Ep. 10 Alina Fong: How MRI Technology Gives Us Hope in Mental Health Healing

Ken Krogue: Hello everybody. This is Thom Harrison and Ken Krogue with the EternalCore podcast. We’re so excited to have Dr. Alina Fong here today. In fact, two of my favorite people on my personal journey back from the struggles that I had with my truck accident. It’s so exciting to have you guys both here at the same time. So I have to just introduce Alina. She is the founder of an amazing clinic called Cognitive FX. And I spent a whole week there. They warned me that I would be going through like mental gymnastics, and I would be worn out by the middle of the week. And it really happened. I couldn’t even drive home, but by Thursday, I felt like a new person. Do you mind giving a little bit of the background of how you came to founding Cognitive FX and the amazing process that you go through?

Alina Fong: Sure. How to tell that story in a condensed version, right? Well, I was fortunate enough to have completed my education at BYU where I met one of my mentors, Dr. Mark Allen. And he and I, he became my dissertation advisor and my supervisor. We created this project. At that time we, he was more interested, and we were doing more with EEG. And fMRI was this emerging fun, new technology. I convinced him to kind of drop a lot of the EEG stuff, and he dabbled in some fMRI, but just to go forward with fMRI. So he and I kind of figured a lot of things out from scratch together and did this fMRI project while I was a graduate student. We were fortunate enough to have a friend in the area who had an MRI machine that we used at night, when it wasn’t busy. And we just started running people on the MRI.

Alina Fong: Really what I was interested in was seeing if neuropsychological test’s batteries which, as a neuropsychologist, we’re giving all the time. I wanted to know what parts of the brain were really being tapped into when they’re asked to do a cognitive task like that. So we had to modify these really complicated neuro-psych tests into an MRI protocol, a functional MRI within the constraints of fMRI. Including, you know, you can’t really move, you can’t really talk, you can’t write like you would with a regular paper pencils. So, kind of working within those constraints was very interesting and an exciting endeavor. But after years of work, we had six of these tests that we could then start using on Guinea Pigs, AKA college students. So we would just run them and we just started to get all this data. We didn’t really know what we were looking for. We just said, “Okay, let’s do these tests and let’s see what parts of the brain light up.”

Ken Krogue: Interesting.

Alina Fong: And we started to see patterns with people that we called, you know, with our control group. People that didn’t have traumatic brain injury before. Luckily, they didn’t smoke or drink, you know, didn’t have some of those other vices. And we screened out other things like other kinds of psychiatric or psychological issues. So we tried to get as clean a sample as possible, but we started to see that there are patterns, and there are structures, and there were parts of the brain that would always light up. It would always light up within a certain level. So there was a certain amount of blood flow that was kind of normal for these certain parts of the brain. It was there that kind of lights went on for mark and I, for Dr. Alan and I. We’re like, “Gosh,” you know, “If this is kind of what standard for someone that’s normal, let’s start scanning people that aren’t normal.” And luckily, at that point, I was working. I had already graduated. I did my dissertation and was working at Intermountain Healthcare. So this year it makes 14 years with IFC as well. I had a ready access to concussion patients.

Alina Fong: So, we started to run concussion patients. And that was even more interesting, because we started to see that these patients that were dealing with these cognitive changes after concussion, their brain search looked quite similar. Then we were able to start deriving biomarkers or these set patterns that match concussion, but didn’t match a normal person or a control. And it didn’t match someone with dementia or Alzheimer’s. So when we started to test concussion patients, that were readily available to me because of my work at IHC, we started to see that there were patterns of dysfunction or deregulation in blood flow. Then we started to scan 10, and then 20, 30, 40, we have now close to 10,000 individual fMRI scans of concussed brains. With 10,000 scans…

Ken Krogue: You’ve got a pretty good profile.

Alina Fong: We can pretty clearly say that we have some robust findings with regards to patterns and what we call these biomarkers. So that is the long… Well, that’s actually the short story of how we developed this clinic. Because once we had all this data, that allowed me to say, “Okay, well now how do we do something about it?” Because it’s one thing to say, “Oh, you’ve got a concussion.” Lots of people can do that, but there aren’t enough people that are doing something about it.

