Dr. John McClaren  00:00

What you're looking at for people who are getting these reflex tests done, those are the things they're going to do, the cue start testing and the tilt table test, which you know we're going to, we're going to orthostatically challenge you and see what happens to your blood pressure and your heart rate over time. And do the responses occur normally, or do I get, you know, a huge rise in my in my heart rate and a drop in my blood pressure when I become upright, which is not, you know, the response that you want to have. And it's got to meet a certain criteria, which they change, you know, they move the goal posts all the time on this stuff too. You know, used to be 30 beats a minute. Now some people are saying 40, you know, because it's like one do we have so many people, especially in this post COVID era, that have autonomic nervous system dysfunction, you know. And you know, again, what we you know, not to get ahead of ourselves on topic there, but you combine some of these things, which is the human experience, you know, oh boy, right.

 

Sophia Bouwens  00:52

Welcome to the life after impact podcast where we do a deep dive into all things concussion and brain injury related. We talk about all the different symptoms that can follow brain injury, different testing methods, different types of specialists out there, and different therapies available. I'm Sophia Bowens. I'm here with Dr Ayla Wolf, and we will be your guide to living your best life after impact.

 

Dr. Ayla Wolf  01:22

Welcome to the life after impact podcast, where today we have Doctor John McLaren on the show. And Doctor McLaren, you've been in private practice since 2002 outside of Omaha, Nebraska, correct, correct. And you have a diplomat in chiropractic neurology. You also completed a very intense program and earned a fellowship by the American Board of brain injury and rehabilitation. And then, if that wasn't enough, you actually went back to school. You already have a doctorate degree, but you went back to school. You got a master's degree in clinical neuroscience, where you spent a lot of time studying traumatic brain injuries as well as dysautonomia, and then you earned your master's in clinical neuroscience. You're on the faculty of the Carrick Institute. You've had the honor of presenting at the International Symposium of clinical neuroscience, and you specialize in your practice in brain injuries, concussions and different neurological disorders. So I'm thrilled to have you on the show. As one of my teachers, I find you to be just a wealth of information and so generous in sharing your information. So thank you so much for being here. That

 

Dr. John McClaren  02:35

is about the greatest introduction I could ever ask for. Thank you so much for the kind words. And, yeah, I've done, I've done all that. I guilty as charged. My wife would say it's just because you're bored or, you know, things like that. But, but the thing that is great about clinical practice, and when you get into this stuff, you just, you know, you dip your toes in a little bit, and it's like, oh, I'll just go to, you know, I even me, you know, it's like, I'll just go to the first TBI seminar, I'll get some guidelines. I already kind of know what I'm doing, and then I'm like, I don't know what I'm doing at all. So here I am, you know, like I said, you know, sucking that from the fire hose, trying to get more and, you know, you're in over your head. And it's, it's definitely something you can never, you can never know enough in this practice. You same with you. You know you're super duper credentialed, and you just keep going. And I am so excited for your book, you know, personally, and for my patients and anybody else that I'd refer to. So

 

Dr. Ayla Wolf  03:34

put me on the list. Thank you for that. And you know, you are so right. I think every single patient comes in and presents with their own unique challenges that forces us to constantly be learning more, and it's never ending. I mean, even with my book, I referenced papers that were published in January of 2025, in my book, like, I mean, it's just the amount of new stuff coming out is so good,

 

Dr. John McClaren  04:01

it is. And that's the thing. You go one more paper. I remember when I did my long COVID class, I found a paper, I think it was that week or the week before they got published, and it's like, Hey guys, this is hot off the press. I I don't even have a citation for it yet, so it's the way it goes. For sure, you find stuff all the time, and it's kind of nice when assertions you make in your inner research get validated, kind of at the last second, like that too. It's,

 

Dr. Ayla Wolf  04:25

oh, yeah, absolutely. You know, things like patterns that you were seeing or things you observed, all of a sudden, someone publishes a research paper on it, and you go, Okay, so I'm not crazy. I really am, you know, seeing this correctly. And,

 

Dr. John McClaren  04:38

yeah, I'm not the only person that saw this, or you find stuff that was way, way buried in the in the weeds, and it, you know, for some reason, it wasn't really spoken about a lot. But then, you know, a lot, with the old faction and the long COVID, that was really, really big. And it was nice to see that, because olfaction, you know, I always said it's kind of like the red headed stepchild of our you. Vista, you know, it's a vestigial sense. It doesn't mean much. And then COVID happens, and everybody's like, well, I guess olfaction is probably pretty important for cognitive function.

 

Dr. Ayla Wolf  05:07

Yes, I mean the amount of anxiety that people were having when they couldn't smell. And I think people don't realize, you know, when you can't smell, you don't know if your house is on fire, and that, you know, not knowing can create tons of anxiety when you aren't when you lose that sense?

