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Episode 5: Healing the Brain After Concussion with Dr. David Musnick, MD, IFMCP



Podcast Drop Date: 11/30/22



Amber Warren, PA-C: Welcome to Functional Medicine Foundation's podcast, where we explore root cause medicine, engage in conversation with functional and integrative medicine experts and build community with like minded health seekers. I'm your host, Amber Warren. Let's dig deeper. Hi. Welcome back. I'm here with Dr. David Musnick, a board certified medical doctor who offers both in-person and telemedicine care from Functional Medicine of Idaho at our Eagle Clinic. Dr. Musnick offers functional medicine, sports medicine, functional immunology and primary care for both adults and teenagers. He specializes in sports, orthopedic medicine, internal medicine, frequency, specific microcurrent scars, homeopathy, pro low therapy and low level laser treatments. He has developed a unique program to heal the brain after concussion. His program integrates diet supplements, sleep, exercise, microcurrent, and brain training to heal the brain after concussion. He also applies this to other brain based disorders, including cognitive impairment and dementia. He has a special interest in autoimmune disorders and is well studied in functional immunology. He's one of the top ten clinicians in the world with frequency specific microcurrent and he teaches at Microcurrent meetings. He's very experienced in pro therapy, regenerative injections to build more ligament to stabilize a joint or area of the spine. After his internal medicine residency in Seattle. Dr. Musnick completed a fellowship in sports medicine. Dr. Musnick has more than 24 years of experience in functional medicine, and he's author of the book Conditioning for Outdoor Fitness. And he has helped in writing textbook chapters on both arthritis and concussions. Dr. Musnick received his Doctorate of medicine from the University of California, San Francisco. He is certified through the Institute for Functional Medicine. He has also studied in the French School of Homeopathy. Dr. Musnick, welcome. Thank you. We're so excited to have you. And this first talk is on brain brain trauma, brain health. And I'm so excited to just dig in. So I mentioned in your intro this development of this this protocol, this program that's based on integrative pathophysiology and its approach to healing the brain. Why and when did you develop this program?


Dr. David Musnick, MD: Well, I've been taking care of people with concussions for many years because in my former practice in Bellevue, Washington, I had been getting a lot of head injury patients from the local hospital emergency room. So they would just like go to Dr. Musnick, go to the doctor. And so I had been exploring different ways to heal the brain. But I also knew that the neurology approach, if you see a neurologist, the patients didn't get any care or they got to like physical therapy or occupational therapy. But in the fall of 2016, I got I got asked by the Institute of Functional Medicine to develop a comprehensive approach to healing the brain after concussion, to present it at the brain meetings in 2017 in Los Angeles. That would have been June. I got asked if I would take this on, and I actually didn't know what I was getting into because I had no idea how much research there was to explore, to develop this program. And I had an idea that there was a lot a lot of work to do on this, but I did not know how many hundreds and hundreds and hundreds of hours that I was going to put into this. And it probably was 500 plus hours that I put into this reading. All the research and such. And I also knew that we needed a better way to heal the brain after concussion, because what the average primary care neurologist was doing was almost no treatment. And what the average sports medicine doc was doing was almost no treatment, just telling people they had a concussion, monitoring them until they said, okay, you can go back to whatever you're doing or or you can't. So. That's when this really started. And then after I gave this a. At the Institute of Functional Medicine meetings there are about. 350 people there, I think, and I had 180 slides. I think I got through them. But I talk so fast. But I do remember some sort of standing ovation at the end of it, because this was the first time anybody had heard this approach.


Amber Warren, PA-C: Yeah. Very, very new, very unique. So your training has been and was at the time in sports medicine. How did that training really allow you to facilitate this program and dig deeper into this?


Dr. David Musnick, MD: Well, I mean, a sports medicine doctor should be able to treat, diagnose and treat concussion, but that was the extent of it. I mean, it's like, okay, is it community standard to either refer to a neurologist or a sports medicine doctor? Yes, it is, but that was only the beginning of it, because if the average sports medicine doctor does not know how to heal the brain after concussion, but it gave me the, you know, the credentials to develop this program and to receive all the referrals that I received for it.


Amber Warren, PA-C: Yeah. So how did your clinically speaking, how did your outcome start to change?


Dr. David Musnick, MD: Oh, they started improving significantly because what I used to do beforehand was I would get people exercising, I would get people sleeping, I put them on turkey and sort of put them on some fish oil. But it was a piecemeal approach to this. It wasn't a comprehensive approach. So I already had probably better results than most doctors. But once I put this whole program together, there are very few people that didn't get 100% or real close to it, and there wasn't anybody that didn't get significantly better. It's just that some people didn't get 100%, but my outcomes just really improved.


