May 27, 2025 • 38 mins
Dr. Ayla Wolf and Dr. Tatiana Habanova discuss the neuroendocrine changes post-concussion, particularly the impact on thyroid and adrenal function. Dr. Habanova explains that hypothyroidism often results from pituitary dysfunction rather than direct thyroid issues. She emphasizes the importance of assessing hormone levels immediately post-concussion or after a few weeks. They highlight the need for regular re-evaluation of thyroid medication dosage as the brain heals. Dr. Habanova also advocates for annual brain health assessments to monitor cognitive function and overall brain health, stressing the importance of early intervention and comprehensive neurological evaluations.
• New research shows even mild concussions can cause significant hormonal changes
• Pituitary dysfunction creates a downstream effect on thyroid, adrenal, and other systems
• Thyroid medication needs may change frequently during concussion recovery
• Thyroid symptoms often overlap with dysautonomia symptoms, complicating diagnosis
• Cortisol rhythm disruptions explain afternoon energy crashes in concussion patients
• Annual brain health assessments should become as routine as dental checkups
• People with mild cognitive changes often "shrink their world" without realizing it
• Cognitive testing isn't about measuring intelligence but identifying functional changes
• Tracking symptoms and biomarkers empowers patients in their recovery journey
• Addressing toxins and environmental factors that burden the endocrine system is essential
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
This is part two of my important conversation with
Dr Tatiana Habanova, where wediscuss neuroendocrine changes
that can happen after aconcussion that has an impact on
thyroid and adrenal function,as well as blood sugar control.
We also discuss the importanceof more consistent
neurocognitive testing andscreening for monitoring brain
function.
(00:21):
I hope you enjoy thisconversation.
Please subscribe to our show soyou don't miss an episode and,
as always, you can email usquestions at lifeafterimpact at
gmailcom or send us a text byclicking on the text us link in
the show notes.
Welcome to Life After Impact,the concussion recovery podcast.
I'm Dr Ayla Wolf and I will behosting today's episode where we
(00:45):
help you navigate the oftenconfusing, frustrating and
overwhelming journey ofconcussion and brain injury
recovery.
This podcast is your go-toresource for actionable
information, whether you'redealing with a recent concussion
, struggling withpost-concussion syndrome or just
feeling stuck in your healingprocess.
In each episode we dive deepinto the symptoms, testing,
(01:08):
treatments and neurologicalinsights that can help you move
forward with clarity andconfidence.
We bring you leading experts inthe world of brain health,
functional neurology andrehabilitation to share their
wisdom and strategies.
So if you're feeling lost,hopeless or like no one
understands what you're goingthrough, know that you are not
alone.
This podcast can be your guideand partner in recovery, helping
(01:32):
you build a better life afterimpact.
I have certainly had patientsthat have.
After a concussion, they'veactually developed thyroid
conditions.
I've actually seen people gohypothyroid and I've seen people
go hyperthyroid.
And so why don't you talk alittle bit about this research
(01:53):
that was published in 2023,where they were looking at
pituitary levels and obviouslythe pituitary then talks to the
thyroid, the ovaries, theadrenals.
So maybe get a little bit intosome of this newer research that
is looking at these types ofchanges.
Speaker 2 (02:08):
Yes, absolutely.
So really it's just a trickledown downstream aspect.
You know, it's really almost asecondary hypothyroidism as
opposed to a primary conditionaround the thyroid.
So I know sometimes languageand words that we use to explain
things in the medical world canbe slightly confusing, so we
(02:28):
really have to tease that out.
So it's probably not a directissue at the thyroid, although
we obviously want to make surethere's no growth or problems.
You know, maybe there's anautoimmune condition at the
thyroid.
That could certainly happen.
So we got to be careful.
But it's usually a downstreameffect coming from the pituitary
.
Now we can't really address thehypothalamus per se, so we can
(02:49):
assess from the pituitary leveland then, of course, downstream
from that.
So definitely, you know currentresearch is indicating that and
this is the interesting thing,that was nice to see it they now
say it doesn't matter the levelof injury, Like they used to
believe.
A more severe injury would leadto more severe hypothyroidism.
(03:11):
Low um, um or hypopituitary isa low pituitary function, which
would then lead to low thyroidfunction, which would lead to
low adrenal function.
Right, so it's just adownstream effect.
Now actually means it's justshowing that it doesn't matter
the degree of injury, even mild.
You know, TBIs, which areconcussions, can even cause
(03:34):
those issues.
So, definitely, seeing, whatthey recommend is to have a.
Let me take a step back.
Some recommend doing anassessment at the acute phase.
Okay, when you first have theconcussion, go ahead and just do
the hormonal panel at thatmoment and just sort of document
what's going on.
Others are like, give it a fewweeks, maybe even six weeks, let
(03:54):
kind of everything, let thedust settle, so to speak, and
then take the assessment at thatpoint and see sort of how has
the system kind of rallied back,um, you know, and then from
that point, if there's issues,consider moving forward, you
know, in care, treatment andcontinuation of assessing, uh,
long term in that management,right, so there's a couple ways
(04:16):
to go about that, but definitely, um, you know, seeing changes,
those neuroendocrine changeswhich, of course, for the
thyroid, is so important forbrain function.
So not only is a person maybedealing with the concussive
symptoms, whatever that profilemight look like, now there's an
added layer that kind of comesback and nips them.
(04:36):
You know, in the bud, like inkind of a round two, where you
know, maybe it's just now newsymptoms are showing up or
symptoms are getting moremanifested, you know, at a
greater degree, and the theapproach they were doing to
manage them isn't workinganymore Right?
So, like with headaches, forexample, you spoke about earlier
, maybe they were managing thema certain way and that worked
(04:57):
until the shoe dropped becausethat neuroendocrine change, you
know, was affected.
It took several weeks to monthsto do what it's going to do and
it didn't rally back.
So throughout that time maybethere weren't those thyroid
symptoms just yet, but now thereare, you know, because it's
dropped so much.
And here, two, three months,six months later, a new you know
(05:21):
a new manifestations occurring,or you know the treatment is
not working anymore.
That's again when I a newmanifestations occurring or you
know the treatment is notworking anymore.
That's again when I talkedabout that stagnation.
We need to go back and evaluateif we haven't initially.
Speaker 1 (05:31):
Yeah, and I think there's a really important piece
here too where, if you look at,like you mentioned, be great if
we could all just get abaseline hormone test, you know,
just to know where things areat.
But I think a big piece here isthat when you have a brain
injury at.
But I think a big piece here isthat when you have a brain
injury, as people's brain heals,then also if there's a
pituitary dysfunction orimbalance, then that is all.
As the brain heals, that canalso heal.
(05:53):
And so it might be a case toowhere if somebody does get put
on a thyroid medication, wemaybe shouldn't wait a year to
recheck it, right?
Maybe we shouldn't even waitsix months to check it because,
as the brain heals, they mightnot need the same dose.
And so I think that that's alsoimportant too is that, in the
context of a brain injury, ifsomebody is taking medications
(06:14):
to manage a thyroid disorder,that might need to actually be
like retested every three monthsinstead of every six months or
every year.
Speaker 2 (06:23):
Absolutely.
That's exactly the take homepoint and you're right Again
that thyroid medication may be aneeded ingredient to help also
the brain heal right, inaddition to other things that's
going on for the brain to heal,and maybe the brain needed that
little bit of thyroid hormone inthe brain to be able to do that
right.
(06:43):
And then it heals up.
And now maybe we need totitrate that down or slowly take
it away and not becomedependent on it.
And I think currently in thefield of medicine, you know,
thyroid is not looked at thatway.
It's sort of looked at oh, yougo hypo and then you most likely
need meds your whole life.
And then maybe they're justgoing to slightly tweak the
(07:04):
levels because you know maybesomeone's feeling a racing heart
or blah, blah, blah, blah,right, so they're going to start
to maybe kind of play with thedose, but they never take you
off of it right.
Or look to maybe wean outcompletely and again, maybe that
is needed, maybe it's not, butI agree with you.
I agree with the idea ofproviding it if necessary and
(07:25):
then seeing how the braindevelops right and heals.
Speaker 1 (07:30):
Yeah, and I think you just mentioned a beating heart
which made me want to point outthe fact too that we in
functional neurology we spend somuch time assessing for
autonomic dysregulation and soit is really important to also
see this overlap between thyroiddisorders and a lot of the
symptoms, kind of overlap with adysautonomia type presentation
(07:53):
too, and so it just like makesit like you said, it's just the
ability to understand thefunctional medicine and the
functional neurology at the sametime is so huge.
