Gabrielle Tells Her Story

At the end of the lecture, Gabrielle went over and spoke to Anita Saltmarche, told her about her neurological and cognitive difficulties, and said she'd be pleased to offer herself as a Canadian subject for the U.S. study. Saltmarche said she would look into it.

I lined up to ask Kahn what kind of brain problems he'd used lasers for—since he hadn't given details. While I was waiting in the line, Gabrielle came over to me with an elderly gentleman, whom she introduced as her father, Dr. Pollard; he was bespectacled, with a delicate, distinguished English accent. As a young man, he had studied medicine at Cambridge on a scholarship. He was now eighty-one years old, a year younger than Kahn.

Dr. Pollard said he recognized me as the author of the book Gabrielle had been reading since 2007—for the last four years—and she realized she knew my face from the jacket flap that she used to hold her place. "Normally, I have a very good memory for faces," she said wistfully. Then she told me the story of how she had lost so many of her mental faculties.

Gabrielle, divorced and living alone, had supported herself with her own successful tutoring business, helping children who suffered from learning disabilities. Music was central to her life, and she sang in a choir. In 2000 she began to experience hearing loss and was sent for a CT scan of her brain, followed by an MRI. Both revealed an abnormal structure in her brain, toward the back, but her doctors weren't certain what it was. They decided not to operate but to observe the abnormality with repeated MRI scans. Gabrielle was thirty-five years old.

In 2009 the lesion was diagnosed as a brain tumor—most likely benign. But benign tumors can grow, and depending upon where they are, they can kill. The tumor extended from inside her skull out through the hole at the bottom of the skull that contains the spinal cord. That hole is small, and as the tumor grew, it compressed all the neural structures that passed through it. Her tumor grew in such a way that her spinal cord, to accommodate its presence, had to partially wrap around it, and her cerebellum, a part of the brain involved in fine-tuning movements and thoughts, was gradually being compressed. Her brain stem, the lowest part of the brain, which sits just above the spinal cord, was also being compressed and moved to the right. The tumor was diagnosed as a choroid plexus papilloma, meaning it was made of the same kinds of cells that produce the cerebrospinal fluid in the brain.

She would require extremely delicate, challenging brain surgery, in a very small area where most nerves are crucial to survival. "By the time I got to the neurosurgeon," Gabrielle told me, "I already knew I could die as a result of my surgery." She was told she could lose her hearing on one side, and "that after the surgery I could develop trouble swallowing, might not be able to eat or drink for the rest of my life, might have trouble talking, or walking, or have a stroke." She recalled her surgeon telling her, "There is a three to five percent chance you will be really mad I did your surgery." When she asked what would happen if she didn't go through with it, she recalls him saying that the chances of her being mad at him would rise to "one hundred percent." The expanding tumor would eventually strangle her breathing centers, and she would die. But the surgeon also told her that after surgery, she would likely feel better than she had in ten years.

She had the surgery in November 2009, and it saved her life. The tumor was cut out, and it was indeed benign. She was delighted to have sensation in all her limbs. But she soon noticed trouble swallowing and eating and was constantly nauseous. She now had balance problems and difficulty walking. Over a year and a half later "I was still on a walker, couldn't hold my head up, and was throwing up." She slurred her words and had problems pacing her speech and producing a normal volume, so that people could "barely hear me speak." But "the most terrifying experience was losing my mental functioning—my cognitive abilities and memory. I would picture something, but couldn't get the word for it. If I headed for the word fork, it came out, in speech, as knife, and I knew it wasn't right. And I couldn't multitask anymore."

She had lost her short-term memory. She would put something down for a second and wouldn't be able to find it. Sometimes what she couldn't find was in her hand, and she'd forgotten sheM picked it up. If she took off her glasses and put them aside, it could take two hours to find them in her fifteen-hundred-square-foot condominium. When anyone spoke to her, she had to ask them to repeat their words several times because she'd forget them almost immediately. "I couldn't recognize objects," she said, "and I could see only what was directly in front of me. My mom would take me to the supermarket. If I was looking for orange juice to make fruit salad for a friend and I saw two liters of it in front of me, I'd know that was too big. But I couldn't look to the left to see the one-liter size. I once had a pair of black sweatpants, which I kept at the edge of my computer keyboard, with something much smaller on top of them. It took me three weeks to find the sweatpants, even though they were right beside my keyboard, which I used every day. I could only see surfaces."

She had trouble with visual tracking. "I had seen written music all my life. Normally, I could sight-read. But the first time I went back to choir, it was just a page of notes, with no meaning. When I got to the end of a line, I didn't know I had to go to the line underneath."

