CHAPTER 9

H IS FOR HEAD TRAUMA

THE SILENT EPIDEMIC

I wouldn’t let my six-year-old son near any football field. And if any coach asks my son to play football, I’ll sue that coach, and I’ll sue the school.

BENNET OMALU, MD, NEUROPATHOLOGIST WHO DISCOVERED CTE (FOOTBALL DEMENTIA)

SHAWN DOLLAR: THE SURVIVAL STORY OF A BIG WAVE SURFER

Shawn with his family

Shawn Dollar with his wife, Jenn; son, Kai, 5; and daughter, Kaylee, 1; in 2016 at the beach in Pleasure Point, California

When I first met with Shawn Dollar at our clinic, I was transfixed by this professional surfer’s story. On September 7, 2015, 35-year-old Shawn was surfing in a remote area off the coast of Big Sur. As a 25-foot wave approached, Dollar stood up on his surfboard and dove headfirst under the wave. Unfortunately, the sharp edge of a boulder sat just below the surface, and his skull slammed into it. On impact, he heard his neck shatter. In fact, it had broken in four places, and he’d suffered a concussion. Although he was dazed, Shawn knew people weren’t supposed to move after breaking their spine.

As Shawn floated in the ocean, trying to remain conscious but without moving, he realized he had three choices. He could drown, allow himself to be pounded against the rocks, or begin paddling toward shore and risk paralyzing himself. None sounded ideal, but as Shawn thought of his wife and kids, he was determined to try paddling the 30 to 40 feet to shore.

“I had to muster up all the strength I could to survive,” he said. “It was terrifying.” He had little strength to move or even mount his board. The waves relentlessly knocked him off his surfboard. Yet not only did Shawn make it to shore, he hiked up the beach and walked a mile through ravines and up switchback trails to get to his car at the top of a cliff.

As it turns out, surviving and then making it to the hospital were the easy part. The recovery ahead was far more brutal than Shawn could have imagined.

Shawn surfing.

During a break between the semifinal and final heats of the 2010 Mavericks surfing contest, Shawn Dollar —though not a competitor —paddled into and then rode this 55-foot wave, setting a Guinness World Record. Photo by Phil Gibbs. Used with permission.

But one thing Shawn Dollar had going for him was tenacity. He isn’t your average surfer. He’s an internationally recognized professional who has broken the Guinness World Record twice for the largest wave ever paddled into —once during the legendary Mavericks competition near Half Moon Bay, California, and again off the coast of Cortes Bank, southwest of Los Angeles, where he rode a 61-foot-high wave.

After his injury, Shawn, a gifted athlete accustomed to training, did everything the doctors and physical therapists asked of him. He was determined to make a complete recovery, and by November, his neck had healed.

“As soon as the neck brace came off, everybody thought I was back,” Shawn told me. “But I could feel my life falling apart.”

Shawn had severe migraines every day that made him throw up and kept him from sleeping. His mood swings were intense, accompanied by feelings of depression, anxiety, confusion, and even suicidal thoughts. His memory had also deteriorated: He couldn’t focus, do simple math, or match his socks.

“He had trouble with recall,” Shawn’s wife, Jenn, said. “There were memories that had gone missing, experiences that had fallen through the cracks.”

After months with no improvement, Shawn explained his concerns to two neurosurgeons. Their advice? Relax. The standard medical protocol for concussions is rest, wait, and monitor, and that’s what they urged Shawn to do.

But things did not get better; they got worse. One doctor gave Shawn the impression that, although his neck had healed, his mental condition might remain unchanged for the rest of his life. “The brain doesn’t really heal,” he told Shawn. “Once you have brain damage, that’s it. That’s what you’ve got.”

Greatly concerned over his poor memory and mental state, Shawn began looking for other sources of help. He researched new doctors and therapists and experimented with various treatments. “A lot of the places I went to have one medium of care and that’s what they focus on. It’s frustrating because, you know, care needs to come in multiple ways,” he said.

Then Shawn’s wife, who loves health and fitness, told him about our work at Amen Clinics. She had seen my public television specials and during Shawn’s recovery started showing him some of my online videos. A mutual acquaintance connected us. Of course, after we took his history, we had to see his brain.

“From my MRI to CT scans,” Shawn said, “everything in my brain looked fine. The SPECT scan showed a totally different picture. . . . It put things into perspective. This is when things started to get better.”