Amber Warren, PA-C: And those patients that maybe didn't get that, that 100% that you were shooting for, what what were those patients like? What was the reason their can you pinpoint?


Dr. David Musnick, MD: Well, most of them had been out for years. You know, they didn't get any care initially. But but more, you know, some of them just had still some light sensitivity or sound sensitivity. Virtually all of them, the headaches went away. The brain fatigue got better. I mean, the brain fog got better. Almost all their symptoms got better. But some of the toughest things were, you know, the sensitivity to light and sound.


Amber Warren, PA-C: So I think that kind of speaks well to the conventional approach is really, oh, you're now eight, nine weeks post concussion. It's too late. Right? Or what? What are you going to do then? Can you heal those people? Do they have as much success as maybe someone who gets in and gets seen by someone like you within 48 hours of head trauma?


Dr. David Musnick, MD: Yes. So what I would say is I always considered the first 8 to 10 weeks is really important to start this type of a program, because that's when we have the most what's called neuroplasticity, which is the ability to change the outcomes. But I say at least 50% of my patients are much more than eight weeks out, and I've been able to help them.


Amber Warren, PA-C: And does that because they've failed the conventional approach or they have to wait a long time where they're not getting better, where someone else comes into their life and says, Hey, have you thought about functional medicine? Have you thought about Dr. Resnick?


Dr. David Musnick, MD: Well, I mean, you know, one of the things I'm trying to do is get the word out on this program because I don't want people suffering out there. And when you hear the stories of some of these people, I mean, a lot of the people that are chronic, they have mood issues, they have depression, they have anger issues, They're having trouble with their jobs. The kids are having trouble in school. So, I mean, a lot of it is just like getting the word out so people know that, you know, we do handle that diagnosis very well.


Amber Warren, PA-C: And there's hope for them, right?


Dr. David Musnick, MD: Yeah. I'm trying to train other people around the country. That's why I do these podcasts.


Amber Warren, PA-C: And so how does your approach change with our patients that have had more than one traumatic brain injury concussion?


Dr. David Musnick, MD: Well, that's a good question. So if someone has a traumatic brain injury or concussion, then they can lose neurons. They those are the key cells in the brain. They can also lose the connections called the synaptic connections. So if you say they've already had one of those, so they've already had some lost neurons, lost synaptic connections in a region of their brain, then the next one might not even be as serious as the first one, but then they have even more symptoms from that. And so you really have to work on if they've had more than one, you have to work on all the acute stuff and then you're going to have to work on chronic things that the chronic things you have to work on is actually getting nerve stem cells to actually move to the injured areas, then survive and create synaptic network connections. And there's a lot of other things that you have to work on that we're going to be talking about. So. Hope that answers that.


Amber Warren, PA-C: Yeah. No, it does. So that when you talk about like that and I've heard you break this down multiple times at different different talks, it really what impresses me so much about the just the work you've done is how you can apply this to just the brain in general and not just after a brain injury.


Dr. David Musnick, MD: Right.


Amber Warren, PA-C: And that's really impressive.


Dr. David Musnick, MD: Yeah. And that's also really interesting because a lot of these pathways that we're going to talk about apply to other issues in the brain and such as the micro glial cells, the support cells, I mean, these micro glial cells can turn inflammatory. They can stop producing their beneficial trophic factors like brain derived nerve growth factor. Well, that can go on with a virus that can go on in Parkinson's disease, that can go on in RMS And then we're probably going to talk about this, but I don't know if we are, but there can be autoimmune issues that go on where someone develops actually antibodies to the lining of the brain called the blood brain barrier. And that can be the sort of breached barrier that sets up for something like Parkinson's. Ms. Auto immunity in the brain. And so there's a lot of things that go on that I've learned about initially through brain injury that actually affect and influence cognitive impairment, mild cognitive impairment, dementia. There's a lot of brain based issues that people have. Potts There's so much I've been able to apply these concepts to so many brain based issues. And, you know, the brain is actually involved with a lot of stuff in the body. Yeah, even the vagus nerve the is involved with that because the nuclei are in the brain. So there's a lot of talk now about the vagus nerve. Well, if the brain gets inflamed, the vagus nerve doesn't work as well.


Amber Warren, PA-C: Gut brain connection, right? Yes. And vagus nerve making things like stomach acid, which are really important for healthy digestion.


Dr. David Musnick, MD: All right.


Amber Warren, PA-C: How about COVID? I think that's something still on everybody's minds, right? Are you seeing some of these post COVID patients developing some of these autoimmunity in the brain or these neuro inflammatory issues you speak of?


