By Wanda –
You would have to sit in on an appointment with my awesome neurologist and me to understand the differences between rice cereal, rice pudding, sticky white rice, and what they have to do with a brain.
Every once in a great while, after seeing countless doctors, you might be lucky enough to find one at the top of their game who you just click with instantly. If you are a migraine, chronic pain, chronic illness, or cancer patient I imagine you are nodding right about now. Just to be clear, I am a cancer survivor — that battle is different from all others a person ever faces, but is still the same in that we all want that special doctor.
As this story unfolds we are going to touch on chronic migraines, traumatic brain injuries, concussions, and the “post concussive state.” So, brew a cuppa, make some coffee, grab your wine glass or what ever you have on hand and take a journey with me…
In early childhood, around age three, I experienced the first of five moderate traumatic brain injuries (MTBI). According to brainline.org, each injury can impact thinking and cognition, mood and behavior, sensing and perceiving, and in a small percentage may cause seizures. This actually has a name — outside “graceful” as people like to think they are teasingly calling a victim — it is known as Repetitive Head Injury Syndrome.
BrainLine, like most other reference and support pages, concentrates on the effect of repeated concussion as this is the most common form of brain insult/injury. The effect of even multiple concussions over time remains significant and can result in long-term neurologic and functional deficits. Multiply those outcomes with the severity levels of moderate traumatic brain injury and you get a picture of longer recovery times, decreased recovery levels, and an elevated incidence of Alzheimer’s Disease and other dementias with younger levels of development for AD.
Let’s look at the healthy brain as a bowl of sticky white rice. A healthy brain shows even coloring and activity throughout its grey matter (rice) which is composed of the cerebrum, cerebellum, and brainstem. The Mayfield Clinic illustration shows the anatomy of the brain quite well. Each area of the brain is responsible for a different aspect of our body, memory retainment, personality, and speech. In the rice analogy, the healthy brain maintains its uniformity of shape and function rather like a ball of sticky rice. It’s consistent, each piece works with the others to make the entirety work well, and it’s stable in shape with no oddities.
Now, after a moderate traumatic brain injury, there are physical changes to the brain which result in changes to a person’s cognitive and neurologic and functional defects. The brain begins to show physical changes — our healthy sticky rice has become rice pudding. There are signs of discoloration like the cinnamon and nutmeg, there may be lesions which would be the raisins in the rice pudding, and cognitive function may become impaired which would be the cooling of the pudding. Consider that with each new injury we add more raisins, more spices, more milk and sugar to hold our rice together, and need more cooking time to have the pudding come out with correct consistency.
What started out at rice holding itself together (healthy brain) becomes a more and more complex process with each injury (rice pudding). What we want to avoid at all costs is a permanent state of Post Concussive Syndrome (rice cereal) in which the brain no longer completely heals. This syndrome often occurs following repeated moderate to severe brain injuries. The symptoms include many of the same as the injuries themselves such as head pain, dizziness, fatigue, irritability, difficult it in concentration and preforming mental tasks, memory impairment, insomnia, and a reduced tolerance to stress, emotional excitement, environmental stimuli, and alcohol.
Patients with PCS discover quickly there is few interventions for addressing this prolonged recovery. Individual symptoms can be treated, occupational and physical therapy can address motor and cognitive rehabilitation, but research is limited. This is the point where you stand the change of making your brain in to rice cereal – that bland warm grayish white baby food. The more you injure your brain, the less it can recover. My wonderful neurologist has become fond of warning me against making my brain into rice cereal.
Outside of Moderate Brain Injuries, chronic migraine can also cause changes to the brain’s make-up. It is important to do fairly regular brain imaging to map these changes. At the rice pudding stage, you are pretty much looking for raisins but once in a while you may find a clump or even some nuts. Lesions, edema, cysts, and hematoma can all be found and mapped with MRIs and CTs. The important thing is to have an open communication system with your neurologist, to report any injuries, to carefully track symptoms and recovery times, and to NOT make your brain into rice cereal. The rice cereal state is something that occurs with repeated moderate or severe trauma (head injury with loss of conciseness lasting 20 minutes to multiple days).
Right now, I am in a Post Concussive State due to my previous braking injuries and a bad concussion incurred during a wreck in October of 2017. This is the halfway mark in my recovery, the point where regaining functions begins to slow and learning to live with my “new normal” begins to take root. There may be small steps forward in the next six months, but it isn’t likely. Now is when you really begin to read about the heightened chances of early onset Alzheimer’s Disease, cognitive and speech impairment, mobility aids to help with balance issues, and the realization that every mild concussion, every complex or hemiplegic migraine will have detrimental lasting impact on your brain health and function.
So, what do you do? Read as much as you can about brain health. Find out from your primary doctor what the best brain foods are, take the vitamins and minerals that support brain health, challenge yourself daily to do one thing harder or longer or more detailed. Develop a sense of humor, because you are going to need it. Live your life, take the trips you’ve been putting off, start concurring your bucket list, pick up a hobby you “haven’t had time for,” explore new art and music, and make real rice pudding!