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
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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Linear analysis of heart rate variability in post-concussive syndrome.
Heart rate variability (HRV) represents measurable output of coordinated structural and functional systems within the body and brain. Both mild traumatic brain injury (mTBI) and HRV are modulated by changes in autonomic nervous system function. We present baseline HRV results from an ongoing mTBI clinical trial. HRV was assessed via 24-hour ambulatory electrocardiography; recordings were segmented by physiological state (sleep, wakefulness, exercise, standing still). Time, frequency, and spatial domain measures were summarized and compared with symptoms, sleep quality, and neurological examination. Median low frequency/high frequency (LF/HF) ratio exceeded 1.0 across segments, indicating prevalence of sympathetic modulation. Abnormal Sharpened Romberg Test was associated with 29% LF/HF decrease (95% CI [2.1, 47.7], p=0.04); pathological nystagmus associated with decreased standard deviation of electrocardiogram R-R interval (SDNN) index (25% decrease, 95% CI [0.8, 43.4], p=0.04). Increased sympathetic modulation was associated with increased anger scores (19% LF/HF increase with 5-point State Trait Anger Expression Inventory-2 trait anger increase (95% CI [1.2, 39.1], p=0.04)). A 13% HF increase (95% CI [2.1, 25.7], p=0.02) was observed with increased Pittsburgh Sleep Quality Index scores. These results support autonomic nervous system dysfunction in service members after mTBI.
TBI study questioned: Dr. Weaver response.
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Sleep assessments for a mild traumatic brain injury trial in a military population.
Baseline sleep characteristics were explored for 71 U.S. military service members with mild traumatic brain injury (mTBI) enrolled in a post-concussive syndrome clinical trial. The Pittsburgh Sleep Quality Index (PSQI), sleep diary, several disorder-specific questionnaires, actigraphy and polysomnographic nap were collected. Almost all (97%) reported ongoing sleep problems. The mean global PSQI score was 13.5 (SD=3.8) and 87% met insomnia criteria. Sleep maintenance efficiency was 79.1% for PSQI, 82.7% for sleep diary and 90.5% for actigraphy; total sleep time was 288, 302 and 400 minutes, respectively. There was no correlation between actigraphy and subjective questionnaires. Overall, 70% met hypersomnia conditions, 70% were at high risk for obstructive sleep apnea (OSA), 32% were symptomatic for restless legs syndrome, and 6% reported cataplexy. Nearly half (44%) reported coexisting insomnia, hypersomnia and high OSA risk. Participants with post-traumatic stress disorder (PTSD) had higher PSQI scores and increased OSA risk. Older participants and those with higher aggression, anxiety or depression also had increased OSA risk. The results confirm poor sleep quality in mTBI with insomnia, hypersomnia, and OSA risk higher than previously reported, and imply sleep disorders in mTBI may be underdiagnosed or exacerbated by comorbid PTSD.