Dr. David Musnick, MD: Yes. And that might be called neurological post-COVID syndrome. The neurological sequelae are consequences of the COVID long hauler syndrome. I am seeing that and it varies person to person. A lot of people have brain fatigue, they have brain fog. There's all kinds of issues that some of these patients have. Some of them are dizzy. Yeah, they have vertigo, they have dizziness, some of them have developed postural orthostatic tachycardia.


Amber Warren, PA-C: Anxiety, post COVID. Yeah.


Dr. David Musnick, MD: And the mood disorders are pretty significant and a lot of it's related to brain inflammation.


Amber Warren, PA-C: And there's really we were talking about this actually a little bit offline. There's really amazing ways to test for some of the things that pathophysiology that's going on in the brain. And you've really honed in on a lot of the ways to test for that. So we'll definitely get into that. But I want to start with kind of some some some definitions. So I have three young boys. They hit their head all the time, right? I get calls from school, they hit their head playing football, hit their head on the playground. How do you differentiate and define maybe it's a bonked of the head, bruise to the head versus a true concussion.


Dr. David Musnick, MD: Okay. Good question. So someone could bruise their head, have like a little egg on their head or a bruise. But if they don't have generalized headaches, they don't have fatigue. They don't want to sleep a lot. They don't have balance problems. They don't have nausea, they don't have brain fog, that kind of stuff. Then they just bruise their head. So so that can go on without having a true concussion. So a true concussion, somebody might feel sort of see stars. They and they can get very fatigued for the first few days and just want to sleep and sleep. And there's all these things called post-concussion syndrome, which are these common things like headaches and other things. And then, of course, we have to see if someone injured their neck at the same time. But there's a differentiation between just hitting the head, bruising your head and a concussion. And there is actually differentiation between a concussion and a mild traumatic brain injury or traumatic brain injury.


Amber Warren, PA-C: What's that definition?


Dr. David Musnick, MD: Okay. And that's a good question because most people don't understand that. But if someone has. Persistent cognitive issues or brain region issues. So what's really interesting is our brains are like like they have many different departments, many. There's all kinds of functions our brains are doing. And so we call these brain region functions. And different parts of the brain are in different areas and they do different functions. Well, if someone has persistent problems in different areas of the brain, that is traumatic brain injury because they are actually having problems in an area of the brain. So we call that traumatic brain injury. It can be classified as mild, moderate or severe. For instance, some of the can't find words very well that would be considered mild traumatic brain injury. You know, brain fog can be sort of a lot of people can have brain fog. And that may not be mild traumatic brain injury, but it often goes along with it because it's related to brain inflammation and decreased frequency of firing of the neurons. But there's a lot of issues that people have, like memory issues. That's the that's part of the that's the hippocampus primarily. So there's so many regions of the brain. And one thing that I do when I see a patient with this problem is I have a three page questionnaire that I'll use to assess every brain region. And I want to know what brain regions are in dysfunction. So I can classify this well, this is concussion or mild traumatic brain injury and find out what we need to work on because one of the concepts is if we want to build more synaptic connections in an area of the brain that isn't functioning well, we have to challenge that person, like with speech or word finding or their memory or if they're cerebellum, their balance, then you've got to challenge it and have them do like literally homework that's going to challenge it because that's the only way they're going to build new connections.


Amber Warren, PA-C: So it really does change your treatment protocol.


Dr. David Musnick, MD: Yeah, that's called brain training. And you have to know which part of the brain is in dysfunction. You don't need like a really expensive neural psych test for that. You just.


Amber Warren, PA-C: Need an MRIs is not going to find that.


Dr. David Musnick, MD: Mri. That's good. Good.


Amber Warren, PA-C: Good point. Yeah.


Dr. David Musnick, MD: People. People. You know, sometimes someone orders an MRI and they often order it with contrast. And the contrast is problematic because gadolinium may not get out of the brain. So MRIs often are not good diagnostic tools for head injuries. Everybody will usually get a CAT scan to make sure they didn't have a brain bleed. Right. But MRI is not useful most of the time.


Amber Warren, PA-C: And can be harmful because then you're increasing toxicity. Yeah.


Dr. David Musnick, MD: Yeah. And even some people don't tolerate brain MRIs.


Amber Warren, PA-C: Definitely. So how when you are examining your patient are more or less hearing their story? How most often mechanistically, how are they getting these concussions on average?