Sound—as is often the case for people with brain injuries—posed a special problem. She was hypersensitive to all sounds, which now seemed unbearably loud. Shopping malls with piped-in music, cacophony, and buzz drove her crazy. Music, which had been her chief joy—she sang every day—was now unbearable: "It had no tonality of pleasure. It was more like noise than notes." She couldn't participate in any group where more than one person spoke at a time. Her balance was so bad that she had to run her hand along the wall to walk.

And she was chronically exhausted

"I am a very strong person," Gabrielle told me. "I have had a lot of difficult life experiences that led me to this point, I was always a religious person, and I had always felt I was not alone, and whatever the difficulty, I felt there would be a gift of the same magnitude."

She began to focus on learning from her experiences, hoping they would not go to waste, so at the very least others might be helped. She studied her mental fatigue, the energy component of her condition. "After the surgery I felt that the energy had been sucked from every cell in my body," she said. "This lasted ten months." After doing the slightest activity, she would have to rest, sometimes for days. She had no reserves.

"I have always thought of my brain as where my thoughts were. I never thought of it as a physical organ, in charge of everything I do. So I didn't realize that I only had one energy for both my brain and my body, and if I used energy for an intellectual activity, I then didn't have the ability to speak, or move my legs, or to stand up.

"I knew it was time for a portable phone when I was lying down on the couch, and my phone rang, and I felt like I was on a desert island and didn't have the energy to get up, or move my limbs to go answer it. I was completely spent.

"Every time I reached a new skill level in recovery, there wouldn't be enough energy to run other things, because my energy had already gone into building and incorporating that new skill. If I had a setback, it could take two weeks to go from not moving, to doing a little bit of exercise, to adding the next level."

Now as people were leaving the lecture room, Gabrielle told me something she found quite odd. She said when she was looking at things, certain patterns had become quite unbearable. When a clinician at rehab wore a shirt with dark blue and black stripes, "the horizontal contrast was like a visual scream for me. I asked her to put a towel over that shirt."

At this point I started to put things together in my head. Almost all of Gabrielle's current problems could be explained as the result of brain stem damage and malfunction. The brain stem processes the flow of signals from most of the cranial nerves that govern the human face and head. A cranial nerve controls the balance system and receives signals from the semicircular canals inside the ear. Damage to the brain stem areas that govern that nerve would help account for her tentative walk and her balance problems.

Her hypersensitivity to sound was also likely related to the brain stem. The ear has within it the equivalent of a zoom lens that allows us to focus on some frequencies and dampen others. People with damage to this system hear booming, buzzing confusion because they have lost control of that regulating mechanism (described in Chapter 8). Thus, Gabrielle couldn't tolerate malls, echoes, and Muzak, and preferred listening to one person at a time.

A damaged brain often cannot integrate different incoming sensations. For instance, maintaining balance involves integrating input from the semicircular canals in the ear (which signal position) with input from the eyes (which visually track horizontal lines in the environment, also, in part, a brain stem function) and with input from the soles of the feet. When those systems are out of sync because one or more of them are damaged, the person becomes confused and disoriented and has what is called a sensory integration problem.

I surmised that the "visual scream" that Gabrielle experienced while looking at the woman's striped shirt occurred both because, in her off-balance state, her brain was desperately seeking horizontal lines to orient her in space, and because her visual system, part of that damaged balance system, was also misfiring. When a sensory part of the brain is damaged, it tends to fire too easily, and we feel overloaded by the sensations.

The sensory systems consist of two kinds of neurons, those that get excited by external sensations and those inhibitory neurons that dampen sensations so that the brain is not overwhelmed and just the right amount is filtered in. (For instance, when an alarm clock goes off, the brain is very stimulated, because the excitatory neurons fire. But should the stimulation become too intense, it is good to have inhibitory neurons to "lower the volume" so that the person is not overstimulated.) When the inhibitory neurons are damaged, the patient experiences sensory overload, and sometimes sensation actually hurts. When I told Gabrielle about these sensory integration problems, she said, "Oh wow," explaining that it was a relief to learn that all her symptoms fit together and were part of a package.

As we were chatting, Gabrielle's father saw that Dr. Kahn was free and went to speak to him. Gabrielle's father knew that for the two years since her surgery, she had also suffered from a chronic postoperative infection called folliculitis—a disfiguring inflammation of hair follicles on the back. Neither antibiotics nor other medical measures had worked. Since Kahn had had so much experience treating skin problems, Dr. Pollard, at her request, told Dr. Kahn about Gabrielle's folliculitis. "Might the laser light help it heal?" Dr. Pollard asked. Kahn assured him it would. "Stop by anytime," he said.

