It was a few days after Thanksgiving in 2001, and Paula Offenhauser was rummaging for her plastic Christmas tree in the attic. Realizing she needed scissors to free the decorative shrub from its packaging, she headed back down to the floor below. The attic ladder was one of those steep, narrow, precarious ones. Offenhauser tripped at the top and tumbled down, her body crumpling at the bottom, wedged between the ladder and the door opposite the bottom rung. After that, she doesn’t remember much.

“I went to the attic, and I woke up in a hospital six days later,” said Offenhauser.

She hit the back of her head on either the wall or the ladder––the bloodstains were unclear. Her 25-month-old daughter answered the phone when Offenhauser’s sister called an hour later, and was able to communicate enough to prompt an immediate 911 call.

Offenhauser was initially in the hospital for a month. She was told she’d be able to go back to work by September 2002, 10 months after her injury. But, being a single mother, she got restless at home and worried about finances, so she went back to work in February, just three months after the accident.

A graduate of the University of Texas School of Law, Offenhauser’s been working as an appellate lawyer for 36 years. “I was trained to be a think tank,” she explains. “You get an issue like a mathematical problem, and you have to do a lot of research, a lot of reading, a lot of critical analysis. You have to have independent judgment.”

After the accident, the damage to her brain made it nearly impossible to use the skills she’d developed. “You go from a very proficient legal appellate warrior to being a deer standing frozen in front of a headlight. To this person who’s turned into a weak little mouse.”

One of the first doctors that treated her, a behavioral neurologist, told Offenhauser she’d likely lost around 20 percent of her brain. Headaches, fatigue, difficulty forming sentences and terrifying sleep disturbances became routine. She was referred from doctor to doctor for several years, but nothing worked.

Then she met Dr. Randy Urban.

Urban, a professor and chair of the department of internal medicine at the University of Texas Medical Branch, is one of first doctors in the country to prescribe human growth hormone to patients with traumatic brain injuries––with remarkable success.

In the late nineties, Urban was approached by Galveston-based billionaire Robert Moody. Moody’s college-age son, Russell, was in a devastating car accident in 1980 that left him in a coma. Doctors told Moody that his son would remain that way forever, but Moody wouldn’t accept it. He began funding all kinds of research on treatments for traumatic brain injury. Some things helped Russell, some things didn’t.

Then Moody came up with the idea that he brought to Urban––that his son’s condition might be due to a dysfunction of the pituitary gland: “the gland behind the middle of your eyes, on a stalk, in the brain,” Urban explained.

“I looked in the literature and there was no evidence of that,” Urban said. “I told him I didn’t think there was anything to this.” Moody pressed, and offered to fund research on the topic. “I got into this based on serendipity and greed,” Urban said.

The first studies shocked Urban and his UTMB team. “About thirty percent of the patients we initially tested had pituitary dysfunction of one form or another,” he said. Urban discussed the findings with colleagues in the field and starting talking publicly about it. “The Europeans got excited and it became a worldwide interest.”

That led to funding for bigger studies at UTMB, first through the Moody endowment, and then through more varied sources like the National Institute for Health and Pfizer. The first published study, in 2001, focused on the “most severe folks,” said Urban. “Couldn’t walk, were wheelchair bound. When we put these folks on growth hormone, they began to do better. We saw trends of improvement in short term memory and executive function.”

After that, they did another study on the less severe cases: “Those who are able to be out in society, moving about more,” said Urban. That study showed significant improvement in energy and cognition after a few months of growth hormone therapy.

“We can give you people who couldn’t do their job and now are back full time,” said Urban. “They were talking to us about brain fog, couldn’t do their normal routine, and then all of a sudden––they could.”

That’s how it happened with Offenhauser. Fifteen years after her accident, Urban diagnosed her with brain injury associated fatigue and altered cognition, or BIAFAC, and prescribed human growth hormone.

“It was night and day,” said Offenhauser. “I wish I had had this ten years earlier.”

Offenhauser describes her brain function using roadmap analogies, her thought process as a freeway. Before growth hormone therapy, “I had freeways that were going up and down, every which way,” she said. “Freeways that there are no exits to get off of.”

The growth hormone therapy helped to rebuild direct routes in Offenhauser’s brain from the word or concept she was mentally reaching for, to the thing itself. “What Dr. Urban built for me––he built my freeway,” said Offenhauser.

The biggest roadblock for most eligible TBI patients is financial––insurance companies balk at the $14,000 per year price tag. Urban’s office has resources to push for coverage, which they were able to do for Offenhauser. Unfortunately, said Urban, most regular practitioners aren’t able to do that kind of advocacy for their patients. As a result, coverage is often denied by insurance companies.

It’s expensive, Urban said, because there isn’t much of it yet: “About six companies make growth hormone.” With more awareness for the benefits of the treatment, though, that could change.

Offenhauser still gets headaches, she says, and had to add another medication to the growth hormone to reduce a swelling side effect. But overall, she calls the treatment a “miracle.”

Though swelling is really the only side effect Offenhauser’s experienced, Urban’s seen a few other consistent side effects as well, such as fluid retention, a risk of carpal tunnel and a risk of insulin resistance with higher dosages. But it hasn’t been studied long term, so there are a lot of questions that remain.

“Will GH increase the risk of cancer?” Urban asked rhetorically, “No one knows the answer to that.”

“What I know is when they present with this BIAFAC syndrome,” said Urban, “and I treat them with GH, 85 percent get better.”

The research is encouraging, but still very new. To better understand the syndrome, Urban and his team are working to develop new studies to learn why, exactly, growth hormone makes these people better.

But so far, most of the time, it does.

Even Russell Moody has seen improvements with the help of growth hormone therapy. He’s now “a happy, middle aged guy,” said Urban. Though not completely independent, those close to Russell have noticed a marked difference as a result of the treatment.

For Offenhauser as well, growth hormone therapy has been the thing that brought her life back. “Dr. Urban is pretty incredible,” she said. “I am eternally grateful.”