Traumatic Brain Injury: Shawn Dollar

Before getting crushed by a 25-foot wave, Shawn Dollar stood up on his surfboard and dove headfirst under the wave. Unfortunately, just below the surface of the water, the pinnacle of a boulder was protruding and he slammed his skull into the rocks.

On impact, Dollar heard his neck shatter.

He broke his neck in four places and suffered a concussion. You’re not supposed to move when you break your neck (cervical spine). On Sept. 7, 2015, in a remote area off the coast of Big Sur, California, Pro Surfer Shawn Dollar was floating in the ocean, trying not to move with three choices…

He could drown, get bashed against the rocks, or start paddling to shore and risk paralyzing himself.

In the midst of just trying to stay conscious, he thought to himself, ‘I don’t know if I’m going to be able to get myself out of here.’ But as a 35-year old husband and father, he was determined to get back to his family. His survival instincts kicked in and he decided to paddle back. “I had to muster up all the strength I could to survive,” he says. “It was terrifying.” He was 30 to 40 feet from the shore and barely had the strength to move, let alone the energy to mount his board and paddle back to shore with waves relentlessly knocking him off the surfboard every 10 feet. And once he’d made it to shore — his car was at the top of a cliff — so he’d have to hike up the dunes, climb up over the rocks, walk a mile through ravines and up switchback trails to get onto the road, all while holding his neck steady to not collapse. And that’s exactly what Shawn did. He made it to the hospital. He survived.

That was the easy part. But this isn’t an against-all-odds story of human survival. This is a powerful story about recovery

As an athlete used to physical training, Dollar approached his recovery with the same discipline. He did everything the doctors and physical therapists asked him to. He was obsessed with achieving a full recovery. By November, three months later, his neck had healed.

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

Things did not get magically better overnight. He suffered severe migraines every day and couldn’t sleep because he was vomiting from the pain. Dollar had intense mood swings, feelings of depression, anxiety and even suicidal thoughts. He couldn’t do basic math or match socks, and sometimes he just felt confused. Months went by with no improvement. Dollar’s wife, Jenn, remembers. “He had trouble with recall. There were memories that had gone missing, experiences that had fallen through the cracks.” He was seeing two neurosurgeons and expressed his fears to his doctors. They all told him to relax. “It’s just a concussion.” The standard medical protocol for concussions is rest, wait, and monitor.

“Every medical practitioner was telling me, ‘Don’t worry about it. You’re fine,’” Dollar recalls, “But I was scared.”

He talked to a lot of doctors. The impression they gave him was that his neck will heal but his mental condition may be permanent. His doctors told him, “The brain doesn’t really heal. Once you do brain damage, that’s it.” Dollar did not accept that answer. He decided to take matters into his own hands and began seeking out other options. He researched other doctors, therapists and experimented with various treatments.

“A lot of the places I went to had one medium of care and that’s what they focus on. It’s frustrating because you know… care needs to come in multiple ways.”

Dollar’s wife, a health and fitness devotee, is apparently a big fan of my work. She had seen my TV specials and during Dollar’s recovery, she started showing him videos of me on Youtube. When we met, the first thing I had to do was give him a SPECT (single photon emission computed tomography) brain imaging scan. We just had to see his brain. Dollar says, “From my MRI to CT scan – everything in my brain looked fine. (SPECT) is a brain scan that shows a totally different picture… SPECT put things into perspective.”

“This is when things started to get better,” Dollar says.

After 25 years of seeing thousands of patients with traumatic brain injuries, along with my work with 200 active and retired NFL players, I’ve seen this type of brain before. The overall low activity, evidenced by what looks like holes of activity was consistent with a severe traumatic brain injury.

Dollar’s brain SPECT image scan

Like football players, as a big-wave surfer, Dollar had been banged around. Dollar says, “I’d taken some bad wipeouts at Mavericks and come up feeling dizzy, but I always got better, now I understand why I am not getting better. My brain shows why but also gives me hope. It gave me the diagnosis to start to heal. And to get everyone around me on the same page.”

“I got really lucky. I got connected with Dr. Amen… And now it was a question of what to do,” Dollar says.

We immediately began treatment. I first prescribed Hyperbaric Oxygen Therapy (HBOT), which was administered by a facility closer to his home. HBOT is a treatment that delivers pure oxygen at greater than atmospheric pressure to improve or correct virtually any condition where the body is affected by poor circulation. It’s a well-established treatment for decompression sickness, a hazard of scuba diving. It’s non-invasive and safe. Hyperbaric oxygen therapy increases the amount of oxygen your blood can carry. An increase in blood oxygen temporarily helps stimulate the release of substances called growth factors and stem cells to restore normal levels of blood gases and tissue function to promote healing. “I felt significantly better after the first treatment,” Dollar says. He did over 85 HBOT treatments, six days a week, sometimes two a day. He was making major improvement daily. For follow-up treatment, Dollar saw Daniel Emina, MD, a top psychiatrist at our Northern California Amen Clinic. “Shawn embraced the treatment protocol the same way he tackles those big waves,” Dr. Emina says. Dollar became a brain warrior. From supplements to meditation, nutrition to lifestyle, therapy to sleep, it was a multiple modality approach which proved extremely effective and worked wonders for him. Dollar is happier and closer than he has ever been with his family. Though he’s decided to not surf big waves anymore, he is starting to surf again and have fun.

The Dollar Family

It’s stories like this that remind me why we do what we do at Amen Clinics. I’ve been practicing SPECT brain imaging for decades, but when a patient and his or her family comes to us exhausted and weary and then when we’re able to help, it’s an incredible feeling. I still get misty-eyed and emotional when I see the relief in their faces — that there’s hope, a better way to recovery.

I am so thankful for these moments that remind me of why I became a psychiatrist and continue the crusade for SPECT brain imaging. We must strive to make the invisible visible. Because, after all when it comes to your brain, how do we know unless we look?

When it comes to concussions, we’ve all been so focused on major professional sports like the NFL, boxing, and other contact sports that include purposeful direct impacts to the head. It’s alarming to think how undetected concussions are most likely running rampant in action sports like surfing, snowboarding, skiing, mountain biking, BMXing, skateboarding, and motocross. It’s common for an action sport or X Games athlete to never report concussions or hits to the head. It’s just not part of the sport’s culture. Plus, these athletes often lack resources, the support of a league or even a team. Take the story of Dave Mirra, the famous BMX X Games medal winner who struggled with numerous concussions after years on the racing circuit. He was recently in the news because he died of a self-inflicted gunshot wound at age 41. This is important because Mirra is believed to be the first action sports athlete to be diagnosed with Chronic Traumatic Encephalopathy (CTE), which is a progressive degenerative disease of the brain found in athletes with a history of repetitive brain trauma. CTE can lead to depression and lack of impulse control, which, in Mirra’s case, is the main suspect of his death.

It’s only now that the issue of concussions in action sports is emerging from the shadows.

“It’s crazy how action sports are starting to pay attention now,” Dollar says. “Usually these athletes are so counterculture that they wouldn’t care. Many still won’t, but I’m glad that the discussions are happening.” Major league sports already have concussion protocols, but the level of education and prevention in action sports still has serious room for improvement. I think the most important thing is to be aware of the risk. No matter how careful you are, know that head injuries happen in almost every sport and if not addressed correctly, can have severe lifelong consequences, such as memory loss, emotional issues, and cognitive impairments. Research shows long-term effects of multiple concussions can also lead to Alzheimer’s and even Parkinson’s disease. The question I pose to these athletes is: Would you rather live the rest of your life pushing your limits safely or live the rest of your life not even remembering you went for it? And even worse, not remembering your own family?

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