 

Dr. John McClaren  05:23

Oh, for sure, yeah. Or, you know, even simple things, like, while the baby's got a load of diaper and, you know, stuff like that, you just go cheese. It's like, I don't want to smell it, but you kind of want to know for the kid,

 

Dr. Ayla Wolf  05:35

right? You do need to know if the diaper change needs to happen. Yeah, yes. Well, I did read a study that said that 55% of people after a traumatic brain injury have changes in their smell that lasted for, you know, up to a year afterwards. I've certainly had patients that have experienced a loss of smell longer than that. So you know, also with brain injuries that loss of smell can be a symptom as well. Why don't you give us some of your background in terms of what led you to not only study chiropractic, but then to specialize in neurology specifically?

 

Dr. John McClaren  06:13

You got it? Yeah, the so how did I get here, so to speak? And you know the thing, and in listening to you guys in the podcast and in our discussions from before too, we always, you know, when we kind of choose our healthcare profession, we have kind of a horse in the race, you know, so to speak, or or things like that. I was a, I was a high school student at Cornhusker Boys State. The the Boys and Girls State programs are these Legion programs that they do for like leadership development and things like that for high school, like juniors going into senior year. I was at Cornhusker Boys State my, you know, Junior going into my senior year, and I get a call from my mom, you know, your dad was in an accident, you know. And I think eight, I had some friends in the room, and we were, we were meeting with one of my, one of my friends, who was, like, this gubernatorial candidate. And, you know that my face goes white, and, you know, one of the guys is like, All right, get out of the room. Guys, you know, clear the room for John. And then, you know, mom tells me the whole details. My dad was a locomotive engineer, and he was on a on a train headed, I can't remember which was eastbound, which was westbound. Now it's been, you know, it was 1994 he was headed one direction, and there were two trains headed the other direction. There was a signal failure, lightning, and these kind of things that happened. One train ran into the other. This wreckage goes everywhere. And my dad was in an oncoming train, and his conductor jumped off the train, and dad was thrown off the train as these things collided, landed on his head, his neck and so on. Luckily, was not paralyzed worse. You know, you know, what gets up. You know, see stars, clauses, way up the hill, this kind of thing. And, you know, they run for their lives. They get away far enough, and they just watch the carnage happen. And then, you know, ambulances come in and and they transport them to North Platte, which is, you know, a central Nebraska town that's kind of got the hub for emergency services and things like that. And his, his doctor in North Platte was our like childhood, my childhood doctor, he'd moved on, and so it was kind of nice to get a familial connection. Nebraska is small like that. I grew up in western Nebraska. So, so then, you know, I became intimately familiar with the world of traumatic brain injury. It took a little while for my dad to get the diagnosis. He's diagnosed with a traumatic brain injury PTSD, which, you know, some of the things we're going to be talking about today. You know, all these kind of things he had. He had a neck injury as well, which I have loved the way you guys have talked about neck injury on the podcast so far. I mean, your chef's kiss, you guys nail that stuff super well. And this is dad. He ends up having four vertebre fused. And, you know, had a neuropsychologist who got, you know, the diagnosis correct for him. And, you know, and the thing I saw with my dad, as, you know, I went on, I was a power lifter in college. I didn't know that I was going to be a healthcare guy at that time when dad got hurt, but I was, you know, it's a stem was, was kind of my path. It was, it was stem, or it was politics. And I'm glad I went to stem and not politics, you know, with the Boys State thing. And I had, I was a collegiate power lifter. I had a shoulder injury, had a chiropractor that I found via this muscle media you remember muscle media magazine back in the day I started

 

Dr. Ayla Wolf  09:26

working in a health food store that was managed by a bodybuilder when I was like 15 years old, so we probably had it laying around.

 

Dr. John McClaren  09:34

Yeah, it's around there. Bill Phillips would do the challenge, and he'd give his Corvette away to these guys. You know? Yeah, they had an article on on active release technique at the time, and I'd had the shoulder injury, and the orthos couldn't figure out what to do. And, you know, it's like, we can open you up and go in. And I was, I was nationally ranked as a power lifter, and the shoulder thing kind of took me down a few places. So I went to this A R T chiropractor, and it's like, that is what I want to do with my life. I don't, I didn't know. The time, how it would tie in with a traumatic brain injury until later, you know. So I decide chiropractic school, is it? I enroll at Parker. My sister lived in Dallas. That's why I chose Parker. You know, everybody will say my chiropractic school is the best because it's because my sister lived in Dallas and I, I wanted to have family close by for professional school, just because sometimes it's like, Man, I I'd like to have a home cooked steak, or, you know, something like that, or somebody to listen to me cry when I'm struggling, or

 

Dr. Ayla Wolf  10:27

quiz you with the note cards

 