Speaker 2 (08:03):
Exactly that makes me think of a case I had about
four years ago with a patientwho had a history of concussion
and previous, and was on thyroidmedication for a very long time
maybe 30 plus years andconstantly spoke about a racing
heart, like she used to call it.
(08:24):
Like horses are pounding in mychest, like when horses run near
their hooves, you know, theycome out beating.
And so she was going to herdoctor constantly about the
thyroid and they didn't want tochange levels because they're
going to have the highest shecould be and they'd take her too
low and then she would havesome thyroid crashes because
again there's some dependency, alittle bit on the meds too,
(08:45):
because the system isn't kind ofworking on its own, it's
working on the environment, it'sprovided with Right, so um.
So again that could be achallenging river to navigate to
some degree as well and um, butjust never could get it right
and I always felt it was thethyroid and had brain fog and
all this and you know evaluateher and she had dysautonomia and
(09:12):
so treat the dysautonomia andthe racing heart went away and
was able to lower her thyroidmeds to some degree.
She still did require some, butnot to the degree that she was
no more racing hearts and theenergy level of brain fog.
A lot of things help.
But again, was it dysautonomia?
Was it over medication ofthyroid?
You know it's, it's reallytakes, I think, a practitioner
who can peel back multiplelayers and look at the person
(09:35):
from different perspectives.
Speaker 1 (09:37):
Yeah, yeah, I had a patient that was in a lot of
pain after her concussion.
She also had a, an injury to herneck, and so being on a lot of
pain after her concussion, shealso had a, an injury to her
neck, and so being on a lot ofpain can cause your blood
pressure to rise, and so she wasplaced on a blood pressure
medication at some point and I,you know, I think what happened
was, you know, maybe the painlevels came down, but she was
(09:58):
still on the blood pressuremedication and so a lot of the
autonomic nervous system, likethe dysautonomia piece, wasn't
getting better because she hadthis medication artificially
decreasing her blood pressure.
And it was like once she wentoff of that because she was able
to track the blood pressure,say to her doctor, hey, this is
consistently low, like I don'tthink I need to be on this
medication.
(10:18):
And so they said, yep, you'reright, I'm looking at the data
here, let's take you off of it.
And then, all of a sudden, thedysautonomia improved and
instead of plateauing, it's likeall of a sudden it's like her
progress just shot way up, andso it just really highlights
that importance of like in thecase of concussion recovery.
We've got to be payingattention to all the data, you
(10:40):
know, the hormones, the bloodpressure, the autonomics.
If we've got any medicationsthat are controlling any piece
of this, as things improve or ifpeople plateau, we got to step
back and say, okay, is all ofthis stuff still needed at the
moment?
Speaker 2 (10:56):
Right and I think you hit upon some two really
important pieces is allowingpatients to take on more
responsibility of trackingsymptoms.
Right so?
Like tracking the bloodpressure regularly or whatever
the case is, and keeping alittle journal or log, like
really normalizing that, reallyallowing patients to just take
that time to do that andrecognize how key that is.
(11:17):
That data is so important.
Right so, that data collectionand then working cooperatively
with their primary carephysician and being able to say
okay, you know, let's work onthis where the medication is
needed for a time being.
Speaker 1 (11:31):
But as the system heals.
Speaker 2 (11:32):
Let's work on normalizing and maybe getting
off of it if needed or whatnot.
Right so that collaborativepiece amongst professionals and
really to serve the patient atthe highest level.
Speaker 1 (11:44):
Professionals and really to serve the patient at
the highest level.
Yeah, yeah, it takes a lot of,you know, awareness of all the
moving parts.
Speaker 2 (11:52):
So it does.
Speaker 1 (12:01):
And then when you are seeing these hormonal
imbalances and things showing upon labs you know that are
cluing you into, say, apituitary imbalance having
downstream consequences, do youwant to talk a little bit about
your approach to working withthose patients?
Speaker 2 (12:11):
Sure.
So you know, kind of anofficial kind of meeting, and a
lot of times I am in favor ofgetting some lab tests on the
front end.
Sometimes patients will alreadyhave some recent blood work
that they've done, so I alwaysask them to send that to me if
it's within three months, canutilize that data.
I find a lot of times they'renot very complete or a lot of
(12:31):
bits are missing, you know.
So we'll have to just go outand get a little bit more
testing if we need to fill in afew gaps.
But really then you know, upondoing a comprehensive
neurological evaluation, I takeabout three hours to do that
comprehensive assessment.
So again, information gathering, data gathering and being able
to look at what are the primaryareas that are needed, depending
(12:54):
again on symptomology and whatthey're presenting with right.
So then I like to prioritizefor patients sort of how can we
best achieve?
You know their goals, right,usually most people want to get
out of pain, they want tofunction better than when that
brain fog, you know.
They want to feel dizzy,headache like, whatever those
things are.
You know, we'll start toidentify their goals and then
(13:16):
I'll lay out trajectories orpaths and be okay, this is the
goal you want to achieve.
This is what I feel we need todo to achieve that.
And then I'll really ask themwhat do they want to take on,
what makes what gravitates tothem the most, what matters to
them the most, and what are theywilling to take on?
Because I think what's alsoimportant before I start working
with anyone and really gettinginvolved in their care, because
(13:38):
I want them to be aware of thethings that they're going to
have, what hurdles they're goingto have to cross, and to also
start preparing for some of that.
So not all of a sudden, oh okay, here we are, and now you need
this.
And they're like oh, you know,because many times when you have
brain fog, you're not firingoff all pistons.
It takes a lot of energy just todo something simple, right?
(14:00):
The resources are limited.
You're probably not sleepingvery well, right?
So there's a little bit of thatgoing on.
Symptoms, pain all of that canjust add to the burden, right?
So I want to try to make it assimple as possible for patients
to be able to feel they can beempowered, to feel like they're
in control, that I'm guidingthem, so that they feel
confident in the path thatthey're taking but that they
(14:22):
feel comfortable they're takingon, and the most important part
is creating that compassion andsafety right.
So that's really kind of how Ibegin leading those cases.
They can take a long time, inthe sense that it could be a six
month to a year processtogether.
We're not just gonna solve somethings immediately.
Some things may happen quickly,which is great, and some things
(14:44):
can take a little longer.
So you know what are thingswe're going to do to manage some
of the symptoms in the meantime, what are going to be things
that we're going to heal andimprove and what does that take.
So I think it's reallyimportant to have an honest
conversation about that sopeople can make a decision that
makes sense for them and thewillingness to take that journey
on and to do that together.
Speaker 1 (15:05):
So I'm not sure if I answered the question where you
were leading it, but well, Imean you, you, you bring up that
important concept ofexpectations and I think that
when you do all that work on thefront end and you spend the
three hours, you know, assessingsomebody and looking at all the
data and then maybe collectingmore data, A lot of times what
(15:26):
happens is that because youspend all that time on the front
end, you can very quickly getto here's what is wrong, here's
what the problem is.
But then the patient says ohwell, they were so quick to
figure out what's wrong, so thatmust mean that they were going
to be really quick to fix it too.
And, like you said, sometimesit takes a while, and so
managing those expectations ishuge.
Speaker 2 (15:48):
Yes, and even on my end, because trust me, if I
could wave that magic wand andmake it all go away like this, I
would be waving it all day foreverybody.
So I tell them, I can only workas fast you know and guide you
and support you and coach youand address these things, as I
have to respect your body andyour body's healing time.
I can't push you more than orpush your body and brain more
(16:10):
than it's capable of.
And that's a really importantpiece.
Because if we over fatigue, youknow, we end up crashing the
system and now we're kind of,you know, putting ourselves
behind the eight ball right.
That doesn't make sense.
So, again, managing thoseexpectations and guiding them,
even in their life, becausepeople tend to take on more than
you know and sometimes can setback their healing a little bit
(16:31):
too.
So yeah really supporting him inthat.
But definitely if I seeing someissues, you know, on the
thyroid side because I don'tprescribe medications, you know
that is something where I'llrefer them to their primary or
another physician if thatsupport is needed.
Many times we'll also work onsupplementations and other
things to kind of support thethe need for the body to work
(16:53):
better, just support cellularfunction.
