578: The cutting edge treatment for brain health, trauma, and long COVID | Shai Efrati, M.D.
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What if the brain had the power to heal itself long after injury, illness, or even the natural effects of aging? Today's guest, Dr. Shai Afradi, is here to explain how that might be possible. Dr. Afradi is the founder and director of the Sagal Center for Hyperbaric Medicine and Research at Shamir Medical Center, one of the world's leading institutions in hyperbaric medicine.

He's also a professor at Tel Aviv University and a global pioneer in using hyperbaric oxygen therapy to unlock the body's natural ability to repair and regenerate. His groundbreaking research has shown the brain is far more adaptable than we once thought, capable of generating new neurons and blood vessels even years after traumatic brain injury. In today's show, we dive into Dr. Afrati's innovative approach called the hyperbaric hypoxic paradox.

stimulates stem cells, triggers neuroplasticity, and supports recovery from strokes, traumatic brain injuries, and even cognitive decline related to aging and long COVID. We'll explore how this therapy is promising for conditions like long COVID, Alzheimer's, offering hope where conventional treatments fall short. Dr. Afradi will break down how hyperbaric therapy works, who it can help, and why this enhanced medicine could be the future of brain health and longevity.

Hyperbaric oxygen therapy. What exactly is it? I will start with general description of what are the tools that we as physicians have. So for example, in medical school, we are teaching the medical student to use the knife. And that's what we call surgeon or surgery intervention.

We are teaching the students to use chemical entity, whether you inject it or take it orally. This is a different drug that we use. And when we are speaking about hyperbaric medicine, it means that we take advantage

over changes in the environment in order to achieve a biological goal. So for that, we need to generate a controlled environment where we can play with the pressure, with the gases, with all the elements that we want. So in order to do that, we have a chamber. A chamber that we control everything that is happening inside. And if we want to divide the indication

into major application. One application is the pressure. We are using the pressure as the active ingredient. Another indication is the oxygen. We use the oxygen as the active ingredient. And probably we are speaking now of the third element, which is regeneration. How we can induce repair mechanism in our body.

So if we are speaking about the first one, which is pressure, pressure per se, we use this indication when we have bubbles in our body. For example, the bends. If you're diving and going up fast, you have bubbles stuck in your body and we need to shrink the bubble. In order to shrink an air bubble that is stuck in our body, we're increasing the pressure and then the bubble shrinks.

Here we are going to very high pressure. We don't use oxygen because at those high pressure oxygen can be toxic. So we are using gases like heliocs or so which are inert gas. So this is a classical one indication. The other indication, the second one is the oxygen. So if we want to bring more oxygen to our body, we can either increase the oxygen concentration by a mask

But if we want to go higher than that, we should increase also the pressure because oxygen is a gas. And if we want to deliver more molecules of gas, we need to compress more molecules per square.

More molecules will go into the lung and from the lungs to the rest of the body. Bringing more molecules into the same square means that we are increasing the pressure. We are condensing more molecules per square. That's the pressure-oxygen relation. So we are using the oxygen and the pressure in order to increase the amount of oxygen delivered to our body.

A classical indication related to that, for example, CO poisoning, smoke inhalation. When the CO is toxic to our body, we want to eliminate it. We are increasing the oxygen to compete with it.

If you have ischemic wounds, when you don't have oxygen delivered to a certain tissue, so we increase it several degrees high so it can bypass the occlusion. And this is the second element. So we spoke about hydrobaric medicine, control environment to achieve a biological goal. We spoke about the pressure, we spoke about the oxygen, and now we are reaching

to the third part, which is why we are speaking now, which is regeneration. And our thinking is how we can induce the repair mechanism, how we can induce regeneration. Because at the end of the day, the functionality, the way we function is the balance between degeneration, things that takes us down, to regeneration, to the repair mechanism.

If you will take a car that is coming out of the factory, from this point on, it's only been damaged. And from time to time, you need to repair. So we were asking ourselves, what are the crucial elements that are needed in order to repair, in order to have regeneration? So there are several crucial elements. First of all, we need a trigger.

Okay, a trigger that will initiate the repair mechanism. The body is lazy. It will never do anything without a trigger. Even us, we will not go out of bed in the morning unless we have a trigger. So we need a trigger. In addition to the trigger, we need stem cells. We need cells that can differentiate into the missing tissue. And this is the repairs.