Dr. David Musnick, MD: Oh, I mean, you know what's funny? Kids in school, you know, they get them from kickball, they get them from soccer. I've had so many kids as patients, they're just standing in line and they're swinging their heads around. It's unbelievable where these kids, they don't have as much awareness of their heads. Oh, yeah, they'll get them falling on the playground. And of course, kids in high school get them in football. Skiers, snowboard, snowboarders are falling a lot. And so and then mountain bikers fall a lot and then people can slip on the ice. I've had I ask people, have you ever had a head injury? And they say, no. I said, Have you ever fallen in the ice and hit your head? They say, Yes. Yeah. They don't consider it like, Oh yeah, that's I did that. And so most people have actually had at least one head injury. Some of them are significant and they don't consider they've had.


Amber Warren, PA-C: It As far as the your your analysis of just a brain bruise or a head bruise, I should say, versus a concussion. Is it different how our pediatric population presents versus the adults? Yes. Yeah.


Dr. David Musnick, MD: Because kids kids don't talk that much.


Amber Warren, PA-C: Okay.


Dr. David Musnick, MD: And they're not very specific and they end up having problems with sleeping. They can have mood irritability. They can the parents may say they don't seem like themselves and definitely problems in school and that's what they present.


Amber Warren, PA-C: With and how long do we need.


Dr. David Musnick, MD: But they can also present with neck pain and headaches that often is related to their.


Amber Warren, PA-C: Necks and with kiddos specifically, is it always right away? Are there sometimes a delayed onset of symptoms with with with kids?


Dr. David Musnick, MD: Well, the interesting thing is that it's usually a delayed onset, but a lot of kids the day after head injury, they're going to want to sleep. They don't want to go to school.


Amber Warren, PA-C: And we encourage that, right? We let their brain rest. They need.


Dr. David Musnick, MD: To rest. But the worst advice to give a parent is tell this kid not to do anything for two weeks. That is not good advice. And that's the that's the common advice. Primary care and neurologist don't do much. Don't get exposed to much light. No kids need to get active once things are stable because the exercise creates trophic factors like brain derived nerve growth factor, PD, TNF and the exercise helps create. It's really essential so we can determine when they're ready to exercise. It's much sooner than when most people think.


Amber Warren, PA-C: With kids specifically after a head injury. I know this is just a really hot topic for a lot of our parents that tune in to to our podcast. And in general, I'm thinking two things off the top of my head with kiddos nowadays. M's blue light, right? What's your advice there in that post concussion window?


Dr. David Musnick, MD: Well, that falls under two different categories. The MFS fall under the category of protect the brain. So one thing we have to do after a head injury is protect the brain. Because because you don't want more injury than you're going to have anyway. So we want to decrease the EMF. So I tell most people, turn the wifi off at night and don't have a phone within eight feet of your head. And for some people I tell them, you know, hire a technician to go into your home and measure these fields and lower them as much as you can because. Especially with kids. Emfs penetrate the brain even more than adults. So with adults, there's even more suggestions. But one good suggestion a take home message is. If you have a Lexus in your house, turn them off. Right. Or they're big field generators.


Amber Warren, PA-C: Yeah. And that's what I'm surprised about. It's not always just the router or your wi fi or the cell phones. It's you mentioned a Lexus, but like the robot vacuums or the wireless thermostats now or I've learned just from having my own home tested wireless printers are one of the more aggressive wireless printers. Yeah. So we're making you know, we when we kind of redid some things in our home a couple of years ago to make it less, more or less EMFs, I just got so many people looking at me like we were crazy that we wanted to, like hardwired the house and go backwards, right? Because everything smart refrigerators and smart TVs and smart and it's like, Oh my goodness, what is this doing to our brains and our bodies?


Dr. David Musnick, MD: Yeah, I don't have any wireless in my house. I can turn it on if I need to, but it's usually off.


Amber Warren, PA-C: No, it's really important. So let's really quickly define that. So post-concussion syndrome versus a mild TBI, we kind of already touched on that, but let's maybe go that direction a little.


Dr. David Musnick, MD: Well, I mean, most post-concussion syndrome patients have headaches and they're fatigued and they want to sleep longer and they have some brain fog. And that can go on like six ish weeks. But it's most prominent for probably the first 2 to 3 weeks. But if people have persistent problems with word finding and memory and speech and concentration or balance, that is a brain, a persistent TBI, traumatic brain injury.


Amber Warren, PA-C: Okay. And how are most of these concussions or traumatic brain injuries treated here in our country?