Thom Harrison: Right. I remember in the late seventies and the eighties, I had the opportunity of working at Primary Children’s Medical Center and also the old LDS hospital. And, you know, we would see individuals that would come in with neurological problems from contrecoup injuries or car accidents or, you know, falls or things of that nature. And often they had gone through a battery of misdiagnoses. And many of them were so frustrated and overwhelmed because nothing was helping them. And then, in our very little science that we understood about the brain at that time, we realized, we have a population here that is profoundly underserved and often misdiagnosed. Can you speak to that at all? I just find it so wonderful that I can refer these people to you, and they get better. They come out saying, “Oh, I’m not going crazy.” And “That’s why this medicine didn’t work for me, and actually made me worse, because I was misdiagnosed.” Any comment on that Dr. Fong?

Alina Fong: Oh, so many comments on that Dr. Harrison. Because what’s so limiting, what’s so difficult about these concussion cases is that regular imaging is normal, right? Regular CT, regular MRI is so normal. Which, interestingly, the normal findings are part of the definition of what a concussion is. But, that makes it really hard for a clinician to say, “Well gosh, if these tests are showing normal, I don’t know, maybe it is in your head.” Right? Well it is.

Thom Harrison: It is, but differently than what you’ve been diagnosed as.

Alina Fong: Exactly. And so, I can’t tell you how often patients come to me saying, “Well, you know, I have this diagnosis of ADD now” or “I have ADHD, and I have a diagnosis of anxiety.” And, “I’ve been an ADD medications, but that’s not working. I’ve been on anxiety medication, so that’s not working. Well, but, I also got diagnosed with depression, so we tried that, and that’s not working.” When, so often, there was this hidden or latent head injury that happened, maybe even years before. Months, years, sometimes decades before, that might be what’s underlying all of this. So I can’t tell you how often these patients come into me, and the first thing I say is, “Well, can we try to get you off these medications if they’re not helping?” And you’d be surprised how many of them say, “Yes, please.” You know, every once in a while some of them are like, “Oh, I don’t want to get off.” But, most of the time, these patients didn’t need medication before. They’re just being used as Band-Aids almost because that clinician, bless his or her heart, they don’t really know what else to do. Right?

Alina Fong: So, they’re trying. And the good clinicians I know admit that to the patient. They say, “Well, okay, let’s try this and let’s see if this helps. Let’s try this.” And then they themselves start to feel a little bit like guinea pigs. The wonderful thing about utilizing advanced imaging techniques… And fMRI is just one type. There’s DTI, diffusion tensor imaging, which I have some good friends that that’s where their area of expertise is. There’s SWI, or susceptibility weighted imaging, as well. There’s all these new types of MRI-based imaging that are allowing us to see that there are changes that can happen; that can actually be recorded and used. So as great as regular MRI and CT are, they don’t go deep enough, right? They’re just looking at structural changes. But often, when we have issues like concussion, or other types of brain dysfunction that doesn’t affect the structure, for example, brain toxicity. I mean I’ve seen patients with lead poisoning, with carbon monoxide poisoning, other types of issues like that, where the brain still looks normal though. But, they present with all this brain fog, sleep problems, anxiety, attentional issues, chemo brain. How many people have known someone that has gone through chemotherapy that their brain’s just not the same.

Thom Harrison: Right, and I’ve never seen anyone who’s gone through that, that didn’t have, at least some deficit after the chemotherapy, neurocognitive.

Alina Fong: Me too. But the problem is if you just do a regular scan, they look normal. So these advanced imaging techniques are now able to capture this huge population of people that, you know, that there’s something going on and there’s something wrong. They’ll swear to you that there’s something wrong. Family members that are close to them will say, “Something’s a little different here,” you know? But now there’s imaging that can back that up. So it’s not just concussion, right?

