Post Concussion Syndrome, Co-Management, Treatments & More

Post Concussion Syndrome, Co-Management, Treatments & More

Post Concussion Syndrome: Concussion Rescue with Dr. Kabran Chapek and Upper Cervical Chiropractic Care.

Upper Cervical Chiropractic Research Show #017b – Chiropractic Deep Dive Podcast – The Role of the Cervical Spine in Post-Concussion Syndrome by Cameron M. Marshall, Howard Vernon, John. J. Leddy and Bradley A. Baldwin published in The Physician and Sports Medicine

Post Concussion Syndrome is common among Concussion sufferers, but most people don’t get the true help they need. Dr. Chapek and I discuss the needs of patients with Post Concussion Syndrome and how we co-manage patients. I have the highest respect for Dr. Chapek and he is truly one of the nicest people I know. I hope you enjoy.

– To Your Health

Dr. Kevin Leach

Dr. Leach:  So again this episode is kind of in conjunction with 17 where we already talk about the role of the cervical spine in post-concussion syndrome but I wanted to do this with Dr. Chapek because we worked together with different patients and he works on the brain component obviously with the concussion rescue and working with the brain healing so I wanted to get his take on this. Hi there. I’m Dr. Kevin Leach here with The Chiropractic Deep Dive Podcast bringing you the most important research and information on conservative primary spine care, upper cervical chiropractic care, and traditional chiropractic care. These research reviews, interviews and episodes are made for you whether you’re a medical doctor patient or concerned family member or friend. The goal of these shows is to bring awareness of the importance of taking care of our spine and the impact it has on our health and the hundreds of different health conditions it could cause without us realizing it. I’m really trying to bring value with these so I’d appreciate commenting on the videos, hitting the like button, and sharing them with as many people as you can. You never know who might need to see it and consider subscribing to the channel so you can see all the other episodes and videos coming out. Thank you so so much. I truly appreciate your support. Now onto the show. Well welcome back everyone to The Upper Cervical Chiropractic Research Show, this is episode 17B. I am Dr. Kevin Leach and I’m here with a good friend and colleague Dr. Kabran Chapek and Dr. Chapek is a staff physician at the Amen Clinics. He is a naturopathic physician with a primary focus on mental health and brain health. His prior psychiatric experience was in working at a treatment center with an integrative team and he is also the author of “Concussion Rescue” and we’ve got right here. We’ll probably get into that a little bit. We’ll put a link in the description below for anybody who’s interested. It’s highly recommended and very very informative. How are you this morning doc? 

Dr. Chapek:  Great to see you Kevin. I’m doing good. Pleasure to talk with you.

Dr. Leach:  Yeah. Awesome. Awesome. Awesome. And so again this episode is kind of in conjunction with 17 where we already talk about the role of the cervical spine in post-concussion syndrome but I wanted to do this with Dr. Chapek because we’ve worked together with different patients and he works on the brain component obviously with the “Concussion Rescue” and working with the brain healing so I wanted to get his take on this. So if you want to check out the episode and how the next related to post-concussion syndrome that’s episode 17. This is episode 17B but Dr. Chapek I guess give me just a brief background about how you got into focusing on the brain and you wrote a book on concussion. How did you get into doing this? 

Dr. Chapek:  Kevin, I think it started working at that treatment center. I had all this experience working with patients with mental health issues for six years. Patients are struggling with severe depression, they’re suicidal, they’ve just come out of the hospital and then I started working at Amen Clinics the past eight years and part of our work there is doing brain imaging. And when you look at the brain we would have patients come in who had had chronic depression for many years. We’re sort of a clinic of last resort often and so why aren’t they getting better then we image their brain and we can see there’s been this clear brain injury and they didn’t know about it. And so we picked this up in a number of patients and I found and realized that brain injuries are a major cause of mental illness and no one has realized it. So that was for me the “aha moment” and I had to know more. Had to learn more. And then people who have had brain injuries have not gotten better. That’s why I wrote the book.