After treating thousands of patients with traumatic brain injuries, coupled with my work with 200 active and retired NFL players, I had seen this type of brain before. The overall decreased blood flow, evidenced by what appear to be holes of inactivity, was consistent with the pattern of a severe traumatic brain injury (TBI). Like the football players we’ve seen, Shawn had been knocked around while surfing.

“I’d taken some bad wipeouts at Mavericks and come up feeling dizzy, but I always got better,” he said. “Now I understand why I was not getting better this time. The scan gave me hope. It gave me the diagnosis to start to heal and to get everyone around me on the same page. My wife started to have more empathy for me as well, which helped our relationship.”

SHAWN DOLLAR’S “BEFORE” BRAIN SPECT SCAN

Surface SPECT scan showing areas of very low blood flow.

Shows damage to both of his temporal lobes and overall decreased blood flow

SHAWN’S BRIGHT MINDS RISK FACTORS AND INTERVENTIONS

BRIGHT MINDS

SHAWN’S RISK FACTORS

INTERVENTIONS

Blood Flow

Low blood flow on SPECT

Exercise, diet, ginkgo biloba

Retirement/Aging

    

Inflammation

    

Genetics

    

Head Trauma

Serious

HBOT, neurofeedback, supplements

Toxins

    

Mental Health

Depression, stress at home

SAMe, betaine supplement, stress management tools

Immunity/Infection Issues

Low vitamin D

Vitamin D3 supplements

Neurohormone Deficiencies

    

Diabesity

    

Sleep Issues

Insomnia after accident

Sleep strategies

We immediately began treatment, and Shawn attacked his recovery like he attacked the big waves. He did everything we asked of him, which included changing his diet, taking nutraceuticals, and undergoing neurofeedback and hyperbaric oxygen therapy (HBOT). HBOT is a noninvasive, safe, and well-established treatment for decompression sickness, a hazard of scuba diving. It delivers pure oxygen at greater-than-atmospheric pressure to improve poor circulation and increase the amount of oxygen your blood can carry. We recommended it as part of Shawn’s treatment plan because an increase in blood oxygen helps stimulate the release of substances called growth factors and stem cells to help in the healing process (see more on neurofeedback and HBOT in chapter 19). Shawn said, “I felt significantly better after the first HBOT treatment.”

Today, Shawn is happier and closer with his family than he has ever been. His focus and memory have improved as well. He is starting to surf and have fun again, but he has wisely decided not to surf big waves anymore. He and his wife, Jenn, are two of my favorite brain warriors and memory rescuers.

SOFT BRAIN, HARD SKULL

In multiple studies, having one or more head injuries has been associated with an increased risk of lasting memory issues.[282] If the injury occurred before the age of 25, a person has 2.5 times the risk of memory problems; if it occurred after 55, a person has almost 4 times the risk. And the risk is even higher if that person has the APOE e4 gene.[283]

Many people think of the brain as firm, fixed, and rubbery, but it’s not. It only becomes that way after someone dies and the brain is fixed in formaldehyde. During life, the brain has the consistency of soft butter, tofu, or custard —something between egg whites and Jell-O.[284]

Your very soft brain is housed in a really hard skull that has multiple sharp, bony ridges, which means that the brain is easily damaged. Whiplash, jarring motions (think shaken baby syndrome), blast injuries, and blows to the head can cause the brain to slam into the hard interior ridges of the skull. Here are several mechanisms of brain trauma:

In addition, because your pituitary gland (the master hormone regulator) sits in a vulnerable part of your skull, it is often damaged in head injuries, causing significant hormonal imbalances.

Soft brain + hard skull with sharp ridges = big trouble when head injuries occur

A LOOK INSIDE THE SKULL

Top-down diagram of the inside of a skull showing symmetrical arrangements of chambers.

Notice the sharp, bony ridges. Looking down from the top, you can see the protective bony ridges along the interior of the skull, which can damage your soft brain in an accident or injury.

Each year about two million new traumatic brain injuries occur. At the time of this writing, more than 350,000 military veterans have sustained a TBI since 2000.[285] This means the Iraq and Afghanistan wars will likely have a 70-year tail, as these veterans will have an increased risk of psychiatric issues and dementia. They need our BRIGHT MINDS approach more than ever.