So, you know, with theendocrine system particularly,
you know looking at endocrineburdens, right?
So what are things that areaffecting the hormonal system
from working as well?
And I'm talking about nowreceptor sites.
So are we dealing withtoxicities and things of where
(17:16):
we can do some liver support andmaybe you know, clear out some
things, some toxins and burdensthat will allow your hormonal
system to actually functionbetter, right?
So it's almost like I say youhave a knapsack with a bunch of
rocks in it or boulders andyou're trying to run up a hill.
That's really darn hard.
But why don't we take thatknapsack off?
Boy, you can sprint up noproblemo, right?
(17:37):
So let's deal and look atsometimes, instead of always
working from a mindset of let'sjust improve, improve, improve,
improve, why don't we stop andtake a look and go behind our
shoulder and kind of look whatare some of the burdens that are
occurring to the system.
What's going on dietarily?
Are the things that we may beconsuming, you know, that have
(17:59):
pesticides in them or we'reexposed to environmental toxins,
you know?
Maybe we should do a panel andsee if there is mold or, you
know, various infections orother things that are maybe
burdening and pulling the systemdown.
So I think that's an importantthing as well, instead of saying
, oh, let's just always try tocreate peak performance for
these hormones.
So again, another mindset ofconsideration.
(18:22):
Their history will dictate someof this, of course, right,
women that are in theirperimenopausal and menopausal.
We now need to be thinking alittle bit on hormones and
what's going on there.
So definitely, I start to seechanges in progesterone as women
are in their perimenopausalphases, whereas progesterone is
(18:45):
starting to decrease.
So that is going to not be asmuch of a neuroprotective effect
and create a little bit of aheightened anxiety around things
as well.
So, in terms of managingpatients that might have these
neuroendocrine changes perhapsdue to a concussion, perhaps
just neuroendocrine changes thatare happening in life to also
(19:07):
support them from thatperspective as well.
So the literature doesn't speakper se to any of the sex
hormone changes.
They're really talking moreabout that pituitary and the
thyroid and the adrenal, thecortical.
They do also now mention growthhormone and insulin growth
(19:28):
factor starting to be influenced.
So that is going to now linkback up to sugar handling.
Okay, so that's important froman energetics perspective.
So, energy metabolism.
So how else do I manageneuroendocrine changes?
Is I look at bioenergetics?
Um, I know you've talked a loton your podcast about red light
(19:49):
therapy.
I also like to do a lot of pemfpulse, electromagnetic um
stimulation as well, um, so,other ways to provide energy to
the system, supplementation,herbs there's a variety of
things, lifestyle changes tosupport those processes too.
So I think we've got to look atit from a practitioner's
(20:10):
perspective, a few differentangles, and for patients to
realize oh, there's a lot ofchoices and options that I can
maybe explore when I'm trying tostabilize a system or improve
upon a system.
What are some rocks that Ihaven't unturned, turned over
yet, to explore Again, thoseneuroendocrine disruptors right,
(20:31):
there are several that we are,know in the food and just you
know chemicals and water andthings like that.
Should I get a you know waterpurifier?
Should I just you know, shopslightly differently, eat
slightly differently.
That goes a long way, thatreally goes a long way.
And then, you know, looking atsome energetics as well, so I
(20:51):
kind of again looking at thecase really guides me.
But these are all the thingsthat I have at my disposal that
I'm kind of considering, as Ikind of have this imaginary
whiteboard in front of me, as I,you know, have all the dots for
the patient and you know, allthat information I'm kind of
holding in my mind.
But these are the things thatI'm thinking about as well.
You know, there's nothingreally we can do for the
(21:13):
pituitary specifically.
We can only do, like thedownstream.
Speaker 1 (21:17):
Yeah.
Speaker 2 (21:18):
And then stress, right.
So cortisol, the othercomponent, we haven't discussed
if you want to approach that ornot, but looking at cortisol,
elevation of cortisol anddysregulation of the circadian
rhythm and just stress, overallright and the influence that has
on neuroendocrine effects.
Speaker 1 (21:37):
Yeah, when you do the Dutch test, are you typically
ordering the one that includesthe cortisol awakening response
to look at that cortisolactivity first thing in the
morning within that first hour?
Speaker 2 (21:48):
I do absolutely, and there's always disruptions, you
know, in that circadian rhythm.
And then also I look at thedrop that occurs around the
lunchtime hour, Because that iswhen the adrenals need to kick
in to provide the cortisol, foras the circadian rhythm will
(22:09):
naturally decline that's anatural circadian rhythm it
should drop and then kind oflevel out around 5pm, Right, so
it should start to rise in themorning.
We do want cortisol first inthe morning.
That is a very good thing thatcreates an awakening response.
So you know, sometimes peopleare alarmed that their cortisol
is so high in the morning.
It's like, well, relativelyright so.
But then I look at the peak andthen look at that drop and
(22:31):
generally that's where peoplehave an afternoon lull, right.
Sometimes it could be kind ofeating food.
Maybe they have some, you know,glucose intolerance, so they're
eating lunch and then they getsleepy, tired, drowsy 15 to 30
minutes after a meal.
Well, you know, that's aglucose metabolism issue, right.
(22:51):
But assuming it's not that theyjust kind of feel like drop in
energy and then they kind of getbetter later in the day, those
adrenals are not kicking in andsupporting the chain, the
dropping of the cortisol, andthe adrenals are supposed to,
are supposed to bring it in andto kind of level you out slowly,
right, not crash.
So there is herbs that can beused to support that process, to
(23:15):
help kind of bring you downmore comfortably, and I find
that very, very effective forpeople to manage their energy so
they don't crash.
They can be productive all day.
Keep going.
You know, we know movement,brain function, thinking, body
movement is so important forbrain health and brain healing,
absolutely.
So, again, managing andsupporting those effects.
Speaker 1 (23:36):
Well, you have shared a wealth of information.
Do you want to talk a littlebit?
You said at one point, summer,you're on a mission to provide
annual brain health assessmentsto everybody.
So tell me a little bit aboutwhat that looks like, because I
think that this is somethingthat I would love to see this
happen.
If we were in charge ofhealthcare, right, this is what
(23:57):
we would implement.
Speaker 2 (23:59):
I think, to some level there might be bigger
powers in motion.
There's some amazing womenalready on, I think, moving this
torch forward as well.
So I'm happy to be one of thosevoices to continue to create
that movement, and not justparticularly for women, but
definitely for everyone.
For everyone In terms of.
(24:20):
You know, we go to the eyedoctor once a year.
We go to the dentist maybe onceor twice a year.
We get an a yearly physical.
These are normal.
You know, little moments ofassessments that we do in our
health, right, it's just norm,it is what we do.
But we don't do that for ourbrain.
And why not?
We're living longer.
You know.
(24:40):
We want longevity, health.
You know.
I think it becomes a more of adue diligence that you take it
upon yourself to say, hey, ifyour practitioner is not
recommending this, which most ofthem aren't at this moment.
But trust me, time will come,they will be and this will be a
(25:02):
norm.
You know how that looks like.
I'm trying to develop a modelright now of what should be
included because, as you know,we could do so many elements to
neurological assessments and wedon't want it to be taxing and
and too comprehensive in thesense, where it takes so many
hours and it's difficult toimplement into a practice and
(25:23):
for people to come in and maybeget in a one hour visit, right.
So keep it doable, to keep itthe right information and things
like that.
So I'm trying to create a modeland a standard or beginnings of
something that we can do.
But the idea of that yearly isso critical because it's going
to pick up on anything thatmaybe you need to work on that
you don't realize, right?
(25:44):
It's just sort of like you geta dental and you realize, oh,
you have a little cavity, well,you better deal with it, you
better do something.
You're not going to just let itgo, you're going to treat it
right.
Or your eye prescription maybeneeds to change slightly, right?
So you go ahead and change yourprescription, get new contacts
or glasses.
It's just what happens.
So why not here and why notmove forward in life with the
(26:06):
best brain that you possibly canhave?
Right?
Because should something happenlike a concussion or some brain
injury, you know going into theconcussion is so important that
you go.
You never want to have aconcussion, I don't want for
anybody, but should that happen,you want to go into it with the
best brain possible, and theonly way you can do that is you
(26:27):
keep tabs on.
If you don't measure it, youdon't know what's going on.
So I think that idea of justdoing that yearly and then
checking again the next year andeverything's the same, awesome.