As we walked out, Dr. Pollard offered me a lift home, with Gabrielle—their car was parked just past my office. The brief distance that I had skipped across so lightly and quickly an hour and a half before was now traversed, in reverse, with slow labored steps, as Gabrielle struggled to walk. We slowed to her pace. We reached the car, and in the few minutes' ride to my home, we discussed how impressed we were by the lectures. I thought light therapy might succeed for Gabrielle, because her surgery might well have cut through tissue and caused scarring and inflammation in the surrounding areas. I suspected that she was suffering from a noisy brain and learned nonuse, and that not all the neurons in her brain-stem-related circuits were in fact dead; some might be damaged and firing pathological signals, while others were dormant. If the lasers could heal the inflammation and provide better circulation and more energy to those cells, she—like those who had traumatic brain injuries—might benefit. We agreed to stay in touch.

Visits to Kahn's Clinic

In the weeks that followed, I frequently visited Kahns clinic and research laboratory, to see how lasers worked, talk with staff, try the equipment myself, and then train to use it. Kahns clinic, called Meditech, had a staff of forty-five people, mostly clinicians, and also a laboratory that designed the lasers. The ultimate goal of my visits was to see how lasers might influence the brain, but first I wanted to understand how lasers worked and see what serious laser treatments could do for common bodily afflictions.

Kahn told me that after the lights cured his shoulder, he reviewed all the scientific literature on lasers. He had been confused by all the many different light protocols—the different wavelengths, frequencies of treatment, and doses of light that various clinicians or companies were using for different conditions. He then spent time with the Russian scientist Tiina Karu, head of the Laboratory of Laser Biology and Medicine, at the Institute on Laser and Informatic Technologies, Russian Academy of Sciences. Karu is one of the world s leading experts on how lasers heal tissue. In 1989, following his time with Karu, he worked with engineers at Ryerson Polytechnical Institute in Toronto to develop an adjustable laser called the BioFlex Laser Therapy System that could produce an infinite number of light protocols and be used for both basic and clinical research. Kahn then spent years trying to determine which types of light would benefit different patients, given their skin color, age, body fat composition, and kind of illness, and he developed numerous protocols for use with the equipment he developed.

Physics of Lasers

Laser stands for Light Amplification by Stimulated Emission of Radiation. Since the 1600s, light has often been understood to behave like a continuous wave—traveling through space the way waves travel through water. (This is why scientists speak of "wavelengths" of light.) But Albert Einstein showed that light could also be understood as behaving like a particle, which ultimately came to be called a photon. A photon is like a small package of light, smaller than even an atom.

Two key concepts explain how lasers are produced from photons. The first, familiar from high school physics, comes out of the model of the atom that the physicist Niels Bohr proposed. Simply put, every atom consists of a nucleus, with electrons that orbit around it, at different distances from the nucleus. If an electron is in a close orbit to the nucleus, it has a low amount of energy; if it is farther away from the nucleus, it has a higher amount of energy. (These high-energy electrons are said to be in an "excited" state.) Thus each electron orbit is associated with a different energy state.

In most atoms, most of the time, the population of electrons in low-energy inner orbits (close to the nucleus) is larger than the population of excited electrons in the high-energy outer orbits (farther away from the nucleus). Whenever an electron falls from the high-energy orbit to a lower-energy orbit, a photon of light is given off, called a spontaneous emission of light radiation. This spontaneous emission occurs randomly in normal light (for instance, within a typical electric lightbulb).

But by bombarding atoms with an outside energy source, such as an electrical current or a beam of light, we can create atoms where more of the electrons are in the excited high-energy state. Now the population of electrons in the excited state is higher than the population of electrons in the resting state in the low-energy orbit. This so-called population inversion is the first key concept for understanding lasers.

The second key concept is stimulation. In lasers, atoms are artificially stimulated—bombarded is a better word—by an outside energy source, to bring about population inversion.

Normally, when atoms are bombarded with energy, they release photons. Bombarding atoms where population inversion has occurred, as happens in lasers, leads to a large release of photons. These photons, in turn, stimulate other nearby atoms to release more photons still, so that a cascade of photons is released. A way to enhance this process is to surround the photon-emitting atoms with mirrors, so that once emitted, the photons hit the mirrors and bounce back into the atoms with population inversion, hitting still more atoms and stimulating them to emit even more photons. Hence the name Light Amplification by Stimulated Emission of Radiation.