Dr. David Musnick, MD: They're not. So what happens is they see their primary care. And the primary care just as you. So they're treated by labeling it. They sing your child or you have a concussion. They write that down. They they bill for it and they don't make specific recommendations. Or the neurologists might say, see a speech therapist? Well, that's fine. But the speech therapist needs to know exactly what's going on. And so that does make sense for some people to see a cognitive oriented speech therapist. But most of the other issues of the physiology of the brain are being completely ignored. And I mean completely because the neurologists are not telling people to decrease the electromagnetic fields. The other thing we haven't talked about in terms of the category of protection is there's a lot of neurotoxins in our food supply. So I have I've developed a whole healthy brain diet that we give our patients. I think it's a three or four page handout at this point. And one of the things is turn everything, buy everything organic for the time being non-GMO, and let's clean up the diet so you don't introduce more neurotoxins. So the average patient really doesn't get much treatment. And then we have what's called secondary brain damage, which we'll go into. But what that means is from the initial injury, then there's all these things like inflammation and cytotoxicity and all these other things that keep going on to lead to more destruction of neurons and synaptic connections and micro glial cell issues. And this stuff didn't need to happen. All these unchecked, all of a sudden, necessary damage could have been stopped.


Amber Warren, PA-C: Yeah. So what's the what's the pathophysiology that you target early on versus like later in the timeline?


Dr. David Musnick, MD: Well, early on, you target swelling. You target hemorrhage in the brain and something called neuro cytotoxicity. So just for instance, with that neuro cytotoxicity, that has to do with this very fast calcium influx into a cell where the cell actually dies because the MDA receptors on the outside of the cell are being triggered by something. And there's different things that can do it. You know, we all know that MSG can do it, but other things can do it. And this is happening after a head injury during the first few weeks. It's a big deal. Some of my patients that keeps happening and we have to interrupt it, but that's one of the reasons why we use certain types of magnesium for this to stop it, because you can block the NMDA receptor with magnesium. So that's just an example of some of the acute things. The other acute thing that's going on is decreased oxygen delivery. That's the another acute thing that's going on is this injured tissue is just sitting around. And if the body doesn't clear it out, the immune system will go, I don't know, I might present this to the immune system. The immune system, Then if there's too much of it around me, it may mount an autoimmune issue.


Amber Warren, PA-C: And that's where the the blood brain barrier antibodies come into play.


Dr. David Musnick, MD: That's where blood brain their antibodies come into play in antibodies to other areas of the brain come into play. If there's too much damage and it's not cleaned up right away. So there's a lot of things to be aware of acutely, and that's like the first week and then some acutely into the six weeks and then more chronically after that. There's different things that I would address depending on where they're at with all these things.


Amber Warren, PA-C: Okay, So let's go back to those trophic factors and why they're really important in the healing of the tissue in the brain. We talk about.


Dr. David Musnick, MD: That. Yeah. So there's a lot there's a lot of them. There's one called Nerve Growth Factor NGF, and then there's brain derived nerve growth factor. There's others. But the one most people probably know most about and the research looks most into is BDNF, brain derived nerve growth factor. And so how. If there's enough of this around, the nerves are able to regenerate better, to heal better, and the synaptic connections are easily able to grow from the nerves to other neurons, because the more connections we have, the better the region works. It's not just the number of nerves, it's the more connections that we have. Enough has to be around for this to occur along with brain training. You can't I mean, somebody said, well, what if I just take a supplement to increase BD and F? Well, the best supplement to increase speed and F is aerobic exercise. It's not a supplement, but there is a supplement. There are some supplements that might be able to do it. But so. We got to encourage those trophic factors. And that's why I put everybody on an aerobic exercise program that meets certain criteria.


Amber Warren, PA-C: And that's the steady state cardio where your heart rates in a specific zone and heard you educate.


Dr. David Musnick, MD: Your specific zone.


Amber Warren, PA-C: About that.


Dr. David Musnick, MD: That's great. And I want them doing it 4 to 5 days a week.


Amber Warren, PA-C: I love that. What can happen to these micro micro glial cells in our brain that are supposed to support our cells?


Dr. David Musnick, MD: Okay, So. Well, you could have asked me what my favorite cell in the brain was.


Amber Warren, PA-C: I heard your answer.


Dr. David Musnick, MD: I love the microwave.


Amber Warren, PA-C: I knew it. I knew that was the answer, honey.


Dr. David Musnick, MD: They are support cells now. Here's an interesting fact. Did you know we have nine of those to every neuron?


Amber Warren, PA-C: No. Yeah. So?


Dr. David Musnick, MD: So that's like that's like me having nine medical assistance or someone having nine secretaries.


Amber Warren, PA-C: So a lot of our audience probably doesn't even know what a neuron is.


Dr. David Musnick, MD: Yeah, neuron is the main it's the main cell in the brain. It's like the liver cell. It's like the mean cell in the brain.


Amber Warren, PA-C: You've got this 9 to 1 ratio of support cells to the right cell.