Dr. Leach:  Yeah, so you were with the clinic that was focusing on the treatment center

for the suicide, for depression, anxiety that kind of stuff and then you just started to realize hey there’s more, there’s more things going on with the brain. How do we heal the brain. And so was that during your time there you did that or did you leave to start pursuing that because that kind of wasn’t an option where you were? 

Dr. Chapek:  Yes. I left and when I found out that we could do brain imaging for people and the way that we’re doing it at Amen Clinics is very unique, I just had to check it out. And so I left and now thinking back to all the patients that I could have helped more if I would have known what was going on with their brain and how it’s being missed all the time. And mental psychiatry and mental health in general there’s not a lot of biochemical or physiological. There’s no testing. It’s just talking prescribing. You’re depressed here’s an antidepressant. It’s terrible.

Dr. Leach:  Yeah. 

Dr. Chapek:  There’s more going on. 

Dr. Leach:  Yeah. So how do patients find you because I have a very strong feeling that even the Amen Clinics and yourself specifically, just like with upper cervical chiropractic, it’s not like the medical profession just knows about us and like oh you need to go here. People have to find us through circuitous routes, so  how do patients find you typically? How do they get to you? 

Dr. Leah:  Referrals from other providers like yourself or internet searches. Dr. Amen is a celebrity at this point. He’s a very famous psychiatrist and has been on PBS. So he’s written many many books on the brain and how we should be using brain imaging to help people. And brilliant books Change Your Brain Change Your Life was the first and I think that’s how many people find us is from his PBS and his talks and going on tv and stuff.

Dr. Leach:   Yeah. For sure. I’m hoping that I’m doing these podcasts to obviously create awareness and get people that need our help. If one of those patients has been searching and they’re dealing with this and they’ve tried the traditional medical route and they’re still kind of suffering what would you say to that patient just to kind of say hey listen this is a possibility this is how this could potentially help you? 

Dr. Chapek:  Right. So brain imaging I think about it for two reasons. First is that it’s diagnostic. It’s helpful to figure out what’s going on with someone and this kind of imaging is looking at blood flow. What’s working well. What’s not working well. The major brain regions. It doesn’t tell us everything but it does tell us some really important pieces. It also is useful therapeutically. So if patients have struggled with brain injury, they know they’ve had a brain injury, or they have some other mental or brain problem and it hasn’t gotten better family members may not understand what’s going on with them they may not understand what’s going on with them and to see that injury is very therapeutic and encouraging/motivating. People have used substances. The treatment center I worked at a lot of substance abuse, a lot of denial around alcohol, or cannabis or other various drugs. Seeing your brain full of holes is how it looks on the scan it’s just – there’s no denying that. Just breaks through denial in seconds what previously took months and months and weeks. 

Dr. Leach:  Yeah it makes me think of when Dr. Evans and I did the other podcast on the role of the cervical spine and post concussion syndrome and they talk about the medical field talking about a psychological reason or a psychological and or physiological component. It’s almost like it shows them a reason that hey there is something that says something’s wrong not just oh it’s in your head or go see a psychologist or something like that. It’s validating that they’re not just going crazy or they’re not just pushed to the side and saying oh it’s in your head and there’s no answers. 

Dr. Chapek:  Yeah. If the brain isn’t working well how are you supposed to feel good and happy and so seeing that is just so affirming. So there’s that and the diagnostic first so put the two together it’s a very powerful tool. And then the next key is really understanding what’s going on but then putting together a plan and over the past you know six to eight years I’ve done that because I’m a naturopathic physician. I want to treat all of the causes contributing factors and when it comes to the brain as you know well it’s not just one thing that helps cure someone. It’s not just take this supplement or medication or just do this treatment, it is really putting all the pieces together. 

Dr. Leach:  When I did the last episode with Dr. Evans over his years of treating post-concussion syndrome he’s talked about neurofeedback. He’s talked about obviously the upper cervical spine. What would you say are kind of the major treatment approaches that are kind of the big guns that you’ve seen that probably pretty much anybody with a brain injury probably needs and could benefit from? I know everyone’s like you said everyone’s specific and needs certain things and diagnostics are important but what would you say are some of the big things that you’ve seen? 

