There is a term for the treatment of stroke and traumatic brain injury – "Time Is Brain.” It stresses the need to treat brain trauma as soon as possible, to save as much brain function as possible. This is imperative in order to mitigate the damage and outcome. Please keep this in mind as you read insane events that follow.
Tony is the victim of four severe incidents of blindsided violence to his head at the jaw. They came out of the blue. Tony had no idea that something like this could even happen. He said he might as well have been eating breakfast or watching a sunset when he was punched. This is why they were so damaging.
The punches were thrown by his then partner, who has a disorder of radical personality shifts, and a history of spontaneous rage and violence in previous relationships. Each of the four punches created high-speed rotations of his head and extreme torque on his brain, brain stem, and neck, snapping and stretching white matter axon networks in the frontal lobes that are critical for second to second and minute to minute functioning.
A rotational brain injury is a high-velocity brain injury to an unsupported head, meaning the neck muscles do not have time to engage in order to slow the head down. It only takes a split second to cause the primary damage. It is uniquely the most destructive form of closed-head brain injury for the following six reasons:
1. -- It causes permanent damage to the brain’s management system -- frontal lobe networks that communicate with all eight cognitive domains of the brain and the central nervous system -- that take forty years to fully mature.
2. -- It causes damage to the delicate brain stem, and can affect breathing, swallowing, balance, gait, digestion in the gut and mouth, visual and auditory disturbance, and much more.
3. -- It has the ability to affect any of the cognitive domains of the brain, any area of the body, any area of the central nervous system, any of the autonomic functions, any sensory organs, and digestion.
4. -- It triggers a very destructive secondary progressive brain injury called Wallerian degeneration, a process that that actively destroying healthy axons in the frontal lobes that were unharmed by the primary brain injury, playing out for up to two years, but often longer if the brain trauma goes undiagnosed and subjected to even trivial stress.
5. -- Since the frontal lobes are home to our individuality, everything we know about ourselves, including how we negotiate our internal life and the world outside, this progressive destruction eventually destroys one’s sense of self.
6. -- It makes you dependent on someone else.
It bears repeating that Tony suffered four of the exact closed-head brain traumas that cause all this. Despite this, he never returned the violence. She is on record saying he would never hit her. It's a shame that this counts for nothing.
Each successive attack was separated by time, and so they are classified as repetitive brain damage — meaning each successive brain trauma is worse than it would be in isolation. These repeated violent attacks caused permanent disability in 2011, and made him dependent on the very person who brought the violence, who in her own written words bragged about her violence, and frankly admitted that she was completely out of control during these years.
The first three punches came in 2010. Weeks after the third punch, Tony spontaneously collapsed to the floor one morning. His neuropsychologist said, in hindsight, that Tony should have been placed in Neuro-critical care at this very moment to prevent what would come weeks later, an incident of severe brain swelling called a Thunderclap Headache that symptomatically matched a trauma-induced brain bleed, and brought life- altering, irreversible cognitive damage. Tony has long said that this was the day that his life changed, and that it has never been the same since.
But months later, he would take on a severe and different kind of decline, one that was not only cognitive, but physical, and neurological as well, as he entered three long term cycles of the secondary brain injury phase. As a result, Tony developed catastrophic damage to his brain’s management system, a host of skill sets we don’t even know we have until they disappear. They are the most complex thing the brain accomplishes. This naturally brought on severe PTSD.
That Tony made no connection between the violence and his severe decline in health is normal, his doctors say. His injuries would go undiagnosed partly because the onset of symptoms were delayed, and partly because it is the nature of brain trauma to not make that connection. But the effects of the brain bleed would do this all on its own. Un-diagnosed severe brain trauma makes your world incredibly small. It brings a loss of vigilance. It destroys your sleep cycle. It brings a severe decline in health of unknown origins, and this was the only thing on his mind for years.
But the one person who should have made the connection for him was the person who brought the violence. Instead, his partner just watched his four years-long decline without making the connection for him when he so obviously couldn’t. Worse, while incredibly ill during this time, he was the target of her spontaneous rage and self-inflicted harm, leaving him to play caretaker to someone who should have played that role for him. She was obviously not capable.