There are many ways to make lasers. If you look inside a small laser pointer of the kind used by lecturers (or inside your computer s CD reader), you will find an energy pump, in the form of batteries or an electrical source, that supplies a pulse of electricity for stimulation. You will also find a small laser diode, which is where the population inversion occurs. A typical laser diode consists of a sandwich of two solid materials that partially conduct electricity. They are called semiconductors for that reason.

There is a small space between the two semiconductors. One semiconductor is made of a material that has a relative surplus of electrons; the other is made of a material that has a relative deficit of electrons. Population inversion is created in this sandwich. When electromagnetism of a particular frequency is passed through these semiconductors to stimulate them, it triggers the cascade of light amplification. Mirrors in the space between the two semiconductors capture those photons and augment the cascade of light, which can then be projected in the form of a laser light beam. The exact frequency of light emitted can be controlled by adjusting the frequency of the energy pumped into the system.

The first laser—developed by Theodore H. Maiman at the Hughes Research Laboratories in Malibu, California, in 1961—was a hot laser. Within a year, hot lasers capable of burning tissue were being used in surgery in place of scalpels, and by 1963 they were being used to destroy tumors in laboratory animals. Lasers became widely known when the movie Goldfinger (1964) had a scene in which James Bond was strapped to a table, legs splayed apart, while a hot laser, looking like an oversized, glowing syringe and emitting a thin, focused red light, threatened to cut him in two:

Goldfinger (not overly impressed by Bond's special high-tech car): I too have a new toy.... You are looking at an industrial laser, which emits an extraordinary light, not to be found in nature. It can project a spot on the moon. Or at closer range, cut through solid metal. I will show you. Bond: Do you expect me to talk?

Goldfinger (jubilant): No, Mr. Bond, I expect you to die.

How Lasers Heal Tissue

By 1965 it was known that low-intensity lasers could heal. Shirley A. Carney, working in Birmingham, England, showed that low-intensity lasers could promote the growth of collagen fibers in skin tissues. Collagen is a protein that makes up our connective tissue, helps give it form, and is necessary for healing. In 1968 Dr. Endre Mester, in Budapest, showed that lasers could stimulate skin growth in rats, and a year later that lasers could radically improve the healing of wounds. By the mid-1970s, the USSR had opened four large-scale research and clinical facilities to use lasers to stimulate living tissues, a technique that, by the 1980s, was common in the Communist bloc, though rare in the West.

Not until the end of the Cold War did medical lasers become more common in the West, and not until 2002 did the FDA approve the first low-intensity laser therapy device in the United States.

When photons encounter matter, one of four things can happen. They can be reflected away from the matter, they can pass through it, they can enter it but scatter within, or they can be absorbed without dispersing a great deal. When photons are absorbed by living tissue, they trigger chemical reactions in the light-sensitive molecules within. Different molecules absorb different wavelengths of light. For instance, red blood cells absorb all the nonred wavelengths, leaving the red ones visible. In plants, green chlorophyll absorbs all the wavelengths except green.

Human beings tend to think that light-sensitive molecules exist only in the eyes, but they come in four major types: rhodopsin (in the retina, which absorbs light for vision), hemoglobin (in red blood cells), myoglobin (in muscle), and most important of all, cytochrome (in all the cells). Cytochrome is the marvel that explains how lasers can heal so many different conditions, because it converts light energy from the sun into energy for the cells. Most of the photons are absorbed by the energy powerhouses within the cells, the mitochondria.

Amazingly, our mitochondria capture energy originating 93 million miles away—the energy of the sun—and liberate it for our cells to use. Surrounded by a thin membrane, the mitochondria are stuffed with light-sensitive cytochrome. As the suns photons pass through the membrane and come in contact with the cytochrome, they are absorbed and stimulate the creation of a molecule that stores energy in our cells. That molecule, called ATP (adenosine triphosphate), is like an all-purpose battery, providing energy for the cell's work. ATP can also provide energy that can be used by the immune system and for cell repair.

Laser light triggers ATP production, which is why it can initiate and accelerate the repair and growth of healthy new cells, including those that make up cartilage (chondrocytes), bone (osteocytes), and connective tissue (fibroblasts).

Lasers of slightly different wavelengths can also increase the use of oxygen, improve blood circulation, and stimulate the growth of new blood vessels, bringing more oxygen and nutrients to the tissues— especially important for healing.