Dr. John McClaren  10:32

all that. Yeah, here, you know, throw them at her when I miss, you know, she got good at dodging them, you know. So, so I chose Dallas, and I went to Parker, and my friend Haney helped me my first trimester in school, you know. And Haney and Glen Zlin, you know, those guys were like, try six at the time, I was try one. And these guys, you know, they they were like, you gotta see this professor, carrot guy. And they showed me a couple of the short shorts videos where he's running around on the stage, you know, and he's getting these people with Parkinson's to get up out of chairs and all these kind of things. And he had a, he had a patient on one of the case studies they showed me that was a traumatic brain injury patient. I'm like, Tell me more. And they did, and they got me hooked. And, you know, we started a, we they started a neurology club, and I just went and, you know, same thing. It's like, Give me all you got. So, so I start to learn some things. Go home, maybe some of this stuff. My dad had residuals. This is, I went to chiropractic school in 98 you know. So I go home for breaks, like, you know, as these guys kind of introduced me to some of the principles of examination and treatment, you know, let's, let's try it with dad. You know, Dad's balance is terrible, eyes closed, you know, when he tips his head back, things like that. He'd had, he'd had some fusion in his neck and things like that, too. So it's one of those really complicated cases. It's like, right away, I got a cool TBI case before I even leave school, whenever I want, you know, and he was, he liked it because it helped him, you know, he noticed differences right away. And again, I'm hooked. They started the diplomat on campus my seventh trimester at Parker. You know, at the time, it was a nine trimester program. So, you know, my last year, they started the program on campus again, Dr klotzig and Dr Peter Percoco were there as my instructors. And you know, like module one, I had like, 35 pages of handwritten notes. And if you see my handwriting, terrible. So then I was in,

 

Dr. Ayla Wolf  12:26

yeah, hooked, for sure. And so how do people find you in your community? And I actually lived in Omaha for about six months, by the way, when I was an infant, Oh, how about that? I didn't know. My dad got transferred there for work for like, six months. So obviously, I have no recollection of it, but I did live in Omaha.

 

Dr. John McClaren  12:46

You don't remember the flat planes and no,

 

Dr. Ayla Wolf  12:49

I just remember that we have home videos where there's just, like, really trippy music playing in the background. I was like, Dad, what were you into?

 

Dr. John McClaren  12:57

That's kind of awesome, yeah. What did Omaha introduce him to music wise, right? That's cool. That's cool. Yeah, I've been in practice. You nailed it. I've been in practice for 23 years now. And you know, it was just last month we celebrated kind of the birthday of the practice, which is, which is awesome. I, in my wildest dreams couldn't have imagined it going as well as it has it, of course, hiccups and bumps and bruises and all sorts of things, but it's just, it's been awesome. I haven't had to do, we just brought in some new stuff, you know, I've got, I've got some things that I've never marketed for that I really want to expose people to a little more and brought in some new stuff, but I haven't done any marketing or, you know, those kind of outreach things since the yellow pages were like a way to actually find people, yeah, you know, to date myself, right? You know, that's, you know, and yellow pages don't work anymore

 

Dr. Ayla Wolf  13:50

When you're so busy with patients, you don't have the time to then also be a marketing executive for your own company.

 

Dr. John McClaren  13:57

Yeah? And then, and then, you don't really, too. It's frustrating, because what works, what doesn't. I was off social media for four years, and I just jumped on a couple weeks ago. There was a guy that's like, Oh my God, you're still alive. I'm like, hey, you know, I've been here. You know, we've had our website and things like that this whole time. But, yeah, I got off for four years, and I decided to get back on again to kind of expose some of these new things and, and, yeah, you know, taking the faculty position, I wanted people to have more than one avenue to get a hold of me. Sometimes, you know, like Becca and Trish and Sammy are so busy, you know, you reach out to the Carrick Institute. They're, they're doing so many things. It's like, just Facebook me, you know, that kind of thing, or whatever. So you don't have to, you don't have to bother them with it, even though they're super great at taking care of people. So it's like, yeah, let's, let's get back on. And I just today, you know. And so, you know, you start posting things like, Here, here's another hyperbaric treatment, or here's some pulsed EMF that we're offering for, you know, all the the stuff you would offer that for now, like, like, my, you know. And of course. Because I've been dead for four years on Facebook, nobody, nobody's watching me anymore or anything anyway. And then today, I took the wife and kids to brunch before this, and I posted a food picture because I'm like, I haven't seen a food picture since I've been on Facebook. More engagement with that than any of my work stuff.

 

Dr. Ayla Wolf  15:17

I totally know that, like, I will post, you know, a link to a blog that I think is just so rich with information, and it gets like, one like, and then I post a picture of my dog, and it gets like, 55 likes, and you're just like, all right, the animals win every time.

