Health care staff and intrigued residents alike were invited to meet one of the state's few certified brain injury specialists last Friday. A presentation was delivered at the Alaska Island Community Services clinic by Dr. Amy Murphy, who is also medical director for Providence Medical Group Brain Injury Services in Anchorage.
Brain injury is a medical subspeciality, with only 312 certified specialists in the U.S. As such, it was a unique opportunity for her visit, which was sponsored through a Rural Veterans Health Access Project by the Division of Public Health.
In addition to her public presentation Friday evening Murphy met with AICS staff earlier in the day for some instruction in practical treatments for cognition, headache management and mood disturbances.
In her profession, Murphy treats both Acquired Brain Injury and Traumatic Brain Injury (TBI), in three classes of injury: mild, moderate and severe.
The main area of her concern in the presentation was TBI, often acquired through fluid percussion and blunt trauma. Repeated or consecutive such injuries can have a devastating effect on brain function.
“Brain injury can definitely be a life-changer,” Murphy explained. Sufferers can experience feelings ranging from fuzziness and lost vision to a change of identity. Treatment can be long and taxing, affecting both the sufferer and relatives. “It's very profound because it hits all areas of life.”
Recently public interest in the field has been spurred on by Players Association of the National Football League, following several high-profile suits against the league relating to high incidence of chronic traumatic encephalopathy among players.
“That put a big spotlight on sports concussions,” Murphy said. She pointed out the dialogue has been important in transforming sports culture, not only in the professional leagues, but also among youth players.
Murphy pointed to recent improvements in medical understanding of the effects of cumulative head trauma, which have helped shape more effective treatment guidelines for pro and amateur organizations.
By stepping forward and treating CTE and other related head injuries as real concerns, she noted the NFL has helped lessen social pressures to disregard minor concussions and resume play.
The military has also led the way in research and public awareness, dealing with TBI and similar injuries sustained by personnel during the wars in Iraq and Afghanistan.
Murphy's own involvement in the field of brain injury began in the Army, where she began work at Washington D.C.'s Walter Reed National Military Medical Center in 2007. Like the professional sports world, she noticed the military had had its own culture of ignoring or underestimating head trauma.
“That entire culture has changed from the press that's coming out,” Murphy said.
Part of diagnosing traumatic injuries is through neuropsychological testing, which scrutinizes memory and other brain functions. These tests serve as a counterpunch to MRI and CT scanning, which examine the brain's physical characteristics.
Common issues for TBI sufferers include lack of sleep, physical fatigue, cognitive problems and mood swings.
“The fortunate thing is that we have great treatments for all of these,” Murphy commented.
These include pharmaceutical approaches that can help with TBIs. She said amantadine – originally a prophylactic approved in the 1960s for use against influenza and Parkinson's disease – has been shown to help, improving the brain's reception and processing speed of dopamine, a neurotransmitter.
She said not many doctors are aware of the drug's usefulness in treating TBI, and one of her aims in delivering these presentations is to spread the word. Though pricey, amantadine is by now generally generic, and so is often covered by insurance.
Most users with mild injuries can be weaned off the medicine within two months of reportedly feeling “100-percent” again. For more severe cases, patients may have to use the drug for life. Amantadine's main side effect is a decrease of appetite, which may seem like a boon but can also make maintaining proper nutrition difficult.
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