Dr. David Musnick, MD: And crazy. Yeah. And the support cells, they're supposed to produce these trophic factors, but they also do these things called pruning, and they actually move around in real life. They're moving around pruning the synaptic networks so that there's the best transmission there. And so they have these almost they're not arms, but there's extensions on them that just look like those things, you know, in a. You know, when the wind's blowing on a dusty road and the what do you call that thing rolling on the road?


Amber Warren, PA-C: Not sagebrush. No, I know what you're talking about.


Dr. David Musnick, MD: Yeah, it's like got all these extensions on it where you can think it's not quite like a starfish. But anyway, what happens is these get injured and called, they get primed, they get injured, they lose their extensions. They go from these longer extensions to looking like a starfish. So they can't move anymore. But they could still be in a healthy sort of situation where they produce the trophic factors. They can be in an unhealthy situation called the Gm1 phase, where they're not even producing the BDNF and the trophy factors and they're producing inflammatory molecules, and that's when the brain's inflamed. And this is happening in a lot of people, not just after head injuries. There's a lot of people with brain inflammation.


Amber Warren, PA-C: Like some of these post COVID patients, post COVID patients.


Dr. David Musnick, MD: There's a virus. People with viruses. There's so many people with brain inflammation. You don't have to have some god awful thing to have brain inflammation anymore.


Amber Warren, PA-C: And how what's what are some of the best ways while we kind of touched on them, but best ways to support the support cells. And ensure that they're functioning like one.


Dr. David Musnick, MD: You've got to protect the brain. We don't want any more of them getting primed. Two. We don't want a viral infection. Did you know that viral infections can prime and injure more of them? So we don't want viral infection.


Amber Warren, PA-C: That's a huge feat with the amount of viruses that are that are around us every day, all day. How do you how do you prevent getting a viral infection? That's a big that's a big ask. I get that we can go into a lot of topics in that way, but that's what we're good at as functional medicine practitioners.


Dr. David Musnick, MD: Hopefully most functional medicine. I mean, I've studied functional immunology, I love it and we can get into that topic. I think we should have a whole podcast just on viral stuff. Yeah, but, but. So we can support micro glial cells. You know, and so I always talk about this funny thing. I mean, you know, people used to have bumper stickers, so not that many people have bumper stickers anymore. But I always used to say in a teaching mode, if you had a bumper sticker, I'd say, support your microglial.


Amber Warren, PA-C: Cells and.


Dr. David Musnick, MD: Everybody would look at my car like, okay, what? What is a microglial cell and support your microglial cell? Yes. So one thing we can do is take special forms of curcumin, believe it or not, to support the micro glial cells, because they do. And there's certain other supplements that will support the micro glial cells including. Believe it or not, something in parsley.


Amber Warren, PA-C: That's your favorite food, isn't it? Parsley. You talk about.


Dr. David Musnick, MD: My favorite health food.


Amber Warren, PA-C: Favorite?


Dr. David Musnick, MD: Not my favorite. Not for me to eat. But I put it in smoothies. Even yesterday, I juiced parsley. That's something.


Amber Warren, PA-C: I've tried to hide it in my kids smoothies, and they just cringe every time they taste it in their smoothie. They can't handle it. Yeah.


Dr. David Musnick, MD: Yeah. No, Parsley has a passion, and it helps the microglial cells. Another thing that helps is luteal one.


Amber Warren, PA-C: Yep.


Dr. David Musnick, MD: So those are called flavonoids that help the microglial cells. And so but it's a fine balance between having these microglial cells switch from an M one to a two phase. Because if they're fighting an infection and someone gets and they need to deal with stuff, we can't shift too many of them that way. So it's almost like I talk about this like chess.


Amber Warren, PA-C: It's not like.


Dr. David Musnick, MD: A checkers game. This is a chess game. The doctor really needs to know how to play chess. Not like you've got a concussion. So go rest. That's checkers. Yeah, that's labeling and matching. This is a fine tuning of all these variables.


Amber Warren, PA-C: Yeah. We're just so thankful to have you. So, blood brain barrier. We talk so much about gut health. Yeah. And our our gut health barrier and the importance of it with regards to our immune system and interacting with our outside environment. Let's speak to the blood brain barrier. Why is that so important? And why do you care so much that we now have tests to test test for the health of it.


Dr. David Musnick, MD: And it's also abbreviated the b, b B.


Amber Warren, PA-C: We can refer to it as that.


Dr. David Musnick, MD: Because another bumper sticker I would have is take care of your B, b B.


Amber Warren, PA-C: I'd be worried about what kind of questions might come of that. So I wouldn't recommend getting that bumper.


Dr. David Musnick, MD: No, I don't. I don't have any members. It's just a way to make how people remember things.


Amber Warren, PA-C: I love it.


