Episode Transcript
[00:00:00]
Jill Brook: Hello, fellow POTS patients and marvelous people who care about POTS patients. I'm Jill Brook, and today we are interviewing Dr. Erik Reis about concussions and POTS. Dr. Erik Reis is a doctor of chiropractic medicine and board certified chiropractic neurologist at The Neural Connection in Minneapolis, Minnesota.
He specializes in the neurological, orthopedic, and nutritional rehabilitation of traumatic brain injuries, concussions, vestibular disorders, and more. He is a Certified Brain Injury Specialist through the American Brain Injury Alliance. And he is the founder of The Neural Connection, a clinic that focuses on treating complex neurological and orthopedic disorders that range from traumatic brain injuries, dysautonomia, POTS, concussions, and much more.
Dr. Reis, thank you so much for joining us today.
Dr. Erik Reis: Thank you for having me, Jill. I'm absolutely excited to be here.
Jill Brook: So, since this community is not that [00:01:00] big, how did you become interested in POTS and dysautonomia and concussions?
Dr. Erik Reis: Well, I think there's always a really good story behind why somebody is doing something with their life. And for me, it was really because fortunately and unfortunately, I was a patient first, became a doctor second, and now here I am being a massive advocate third. So, most of my life was spent playing contact sports, so ice hockey and soccer, or football for those who are in the rest of the world was really my main focus for the first 18 20 years of my life.
And so with that being said playing at a pretty high level and very competitive, I was, for better or for worse, at mercy to my environment, which involved taking hits to the head, to the body, and being quite physical with contact sports. And so, you know, I was fortunate that I never had a season ending or career ending injury, but, you know, have I had my bell rung, for lack of a better term?
Yes. Have I you know, had instances where I've felt as [00:02:00] though maybe I've felt quite off for having memory delays or sleep issues. Absolutely. So that whole journey really got me started and moved me down to the path of where I am today, where now I'm working with those complex cases and treating them.
And it's really given me an opportunity to understand and really relate to the patients in front of me because, you know, I still you know, deal with symptoms in some way, shape or form as well. So.
Jill Brook: I'm sorry to hear that, but I'm glad we have you on our team. Can you tell us more, like, what exactly is a concussion? Like, I think we all have this association with, yeah, you're playing that sport, you hit your head hard. Something happens, but like, what, what really is a concussion?
Dr. Erik Reis: It's a great question. I think a lot of people make the assumption that they actually understand what a concussion is. If you would have looked Just kind of polled people, I guess, maybe 20 30 years ago. They would have said a concussion is just kind of getting your bell rung and you'll recover and you'll, you know, if you know where you are or your coach asks you, hey, what day it is and you can say that, then you can go back out [00:03:00] and keep playing.
But a concussion really is, you know, analogous and similar to a mild traumatic brain injury. So, you know, getting a concussion, is the equivalent of properly, and from a functional standpoint, having some sort of injury to the brain or the central nervous system. And the question kind of subsequently comes up of what happens during a concussion.
Well, you know, you don't have to hit your head to actually have a concussion. I have many patients in my office who have had concussions from auto accidents, or they've slipped and fallen and smacked their tailbone really hard, but all of those forces translate throughout the spine, throughout the skull, and throughout the brain.
And so a concussion is a mild traumatic brain injury. Mild is kind of put in quotations because you could have a very severe concussion that could cause a lot of damage or you could have a mild one where you do feel like you hit your head and maybe you have symptoms but hopefully they improve and they go away.
And so, you know, majority of concussions will for lack of a better term, heal on their own, or patients will no longer [00:04:00] experience symptoms. But there can be secondary and tertiary effects that affect people down the road and it's one of the reasons why we really look at people both structurally and neurologically, but also look at them metabolically and from a nutritional standpoint.
It's not because we want to, it's literally because we think that we have to. Because we know so much more about concussions today than we did 10, 20, even 30 years ago.
Jill Brook: So that's just interesting to me. Like, I know we have so much interesting stuff to cover, but as somebody who has also done a lot of fun sports that were a little bit rough and tumble, it's just interesting to me that some people can go their whole sports lifetime with no issues. Other people, it looks so bad.
It looks like they're really getting slammed and they seem fine. And then, you know, like, I'm guessing that you have to have that head get jerked or hit pretty dang hard to have something happen? Or is it different for different people? Like, you know, like, [00:05:00] do some people have a brain that can get injured by a relatively minor hit, and other people, like, just have these heads of steel?
Like, why, why are some people barefoot water skiing at 60 miles an hour, wiping out every day and they're okay. Like, it's just interesting to me that some people's heads can take that and some people's heads cannot.
Dr. Erik Reis: It's a great question, and my doctor coppout answer is it really just always depends on the patient and the person in front of you, right? So, unfortunately, you know, this is a major part of where we're moving in medicine is very specific, highly personalized and individualized care. So, why do some people struggle more than others?
What I would tell you is that the brain and body and nervous system and the metabolic capacity of that individual before an injury has a significant effect on how they will heal and sustain from that injury and also how they will recover. So if you have pre existing comorbidities, maybe you have [00:06:00] type 2 diabetes, or you have Crohn's disease, or you have a proper autoimmune condition, and you all of a sudden have an injury to the nervous system or the brain, right, via concussion or mild traumatic brain injury.
