John and Dee,

I am writing to update the TBI Fund on the outcome of my SPECT scan on 2/21/22, which I was able to receive through Delaware’s TBI Fund. I also would like to thank you for giving me the funds to receive the scan, because it has increased my options for treatment.

The SPECT scan found two more areas of my brain had been injured than at the actual site of impact. Overall, several areas of my brain sustained damage.

A summary of the revised treatment plan from Dr. Schaller is below:

1. Brain Rehabilitation Program – vestibular, ocular and cognitive therapy.
2. Neurofeedback
3. Hyperbaric Oxygen Therapy (HBOT) to enhance overall blood flow to the brain to enhance rehabilitation therapies.
4. Anticonvulsants like Neurontin/gabapentin – already started.
5. A stimulating antidepressant such as Effexor/venlafaxine or Cymbalta/duloxetine to enhance prefrontal cortex function and calm cingulate and limbic hyperactivity.
6. Supplements can also be considered.

Out of the above, I started a new antidepressant. I have recently started a new medication (Pepcid) to reduce its side effect of loss of appetite after losing 10 lbs. In spite of this the medication appears to be helping my depression, at least minimally, but it remains to be seen if it will be sustainable long-term.

Dr. Schaller had said his office would submit a Prior Auth to my insurance company for HBOT, however, I have not heard back from MAC Concussion or my insurance company. Dr. Schaller said if HBOT is denied, his office would send out-of-pocket information to pursue this treatment at their facility in Delaware, but I expect the treatment would be a couple thousand dollars and am not sure whether it would be something I can afford to pursue.

After reviewing the results of the SPECT scan with me, Dr. Schaller communicated with the primary physician at DE Vision Academy to request them to see me more quickly. I had been on a waiting list for therapy for 5 months. DVA called me to schedule an appointment within a couple days of that conversation. I have had one vision therapy session there since. DVA sent the invoice on May 14, and it is awaiting response. They expect sessions will not be approved, at which point I would be expected to pay at the time of service out of pocket costs around $147 per therapy session for at least 10 sessions. This may not be affordable for me.

Although not a result of the SPECT scan, I have begun taking sumatriptan once a day and have noticed improvement in my migraine symptoms when combined with Tosymyra and Ajovy.

I have reconsidered re-starting gabapentin because of the result of the scan. I cannot combine gabapentin with Lyrica so I still have to make a decision as to which part of my body I want to treat right now and let Dr. Schaller know if I would like him to order a refill so I can restart that.

Dr. Schaller said MAC's primary focus on treatment is outside of supplementation, but I plan to purchase some of the recommended brain supplements to boost my cognition.

Overall, my depression has improved slightly. My activities of daily living remain the same. I struggle with low motivation at home and work (for instance, I have not yet done my taxes for last year, and I have low motivation to start assigned projects at work) as well as high anxiety. Regarding the scan results. I am attaching them (and the summary from Dr. Schaller). I am giving permission to John to decide if you would like to share these documents with TBI Fund members who make decisions for the TBI Fund. However, if you choose to do so, please remove any PII from the documents.

Thank you,
Antigone