Dr. Chapek:  Yeah. I’m glad you asked that. That’s what I really wanted to share with people because this is really important, the upper cervical work that you’re doing is key. It is actually one of the first things I think of to rule out, assess and rule this out. I refer to you and other upper cervical chiropractors across the country. If they can’t come see you and say Dr. Leach is one of the best in the area, best in the business, why not see him but some people are in Michigan. 

Dr. Leach:  Of course.  

Dr. Chapek:  And you can’t supplement away upper cervical problems. Hyperbaric oxygen will not heal upper cervical impingement of cerebral spinal fluid flow and blood flow. It’s just you have to do this or else nothing else will really.. so actually in the past few weeks I had a couple of patients call in and do a pre-consult before getting the evaluation just to see “is this right for me?” I’ve been having these severe headaches and migraines every single day for years. They’re in this pain and nothing has worked. They’ve seen neurologists everything. I say before even coming to see us I want you to go have this checked out. Go to one of the best upper cervical chiropractors in your area and just rule this out, this could be what’s going on for you before we’re investing in all of this. So I really put that as one of the key pieces and I was missing it to be honest with you Dr. Leach. I was missing this for years before. 

Dr. Leach:  A lot of people do and that’s why I’m trying to do this podcast and trying to get the information out because unfortunately it’s just still the idea and I think it’s just kind of the way that the medical doctors are kind of trained. They’re not really finding a nuance misalignment in the upper neck. For them it is just like “ah” because they’re looking at tumors and infections and fractures and dislocations and things that are severe. They think something like that is completely insignificant and so.. 

Dr. Chapek:  We have our place for that severe but then if people aren’t getting better.

Dr. Leach:  Absolutely. 

Dr. Chapek:  Let’s look further. So upper cervical is one of the first things, and I talked about that in the book, is the structural piece and naturopathic medicine. We have correct structural integrity as a foundational piece of helping people and for some reason I missed it for the first few years. Like hey! Why was I thinking about that with the brain but any case I know now. There is our diet. So our brain uses 20% to 30% of calories in our diet, a quarter of our plate of what we eat goes to our brain. It’s so hungry. It’s 2% of our body weight. It’s amazing and the article you sent me, we know that after an injury it needs more fuel. In the healing state of post-concussion state it actually has a higher need but yet it has less ability to utilize glucose, glucose. Transporters are damaged, there’s less blood flow. You’ve kind of burned out your ATP and mitochondria because of this ion exchange and so there’s actually this energy deficit. So you’re in this very difficult state and so I’ll often recommend a ketogenic diet to bypass those glucose transporters to use ketones for fuel to help the brain. That’s the highest recommendations, not for everyone ketogenic diet but diet in general is really key after a brain injury. It’s hard to heal if your diet is poor. Sleep, everyone has to have solid sleep to heal. It’s a no-brainer in some ways but it’s really true and 50% to 70% of people after a brain injury will have sleep problems. It’ll either be daily – during the day really sedated or at night just can’t sleep. So getting that corrected. Some of the therapies beyond that are supplements. So certain key nutrients and supplements to help the brain sort of quench that inflammation, that oxidative damage and inflammation that has been smoldering like a fire that hasn’t been put out continues to go on for months and sometimes years in the brain. There’s key nutrients there. 

Dr. Leach:  We can definitely say years. I did a SPECT scan with you and we saw my brain and I’ve had a history of playing football and there was some evidence. 

Dr. Chapek:  That’s exactly right until it’s corrected. So we should rescan you and see where we’re at.

Dr. Leach:  Yeah. 

Dr. Chapek:  But in any case it can continue. If I had only one treatment to give people to help them feel better and improve it would be hyperbaric oxygen. There was one only one thing. Now I don’t think hyperbaric alone. I’ve seen this many times where people get excited and they’ll do hyperbaric and their symptoms will improve. They’ll do maybe even 20 to 40 sessions and then they will go back and regress after stopping. Then we’ll come to find out they’re very deficient in iron, zinc, B12, they have a lot of inflammation still, or they have hormonal deficiencies. 25% to 50% of people with a history of brain injury have pituitary damage. Master hormone gland. If it’s not working or it’s taken out you may have for men low testosterone, for women low estrogen/progesterone which can affect the menstrual cycle. There can be low growth hormone which will cause many of these post-concussion symptoms – fatigue and so that’s another key piece is ruling out hormonal deficiencies and nutrient deficiencies. So those are kind of the big ones.