 

Dr. John McClaren  15:34

Yeah? Everybody's like, I want to hug him, you know, that kind of thing, yeah, yeah, I know. I'm giving you the like on the post, and you're like, well, that that's great, but it doesn't help. You know? Yeah, so it's fun, but it's really good. And you know, the thing, I think, with me and in developing your practice goes through transitions, especially when you've been through as long as I have, I've always done functional neurology, and you know, some of the soft tissue techniques that athletes like have always spoke to me really well. I know, like Mark Ellis does a ton of soft tissue as part of his practice, and it's like you're speaking my language, man, because that I've been remapping collicular aspects like he has with with the soft tissue work all along. And that was a huge emphasis on my practice, especially early on, you know. And you see movement disorder cases and TBI cases, and you do some things, you know. And there wasn't a Facebook forum for collaboration, like there is now, or any that kind of stuff. So, you know, it's like, I'd call the one or two people I knew, and they're like, I don't know, you know. And we just kind of learned to try, you know, what would an optical kinetic do in this situation, or or things like that. And then, you know, the TBI fellowship program starts, and I found out how behind I was a lot of other people when I first got into that. Because, you know, we have so many people in this Carrick trained, you know, variety of disciplines between, you know, like, you know, your acupuncturists, the physical therapists that are doing it, you know, the the nurse, nurse and nurse practitioner, people that are doing it. I mean, you'll get Melissa Biscardi word, you know, those kind of things just amazing. And even medical doctors that really are fascinated with this kind of work. So, you know, a lot of it, originally, it was a lot of doctors of chiropractic, you know, and then, and then Professor Carrick built the bridges, and here it is. It's like, hey, you know, we're not the only people that can do this stuff. There's an evidence base for it. And it really, I think it's impressed so many varieties of people, and you can really tie it into whatever kind of practice you want. So I just think we have people that are trained really well. I've gotten to where, you know, Carla mellenbacker made a connection for me with somebody who's a speech language pathologist in our community. You know, in that they, they went out to see her when she was out in California for TBI. Because, again, you know, I wasn't marketing that I was in TBI, and they live in my community, so Carla's like, go see John when you get back home and and the thing organically grew. Tammy got me involved with the the Brain Injury Alliance, you know, and I've spoken at their state annual conference. I've done a lot of their support group work and things like that. So it really kind of got me into that community. I've done some collabs at the hospital up there, where we've rounded with each other. I've rounded with them. They've come and rounded with me. And a lot of times now, you know, some of the SLPs that are doing a lot of the TBI work up their speech language pathologists. They get a ton of this stuff. You know, they get a ton of really complex TBI is. And sometimes the thing, and again, you know, a lot of people are doing TBI work now in a variety of professions, because there's so much of it out there, and there's such a need. But people have a tendency to not blend things together because of, you know, differences in training and things like that. And that's the thing Professor Carrick has kind of showed us, is we can blend principles from every specialty together into what he calls head, eye, vestibular motion therapy or, or, you know, those kind of things. So it's like, Hey, John, I got one. I'm I've done X, Y, Z, can I send them over? And, of course, it's like, well, yeah, please. Some of them are really, really tough, you know. And I get why there's struggles there, for sure. So, that's one of the ways I've kind of become known in the community. A lot of it is referral, you know, from from internal patients. It's like, hey, my cousin's sister's brother had a TBI. Can they come see you? And it's like, well, yeah, of course, I'm here. And that's the thing. I think people don't want these cookie cutter approaches, you know, that you can find that, you know, just like any modality on its own, you kind of get that 8010 10 rule. You know, maybe it works for 80% of people, 10% of people, it somewhat works for and 10% or your your non responders that need to move on to something else.

 

Dr. Ayla Wolf  19:57

short answer, you get a lot of people the community. Who know your specialty and and so one of the things that I know you worked really hard on was this presentation on long COVID that you taught for the Carrick Institute. And I know a huge part of that was a deep dive into autonomic nervous system dysfunction. And so I wanted to, you know, have you maybe talk a little bit about autonomic nervous system dysfunction that you see, you know, not only with long COVID, but also that is one of the things that when patients come to me, that I often find has been the thing that's been undiagnosed until they come in and I start paying attention to it. And so a lot of, at least in where I live, I know there's like, a three to six month waiting list for people when they get referred to these conventional, big hospitals for their autonomic reflex testing. So it's great that we have some really great tools that we can do bedside that, you know, don't have a six month waiting list or don't require, you know, some super high tech and why don't you talk a little bit about, you know, somebody comes in to see you a lot of times the autonomic assessment is really the cornerstone, or the foundation of, you know, what we're looking at here. So maybe talk a little bit about how frequently you do see that in people that are having these lingering post concussion symptoms, and then how you're assessing it.

 

Dr. John McClaren  21:22

There are so many things that we can do. I mean, you talk about like, cue start testing, or tilt table testing and things like that, you know. And one of the things like you, you know, not to, not to make it sound like I'm a super genius, you sent me a list of topics ahead of time so I could kind of get in there and do a little bit of research on my own. And I thought, you know, let's look at CU, start testing your qualitative, you know, pseudo motor axon testing where, you know, we're putting somebody in conditions and seeing what the sweat response is, right, you know. And I thought, let's see if that actually has a body of literature associated with TBI. I mean, did you, did you go out and look for that cue? Start testing, TBI, like Google Scholar, PubMed, that kind of

 

Dr. Ayla Wolf  22:05

No, I did not look for a specific link between those two. What'd you find?