Sometimes those injuries can trigger such an inflammatory and a neurochemical cascade that now you have these dormant underlying, you'll say, conditions. That can kind of creep their ugly head. And so, unfortunately, we know that autoimmune conditions are quite prevalent with a lot of POTS and autoimmune dysautonomia cases.
But unfortunately too, we see a lot of patients who don't really have any signs or symptoms of having autoimmune condition, but after a head injury, now they start expressing these things because of the inflammatory cascades that occur. And the traumatic experience that triggers genetic and epigenetic traits.
And so, We don't really know why some people can handle them more than others. We could make arguments about, you know, neurological kind of bandwidth, like how many hits, for lack of a better term, can you take, what is your aerobic endurance, the strength [00:07:00] of your neck, you know, how you're hit. All those things do matter, but to just grab 20 people off the street and say, you're predisposed to a concussion from an injury and you're not, is very difficult and, to be fair, nearly impossible to do at this point,
Jill Brook: And you're reminding me that it's not just the hit, it's your body's response to the hit and ability to heal from the hit. So that starts to sound a lot like all the other stuff we talk about in this space, like COVID. Some people, their immune system goes crazy to COVID and some people it doesn't. And it's not that the COVID was different.
It's that your immune system was different.
Dr. Erik Reis: Correct. And it could be any opportunistic infection. I have a patient in the clinic right now, you know, she had issues from COVID, but she had a really, really strong response to Epstein Barr virus that she's still dealing with. And, you know, it kind of took her nervous system out for a bit. She's got the brain fog, the dizziness, the POTS, the dysautonomia, the digestive and gut issues.
And, she's seen a ton of different doctors. And I, I think this is probably one of the hardest parts about treating these [00:08:00] cases. And unfortunately for, really for patients is that, you know, we'll say take somebody who is dealing with POTS or a concussion. Let's say you're having dizziness issues. Well, maybe you first go see an ENT who checks you out, but then you also have some digestive and dietary and gut issues.
And so they send you to a gastroenterologist to go get checked out there. And then you're like, well, my vision maybe feels a bit off. And so now they go have you send you to an optometrist or a neuro ophthalmologist. And then you're like, well, gosh, I'm getting brain fog and I'm kind of confused. So now you go see a psychiatrist or psychologist.
You get sent to so many different specialists. But the unfortunate part about that is none of them are looking at you from a complete integrative perspective about structurally, neurologically, nutritionally, even emotionally what you need. And they're not talking to each other. They may or may not agree or disagree on things, but there's no conversation being had about the fact that you're one person with one nervous system, one digestive system, right?
One, you know, limbic emotional system. And so unfortunately you get [00:09:00] seen by all these doctors, your care is so segmented. And then either you maybe make some improvements or you don't. And now you're exhausted from care, from treatment. You've tried a bunch of different modalities and therapies that did or didn't work.
And you're just spent. And I think a lot of people who are in the, chronic disease camp, we'll say for the lack of a better term, have really felt that. And unfortunately, they are just sick and tired of being sick and tired. And that really is something that I've experienced clinically, but also what I've seen in the last decade of practice is that patients really need somebody kind of being there to be their healthcare quarterback.
And I love being that kind of provider co pilot for them to say, listen, let's set a path for you. Let's figure out what this looks like, but it might be dealing with a multitude of symptoms. We need to take a strategic approach at how to approach this because gut issues might be an outcome after a concussion or a brain injury, but a lot of patients wouldn't attribute that to that.
Even though the literature is quite rife, justifying and showcasing that that's a viable option that we can see. And so. [00:10:00] A lot of the things have changed with the research and the data, and you know, one of the big focuses that we're trying to do as a clinic is just get on platforms like this to educate patients and empower them to say hey, you're not broken, you're not stuck, I know this wasn't on your bucket list, and this probably, you know, you didn't have a road map on how to handle this, but there are options out there for you, and that's what I'm really passionate about is empowering people to be able to own their health and find those providers who are looking at them from an integrative perspective.
Jill Brook: That's fantastic. You said a lot of things there that I'm excited to dig into.
So you mentioned, for example, gut issues following a concussion, and maybe we should even just like go up a level of abstraction from there. Like, how is it, do we know, does anybody know, how a concussion can result in POTS or dysautonomia or other autonomic things?
Dr. Erik Reis: It's a great question. I think what I'm going to start with is maybe a better explanation to give you kind of the [00:11:00] mechanism of action about what happens with a concussion. So your, your brain is suspended in cerebrospinal fluid, which kind of bathes it in all these chemicals that the brain really needs, and it helps the brain take out the day's trash too, right?
Cerebrospinal fluid is just really interesting and so your brain is suspended in cerebrospinal fluid inside your skull, and your skull is a hard shell, right? So when you have a concussion or an injury, all of these forces that go into the body or the neck or the head or all of the above, you know, regardless if you're wearing a helmet or not, or when I was playing ice hockey, they tried to say that mouth guards could prevent concussions.
Well, we found out really quickly that they didn't, because you can stop the exterior abrasions of the skull or the injury by wearing a helmet, but it doesn't stop the brain from moving and sloshing inside the skull. And what happens is that when the brain is moving and has all these forces at different vectors coming into the brain and body, the brain starts twisting and shearing and rotating on top of itself.
So the analogy that I give patients is that if you take, you know, a thing [00:12:00] of like dry spaghetti and you try and twist it before you put it in the water, you'll notice that a lot of those strands can break. And that's essentially what happens with a concussion, is that you have these different neural pathways that are there to sustain function that can be injured.
