Traumatic Brain Injury (TBI)

TBI has been in the news a lot lately and since it is Super Bowl Sunday (go Niners!), I thought I’d touch on this subject today!

 So, what is TBI? Basically, it’s a brain injury. Injuries that can be caused by hard blows to the head or body. Serious TBI can cause bruising, bleeding, or tearing. Most TBIs happen as a result of sports injuries, car accidents, or other physical activities (like you’ve heard about happening to our military troops). People often wonder how this happens; the physical injury can lead to a back and forth motion of the brain inside of the skull. The back and forth motion leads to the injury of the brain. That’s known as the primary injury. Secondary injury results when the brain becomes so injured that it leads to swelling. The swelling can lead the brain to become grow larger than the space inside the skull, which can lead to stopping oxygen flow to the brain. This secondary injury leads to more serious and potentially permanent damage.

What are the symptoms of TBI? According to the Mayo Clinic, symptoms can range from mild to severe, including:

• Mild: person is awake; eyes open. Symptoms can include confusion, disorientation, memory loss, headache, and brief loss of consciousness.
• Moderate: person is lethargic; eyes open to stimulation. Loss of consciousness lasting 20 minutes to 6 hours. Some brain swelling or bleeding causing sleepiness, but still arousable.
• Severe: person is unconscious; eyes do not open, even with stimulation. Loss of consciousness lasting more than 6 hours.

So how does TBI differ from concussions and chronic traumatic encephalopathy (CTE)?? Concussions, contusions, and hematomas for example, all fall within the TBI definition. They are different types of traumatic brain injuries. Most recently, you may have heard a lot about CTE, especially if you know about football players like Aaron Hernandez. CTE is very much an area of active research, so we still don’t know a lot about it. According to researchers at Boston University, CTE is a progressive disease where the function of the brain becomes progressively worse over time. This has been identified in individuals, especially boxers, as early as the 1920s, but has gained the interest of the public in the context of football. Most common, CTE is found in people with a history of repetitive TBI (often athletes), including symptomatic concussions as well as concussions from hits to the head that do not cause symptoms. It’s important to note that CTE is not limited to current professional athletes; it has also been found in athletes who did not play sports after high school or college. The changes in the brain can begin months, years, or even decades after the last brain trauma or end of any exposure to sports.

How would you know if you have TBI or CTE? Also, can I get CTE after a single TBI?? After an injury to the head or body (e.g., if involved in an accident or sports injury such as a tackle in football for example), if a person experiences any of the symptoms listed above, the person may have a TBI. CTE usually involves chronic, repetitive injury, and according to scientists, “at this time the number or type of hits to the head needed to trigger degenerative changes of the brain is unknown. In addition, it is likely that other factors, such as genetics, may play a role in the development of CTE, as not everyone with a history of repeated brain trauma develops this disease. However, these other factors are not yet understood.”

For more information, consider the resources provided below:

https://www.bu.edu/cte/about/frequently-asked-questions/

https://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/symptoms-causes/syc-20378557

https://www.cdc.gov/traumaticbraininjury/index.html

Three years ago, I experienced tiredness like never before. There were days where I could barely manage to get off the couch on the weekend, because the fatigue was simply so overwhelming. I finally decided to go to the doctor and requested they run some labs. Because my fatigue was so significant, they also ran a vitamin and hormone panel. The results were astounding. While the Institute of Medicine recommends that Vitamin D levels fall between 20-40 ng/dL, mine was 12 ng/dL. TWELVE! One week of intensive vitamin D supplementation and I was back to feeling like myself again.

I’m not certain that the Vitamin D supplementation alone was responsible for my fatigue. I was a mom of two under 7, it was a very busy/stressful time for me on the faculty, etc etc. It could have very well been a placebo effect (ie, “a beneficial effect produced by a placebo drug or treatment, which cannot be attributed to the properties of the placebo itself, and must therefore be due to the patient’s belief in that treatment”), given that a big study in the New England Journal of Medicine (one of the premier journals in academic medicine) published a study indicating that a more appropriate cutoff might be closer to 12.5 mg/DL, based on the analysis of blood samples from hundreds of thousands of individuals. 