Thom Harrison: Right. I remember, about three years ago, I had a local linebacker on one of the college football teams who was just struggling horribly. He had been to psychiatry, had been to a psychologist, been to social work. He was put on a boatload of medications, was losing his relationship with his wife and his children, just felt awful. Started to overuse alcohol. And nobody had even suggested that this could be brain trauma, concussion after another concussion. I think it was four concussions during games, but nobody had even looked at that. And I sent them your way, and amazing change and an amazing difference. Personality came back, you know, father and mother called me and said, “We’ve got our boy back.” But nobody had even looked at that. So I think often we ignore this process so profoundly in the psychological community or psychiatric community. So thank you for your pioneering work in this.

Ken Krogue: Yeah, it’s profound. You know my personal story, again, football, middle linebacker, but it was really the car accident, the truck accident, that was so profound. That had me. Now, I understand in the early days of the clinic you had some folks involved from the football industry, Tom Brady, Austin, Collie. Tell us a little about how that came to be. That’s sort of interesting.

Alina Fong: Yeah. It seems like all of this conversation has always come back to sports and football, because that’s what’s driving a lot of this concussion research, and this awareness, especially with this class action lawsuit. So quite a few years ago, I think about six or seven years ago now, we caught the attention of Tom Brady. And what’s so wonderful about Tom is that he is, he’s so healthy. He’s always looking for that health benefit that’ll give him the edge, you know? And one of his really good friends, coaches, mentors, trainers actually, was also a good friend of ours, and brought him to us and said, “Look, why don’t you do the scan and let’s just see what’s going on, because he’s someone that everyone knows.” I mean we’re the same age. He’s at the top of his game, even this year, right? He’s doing fantastically. And not that there’s anything wrong, but it was, “Well, what can I do that can give me an edge?” Right? And once he saw the value of what we did. Even for someone who maybe doesn’t have, isn’t suffering with concussion at that point in time, he said, “Wow, this is something that everyone can benefit from.” So actually, our very first clinic we ever opened was with Tom in Boston, and it was TB12. So I had to go get licensed in Massachusetts. And we opened up shop in Massachusetts. That’s where we first started seeing our patients. While we were there, however, we were in the works of creating this one here in Provo.

Ken Krogue: Gotcha. How long has it been open now?

Alina Fong: Going on five years now. Yes, here in Provo. But yeah, that’s our connection with Tom. And since then, I am not, we don’t physically, we’re not practicing there anymore. But I still have my license there. They still refer patients back and forth.

Ken Krogue: So they’re still going as well.

Alina Fong: They’re still going. Yeah, they are. But of course this Provo location has taken up all my time at present.

Ken Krogue: We just met the other day with Austin Collie. He’s going to be joining us at the show in March. And he worked for a little bit with cognitive effects. He went through a lot of struggles with concussion and still played five great years in the NFL. But, talk to us about where are the different areas? The different sports, the different challenges where brain concussion typically occurs. I mean, what are some of the big areas where you get patients?

Alina Fong: So football, of course, is one. And yes, you know, Austin is a dear friend of mine as well. He did work for CFX for a while and we still work together quite a bit.

Ken Krogue: Yeah. In fact, he is in a similar industry now, a company called Canary Speech, with a derivative called Canary Concussion. So technology helping to determine if a concussion has occurred.

Alina Fong: Through the slightest inflections and changes in speech. It’s phenomenal. I mean I really love it. And I think, you know, people are understanding that the diagnosis of concussion has been lacking. People need to be more aware that you can get a concussion, even if you don’t physically hit your head. In fact, I’m dealing with something like this right now. Where, I’m in a little bit of a battle with another doctor who is claiming that this certain patient did not hit their head, and did not lose consciousness. So, therefore, does not have a concussion. Which, yeah, most of us in the industry know that, okay…

Ken Krogue: I didn’t go out with mine. I wasn’t knocked out.

Alina Fong: Yeah. You don’t have to. And in fact, over 90% of concussions don’t have a loss of consciousness. You don’t even have to physically hit your head, a whiplash movement, you know? So think about our sports. Think about, you know, things like football. Yes, there’s impact, but then there’s things like, if you were a linebacker, you don’t actually have to be… You can just have little hits here and there over, successively, over and over and over.

