Dr Hart was the first doctor in Australia to be trained and registered with Dr Mark Gordon's Millennium - Traumatic Brain Injury Network.
Dr Hart has advanced diagnostic and treatment skills in identifying the underlying damage and remediating the causes of traumatic brain injury. Drugs provide poor symptom control, and usually cause more symptoms (requiring more drugs) than they treat in traumatic brain injury.
The H.A.R.T. Clinic donates its services for free to veterans who sustained a traumatic brain injury whilst in the line of duty. The only costs are for blood tests (bulk-billed) and supplements / medications (at cost).
The prevention of physical trauma to your brain is much more effective than cure. However, reducing the resulting neuro-inflammation and replacing the missing neuro-steroid hormones (made in the brain) and neuro-active steroid hormones (made outside the brain, but affecting brain health) can cause amazing changes in the brain function, and therefore the life, of people with traumatic brain injury.
Blows to the body can transmit forces into the brain and cause damage without direct head contact i.e. falls, concussive forces from explosions, shooting a gun.
Energy waves from explosions (which travel faster than sound) cause tiny bubbles, or 'microcavitations' to form, pop, and disappear so quickly that they can’t be detected by brain-imaging—but can seriously unbalance an array of cellular pathways.
Often, there is both primary and secondary injury. Primary injury occurs at the time of injury and is considered irreversible. However, complex secondary mechanisms affect the delayed progression of brain damage. One secondary process potentially promoting latent neuronal death is post-traumatic inflammation, which increases blood-brain barrier permeability, resulting in cerebral edema, intracranial pressure, and neuronal dysfunction.
The brain has the consistency of toothpaste, and is housed within a rigid bony skull. The lower surface of the skull cavity, upon which the brain sits, has many sharp ridges. The small pituitary gland sits in a bony cup underneath the brain, and is connected by a narrow stalk to the hypothalamus. The hypothalamus instructs the pituitary when and how much hormone to release. These messages are relayed by nerves and blood vessels that travel from the hypothalamus to the pituitary gland via the pituitary stalk. When the skull moves rapidly, the soft brain is stretched and compressed and dragged over these basal ridges, the pituitary stalk is stretched, and different regions within the brain are variously stretched and compressed. When nerves are stretched 5%, the cell membrane is broken, and cell contents can leak out. This will usually repair. If nerves are stretched 10%, the cytoskeleton within the nerve is damaged, leading to permanent cell dysfunction. If the nerve is stretched 20%, the cell is torn and often dies, releasing more cell contents into the fluid between the brain cells. Stretching brain blood vessels will lead to small tears and bleeding. The blood is broken down and removed, but residual iron molecules can remain. The nerve and blood vessel damage releases cell contents that the immune system, appropriately, interpretes as needing an inflammatory response to remove and heal. The iron acts as a free radical generator. The direct physical impact with the skull, or indirect forces transmitted through the body to the skull, or from concussive energy waves from a nearby explosion, cause nerve and blood vessel damage. The end result is inflammation and oxidative stress that causes more cell damage, perpetuating the process. Over time, continuing neuro-inflammation causes accumulating cell dysfunction and death, leading to many different symptoms:
- Outbursts of anger
- Mood swings
- Memory loss
- Inability to concentrate
- Learning disabilities
- Sleep deprivation
- Increased risk for heart attacks
- High blood pressure
- Loss of libido
- Menstrual irregularities
- Premature menopause
- Loss of lean body mass
- Muscular weakness
The deep inner brain structures control consciousness. You can significantly damage the outer cortical processing region without affecting the deeper regions i.e. you get significant, permanent brain injury even without loss of consciousness. So traumatic brain injury may cause minor immediate symptoms, with medical imaging of the physical structure via a CT or MRI showing normality, but over the following weeks / months the person will gradually start to show more signs of brain dysfunction as the neuro-inflammation accumulates. These symptoms include becoming tearful, angry, irritable, experiencing brain fog, poor concentration, developing headaches, confusion, blurred vision, memory loss, nausea, personality changes, temper problems, low mood and difficulty expressing emotions and understanding others. This means that the brain cells are not working correctly. This may be detectable by advanced imaging modalities such as PET scan, SPECT scan or quantifiable EEG. The end result of multiple small injuries or one large insult is the ‘walkie-talkie’ – a brain-injured person who can walk and talk but whose brain function is permanently impaired.
Studies demonstrate that hypopituitarism - where the pituitary gland fails to produce normal hormone levels - is relatively common following traumatic brain injury. Sometimes, however, hypopituitarism is not diagnosed for over 20 years post-injury.
Many traumatic brain injury patients have a growth hormone deficiency, exhibiting greater deficits in attention, executive functioning, memory, and emotion than patients with normal levels. Growth hormone binds to brain receptors that are especially dense in regions responsible for learning and memory - perhaps explaining why declining levels are associated with poorer cognition.
Critically, growth hormone increases survival of damaged nerve cells and promotes nerve tissue regeneration. It increases body-wide receptors for other hormones, helping overcome the effects of their deficiencies.
Growth hormone levels fall with age and are especially low in Alzheimer’s disease, the symptoms of which often mirror traumatic brain injury symptoms.
Other hormones are also closely related to cognitive stability. These hormones can function directly as neurotransmitters in the central nervous system. At least 16% of long-term traumatic brain injury survivors develop hypogonadism, meaning that male testes or female ovaries produce insufficient sex hormone levels. These deficiencies are not identified or treated in most individuals.
Sex-hormone insufficiency doesn’t simply relate to sexual desire. Whether due to traumatic brain injury or aging, low sex-hormone levels are increasingly linked to dementia. Age-related sex-hormone declines significantly contribute to Alzheimer’s risk. In a study involving over 500 aging men and women, optimum testosterone levels were linked with better cognitive performance. Other studies concluded that testosterone levels are positively associated with multiple aspects of cognition.
Recovery of patients with traumatic brain injury is greater in those with higher testosterone.
Dr Hart tests the main neuro-active steroids and replaces them to normal physiological levels if they are low, as well as implementing multiple anti-inflammatory measures to minimise the chronic neuro-inflammation that is present.
Quantifiable electroencephalography maps the brain's electrical activity, and a course of 20 - 40 thirty minute training sessions has been show to significantly improve the mood, memory and attention of traumatic brain injury sufferers.
Think of your brain before doing activities that put it at risk. Children must wear protective headgear while playing sports that involve any element of physical contact including football and hockey. It is essential to minimise or disallow them to head soccer balls, with the encouragement geared towards non-contact sports. It is also imperative to ensure seat-belts are worn in cars, that age-appropriate restraints are used when transporting children in a vehicle and that helmets are always worn when riding a bike. Other key ways to minimise physical trauma to the brain and body include not riding motorcycles, obeying road rules including staying aware of traffic around you and using a ladder to reach something high instead of hastily grabbing a chair or standing on a countertop. Just as important is ensuring infants are protected from physical trauma so never shake a baby or toddler, always fasten the safety belt on a high chair and a changing table and use a safety gate to protect toddlers from falling down stairs.
THE HART CLINIC