You know, if things havealtered a little bit, let's fix
that and again, it's alwaysbetter to it'll only be a quick
little fix, it won't be majorright Now.
If there's something that weneed to work on, let's work on
(26:49):
it.
Let's get that sorted out andthen you're good again, let's
move forward, right?
So so that's kind of themission there and just that, the
stigma around the cognitiveaspects of it.
Most people are prettycomfortable having their
vestibular system evaluated orthe cervical, the neck and
various things, but sometimes itcomes to the cognitive people.
(27:10):
People don't sometimes reallywant to take those cognitive
tests because they don't want toknow, because I think they're
afraid that maybe the test isgoing to show that they have
some you know a cognitivedecline and they feel at this
moment still in society againthere's people who are doing
amazing work of altering thatstigma and helping people
(27:33):
realize that even with mildcognitive impairment there are
things that we can do to turnthat boat around and improve
brain health.
You know, having an evaluationthat shows that there's some
mild cognitive impairment is nota death sentence or a sentence
to alter ice home.
You know there isn't that, butwe don't want.
(27:55):
You know, if we leave itunattended, maybe it might lead
to that.
So why?
Why be risky like that?
Why not take care of it?
I personally would rather learnabout something sooner than
later, so there's still a fewthings to kind of help people in
terms of navigating that andlearning and education, and you
do just such an amazing job onyour podcast, sharing this
(28:15):
information, helping listeners,you know, really get to the
truth behind things, and so youknow, I just support you.
A thousand different ways.
Speaker 1 (28:25):
Thank you.
Speaker 2 (28:26):
And all your pursuits as well and the work that you
do in the world and in yourclinic and personally with
patients.
So but yeah, the yearly brainhealth assessment, I think is
something that should benormalized.
I'd love to see morepractitioners do it.
I think they're not sure justhow to, not not how people know
what tests to do, just how wellto structure.
So I'm working on a doablemodel that people can just
(28:47):
cookie cutter, tweak it toobviously your patient
appropriately, but somethingeasy to implement.
And there you go, there's theblueprint.
You know, go have at it andlet's get this going.
Speaker 1 (28:59):
And, like you said, I think a lot of people are.
They're okay being assessed,other things being assessed, but
as soon as you say let's assessyour brain, it's almost like
people have reminiscence of likehigh school math test.
Right, they're all of a suddenhaving like test anxiety or they
, you know, they are reminiscentof this whole grading system in
school and it's like, oh,you're gonna make me do a test,
(29:20):
and so I think that the that's alittle bit, like you said, of a
hesitancy, where people arelike I'm fine, I don't want you
to look at my brain, I don'twant to be tested, you know, and
it's.
It's like we're not.
We're not testing yourintelligence, we're just
assessing different cognitivefunctions.
It's not an intelligence test.
Speaker 2 (29:37):
Exactly, and that's a key point there.
And also I find, like somepeople like honestly, don't want
to know, they're in denial.
So there's that.
But also what I find is, ifthere are cognitive changes,
right, mild cognitive changes,so it's not like drastic, right,
sometimes after a concussionyou can have significant
cognitive changes like this,right, and it is clear, I, that
(29:59):
was a little bit my experience,I think, maybe your experience
to some degree as well, right,but the mild cognitive changes,
people start to shrink theirworld so they could operate in a
way that that they can tolerateto their brain function.
So they don't realize thattheir world is shrinking to some
degree so they could keepmanaging within that.
(30:21):
Well, because we all want to dowell, we want to feel well and
good and successful, right, it'svery important, so, so, but
they don't realize they'reshrinking their world.
And then when you expose themto some standardized cognitive
tests, and again, not not tomake them feel bad, but just to
say, hey, here's a benchmark ofreally the level you should be
functioning at, Right, andthat's where we want to get you
(30:44):
to and we can make that happen,right, if possible.
Right, so again, don't make aconversation, but again, let's
say realistically.
I think that really helps.
Sometimes people realize like,oh, wow, because they feel I'm
fine, I can drive, I can go towork, I can do this and this and
this, my life's okay, I don'tneed that right.
And it's like, well, okay,let's just kind of measure you
(31:07):
to some standards, you know, isyour world shrinking or not?
Um, Because the smaller it gets, the smaller it gets.
The smaller it gets, the lessof an existence we have and
there's so much to enjoy in thisworld and we don't want to
limit our potential, ourabilities and our experiences.
So I find also that has beenthe case for many people too,
where they're thankfulafterwards and they're like, wow
(31:30):
, I had no idea that that washappening, because I felt, you
know, you put them in a newenvironment, you put them a
little bit outside their worldand now can you navigate things
if you're not in the familiarityof your own little space.
Speaker 1 (31:47):
Yeah, right, and the other thing that I see is that
when people have had aconcussion, if their executive
functioning is affected to somedegree, part of executive
functioning is internalself-monitoring and
self-awareness, and so somepeople are not able to have that
self-awareness of when they'remaking mistakes, and so they
might actually not evenunderstand the degree to which
(32:10):
the concussion has beenaffecting them cognitively,
until somebody comes in and sayslet's just look at these
functions, let's assess them,and then maybe shine a light on
where you're struggling.
Speaker 2 (32:22):
Absolutely.
I think that's a good point andthat main times, that's what I
do.
I just shine a light on peopleas well.
They may not want to pursuethis or that if something showed
up.
Sometimes they do, sometimesthey don't, but I said, hey, at
least we have data.
And this was a case actuallywith a patient of mine.
Four years ago.
We did a little mini evaluation.
She's an equestrian athlete andleft for season, so they go up
(32:46):
north and then back, so workingtogether, and this season,
actually just a few months ago,I was like you know what?
We haven't done an assessmentfor a while.
Why don't we just run that realquick, right?
I mean, we didn't do anythingabout it before, but we gathered
some data, which is why notjust take a few minutes?
Let's just run a few tests,right?
Well, she was significantlyworse at this current moment
(33:09):
than she was four years ago andthat opened her eyes.
I was just like, oh, wow.
And I was like I have aconcussion in these last four
years.
Now, of course, she had alittle history prior to that,
but she felt she was functioningfine.
It happens, life happens.
But she's like, oh yeah, I didfill up a horse in September.
Oh wow, I didn't really thinkthat that affected me in any way
(33:33):
.
And here we are in FebruaryMarch I believe it was when we
did it.
So, again, many months afterthat incident, she got right
back on the horse and she said Ifelt a little off for a couple
of days, but whatever andcarried on.
And so, wow, now that we did ourcomparison, she was like she
just said thank God, we did thatfor you.
She goes, tom, I really didn'twant to do it, but I did it
(33:55):
because you kind of did it.
Speaker 1 (33:57):
I did it to make you happy, but now I'm glad I did it
.
Speaker 2 (33:59):
Yeah, she kind of did she kind of did I bless her,
but I'm good and grateful thatwe just did that.
Now we did some neuro rehab andcleaned that all up and a few
months later now she's left forseason again and she's doing a
whole lot better.
Speaker 1 (34:16):
Amazing.
Yeah, what a great example.
Speaker 2 (34:19):
Exactly so, even if you think it doesn't really
matter.
I think this is why it shouldjust be a part of an annual.
You don't think there's aproblem.
But hey, let's just take a look, let's document it, let's just
keep some tabs.
Same with the hormonal changes,you know.
Women should definitely bemanaging and tracking their
(34:40):
menstrual phases, evenpostmenopausal or
perimenopausals and things likethat or any type that someone
has a concussion.
I think they should just get alittle notebook out, you know,
and start writing down andtracking some of those symptoms
as well, so that a physician canmaybe then look at it and piece
it together.
Speaker 1 (34:52):
Yeah, yeah, Awesome.
Well, you have shared such awealth of information that I
think a lot of people are goingto be.
It's gonna be eye opening andfascinating for a lot of people
to be able to to listen to this.
So thank you so much for forcoming on the show.
Why don't you tell us wherepeople can find you?
Speaker 2 (35:08):
Absolutely.
You can just reach out to PalmBeach Brain Center.
I'm actually not heavily onsocial media, as I once was in
the past trying to do a littlebit of detoxing in terms of
mental health and well-being.
So you can just go to thewebsite palmbeachbraincentercom,
or the phone number and emailis there.
(35:29):
You could always reach out thatway if you have any questions.
Speaker 1 (35:32):
Wonderful, amazing.
Thank you so much, dr Tatiana.
