Sidney Crosby and brain pull

Sidney Crosby gave a news conference. I quote from Red Fisher’s  column of the Montreal Gazette, Thursday, September 8, 2012. “What Crosby was saying on Wednesday was that nothing new from what all of us have been hearing for weeks; namely, that he’s been working out all summer, but when worked too hard his concussion symptoms returned to the point where it was difficult to drive (his car) or even to watch television.” So Crosby is right back to square one. Again from Pat Hickey’s article, “Crosby’s troubles began when he caught an elbow from Washington’s David Steckel in the New Year’s Day Winter Classic outdoor game in Pittsburg. He was cleared to play in the team’s next game against Tampa, but left that game after Lightening’s Viktor Hedman drove his head into the boards.”

I cringe when I read those words, “…drove his head into the boards.”

Mr. Crosby was quoted, asking out loud, ” A guy’s got to be responsible for his stick, why shouldn’t he be responsible with the rest of his body when he is going to hit someone? Whether it’s accidental or not accidental, you’ve got to be responsible out there.” What do you think Mr. Gary Bettman?

If I were to write now to Sidney Crosby, I would compose these words to him, they are heart felt, they ache with pain. Yet they offer hope.

Dear Mr. Crosby

I am a black sheep, hybrid style brain researcher. I live in Montreal. I have worked my entire adult life at McGill University. I first worked as a technician at the Montreal Neurological Institute (MNI) for a long time. I had a major life-threatening infection. I almost died. I was saved because I had massive doses of penicillin antibiotics infused into me. I learned the preciousness of life. Each day became special. Can I create a gift too, a medical discovery to improve all our lives?

At one  point I began to work with my new brother in law, Peter Dadoun at the MNI. Peter really opened my eyes, he taught me his passion, how to care for the experiments, how to feel them. Peter opened the possibility for me to really start thinking about our experiments, to actually design our own experiments. We compressed the way we did experiments, we tried all sorts of different things. I learned to be rigorous, to challenge my boss, Dr Hanna Pappius, with her ways. It was a huge turnaround for me. Uncle Pete and I were coauthors on ten papers centered around Dr. Pappius specialty topic of brain edema.

Last year although I have left Dr. Pappius lab over a decade ago I still visit her at each Christmas. She is such a precious person for me, my mama scientist. She allowed me to nurture myself in her lab. I always bring her a poinsettia plant. Last year she surprised me with this comment, “Michael all those years we thought we were studying brain edema. It looks like our lesion model that you were so skilled at performing  on the brain was really a concussion model. ” Wow, from  a real scientist leveling such courage, realizing such vulnerability, for her to admit such a thing is wonderful. It just proves how difficult studying the brain really is. So all those years we were really studying concussions, not brain edema. No wonder after two decades I have a powerful gut feeling for some keen understanding toward concussions.

After surviving my infection I wanted to really change myself, so that’s when I took my first sabbatical around 1991.  Rapidly, I found volunteer work in RVH cardiologist, Dr Duncan Stewart’s research lab. I wanted to learn about Dr Stewart’s speciality interest involving nitric oxide (NO) metabolism. I was fascinated that this NO gas, that NO could actually do things in terms of harmonizing smooth muscle cells responding inside blood vessels, causing dilation of the blood vessel. By the way this nitric oxide gas is really how Viagra works,  gorging the corpus cavernosum, making things stiff. I digress, I love to read in the medical literature. I read a ton, especially at PubMed, the National Institute of Health main  medical data web site-I still do avidly to this day. You can never never stop picking up new insights, especially with the brain.

Looking back the key to really learning about concussions is basically asking the simple straightforward question, “What do we pay attention to, in terms of data, symptoms, right after a conccussion ?”

The key link was pointed to me by former Director of The Montreal Neurological Institute, Dr William (Bill) Feindel. Feindel one day, I’m not sure why, probably because I was bugging him about how seizures start, chose to show me an article from the 1930 journal Brain written by Wilder Penfield with German co-author, Foerster. The article described horrible, penetration wounds suffered by people to their brains. Penfield described the healing process, specifically glial scarring pulling things inside the tissue injury tracts. Penfield called this cicatricial contraction, brain pull. Once a certain inner brain tissue strain was established, seizures would start to happen. Feindel told me as he assisted at Penfield’s side during scar removal surgery the following amazing observation. Feindel, described what happened next, “When Penfield would grab the dura mater (the covering skin if you like surrounding the brain) with his tissue forcepts, a seizure would trigger.” In other words, traction in the scarring tract of the wound would pull inside the brain to the point where the new tension would create different conditions so that a seizure would trigger. At this point you have to be familiar with Nigel Shaw’s work, in a gorgeous review paper with the title: The Neurophysiology of Concussion, published in Prog Neurobiol 2002 Jul:67(4):281-344

Mr. Crosby, this is I believe similar to what you have experienced within your brain. There is a new tension within your brain not visible with the best MRI at the University of Pittsburg. Although everything looks normal it is not, as you know.