So why is it possible that my potential vitamin D deficiency may have led to such extreme tiredness??

Well, Vitamin D is not frequently found many of the foods humans consume. Furthermore, we typically get Vitamin D from the SUN! So, if you don’t consume many of the foods that contain vitamin D, or consume them in quantities large enough to provide the Vitamin D levels your body needs, AND/OR you don’t get a lot of sun exposure, then it possible you could be vitamin D deficient. Since I wasn’t getting Vitamin in my food and getting very little sun exposure, it’s likely that the combination of those two things led to my deficiency.

So, what are some of the foods that contain Vitamin D naturally??

• Fatty fish, like tuna, mackerel, and salmon
• Foods fortified with vitamin D, like some dairy products, orange juice, soy milk, and cereals
• Beef liver
• Cheese
• Egg yolks

At that time in my life, I didn’t eat eggs, I didn’t drink milk at all, I rarely ate salmon or tuna, definitely did NOT eat beef liver (although no judgement of those who do!!), and didn’t consume orange juice fortified with Vitamin D. Furthermore, this time of year three years ago also meant that I had been wearing lots of layers, and likely hadn’t spent much time outside because it’s winter. Also, it’s flu season and hello! Best to stay indoors. 😀 All that to say, I now consume a lot more salmon, and definitely take the Vitamin D dosage my physician prescribed.

Studies suggest that people most at risk for Vitamin D include:

• people with anorexia nervosa
• people who have had gastric bypass surgeries
• people who suffer from other malabsorption syndromes like celiac sprue
• people who have dark skin
• people who wear total skin covering (and therefore absorb less sunlight even when they are outdoors for extended periods of time) 

 What are some of the symptoms of Vitamin D deficiency??

Some people have no symptoms at all. Others experience tiredness or fatique (like I did), others experience muscle aches. Extreme and prolonged (that lasts a long time) vitamin D deficiency can lead to brittle or misshapen bones.

If you have vitamin D deficiency, and have questions about what to do or what to take, definitely consult with your healthcare provider about an appropriate dosage if you’re not already getting it in your diet or you’re not in the sun a lot. Oh, but don’t forget, if you’re in the sun, WEAR SUNSCREEN because, hello, skin cancer. 😦

For more information, visit the following sites which include significant information about this topic!

https://www.health.harvard.edu/blog/vitamin-d-whats-right-level-2016121910893

https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

https://ods.od.nih.gov/factsheets/VitaminD-Consumer/

JoAnn E. Manson, M.D., Dr.P.H., Patsy M. Brannon, Ph.D., R.D., Clifford J. Rosen, M.D., and Christine L. Taylor, Ph.D. Vitamin D Deficiency — Is There Really a Pandemic? New England Journal of Medicine

Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism 2011

Heaney RP, Holick MF. Why the IOM recommendations for vitamin D are deficient. Journal of Bone and Mineral Research

Bouillon R, Van Schoor NM, Gielen E, et al. Optimal vitamin D status: A critical analysis on the basis of evidence-based medicine. Journal of Clinical Endocrinology & Metabolism.

Cauley JA, Greendale GA, Ruppert K, Lian Y, Randolph JF Jr, Lo JC, Burnett-Bowie SA, Finkelstein JS. Serum 25 hydroxyvitamin D, bone mineral density and fracture risk across the menopause. Journal of Clinical Endocrinology & Metabolism, May 2015.

Another ‘Science Says’ Sunday is here and this one came HIGHLY requested, so here’s some info about the Human Papillomavirus (HPV) and the HPV vaccine you will want to read!
First, let’s start with what HPV is and what it does:

What: HPV is one of THE most common sexually transmitted infections in humans. Since there are often no symptoms, it’s difficult to know whether the person is infected or not. A person can be infected with the virus for years and not have symptoms until years later. There are different types of HPV (just like the different strains of the flu virus we talked about last week, remember??), and the different types can result in different outcomes (see the What does HPV do? below).

