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Interviewer: According to the Centers for Disease Control and Prevention, more than two million Americans experience a brain injury each year. While some of these injuries result in relatively short-term impact on a day-to-day function, others can lead to long-term challenges or even a permanent disability.

Today, we'll be speaking with Zoe, a young woman who experienced a traumatic brain injury after an accident and the long journey of her recovery and the daily experience of overcoming the long-term challenges of life after an accident like this.

And to help us better understand the medical side of a traumatic brain injury, joining us is associate professor of neurosurgery at University of Utah Health, Dr. Ramesh Grandhi, the doctor who helped stabilize Zoe after her accident.

Zoe, why don't we start with what kind of led to your traumatic brain injury in the first place? What exactly happened?

Zoe: Yeah. Well, interesting story. I had just moved to Salt Lake City in August of 2020, and this occurred . . . or rather, my accident occurred December 5, 2020. So I had just shy of five months in the state, really.

So I hadn't experienced a lot, but a friend and I really wanted to ski together. I bought a season pass at Alta, was really excited to get up there. And it was day one, in fact, of the ski season that this happened. So really did not get any other skiing in, obviously, but this was day one.

Yeah, I mean, I don't remember a whole lot about the day itself. I have spotty memories of the drive up to Alta, getting to Alta. I actually have some spotty memories of being on the lift up to the first run. After that, I don't remember anything. I remember a bit of skiing, and that's really about it in terms of the day.

And then subsequently, upon waking up, I have absolutely no memory of the remainder of December. My memory is really spotty from about Thanksgiving up to December 5th. So Thanksgiving, I would say, is the last clear memory that I have and everything else is kind of spotty. It appears in my head almost as if I made it all up.

I've had to ask a lot of people, especially family members, "Did this really happen? Can you describe this thing to me or remind me who was at Thanksgiving again?" I never would have guessed something like this when I first started skiing with my dad 10-plus years ago.

And I was maybe 500 yards behind several of my friends, so I was alone during the actual collision. I ran into this group of trees that sat right in the middle of the run that I was on at Alta.

In this tree well, it was icy. I slipped on the snow evidently and collided with some trees in the tree well. What I would assume happened at that point is I was knocked unconscious by the collision and then fell and was hidden by this tree well and this group of trees. And then because I wasn't found until about four hours later, I had become buried or covered by snow by people skiing by, obviously.

Interviewer: Sure. So you're spotty memory-wise from Thanksgiving to . . . When did you start to remember things again?

Zoe: Right. So really, my lucidity, I would say, started to come back right around January 6th, 7th, 8th, right in that area. This is purely what I was told, is that I woke up somewhere mid to end of December. The rest of December went by. I was then transferred to a long-term care facility outside of Salt Lake City. And right around that, again, 6th, 7th, 8th of January is when I have memories that I'm able to go back on and say, "Oh, yeah, that was right in the beginning of January." Before that, though, I have no memories.

Interviewer: Wow. So, Dr. Grandhi, I want to go to you at this point. When did Zoe come into the care of you, your team, the University of Utah Hospital?

Dr. Grandhi: As I recall it, I didn't find out about Zoe until Sunday morning first thing. I know that she presented as a transfer to our hospital, and clearly, she had traumatic injuries. And the first principle of what we do is just stabilize the patient. The trauma surgeons and a number of other services are super important and are our partners in making sure that a patient is appropriately stabilized.

And then my partner was actually on call and received the first call about her. He then got in touch with me. We do a really nice job within our department about communicating about patients with traumatic brain injuries, and specifically, patients with severe traumatic brain injuries.

So I remember that Sunday morning very well because she was downstairs in our surgical ICU. I went and saw her and just looked at her images, and then went out and talked to her dad who was sitting in the waiting room all by himself.

I remember the exact seat he was seated in early on that Sunday morning, probably around 8:00 a.m. or 9:00 a.m. And he was just by himself. I just walked up to him and told him what my assessment was of the situation based on looking at her head CT and things like that.

And at that point, it was just me trying to tell him that we're going to do our best to take care of her, that she presented with what we call a severe traumatic brain injury, and what the principles of managing patients with that are, and also, honestly, giving him hope.

Interviewer: When we talk about traumatic brain injury, is it a lot of skiing injuries, sports injuries? What is the most common type of traumatic brain injury?