Can we fix your brain Mr. Crosby?

Yes we can try, there is a way.

First we have to demonstrate what we think Nature is really doing in your brain right after a concussion. Oh, by the way Mr. Crosby, six summers ago I was given the priviledge to supervise a summer student with the entire support of Dr. Hojatollah Vali, who is in charge of our electron microscope facility here at McGill University. I supervised, student Stephane Ong-Tone with the following query. What does the heart have to do with concussions ? First we came across the work of Nigel Shaw from the University of Auckland. Shaw makes the jump between seizures with concussions. There is no doubt that cardiac derangement occurs with epileptic seizures. It dawned on me one day in the Montreal Neurological Institute (MNI) library, whispering to myself literally standing up in my little cubicule, breathing the words, “O mon Dieux, both concussions and seizures are involved with heart deregulation.  It’s both the brain plus the heart that I have to pay attention to.” That’s the perspective of neurocardiology, the heart beats from the brain.

Toward the end of that summer, Stephane prepared a Power Point presentation about our summer work. I arranged for a meeting with Dr Karen Johnstone, working then at McGill. Dr Johnstone was taking care of all the big concussion cases in the NHL like with Eric Lindros. I made my presentation in Dr Johnstone’s office, one on one. At one point she stopped me with, “You mean, the heart is involved with a concussion?” I was jolted by her remark. Her body language was somehow completely wrong. I would have expected a more passionate response, something like, “Holly smokes that’s incredible, WOW, tell me more!” Instead I had this flat reaction. To me I felt like a Broadway producer, watching an actor, it’s similar to reading a part for a Broadway play. If you don’t have the fire in your gut, you don’t get the job. I stopped the interview as fast as I could. She was not showing me any enthusiasm to think outside of her brain  box. I don’t care if you’re a neurosurgeon at one point you have to be able to close your eyes to feel Mother Nature. She wasn’t showing me that energy, that intense feel for her subject. I think of research as art, it has to come from the fire in your gut. You really want to know how things work, down to your best detail. Anyway that’s how I function

So you see Mr. Crosby there’s a lot of work to be done to break some stereotypes of how we think things are understood for concussions. By the way Stephane got into medical school at McGill. I wrote one of the three referee letters for his application into the difficult MD/PhD program at McGill. Only the best of the best get into the MD/PhD program. Stephane just graduated from the PhD component in neurology. I hope he can help us once he’s cleared the MD component  as we will eventually reach funding support toward demonstrating some of the great groundwork he helped us research those six summers ago.

Mr. Crosby, my best progress was made during the last nine months once my second sabbatical was started this year. But the twenty years it took to get to ask a sensible scientific query is about the norm in science. I just wish we had those mice experiments with Dr Faleh Tamimi were completed to demonstrate our catching of the right things to watch following a concussion. Hopefully our Kinesiology project with the kind help of Coach Clinton Uttley from the McGill Redmen football team will be the first real data toward observing the very elusive body signals following a concussion. We hope, like all good medical discovery that once you see the truth in Mother Nature, you say to yourself, wow it was always there, we just did not know how to see it.

So please be patient Mr Crosby. We believe we can diagnose accurately a concussion. If you’re very patient after we figure out how to diagnose the concussion rigorously, not the current nonsense self reporting stuff,  it means we’re dealing with the appropriate  brain zones for a treatment. That is our true dream, to be able to offer a real treatment other than the current situation of self repair.

Best regards,

Michael McHugh

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About cerebrovortex

Montreal Grandmother, Agnes Kent was saved by Raul Wallenberg from certain death, when he provided papers for her and her Mom to escape away from the Nazis. Today when asked what that escape meant, she replied,"Remind people, that while statesmen and whole countries remained silent and did nothing, a single individual chose to act, with ramifications that proved enormous. Similar choices confront us today. Write that simple truth she said, it can never be repeated often enough because the world keeps forgetting it."
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