HBOT Conversations:
Dr. Jay Stevens

Head Injuries : TBI, mTBI, Concussions, & Post-Concussion Syndrome

Dr. James “Jay” Stevens is the Medical Director of Extivita-RTP.  He earned a Bachelor of Arts in Zoology from UNC-Chapel Hill and a Doctor of Medicine from East Carolina University School of Medicine. He completed a Family Practice Residency at the Fairfax Family Practice Program at the Medical College of Virginia and the first Sports Medicine Fellowship at the University of North Carolina, Chapel Hill in 1991. He is Board Certified in both Family Practice and Anti-aging Medicine. He also holds a Certificate of Added Qualification in Sports Medicine. In 2003 he founded Carolina Family Practice & Sports Medicine with locations in Cary, Raleigh, and Holly Springs, NC. He has served as the Team Physician for the National Hockey League’s 2006 Stanley Cup Champion Carolina Hurricanes since their arrival in 1997. He also serves as Company Physician for the Carolina Ballet.

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Dr. Jay Stevens, Medical Director of Extivita returns to talk about head injuries in general, and the importance of treating all head injuries with Hyperbaric Oxygen Therapy.

Dr. Stevens has a wealth of knowledge in this area. He stresses that we are in the middle of an epidemic for head trauma. While there may be scientifically subtle differences between the definition of concussion, TBI (Traumatic Brain Injury), mTBI (minimal or mild Traumatic Brain Injury), PCS (post-concussion syndrome), and PPCS (persistent post-concussion syndrome), they are all classified as head trauma. Dr. Stevens explains that once we understand that a head injury exists, the next thing we need to understand and address is the magnitude of the injury.  But, let’s not forget about PTSD either, Dr. Stevens believes that PTSD falls into the category of PPCS.  PTSD is an interesting and complex head injury, because even though there was never head trauma that was labeled as a concussion, PTSD is absolutely a TBI, because it is a persistent injury past the acute phase where the neuron doesn’t know the difference.

Dr. Stevens talks about the difference between acute, sub-acute, chronic, and persistent head trauma, and why it’s important to know the difference between these when diagnosing and treating head trauma. The same goes for understanding the severity of the concussion grade. But no matter the type or grade of the concussion, all head traumas will benefit from immediate treatment with Hyperbaric Oxygen Therapy (HBOT).

Beyond diagnosing and treating head trauma for professional athletes and those in the military who have served our country, it’s incredibly important to also understand the benefit of HBOT for adolescent athletes. In Wake County, NC, where Dr. Stevens’ practice is located, there are somewhere between 2,000 and 3,000 concussions reported a year. While Dr. Stevens states that’s probably a pretty fair statement to make, he makes a point to expand on such.  At Carolina Family Practice & Sports Medicine (Dr. Stevens’ primary care sports medicine practice in Wake County), they see roughly 1,100 concussion visits per year at the high school level in the county.  Dr. Stevens shares past stories of high school students who have never been quite right after a concussion, and how he wishes there was a HBOT facility like Extivita-RTP in their backyard then.  He trusts that these student athletes would be living a different life today. Dr. Stevens informs viewers that his practice has penetrated the Wake County school system with screening & concussion testing, and feels confident that the baseline testing is making all the difference.  Now the student, coach, and doctor better understand when an athlete is just not feeling “quite right” after a head injury, and should be evaluated further.

di Girolamo questions how many of the thousands of concussed student athletes in Wake County are getting hyperbaric oxygen therapy.  Dr. Stevens agrees that most adolescents likely aren’t using HBOT unless they are coming to him; and he does have parents who seek him out to treat concussions with HBOT and some who also will find their way over to Extivita to use HBOT for concussion relief.

The connection between the gut (also referred to as the second brain) and the brain is discussed.  Dr. Stevens and di Girolamo agree that there is a beautiful connection between the two and how one plays off the other for good health.  If your gut or your mind are not healthy, it affects your entire body, state of mind, and quality of life. An amazing Hyperbaric Oxygen Therapy healing story of an adolescent with Ulcerative Colitis is highlighted to help our viewers understand this connection.

di Girolamo and Dr. Stevens stress that Hyperbaric Oxygen Therapy is one of the best things you can do for yourself or your child for head trauma relief. HBOT is an amazing natural treatment that will change the life of a concussed individual. Dr. Stevens informs viewers of the importance to use Hyperbaric oxygen in the acute concussion stage to give your brain the oxygen it is starving for as it heals from head trauma, and how if you do that then you can give someone back their quality of life and help the injured avoid post-concussion syndrome.