Kahn uses four different methods to get light into the cytochrome molecules. The first is red light, generated by 180 light-emitting diodes (LEDs), laid out in rows, mounted on a soft plastic band the size of an envelope. Typically, the therapist will cover a body surface with red light for about twenty-five minutes. This red light penetrates one to two centimeters into the body and is always used first, to prepare the tissue for deeper healing, and to help improve circulation.

Next Kahn uses an infrared band of LEDs for about twenty-five minutes. Its light penetrates about five centimeters into the body, spreading the healing light deeper still.

LED lights have laserlike properties, but they are not lasers, and thus you can look directly at them with no ill effects.

Then Kahn uses the pure beam of lasers, beginning with a red laser probe, followed by an infrared laser probe.* A laser probe can deliver much more power than LEDs, in a focused beam that goes very deep. By the time the laser probe is applied, the superficial tissues have already been saturated with so many photons from the red and infrared LEDs that the laser creates a cascade of photons in the tissues, reaching as deep as twenty-two centimeters into the body. The laser probe is applied for a short time, in various spots. A total treatment with the probe darting over many points may last about seven minutes. As is not the case with LEDs, looking directly at the laser light from a probe can be dangerous, and patients and clinicians wear special glasses when using them. The energy of a "dose" of light depends on two things—the number of photons the light source gives off, and the wavelength or color of those photons. As Einstein showed, the color of a light is a measure of how much energy it contains.

In the immune system, laser light can trigger helpful forms of inflammation—but only where required. Where inflammatory processes have become stuck and "chronic," as happens with many diseases, laser light can unblock the stalled process and quickly move it to a normal resolution, leading to decreased inflammation, swelling, and pain.

So many modern diseases, including heart disease, depression, cancer, Alzheimer's, and all the autoimmune diseases (such as rheumatoid arthritis and lupus), occur in part because our body's immune systems produce excess chronic inflammation. In chronic inflammation, the immune system stays on too long and may even begin to attack the body's own tissues, as though they were outside invaders. The causes of chronic inflammation are many, including diet and, of course, the *The LED red lights are 660 nanometers; the LED infrared lights are 840 nanometers; the red laser probe is 660 nanometers; the infrared laser probe is 840 nanometers.

countless chemical toxins that become embedded in the body. Chronically inflamed bodies produce chemicals, called pro-inflammatory cytokines, which contribute to pain and inflammation.

Fortunately, laser light fights excess inflammation by increasing the anti-inflammatory cytokines that bring chronic inflammation to an end. They lower the number of "neutrophil" cells that can contribute to chronic inflammation, and they increase the number of "macrophage" cells in the immune system, the garbage collectors that remove foreign invaders and damaged cells.

Lasers also decrease a stress on the tissues caused by oxygen. The body constantly makes use of oxygen, producing molecules called free radicals that are highly active and interact with other molecules. When they are in oversupply, they cause damage to cells and can bring on degenerative diseases. Another unique aspect of lasers is that they preferentially affect damaged cells, or cells that are struggling to function and need energy the most. Cells that are chronically inflamed, or that have only a limited blood supply and oxygen due to poor circulation, or that are multiplying (as happens when tissues are trying to heal themselves) are more sensitive to red and near-infrared low-intensity lasers than are well-functioning cells. For instance, a skin wound is more sensitive to low-intensity lasers than is normal tissue. In other words, lasers have a good effect where they are most needed.

To heal, the body often needs to make new cells. The first step in cell reproduction occurs when DNA replicates itself. Laser light can activate DNA (and RNA) synthesis in cells. Human cells in a petri dish will synthesize more DNA and grow in response to specific wavelengths of light. E. coli a very simple form of bacteria, responds to some but not all of those. Yeasts respond and grow to still other wavelengths. There is thus a whole language of light energy, in which the specific wavelengths are the words, to which living cells respond.

But how might lasers influence the brain? Even normal sunlight affects the brains chemicals. Serotonin, a brain neurotransmitter, is known to be low in some depressions; studies show that normal sunlight causes the body to release serotonin, which is one reason people living far from the equator feel rejuvenated and in a good mood on sunny holidays. Laser light also releases serotonin, as well as other important brain chemicals, such as endorphins, which lower pain, and acetylcholine, which is essential for learning—and which might help an injured brain relearn mental abilities that have been lost. Kahn, Naeser, and the Harvard group believe that laser light affects the cerebrospinal fluid as well. Kahn believes that the cerebral spinal fluid and the blood vessels carry the photons into the brain, where they influence the brain cells, as they might other cells. The scientific research on this pathway is in its infancy.