Thom Harrison: Skiing, snowboarding, those things can create…

Ken Krogue: I know women’s soccer is really big.

Alina Fong: Exactly. Women’s soccer, and then another one is cheerleading. We get a lot of cheerleaders. Yeah, because think about it, you’re getting thrown. Sometimes, you get dropped. But, it’s not always a flyer. It’s the base, because they come down and they hit heads.

Thom Harrison: The brain slaps up against that bony prominence. And there we are, you know.

Alina Fong: There we are. Motor vehicle accidents, whiplash, that’s another big one we get. Slips and falls, especially on the ice right now, in the winter.

Ken Krogue: One of our friends here at Mobaliz, Eternal Core, was on a bicycle and had a bicycle accident.

Alina Fong: Exactly

Ken Krogue: What are some of the things family members might notice, behavioral wise, that might indicate they probably ought to come and talk to you.

Alina Fong: So that differs for different ages. So if it’s a child, for example, a parent that is wondering if their child may have these longstanding issues. You know, how are they doing in school? Has their school gotten a lot harder? Are their grades not as good and you don’t know why? Is that child more tired, doesn’t have as much energy as they used to have? And, the thing is, it’s so easy as a parent to say, “Oh well, they just didn’t sleep well, that’s why.” But if you’re seeing a pattern of this over time, and you’re looking back and saying, “Gosh, her personality is a little different. She used to be really outgoing, and now she just kind of wants to stay in all the time.” Those are some really big red flags for children, because they don’t often… They’re just not as aware of how they’re feeling. They can’t verbalize exactly what’s going on. So they might manifest with those types of behavior changes.

Thom Harrison: How about infections like encephalitis or things of that nature? Do you work with any of those people who have suffered with those kinds of injuries or illnesses?

Alina Fong: I want to say, yeah. I say yes, but I don’t want to say yes because then… Yes, exactly. But absolutely, you know, we brand ourselves as concussion, but truthfully, we get calls every day from parents or family members that say, “My daughter had a viral infection. She had meningitis, encephalitis, and things just haven’t been the same. Can you help?” And what I always say is, “I believe we can help, but let’s get a scan first,” because, if we can see that the brain has changed, as far as functionality. Blood is not getting to where it needs to go, the brain is less efficient, then yeah, we can definitely… If we could see it, then we could treat it is what I say. The caveat is that all the research that we’ve done, most of the research that we’ve done, has been in the realm of concussion. So I can’t say to a parent or even to another doctor, “Hey Dr. Harrison, thanks for sending me that patient. That patient is going to get 75% better.” We can’t guarantee anything in medicine, right? But, we still have improvements. And I can’t say if they can improve as much as it concussion typically does, but usually they do.

Ken Krogue: I remember that I was there with the scan on a Monday morning and you had me in there for a little over an hour doing different kinds of exercises. I remember you showed me some of the scans later. And then, you had me doing brain workouts for an entire week. And I was a little bit nervous by Tuesday, Wednesday cause I was really feeling it. But it was so profound Thursday morning when

I could think clearly again. And, by Friday, I was a new person. You even scored my scans, and then you put me back through Friday afternoon. That’s sort of what the process was. Maybe talk to some of the details if you don’t mind for a minute. That was so intriguing.

Alina Fong: Sure. So this picture that you have here actually is the bookend, right, the bookends. So this is what you did when you first came in. That’s actually Dr. Allen right there. That little pad that this patient’s holding is a fiber optic response pad, and that’s what allows us to record whether or not they’re getting the right answer. This little screen here is an LCD screen that allows us to present the test.

Ken Krogue: Yes, I remember.