Dr. David Musnick, MD: You know, I have also another way is like if you're in the grocery store and someone comes up to you and says. For $100 gift certificate for this grocery store. What is a barrier that you want to protect in your body? And if you said the blood brain barrier, they should give you a gift card?


Amber Warren, PA-C: I would hope so.


Dr. David Musnick, MD: I would hope so. But anyway, so it's the lining around our brain. And it's not it's mostly small capillary networks, but it's also some of the support cells are in there, like the micro glial cells and the astrocytes. There's not neurons, they're not part of it, but it's the barrier. And that barrier is only supposed to let oxygen in certain nutrients and it's supposed to let waste products out. It is not supposed to let bacteria in there. It's not supposed to let viruses in there. It's not supposed to let all these toxins in there if and it's not supposed to let something call LPs lipopolysaccharide. And if it gets breached and if it gets damaged, there's a lot of stuff that can go in the brain that should not be in there, The brain grossly inflamed and damaged. So this is what I call secondary brain damage. The blood brain barrier has to be assessed. It has to be treated.


Amber Warren, PA-C: And you have success treating blood brain barrier. What are some of your favorite approaches to treating damage to that fine lining?


Dr. David Musnick, MD: That's where my ears are hurting by.


Amber Warren, PA-C: These You're.


Dr. David Musnick, MD: Fine headphones. Oc. There's a supplement called alpha lipoic acid. That helps. I'm not giving out doses here because it will get too confusing. Riboflavin. Which supplement can help. And then there's a modality which is my favorite sort of machine modality treatment called frequency specific.


Amber Warren, PA-C: There's your bumper sticker.


Dr. David Musnick, MD: Yeah, it's abbreviated form. At any rate, when we stream the microcurrent into the brain, it's really micro amperage. It doesn't hurt it. It's. You can directly help in the healing of the blood brain barrier because you literally got to treat the capillaries and there are frequencies for capillaries. So I have a combined approach with this where I test for it and then use the supplements and then use the microcurrent to treat it and. Thing is, you not only have to test for it once, but if there's positive antibodies, you got to you get a test for it about 4 to 6 months later, make sure those antibodies are going down.


Amber Warren, PA-C: The same way we do thyroid antibodies.


Dr. David Musnick, MD: Well, the same way we should test intestinal antibodies to the to the gut and then see that they went down, not just you got leaky gut, it's treated and never tested. You got to assess and make sure they're going down.


Amber Warren, PA-C: Make sure we've honed in on root cause. Right. Can you do anything about some of these visual disturbances our patients complain about after head injury? Do you have success with that?


Dr. David Musnick, MD: Yeah, this gets tricky because. But. People actually develop blurring vision. They can develop what's called a convergence disorder. There's different things that can develop. I had one gal who's one one eye was literally turned outward. It's called a strabismus. It was one I was tracking for. The other was turned downward. She was seeing blurry all the time. So I actually developed Microcurrent programs to train her eyes and we actually had to. She came in with one eye, blocked with glasses, so she only seeing out of one eye and that's what someone told her to do. The whole part of her brain that processed the other. I wasn't being used, so I had her have two different glasses, one that blocked one eye for part of the time and the other eye. So she was using both. And then we actually I do use a a neural optometrist in in the Boise area to assess people. Sometimes people need sometimes people need prism glasses, sometimes they need vision therapy. I added the frequency specific microcurrent to help that situation. Yeah.


Amber Warren, PA-C: I love it. How? Mood disorders. So that's something that's obviously well known in our in our in our medical arena. Right now is just anxiety depression. So let's speak to those patients that after some kind of brain injury, they develop some of those mood disorders. How do you treat those?


Dr. David Musnick, MD: Yeah, people develop anxiety and that's usually related to brain inflammation. The worst thing is anger. Anger management problems like severe anger that's been associated with chronic traumatic encephalopathy, multiple head injuries and then depression. Really tough depression to manage. So. First thing I do is like, you know, start treating brain inflammation. I'll use certain supplements. I want to try increasing neurotransmitters, starting with serotonin. See how well they do then go to dopamine to increase that. Want to decrease the fight or flight. Molecules and then I'll use frequency specific microcurrent to work on the actual limbic system, which is the emotional part of the brain, which helps a lot of people because some of these problems are tough.


Amber Warren, PA-C: What about these patients? I see them a lot. I know you see them probably ten times more than I do. Just happened to note in their paper, in their intake paperwork that there was a concussion or head injury or some kind of injury nine years ago. Can you help them if they're still having the anxiety, depression, maybe even the anger, let alone some of the the headaches or chronic pain or dizziness? Yes. Yeah. So, like up to a decade later.


Dr. David Musnick, MD: I love it even longer.


Amber Warren, PA-C: Yeah.


