if you'repower lifting, you got to have
that sympathetic output,otherwise you're not going to be
(35:27):
a good power lifter.
Dr. John McClaren (35:29):
Yeah, or you're snorting all these salts
and doing all these other thingsto try to get it to activate.
And and know, I had a buddy man, he would.
He would just literally havehis training partner hit him
with a two by four just to getthat sympathetic.
You know, and I'm like you know, and some of them, you hear it,
it's like, oh my God, I'm likeI'm out of the gym.
I'm like I'm like if you guysslap me like that, I'm gonna
slap you back.
(35:50):
And I'm like if you guys slapme like that, I'm going to slap
you back and I'm out.
These kind of things.
I'm like don't smack me.
I'm like, tell me nice things,give me some validation.
You're a really good lifter,john, you're going to lift.
I'm not the tough love guy withthat.
Don't corporately punish mebefore my lift.
But yeah, you see people do thisstuff all the time and it's
(36:14):
just fascinating.
And yeah, you know, that's thegreat thing is we've got these
tools that are relativelyinexpensive to assess it in a
very thorough fashion.
You know, this orthostatictesting is really a great thing
to do.
You can, you can check bloodpressures in those different
positions, you know, and if alot of this to people kind of go
how do I save time?
You know, and I think the thingtoo, if you really want to do a
(36:35):
service in this autonomicnervous system in your TBI
community, you've got to bewilling to spend a little bit of
time and it's okay.
Maybe you don't do your wholeexam in one visit, or something
like that with people, becauseif you're trying to fit a TBI
exam into a 30-minute window, Ican't do it.
Dr. Ayla Wolf (36:53):
It doesn't work.
Dr. John McClaren (36:56):
I mean, professor Carrick can probably
do it in two minutes because hehas it when he looks at you walk
.
But you know, I mean for meit's like, especially with some
of this, yeah, you get, you know, the pupillometry is pretty
quick, blood pressures arepretty quick, but you could.
You got to spend some time andand you've got to try some
different therapies and kind ofsee what happens as well so you
can do a pull.
I mean you've got to pull socks.
If you don't have a bloodpressure cuff and a stethoscope
(37:21):
and a pull socks, don't do thiskind of work, right, I mean?
And we should all have thosethings, probably after a
professional school or thingslike that.
The pull socks, you know, get agood one.
Don't buy the $20 junkie oneoff Amazon or from Walgreens
nothing against Walgreens butget a good one like a non or you
know something like that.
My brother was a critical carenurse for a really long time and
(37:43):
he's like, don't you know, andthey, these are guys, those
measurements, you know theirlife and death for for the
things that they're doing.
You know he was a flight nurse.
He's a nurse, anesthetist nowand he's like you really want
good equipment if you're goingto do that stuff.
And again, professor Carrickwould say the same thing Get a
good pulse ox, you know.
Get a good stethoscope andauscultate the heart too.
You know.
(38:03):
You can find so much withregards to the autonomic nervous
system by what happens withheart sounds.
You know not only you know.
Is there a murmur or somethinglike that which you should find?
If they have autonomic nervoussystems, do they have a primary
cardiovascular issue?
But you can listen to your S1and S2 sounds.
Have them turn the head justlike we would in a
post-geographic exam.
(38:24):
You go.
Well, if I turn the head to theleft and I've got differences
in S2 splitting or you know somemuffling of an S1 sound or
things like that, then I knowthose are things that aren't
supposed to normally happen.
A whole lot with physiology.
Right Now I've got a deviationfrom what and that's the thing
like we get normal physiology inour schooling.
What is a deviation from that?
(38:44):
Is that related to how I getblood and oxygen to my body?
That's what your autonomicnervous system does.
Yeah, you know.
And, like I said, I just gotback on social media.
I mean, I go down my feed andeverybody's got a way to
activate the vagus, right, it'sthe new hypoglycemia, right.
You know it's like everybody'sfiring that vagus up, you know,
(39:05):
due to the cold plunge, andbreathe this way and eat these
foods and all these kind ofthings.
And you know that's great thatpeople are talking about it.
You know, I I see like NateKaiser's post he did the
dysautonomia program for theCarrick Institute.
You know he's like.
You know he kind of takes someof these things and he's like,
yeah, but Right.