To fully appreciate Kahn's clinical work, I had to overcome a prejudice

It is not difficult now to make a simple, inexpensive, "one size fits all" laser. Chiropractors and other health professionals will often use small lasers for a few minutes in their offices after a chiropractic correction, almost as an afterthought. I had tried such procedures myself and been unimpressed. I told Kahn this, and he was not surprised: "These short application times are not nearly long enough for lasers to heal anything."

Kahns lasers are different from most small handhelds. Some of his devices cost tens of thousands of dollars and are attached to sophisticated computers. His staff members are constantly hovering over patients, changing their settings and varying their treatments.

In his twenty years of work, Kahn and his staff have observed the effects of almost a million laser treatments to determine which protocols work best for which conditions and for which kind of patient. Kahn himself still sees 95 percent of patients who come to his clinic and follows up on them. A patient s skin color, age, and amount of fat and muscle all affect how much light is absorbed. As a patient responds, the practitioner adjusts the frequency of the light pulse, waveform, and the dose of energy (number of photons passed to each centimeter of tissue over time). As Michael Hamblin observes, "There is an optimal dose of light for any particular application, and doses higher or lower than this optimal value may have no therapeutic effect." Sometimes, however, "lower doses are actually more beneficial than higher doses."

I first got to know what Kahn's lasers could do by observing their effects on the conditions they were best known for. One woman I observed had a rotator cuff injury in her shoulder, usually caused by a tear to the muscle or ligament. For a year, she had had massage, chiropractic, and osteopathic help, with little benefit. After four laser sessions, her pain disappeared, and her strength and flexibility normalized.

Professor Cyril Levitt, a sixty-six-year-old anthropologist and sociologist, walked poorly because of osteoarthritis in his hips and knees, which he had had for six years, and a torn Achilles tendon. Osteoarthritis is often treated with hip or knee replacements. In four laser treatments, over the course of a week, he was pain-free in his hips and knees without medication, going up and down stairs again without discomfort; with more treatments, over a number of months his arthritis healed completely, as did his torn Achilles tendon. Several cases of sciatica, ankle problems, and chronic pain from shingles were cured. A physician who had completely ripped a shoulder tendon and was scheduled for surgery got so much better he canceled his operation. Another person, referred for chronic sinusitis, found that it improved, along with his hearing, while the ringing in his ears decreased. The improvements in all these people were permanent, so they didn't require ongoing treatment. A few people didn't get better, but they all stopped their sessions after only a few of them.

One of the neuroplasticians I described in The Brain That Changes Itself, Barbara Arrowsmith Young, who had healed her many learning disorders with brain exercises, also visited Kahn. As a younger woman, she had had severe endometriosis, a condition in which the cells lining the womb grow elsewhere in the body; it can cause pain and bleeding and rendered Barbara unable to have children. Multiple surgeries for it led to the development of tremendous scarring inside her abdomen, called postsurgical adhesions. The scar tissue was so extensive that she was left with continuing pain and monthly bowel obstructions, some life-threatening. Every time the surgeons went in to fix it, the scarring got worse. She suffered for decades. Finally, a test revealed that she had a genetic abnormality that caused her to form excessive scar tissue.

With all this scarring and surgery, she developed a chronic pain syndrome, with incapacitating abdominal pain, which Michael Moskowitz and Maria Golden helped to diminish. But she was still prone to severe bowel obstructions.

Knowing that low-intensity lasers can help scar tissue heal normally, I told Barbara about Dr. Kahn. After a series of treatments, her problem—which she had been told would be permanent—radically improved. Her bowel obstructions became very infrequent, only several a year, and were less dangerous, enabling her to travel, and her pain went down. Kahn has also achieved outstanding results treating endometriosis, and was able to control it in some patients so well that they were able to cancel surgery they had scheduled. I found it painful to realize that Barbara might have been spared multiple operations, infertility, and decades of living in fear of obstructions had lasers been better known.

Kahn showed me the barely visible remnants of a lesion on his own face, typical of the elderly, caused by too much sun exposure. "As a boy on the farm," he told me, "we always worked outside without shirts, hats, or sunscreen." Now he was paying the price; his dermatologist had told him that the skin lesion (called actinic keratosis) was precancerous. Typically these lesions are cut out or burned off with a hot laser. But instead of having it burned off, Kahn used the low-intensity laser, and the skin normalized itself in several sessions. Many less severe skin cancer lesions, he told me, such as some basal cell cancers, can also be healed by low-intensity laser light.

I was becoming convinced that lasers, in Kahns and his colleagues' hands, were rapidly healing all sorts of things that should not be healed—cartilage, badly torn tendons, ligaments, and muscles.