Alina Fong: This is just one frame of, you know, dozens of tests that are given while the patient’s in the scanner. So yes, this is at the beginning, but while he’s in there, he doesn’t just do the fMRI and the cognitive tasks. He also gets a brain MRI, because we do still want to make sure that everything’s okay structurally. And then we also get an MRI of your neck, because we want to see. Usually when there’s a concussion, there is cervical injury. Very rarely do you get a concussion without also there being some change to the neck. Right? Then after this, you come out and we go over your results. And yes, we get you right into therapy. Therapy varies for each individual patient, because even though there are biomarkers that are common, there’s still individual differences between each patient. Someone might come in with more neck pain, right? And so we want to address that. Someone might come in with more visual issues. We address that more. Someone might come in more psychological issues, and we have a psychologist that is there for that. So, you know, we want to make sure that every patient’s need gets taken care of. But, in general, they’re having occupational therapies twice a day, cognitive or speech therapies twice a day, massage, neuro-muscular therapies.

Ken Krogue: That was my favorite part.

Alina Fong: It usually is.

Ken Krogue: I was hoping you would max that one out a little bit more.

Alina Fong: Well complain more about neck problems, and I will.

Ken Krogue: I should’ve learned.

Alina Fong: You know, but every day we’re adjusting. We’re changing. In fact, Ken, if you were to come to the program now, it is different than when you went through the program. We are instituting more nutrition. In fact, after first quarter of this year, so about April, we are going to be providing meals for the patients.

Ken Krogue: Oh interesting, I will be back.

Alina Fong: We’re doing meals, we’re doing more cardiovascular, even though we were doing cardio before, we’re incorporating it much more into the program. So, you know, we’re always involved in research and outcomes and seeing what adjustments we can make that will affect that brain’s health and improve that brain’s efficiency. The reason we can do that is because at the end of that full week, you get another scan, right? That other bookend, and we have tangible data that shows, “Okay, did what we do this week make a difference more than what we did the week before.”

Ken Krogue: I remember even my scores.

Alina Fong: Do you?

Ken Krogue: Yeah. If I remember it’s like zero to five.

Alina Fong: Zero to six.

Ken Krogue: Zero to six, okay. And I was like in the mid 2.57-2.58, but in a week, I was well below a one. Except in those two areas where, you know, they were still a bit up. But you had helped me sort of, it’s almost like routing around or activating the areas around it, and I was doing so much better.

Alina Fong: Well, you know, one of the things that a lot of my patients understand is that we do so much for you in that week, but does therapy end on Friday? No. You have to go home with these therapies and these things we give you.

Ken Krogue: Doesn’t Tom Brady comeback? Didn’t he go back occasionally and tune things up even a little bit more?

Alina Fong: Austin for sure. Yeah, Tom has been so good. His brain’s doing great. But you know, other players that I can’t name, there are some I can name and some I can’t name that come back much more regularly, once a year.

Ken Krogue: Almost like a brain workout.

Alina Fong: It’s like a little boot camp. It’s like a booster day where they come in. And not just athletes, you know, we have businessmen, we have college students, we have professionals, attorneys, doctors, that just need that extra boost. And they want to see where they are. They just want those little extra exercises that help them feel even better.

Ken Krogue: So this was my truck. I remember the engine was under the front seat.

Thom Harrison: And you were in there somewhere, right?

Ken Krogue: I was in there somewhere. They pulled me out.

Thom Harrison: You were in there close to the carburetor, right?

Ken Krogue: So talk to us about that. I mean the imaging of the brain and the things that you guys are looking for. That was so interesting, and you showed me some of the images. But what are we looking at here?

Alina Fong: So interestingly, this image here, this is actually an image that is post, post, post, post process. So we only do this for display presentations like this. It’s really just pretty pictures, right? If you remember the actual data that, Dr. Harrison, I think you’ve actually seen, they’re graphs.

Ken Krogue: That’s right.

Alina Fong: What this is is this is a kind of a visual representation where the colors represent how much blood is actually flowing to those areas. Okay? So what we’re looking at here is a scan where we’re actually looking at where blood flow, where blood is going. And this is actually on one of our picture naming tasks. I can tell just by the different regions that we’re looking at. But this is a pictorial representation of a normal distribution, where we’re looking at how much blood is flowing to different parts of the brain. So the actual graph that you got, with that 2.3 score, or ones that we’ve sent to you, are really just based on z-scores and normal distributions. Which, we as psychologists, understand very well, you know?