And the hard part with that is we don't actually know where that injury is going to occur. Just because you got hit on the left side of the head doesn't mean it's, oh, it's going to be frontal lobe rehab on the left side of the skull, because the brain shifts and moves and it could actually cause trauma throughout all these different areas.
There's a term called diffuse axonal injury that would relate to that. The analogy that I give patients overall for a concussion is a concussion is kind of the equivalent of me pouring water on my laptop. I can't really tell you what's going to go on, right? So maybe my Microsoft Word works really well, but my Google Chrome is completely down, right?
For a patient, maybe that means that their balance is severely affected, but their neck is kind of okay. Or their eyes are now really having a hard time focusing, [00:13:00] but they're still getting good sleep, right? And so what are the things we can do to help people update their software? By looking at every single aspect, if I'm looking at my laptop, if I can update any sort of software to help optimize the computer, that's what I'm looking to do.
It's the same thing from a clinical and rehabilitative perspective. And that's why I come back to the looking at you structurally, neurologically, metabolically, and even like emotionally, because those are all big aspects that go into it. So when you break down a concussion, you know, everything's fair game, and you just don't really know what you can get into.
And that's why for me, I think the gold standard really is doing an in depth neurological and orthopedic exam to try and look and see what's working and what isn't working. And it's the same thing for a patient who's dealing with POTS, somebody who's dealing with an underlying autoimmune condition, anything along those lines.
So, I know you would ask the question of how does a concussion relate to digestive issues. So, where that comes into play is when you start seeing that rotating and shearing and twisting of the brain, [00:14:00] there are lower areas of the brain that can inevitably become affected. And these lower areas of the brain are kind of like the foundation of a house.
If you and I decided to build a brand new house, the first thing we would build is a really stable foundation. And in that foundation, we would put a lot of things that we, we need, but we don't really want to look or think about. So, things like plumbing, heating, electricity, and sewage. Well, those same areas of the brain are located in the lower part of the brain, aka the foundation of the house.
Those are things like things that regulate your digestion, your heart rate, your blood pressure, your sewage system. So, you know, making sure you're having adequate bowel movements and digestion. Those areas are a little bit at mercy to the twisting and shearing of the brain during a concussion. And specifically, we're talking about the vagus nerve and vagal nerve innervation.
So I know a lot of people are learning more about that and maybe becoming aware of it, but it's really, it's really the outcomes of the vagus nerve and the feedback between these other areas of the brain that integrate in those [00:15:00] lower areas of the brain and brain stem.
Jill Brook: Okay, so you're, you're dry spaghetti metaphor is really sticking with me. And that's, that's painful to think about of all those things actually breaking. So, so like that's the equivalent of like neurons actually breaking or getting damaged and those have to then be re grown. Can that, can that happen?
Dr. Erik Reis: Yeah. I think regrown is a relative term. So I think, you know, the beauty part, the beautiful part of the brain is that it can grow and adapt and it can change. So this whole concept of neuroplasticity is something that is probably one of the most profound discoveries that we've had over the last couple of decades, just realizing that the brain can continuously change and can always go through a state of evolution.
So you can always make new connections. I think they say on average, one neuron connects to up to 10, 000 other connections. And so the brain is quite powerful for being able to update its software and adapt. We can't just [00:16:00] necessarily grow new neurons. There are two areas of the brain that we have quite a conviction that can, and maybe the research will show we can have more, but those are two specific areas for the rest part of the brain,
you can always grow new synapses and form new connections, right? So, you don't necessarily get back new cells, but the connections that you can make can become stronger, they can become more efficient, and you can regain functionality back to a degree. It always depends on the severity of, of the injury.
But that's the whole focus and that's the whole game, right? So we want to do things that can help you, like I said, update your software. I think that's the easiest analogy that I've given patients where they can just relate to it and help you just regain functionality. So whether that's with rehabilitation, whether it's supporting you from a metabolic or nutritional standpoint, let's look at the inflammatory profile and dampening that to allow your nervous system to recover.
For a lot of patients, it's just genuinely helping them optimize their sleep because sleep is so restorative and so beneficial for us, from a cognitive, from an emotional, even [00:17:00] metabolic, like it's so interesting how sleep can have a massive impact on your blood sugar levels. So there's a lot of ways to really go at that, and I think that's why we really want to help patients build them you know, from a metaphorically speaking standpoint, build a healthcare toolkit.
What kind of tools do you need to use? You know, you can't build a house with just a hammer. And so what kind of tools can we provide you or show you that you can use to help you rebuild your house and regain function? I'd say that's probably a bigger part of it. And so when you're looking at these underlying factors that occur, every concussion is completely different than the one I've seen before.
And that's why every person needs that personalized care plan.
Jill Brook: Okay. But, but it sounds like neuroplasticity is a key. That's always good no matter what. I mean, I guess even if you have a healthy brain, you want more neuroplasticity just to age better. So there's, there's like no wrong time to be doing things to support neuroplasticity. Maybe you just need it more when you have one of these injuries.
Dr. Erik Reis: Here's what I will say is [00:18:00] neuroplasticity is going to be your friend in 99. 9 percent of situations where you want to change the brain, you want to improve the brain. Let's say you start playing guitar and you're bad at it right away, but days, weeks, months go by and you get better and better and more efficient.