Among the people I observed who completed treatment, the overwhelming majority got better. What might he do for brain problems? I wondered.

The Second Meeting

The next time I heard from Gabrielle was when I opened an e-mail from her on February 24. "Gaby," as she sometimes called herself, wrote that she had been busy. She had been in touch with Anita Saltmarche to set up some sessions and had become part of the Boston study. Saltmarche said the treatment would involve shining lasers over the top of her head for short periods. Gaby understood that she would need to treat herself with light for ten minutes a day for the rest of her life, starting in a few weeks. In the meantime, she had also decided to see Kahn for her folliculitis, because he had had so much experience with skin infections and wounds.

Gaby never discussed the idea of Kahn s working on her brain problems, because he had mostly shown slides of wound healing. But when he heard about her cognitive symptoms, he, as a surgeon, was quite certain they were secondary to the trauma of surgery, because no matter how meticulous a surgeon is, particularly in intracranial surgery, considerable bleeding usually occurs, resulting in scar tissue, especially in the protective layers surrounding the brain called the meninges. He also thought there was damage directly to the brain cells, leading to her symptoms.

"When I was sitting in the chair," Gaby told me, "doing the lights for folliculitis, [Fred] said, T can help you with the brain stuff too, I have been doing this for years.' He just shrugged his shoulders matter-of-factly as he said it. You know Fred."

Since 1993 Kahn had been treating the cervical spine, the higher part of the neck, in people with neck issues, and he noticed, unexpectedly, that when a patient also had a central nervous system or brain problem, those symptoms often improved too. He realized that the brain's cerebrospinal fluid, which flows around the spinal cord, was probably flowing back to the brain after being irradiated by the light.

Gaby asked Kahn what the treatment would involve, and he said that in the sessions when he was treating her folliculitis, he could shine another light high up on her neck, focused on her brain stem. His review of the literature had proved to him that lower doses of light, over longer periods, were effective for regenerating tissue and reducing pathological inflammation, as well as increasing the general circulation of blood in the brain—something that he, as a vascular surgeon, knew was essential to healing. The initial sessions would last longer than an hour, but he didn't think Gaby would need the lasers for life.

At the first treatment, he put the lights high on her neck and down her spine. Afterward she was exhausted, even though all she had done was sit in a chair. She needed to sleep—a typical response as the brain begins to recover. Its nothing like the exhaustion that occurs with radiation treatments for cancer, in which cells are destroyed. As I described in Chapter 3,1 believe it happens because the injured brain, which has been in the sympathetic fight-or-flight response, enters the parasympathetic state; it turns off the fight-or-flight reaction, calms and neuromodulates itself, then enters the healing state of neurorelaxation.

After the second treatment, Gaby knew her life was changed. She noticed she could concentrate longer. By the end of three weeks, she noticed memory improvements and greater energy—she was able to brush her teeth for a whole minute. Her nausea stopped. And she had strength to open the refrigerator door. Eight weeks later she wrote me:

I can now remember, concentrate, and multitask. I have mental
clarity. I can fully rotate my head to the left and bend over. I can
listen to the radio, sing, use the shredder, and go into restaurants
and shopping malls. I returned to synagogue (the microphones don't
bother me anymore), and Ym back doing exercises in the swimming
pool. (Screaming kids, ghetto blasters, and hair dryers are no longer
an issue for me.) I can walk faster than my dad on good days, and
Ym a lot stronger.... Ym hoping... J will be able to drive again..,.
It's very exciting to go from any change requiring months to take 

hold, to having changes every two or three days…. I'm not 

counting any chickens yet, but I haven't thrown up in 2012.

Then she added a little P.S.:

The concert: Beethoven and Your Brain: with Daniel Levitin is this Saturday night at Koerner Hall

Thank you for your interest and help.

Daniel Levitin is one of the world's leading experts on how music influences the brain. He would be appearing with the conductor Edwin Outwater and the Kitchener-Waterloo Symphony Orchestra, which would play Beethoven. Levitin would explain how the music was affecting the audience's collective brain. Levitin was no disinterested academic. He had had a serious career as a musician, performing with Sting, Mel Torme, and Blue Oyster Cult, consulting with Stevie Wonder and Steely Dan, and having been recording engineer for Santana and the Grateful Dead. Then he—like Kahn—had done a big switch and become a research psychologist, investigating how music interacts with the brain. He was now head of McGill University's Laboratory for Musical Perception, Cognition and Expertise and author of This Is Your Brain on Music. I immediately got tickets, and because we had not met, I called his secretary in Montreal to invite him for dinner at my home that very evening, the night before the concert. She said she'd try to reach him, but he was traveling from L.A.