Speaker 2 (35:35):
Thank you so much for having me on your podcast and
to share this time with yourlisteners.
I'm really appreciative andgrateful for our time together.
Thank you.
Speaker 1 (35:48):
Medical Disclaimer.
This video or podcast is forgeneral informational purposes
only and does not constitute thepractice of medicine or other
professional health careservices, including the giving
of medical advice.
No doctor-patient relationshipis formed.
The use of this information andmaterials included is at the
(36:08):
user's own risk.
The content of this video orpodcast is not intended to be a
substitute for medical advice,diagnosis or 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
medical professional for any andall health related issues.
A link to our full medicaldisclaimer is available in the
notes.
This is part two of my important conversation with
Dr Tatiana Habanova, where wediscuss neuroendocrine changes
that can happen after aconcussion that has an impact on
thyroid and adrenal function,as well as blood sugar control.
We also discuss the importanceof more consistent
neurocognitive testing andscreening for monitoring brain
function.
(00:21):
I hope you enjoy thisconversation.
Please subscribe to our show soyou don't miss an episode and,
as always, you can email usquestions at lifeafterimpact at
gmailcom or send us a text byclicking on the text us link in
the show notes.
Welcome to Life After Impact,the concussion recovery podcast.
I'm Dr Ayla Wolf and I will behosting today's episode where we
(00:45):
help you navigate the oftenconfusing, frustrating and
overwhelming journey ofconcussion and brain injury
recovery.
This podcast is your go-toresource for actionable
information, whether you'redealing with a recent concussion
, struggling withpost-concussion syndrome or just
feeling stuck in your healingprocess.
In each episode we dive deepinto the symptoms, testing,
(01:08):
treatments and neurologicalinsights that can help you move
forward with clarity andconfidence.
We bring you leading experts inthe world of brain health,
functional neurology andrehabilitation to share their
wisdom and strategies.
So if you're feeling lost,hopeless or like no one
understands what you're goingthrough, know that you are not
alone.
This podcast can be your guideand partner in recovery, helping
(01:32):
you build a better life afterimpact.
I have certainly had patientsthat have.
After a concussion, they'veactually developed thyroid
conditions.
I've actually seen people gohypothyroid and I've seen people
go hyperthyroid.
And so why don't you talk alittle bit about this research
(01:53):
that was published in 2023,where they were looking at
pituitary levels and obviouslythe pituitary then talks to the
thyroid, the ovaries, theadrenals.
So maybe get a little bit intosome of this newer research that
is looking at these types ofchanges.
Speaker 2 (02:08):
Yes, absolutely.
So really it's just a trickledown downstream aspect.
You know, it's really almost asecondary hypothyroidism as
opposed to a primary conditionaround the thyroid.
So I know sometimes languageand words that we use to explain
things in the medical world canbe slightly confusing, so we
(02:28):
really have to tease that out.
So it's probably not a directissue at the thyroid, although
we obviously want to make surethere's no growth or problems.
You know, maybe there's anautoimmune condition at the
thyroid.
That could certainly happen.
So we got to be careful.
But it's usually a downstreameffect coming from the pituitary
.
Now we can't really address thehypothalamus per se, so we can
(02:49):
assess from the pituitary leveland then, of course, downstream
from that.
So definitely, you know currentresearch is indicating that and
this is the interesting thing,that was nice to see it they now
say it doesn't matter the levelof injury, Like they used to
believe.
A more severe injury would leadto more severe hypothyroidism.
(03:11):
Low um, um or hypopituitary isa low pituitary function, which
would then lead to low thyroidfunction, which would lead to
low adrenal function.
Right, so it's just adownstream effect.
Now actually means it's justshowing that it doesn't matter
the degree of injury, even mild.
You know, TBIs, which areconcussions, can even cause
(03:34):
those issues.
So, definitely, seeing, whatthey recommend is to have a.
Let me take a step back.
Some recommend doing anassessment at the acute phase.
Okay, when you first have theconcussion, go ahead and just do
the hormonal panel at thatmoment and just sort of document
what's going on.
Others are like, give it a fewweeks, maybe even six weeks, let
(03:54):
kind of everything, let thedust settle, so to speak, and
then take the assessment at thatpoint and see sort of how has
the system kind of rallied back,um, you know, and then from
that point, if there's issues,consider moving forward, you
know, in care, treatment andcontinuation of assessing, uh,
long term in that management,right, so there's a couple ways
(04:16):
to go about that, but definitely, um, you know, seeing changes,
those neuroendocrine changeswhich, of course, for the
thyroid, is so important forbrain function.
So not only is a person maybedealing with the concussive
symptoms, whatever that profilemight look like, now there's an
added layer that kind of comesback and nips them.
(04:36):
You know, in the bud, like inkind of a round two, where you
know, maybe it's just now newsymptoms are showing up or
symptoms are getting moremanifested, you know, at a
greater degree, and the theapproach they were doing to
manage them isn't workinganymore Right?
So, like with headaches, forexample, you spoke about earlier
, maybe they were managing thema certain way and that worked
(04:57):
until the shoe dropped becausethat neuroendocrine change, you
know, was affected.
It took several weeks to monthsto do what it's going to do and
it didn't rally back.
So throughout that time maybethere weren't those thyroid
symptoms just yet, but now thereare, you know, because it's
dropped so much.
And here, two, three months,six months later, a new you know
(05:21):
a new manifestations occurring,or you know the treatment is
not working anymore.
That's again when I a newmanifestations occurring or you
know the treatment is notworking anymore.
That's again when I talkedabout that stagnation.
We need to go back and evaluateif we haven't initially.
Speaker 1 (05:31):
Yeah, and I think there's a really important piece
here too where, if you look at,like you mentioned, be great if
we could all just get abaseline hormone test, you know,
just to know where things areat.
But I think a big piece here isthat when you have a brain
injury at.
But I think a big piece here isthat when you have a brain
injury, as people's brain heals,then also if there's a
pituitary dysfunction orimbalance, then that is all.
As the brain heals, that canalso heal.
(05:53):
And so it might be a case toowhere if somebody does get put
on a thyroid medication, wemaybe shouldn't wait a year to
recheck it, right?
Maybe we shouldn't even waitsix months to check it because,
as the brain heals, they mightnot need the same dose.
And so I think that that's alsoimportant too is that, in the
context of a brain injury, ifsomebody is taking medications
(06:14):
to manage a thyroid disorder,that might need to actually be
like retested every three monthsinstead of every six months or
every year.
Speaker 2 (06:23):
Absolutely.
That's exactly the take homepoint and you're right Again
that thyroid medication may be aneeded ingredient to help also
the brain heal right, inaddition to other things that's
going on for the brain to heal,and maybe the brain needed that
little bit of thyroid hormone inthe brain to be able to do that
right.
(06:43):
And then it heals up.
And now maybe we need totitrate that down or slowly take
it away and not becomedependent on it.
And I think currently in thefield of medicine, you know,
thyroid is not looked at thatway.
It's sort of looked at oh, yougo hypo and then you most likely
need meds your whole life.
And then maybe they're justgoing to slightly tweak the
(07:04):
levels because you know maybesomeone's feeling a racing heart
or blah, blah, blah, blah,right, so they're going to start
to maybe kind of play with thedose, but they never take you
off of it right.
Or look to maybe wean outcompletely and again, maybe that
is needed, maybe it's not, butI agree with you.
I agree with the idea ofproviding it if necessary and
(07:25):
then seeing how the braindevelops right and heals.
Speaker 1 (07:30):
Yeah, and I think you just mentioned a beating heart
which made me want to point outthe fact too that we in
functional neurology we spend somuch time assessing for
autonomic dysregulation and soit is really important to also
see this overlap between thyroiddisorders and a lot of the
symptoms, kind of overlap with adysautonomia type presentation
(07:53):
too, and so it just like makesit like you said, it's just the
ability to understand thefunctional medicine and the
functional neurology at the sametime is so huge.
Speaker 2 (08:03):
Exactly that makes me think of a case I had about
four years ago with a patientwho had a history of concussion
and previous, and was on thyroidmedication for a very long time
maybe 30 plus years andconstantly spoke about a racing
heart, like she used to call it.
(08:24):
Like horses are pounding in mychest, like when horses run near
their hooves, you know, theycome out beating.
