Table of contents:
00:45 Dr. Nathan Zasler
04:01 Concussion recovery: always things to try
07:19 Rehabilitation: there is always potential
09:16 Recovery from post-concussion syndrome
10:57 Post-concussion rehabilitation & hope
13:06 Post-concussion headaches

Introduction to this episode on post-concussion rehabilitation

Post-concussion rehabilitation is a specialized field of rehabilitative care that isn’t practiced by a lot of doctors in the world. Dr. Zasler has seen thousands of concussion and post-concussion syndrome patients throughout his career and that qualifies him as a concussion specialist. 

In this episode, he talks about the importance of maintaining hope and motivation during rehabilitation. He also shares how improvement is always possible, even 5 or 10 years after injury. This is part 1 of 2 episodes with Dr. Zasler.

Concussion Stories

[00:00 Melanie] Welcome to Concussion Stories, a Lifeyana podcast series filled with hope. I’m here to let you know that you are not alone in your concussion recovery. I’m Melanie and I spent more than six years experimenting, training and learning in order to heal myself from a very bad case of post-concussion syndrome. And today, I feel better than ever before.

In Concussion Stories we dig deep while discussing hopeful stories of recovery, as well as the hard stuff in the messy middle. If you’re struggling to focus, be sure to take breaks. Down in the description of each episode, you can find a table of contents, in case you want to skip ahead. Let’s dive right in. 

Dr. Nathan Zasler

[00:45 Melanie] Today, we’ll be meeting Dr. Nathan Zasler. As the Founder of the Concussion Care Center of Virginia, and a passionate doctor, he is well trained when it comes to post-concussion rehabilitation. 

During this and the next Concussion Stories episode with him, you’ll recognize his familiarity with our experiences. After listening to him, you’ll realize that you are not doing anything wrong when it comes to feeling the way you feel. Dr. Zasler is used to seeing in cases like ours, and that makes history like a sound bath of recognition. Let’s get started. 

Concussion patient care

So, how are you doing?

[01:24 Dr. Zasler] I’m good! Busy day but I was looking forward to this as something different.

[01:32 Melanie] Because what does a busy day look like for you?

[01:35 Dr. Zasler] A busy day? Looks like staying busy with taking care of patients. 

[01:40 Melanie] Yeah, I’ve looked of course through your positions, right? There are so many things that you’re doing, and that was why I asked: what does your day look like? It looks like you have so much to do already: how can you see patients? But you’re just doing it all!

Variety is the spice of life

[02:00 Dr. Zasler] My wife has no conception of what I juggle. I try to express it, but I juggle so much that it’s kind of difficult to put in words. But I enjoy juggling. So for what that’s worth…

[02:16 Melanie] Yeah, what is the saying? Variety is the spice of life. 

[02:20 Dr. Zasler] Right? 

[02:21 Melanie] Yeah. So…

[02:22 Dr. Zasler] But I have interests outside of medicine as well. So…

[02:25 Melanie] What are your interests? 

Practicing magic

[02:26 Dr. Zasler] What are my other interests? My kids, I enjoy gardening, I enjoy cooking, I enjoy music, and I dabble in magic.

[02:39 Melanie] Tell me more. 

[02:43 Dr. Zasler] That’s probably enough. 

[02:46 Melanie] Is that enough? Like you practice magic… Can I say tricks? 

[02:51 Dr. Zasler] Yeah. 

[02:53 Melanie] Is that what you do? That’s wonderful!

[02:56 Dr. Zasler] I mean, when I see younger patients, it’s a nice way to break the ice and make them feel more comfortable.

[03:06 Melanie] So, probably the younger patients are an excuse for a very fun hobby, probably, right?

[03:13 Dr. Zasler] There you go. 

Life is too important to be taken seriously

[03:14 Melanie] Yeah, I gotcha. Okay, I understand. 

[03:16 Dr. Zasler] It’s also a distraction when I go to conferences and go to dinner with people. It’s a nice little thing to do, to keep people on their toes and amused.

[03:30 Melanie] Interesting. Yeah, there we have another quote, another saying. I don’t know who said it, but it goes like this: “Life is far too important to be taken seriously.”

[03:44 Dr. Zasler] I don’t know who said that either, but I have heard it.

[03:47 Melanie] It fits you, I think. 

[03:51 Dr. Zasler] I think it does. I tend to be an eternal optimist. So, a realist, but an optimist. 

Concussion recovery: always things to try

[04:01 Melanie] How does that translate to saying seeing patients for you?

[04:05 Dr. Zasler] Oh, I knew I was setting myself up for that one. Well, how I think it translates is that I try to be factual with them, I don’t sugarcoat stuff. So that’s the realist part. But I also feel that all too often, patients are viewed with blinders on, and that there’s inadequate differential diagnosis, which results in suboptimal treatment and suboptimal outcomes as a result. 

Recovery potential years after injury

I think that all too often, even people 2-3-5-10 years post injury, if I see them for the first time, there’s generally something that I have to offer that hasn’t been offered previously, hasn’t been adequately discussed or explored. So I generally am not one to say – just because you are two or three years post-injury – that there’s nothing further we can do.

[05:16 Melanie] Yes, that’s a very helpful translation for all patients.

Chronic post-traumatic headaches

[05:24 Dr. Zasler] Very true, by the way, for headache patients. We can get into that when we talk about headaches. But just briefly, I’ve seen many patients who’ve seen many, many different clinicians before seeing me, who are told: it’s a chronic post traumatic headache, and you have to live with it. And in fact, that’s not accurate ultimately.