Who, What, and When: It can be transmitted during any sexual encounter that involves vaginal, anal, or oral sex with someone who has the virus. Anyone can get it, even if the person has only had sex with one single person.

What does HPV do? In most people, the virus ‘goes away’ on its own, much like the body would clear a cold virus. However, in some cases, the virus remains ‘hidden’ or ‘sleeping’ in the body. When that happens, it can lead to things like genital warts, cervical cancer, or mouth/throat cancer, specifically cancer in the back of the throat, including the base of the tongue and tonsils. It can also cause other cancers like cancer of the vulva, vagina, penis, or anus. The strains that cause cervical cancer are not the same as the ones that cause genital warts.

What can you do to prevent infection?? I know that vaccines can be scary and there was A LOT of interest about the HPV vaccine, specifically when I asked about topics to cover for this series. I totally get it. This vaccine was not around when people my age (late 30s-40s) were growing up, and much like any new thing, there is a lot of talk about it. Peer-reviewed studies (those that have super strict guidelines for assessing how valid a study is and who funded it and whether the results can be generalized to all populations affected, for example), show that the vaccine is SAFE and helps PREVENT the diseases caused by HPV infection.

Who should get the vaccine and when: Current guidelines recommend that the vaccine for those who are ages 11 or 12 (or you can start at 9 years old) for both boys and girls. Adults aged 27-45 who have not been vaccinated can speak with their healthcare provider about their risk for new infections and consideration about whether or not to get the HPV vaccine. Scientific evidence does suggest that the HPV vaccine provides less benefit when people have a higher likelihood of having been already exposed to HPV. People used to think that HPV only lead to cervical cancer and if cervical cancer is a woman’s disease, then why do boys need the vaccine too. Here’s where we get into what ‘herd immunity’ is and WHY vaccines are SO IMPORTANT for the general population. The ONLY way to fully eradicate (get rid of complete) a disease, is to have everyone – or as close to it – free of disease. So herd immunity works by making sure that a large enough proportion of the population is vaccinated so that the majority can protect the few people who can’t be vaccinated (like babies, older individuals who are sick, people with cancer, people getting chemotherapy, etc). So, in order to prevent cancer and all the other diseases caused by HPV, we need to get the HPV vaccine and both boys and girls need to get it before the first time they have sex. It doesn’t mean that getting the HPV vaccine will make them ready to have sex (especially at 9-11 years of age) it just means they will be protected when they do, even if the first time isn’t until they are 30. 🙂

HPV vaccine risks: This is a point of contention for many and there is so much mis-information about this out there. Here is what we know: We have now had data on the vaccine that spans 12 years. In that time, clinical trials, use by many in the general community, reports to the Food and Drug Administration (FDA) all agree that the vaccine is SAFE TO USE with MINIMAL risks. Overwhelming data suggests that the most frequent side effects include dizziness after getting the vaccine and something called syncope (fainting), which sometimes happen to people generally when getting any shot, the HPV shot included. While blogs and the anti-vax community has stated that the HPV vaccine leads to adverse effects such as death, there is no evidence to suggest that the HPV vaccine has been directly responsible (ie, no evidence to suggest HPV is causal for death as an outcome) for any deaths in individuals who have gotten the vaccine to date.
This summary comes from evidence provided by the Centers for Disease Control (CDC) and highly reviewed, scientifically regarded studies published in peer-reviewed journals with no conflicts to declare.

For more information and to peruse the sources for today’s post, please visit:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6511986/#__ffn_sectitle
https://www.ncbi.nlm.nih.gov/pubmed/26908690
https://www.cdc.gov/hpv/parents/vaccinesafety.html
https://www.cdc.gov/std/hpv/stdfact-hpv.htm