Common Causes of Head Trauma

PROTECT YOUR HEAD —IT COULD SAVE YOUR LIFE

This is worth repeating over and over: Protect your head. It contains your brain, which runs everything in your life. Seems obvious, right? Yet until very recently, this simple concept escaped the consciousness of many people in our society, me included. We let little children hit soccer balls with their heads and do dangerous gymnastic routines. People cheer at high school football games when the opposing quarterback is knocked out of the action after a vicious hit to his head. Many fans love the fights in hockey so much that the National Hockey League has not yet considered eliminating them from the game.[286]

I was once a crazy football fan. I played football in high school and for fun on weekends, and I was a passionate Los Angeles Rams and Washington Redskins fan. Football had been part of my life since I was young, and nothing in my medical training caused me to question my devotion to it.

That all began to change in 1991 when I started looking at the brain. One of the first big lessons I learned from our brain SPECT imaging work was that traumatic brain injuries (TBIs) —even those considered mild without a loss of consciousness and that occurred decades earlier —cause lasting damage that we could clearly see on scans. Those injured areas were wreaking havoc on people’s lives, causing depression, suicidal thoughts, panic attacks, temper problems, addictions, and memory and learning issues. What’s more, very few professionals knew it because most psychiatrists who see patients who struggle with these issues never look at their brains.

I also found (and still find) that I usually have to ask my patients multiple times whether they ever had a brain injury because many have forgotten even major events. The typical scenario goes like this: A person comes into one of our clinics complaining of a mood, anxiety, learning, memory, or relationship problem.

While taking the patient’s history, we ask if he or she ever had a traumatic brain injury.

Usually the patient says no.

Then we examine the SPECT scan, which shows clear evidence of a TBI. We see damage to either one side of the brain or to both the front and back parts of the brain. (This pattern is the result of a coup-contrecoup injury, in which the force of a blow causes the brain to move in the opposite direction, hitting the other side of the skull and damaging that side of the brain as well.) Once we see evidence of a TBI, we ask again, this time with more persistence and specificity. We’ll ask:

At first, I was amazed at the number of people who answered no five, six, maybe even ten times, and then, all of a sudden, remembered falling out of a second-story window, being thrown from a vehicle moving at 30 miles per hour, or falling off a cliff 150 feet into a riverbed below. One man said his mother told him he had fallen down a flight of stairs at the age of three and was unconscious for days, but he had no recollection of it.

It became clear to me that traumatic brain injuries are a major cause of lasting psychiatric illness and memory problems.

Of course, I was not the first person to make this discovery. Researchers who study and understand this issue have linked TBI to drug and alcohol abuse, anxiety and panic attacks, depression, ADD/ADHD, learning problems, school failure, murder and violent crime, suicide, job failure, incarceration, and homelessness.[287] In a study of homeless people in Toronto, researchers discovered that 58 percent of the men and 42 percent of the women had a significant brain injury before they were homeless.[288] This problem was much bigger than I ever imagined.

Sadie: overcoming a kick in the head

I met 42-year-old Sadie after she had failed her sixth alcohol treatment program. She desperately wanted to stop drinking but couldn’t follow through with any of the program recommendations because she was so impulsive and her memory was poor. Whenever alcohol was around, she just couldn’t say no or remember the sobriety strategies she’d been taught. Her brain scan, below, showed severe damage to her prefrontal cortex (impacting focus, forethought, judgment, and impulse control) and temporal lobes (affecting learning and memory).

After about the tenth question on the topic of brain injury, Sadie told me that she had been kicked in the head by a horse and lost consciousness when she was 10. Once we focused on the injury and its aftermath, she remembered that her grades at school had started to slip and she became more rebellious at home. People treated her as though she was just a bad person, which made her feel sad and hopeless. In addition to the alcohol and brain injury, Sadie had a family history of dementia, was not sleeping, rarely exercised, had mild hypertension, was often depressed, and wasn’t engaged in any type of new learning. Rehabilitating her brain with the BRIGHT MINDS strategies helped her to stay sober and rescue her life.

SADIE’S “BEFORE” BRAIN SPECT SCAN

Surface SPECT scan showing areas of very low blood flow.