And we need access road. We need blood vessels. Okay? And we need energy. That's the four elements that we need. Now let's go one by one. We spoke about the trigger. Well, before we go, I want to spend some time

talking about the benefits. So who can, and I want to come back to also, what does this feel like? What does this look like? So what are the use cases for this medicine, for this therapy? Is it, you know, let's talk about trauma as in concussions or is it longevity? Is it like, well,

Who can benefit? What are the use cases? So once we understand what we are doing, we can speak about the use case. What we are doing is inducing the repair mechanism. So for example, what we are doing, it's not hyperbaric oxygen therapy.

What we are doing is generating fluctuation in the pressure and the oxygen in order to induce the repair mechanism. So what we are doing, people are going into a chamber. It's not a tube, it's not a sack full of air, it's like an airplane that you sit inside. The pressure is compressed with air, not with oxygen.

And then you get the oxygen by mass. So, for example, we are increasing the pressure from one atta to two atta and taking 100% oxygen by mass. It means that we increase the oxygen level in the blood from 100 to 1600. And then this is the trick. We ask the people to take the mask off. What happens when they are taking the mask off? Oxygen is declining from very high back to the normal.

This decline from very high back to the normal is being interpreted at the cellular level as lack of oxygen, as hypoxia. Even though we don't have hypoxia, this is what we call the hyperoxic-hypoxic paradox. We are inducing all the things that happen when we lack in oxygen without the lack of oxygen. That's the trick.

Meaning, we are inducing the stem cells to proliferate. We are inducing generation of new blood vessels, generation of new neurons in the brain. And that's the treatment. Now, what are the use cases? We have a drug, or not a drug, an intervention that can induce stem cells, that can induce angiogenesis, generation of new blood vessels, generation of stem cells that can differentiate into the missing tissue. You can take it wherever you want.

So our main focus is on the brain because we think that the brain is the most important organ that we have in our body. Actually, this is our world. Whatever happened between our ears, this is the world that we experience. There is no real world, okay? Everything is fiction. Fiction between our ears. So it happens to be that the brain can repair itself.

When I was in medical school, we were taught that the neurons cannot be regenerated. Surprise, surprise. We have stem cells in the brain, in the hippocampus, in the periventricular area. And when we are doing this fluctuation in oxygen and pressure, we are inducing them to proliferate. They are migrating. And then we can see for the first time in humans, we can see neurogenesis, generation of new neurons, generation of new blood vessels in the brain.

we can see more mitochondrial activity, more metabolic activity. So who can benefit from that? The first study that we have done was on stroke patients. Patients who had stroke, classical insult, after the stroke you can have several degrees of injury. The most severe injury is necrotic, meaning the tissue is totally dead and being replaced with fluids.

With this kind of injury, we cannot help because there is no infrastructure. It's totally gone. We cannot help yet. I must say yet because we are working on solutions also to that.

However, surrounding this necrotic area, there might be tissue that is damaged but not fully dead. And this tissue, when we have the infrastructure, this tissue can benefit. This tissue enables the stem cells to come, enables the generation of new neurons, of new blood vessels, and then this tissue can repair. This is one element.

Another element is post-concussion syndrome, blast injury, mechanical injury, car accident. Again, we are evaluating the tissue by metabolic and anatomical imaging. Defined if we see an area, a kind of wound that we have the infrastructure, but the tissue is malfunctioning, then we can repair it.

And you can take it also to post-COVID. From our perspective, we are not treating the primary insert. We are treating the wound. And from our perspective, we don't care what caused the wound, as long as we can characterize the tissue and see that this wound can be repaired for us.

For example, it doesn't matter to us if you have a peripheral wound, if the wound, you got it by car accident or somebody hit you or stag you or gunshot you. At the end of the day, you have a wound. Now we need to characterize the wound and see what's going on. The same in the brain. We characterize the wound by the metabolic anatomical imaging.

characterize the wound, and if this kind of wound can be repaired with the intervention that we have, which is the hyperoxic-epoxic paradox, it's not hyperbaric oxidant, it's the hyperoxic-epoxic paradox, then you can get to the treatment and gain the benefit. And it's not symptoms, it's tissue. And if the tissue is responsible for the movement in the hand, the hand will move. If it's the leg, the leg will move. If it's related to your mental status, then that will be repaired.

So I'm hearing head trauma. I'm hearing long COVID. What about your run-of-the-mill cognitive decline that people experience over age? So we have done probably one of the most comprehensive studies done so far on normal aging. We took people age 65 and older, healthy, not diabetic, not strong, fully functioned. Us,

And we randomized them into treatment control and we were able to demonstrate that with this specific protocol, I'm emphasizing this specific protocol, we can induce neurogenesis, angiogenesis in the brain. And once we are doing that, the cognitive function is improving. Not because we are training cognitive, because you have a better brain functionality, biological function of the brain. And that's

That's great. So we did it on normal aging. We did it on mild cognitive impairment. And now we have a study that we try to push the boundaries even further. We take people with prodromal Alzheimer's to see if that's not too late. Prodromal Alzheimer's means that they have a significant cognitive decline. We can see the amyloid in the brain.

