Peak Medicine

David Musnick, MD

Author: David Musnick MD

Integrative Concussion TBI Treatment

At Peak Medicine clinic in Bellevue WA. I have developed and treat with an Integrative Functional Medicine approach to healing the brain after Concussion and TBI. I have called this the DMMD approach ot healing the brain. Of note this approach is not being used by most Doctors(even Neurologists, Functional Medicine Drs or NDs) because they are used to simply diagnosing a Concussion and referring for certain therapies. The underlying changes and physiology of what is going on in the brain is not actually being addressed by most Neurologists and doctors when a person presents with a Concussion. Not addressing the physiological processes in the brain can lead to poor outcomes, loss of brain functions, brain fog, low energy, headaches, and very slow to poor recovery. Brain reserve can be decreased in injured areas of the brain even when a Dr says that you ahve healed the concussion.

The DMMD approach is based on the pathophysiology of what actually happens after a Concussion and TBI. This can apply to the acute stage as well as to the subacute and even the chronic pared after the head injury. If you still have symptoms there is still some dysfunctional physiology and problems with brain structure that are still going on that may be improved. The pathophysiology issues are: mitochondrial and energy crisis, low oxygen delivery, loss of neurons and synaptic connections, Neuroinflammation, free radical damage, Neurotransmitter problems especially of Dopamine, excitotoxicity, Limbic System near threshold and mood problems, blood brain Barrier damage, permeability and Autoimmunity, Hormone dysfunction(thyroid, Adrenal and Sex hormones). Other issues that should be also addressed are: headaches, sleep issues, vision, vestibular(dizziness), cognitive dysfunction as well as mood issues. A Brain Injury diet can be used to protect the brain and to aid in building healthy membranes. Neuroprotection Strategies for TBI are very important and involve dietary and EMF strategies. Supplements can be used to address parts of the pathophysiology for instance Taurine can be used to help with building more neuron and synaptic density. It is often important to get a blood test to see if a person has antibodies to the blood brain barrier and to set up a program to protect and heal this very important structure. It is important to do physical exercise in an aerobic heart rate training zone for 40 minutes to increase BDNF brain derived nerve growth factor. It is also important to do brain cross training. In subsequent blogs I will go into some more detail of a Integrative and Pathophysiology approach to healing the brain. Also at Peak Medicine I do Telemedicine as well as in person clinic Consultations with patients and their families as well as consultations with your doctor. David Musnick MD

Concussion/TBI:Testing

Inflammation or Neuroinflammation in the brain is a big problem soon after a head injury/Concussion. Inflammation can lead to”secondary brain injury” and increase the areas of loss of functioning neurons, synaptic networks etc. well past what the original injury would produce. It can lead to problems with neurotransmitters and poor functioning in different brain areas. It can also lead to fatigue and brain fog. If a person has antibodies to their own brain lining called the blood brain barrier BBB they can have more inflammation in the brain. If they have Intestinal Permeability they can have even more inflammation in the brain. This can occur soon after the injury or at any time from the time of the injury. If you or someone you know has had a Concussion and is having brain symptoms it is important for them to have an integrated approach to dealing with and modulating Neuroinflammation. A test for antibodies to the BBB as well as a test for antibodies to the Intestinal tight junction proteins can be very helpful in guiding care. These tests can be ordered by any MD, DO, DC or ND Dr but are best ordered by a Dr that can interpret the test results and make decisions to heal these areas. Labs that do these tests are Cyrex, Vibrant Labs, Mayo Clinic to name a few. In future blogs I will discuss more about neuroinflammation and how to limit inflammation by diet, supplements, sleep, stress management etc. I will also be discussing other aspects of David Musnick MD

Prolotherapy of the Ankle and Foot

Prolotherapy is an injection technique to strengthen ligaments by increasing collagen and fibroblast content. A number of injection techniques are trying to accomplish this including Prolotherapy and PRP and Stem Cells. Stem Cells are more appropriate for inside a joint. PRP may be more appropriate to fill in a tear in a tendon but can be used on ligaments or inside a joint.