Brain injuries after a kick to the head by a horse

SADIE’S BRIGHT MINDS RISK FACTORS AND INTERVENTIONS

BRIGHT MINDS

SADIE’S RISK FACTORS

INTERVENTIONS

Blood Flow

Low blood flow on SPECT, low exercise, mild hypertension

Exercise, ginkgo biloba, omega-3s EPA and DHA, diet

Retirement/Aging

No new learning activities

New learning

Inflammation

    

Genetics

Family history of dementia

  

Head Trauma

Serious

HBOT, supplements

Toxins

Chronic alcohol abuse

Eliminate alcohol

Mental Health

Depression, stress of addiction

Supplements, exercise, and eliminating the ANTs (automatic negative thoughts)

Immunity/Infection Issues

Low vitamin D

Vitamin D3 supplements

Neurohormone Deficiencies

    

Diabesity

    

Sleep Issues

Chronic insomnia

Sleep strategies

Football and brain trauma

Although many of our patients, like Sadie, have forgotten long-ago head injuries that contribute to memory problems, I’ve spent decades working with a group of people who regularly take hits to the head: football players. When I first started looking at their brain scans, I noticed that many Pop Warner and high school players showed clear evidence of traumatic brain injuries. These young players were between the ages of 8 and 18, and I was horrified by what I saw. Then I saw college players whose brains showed damage that was even worse. One college player was referred to me after a domestic violence incident. The left side of his brain was clearly damaged (see below).

A COLLEGE FOOTBALL PLAYER’S “BEFORE” BRAIN SPECT SCAN

Surface SPECT scan showing areas of very low blood flow.

Note the damage to the left side of his brain scan.

In 1999, retired Minnesota Viking offensive guard Brent Boyd came to see me, complaining of headaches, depression, fatigue, dizziness, and cognitive dysfunction. He had suffered multiple concussions in his football career; in fact, his teammate Joe Senser told me that he heard one of the hits against Brent all the way across the field. Brent spent many years dealing with postconcussive syndrome.

Yet when Brent applied for disability through the NFL, the league denied his claim and said his injuries were not football related. It was disturbing. “It was hell,” he said, “to experience decades of being called ‘lazy and crazy’ by friends and loved ones, not to mention employers —and then internalizing it and believing it myself.” Prior to the concussions, Brent had been a highly motivated self-starter, graduating with honors at UCLA while playing football.

Brent’s SPECT scans showed clear evidence of brain damage. Being able to see the damage changed the way he thought about himself. He later wrote to me, “I am eternally grateful to you for finally correctly diagnosing my problem and putting an end to the self-talk and put-downs by others. I had been so embarrassed by my condition that for over a decade I had cut myself off from friends, family, [and] ex-teammates and crawled under my blanket to die.”

In 2007, Brent was the first NFL player to testify in front of Congress about brain injuries in football, especially about the ramifications for younger players.

BRENT’S “BEFORE” BRAIN SPECT SCAN

Surface SPECT scan showing areas of very low blood flow.

Damage to multiple areas

In July 2007, Anthony Davis, another former NFL player, came to see me as well. He was concerned about the cognitive problems he saw in other retired professional football players, and he was struggling with his own memory, as well as periods of confusion and irritability. AD, as he is called by most who know him, was a College Football Hall of Fame running back for the University of Southern California who scored six touchdowns against the University of Notre Dame in 1972, earning him the nickname the Notre Dame Killer. He then went on to play professional football for eight years.

Because AD’s brain showed clear evidence of trauma to his left prefrontal cortex and left temporal lobe, we recommended a number of interventions to him. He faithfully followed through on all of them and reported significant improvements in memory, energy, focus, and judgment. Ten years later, I used SPECT imaging to rescan his brain, which showed remarkable improvement. Usually, as we age, our brains become less and less active. This is especially true for damaged brains, but as I’ve said, it doesn’t have to be the case. Your brain can be better, even if it has suffered.

DR. AMEN AND ANTHONY DAVIS

Amen and Davis

ANTHONY’S “BEFORE” BRAIN SPECT SCAN

Surface SPECT scan showing areas of very low blood flow.

Damage to left prefrontal and temporal lobe

TEN YEARS LATER

Surface SPECT scan showing uniform blood flow.