[05:50 Melanie] No. Yeah, that was the thing that I wanted to say, because you just mentioned that if patients have had their symptoms for years already, you were not one to say: “Okay, that’s it, there’s no recovery possible.” But in the field, for years and years, it has been the norm, that after two years or so, no further recovery would be possible, right?

Laws limiting concussion recovery

[06:17 Dr. Zasler] There’s a term, I don’t know if you use it in Europe, or in your country, but in America, there’s a term “MMI”: maximum medical improvement. It is an acronym. It basically means that point at which no further change in impairment is going to occur. 

I hate it, because it’s extremely poorly defined. It comes out of the workers compensation laws, it is not medical in origin. It is misused all too often and then serves as an obstacle to people getting looked at more closely to determine if there is in fact something that can be done further. 

What we both just discussed still happens all the time. People say: “Oh, you’re three years post, there’s not much I can offer,” and they don’t take it any further than that.

Rehabilitation: there is always potential

[07:19 Melanie] That’s true. So you have been the one who has been going with your own vision – and probably also your own experience – because you saw that improvement was still possible later on, while many in the medical community were saying: “This is impossible”.

Thousands of concussion patients

[07:41 Dr. Zasler] Right. I mean, some of that, admittedly comes with experience; not just with me, but with any clinician who sees enough of this patient population. You know, after you’ve seen 3, that’s a very different place to be than seeing 3000. So, some of that, you know, just translates from seeing larger numbers of patients and having that experience under your belt and following patients for years. 

Long-term brain injury outcomes

When I first started doing this, I had no conception (in terms of actual experience), what happens to people 10 to 20 plus years post-injury, particularly severe brain injuries, and how much improvement you could potentially see over time. You’ve probably heard of these stories where people who were supposedly vegetative recover after many years. Have you heard those stories? 

[08:47 Melanie] Yes. 

[08:48 Dr. Zasler] So those are outliers. 

Neuroplasticity and brain injury recovery

But they occur and they say something about the brain’s potential for longterm neuroplastic change. When I first started doing this, which is many more years ago than I wish to admit, we didn’t know that. I mean, people just accepted that if you were a year or more post-concussion, your symptoms weren’t going to change.

Recovery from post-concussion syndrome

[09:16 Melanie] Yes, it’s really interesting when you start talking about these kinds of examples, and you call them “outliers”: they are outliers. But still, one, if they haven’t been researched enough, how do we know how much of an outlier they are? And that’s the same as, for example, with post-concussion recovery, that’s something…

Post-concussion treatment research

[09:41 Dr. Zasler] I’m not disagreeing at all, what I’m saying is: it sheds a light on a topic that we don’t know enough about, and it provides implications about what might be possible If we figured out what the mechanisms were, for example, of why it was people recovered and another group that many years out didn’t recover? What’s the commonality? What are the disparities that might implicate treatment courses that affect recovery?

I fully recovered from post-concussion syndrome

[10:17 Melanie] Yeah. And that’s the interesting thing, because until it’s fully researched, they are still outliers. For example, I am often called implicitly an outlier because I fully recovered from post-concussion syndrome, six and a half years after injury. And what I then get a lot is: “You are lucky,” or: “You are displaying false hope”. And those are things that are… I’m sorry?

[10:50 Dr. Zasler] I hate that term. How is hope false?

Post-concussion rehabilitation & hope

[10:57 Melanie] Well, okay, as a doctor, of course, you have made an oath to help people and to give them honest information about their situation, right? And that is, I think, where optimists and realists are separated. You can’t take hope away from people. That’s what Dr. Ramon Diaz-Arrastia said.

[11:22 Dr. Zasler] I know Ramon.

[11:23 Melanie] Yes, you know him. These are his words: “You cannot take hope away from people”. All of my guests on Concussion Stories always agree with me, otherwise, they can be on the podcast. 

Hope gives perspective

But still, if you are to communicate honestly with a patient about their situation, a lot of doctors feel that you shouldn’t angle toward giving too much hope if there isn’t any reason to hope. 

But that’s the thing that I believe and that’s why I wanted to talk about these outliers as well: if there’s no hope at all – so if you don’t feel like there’s any perspective, any possibility of improvement or recovery – then there is no way. Because your mind is just not open to the possibility. 

Hope started my full recovery

That was the thing that for me made my recovery possible in the end because in the beginning, I felt that there was no hope, because doctors have told me repeatedly. Once I decided that I would recover, suddenly, there’s at least the potential that I could recover.

Refer patients to concussion specialists

[12:27 Dr. Zasler] If as a physician, you felt you had nothing to offer a patient, then I think ethically, you need to say, “I don’t think there’s anything I can offer you, maybe you should see Dr. M. or Dr. S, who might have other ideas about how best to manage your case or your son’s case.” 

As a rehabilitation physician, that’s kind of a core philosophy: that concept of hope. How important it is to maintain motivation, engagement, and hope in the context of recovery.

Post-concussion headaches

[13:06 Melanie] Yeah, this was episode one of two episodes with Dr. Zasler. In the next episode, he’ll talk in depth about post-concussion headaches. So if you experience persistent concussion headaches, it will be really valuable to listen to that episode, too. He will explain which are the most common headaches and how you can recognize them and more. 

Penny for your thoughts?

[13:33 Melanie] Now, I would love to hear from you. What do you take away from this episode? Is there something that you can apply to your life right away? Head on over to lifeyana.com and leave your comment now. 

And if you want to hear and read more Concussion Stories, actionable steps and inspiration, be sure to subscribe to the Lifeyana email list while you’re there, so that you never miss out on new materials we constantly make for you. If you want to support this podcast, head on over to patreon.com/concussionstories.

Thank you for listening to this concussion stories episode by Lifeyana. May you be well, and may you be happy.