But they are still good enough to sign by themselves the informed consent. They still understand what's going on. And we want to see if that's not too late.

And we will have to wait and see what the results of this study will be. Wow. And so in terms of like for the run-of-the-mill cognitive decline, does that show up in people demonstrating they have improved executive function, recall, or are you just purely looking at like the brain of what's going on? Like what does this feel like for someone who's gone through this treatment and

to the, is it noticeable on day one? With regard to the noticeable, I want to, I will give you an example. Let's say that somebody is running the marathon and you are improving his ability to run better, but he's walking on his daily routine. So when he's walking, he will not feel the improvement. So what we are doing in the test that we are doing at the beginning, we bring everybody

to its limits, not to the normal for his age. I hate the word normal for age. Okay. Nobody wants to be the normal for his age. We want to perform at our best. So what we are doing, we are doing cognitive tests, bringing everybody to its limits with regard to memory, executive function, information processes, speed, attention. And after the treatment, you see that you are improving with that.

Now, whether you feel it on the daily routine, that depends what you are doing in the daily routine. If in the daily routine, you are a couch potato and sit on the couch and do nothing, then you will probably don't feel anything. But if you are active, challenging your brain, hanging around, meeting people, thinking, doing some executive function, then you will feel it definitely. And going back to where we started. So it sounds like this looks like a cockpit. So someone walks in.

Can you talk about, is it uncomfortable? They put on this mask. Are they sitting there? Are they reading? Are they watching TV? Is it a minute? Is it two?

three hours, just walk us through like, what is this experience for someone who's listening and saying, wow, I could benefit from this, but I need to understand what this feels and looks like. So if we are speaking about the brain as the primary indication, then it takes time. It's not a magic. It's not that you will do it once and that's it. You're inducing the repair mechanism and you need to give it time to repair.

So with regard to that, we are speaking about 60 sessions, six zero session, daily session, five days per week. Each session is two hours where you are sitting in a cabin of an airplane. And while you are inside, we will try to take advantage of this environment. So while you are inside, we will ask you to do some cognitive training.

that will actually trigger the certain areas in the brain where we want the stem cells to go there the most. And that we are doing best on the brain imaging. So if we think that we need area in the temporal lobe, we will ask you to do some executive function and things like that. So we will trigger that. So this area will have the most neuroplasticity.

It's not what you see. Unfortunately, there's a lot of fraud going around us. If people will write "hyperbaric oxygen" in Google, they will find tubes, sacks full of air that you can buy from Alibaba, bring them home and things like that. This is not it. Unfortunately, I see my face in some bizarre places that are unrelated at all.

If you want to see how it looks, you can look, for example, you can write Aviv Clinics. You will see it's a suite. You're going inside, you sit inside comfortably. You have a medical team with you inside who is well-trained in handling any condition that might happen while you're inside. Everything is controlled, the air, the pressure, the environment, no infections, not by virus.

bacteria, viruses, and not by oils and everything like that. It has to be well controlled. It has to be medical grade that you have the quality assurance that makes sure that once what we write is actually being delivered. And so it sounds like

60 sessions, two hours a day, five days a week. So this is like a five-week intensive. It's not for the faint of heart, but if you're suffering from long COVID or concerned about cognitive decline or have suffered from head trauma, I think this is something that you're really going to take a look at and commit to it. You mentioned the credibility piece, that there's a lot of potentially frivolous or dangerous places advertising on there. How does one go about finding people

a treatment center that's credible? So first of all, you must make sure that you have a physician. I mean, it's somebody who have license that can lose it if it's not operating appropriately. Physician that specialize in hyperbaric medicine. It has to be medical grade and you can make sure and just by looking at it, if you don't see that it's a multi-place cabin sitting inside

control environment, technician outside, medical team inside, physician outside to take a view. If you don't see that, then this is not it. Okay? And I highly recommend people not to play with their health. Our health is the most important thing that we have.

And in today's world, we have a lot of fake. We have a lot of crap going around. So people should be careful. There's a lot of accidents with the tube, with the sacs. Just this morning, I received a patient that was blasted in one of these tubes who came to our care. So be careful. And what are the typical costs, Ron? That depends on the area and location. So this is not me to say.