That's neuroplasticity at play. Same thing with learning a new language. Same thing with, you know, learning new content. Same thing with just anything you're going to do to challenge your brain to acquire more information. But neuroplasticity inherently is a bit neutral. Because, here's what I'll tell you is that the patients that come into my office, some of them have maladaptive neuroplastic changes.
For example, what would we consider anxiety or PTSD? Those are neurological pathways that have wound up and self propagated themselves to the point where the brain has changed via neuroplasticity, but now the outcome is that they have more anxiety. Or they're struggling with an experience that they can't get out of from an emotional loop, and so that's also neuroplasticity, but in a negative fashion and something we would say we wouldn't want to promote for our [00:19:00] patients.
So my job as a doctor is to say, how can I promote positive and beneficial neuroplasticity to alleviate symptoms but help my patients improve their quality of life? Neuroplasticity, once again, is an amazing, amazing thing that we all possess. It doesn't cost you anything. And you have the ability to change your brain until the day you get called upstairs.
But what I'm going to tell you is that you also need to understand that there are, there are different neuroplastic changes that can have occurred already, or that could occur, that you may want to halt if not completely reverse. And that's always the trick is how do you get the brain to change for better and not for worse?
Jill Brook: Oh, that's a great point. I hadn't thought about that. Okay. So that's fascinating. So can you talk more about your toolkit for how you help people do this? Or, you know, talk about it whatever way is best for you. If you want to tell us a couple of stories of specific patients, or if you want to just talk in general, but just give us a feel for what kinds of things you are doing to get people better.
Dr. Erik Reis: Yeah. [00:20:00] You know, it's a really interesting question. I, whenever I, whenever I get asked about like therapies and toolkits and rehab, it's always, patients always come to mind for me because they're the ones where, I mean, I love clinical practice, for so many reasons, but I really get to learn and build trust and connections with the patients that have trusted me with their care.
And I think that's probably my favorite part about practice is meeting people, learning about them, but getting them better and then getting them out of my office. I love kicking people out of my office, and I mean that wholeheartedly in a loving way, because that means that we've accomplished our goal of getting them better, giving them their quality of life, and then hopefully allowing them to go live their life without having to see me, right?
You know, I always tell patients like, I think that I'm cool, but I'm not that cool. I don't want you spending any more time with me than you need, because I know that your life is probably far more exciting than spending, you know, however many days, weeks, months with me in the office. So that's always the goal.
And, you know, some cases come to mind where, you know, I've seen so many patients that [00:21:00] have come through our clinic and they've been to the major medical centers, they've been to the Mount Sinais, the Cleveland Clinics, the Mayos, and they have either gotten care that's maybe helped them, or they have been told like, hey, we don't really understand what's going on.
Unfortunately, a lot of patients do get labeled as this is just in your head, or it's just anxiety, or they get diagnosed with Functional Neurological Disorder, which essentially means we have no organic reason for why you're experiencing your symptoms. But what I've found is that in a lot of situations, patients just maybe were misunderstood or patients, unfortunately, weren't looked at from an integrative perspective and looked at integratively from structurally, neurologically, metabolically, emotionally.
I think that that's such a massive component that I've really honed in on because I've realized that I've just had to do that with most patients who come in because we see kind of, we'll say the worst of the worst of the most complex cases who've seen 5, 10, 15. I was the 26th doctor somebody had seen a couple of weeks ago, and that to me is completely disheartening.
So with a lot of these cases and a lot of the tools we're [00:22:00] using, The first and foremost thing that I will always do with a patient is I'll always do a complex neurological and structural exam. And if I think I need to, I will run labs regardless of what those labs are or where they need to go. Because I want to understand not only the patient in front of me, but I want to understand what is actually going on with them.
I want to know what the complete picture looks like. And then what I will do is I will say, okay, based off of this, if I think you need more metabolic work or nutritional and gut based work, and we'll go after that as the low hanging fruit, because if that's where I think we can make the quickest improvements, that's where I will go.
But at some point, I will slowly go down that checklist and make sure we're addressing everything as as, as comprehensively as possible, we'll say.
Jill Brook: Can you say what you mean by metabolically?
Dr. Erik Reis: Yeah, all I mean is looking at people from a nutritional standpoint and running some sort of blood chemistry panel. So it could be a complete blood cell panel, white blood cell panel, cholesterol, maybe it's an autoimmune panel like an ANA panel or looking at their full [00:23:00] thyroid panel. I'm looking at labs to determine if there are proper nutritional deficiencies or if I start to see patterns of inflammation and immune dysfunction.
And so when we're looking at those things. You know, we can go after everything and get no results, or we can really be specific with what we think the patterns are showing and where we're going. And so, maybe what that means as a tool is that we have to overhaul your diet. And really make sure if you have any food sensitivities, we get those out, we start healing the guts.
You know, if you have any things like H. pylori or mold infections or a relentless Lyme, you know, co infection you're dealing with. Those are things we need to approach and go after. Because they will affect you neurologically as well too. You know, I've done neuro rehab with patients in the past where I thought they were stable metabolically and I just completely pushed them to the point where they were so exhausted and fatigued that they weren't able to recover as well as I thought they were.
And so most of the time I'm starting with making sure that they're stable enough to handle rehab and rehabilitation can look like it could be [00:24:00] visual therapy, it could be inner ear vestibular therapy. It could be cognitive based exercises, we could be working on balance and stability, we could be doing a lot of structural work.