Guest

Robert Beckman

Dr. Jay Stevens

Dr. James “Jay” Stevens earned a Bachelor of Arts in Zoology from UNC-Chapel Hill and a Doctor of Medicine from East Carolina University School of Medicine. He completed a Family Practice Residency at the Fairfax Family Practice Program at the Medical College of Virginia and the first Sports Medicine Fellowship at the University of North Carolina, Chapel Hill in 1991. He is Board Certified in both Family Practice and Anti-aging Medicine. He also has a Certificate of Added Qualification in Sports Medicine. In 2003 he founded Carolina Family Practice & Sports Medicine with locations in Cary, Raleigh, and Holly Springs, NC. He has served as the Team Physician for the National Hockey League’s 2006 Stanley Cup Champion Carolina Hurricanes since their arrival in 1997. He serves as Company Physician for the Carolina Ballet as well.

In 2009, his commitment to helping his patients create healthy lifestyles for long-term wellness, along with his desire to provide the highest quality health care services, motivated Dr. Stevens to establish Essential Health & Wellness (EHW). EHW offers its patients a comprehensive health care service tailored around their busy schedules with the goal of optimizing their performance and longevity.

In 2018, he continued this commitment to long-term wellness of his patients by becoming the Medical Director at Extivita RTP, a hyperbaric oxygen therapy facility with two, twelve seat treatment chambers in the Research Triangle Park, Durham, NC.

Dr. Stevens is also a Fellow in both the American Academy of Anti-Aging and Regenerative Medicine and the American Academy of Family Practice. He is a member of the American Medical Society of Sports Medicine and Hyperbaric Medicine International.

Dr. Stevens lives in Cary, NC with his wife, Dr. Patience Stevens. They have three sons Eric, James, and Timothy. He is passionate about surfing, triathlon and almost any form of exercise.

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Recent HBOT News

Clinical Trial – Intrathecal Neostigmine for Prevention of PDPH

Neuraxial blocks continue to be the cornerstone of anesthesia and postoperative analgesia for
normal vaginal delivery and elective caesarean section due to its approved safety and
efficiency for decades. Post-dural puncture headache (PDPH) is still one of the most common
complications of neuraxial anesthetic techniques. The headache could be severe and limit the
activities of the new mother to care for her baby, prolong hospital stay.

PDPH is defined as a headache that develops within five days of dural puncture and can’t be
attributed to any other types of headache and mostly is postural in character.

Neostigmine methylsulfate is a synthetic carbamic acid ester which reversibly inhibits the
enzyme Acetylcholine esterase (AChE) that makes more Acetylcholine molecules available at
cholinergic receptors. Neostigmine is used in anesthesia mainly as a reversal for
non-depolarizing neuromuscular agents.

Intrathecal (IT) neostigmine was tried as an adjuvant to local anesthetics in IT block for
elective cesarean sections to decrease local anesthetic consumption and to prolong
postoperative analgesia. Side effects of IT neostigmine are dose-dependent with doses more
than 25 µg especially nausea and vomiting and could be decreased by increasing the baricities
of the local anesthetic solutions and by early head up position after IT injection. However,
its effect on PDPH was not investigated before in literature.

Parturients will be randomly assigned into one of two groups: the intervention group will
receive 20 µg with IT Bupivacaine and the control group will receive an equivalent volume of
dextrose 5% with the IT Bupivacaine.

The objective of the current study is to evaluate the efficacy and safety of IT neostigmine
as an adjuvant to bupivacaine in reducing the incidence and severity of post-dural puncture
headache in parturients scheduled for an elective cesarean section.

Evidence brief: hyperbaric oxygen therapy (HBOT) for traumatic brain injury and/or post-traumatic stress disorder.

This report is a product of the VA Evidence-based Synthesis Program. The purpose is to provide “timely and accurate syntheses of targeted healthcare topics. to improve the health and healthcare of Veterans”. The authors have made a comprehensive search and analysis of the literature and make recommendations to assist clinicians in dealing with veterans suffering from either traumatic brain injury (TBI) or post-traumatic stress disorder (PTSD). The report is timely and of great potential impact given the vigorous and lengthy debate among hyperbaric physicians and lay people determined to find an answer for the large numbers of veterans deeply affected with some combination of PTSD and post-concussion dysfunction.