So that depends on what you have. There are programs that in addition to that, you will have the neuropsychologist, cognitive training and all of that. So there's a lot of variability. So people can...

Find the place and ask and what the program include. Is there like a ballpark? It's in between 40 to $80,000 for the whole program that includes imaging, cognitive, physiological, all of these things, all of these elements that are needed in the program. Wow.

And so I'm assuming insurance does not cover this yet. That depends on the insurance and location. Interesting. If insurance covers it. Of course, aging is not considered to be a disease yet. Not yet. Right. But brain injuries, because I want to spend, I think that's where I, if you have a brain injury, this, my guess is it probably would be covered. But why I want to spend more time there is people who've suffered from brain injuries are,

It's terrible. And there's not there seems to be a perception that there's not much you can do. It's not like I tore my ACL or my Achilles where the rehab is going to be tough, but I'm probably going to be able to get back to 90% or 80% or 100% of unlucky brain injuries. On the other hand, people are often told it kind of is what it is.

And that's to lose one's mind. We've seen this play out in the press with people with concussions and no shortage of disasters where people suffer traumatic injuries, lose control of their mental health, potentially take their lives, hurt people. It doesn't end well. It's horrifying. And so this is where I think that the use case of brain injury specifically, this is so promising because I think anyone who's listening is maybe thinking,

known someone who suffered from a brain injury or maybe experiencing it themselves would give anything to get something back. And I think once you start to lose control of your brain, it's horrifying for people. And so can you, you've got these tremendous success stories. Can you talk about, is there a success story as it relates to brain injury that stood out to you? No, plenty.

We are treating here in Israel more than 400 patients per day coming from all over the world. And also in our affiliated center in Florida and even in Dubai. Where's your affiliated center in Florida? It's near Orlando, central Florida. Okay. What's the name of it? I'm in Miami. We've got a lot of Florida listeners. How do you spell it? Aviv. A-V-I-V. Like Tel Aviv, only with the Aviv.

Like Tel Aviv. Got it. So that's the largest and most advanced hyperbaric facility in the US. And people are coming to there not only from around the US, people are coming from Europe, from other parts also to there. And as you say, once somebody have brain injury, especially young people who had concussion,

Post-COVID, I know that an amazing thing happened today related to post-COVID. It's not sexy anymore, so people don't talk about it. It's even hard today to make the diagnosis of the acute COVID if we want the kid because we prefer to ignore it. But COVID is here. Post-COVID is here. And the only thing that was proved to be effective for long COVID

is this specific protocol. That's the only intervention that was proven in a prospective randomized controlled trial to reverse the symptoms of post-COVID. And the most severe symptoms of COVID are related to brain injury. Today we understand that the virus can penetrate the brain. It can penetrate here, through the cribriform plate, or through the bloodstream. If it's penetrating through the cribriform plate, it damages the frontal lobe.

It can bind to the neurons, inject the genetic material into the neurons, damage the mitochondria. And then we have frontal lobe problem. Memory, personality, mood. Okay? That's the frontal lobe. That's the frontal lobe. And if it's penetrating through the blood, then we can see tiny strokes in the brain.

We can actually see the damage in the brain. And you know that now we have an increase in the prevalence of early dementia. And again, when COVID was 60, every medical center had the lock COVID clinic. Today, it's hard to find.

It's hard to find. They were all being closed. This episode is sponsored by Waterloo Sparkling Water. Research shows sparkling water is just as hydrating as regular water. And no sparkling water tastes better than Waterloo. Waterloo crafts every flavor in-house with non-GMO verified natural flavors for refreshing, authentic, full-flavor sparkling waters. Take Cherry Limeade. It brings together bright lime citrus and bold red cherry into nostalgic mashup.

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And you can find out more at drinkwaterloo.com. Again, that's drinkwaterloo.com. Sounds like it's hard to diagnose. You'd have to almost do an MRI of the brain. Yeah, you have to do the MRI, functional MRI. You have to exclude other stuff, our criteria, how you diagnose it. So we have to struggle. And in today's world, people should be active in handling their health, should look for solutions.

Not only count on the physician who's standing in front of them. They should dig in. They can learn. Today we have the access to the data. So use it. So long COVID is something we haven't talked a lot about, but in speaking to a lot of doctors I'm friendly with, there's definitely a feeling that more people have it.

That, you know, probably goes to the millions and we're not talking about it. It's probably underdiagnosed and people are walking around with like a general malaise or maybe brain fog and don't really understand what it is. And it's probably that's probably it. With that said, could you provide.