Marked improvement

The Amen Clinics National Football League (NFL) Study

As AD improved, he started to tell other football players that brain rehabilitation might be possible. He referred many other players to us and then asked me to speak to the Los Angeles chapter of the NFL Retired Players Association. At the meeting in January 2009, I was horrified by the levels of depression and dementia in the retired players I met. One player asked me the same question six times. From this encounter, I knew someone desperately needed to study brain damage and football. My research team at Amen Clinics, together with scientists from the University of California, Irvine, and Thomas Jefferson University, decided to tackle the issue with the help of the LA chapter’s outgoing president, Reggie Berry, and incoming president, Marvin Smith.

Now we just needed to find funding. It is a myth that retired players are wealthy. A large percentage file for bankruptcy, face sustained joblessness, or divorce within a few years of retirement. Most of the players, especially the ones who needed the most help, could not afford to get help, so all of us scientists donated our time and resources to do a pilot study on 30 players —a number that our statistician said was likely to show scientifically valid results. We fell in love with the players, who, as a group, were kind, grateful, gentle giants. We now have a database of nearly 200 players from 27 teams and all positions, including many Hall of Famers, such as Terry Bradshaw. Chris Borland also saw us; he made national headlines in 2015 when he retired from the San Francisco 49ers after his successful rookie season because he was worried about the long-term consequences of repetitive brain trauma.

For the study, we took detailed histories, had the players perform cognitive tests, and did both brain SPECT scans and QEEG studies on each of them. The results were very clear: Playing football had damaged multiple areas of the brain in more than 90 percent of the players.[289] There was persistent damage to the following areas of the brain:

Our group was not the only one reporting these problems. In 2002, neuropathologist Bennet Omalu, MD, autopsied Pittsburgh Steeler Hall of Fame center Mike Webster and was the first to discover chronic traumatic encephalopathy (CTE) or “football dementia.” Omalu then saw this disease of excessive tau protein deposits in many other football players who suffered with depression, violent outbursts, cognitive impairment, and suicidal thoughts. Dr. Omalu’s discovery was celebrated in the movie Concussion, starring Will Smith.

Researchers from the Department of Veterans Affairs and Boston University reported that 96 percent (87 of 91) of former NFL players autopsied had clear evidence of CTE; a study from the Mayo Clinic found that 32 percent of males who played football and other contact sports, even at an amateur level, had CTE as well.[290] Even a study sponsored by the National Football League itself found that retired players ages 30 to 49 were given a dementia-related diagnosis at 20 times the rate of age-matched populations, while players over the age of 50 received a dementia-related diagnosis five times the national average.[291] At this point, there is little doubt that playing football at any level can cause long-term cognitive and emotional trouble.

Recently, the Los Angeles Times reported that some of the powerhouse high school football programs in Southern California were having trouble fielding teams.[292] Mater Dei’s freshman team dropped by 30 percent, Loyola had the fewest number of freshman players in two decades, and significant drops were also seen at Notre Dame, Alemany, and Crespi, where I played football 48 years earlier. Nationally, participation in football has declined in six of the past eight years. This is bad news for high schools, colleges, and the NFL, which make billions of dollars each year at the expense of the health of millions of children, teenagers, and young adults. But it is good news for millions of lives.

If you have children or teens who want to play football, first tell them why it is a terrible idea and then tell them no. Your children’s brain health will take them through the rest of their lives either as happy, healthy, effective adults, or as ones more prone to depression, dementia, relationship problems, and legal trouble. September 2016 was the first month since 2009 that an NFL player had not been arrested.[293] Previously, each of 72 straight months saw the arrest of a professional football player. Does anyone think brain damage may be at least partially involved? In our study, football players had more than four times the level of depression (28 percent) suffered by the general population (6 percent).

As hard as you may try to justify the benefits of football —and there are many, including hard work, teamwork, strategy, and lessons in dealing with adversity —it’s impossible to ignore the physics. The brain is soft and housed in a really hard skull with sharp, bony ridges. It is not anchored to the skull, so the brain floats in cerebrospinal fluid. This means that helmets, which can do a good job of preventing skull fractures, cannot protect the brain from being damaged. Powerful hits propel delicate brain tissue against hard, knifelike edges, causing bleeding, bruising, tearing, and scarring, especially to the prefrontal cortex and temporal lobes. These hits can cause trouble even without a loss of consciousness or any outward symptoms of concussion. In our study, the number of concussions a player had was not associated with the level of brain damage. Brain damage may be occurring insidiously without your brain ever telling you it is in trouble, and it can ruin your life.