We could be doing a combination of all of those things at the same time. Because the patient needs that. And all those systems feed into each other. So, it really depends on what the patient needs in front of me. And as I said earlier, you know, I have a lot of tools in our tool belt. And if I need the hammer, I use the hammer.
If not, I move on to the screwdriver or the monkey wrench or anything else that I think that the patient will need. And then a big focus for us is always making sure that that patient not only is doing things in the office, but I'm always sending them home with therapies and rehab. Because I want them to truly get better outside of the office.
I believe that that's the gold standard we should all hold.
Jill Brook: Okay, so give us a story of a POTSie that you got to kick out the door eventually.
Dr. Erik Reis: Yeah, so I remember this patient very vividly. So she had come to see me a couple of years ago, and she had most likely been dealing with some form of [00:25:00] dysautonomia for the most part of her life. But she had actually got hit pretty hard with COVID and that essentially wiped her out. And so she winded up finding us.
Because she had gone to a lot of other doctors and she had not gotten the care that she was hoping for. And I remember the first day of putting her on the tilt table. She actually had passed out on me when I had gone up to like probably like 30 or 40 degrees. She had had a full passed out, dizzy spell.
And I knew that we were in for, you know, really investigating what was going on with her. Well, we started digging a little bit deeper with her. She had some metabolic issues. She had underlying Hashimoto's, which is an autoimmune condition to her with thyroid. That was a big factor for us that we had to approach and look at.
You know, she had had a concussion in the past. I had asked her point blank if she had a concussion and she had said no, but then I found out later she was involved in a pretty, pretty severe car accident. And so lo and behold, I don't blame patients for that. But that's really what we have to do as doctors is kind of extract that information.
And so we had found out that she had had some traumatic things going on structurally and neurologically as well [00:26:00] too. And the COVID was just kind of the icing on the cake for her where she had realized that this really took her out. And so it could have been anything. Could have been an Epstein Barr infection.
Could have been a CMV infection. It could have been, you know, anything going on that could have pushed her metabolic or her immune system that way. And so what we did with her is we did a comprehensive nutritional workup. We modified her diet. We looked at some nutritional deficiencies. She was really low in vitamin D.
She was dealing with a lot of issues where her homocysteine levels were quite high. That can be looked at as an inflammatory marker, but also as part of a methylation pathway, and so we had supplemented her with a bunch of methylated B vitamins. We approach it from a metabolic standpoint that, that started to make some notable gains relatively quickly for her.
We also had to do a lot of neurological rehabilitation. So we were doing tilt table therapies with her. So, you know, tilt table is a pretty common diagnostic tool and test for patients who are dealing with POTS and dysautonomia. But it's also a phenomenal therapy. [00:27:00] So even though you get a tilt table test, and it shows, you know, elevations in your blood pressure and you have all of the, you know, signs and symptoms of, you know, proper POTS diagnosis or dysautonomia, we use it therapeutically.
So I will put people on the tilt table and tilt them back and forth and condition their nervous system to improve their functionality based off of that, paired together with other things like Vegal nerve stim and other modalities like low level laser. And so with that patient, we ended up doing all of those things with her.
And over time, she started showing some really awesome improvements to the point where I was getting her to be able to walk on a treadmill for a couple of minutes before each session to kind of prehab her brain to increase blood flow. We looked at different concentrations of ions, and so we were supplementing her with electrolytes, things to support her blood volume and brain.
And then we just continued to push her, you know, structurally and neurologically, so we ended up doing some visual and vestibular rehabilitation because she had a concussion from that that auto accident. And she ended up, you know, [00:28:00] leaving our office. What we did with her ended up being really beneficial for her.
She's now working, she's working out, she's quite active physically and she's doing really well. Now that doesn't come without flare ups from time to time. She's very different than she was when she came to our office originally, and so that was a really fun experience to be a part of because she did all the work really pushed herself, but she trusted me with her care, and I really appreciate that.
So, you know, I've had many other patients in those similar situations that can kind of have similar outcomes, but that was really one that changed the way that I look at POTS and dysautonomia.
Jill Brook: That's really cool. Now you named a few therapies that I think listeners and or I have never heard of and I'm wondering if you can talk more about them. I think you mentioned something called low level laser, you mentioned vagal stimulation, which people have probably heard of, but maybe you could
talk more about that. You've mentioned I think structural, structural and [00:29:00] vestibular work. Can you just talk more about some of these specific therapies and what it entails and is there homework or do you just do it in the office and does it hurt and like...
Dr. Erik Reis: I'll give you the full download. So, let me break down, me just kind of give you an analogy for kind of how the brain processes information. I think that can probably be a bit beneficial for you. Your brain is just a master supercomputer that's full of all of these different hubs that we would call lobes or nuclei, which are essentially supercomputers within themselves.
Your brain really functions in networks and neuronal networks specifically. So many different areas of the brain talk and communicate with each other. And we know that there are some relatively strong connections with areas like the cerebellum and the frontal lobe, which we don't have to get into, but we know that there are some strong connections with different highways or super highways of information and neurological inputs.
And that's really powerful for us, especially when I'm dealing with patients who have concussions. I kind of use this analogy of, you know, [00:30:00] inputs and outputs. Inputs need to match outputs. So what I mean is, for instance, if I go check a reflex with your biceps, I should expect there to be a reflexive output where you have a muscle contraction of that.