And so she was going to herdoctor constantly about the
thyroid and they didn't want tochange levels because they're
going to have the highest shecould be and they'd take her too
low and then she would havesome thyroid crashes because
again there's some dependency, alittle bit on the meds too,
(08:45):
because the system isn't kind ofworking on its own, it's
working on the environment, it'sprovided with Right, so um.
So again that could be achallenging river to navigate to
some degree as well and um, butjust never could get it right
and I always felt it was thethyroid and had brain fog and
all this and you know evaluateher and she had dysautonomia and
(09:12):
so treat the dysautonomia andthe racing heart went away and
was able to lower her thyroidmeds to some degree.
She still did require some, butnot to the degree that she was
no more racing hearts and theenergy level of brain fog.
A lot of things help.
But again, was it dysautonomia?
Was it over medication ofthyroid?
You know it's, it's reallytakes, I think, a practitioner
who can peel back multiplelayers and look at the person
(09:35):
from different perspectives.
Speaker 1 (09:37):
Yeah, yeah, I had a patient that was in a lot of
pain after her concussion.
She also had a, an injury to herneck, and so being on a lot of
pain after her concussion, shealso had a, an injury to her
neck, and so being on a lot ofpain can cause your blood
pressure to rise, and so she wasplaced on a blood pressure
medication at some point and I,you know, I think what happened
was, you know, maybe the painlevels came down, but she was
(09:58):
still on the blood pressuremedication and so a lot of the
autonomic nervous system, likethe dysautonomia piece, wasn't
getting better because she hadthis medication artificially
decreasing her blood pressure.
And it was like once she wentoff of that because she was able
to track the blood pressure,say to her doctor, hey, this is
consistently low, like I don'tthink I need to be on this
medication.
(10:18):
And so they said, yep, you'reright, I'm looking at the data
here, let's take you off of it.
And then, all of a sudden, thedysautonomia improved and
instead of plateauing, it's likeall of a sudden it's like her
progress just shot way up, andso it just really highlights
that importance of like in thecase of concussion recovery.
We've got to be payingattention to all the data, you
(10:40):
know, the hormones, the bloodpressure, the autonomics.
If we've got any medicationsthat are controlling any piece
of this, as things improve or ifpeople plateau, we got to step
back and say, okay, is all ofthis stuff still needed at the
moment?
Speaker 2 (10:56):
Right and I think you hit upon some two really
important pieces is allowingpatients to take on more
responsibility of trackingsymptoms.
Right so?
Like tracking the bloodpressure regularly or whatever
the case is, and keeping alittle journal or log, like
really normalizing that, reallyallowing patients to just take
that time to do that andrecognize how key that is.
(11:17):
That data is so important.
Right so, that data collectionand then working cooperatively
with their primary carephysician and being able to say
okay, you know, let's work onthis where the medication is
needed for a time being.
Speaker 1 (11:31):
But as the system heals.
Speaker 2 (11:32):
Let's work on normalizing and maybe getting
off of it if needed or whatnot.
Right so that collaborativepiece amongst professionals and
really to serve the patient atthe highest level.
Speaker 1 (11:44):
Professionals and really to serve the patient at
the highest level.
Yeah, yeah, it takes a lot of,you know, awareness of all the
moving parts.
Speaker 2 (11:52):
So it does.
Speaker 1 (12:01):
And then when you are seeing these hormonal
imbalances and things showing upon labs you know that are
cluing you into, say, apituitary imbalance having
downstream consequences, do youwant to talk a little bit about
your approach to working withthose patients?
Speaker 2 (12:11):
Sure.
So you know, kind of anofficial kind of meeting, and a
lot of times I am in favor ofgetting some lab tests on the
front end.
Sometimes patients will alreadyhave some recent blood work
that they've done, so I alwaysask them to send that to me if
it's within three months, canutilize that data.
I find a lot of times they'renot very complete or a lot of
(12:31):
bits are missing, you know.
So we'll have to just go outand get a little bit more
testing if we need to fill in afew gaps.
But really then you know, upondoing a comprehensive
neurological evaluation, I takeabout three hours to do that
comprehensive assessment.
So again, information gathering, data gathering and being able
to look at what are the primaryareas that are needed, depending
(12:54):
again on symptomology and whatthey're presenting with right.
So then I like to prioritizefor patients sort of how can we
best achieve?
You know their goals, right,usually most people want to get
out of pain, they want tofunction better than when that
brain fog, you know.
They want to feel dizzy,headache like, whatever those
things are.
You know, we'll start toidentify their goals and then
(13:16):
I'll lay out trajectories orpaths and be okay, this is the
goal you want to achieve.
This is what I feel we need todo to achieve that.
And then I'll really ask themwhat do they want to take on,
what makes what gravitates tothem the most, what matters to
them the most, and what are theywilling to take on?
Because I think what's alsoimportant before I start working
with anyone and really gettinginvolved in their care, because
(13:38):
I want them to be aware of thethings that they're going to
have, what hurdles they're goingto have to cross, and to also
start preparing for some of that.
So not all of a sudden, oh okay, here we are, and now you need
this.
And they're like oh, you know,because many times when you have
brain fog, you're not firingoff all pistons.
It takes a lot of energy just todo something simple, right?
(14:00):
The resources are limited.
You're probably not sleepingvery well, right?
So there's a little bit of thatgoing on.
Symptoms, pain all of that canjust add to the burden, right?
So I want to try to make it assimple as possible for patients
to be able to feel they can beempowered, to feel like they're
in control, that I'm guidingthem, so that they feel
confident in the path thatthey're taking but that they
(14:22):
feel comfortable they're takingon, and the most important part
is creating that compassion andsafety right.
So that's really kind of how Ibegin leading those cases.
They can take a long time, inthe sense that it could be a six
month to a year processtogether.
We're not just gonna solve somethings immediately.
Some things may happen quickly,which is great, and some things
(14:44):
can take a little longer.
So you know what are thingswe're going to do to manage some
of the symptoms in the meantime, what are going to be things
that we're going to heal andimprove and what does that take.
So I think it's reallyimportant to have an honest
conversation about that sopeople can make a decision that
makes sense for them and thewillingness to take that journey
on and to do that together.
Speaker 1 (15:05):
So I'm not sure if I answered the question where you
were leading it, but well, Imean you, you, you bring up that
important concept ofexpectations and I think that
when you do all that work on thefront end and you spend the
three hours, you know, assessingsomebody and looking at all the
data and then maybe collectingmore data, A lot of times what
(15:26):
happens is that because youspend all that time on the front
end, you can very quickly getto here's what is wrong, here's
what the problem is.
But then the patient says ohwell, they were so quick to
figure out what's wrong, so thatmust mean that they were going
to be really quick to fix it too.
And, like you said, sometimesit takes a while, and so
managing those expectations ishuge.
Speaker 2 (15:48):
Yes, and even on my end, because trust me, if I
could wave that magic wand andmake it all go away like this, I
would be waving it all day foreverybody.
So I tell them, I can only workas fast you know and guide you
and support you and coach youand address these things, as I
have to respect your body andyour body's healing time.
I can't push you more than orpush your body and brain more
(16:10):
than it's capable of.
And that's a really importantpiece.
Because if we over fatigue, youknow, we end up crashing the
system and now we're kind of,you know, putting ourselves
behind the eight ball right.
That doesn't make sense.
So, again, managing thoseexpectations and guiding them,
even in their life, becausepeople tend to take on more than
you know and sometimes can setback their healing a little bit
(16:31):
too.
So yeah really supporting him inthat.
But definitely if I seeing someissues, you know, on the
thyroid side because I don'tprescribe medications, you know
that is something where I'llrefer them to their primary or
another physician if thatsupport is needed.
Many times we'll also work onsupplementations and other
things to kind of support thethe need for the body to work
(16:53):
better, just support cellularfunction.
So, you know, with theendocrine system particularly,
you know looking at endocrineburdens, right?
So what are things that areaffecting the hormonal system
from working as well?
And I'm talking about nowreceptor sites.
So are we dealing withtoxicities and things of where
(17:16):
we can do some liver support andmaybe you know, clear out some
things, some toxins and burdensthat will allow your hormonal
system to actually functionbetter, right?
So it's almost like I say youhave a knapsack with a bunch of
rocks in it or boulders andyou're trying to run up a hill.
That's really darn hard.
But why don't we take thatknapsack off?
Boy, you can sprint up noproblemo, right?