An example of someone who stands out, who walked into your clinic, who was suffering from long COVID, what that looked like, like how did that show up in them? How did it manifest? And then their treatment and what does that look like today? Because I also want to like give people an understanding of what this looks like and also provide them with some hope. So I'll give you two examples. I will give you an example of a child and I will give you an example of a young adult. The classical young adult is somebody who is active, fully functioned and active.

And after the COVID, surprisingly, he's feeling a kind of mental fatigue. He's more tired. It's hard for him to accomplish the full day of work without being exhausted and needed to sleep. He needs to cut the day, make shorter working periods. Instead of answering 100 emails per day, he can answer 10. Making mistakes while he's writing. The calculation is declining.

And the mood is changing. And it's not psychological, it's biological. It's a damage to the frontal lobe. This is a classical case of long COVID. And when these people, the main problem is that you don't see it from the outside. It's not at the hand and the letter. So if you will go to his physician, even if his physician will do a standard MRI, he will probably see nothing because the MRI show us only the anatomical structure.

You need to do functional MRI. You need to do metabolic imaging in order to see that. They are something like 5% of the professional athletes have retired because they cannot function in the same level as before. So they are now around the normal, but they cannot function the way they functioned before.

This is a classical long COVID. And, you know, in the study that we have done on long COVID, we have two arms. We have the intervention, the people who got the hyperbaric treatment, and we had the control group.

So, our thinking was probably most two groups will improve because you are getting away from the acute infection. Surprisingly, the control group objectively, when you measure objectively the cognitive function and physical function, were not improving.

What happened is that they got used to the new limitation that they have. They got used to seeing the world in a different way. They got used to answering 10 emails per day instead of answering 100 emails per day. That's what happened.

And it's just like you are sitting in a wheelchair. You're getting used to being in a wheelchair after a while. This is your new you. You're me. But if you measure it objectively, there are still malfunctioning. And that's horrifying. It is horrifying, too. And I think people, this would show up. Someone would say, oh, you know, maybe they're struggling. They're

They're withdrawing, maybe they're struggling with their mental health. I mean, it's this thing that's perpetuating because if you're tired all the time, you're probably not, you know, making meaningful connections, going out. And then we all know the consequences. If you're not connecting with people in a meaningful way, it's your mental health that's going to suffer. So it's this downward spiral. Yeah. And they're losing the job, but they're losing the friendship, the partner, the children. It's a new, it's a new person.

But it's biological. And once you repair the biological wound, that's it. Done. Go back to your normal life. And so these people, after the treatment, feel like it's a new lease on life, going back to their old self. It's just like going with a broken leg. You fix it. Now you can train yourself again. But if the leg is broken, it's a biological limitation. I know this question is probably somewhat controversial, but I'll ask it anyway. In your view...

Is long COVID caused by, was it caused by catching the virus? And also for some, potentially the vaccine triggered long COVID? It's two different issues. The vaccine, like any vaccination or any medication that we have, may have side effects. But the side effect, it's not long COVID. Long COVID is a completely different issue.

Long COVID is being caused by the virus. There are damage, tissue damage that caused by the virus. Vaccination, like any vaccination, any drug may have side effect, but it's totally separate issue. Understood. And so for someone who's listening who says, you know what, I think I may have long COVID, the takeaway is...

go get an MRI of your brain and look at the frontal lobe specifically. No. Before, don't do an MRI because this is unique protocol of MRI. Go to expert clinic who knows how to handle and diagnose long COVID. That's the most important thing. And unfortunately today, there are not many of them. But don't take the new me for granted and that's what you have. Don't give up on yourself.

Okay? Struggle to get back. Struggle to make the diagnosis, whatever it is. Don't take it just a mental status. We have people who were diagnosed with different psychiatric disease, which is long COVID. We have people who have central sensitization syndrome with pain all over the body, which is long COVID.

Okay. And once you diagnose and once you treat, they can regain functionality. Otherwise, there will continue to be mental disease, mental retardation, early dementia, and all of this issue. If COVID was not in the magnitude that it came to us, I would never, ever investigate long COVID.

If it was dripping up slowly, then nobody would think of long COVID. You will have some cases that suddenly people are losing their mental status, losing their cognitive. I would never dig into that. But since COVID came in such a magnitude,

And in the first study that we did, we evaluated the immune system. The goal was to, at that time in 2020, you know, in Israel, the government came to me and said, leave whatever you're doing, take your team, now focus on COVID.

So we, because the world is coming to its end. Okay. So we left all the research that we had done and suddenly we did on COVID, we said, okay, we are taking on ourselves the immune system to see where antibodies are going down, up, when we need another vaccination, how much you are safe. At those times, we didn't know what to look for. And when we did that study, we need to follow up the patient because we want to see how long the immune system holds.