A number of joints in the foot and ankle can get loose and lead ot pain or even arthritis in the foot and ankle. One common area is the cuboid bone can flip downward in an ankle sprain and if bad enough can stay or recur in a malalignment. A number of other common ligaments and joint areas in the ankle and foot are: the anterior Tib Fib ligament in the front of the ankle(the high ankle sprain), the subtalar ligaments(sinus tarsi pain) and the ligaments of the medial arch of the foot including the deltoid and spring ligaments. If a person has Pes Planus or a flattened arch they will have medial ankle ligaments that are loose. Prolotherapy can be an ideal way to strengthen foot and ankle ligaments and may even help to avoid surgeries. The procedure should be done about one time per month for 3 or more sessions depending on the laxity. Although it sounds uncomfortable, having a needle int the foot and ankle it can be done quickly and with little pain if done by a Dr that has a lot of experience with the foot and ankle. Successful injections can then lead ot much less foot pain and better function as well as more fun with activities. David Musnick MD

TBI and Concussion

At Peak Medicine clinic I have developed and treat with an Integrative Functional Medicine approach to healing the brain after Concussion and TBI. Of note this approach is not being used by most Doctors(even Neurologists, Functional Medicine Drs or NDs) because they are used to simply diagnosing a Concussion and referring for certain therapies. This approach is based on the pathophysiology of what actually happens after a Concussion and TBI. The pathophysiology issues are: mitochondrial and energy crisis, low oxygen, loss of neurons and synaptic connections, neural inflammation, free radical damage, excitotoxicity, blood brain Barrier damage and Autoimmunity, Hormone dysfunction. Other issues that should be also addressed are: sleep issues, vision, vestibular(dizziness), cognitive dysfunction as well as mood issues. A Brain Injury diet can be used to protect the brain and to aid in building healthy membranes. Neuroprotection Strategies for TBI are very important and involve dietary and EMF strategies. Supplements can be used to address parts of the pathophysiology for instance Taurine can be used to help with building more neuron and synaptic density. It is often important to get a blood test to see if a person has antibodies to the blood brain barrier and to set up a program to protect and heal this very important structure. It is important to do physical exercise in an aerobic heart rate training zone for 40 minutes to increase BDNF brain derived nerve growth factor. It is also important to do brain cross training. In subsequent blogs I will go into some more detail of a Integrative and Pathophysiology approach to healing the brain.

David Musnick MD

Prolotherapy: Introduction

Prolotherapy is a treatment method to treat tendons, joints and ligaments. It is an injection procedure and is repeated at intervals of about 4-6 weeks until the tissue has completely healed.

Prolotherapy for joints is done for 3 major purposes:

  1. To stabilize a loose joint with loose ligaments
  2. To reduce pain
  3. To prevent certain surgeries

Joints can get loose or hypermobile due to injuries such as sprains or simply from aging. They can also be loose related to Benign Hypermobile Joint Syndrome. A loose joint can lead to arthritis or pain from the joint or from muscles. A loose joint can also lead to disc or nerve problems if it is in the low back or neck.

Tendons can develop tendinitis and then become chronic which is called Tendinopathy. Tendons with tendinopathy are degenerative and can be weaker, painful or susceptible to tearing. Prolotherapy can be used to regenerate certain tendons in the body in order to heal them.

Prolotherapy is the injection of certain solutions to get the body to respond with certain growth factors and other biochemicals to produce more ligament or tendon tissue.

Prolotherapy has been done for at least 50 years and requires specialized training and courses to become an expert at it. Dr. Musnick has had thousands of hours of training and experience in prolotherapy and has successfully treated hundreds of patients over the past 20 years.

Future blogs will go into more detail regarding prolotherapy for low back, sacroiliac, hands, shoulders and tendons.

David Musnick MD

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