(17:37):
So let's deal and look atsometimes, instead of always
working from a mindset of let'sjust improve, improve, improve,
improve, why don't we stop andtake a look and go behind our
shoulder and kind of look whatare some of the burdens that are
occurring to the system.
What's going on dietarily?
Are the things that we may beconsuming, you know, that have
(17:59):
pesticides in them or we'reexposed to environmental toxins,
you know?
Maybe we should do a panel andsee if there is mold or, you
know, various infections orother things that are maybe
burdening and pulling the systemdown.
So I think that's an importantthing as well, instead of saying
, oh, let's just always try tocreate peak performance for
these hormones.
So again, another mindset ofconsideration.
(18:22):
Their history will dictate someof this, of course, right,
women that are in theirperimenopausal and menopausal.
We now need to be thinking alittle bit on hormones and
what's going on there.
So definitely, I start to seechanges in progesterone as women
are in their perimenopausalphases, whereas progesterone is
(18:45):
starting to decrease.
So that is going to not be asmuch of a neuroprotective effect
and create a little bit of aheightened anxiety around things
as well.
So, in terms of managingpatients that might have these
neuroendocrine changes perhapsdue to a concussion, perhaps
just neuroendocrine changes thatare happening in life to also
(19:07):
support them from thatperspective as well.
So the literature doesn't speakper se to any of the sex
hormone changes.
They're really talking moreabout that pituitary and the
thyroid and the adrenal, thecortical.
They do also now mention growthhormone and insulin growth
(19:28):
factor starting to be influenced.
So that is going to now linkback up to sugar handling.
Okay, so that's important froman energetics perspective.
So, energy metabolism.
So how else do I manageneuroendocrine changes?
Is I look at bioenergetics?
Um, I know you've talked a loton your podcast about red light
(19:49):
therapy.
I also like to do a lot of pemfpulse, electromagnetic um
stimulation as well, um, so,other ways to provide energy to
the system, supplementation,herbs there's a variety of
things, lifestyle changes tosupport those processes too.
So I think we've got to look atit from a practitioner's
(20:10):
perspective, a few differentangles, and for patients to
realize oh, there's a lot ofchoices and options that I can
maybe explore when I'm trying tostabilize a system or improve
upon a system.
What are some rocks that Ihaven't unturned, turned over
yet, to explore Again, thoseneuroendocrine disruptors right,
(20:31):
there are several that we are,know in the food and just you
know chemicals and water andthings like that.
Should I get a you know waterpurifier?
Should I just you know, shopslightly differently, eat
slightly differently.
That goes a long way, thatreally goes a long way.
And then, you know, looking atsome energetics as well, so I
(20:51):
kind of again looking at thecase really guides me.
But these are all the thingsthat I have at my disposal that
I'm kind of considering, as Ikind of have this imaginary
whiteboard in front of me, as I,you know, have all the dots for
the patient and you know, allthat information I'm kind of
holding in my mind.
But these are the things thatI'm thinking about as well.
You know, there's nothingreally we can do for the
(21:13):
pituitary specifically.
We can only do, like thedownstream.
Speaker 1 (21:17):
Yeah.
Speaker 2 (21:18):
And then stress, right.
So cortisol, the othercomponent, we haven't discussed
if you want to approach that ornot, but looking at cortisol,
elevation of cortisol anddysregulation of the circadian
rhythm and just stress, overallright and the influence that has
on neuroendocrine effects.
Speaker 1 (21:37):
Yeah, when you do the Dutch test, are you typically
ordering the one that includesthe cortisol awakening response
to look at that cortisolactivity first thing in the
morning within that first hour?
Speaker 2 (21:48):
I do absolutely, and there's always disruptions, you
know, in that circadian rhythm.
And then also I look at thedrop that occurs around the
lunchtime hour, Because that iswhen the adrenals need to kick
in to provide the cortisol, foras the circadian rhythm will
(22:09):
naturally decline that's anatural circadian rhythm it
should drop and then kind oflevel out around 5pm, Right, so
it should start to rise in themorning.
We do want cortisol first inthe morning.
That is a very good thing thatcreates an awakening response.
So you know, sometimes peopleare alarmed that their cortisol
is so high in the morning.
It's like, well, relativelyright so.
But then I look at the peak andthen look at that drop and
(22:31):
generally that's where peoplehave an afternoon lull, right.
Sometimes it could be kind ofeating food.
Maybe they have some, you know,glucose intolerance, so they're
eating lunch and then they getsleepy, tired, drowsy 15 to 30
minutes after a meal.
Well, you know, that's aglucose metabolism issue, right.
(22:51):
But assuming it's not that theyjust kind of feel like drop in
energy and then they kind of getbetter later in the day, those
adrenals are not kicking in andsupporting the chain, the
dropping of the cortisol, andthe adrenals are supposed to,
are supposed to bring it in andto kind of level you out slowly,
right, not crash.
So there is herbs that can beused to support that process, to
(23:15):
help kind of bring you downmore comfortably, and I find
that very, very effective forpeople to manage their energy so
they don't crash.
They can be productive all day.
Keep going.
You know, we know movement,brain function, thinking, body
movement is so important forbrain health and brain healing,
absolutely.
So, again, managing andsupporting those effects.
Speaker 1 (23:36):
Well, you have shared a wealth of information.
Do you want to talk a littlebit?
You said at one point, summer,you're on a mission to provide
annual brain health assessmentsto everybody.
So tell me a little bit aboutwhat that looks like, because I
think that this is somethingthat I would love to see this
happen.
If we were in charge ofhealthcare, right, this is what
(23:57):
we would implement.
Speaker 2 (23:59):
I think, to some level there might be bigger
powers in motion.
There's some amazing womenalready on, I think, moving this
torch forward as well.
So I'm happy to be one of thosevoices to continue to create
that movement, and not justparticularly for women, but
definitely for everyone.
For everyone In terms of.
(24:20):
You know, we go to the eyedoctor once a year.
We go to the dentist maybe onceor twice a year.
We get an a yearly physical.
These are normal.
You know, little moments ofassessments that we do in our
health, right, it's just norm,it is what we do.
But we don't do that for ourbrain.
And why not?
We're living longer.
You know.
(24:40):
We want longevity, health.
You know.
I think it becomes a more of adue diligence that you take it
upon yourself to say, hey, ifyour practitioner is not
recommending this, which most ofthem aren't at this moment.
But trust me, time will come,they will be and this will be a
(25:02):
norm.
You know how that looks like.
I'm trying to develop a modelright now of what should be
included because, as you know,we could do so many elements to
neurological assessments and wedon't want it to be taxing and
and too comprehensive in thesense, where it takes so many
hours and it's difficult toimplement into a practice and
(25:23):
for people to come in and maybeget in a one hour visit, right.
So keep it doable, to keep itthe right information and things
like that.
So I'm trying to create a modeland a standard or beginnings of
something that we can do.
But the idea of that yearly isso critical because it's going
to pick up on anything thatmaybe you need to work on that
you don't realize, right?
(25:44):
It's just sort of like you geta dental and you realize, oh,
you have a little cavity, well,you better deal with it, you
better do something.
You're not going to just let itgo, you're going to treat it
right.
Or your eye prescription maybeneeds to change slightly, right?
So you go ahead and change yourprescription, get new contacts
or glasses.
It's just what happens.
So why not here and why notmove forward in life with the
(26:06):
best brain that you possibly canhave?
Right?
Because should something happenlike a concussion or some brain
injury, you know going into theconcussion is so important that
you go.
You never want to have aconcussion, I don't want for
anybody, but should that happen,you want to go into it with the
best brain possible, and theonly way you can do that is you
(26:27):
keep tabs on.
If you don't measure it, youdon't know what's going on.
So I think that idea of justdoing that yearly and then
checking again the next year andeverything's the same, awesome.
You know, if things havealtered a little bit, let's fix
that and again, it's alwaysbetter to it'll only be a quick
little fix, it won't be majorright Now.
If there's something that weneed to work on, let's work on
(26:49):
it.
Let's get that sorted out andthen you're good again, let's
move forward, right?
So so that's kind of themission there and just that, the
stigma around the cognitiveaspects of it.
Most people are prettycomfortable having their
vestibular system evaluated orthe cervical, the neck and
various things, but sometimes itcomes to the cognitive people.