And then suddenly we noticed that young individuals are complaining, complaining on brain fog, that they cannot function, they don't have the attention, mental problems. And we didn't understand what happened. And then we said, okay, maybe there is something over here.

And when we said that, we said there's post-COVID, long COVID, there was no definition of that in those days. And we said, let's dig into that. Let's investigate that. Let's understand what's going on. And of course, many of my colleagues came to me, Shah, you are crazy. Everybody's on lockdown. So it's related to the environment, et cetera, et cetera. I said, yeah, I might be mistaken, but we need to study that. And we understand that the COVID, the virus caused damage.

And again, we know that because physicians, scientists like me got into the study because it was in such large magnitude. The main problem today is that COVID is not sexy anymore. I think the world is so over COVID, the way we handled it, the burnout, like the lockdowns, everyone's just like, we're moving on and the virus has been weakened. With that said...

I don't know anyone, like most of the world was probably infected with COVID and long COVID is real and people are really suffering and it's probably undiagnosed. With that said, you did say, you know, look for an expert. That's the first thing you do if you think you're suffering from long COVID. So other than referral, other than a referral from someone you know who's had a great experience, what are some of the questions one should ask

of a doctor. First, ask yourself, don't take it for granted. I'm crap. I'm fatigued. I cannot, don't do that. Say, okay, I have a problem. When the problem started, okay? That's the most relevant element. If it started after infection, whether you have made the diagnosis of COVID during the infection, yes or not, because today we don't diagnose it in many cases,

Have a high suspicion rate that it might be it. Once you know it might be it, start with your general physician. Come to him saying, I'm feeling that and that. He will do a checklist. If the checklist is negative and the trigger started after an acute infection with COVID, even if the infection was one year, two years, three years ago, look for a clinic who knows how to handle it.

and make the appropriate diagnosis and then move to the appropriate treatment. What are the qualities of a clinic or a physician that you would look for? So, for example, if we're speaking about cardiovascular disease and you go see the cardiologist and you say,

I've got a family history and I want you to test specifically for LP little a, ApoB, and I want to do a clearly scan. These are like the gold standard of cardiovascular treatment in 2025. If that doctor says, no, I don't believe in it, it's time to get a new cardiologist. With that said, are there certain questions or tests one should ask a physician that if they don't check these boxes, you got to find someone else?

So if your physician is not doing high advanced brain imaging, high advanced cognitive evaluation, cardiopulmonary exercise test to exclude that, measuring other type of serology to exclude other disease that may cause that, you are not in the right hand. And look for somebody else who is more professional, who are more happy inside. I'm saying again, the main problem today is that

Most of the hospital or medical center will dealt with that type of close the clinic because, because it's not sexy. And your facility in Orlando, they'll do this. Is that correct? They will do that. People can go there only for the evaluation. Just make the diagnosis first. After you are making the diagnosis, then see what will be the next step, how to solve it. But, but make that diagnosis and be active.

Be active. And so let's segue to brain injuries, head trauma. You know, something I think the world is a lot more responsive to head trauma. I think we recognize it in a way.

that maybe we didn't before. Anecdotally, we have two little girls, wherever they go to, with their kindergarten, second grade, if the child hits their head on anything, the school nurse calls you immediately and says, your daughter hit her head in a tree. She's fine. She has a little bump. She's all there. Just nothing to do. I'm just letting you know. They're so cautious and I appreciate that because I think we all understand how serious head trauma can be. So with

With that said, can you talk about trauma to the brain? And let's maybe start with some of the success stories you've had. What did that trauma look like in this individual? And then how did they walk out? And then also, I think, building off of long COVID, how widespread is head trauma? So let's start when we're speaking about head trauma. It's even the brain is moving from one side to the other.

which is concussion, you know, the brain is flowing in a fluid and hitting the brain or blast or you are moving or being flowing up, then the brain is shivering inside, okay, in the fluids and hitting the borders. In most cases, it's been repaired. However, in either between 15 to 25% of the cases, it's not been fully recovered.

And in the brain we have two layers. We have the cortex, the outer layer, and we have the medulla, the inner layer. The mass is different. So if you have force on different mass, they are moving in a different velocity. And then you may have tears on the neurons in between and the small blood vessels in between. If you have this, then...

there won't be a full repairment of the tissue and you may find yourself ending up in what we call post-concussion syndrome. Post-concussion syndrome can be reflected by declining cognitive concentration, stability, mood. Of course, it depends on the area that was damaged. You spoke about children. We have done a study on post-concussion in children. We wanted to see whether the

the hyperbaric treatment that we give is also effective in the pediatric population.