 

Dr. John McClaren  22:10

well, I wanted to see it. I wanted to see it because, again, that's the thing. What, what you're looking at, for people who are getting these reflex tests done, those are the things they're going to do. The cue, start testing. And the tilt table test, which you know, we're gonna, we're gonna orthostatically challenge you and see what happens to your blood pressure and your heart rate over time, and do the responses occur normally, or do I get, you know, a huge rise in my in my heart rate and a drop in my blood pressure when I become upright, which is not, you know, the response that you want to have, and it's got to meet a certain criteria, which they change, you know, they move the goal posts all the time on this stuff too. You know, used to be 30 beats a minute. Now, some people are saying 40, you know, because it's like one. Do we have so many people, especially in this post COVID era, that have autonomic nervous system dysfunction, you know? And you know, again, what we, you know, not to get ahead of ourselves on topic there, but you combine some of these things, which is the human experience, you know? Oh, boy, right. But, yeah, you know, people go and they get this stuff done, and they get results that maybe aren't conclusive, or things like that. If you know, yeah, I've waited six months to get in. I was gonna come see you, but I figured I'd wait until I had a diagnosis before I would and you go, that's six months of rehab. We lost, you know, that kind of a thing. And again, you know, with traumatic brain injury, you can make progress throughout the lifetime of the person, right? You know, the old conventional wisdom of, you know? And again, the goal post move, it's your your six months is your recovery window. A year is your recovery window. Two years is your recovery window, right? And now it's like, man, you know, it's a lifetime recovery process that you can have as long as you keep working at it. And some of it is slow and some of it's long, but people get frustrated and, you know, you wait six months for a diagnosis, you know? And it just stinks. So I went out and I looked at that, you know, let's go to PubMed, let's go to Google Scholar, and let's see if there's a there aren't a lot of sources out there that link the Q start testing to being significant for dysautonomia associated with traumatic brain injury. Same with the tilt table test.

 

Dr. Ayla Wolf  24:13

I found it really interesting because I had a patient who came in and she had a lot of symptoms. She had had three concussions, and I started working with her, and she had gotten a referral to go do all the autonomic reflex testing, but she had a six month wait list, and so she came in with a lot of symptoms. Well, I got to treat her for six months, and then by the time she went to do all of the autonomic reflex testing, it was everything was normal, except for the cue start. However, there was a little note on the bottom that said, this test can be impacted by certain medications. And there was, you know, I think a certain medication she was on that might have actually thrown it off. But you know, when we, you know, way back in like, beginning of clinical neuroscience training, you know, we talk about this concept of sweating. And as you know, being increased sympathetic activity that can sometimes be uneven. Some people might actually say I sweat more in my right armpit than my left armpit. And so even from a Chinese medicine perspective, sweating is a very important thing that we pay attention to, whether it's, you know, cold, clammy hands or hot, clammy hands, or if people have spontaneous sweating, you know. So in from a Chinese medicine perspective, the whole sweating thing is an important thing that we do pay attention to. But, you know, it's only one small piece of the autonomic pie, obviously. And so, you know, I've, I think that a lot of this conventional testing, like you said, sometimes it's a little it leaves people kind of with more questions than answers.

 

