Brent E. Masel, M.D. is the President and Medical Director of the Transitional Learning Center (TLC) at Galveston. Dr. Masel received his Medical Degree from the Loyola University Stritch School of Medicine and completed his post-graduate training from the University of Texas Medical Branch (UTMB). He is a Board Certified Neurologist. After 16 years of private practice, he accepted his position with TLC. He holds clinical appointments at UTMB in the Departments of Neurology, Internal Medicine, Family Medicine, Physical Therapy and Occupational Therapy. He has conducted research and published in the areas of brain injury rehabilitation and virtual reality, as well as hyperbaric oxygen treatment, sleep abnormalities, metabolic abnormalities, and hormonal dysfunction after brain injuries. Dr. Masel is the Past President of the United Way of Galveston, and serves on the Board of Directions of the TIRR Foundation, the North American Brain Injury Society, and the Brain Injury Association of America where he serves as the National Medical Director. He is the recipient of the Lifetime Achievement Award from the Brain Injury Association of Texas and the Innovations in Clinical Treatment Award from the North American Brain Injury Society.
What do you see as the major problems with current medical treatment of brain injury, and how would treating brain injury as a chronic condition improve the situation?
When I first wrote my paper (Masel & DeWitt, 2010) on the concept of brain injury as a chronic disease, Susan Connors (Executive Director of the Brain Injury Association of America) told me that I would become the “darling” of the plaintiff’s bar. And Although I certainly embrace the idea of being somebody’s darling, that certainly wasn’t the purpose. Brain injury is not being taught in medical schools. Both of my sons are physicians, and all they learned about brain injury was at my kitchen table. Physicians spend a lot of time in school learning about obscure diseases (especially neurologists like me) and yet we’re not taught about a medical condition like brain injury that every single medical specialist will encounter over and over. Chronic brain injury MUST be a part of every health care student’s curriculum.
Up to now, the overwhelming majority of basic science brain injury researches have focused on the first 90 minutes after the injury in order to find something to stop the toxic cascade of tenets that lead to increased morbidity and mortality. It is clear, however, that there is another toxic cascade: slow, progressive, irregular and chronic, that becomes part of the life of almost every individual with a brain injury. Bench scientists must be aware of this, and funding sources must give the scientists the support needed to address these issues.
I think the scent of brain injury is where we were with the science of cancer awareness and treatment 50 years ago. With the appropriate education and allocation of resources, we can start talking about a cure.
Brain Injury medical and rehabilitation providers usually like to furs on the positive. How would you respond if they object to reminding patients with brain injury that they have a chronic condition?
We should always focus on the positive. Nevertheless, if we are not host about the issue, we do that patient an enormous disservice. No one likes to give bad news, but when that is our job, we should do that professionally and compassionately. My approach to practicing medicine has always been to picture myself or a loved on on the other side of the desk. What would I want to be told? Our approach to explaining the issues of chronic brain injury should be exactly the same.