If I have you you know, look at my finger and I bring my finger close to your nose, I should see your eyes converge and come in. Those inputs should match outputs. And what happens with a concussion is that sometimes inputs, the input systems, get skewed and get altered and no longer give you good inputs which skew outputs.
If you had three friends that went to the same party and told you the exact same story, you would have no questions about what happened at that party. They'd probably tell you where it was at, who was there, I'm gonna always want to know what kind of food was there, right? And so that's great and that's awesome, but if those three friends went to the same party and told you completely different stories, who would you believe? Well, you wouldn't know because you weren't there, right? So, maybe one of your friends tells you it was the wrong city, and maybe the other one tells you it was the wrong time. That same conundrum can [00:31:00] happen with the brain after a concussion. And so, the three friends for us that give us major inputs, and this is relevant to concussions and POTS and a lot of just conditions in general, is one, muscles and joints.
So your muscles and joints are always fighting gravity, they're always giving us inputs. That's why we base motor milestones for babies off of motor movements. It's a really important driver of brain function. So that's friend number one. Friend number two are your eyes. So I'm not talking about just the eyeball, but I'm talking about vision, and everything from the retina all the way back, all the software that integrates with keeping your eyes on a target, tracking, judging depth and distance, kind of those things.
And then the third system is your inner ear system. And this inner ear system, this vestibular system, is a relatively old, not that well developed, kind of fragile system that really tells us, like, kind of where we are in space based off of gravity. So Jill, I could put you in an elevator and tell you to close your eyes and tell you to not move anything, but I could shoot you up 20 stories and you'd know in some way, shape, or form that you moved based off where [00:32:00] you started.
That's the inner ear system that I was referencing. And those three friends have to go to the same party and tell you the exact same story. If they don't, maybe what that means is you see changes in your heart rate based off of you going from seated to standing. Maybe what that means is now when you're out in busy visual environments, you get a little bit overwhelmed because your eyes get fatigued and you get some visual strain or you get car sick.
Maybe what that means now is like maybe you have a head tilt or like all these muscles in the back part of your skull are always tight. Okay. And no matter what you do to them, they're always tight and they're never changing. So you can see these outcomes based off of that. Now this is where the vestibular system or inner ear comes into play, is that you can do different rehabilitative therapies to optimize the inner ear system, right?
So you can do things with the eyes, with balance, with different kind of maneuvers of the neck and the body to upregulate and optimize and fix those inputs to make sure they're giving proper inputs and outputs. [00:33:00] So that's one system that's really important for us. You had asked about Vagal nerve stim, right?
So, Vagal nerve stim is essentially stimulating the Vagus nerve in some way, shape, or form. Now, you're already doing this when you're breathing. You're doing this when you're talking, when you're singing, or humming, or doing anything along those lines. Your Vagus nerve is kind of the yin to the yang for your stress response.
Or your sympathetic nervous system. So, your autonomic or automatic systems in the background that do things for you that you shouldn't have to think about, like regulating blood pressure, digestion, sewage, all those things we mentioned earlier. You have kind of a teeter totter. So, the first section is a stress response, the fight or flight or freeze response.
The exact opposite of that is the parasympathetic or rest and digest system, and that's really where the Vagus nerve comes into play. So why is this relevant for patients who have like POTS or concussions? Well, a lot of those patients are dealing with autonomic or [00:34:00] automatic issues. where they're more sympathetic dominant, for lack of a better term, and their parasympathetic or Vagal systems are kind of suppressed a bit.
So using Vagal nerve stimulation, there's multiple ways to do it, multiple modalities to do it, but using Vagal nerve stimulation can sometimes tilt that teeter totter to be balanced, where now you can have a proper and appropriate stress response. But then your Vagus nerve can come into play and say, Hey, we don't need to be stressed anymore.
We can relax and have an appropriate outcome with that. So, that's kind of really why and where we use Vagal nerve stimulation. It's because it can have such a profound effect on rebalancing the nervous system, for lack of a better term.
Jill Brook: Do you have a favorite tool or strategy for stimulating the Vagus nerve?
Dr. Erik Reis: Well, we, yes, I, I like giving patients things for at home. So like belly breathing, like diaphragmatic belly breathing is a really powerful driver of the Vagus nerve. We use the Physiologic Psy. Andrew Huberman is a massive advocate for this and did some great research on it as well too about the [00:35:00] Physiologic Psy.
And so just using different breathing mechanisms to upregulate Vagal tone is, is always nice because it's not going to cost you anything. It's, it's really you know, low hanging fruit and you can do it at home, but we also use Vagal nerve stimulators. So we use GammaCore which is a medical device that's FDA cleared for migraines and headaches.
I think they just gained a clearance as well for anxiety and PTSD and I think that's a variable in some countries versus others. But we use it because if you can find the Vagus nerve wrapped around your carotid artery in the neck. And so we use it right over the neck, right where your SCM joint is, or SCM muscle, and what we can do is we can simulate the Vagus nerve that wraps around the carotid artery there and it's been amazing because it's non invasive, doesn't hurt, and it can be approached in treatment in the office but also used at home for patients who choose to go that route.
So there are multiple ways to upregulate the Vagus nerve and Vagal function, it's just whether or not that's an appropriate response for the patient. Some majority of patients will probably need it. Some might not do well with it. And that's really where the clinical [00:36:00] practice aspect comes into play about looking at what is actually going on with that patient in front of them.