So after getting the ethical approval to doing that study, we were thinking that we will go into the electronic medical record. And in Israel, all the records are electronic. We will write post-concussion, age between 9 to 16. We were thinking we will have thousands of children suffering from post-concussion syndrome. Do you know how many children are suffering, are being diagnosed with post-concussion syndrome, at least in Israel, but also probably the U.S.?

The number is zero, zero. And then we were thinking, wow, amazing. Does the pediatric brain have such a neuroplasticity that no child is suffering from post-concussion or do we miss the diagnosis? So we did another study. We took children that are coming to the emergency room because of concussion. The concussion was not severe, but it was severe.

severe enough that the physician will do brain imaging. And after the brain imaging, the child is being discharged from home. And we took children that are coming to the emergency room with a broken head, without the head injury. And we follow up them to six months, one year, two years. How many children are suffering from post-concussion? 25%. How many of them have been diagnosed with post-concussion? Zero. What was the diagnosis?

migraines, cognitive decline, mental disorder, psychiatric disorder. It was all post-concussion except that nobody diagnosed that as post-concussion. I think, at least for me specifically, I have an image of the definition of concussion and that someone gets hit pretty hard.

and they fall down and they don't know where they are or maybe they can't get up and that's maybe in the form of a car accident or playing an athletic sport or running into something but like there's this moment of i don't know where i am i'm not maybe lucid it takes a second and that's how i i think visualize like the definition of concussion is that fair am i missing something totally fair totally fair and again

Most of the people will recover within three months. However, up to 25% will not. We have amazing cases when the mother is driving the car, the child is sitting behind, they have a car accident, the mother after three months is being diagnosed with post-concussion syndrome. However, the child has suddenly problem with school.

He needs a private teacher to help him handle it all. He's suffering from headaches from migraines suddenly. So the mother has been diagnosed with post-concussion. However, the child in the same car, the same accident, ADHD, very common diagnosis, even though it's post-concussion. So that's amazing to see it happen. And again, just like the post-COVID,

The relation to the insult is the most important thing. If something happened to you and suddenly your child or yourself, you have a step function in your functionality, a step function in function from any kind, suddenly migrants, suddenly disability, suddenly ADHD, somebody suddenly learning disabilities, suddenly your mood is changed, dig in and figure out what was the insult.

And if you can see the insult, then move to the next level. See how you solve it, how you make the appropriate diagnosis and then solve it. Have you worked with any ex-professional athletes who've experienced head trauma or maybe a little bit more approachable veterans? You know, being with a lot of veterans at war, unfortunately, you've experienced severe head trauma. A lot. Okay. So for example, in our clinic in the U.S.,

There are a lot of football players who are coming to recover from their injuries. In Israel, of course, and in Israel, unfortunately, we have a lot of soldiers who are suffering from post-concussion syndrome. In Israel, the treatment

for any soldier with post-concussion is fully covered by the Ministry of Defense. They are coming here, we are doing the metabolic imaging of the brain, making the diagnosis and treating and then repairing and they can get back to normal life.

Okay, unfortunately in the US it doesn't happen this way. They are treating the symptoms. Here you are actually treating the core of the disease. Okay, so that's a significant difference. We are repairing instead of treating the symptoms. There is a difference. One question I have, does the amount of time that elapses, does that play a role in success? For example, let's say I'm a football player.

I have serious head trauma when I'm 25 and then I wait till I'm 50 and I'm starting to really like suffer from my mental health before I go to the treatment versus football. I'm a football player. I'm 25. I have head trauma. I suffer concussion. I go on the protocol and then I keep on playing and I proactively do the protocol. Like is this, not saying this is a great scenario, but let's say hypothetically I'm

The quarterback of the Miami Dolphins has notoriously suffered a number of concussions. A lot of people are questioning if he's going to return. Would a viable protocol for this individual, Tua,

would be to continue on this therapy and even and potentially expose himself to more concussions but continue on the therapy. Would this potentially safeguard him? I will give you an example and then everything will be clear. Let's say you have a sprain of the ankle, okay? But you cannot see it. Suffered many of those.

Would you go back playing or running or jogging on this brain? It will make it better or worse? Definitely worse. You will tear it totally. You have to give yourself a rest until you are fully recovered. And then you can go back again. So the same in the brain. Look at concussion just like any uncle's brain that you have. The only difference is that you cannot see it. It's not tangible.