Dr. John McClaren  25:50

Yeah, for sure. And that's the thing. Or they get an inconclusive test or or, yeah, they get some of those things where it's like, well, it's probably your medicine. It's not your it's not your TBI. And that's the thing I see a lot, especially like, if litigation is involved, they'll try to blame anything but the TBI. You know, I had a guy was like, oh, it's diabetic neuropathy, you know, because he had, he had, like, numb hands and feet, and he had, he had a myelopathic injury to his neck. In addition to his TBI, he had like, an A 1c of 5.7 I'm like, thanks for that. You know, independent medical examiner for saying that. But that's the thing. A lot of these conventional tests, they're waiting on for a really long time. I'm so glad your patient came in and got the rehab you know, it's like, oh, darn you. You passed your test. That means, you know, you high five and go, well, let's just keep doing what we're doing. Then you don't need that stuff anymore, right? You don't. You don't need to wait for it at the next test to try to validate how you feel, you know, because that's ultimately what matters, right? People are coming in because they feel crappy and they want to feel better, and they think, you know, because of whatever, whatever it is that they got to you, that maybe you can help them. So, you know, when we're looking at these things, yeah, how much do you sweat, you know, and things that will happen too, you know, if I've got some dysautonomia and I'm doing some things that I should sweat when I'm doing, what'll happen is, instead, I don't sweat, and my hands and my feet and my nose and all these other things get really, really cold, which, again, you go in Chinese medicine, that's definitely not good. And again, in functional neurology, we know that's not good. And you know, you see these things where, and that's one of the things in in a lot of the training that we get, you know, the autonomic nervous system, everybody talks about how, like, it's parasympathetic, good, sympathetic, bad, too much sympathetic activity is bad, absolutely. But a lot of times, you know that kind of a model you're going you need a sympathetic nervous system to take the load of clothes up the stairs and, like, not pass out, or, you know, things like that, or to run around and chase your kid or something like that. You need to dilate some blood vessels, and you need to get the lungs to expand at a little higher rate. And you need, you know, pupillary dilation. So as we're talking about these things, people who are trained like us already going, yeah, now I know how we're crafting our examination that we're going to do at the bedside for this. So you know that that's one of the things, like, what do we do in our practices for testing? You know? And when somebody comes to see me, the first thing especially, you know, you can look at like a Rivermead post concussive score, especially if it's six months or later, after they've had the TBI, because it's valid six months or later, right? You know, some of these other inventories you can look at are really good to kind of point you toward. Well, we've got some autonomic types of symptoms, but before I do any, you know, pursuit or saccade or vestibular testing or things like that, the first thing I want is a baseline pupil test before I contaminate it with my exam, right? So I'm going to come in and I use the Reflex app, but no disclosures. I have like, a 100th of a 100th of a 1,000th of a piece of stock on it, because they offered it when, you know it was like, you get, you get a free month if you buy, like, a share or something. So I do have a tiny amount of share in it, but you know, it's more just because I think it's a fabulous piece of technology. And again, Professor Carrick introduced us to this, and we're getting a lot of data on what should happen with your people. And you can use this thing, you know, tons of different ways. The way, the way I use it at the beginning of my assessment is, you know, it'll it'll come in, it'll flash. You should see a pupil constrict when it's exposed to light. You should see it dilate, you know, to 75% of its original size relatively quickly. And you should see it maintained. And the app gives you, you know, constriction speed metrics, dilation speed metrics, latency metrics, things that with my pen light I am not as good at. You know, you can pick a lot of

 

Dr. Ayla Wolf  29:36

It's doing 30 frames a second when it does that, I mean we can't do that with the naked eye!

 

Dr. John McClaren  29:42

These guys aren't doing 30 frames a second, that's for sure. Or maybe they're doing it, but its sure not processing that fast up here, you know, I wish! So it gives you a lot of information, and you can kind of segregate that into, you know, some left brain versus right brain types of aspect. In regard to autonomic, you know, activations and so on and so forth. But, you know, those are things you should see. You get a pupillogram. How smooth is it? You know, how much does it constrict, dilate? Do they maintain that throughout the process? That's the first thing I'm doing before I do really anything else, other than maybe Gavin with somebody a little bit. So we'll get some pupils. We'll get some blood pressures bilaterally.

 

Dr. Ayla Wolf  30:23

Some of those reference ranges for the pupil, pupillary metrics are actually very narrow as far as, like, what's considered a normal latency between the light flashing and the pupil constricting, you know, and so though, again, like those windows of time that are measured in milliseconds, very hard to see with the naked eye, if you just shine a pen light in someone's eye. So I also love that app, that pupillary light reflex, for that reason, is to be able to capture a latency down to a certain millisecond, you know, and knowing that their norm, normal reference range is so narrow, you do start to be able to see, you know this, this orchestra between the parasympathetic and sympathetic nervous systems in this, in this test that takes 15 seconds to do.

 

Dr. John McClaren  31:09

That's beautiful. I The orchestra word is exactly what it is. It's this fine waltz between the systems, right, where, where, if they work appropriately, odds are good. You know, that patient's not going to have as big of a symptom load, or they're maybe not even going to come see you, because they feel pretty good if it works like it's supposed to, you know. And then, and then, yeah, you get in, and you grab your sphygnomometer and your stethoscope, and you take your blood pressures, you know, what happens on the left side versus the right side? Then you compare it, you know. And that's the great thing about this. You go, I've got different metrics that I can compare. And then you start to go, does this make sense? Do we have medications on board that can maybe contaminate some of our data? Which you go, well, there are some medications that can influence pupillary actions. There are others that can influence your blood pressure findings, but it's really hard to find medications that influence everything equally. So you can go, Well, I've got and again, even if they're on medications, these systems should adapt relatively well. Sometimes that's why they're taking the medication, is to get the system to adapt well. And if it's still not working, then then, you know, depending on your scope of practice and your relationship with your patient and your providers, you can give them that data. You can go, hey, you know, maybe the dose or the medicine isn't appropriate for this patient because we're still seeing XYZ, and it could be ruining or contaminating or, you know, causing a problem with our rehabilitation coefficients and so on, just communicating with other providers, which, again, you know, when you ask, how do people find you and how do you build this kind of practice, that's one of the best ways, because they go, Well, you're not just, you know, you're not just banging away on people willy nilly. You're actually collecting some data. And there's some care, you know, these primary practice people, they're really busy, and a lot of times they don't have the time to do this stuff if they, if they know how to do it. Sometimes they're, again, not trained like this, but they they appreciate it, and they go, Wow, that's a nice, you know, that's a nice approach that you take. I've got five others that are just like this patient who had a traumatic brain injury. They were, they were maybe on the same bridge, or, you know, something like that, where the multi car pileup happens. And, you know, they do. They become impressed with the way, you know, people, especially that are trained, really start to approach these kind of things. And they go, I never referred to an acupuncturist before, but I'm so glad I did, or I never referred to a doctor or chiropractic before. I always thought you guys were, you know, weirdos or whatever. And, you know, it turns out I was the weirdo for not doing it all this time. You know, and it helps.