And that's why I'll never do a treatment on a patient until I have a full blown, in depth neurological and orthopedic exam to figure out what they need and see what's actually going on.
Jill Brook: Cool. Okay. So, okay. Sorry. Two questions. One, can you talk about your low level laser and what that is? And then second of all you keep mentioning a really kind of big assessment that you do at the beginning. So how long does that take? And when patients work with you, what kind of time commitment are they looking at?
Dr. Erik Reis: Great questions. So I'll do the low level laser one first. So low level laser comes under the category which we consider like photobiomodulation, which is a big fancy term meaning light therapy. You're seeing this in a lot of consumer markets and in a lot of doctor's offices today where people are looking into using red light therapy as a tool to dampen inflammation, you know, increase wrinkles, upregulate collagen.
I mean, the list kind of goes on.
Jill Brook: Oh, I swear by my [00:37:00] Joove light. I feel my MCAS get better within like minutes. When I had COVID, I could feel it get better within moments of sitting. So I'm a believer in that.
Dr. Erik Reis: It's a powerful, powerful driver. I mean, vitamin, you know, you go outside and get some sunshine and you're going to have vitamin D synthesis via your skin, right? So, light has always been therapeutic for humans. What they're doing now with these specific wavelengths is they're helping you upregulate cellular healing.
That's really, at the end of the day, The best analogy I can give you. Now, what is the difference between like an LED and low level laser? Well, an LED, the light spreads. So if I have a light that's close to your nose and I pull it five feet back, you're absorbing less of that light than you would if it was close to your face. With a laser, laser is collimated light. What that means is it's concentrated light. And so I can have the laser a foot away from you, or 20 feet away from you, and you're still getting the same amount of photons inside the cell and into the, into the area that I'm treating. Low level laser is something that is gaining a lot of [00:38:00] traction because it's non invasive.
It has no downtime it can alleviate pain, it can dampen inflammation, it can upregulate your mitochondria, which, produce ATP which we use for energy. It can dampen any unwanted inflammatory responses. It can upregulate your immune function. The list kind of goes on. And so I, I'm a massive fan of Erchonia because they have 22 of the 25 FDA clearances for low level laser.
So that's like neck pain, shoulder pain, plantar fasciitis, postoperative surgery. They have cosmetic lines that help people, you know, you know, do body contouring and non invasive fat loss, but I'm using it with patients in my clinic because a lot of them are dealing with inflammation. A lot of them are dealing with cellular dysfunction.
MCAS is a great example. Histamine intolerances, right? We're dealing with a lot of gut dysfunction, but I can use it in a therapeutic way where I know I'm not hurting them. I know it's low level, so it's not heating up tissue, which is a really big problem for other types of modalities. And then more importantly too it's quick.
So I don't need to have them sit underneath [00:39:00] something for an hour or two. I can use it in 5 10 minutes and I can see benefits for it. So that's why we use low level laser. And patients just have responded really well to those modalities in the clinic and both at home as well. Now you would ask the question about our examination.
My exam takes about 90 minutes. And the reason why is because I spend probably about the first half an hour just genuinely getting to know the patient in front of me. I think that you know, people come in with a diagnosis, and I think that that's important, but you are not your diagnosis. You never have been. Your diagnosis is the condition that you may be battling with, but I want to know what drives a person in front of me.
I want to understand who they are. I want to understand more about them because I want to build that trust. I think that this is something that we've lost in today's current medical system is the fact that most doctors only have 10, max of 15 minutes to get you to come in, do a history, get an exam done, form a [00:40:00] prognosis, set up a treatment plan, and they don't really have any time to build a relationship with a patient.
And I think that that is one of the most powerful things that we need to do as medical providers is build a relationship with a patient, build their trust, and get them to understand that we're there to support them. So I spend about, you know, the first 20 30 minutes just getting to know the patient, obviously taking a history, asking them questions, getting to know really what they've been through, what they've tried.
What's worked and what hasn't. And then I spend the next hour doing an in depth neurological and an in depth structural exam. So looking at the head, looking at the neck, looking at the eyes, you know, inner ear systems, doing a full cranial nerve exam if I have to, digging into gut function, balance, stability.
We're looking at anything and everything we would need to in order to come up with a proper, you know, treatment plan to say here's what I've seen that doesn't work as well as it could. Inevitably there are going to be things [00:41:00] that do work really well, and so we can use those systems as well too. And then my whole goal is to find a way to get them the tools and the resources they need to just improve.
And a lot of times that involves seeing me in the clinic for some sort of duration, but over time all my patients know they're going to get home therapies. I'm going to keep them honest and I expect them to keep me honest. I'm selfish with my patients. I want to see them get better as fast as possible.
And I want to make sure that we're maximizing their ability to improve as quickly as possible. So, like I said, my goal is to always get people in, get them figured out, send them home with rehab, and then, in the most loving way possible, kick them out of my office so that they can go live their life.
So, it just depends on what they need and what they're showing, but most of the time, patients respond in some way, shape, or form positively. We get them doing therapy and treatment at home and then I want to give them that independence back. That's always a big goal for us.
Jill Brook: That's great. Are there any symptoms associated with POTS or dysautonomia that you have noticed are [00:42:00] either easier, like especially responsive to treatment or especially tough?