Dr. David Musnick, MD: That's because what happens is you just figure they've lost neurons, they've lost genetic networks, and then you go to assess what else is going on. Yeah, you have to assess brain inflammation. You probably, probably would order a test to the blood brain barrier, maybe autoimmunity. There's a lot to assess in people that are still having problems, you know, one, two or more years out.


Amber Warren, PA-C: Yeah. Something that you've been talking about on the grand stage for a long time is the kind of equipment you recommend, right? For those of us with little kiddos or even as adults, we want to be active. We want to still ski and snowboard and mountain bike but protect our brain. What is that equipment that you that you recommend?


Dr. David Musnick, MD: A funny thing. I mean, the funny thing is one of these things is sort of like pre sport training. Like, if I don't want, I'm going to tell all my patients to do ski conditioning or snowboard conditioning so they don't have as much of a chance of. Build your thighs and your legs and your balance up.


Amber Warren, PA-C: For.


Dr. David Musnick, MD: Core training. Then there is a company named Six D that has this incredible technology of one shell inside another with grommets. Those would be for bike helmets. I recommend at least a MIPS MIPS, which handles a little bit better rotational force, but I think 60 is better than MIPS for that. I'm hoping that there's better ski helmets coming out because they they're just a shell. They do not. You know, if I had my way, 60 would would be doing ski helmets and I'm I'm actually thinking this winter I'm going to wear my 60 helmet skiing.


Amber Warren, PA-C: Yeah. Why wouldn't you? Yeah. Yeah. I mean, why not.


Dr. David Musnick, MD: I don't know, but I'm going to try it. It's a nice orange helmet, and nobody's going to miss that.


Amber Warren, PA-C: No, you'll stand out. You'll stand out. So are you currently you're currently accepting new patients out of the Eagle Clinic Functional Medicine of Idaho. And we actually have a program slash protocol that patients can come in, have their evaluation done, and then start treatment with you. Yeah, I love that. That's wonderful. Anything else we didn't touch on that you think is really important in healing the brain after after concussion traumatic brain injury.


Dr. David Musnick, MD: Well, I mean, I think, you know. Sleep good. If people sleep six or less hours, their brain is going to be inflamed. And I see this a lot.


Amber Warren, PA-C: Yeah.


Dr. David Musnick, MD: People coming in with brain fog, memory problems, whatever. How many hours are you asleep? Six or less. So did you know that if we measured different inflammatory molecules after you did that night's sleep, you'd have inflammatory molecules and body inflammation leads to brain inflammation. People don't know this. You're going to be inflamed for four days and they go at least two or three days a week. I sleep six or less. So I said, You're constantly inflamed. So that has to be assessed and treated.


Amber Warren, PA-C: Are they undiagnosed sleep apnea? They think they're sleeping six and a half, 7 hours. Right.


Dr. David Musnick, MD: But that's.


Amber Warren, PA-C: True. Are they getting quality?


Dr. David Musnick, MD: So that's an oxygen issue. Yep. So so, yeah, I mean, I've sent a number of head injury patients that I think might have that problem.


Amber Warren, PA-C: Yeah, it's not worth missing that diagnosis. Right? No, you're trying to heal the brain.


Dr. David Musnick, MD: Because one of the things is oxygenation. So there may even be a role for hyperbaric oxygen treatment, especially early. But what you're indicating is, like when people sleep, they better be breathing well. That's true. I mean, there's a lot of these variables. Some of these other variables are. If someone doesn't heal well, well, maybe they have reactivation of Lyme or Co-infections or Epstein-Barr, or maybe they have mold. I mean, there's all these things. If the blood brain barrier gets breached or the immune system goes into dysfunction. Things that were contained before may not stay contained. So that's that's when I have to look at a patient say, why are you not responding as I would, you know, think you should.


Amber Warren, PA-C: Yeah. Functional medicine practitioners are really good at that. Casting a wide net. Right. What else is going on? Right. I love that. So I like to end each one of my interviews with this question. If you had to mention one piece of advice that has moved the needle the most for your patients, given your patients the most access to heal, what would that be?


Dr. David Musnick, MD: Well, we just talked about it. Get more than 6 hours of sleep, get seven or more and be asleep for that.


Amber Warren, PA-C: Long and don't be on your phone. Light exposure right until bed.


Dr. David Musnick, MD: I'm not saying that it's easy. There's so many people that have circadian rhythm problems and, you know, but get assessed by a good functional medicine provider that can really assess your sleep and give you advice on all the aspects of it. So you're actually getting your deep sleep and you're getting your quantity because that will influence so many things.


Amber Warren, PA-C: Yeah, yeah. It's great, great, great, great advice.