Dr. Leach:  Great. Awesome. Tell us a little bit and again I’ll put the link in the description below but tell us a little bit about the book. When was your “aha” moment like you know what I need to write a book? This is going to benefit how many thousands and thousands of people for years to come. So give us a little background on that. 

Dr. Chapek:  So I was giving a lecture at a brain injury conference down in Portland and it was all about natural treatments for healing concussions. Afterwards many people came up to me and said, “Oh my gosh I didn’t know there were natural treatments.” There’s good research on many nutrients for healing the brain and they weren’t aware so that was one. And then many people who have had concussions and brain injuries have often exhausted their resources. They can’t work, they’re on disability, they don’t have enough money to come and see us at Amen Clinics or to get more care. That was my “aha” moment. I turned my lecture from that day into a book.

Dr. Leach:  Beautiful.

Dr. Chapek:  It was the format for that. It took several years. Learning and researching. I added more pieces such as a structural piece and more about hyperbaric. The field continues to evolve and we learn more. As I have been going to my career it’s like okay it becomes more nuanced and specific and we’re always trying to make things easier so people can do it and be more compliant. But the hard part is it’s not one thing, it’s sort of a whole program that tends to help and getting the book and doing most of it you can often get a lot better. And so I’ve been seeing patients who have started things from in the book… 

Dr. Leach:  Great.

Dr. Chapek:  ..and they’re getting better. And then I see them and then we can sort of just go to the next level. 

Dr. Leach:  Nice. Awesome. Cool, is there anything else you kind of want to either tell either patients that might be watching this or even other providers who maybe don’t really co-manage concussion or even post-concussion patients? I’m trying to get the word out to medical doctors and providers all the time that we can help people with this and that it’s not just a psychological thing. Especially the ones that are the 10% to 15% of the concussion cases that become post-concussion cases. So do you have anything else that you’d want them to know or?

Dr. Chapek:  Absolutely. So one thing is we tend to minimize the effect of brain injury and concussions and that you don’t necessarily have to be knocked out to have had a concussion. As you know you played football and hadn’t had a brain injury. We know that just playing football sub concussive hits to the brain can damage it. It’s terrible. 

Dr. Leach:  With the CTE and the NFL. That’s one of the reasons why that I’ve looked into my brain more because I played football for so many years. I never got knocked out but I’ve had my bell rung several times. I played quarterback. I played safety. How many hits did I take and I’m thinking I’ve already had some brain fog and sleep issues and things in the past and I’m just thinking what’s going on with my brain. I need to look at my brain. 

Dr. Chapek:  Yes, because half of us will have dementia by age 85. We all want our brains to be healthy.  You’ve invested so much in this. This is who we are. So this is why I’m so passionate about this. We want to think about our brain and protect our brain. Think about the fact that it doesn’t have to be knocked unconscious. We tend to minimize and we ask patients 10 times when they come to see us, are you sure you’ve never had a brain injury? Never fallen out of a tree? Had a bike accident? Car accidents are very common but may not only have whiplash. “Oh I was fine I didn’t hit my head,” but whiplash is enough to jostle your brain. 

Dr. Leach:  That’s a huge point and back when I played football a concussion was you got knocked out. You lost consciousness. It was never like you could have a concussion. And I think that’s fairly recent isn’t it about finding out that you can have a concussion and not actually lose consciousness? 

Dr. Chapek:  Yes. Absolutely oh get back in there you’re fine. No. This second impact syndrome is devastating. 

Dr. Leach:  Yeah. 

Dr. Chapek:  People get hit again and so we ask people 10 times and think back over your history. So have I ever? Was I worse after? Did I get diagnosed with ADD after I started? I just got to tell you this one story. 