And even standard MRI will be hard to diagnose. So you need to do the functional imaging, the metabolic imaging in order to see. And once you see it, you understand what you are dealing with, just like the ankle sprain.

Okay? Fix it and then go back. And then if it happens again, understood. Yeah. Of course that repeated concussion are less good than having just one. That's definitely. Understood. Avoid concussions at all costs, obviously. But look, I think this is a major, again, I think as it relates to long COVID, it's my view that probably millions are suffering and it's undiagnosed. I think we're just starting to learn more about it. And then head trauma.

People I know have experienced head trauma. It's brutal. They get a lot of crazy stares from doctors or a lot of, I don't know what to do. It is what it is. There's not much we can do. And so I think this treatment is...

really powerful and game-changing for people who are suffering. Because we all know what happens. When you start to lose control of your mental health, I think it's really scary. And it goes downhill quite fast. You're absolutely right. So in closing, if we were to look toward the future, it's 2025, we're recording this. Where is this treatment going to be in three years, five years? Is it going to be...

shorter? Is it going to be hopefully less expensive? Is it going to be something we could bring home? Like if you were to, where's the technology going in your view? I wanted to see this one. You see this, the cellular phone that we all have. So yes, you're pointing for those listening, you're pointing to a cell phone. Yeah. So I remember the first cellular phone that my father had. It was, it was a suitcase.

And I remember that the day that it came with that first to home, I think you can buy a house with the price that this suitcase costed. Okay, it was big, huge. You used to go around with the suitcase. And look where we are now. So the same year, there is a main difference between the cellular phone and the technology world to medicine because medicine world blew fast.

move slow, unlike technology. Technology, it's clear to everybody that they should be active.

And when you're going to buy a cellular phone, it's not that you are going to the store and ask the salesman, what should I buy? Should I buy an iPhone or a Samsung? It's clear that if you are in an Apple store, he will tell you to buy the iPhone. If you are in a Samsung store, he will tell you to buy the Samsung. So you have access to the data, you analyze it.

And you can see the things that are relevant for you. For example, I will look at the processor. My daughter will look at the camera. My other daughter will look whether it fits her pocket. Okay. So it will be nice in the jeans. So everybody's looking for the thing, but we're active about it. We think about it. We make the decision ourselves. We are the clients.

In medicine, unfortunately, and I'm a physician myself, we want as physicians to think that our best interest is the patient, but not necessarily.

We have our own agenda. We have the things that we have learned. We have the paradigm that we've been taught. So listen to us, but don't be fool enough just to take what we are saying for granted. Be active. It might be possible that there's another physician somewhere who has just discovered something.

Okay, that I don't know that it's not part of my agenda. If I'm working in a big insurance company, then it might be possible that I'm not allowed to offer you that because it's not being covered. You don't give a damn about it. You should take care of yourself if you suffer. So we should behave differently.

in our health with respect to our health, at least in the same manner that we behave when we are buying a cellular phone. Be active. Learn, investigate, understand. Don't take what we physicians tell you for granted. Be more active, okay? And get advice from additional people.

And in today's world, the data is available. The data is available. We should just read and learn. And it feels like in the future, hyperbaric medicine will be more accessible and will be something that if you're really serious about longevity, you will incorporate into your protocol in terms of avoiding cognitive decline. Absolutely. And you do it. Can you talk about your protocol? You do it too.

Of course I'm doing that. When we finished the first study, it was on stroke patients. I was looking at the brain imaging at the end of the study, doing the analysis, and I said, "What's going on? What do I see in front of me? What happened here? Neurons? Blood vessels? More perfusion?" I said, "Oh my God, this is first of all for me."

And, you know, it's like when the airplane is crashing, you're saying, first put the oxygen mask on yourself and then take care of the people around you. So the same here. Once I saw what's going on, I said, okay, I got it. This is me first. Okay. I want to stay around. I want to function. So I'm doing that.

And of course, it's highly important also to eliminate the things that take you down faster. It's related to what we put in our body. It's highly important how we function and all the rest of the stuff. And actually, the way we practice medicine, this is what I call enhanced medicine. And it's been summarized in the book, Beyond Normal, that was just released. Yes, right here. I'll hold it up. It's fascinating.

Beyond normal. And if people want to dig in to understand on long COVID, on concussion, on PTSD that we haven't discussed today, on stroke, on brain, age-related cognitive decline, and they don't want to be normal for their age,

and understand better what they can do. They can dig into the book. I hope it will explain it in more detail in a comprehensive way. Well, it's a great book for those interested. I highly encourage you to pick it up. And Shai, thank you so much. Fascinating work. Thank you. Thank you.