Dr. Erik Reis: Yeah, I think one of the hardest symptoms that I've ever, you know, I'll put it this way, I think one of the hardest symptoms to go after is tinnitus, so, or tinnitus, ringing in the ears. So, depending on whether you're a concussion, or you have dysautonomia, or you've got MCAS, whatever it's going to be, tinnitus is really difficult to treat.
And I've, I've, have, rarely have had, clinical outcomes that would justify and say, I know exactly what I'm doing. There are some cool modalities coming out where there's a device on the market where people can listen to these binaural beats in their ears at a specific frequency. And then they're also pairing it together with tongue stimulation.
And so by using different superhighways to get into the brain, they can disrupt kind of that static in your radio station that tinnitus would be considered. But I'm not, I would say that I really struggle with that. I think the most success that we've had with a lot of patients is probably fixing up a lot of their visual issues.
I find so many patients with visual issues that haven't been [00:43:00] addressed or even looked at, and that could be somebody who's having chronic migraines or headaches. That could be somebody who's dealing with balance issues. I have a patient in my office right now who is dealing with some long COVID problems and Epstein Barr issues, and she's got underlying Hashimoto's, and we've been doing a ton of visual therapy with her for her brain fog, and she's been doing
awesome. She's back to reading 15 minutes a day in her book, which she couldn't do for the last year and a half. She's seeing changes in her mood and energy, even in her sleep. So I would say a lot of the visual issues are relatively, I don't want to say easy because nothing's ever easy, but we are, we have a relatively high success rate of going after those.
And then on top of that too, I think just from a metabolic perspective, we've really honed in on helping people metabolically. And a lot of times when you clean up some of the metabolic issues, you just see changes globally like improvements in sleep or less emotional instability. People just feel like their brain is working a little bit better, you know, so it just kind of depends on the patient in front of you.
That's kind of where we would [00:44:00] probably sit for the most part. And of course I'm doing structural work with people, so they're in less pain or they have a greater range of motion and stuff like that. So it just kind of depends on the patient in front of me.
Jill Brook: That's so cool. Well, I could talk to you all day. You're so knowledgeable and maybe we can have you back sometime to do a part two. There's so much, so much good stuff here, but I know you need to get back to your clinic. We're so grateful for your time. We're so grateful that you are saying no to healthcare silos and looking at the whole patient and taking the time to get to know them and, and look at the whole thing.
I have to laugh because my current doctor through my insurance leaves after six minutes, whether he's still in the middle of a sentence or not. And so I really appreciate, I really appreciate that that, you're, you're there to get to know the person, the problem, the solution and take real time.
Thank you so much for all your work and all of your information today.
Dr. Erik Reis: Of course, Jill, thanks for having me, and I would absolutely love to be on another episode. And for those who are, like, looking for [00:45:00] more resources, we have a ton of blogs, a ton of information we've put out. We've built out courses for concussions, and we're building one for migraines and chronic headaches.
I'm sure there's going to be a list of things that we'll probably be building in the future. And so, I'm here to support you and the community in any way possible. And if people have questions, they are welcome to reach out, are more, you can more than happy reach out to me and I'm happy to take a call and see how I can support somebody.
Whether I can see them in the office or I can send them to somebody else who's better equipped, I'll always just give somebody my honest opinion on whether I think I can help them. So thank you for having me on your podcast. It's been an absolute pleasure.
Jill Brook: Awesome. Thank you so much. And we will link to all of those things in our show notes. And where can people go online to learn more about you or your clinic?
Dr. Erik Reis: Yeah, They can just go to the TheNeuralConnection. com. That's our website for the clinic. There's a ton of resources on there. There's consultation links for you to reach out. We have way too many blogs and articles that we've written to help patients. And we're really just trying to build a platform to be a resource for people to help them help themselves.
You'll always need doctors and we'll [00:46:00] always need, you know, practitioners to help, but we really want to help people understand that healing happens at home and that they have the power to, to continue to improve regardless of who they're seeing or what they're doing. So...
Jill Brook: Oh, actually, to ask you one more quick question. As a person who works with a lot of concussions and the aftermath. Are there any sports you would not let your children play?
Dr. Erik Reis: Yeah, that's a really good question. You know, I've had people ask this to me in the past. I think it depends on the position that I would have my child playing American football. Ice hockey to be determined. I think that that would be a relative question as well. You know, I wouldn't probably let them play things like rugby.
Or play something where they're going to just consistently be hitting their heads over and over and over again. So I would say that that would probably be a big thing, but I struggle with the question because sports for me have taught me so much about life and they've given me so much training and resilience about winning as a team, losing as a team, [00:47:00] winning individually, winning, losing individually.
You're talking about teamwork and leadership and just going after a big something so much bigger than myself. And so, can you get that with other team sports? Yes. But I don't know, maybe when I'm a parent one day, I'll be able to come back and tell you which ones I chose no one and which ones I chose yes to.
But for right now, I really struggle answering that question.
Jill Brook: Yeah, absolutely. And I know you always see the worst case scenarios. And so that's probably not a healthy way to be thinking about fun childhood activities, but we appreciate it nonetheless. And this is why we'll have to have you back to talk more at some point. So much more to cover. Dr. Reis, thanks a million.
You're awesome. And hey listeners, that's all for today, but we'll be back again next week. And in the meantime, thank you for listening, remember you're not alone, and please join us again soon.