Dr. Leach:  Of course.

Dr. Chapek:  We’ll call him Jeremy. He came to see me when he was 21. He was this jazz drummer, super wiry, sort of active kid but he had been depressed, suicidally depressed, since he was about 14 years old. And he had tried every class of medications. He had tried many different types of therapy. He was referred by a great therapist and the only thing that helped him was smoking pot. He could drink. He was in a terrible relationship, a very toxic type relationship. When we scanned his brain it was clear he had damage to the left frontal and left temporal lobes. And I said Jeremy you didn’t list any head injury on your history and your intake. When did you have a head injury? And he said I never had a head injury. What are you talking about? Okay and went through the list. Have you ever fallen out of a tree? Had a car accident? His mom said remember you started playing football contact sports when you’re about 13 years old. And he was this little wiry kid matched against the coach’s son, super big kid already, and just get knocked around. He’d have headaches and stuff after practices but they thought it was fine. And that next year he was diagnosed with ADD. He also started having depression and it progressed to having suicidal thoughts every day. So we gave him treatment – supplements, change in diet, you have to stop smoking pot. And over the next several months his suicidal thoughts went away. His mood improved. He broke up with the toxic girlfriend. He left his band that wasn’t going anywhere. He went to music school and now he’s graduating from the Berkeley School of Music. 

Dr. Leach:  Nice. 

Dr. Chapek:  I think he just graduated this past spring. 

Dr. Leach:  Cool. 

Dr. Chapek:  Doing well. 

Dr. Leach:  That’s great. I love it. 

Dr. Chapek:  Think back – do I have any problems? What was going on at the time? Just knowing that brain injuries, you don’t have to have a scan always it’s that history that’s often as important as imaging. 

Dr. Leach:  Yeah. Absolutely. I know in consultations one of the things that always pops into my head whenever somebody indicates anxiety, depression, anything like that I always ask them is this because of something that’s going on in your life or is this something that you’re not really sure why it’s happening? And when people say, “Oh my mom just died.” It’s like okay. Well you’re not really depressed, you’re grieving. Things are tough right now, that’s fairly understandable but it’s the ones that say “I’ve just always kind of been like this” or “oh it’s been for five years. I’m just always kind of this way and I don’t really know why.” My mind obviously goes to the misalignment in the upper cervical spine but obviously it could clearly go to the brain injury as well. And so I think that’s important for people to understand if you’re not really sure why you’re having this mental stuff going on you probably had a brain injury, even if you don’t remember it. People come in all the time and I show them their x-rays and I’m like look right here this is damaged and the rest of your spine is fine. This doesn’t just happen because of nothing so something happened. And they’re like “Oh I don’t remember.” It’s okay. It doesn’t matter. This is what we need to do. We need to fix it. We need to treat it, right?

Dr. Chapek:  Yes. And do you find that half the time you see them a few weeks later and “Oh yeah I forgot to tell you I fell out of a two-story window.” 

Dr. Leach:  Yeah. Maybe even the next visit. A lot of times just the next visit oh yeah I remember blah blah blah. 

Dr. Chapek:  We blocked it out. 

Dr. Leach:  Yeah. Especially when we’re young and and dumb. 

Dr. Chapek:  Right. 

Dr. Leach:  So many things when we’re younger. We are just young and we bounce back. Oh that was fine. Oh I’m fine. I’m cool. Do I still look cool? 

Dr. Chapek:  That’s what matters. The other thing is it’s never too late to try and help heal someone from injury. At least to try. We may not be able to get you back to pre-level of functioning. We’ve seen this. We did some studies at Amen Clinics with football players. We took 30 of these NFL guys. They had depression, they were foggy, they had memory problems, they were angry and we put them on a program and had before and after scans. There was improvement in cognition. And really it was supplements, diet, exercise, treating if they were heavy/overweight weight loss, treating sleep apnea and that was it. And 70% of them improved. They hadn’t played for 20 years. So it’s not too late and of course you don’t have to have played football. You can have a car accident. 