(27:10):
People don't sometimes reallywant to take those cognitive
tests because they don't want toknow, because I think they're
afraid that maybe the test isgoing to show that they have
some you know a cognitivedecline and they feel at this
moment still in society againthere's people who are doing
amazing work of altering thatstigma and helping people
(27:33):
realize that even with mildcognitive impairment there are
things that we can do to turnthat boat around and improve
brain health.
You know, having an evaluationthat shows that there's some
mild cognitive impairment is nota death sentence or a sentence
to alter ice home.
You know there isn't that, butwe don't want.
(27:55):
You know, if we leave itunattended, maybe it might lead
to that.
So why?
Why be risky like that?
Why not take care of it?
I personally would rather learnabout something sooner than
later, so there's still a fewthings to kind of help people in
terms of navigating that andlearning and education, and you
do just such an amazing job onyour podcast, sharing this
(28:15):
information, helping listeners,you know, really get to the
truth behind things, and so youknow, I just support you.
A thousand different ways.
Speaker 1 (28:25):
Thank you.
Speaker 2 (28:26):
And all your pursuits as well and the work that you
do in the world and in yourclinic and personally with
patients.
So but yeah, the yearly brainhealth assessment, I think is
something that should benormalized.
I'd love to see morepractitioners do it.
I think they're not sure justhow to, not not how people know
what tests to do, just how wellto structure.
So I'm working on a doablemodel that people can just
(28:47):
cookie cutter, tweak it toobviously your patient
appropriately, but somethingeasy to implement.
And there you go, there's theblueprint.
You know, go have at it andlet's get this going.
Speaker 1 (28:59):
And, like you said, I think a lot of people are.
They're okay being assessed,other things being assessed, but
as soon as you say let's assessyour brain, it's almost like
people have reminiscence of likehigh school math test.
Right, they're all of a suddenhaving like test anxiety or they
, you know, they are reminiscentof this whole grading system in
school and it's like, oh,you're gonna make me do a test,
(29:20):
and so I think that the that's alittle bit, like you said, of a
hesitancy, where people arelike I'm fine, I don't want you
to look at my brain, I don'twant to be tested, you know, and
it's.
It's like we're not.
We're not testing yourintelligence, we're just
assessing different cognitivefunctions.
It's not an intelligence test.
Speaker 2 (29:37):
Exactly, and that's a key point there.
And also I find, like somepeople like honestly, don't want
to know, they're in denial.
So there's that.
But also what I find is, ifthere are cognitive changes,
right, mild cognitive changes,so it's not like drastic, right,
sometimes after a concussionyou can have significant
cognitive changes like this,right, and it is clear, I, that
(29:59):
was a little bit my experience,I think, maybe your experience
to some degree as well, right,but the mild cognitive changes,
people start to shrink theirworld so they could operate in a
way that that they can tolerateto their brain function.
So they don't realize thattheir world is shrinking to some
degree so they could keepmanaging within that.
(30:21):
Well, because we all want to dowell, we want to feel well and
good and successful, right, it'svery important, so, so, but
they don't realize they'reshrinking their world.
And then when you expose themto some standardized cognitive
tests, and again, not not tomake them feel bad, but just to
say, hey, here's a benchmark ofreally the level you should be
functioning at, Right, andthat's where we want to get you
(30:44):
to and we can make that happen,right, if possible.
Right, so again, don't make aconversation, but again, let's
say realistically.
I think that really helps.
Sometimes people realize like,oh, wow, because they feel I'm
fine, I can drive, I can go towork, I can do this and this and
this, my life's okay, I don'tneed that right.
And it's like, well, okay,let's just kind of measure you
(31:07):
to some standards, you know, isyour world shrinking or not?
Um, Because the smaller it gets, the smaller it gets.
The smaller it gets, the lessof an existence we have and
there's so much to enjoy in thisworld and we don't want to
limit our potential, ourabilities and our experiences.
So I find also that has beenthe case for many people too,
where they're thankfulafterwards and they're like, wow
(31:30):
, I had no idea that that washappening, because I felt, you
know, you put them in a newenvironment, you put them a
little bit outside their worldand now can you navigate things
if you're not in the familiarityof your own little space.
Speaker 1 (31:47):
Yeah, right, and the other thing that I see is that
when people have had aconcussion, if their executive
functioning is affected to somedegree, part of executive
functioning is internalself-monitoring and
self-awareness, and so somepeople are not able to have that
self-awareness of when they'remaking mistakes, and so they
might actually not evenunderstand the degree to which
(32:10):
the concussion has beenaffecting them cognitively,
until somebody comes in and sayslet's just look at these
functions, let's assess them,and then maybe shine a light on
where you're struggling.
Speaker 2 (32:22):
Absolutely.
I think that's a good point andthat main times, that's what I
do.
I just shine a light on peopleas well.
They may not want to pursuethis or that if something showed
up.
Sometimes they do, sometimesthey don't, but I said, hey, at
least we have data.
And this was a case actuallywith a patient of mine.
Four years ago.
We did a little mini evaluation.
She's an equestrian athlete andleft for season, so they go up
(32:46):
north and then back, so workingtogether, and this season,
actually just a few months ago,I was like you know what?
We haven't done an assessmentfor a while.
Why don't we just run that realquick, right?
I mean, we didn't do anythingabout it before, but we gathered
some data, which is why notjust take a few minutes?
Let's just run a few tests,right?
Well, she was significantlyworse at this current moment
(33:09):
than she was four years ago andthat opened her eyes.
I was just like, oh, wow.
And I was like I have aconcussion in these last four
years.
Now, of course, she had alittle history prior to that,
but she felt she was functioningfine.
It happens, life happens.
But she's like, oh yeah, I didfill up a horse in September.
Oh wow, I didn't really thinkthat that affected me in any way
(33:33):
.
And here we are in FebruaryMarch I believe it was when we
did it.
So, again, many months afterthat incident, she got right
back on the horse and she said Ifelt a little off for a couple
of days, but whatever andcarried on.
And so, wow, now that we did ourcomparison, she was like she
just said thank God, we did thatfor you.
She goes, tom, I really didn'twant to do it, but I did it
(33:55):
because you kind of did it.
Speaker 1 (33:57):
I did it to make you happy, but now I'm glad I did it
.
Speaker 2 (33:59):
Yeah, she kind of did she kind of did I bless her,
but I'm good and grateful thatwe just did that.
Now we did some neuro rehab andcleaned that all up and a few
months later now she's left forseason again and she's doing a
whole lot better.
Speaker 1 (34:16):
Amazing.
Yeah, what a great example.
Speaker 2 (34:19):
Exactly so, even if you think it doesn't really
matter.
I think this is why it shouldjust be a part of an annual.
You don't think there's aproblem.
But hey, let's just take a look, let's document it, let's just
keep some tabs.
Same with the hormonal changes,you know.
Women should definitely bemanaging and tracking their
(34:40):
menstrual phases, evenpostmenopausal or
perimenopausals and things likethat or any type that someone
has a concussion.
I think they should just get alittle notebook out, you know,
and start writing down andtracking some of those symptoms
as well, so that a physician canmaybe then look at it and piece
it together.
Speaker 1 (34:52):
Yeah, yeah, Awesome.
Well, you have shared such awealth of information that I
think a lot of people are goingto be.
It's gonna be eye opening andfascinating for a lot of people
to be able to to listen to this.
So thank you so much for forcoming on the show.
Why don't you tell us wherepeople can find you?
Speaker 2 (35:08):
Absolutely.
You can just reach out to PalmBeach Brain Center.
I'm actually not heavily onsocial media, as I once was in
the past trying to do a littlebit of detoxing in terms of
mental health and well-being.
So you can just go to thewebsite palmbeachbraincentercom,
or the phone number and emailis there.
(35:29):
You could always reach out thatway if you have any questions.
Speaker 1 (35:32):
Wonderful, amazing.
Thank you so much, dr Tatiana.
Speaker 2 (35:35):
Thank you so much for having me on your podcast and
to share this time with yourlisteners.
I'm really appreciative andgrateful for our time together.
Thank you.
Speaker 1 (35:48):
Medical Disclaimer.
This video or podcast is forgeneral informational purposes
only and does not constitute thepractice of medicine or other
professional health careservices, including the giving
of medical advice.
No doctor-patient relationshipis formed.
The use of this information andmaterials included is at the
(36:08):
user's own risk.
The content of this video orpodcast is not intended to be a
substitute for medical advice,diagnosis or 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
medical professional for any andall health related issues.
A link to our full medicaldisclaimer is available in the
notes.
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