That evening Daniel Levitin knocked on our door while we were having dinner with friends. The conversation, well under way, was animated, about the modern German and the ancient Greek philosophers. During dessert, Levitin spied two guitars standing against the wall like two maidens hoping to be asked to dance. We spent the rest of the evening singing and playing together, songs by others, songs we had written. Not a word was said about the brain.

The next night at the concert, Levitin was very verbal, and he and Outwater were great witty fun together, both having a bit of the standup comic in them. Koerner Hall is built of beautiful woods that curve and sweep out from the walls and ceilings, giving the feeling that one is inside a beautiful musical instrument built to resonate.

Levitin, Outwater, and the orchestra marched through the Egmont Overture, the fourth movement of Symphony No. 9, the second movement of Eroica, and all of Symphony No. 5. While the orchestra would play the Beethoven passages, the audience used small digital devices to register in real time the specific emotions that the passage of music evoked; meanwhile a computer tallied all the results. It was fascinating how large a majority of the audience, hearing a particular passage of wordless music, would experience the same emotion, be it sadness, grief, or joyful anticipation. We all know that certain musical passages seem happy, sad, or frightening, but here was a truly lucid demonstration of how different oscillations of sound can have similar impacts upon many different brains. Levitin explained how the music—its timbre, pitch, variations, and expected and unexpected flourishes—influences the brain to lead to those emotional reactions. When the concert ended to uproarious applause, the evening wasn't over. Instead of rushing off, people mingled in the foyer overlooking the tree-lined Philosopher's Walk, listening to an exceptional Asian pianist play for everyone.

Then I saw her. I had never dreamed that Gaby, with all her problems with sound and listening to music, would have attended a Beethoven concert, because he wrote thunderous music—not what a woman who had been so damaged could tolerate. Though just the day before I had read her letter claiming she was feeling improved, I hadn't taken in the extent of her recovery. She moved quickly across the hall toward me, with an assured step. Her face was beaming, and her eyes were bright.

After introducing me to two of her friends, she said, "The last time I dared come to one of these concerts, I was so disoriented by the sound that I had to sit in my chair for about half an hour afterward. Then, when I got up"—she pointed from where we were standing, overlooking Philosopher's Walk, to the far exit, about twenty-five yards away—"it took me twenty minutes to go from here to there, and that was with people assisting me."

This woman's brain was being rewired with light

Kahn was least surprised by Gaby's progress. In early April, she and I met again at Kahn's clinic, and he showed me how he positioned the lights on her head, over the skull areas closest to her brain stem and cerebellum. As he placed them on her head, she lifted her hair, and I could see a five-inch-long scar behind her ear—the cut into her skull that had saved her life.

Over the next eight months, I kept in touch with Gaby. She had had her first light treatment in late December 2011 and began getting treatments twice a week. By early March 2012, she was down to once a week and declared that she had both her short- and long-term memory back, could multitask, and most important, could think clearly. Her terror of losing her mental functions was over.

She did various forms of exercise, including aqua-fitness and tai chi an ideal exercise for a woman with balance problems.

Never passive, she was the ideal patient. The lights were healing her tissue, but she still had to relearn tasks she once could do, by engaging her neuroplasticity with repetitive training involving focused attention. What she found difficult to explain to healthy people about recovering from a brain injury was that each time she made a small step forward, she was often set back, exhausted for days, because "small steps" are not small at all. They felt as momentous to her as if she were learning each step for the very first time, because the neurons doing the activity often were doing it for the first time, since those that did it in the past had died. But once she started the lights, Gaby noticed that the setbacks were few. When the woman she was working with wore a top with alternating horizontal stripes of white and black, Gaby said, "I can tolerate it, and I didn't need her to put on anything to cover it. Still not perfect, but it isn't a visual scream anymore!"

She continued, "A week ago I got the music back!" Not only was music no longer tormenting and draining her, it was now invigorating her. "That is huge for me, because music has been so big for me ... and I can dance!" she explained, now that she had her balance back.

"Last week I saw someone I knew from choir," she added. "He saw me when I used to move and speak like molasses. And he said, 'Oh my God you are walking!' And I said, 'It is so nice when someone notices improvement.' And he said, 'You don't understand, this isn't improvement, this is a whole other universe.'"

Proof Lasers Heal the Brain

In the past, Kahn had helped people who had brain and other nerve-related problems such as headaches from concussions, vascular dementia (dementia caused by blood vessel problems in the brain), migraines,