Dr. Leach:  Even other sports. Soccer. Anytime you’re even hitting your head. Things like that. 

Dr. Chapek:  Soccer. Think about misalignment. I’m just thinking about it. 

Dr. Leach:  I always think about it. I’m not a huge soccer fan but when the world cup comes on. When it’s really really good sport. I love it. I watch it. So I’ll make a point to watch it. And the goalie does his goalie kick from the goal to pass the half court line or whatever it’s called and these guys are heading in. I can’t imagine what their necks look like when they’re hitting this huge ball that’s flying, anyway. It’s crazy. 

Dr. Chapek:  I played soccer as well. I need to get in and have my spine checked. I just realized that. 

Dr. Leach:  You’re a busy man. You’re helping lots of people. Okay cool. So where for you and anyone in just the greater Seattle area – where can people find you? Where are the resources? How do people find you? 

Dr. Chapek:  Yeah. So we’ve got a clinic in Bellevue, Washington just on the east side of Seattle. So people come from all over the northwest to come see us. And basically if you wanted to come for an evaluation it’s a couple day process. We do virtual meetings. We scan the brain. We have a meeting to figure out and create a plan. That’s really what I do so you can just google Amen Clinics Northwest. Phone number is 425-455-7500. 

Dr. Leach:  I’ll put all this information in the description below too as well but in case there are any other resources or things for people to know about. 

Dr. Chapek:  That’s great. Thank you. 

Dr. Leach:  Of course. 

Dr. Chapek:  The book on Amazon. There’s a course that I did based on the book “Concussion Rescue,” that’s it. MindWorks, you can google that and it’s at Amen Clinics. You can listen to the book. Often people with having had a brain injury have difficulty reading and so you just listen to it on audible. That’s a really good place to start I would say. 

Dr. Leach:  Cool. Great. Awesome. I’m really glad we did this. Hopefully a lot of people that have been suffering with just even concussion post-concussion syndrome and even if they’re not diagnosed with post-concussion syndrome specifically if they’re having depression anxiety things like that they can hopefully find and get some help from this and get some good information from this. 

Dr. Chapek:  Absolutely. Thanks for doing this. 

Dr. Leach:  I’m really glad we did this.

Dr. Chapek:  Honor to be here. 

Dr. Leach:  Yeah. Absolutely. Any last thoughts or anything for anybody watching this about just anything that they could know? Any last thoughts here?

Dr. Chapek:  It’s all about thinking outside the box. Trying new things. Being open to new ideas and that it’s never too late to heal your brain from injury. It’s a major cause of brain problems/ mental problems. We are our brain in many ways and so having a healthy brain is going to improve and optimize your quality of life so much. 

Dr. Leach:  Absolutely. 

Dr. Chapek:  Don’t wait.

Dr. Leach:  Don’t wait. Yeah. Oh that’s just such a good point people. Don’t wait, literally do it now. Go in the description and call now. If you don’t do it now, tomorrow you can be like “Oh yeah I listen to that thing” and then the next day it’s going to be even further back in the rear-view mirror. Just do it now. Get some information. Get some help. It’s going to help you. It’s going to help your family. It’s going to help everybody around you. Super important. 

Dr. Chapek:  Well said. 

Dr. Leach: Cool. Yeah. Absolutely. Awesome doc thank you so much. I appreciate you. Again all the links and of everything I’ll put in the description below. I’ll share the link with you. You can share it with your community as well and we’ll try to keep getting the word out there. 

Dr. Chapek:  Thank you. 

Dr. Leach:  Awesome. Thank you. Okay that’s it for this episode. So what did you learn that fascinated you or surprised you about their research today? Join or start the conversation in the comments below. Hey thanks so much for watching. To watch more of our research shows click or tap the screen right there. To subscribe to the channel click or tap the screen right there. Until next time, I’m Dr. Kevin Leach with The Upper Cervical Chiropractic Research Show bringing awareness to conservative primary spine care, upper cervical chiropractic care, and traditional chiropractic. Until next time, take care and take care of your spine. It’s the only one you’ll ever have.

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