Dr. Ayla Wolf (39:25):
Well, and you know when I've taught different
classes, because you know youhave the auricular branch of the
vagus nerve, so a lot ofacupuncturists are really into
auricular acupuncture for thatreason, and so a lot of times I
kind of have to say like heyguys, the vagus nerve does not
have a brain of its own, likeit's not making its own
decisions here, and so what youreally need to understand is the
(39:47):
connections of the vagus nerveinto all these different parts
of the central autonomic network, and that you actually need to
be paying maybe a little bitmore attention to what's
happening above the vagus nerve.
Dr. John McClaren (39:58):
It's ideal, right?
Yeah, you know it's like don'tlook at me down here, look at me
up here.
Right, it matters, right, itreally does.
And sometimes it's okay.
You have to with some of thesepeople where they've got this
phenotype that sympatheticnervous system is really really
overactive.
Those pupils are, you know,constricting and then dilating,
like really really big andreally really fast.
(40:19):
The heart rate's really high,the blood pressure is a little
high.
You've got a, you know, a hugediscrepancy between left side
and right side blood pressures.
Again, these are all things,like you know.
The primary question was how dowe examine these?
As people are listening, theycan go.
So I'm checking blood pressureson both sides.
I'm checking blood pressurelying down versus seated, versus
standing.
You can go ahead and checkblood pressure in dual task
(40:43):
settings if you really want to.
Again, how much time do youwant to spend on it?
But you should do some of theseaspects for sure.
What does the heart rate dowhen I change positions?
And you know those are things.
When people see that thosethings break down, you know,
here they go.
They may need some vagal nervestimulation until you get those
connections, those drivers ofthe vagal activity, to work the
way that they're supposed to,which, when they've got a
(41:05):
traumatic brain injury.
That's what they're telling youis.
Hey, you know I've got someissues.
A lot of that really is rootedin those white matter
connections.
Right, you get this whitematter connectivity.
I'm really excited there's aclinic in town now, an MRI and
imaging center.
They do DTI.
It's commercially available,yeah, so it's like I am going to
(41:27):
be sending you more than youprobably want to deal with,
right, just because the workthey're doing with that.
We're looking at theseconnections between the cerebral
they're doing with that.
We're looking at theseconnections between the cerebral
cortex and the brainstem.
We're looking at theconnections between the
cerebellum and the brainstem.
How does the cerebellum driveinto these centers?
How does the cortex drive in?
Because you should get someactivation of inhibition, of
(41:49):
inhibition and so on and soforth, so that that orchestra
plays the way that it's supposedto.
Yeah, inhibition and so on andso forth, so that that orchestra
plays the way that it'ssupposed to.
Yeah, I want to be the Ferrarithat you're talking about.
I want to be able to rest anddigest when I want and somebody
breaks in I've had the big steakand somebody breaks into my
house.
I want to be ready right away.
I want to go.
I'll come back in 20 minutesonce this thing's digested.
I've got to get slapped in theback by my buddy with the two by
(42:11):
four so I can fight you out ofmy house.
You know those kind of things,so you know that's.
That's the thing.
I want that system to be primedand ready to go.
And of course I mean there's alot of ways for, for athletic
optimization.
I think a lot of the strategiesthey're doing may be
unknowingly helping to harnessthese aspects, or knowingly, you
know, to get them to work likethey're supposed to, or
(42:33):
knowingly, you know, to get themto work like they're supposed
to.
Dr. Ayla Wolf (42:35):
This was part one of my interview with Dr John
McLaren.
The second half of ourconversation will be available
next week.
If you have a specific topicyou would like to learn more
about, please leave us a message, either by clicking the send us
a text link in the show notesor emailing us at
lifeafterimpact at gmailcom.
You can also follow us onInstagram at lifeafterimpact,
(43:00):
and sign up for our latest newsand announcements by going to
lifeafterimpactcom.
Thanks so much for listening totoday's show.
Medical Disclaimer.
This video or podcast is forgeneral informational purposes
only.
Thank you.
The use of this information andmaterials included is at the
(43:22):
user's own risk.
The content of this video orpodcast is not intended to be a
substitute for medical advice,diagnosis or treatment, and
consumers of this informationshould seek the advice of a
(43:45):
medical professional for any andall health-related issues.
A link to our full medicaldisclaimer is available in the
notes.
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