Further, it’s evident through doctors records that his former partner egregiously misled his doctors twice, at critical points of failing health. She had explicit permission to speak to his doctors, and on both occasions, she was able to do so in private. In 2011 she convinced his doctors that he was just depressed. In 2015, she led an ER doctor to believe that Tony had been diagnosed with Alzheimer’s dementia. On both occasions, they reversed their course of care.
The fourth punch came in 2015, the first year his severe decline in health from the 2010 violence had finally leveled off. It came just months after spinal surgery to plug a cerebrospinal fluid (CSF) leak and sinus surgery to bring more oxygen into his brain. It also came while he was being treated at Stanford’s Vestibular Clinic for balance and dizziness.
Amazingly, this punch was thrown while he was driving his car, driving her home because she showed up at his home late one night, drunk. It broke his ear canal, brought the sound of his heartbeat in his ear, required brain surgery, in and of itself a traumatic brain injury, and it caused another years-long decline in health. We told you this was insane.
As is often the case in domestic violence, but statistically more so when it's female on male, the violence goes unreported. With the exception of two therapist, a family member and a friend, Tony kept the violence to himself. By the time he finally reported it in December of 2016, to his doctors at Stanford, he had accumulated the following undiagnosed damage:
--- Four separate incidents rotational head traumas causing four traumatic brain injuries
--- Traumatic induced brain swelling after the third punch in 2010
--- Four separate cycles of progressive secondary brain damage
--- A "significant" amount of lacerations/adhesions on his temporal lobes
--- Numerous skull base fractures
--- A years-long, intermittent cerebrospinal fluid leak
--- Damage to two parts of his brain stem
--- Cranial nerve damage
--- Years-long brain inflammation and intracranial pressure
--- Neck injury
--- Nerve and impact damage to his teeth
--- Mild loss of coordination in left extremities
--- Intermittent sensory impairment
--- Dizziness, balance and gait issues
--- Chronic tinnitus; auditory and visual distortion
--- Intermittent disruption of breathing and swallowing
--- Severe damage and disruption of executive functions and working memory
--- A broken ear canal at the skull base
--- A tear in his brain dura
--- Severe time dysperception, as he could no longer tell the difference between the passing of a day and the passing of a year, a function of five cognitive domains working in unison, now permanently damaged temporal cognition.
His neuropsychologist said that in his thirty years treating TBI, he has seen nothing like this. Brain surgery in 2017 forced a delay in diagnosis of both his primary damage and a full neuropsychological evaluation. In early 2018, the directing Neurologist of the UCLA Brain Injury Clinic diagnosed Tony with Diffuse Axonal Injury (DAI), a very severe brain injury to white matter networks caused specifically by the high-speed acceleration and/or deceleration forces of rotational head trauma. It brings permanent damage and life-long symptoms. In 2019, he was diagnosed by his neuropsychologist with severe traumatic brain Injury, with moderate to severe traumatic brain injury symptoms.
Something this bizarre can only happen with a lot of sophisticated gaslighting by his partner about her violence, and about the nature and the severity of his illness, both to Tony, who was very compromised, and to those around both of them. But female-on-male violence is taboo. It's rarely talked about and often disregarded or overlooked. She used all this to get away with it, and evade accountability, as none of what you’re read so far compelled the Mariposa County D.A. to act. Tony even had written and voice recorded admissions by her, of both her violence and of the unique mental disorder that she hid from him, and still hides still from those close to her, a disorder that she had a moral obligation to reveal. Adult Protective Services filed a sheriff’s report on her in July of 2017, given the fourth punch was thrown to the head of someone already disabled with brain damage. But none of this made any impact on the D.A.
In Tony’s case, the imperative "Time Is Brain" was never put into play by those who not only knew of violence and could have made a difference, but in most cases knew about the damage –– beginning with the person who brought the violence — but also friends, family, therapists, the local domestic violence agency, the D.A., and its office of victim services. They all did nothing. Tony and his Behavioral Health team went to great lengths to ensure state mandated rights as a victim of a violent crime were secured, but still they were denied at every turn, including by five domestic violence agencies in five neighboring counties when approached for legal advocacy.