Alina Fong: But, yeah, this is just showing that there are different parts of the brain where, if you see the more yellow, that’s where more blood is flowing to. So we can see concentrations based on different voxels on where blood is going to for different tasks. So we can map out what parts of the brain are working to do a kind of a nonverbal type of a task. Right? So this is a normal brain. We’re looking at a brain that looks normal here. Let’s say we put someone with a concussion. They might not have as much activation here. And they may have activations that are compensated in frontal lobe areas because, you know, they need to recruit other areas to do that job. So this is just a kind of a nice fancy picture that depicts that.

Thom Harrison: I think many people, especially today, don’t realize the significant importance of nutrition. You know, I recently was speaking to a fellow who said, “I drink four monster drinks” and, you know, “A day. I wake up with one. I take one on my way to work. I drink one as I’m coming home, and I drink one with dinner.” And then he’s wondering why he’s not functioning as well, you know? Then he says, “Well, I’ve just given up my coffee, and now I’m taking this monster drink,” but not realizing the chemicals that are in that monster drink, and what it’s doing to his respiratory, to his heart, to his circulatory system. I think so many people don’t have a clue that nutrition and what we’re putting down our esophagus has something great to do with our sense of wellbeing. So I’m glad you’re including that in the treatment, because I think so many people don’t make that connection at all. And then they wonder why they don’t feel well. Or why they’re not sleeping well. Or why they can’t focus. Or, you know, why they’re doing this all day long. Why they’re grinding their teeth, you know?

Ken Krogue: Yeah, that’s true.

Alina Fong: Well, and what’s scary is that, so every patient that comes in with my intake form, we ask them, “Are you taking any medications?” “Are you taking any supplements?” Because some people also think, “Well, it’s a natural supplement. It’s fine. It’s not a medication.” Well, but those natural supplements still have a chemical reaction in your body.

Thom Harrison: Arsenic is a natural substance, but I would not recommend anyone to take it?

Alina Fong: Yes, that is true. Good point. Well, and so is marijuana, right? So this is another battle that we’re fighting. Because, in all seriousness, the amount of patients that come in to me, that they’re like, “No, I’m not taking any drugs. I’m not taking any supplements.” But then I have to specifically ask them, “Are you taking any cannabinoids, any cannabis substances?” “Oh, well, yeah.”

Thom Harrison: “Yeah, I take CBD oil three times a day.”

Alina Fong: “But there’s no THC.” Right. But, well, okay, but we still need to know that, because the truth is, we don’t know yet what the long-term effects of this are on the brain. We just don’t know.

Thom Harrison: And it’s nice to know. And we can include that in our data so that we can have that over a long period of time and then go, “Isn’t it interesting, these symptoms correlate with these people who were taking the CBD oil.”

Alina Fong: Right. And we track our patients longitudinally as well. So we have a study right now that, it’s ongoing, but we’re out three years. And we’re tracking these patients, and we’re doing fMRI scans for them, you know, periodically over now three years. Yes, and some of them are using substances, and some of them aren’t.

Ken Krogue: We need a follow up episode just on this.

Thom Harrison: Yes, we do.

Ken Krogue: I think this one’s going to be interesting.

Thom Harrison: Dr. Fong, I could talk to you all day about this scenario that I’ve been interested in since the 70s. Because, my mind was totally open to something that I had not ever considered. And I made it a significant part of my practice, because I felt like it was just an area that was terribly underserved. So we certainly appreciate you coming today and appreciate having Ken here with us.

Ken Krogue: Yeah, I’m here. Thanks to these two.

Thom Harrison. Thank you so much. She’s going to be speaking at our conference.

Ken Krogue: Yes, March 29th and 30th at the Little America hotel. You can go out to eternalcore.org. Thank you Dr. Fong for joining us today. It’s so good having you here.

Alina Fong: You’re welcome.

Thom Harrison: She has a lot more to let you know, so come listen to her.

Ken Krogue: We’re bringing her back.

Alina Fong: Thank you very much.

Thom Harrison: Thank you.

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