 

Dr. Ayla Wolf  33:44

I see a lot of patients, you know, when they have things like Postural Orthostatic Tachycardia Syndrome, a lot of times they end up taking themselves off the medications they're given because of the side effects that they experience. And a lot of doctors are very upfront and saying, Listen, you know, we don't have a great pharmaceutical solution to fix this, and so let's just try this. And a lot of doctors are also kind of humbly approaching it and saying, You know what? Like, we're not so good at treating this, and we know that. But Here, try this, and if it helps, great, but if it doesn't like, then, you know, don't take it basically. And so, well, they know that, you know, a lot of their medical for, you know, approaches are kind of a trial and error. And you know, the way that I, I think the autonomic nervous system is so complex, and when you try to control one small arm of it with a drug, it usually doesn't equate to a good outcome. And I think, you know, that's what I see play out quite often. And I you know, like you said, you know, people kind of demonize the sympathetic nervous system and say parasympathetic, good, sympathetic, bad, but the way that I like to describe it is like your autonomic nervous system turns you into a high performance. Sports car. And so when you want to, you know, slam on the brakes and come to a screeching halt, you can or if you want to go zero to 60 in point five seconds, you hit the gas pedal. And your system can do that. And so it's like, it's that ability to modulate for whatever is appropriate in the moment. And and in some cases, if you're power lifting, you got to have that sympathetic output, otherwise you're not going to be a good power lifter.

 

Dr. John McClaren  35:29

Yeah, or you're snorting all these salts and doing all these other things to try to get it to activate. And, you know, I had a buddy man, he would, he would just literally have his training partner hit him with a two by four, just to get that sympathetic, you know. And I'm like, you know, and some of them, you hear it, it's like, oh my god. I'm like, I'm out of the gym. I'm like, I'm like, if you guys slap me like that, I'm gonna slap you back. And I'm out, you know, these kind of things. I'm like, Don't smack me, you know. I'm like, tell me nice things, you know, give me some validation, like you're a really good lifter, John, you're gonna, you're gonna lift. You know, I'm not the tough love guy with that. You know, don't corporately punish me before my lift. But yeah, you see, people do this stuff all the time, and it's just fascinating. And, yeah, you know, that's the great thing. Is, we've got these tools that are relatively inexpensive to assess it in a very thorough fashion. You know, this orthostatic testing is really a great thing to do. You can, you can check blood pressures in those different positions, you know. And if you a lot of this, too, people kind of go, how do I save time? You know? And I think the thing too, if you really want to do a service in this autonomic nervous system, in your TBI community, you got to be willing to spend a little bit of time. And it's okay. Maybe you don't do your whole do your whole exam in one visit, or something like that with people. Because, you know, if you're trying to fit, if you're trying to fit a TBI exam into a 30 minute window, I can't do it. Doesn't work. I mean, Professor carrot can probably do it in two minutes, because he has it when he looks at you walk. But, you know. I mean, for me, it's like, especially with some of this, yeah, you get, you know, the people on the trees pretty quick. Blood pressures are pretty quick. But you could, you got to spend some time and and you've got to try some different therapies and kind of see what happens as well. So you can, you can do a pull. I mean, you got a pulse ox, if you don't have a blood pressure cuff and a stethoscope and a pulse ox. Don't do this kind of work, right? I mean, and we should have all, we should all have those things, probably after our professional school, or things like that. The pulse ox, you know, get a good one. Don't buy the $20 junky one off Amazon or from Walgreens. Nothing against Walgreens, but get a good one, like a non and or, you know, something like that. My brother was a critical care nurse for a really long time, and he's like, don't, you know? And they, these are guys, those measurements, you know, their life and death for the things that they're doing. You know, he was a flight nurse. He's a nurse anesthetist now. And he's like, you really want good equipment if you're going to do that stuff. And again, Professor Carrick would say the same thing. Get a good pulse ox, you know, get a good stethoscope and auscultate the heart too. You know you can find so much with regards to the autonomic nervous system by what happens with heart sounds. You know it not only you know, is there a murmur or something like that, which you should find, if they have autonomic nervous systems, do they have a primary cardiovascular issue? But you can listen to your s1 and s2 sounds have them turn the head, just like we would in a posture graphic exam. You go, Well, if I turn the head to the left and I've got differences in s2 splitting or, you know, some muffling of an s1 sound, or things like that, then I know those are things that aren't supposed to normally happen a whole lot with physiology right now, I've got a deviation from what and that's the thing. Like we get normal physiology in our schooling. What is a deviation from that? Is that related to how I get blood and oxygen to my body? That's what your autonomic nervous system does, yeah, you know? And like I said, I just got back on social media. I mean, I go down my my feed, and everybody's got a way to activate the vagus, right? It's the new hypoglycemia, right? You know, it's like, everybody's firing that Vegas up, you know, due to the cold plunge, and breathe this way, and eat these foods and all these kind of things. And, you know, that's great that people are talking about it. You know, I see like Nate Kaiser's posts. He did the dysautonomia program for the Carrick Institute, you know, he's like, you know, he kind of takes some of these things.