Once we saw the high levels of damage in our NFL players, we put them on the same Memory Rescue program I am giving you in this book, including the supplements listed on page 136. Eighty percent of our players showed significant improvement in blood flow to the prefrontal cortex, as well as improvements in overall cognitive functioning, processing speed, attention, reasoning, and memory.[294] In this table, you can see the improvements on the cognitive testing, known as MicroCog.

“BEFORE” AND “AFTER” SCORES ON MICROCOG IN 30 NFL PLAYERS

MicroCog is a computerized neuropsychological battery of tests that looks at nine different areas of cognitive functioning. Scores are presented as a percentage from 0(worst) to 100 (best).

As we saw our football players getting better, often decades after their last concussions, we knew this work was incredibly important for members of the armed forces, firefighters, and police officers —anyone who is at risk for brain trauma. In addition to the supplement protocol below, we often use neurofeedback and hyperbaric oxygen therapy to help rehabilitate head trauma. You can find out more about these interventions in chapter 19.

CHECKUP FOR HEAD TRAUMA ISSUES

Know if you have had a concussion

Take some time to remember whether you ever sustained a concussion or a blow without a concussion (subconcussive impact). Think back (or ask your parents). Did you ever

Consider getting a functional imaging study

A functional imaging study, such as SPECT or QEEG, may help pinpoint injured areas and is worth investigating if your memory is not what you want it to be or if you have signs of cognitive impairment.

Check for loss of smell (anosmia)

Loss of smell, or anosmia, is a common consequence of head trauma, and it could indicate a serious problem. The olfactory cortex, the area of your brain involved with your sense of smell, is near your memory centers, and these regions tend to deteriorate and die together. Having trouble smelling peanut butter, lemons, strawberries, or natural gas is associated with a higher incidence of significant memory problems. Scoring poorly on the University of Pennsylvania Smell Identification Test strongly predicted those who would be diagnosed with Alzheimer’s disease later in life.[295] Of course, if you can’t smell a natural gas leak in your home, you may not live long enough to have memory problems!

Lab tests

Be sure to assess all the other BRIGHT MINDS risk factors that pertain to you, especially through these blood tests:

PRESCRIPTION TO REDUCE YOUR HEAD TRAUMA RISK

The Strategies

  1. 1. Reduce your risk of head injury. Protect your head, wear your seat belt, and avoid high-risk activities if you care about your quality of life. Besides football, sports such as hockey, soccer,[298] horseback riding, auto racing, and skiing can be dangerous.

    The effects of head injury can often be eased with appropriate treatment, providing you offer your brain the support it needs and attack the risk factors for memory decline. I believe the secret to our success with active and former NFL players, as well as other patients with TBIs, is that we use a BRIGHT MINDS approach in all areas, including nutraceuticals. Consider neurofeedback and HBOT, which have also helped some patients. See more about these treatments in chapter 19.

Bright Minds Tip icon

As you age, protect yourself from falls, one of the greatest risk factors for head injuries. (See the BRIGHT MINDS habits list on the next page.)
  1. 2. Go and smell the roses. I mean that literally. There is evidence that repeated exposure to certain odors can improve one’s ability to smell.[299] In a study from Aristotle University in Greece, 111 patients with anosmia repeatedly trained their sense of smell twice a day using four odors (phenyl ethyl alcohol, eucalyptol, citronellal, eugenol). Compared to a control group, after eight weeks participants noticed significant improvement that lasted up to a year. If anosmia is an issue for you, put your nose to work. Research shows that sniffing certain essential oils, including rose, lemon, cloves, and eucalyptus, may help restore the sense of smell.[300]

The Nutraceuticals

The following nutraceuticals are essential to help support the brain’s healing process.

The Foods

AVOID (OR LIMIT):

CONSIDER ADDING:

PICK ONE HEALTHY BRIGHT MINDS HABIT TO START TODAY

  1. Always wear your seat belt when you drive or ride in a vehicle.
  2. To prevent falls or other injuries, do not try to carry too many packages or boxes at one time.
  3. Wear a helmet when skiing, biking, etc.
  4. Avoid going up on the roof or climbing ladders.
  5. Slow down.
  6. Do not text and walk or drive.
  7. Be careful when going up and down stairs; hold the handrail.
  8. If you have had a head trauma, have your hormone levels checked and optimize any that are low.
  9. Take the herb peppermint to help with healing.
  10. Eat eggs to boost acetylcholine.