As a result, Tony waited three years in need of a whole range of treatment for the damage and symptoms of multiple excessive head traumas and brain surgery. If the victim’s compensation funds had been afforded to him, he’d have been able to move to where he could get treatment as early as 2018. Instead, he sat in his apartment for two years, with no resources to move. Again, time is brain.
With the help of a friend and a relative, Tony was finally able to move to the Bay Area in March of 2020. After COVID restrictions were lifted later that year, he was evaluated by the UCSF Stroke Clinic in September, then placed into the UCSF Neurorecovery Clinic. Thus far he has been assigned seven referrals to specialists in the UCSF, Sutter, and Stanford neurological rehab programs.
As his neuropsychologist states, Tony’s life has been irreparably altered. He is financially ruined. He is permanently disabled, unable to work, support himself or his children, or sustain a normal, productive and satisfying life. His sense of self has been upended. His community and reputation has been destroyed, not only due to the effects of the violence, but also by coming out about it.
It’s impossible to put a price on what has happened to my brother. Our community is small, and so we hope enough people outside our community will be inspired to support and help make a difference for Tony as he moves forward. The damage alone to his teeth, caused both by the four jarring impacts, as well as cranial nerve damage that has affected the digestion in his mouth, have brought extensive, serious, and time sensitive dental issues. He has been evaluated at the University of the Pacific Dental Clinic, and his treatment is expected to exceed $20,000.
The funds raised here for Tony will go toward directly supporting his medical care, rehabilitation in San Francisco and New York City, treatment for extensive damage to teeth/cranial nerve and impact traumas, moving costs, advocacy and legal expenses.
This priority for funding is as follows:
— $20,000 Dental expenses related to the violence
— $25,000 Medical care related expenses and debt
— $5,000 Moving Expenses Related Debt
— $2,500 Neurological Imaging - Cedars Sinai
— $5,000 Interview and Immersion at Design Neuroscience Center
— $7,500 Treatment at Functional Neurology Clinic
— $5,000 NYU Rusk Brain Recovery Clinic Interview/Immersion
— $50,000 NYU Intensive Outpatient Brain Injury Program (6 months in 2022)
— $5,000 GoFundMe fees
— $125,000 25% of loss of income — based on his salary of $62,500 at the time of injury ten years ago, minus his disability stipend. Tony’s total loss of income totals $500,000. This category may also be applied to novel treatment not covered by Medi-Care, or out-of-state treatment not covered by Medi-Cal.
Most of Tony’s adult life vocation has centered around cinema. Tony was the founder of a nonprofit arts center, and its Art Director for fourteen years. He spearheaded both its educational program with the local schools, and an extensive renovation of the historic Masonic Hall in the downtown district. The cinema closed its doors in 2011.
Tony is also a talented writer, and hopes to one day make a living by writing. But he lacks the necessary working memory and executive function in the frontal lobes to support any endeavor. First things first, he must spend much time working at and then mastering a rudimentary means of running a household of one. To the reader this will sound simplistic, but for frontal lobe damage, this is Mt. Everest. Neurons in the gray matter can regenerate. It's called plasticity. But this is an injury to the white matter, and white matter axons do not regenerate. Once these forty year old networks die, they stay dead. This is the harsh reality of Silent Traumatic Brain Injury.
We ask that you donate what you can, but more importantly, encourage as many other people as you can to do so as well, so Tony can put this dark decade behind him.
Gina Bissmeyer, Cypress Dubin
* Please read the following press release published in our local paper:
It offers a concise summary of rotational head injury and Diffuse Axonal Injury, Silent Traumatic Brain Injury, Tony's diagnosis, and his recent admittance into the UCSF Neurorecovery Clinic , including a description of treatment. (reading time - 4 min)]
- Melissa R Rowney
- Tonya Pieper
- Teenie Matlock
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