 

Dr. Ayla Wolf  39:25

you know, when I've taught different classes, because, you know, you have the auricular branch of the vagus nerves, a lot of acupuncturists are really into a regular acupuncture for that reason. And so a lot of times I kind of have to say, like, Hey guys, the vagus nerve does not have a brain of its own, like it's not making its own decisions here. And so what you really need to understand is the connections of the vagus nerve into all these different parts of the central autonomic network, and that you actually need to be paying maybe a little bit more attention to what's happening above the vagus nerve.

 

Dr. John McClaren  39:58

It's ideal, right? Yeah. You know, it's like, don't look at me down here. Look at me up here, right? It matters, right? It really does. And sometimes it's okay. You have to, with some of these people where they've got this phenotype, that sympathetic nervous system is really, really overactive. Those those pupils are, you know, constricting and then dilating, like, really, really big and really, really fast. The heart rate is really high, the blood pressure is a little high. You've got a, you know, a huge discrepancy between left side and right side blood pressures. Again, these are all things like, you know, the primary question was, how do we examine these? As people are listening, they can go so I'm checking blood pressures on both sides. I'm checking blood pressure lying down versus seated versus standing. You can go ahead and check blood pressure in dual task settings if you really want to again, how much time do you want to spend on it? But you should do some of these aspects for sure. What does the heart rate do when I change positions? And you know, those are things, when people see that, that those things break down, you know, here they go. They may need some vagal nerve stimulation until you get those connections, those drivers of the vagal activity to work the way that they're supposed to, which when they've got a traumatic brain injury, that's what they're telling you is, hey, you know, I've got some issues. A lot of that really is rooted in those white matter connections, right? You get this white matter connectivity. I'm really excited. There's a there's a clinic in town now. They're an MRI and imaging center. They do DTI. It's commercially available. Yeah, so, so it's like, I am going to be sending you more than you probably want to deal with, right? Just because the you know the work they're doing with that, we're looking at these connections between the cerebral cortex and the brain stem. We're looking at the connections between the cerebellum and the brain stem. How does the cerebellum drive into these centers? How does the cortex drive in? Because you should get some activation of inhibition, of inhibition, and so on and so forth, so that that orchestra plays the way that it's supposed to. Yeah, I want to be, I want to be the Ferrari, you know, that you're talking about. I want to be able to rest and digest when I want and, you know, somebody breaks in, you know, I've had the big stake, and somebody breaks into my house. I want to be ready, you know, right away. I want to go, come back in 20 minutes. Once this thing's digested, I've got to, I got to get slapped in the back by my buddy with the two by four so I can fight you out of my house. You know, those kind of things. So, you know, that's, that's the thing. I want that system to be primed and ready to go. And, of course, I mean, there's a lot of ways for athletic optimization. I think a lot of the strategies they're doing may be unknowingly helping to harness these aspects, or knowingly, you know, to get them to work like they're supposed to.

 

Dr. Ayla Wolf  42:34

This was part one of my interview with Dr John McLaren. The second half of our conversation will be available next week. If you have a specific topic you would like to learn more about, please leave us a message, either by clicking the Send us a text link in the show notes, or emailing us at life after impact@gmail.com you can also follow us on Instagram at life after impact and sign up for our latest news and announcements by going to life after impact.com thanks so much for listening to today's show. Medical disclaimer, this video or podcast is for general informational purposes only and does not constitute the practice of medicine or other professional healthcare services, including the giving of medical advice. No doctor patient relationship is formed. The use of this information and materials included is at the user's own risk. The content of this video or podcast is not intended to be a substitute for medical advice, diagnosis or treatment, and consumers of this information should seek the advice of a medical professional for any and all health related issues. A link to our full medical disclaimer is available in the notes you.