Dr. Grandhi: Traumatic brain injury is a significant burden in the Western world. It's the number one cause of death amongst young folks in the Western world.

Traumatic brain injury falls into three buckets: severe traumatic brain injury, moderate traumatic brain injury, and mild traumatic brain injury. And oftentimes, patients with mild traumatic brain injuries don't even come into the hospital. We call it a concussion. And oftentimes, a patient may stay at home after hitting their head, or being involved in a sports injury, or a motor vehicle collision, or falling and hitting their head.

The burden of traumatic brain injury in the United States today is about 2.5 million patients per year. So many patients don't even come into the hospital. Many patients are discharged from the ER.

Interviewer: Zoe and her accident, of those three buckets, what did hers fall into, and why?

Dr. Grandhi: Zoe had a severe traumatic brain injury. And the way we diagnose severe traumatic brain injury is quite simple. We just gauge it in terms of what their neurologic exam is when they come in. So are they able to open their eyes? Are they able to speak? Are they able to follow commands?

Interviewer: And Zoe was unable to do those things?

Dr. Grandhi: Correct.

Interviewer: Wow. Zoe, do you remember any pieces or parts of the story? How did you feel when you were first, I guess, coming out of it?

Zoe: Yeah. Again, like I said before, the first memories I have are really in the long-term care facility that I was transferred to after leaving The U. I think it was sort of a slow realization.

And then since then, I would say I've noticed things that are sort of side effects or fallouts from having a severe traumatic brain injury: getting frustrated much more easily, being able to jump to anger much more easily, having very little patience, amongst many others. So it was very much a slow realization and slow rollout. And then still to this day, new things come up.

So it was much more slow. It wasn't similar to if you broke your arm and someone said, "Oh, you broke your arm," and then they casted it up right then and there. It was much more prolonged than that and slow realization.

My initial thought, honestly, was because I was awake and lucid and conscious, "Oh, my brain is fine. Well, everything is good. I can speak. I can see. I can hear. I can eat. I have my motor functions." And so, initially, I didn't think too much about the effects on my brain, and that did come up much later and still continues to this day.

Interviewer: Dr. Grandhi, when it comes to treatment of a case like Zoe, what was done to help Zoe get from the accident to where she was stabilized and in, I guess, a longer-term facility to kind of monitor her?

Dr. Grandhi: Well, I think we need to kind of dial it back a little bit to understand the management principles of patients with severe traumatic brain injury. And it starts, honestly, in the pre-hospital setting in which those who are on the first line understand how to manage a person, particularly with a pathology as significant as severe traumatic brain injury.

So first things first, getting the patient stabilized in the field, making sure that people are very cognizant of taking care of the patient, immobilizing their neck. Again, we don't know if a patient has had an injury to the cervical spine. Zoe clearly hit trees, so she could have very easily had damage to her neck, to the bones of her neck, spinal cord, etc. So getting a patient stabilized at the point of injury, then making a decision of where the patient goes.

There is data to show improved outcomes in patients who have a severe traumatic brain injury who are taken to Level 1 trauma centers. So understanding where to send the patient when the patient comes in.

Again, we have a huge bevy of services that are there in the ER, in the trauma bay awaiting a patient, because there's pre-hospital notification. And so if a person is coming in as a Level 1 trauma to a Level 1 trauma center, we do have orthopedics right there. Neurosurgery is right there in the trauma bay. Obviously, trauma surgery, the ER doctors, a number of different services and specialties are there awaiting the patient.

Airway management is important, worrying about circulation, blood pressure, ensuring that there's no intra-abdominal injuries. After that, there are a lot of scans that are ordered inclusive of CT scans that are literally performed head to toe to make sure that we're not missing significant injuries that need actionable treatment, such as rushing a patient up to the operating room for an intra-abdominal injury.

That being said, once that is done and there's nothing imminent that needs to be treated emergently, the patient is generally taken up to the ICU. And in Zoe's case and a patient with a severe traumatic brain injury, they're ventilated, and then there's a lot of management that occurs then predicated on blood pressure management, good oxygenation for the patient.

And for patients with severe traumatic brain injury, when we know a patient has a severe traumatic brain injury, we place particular monitors in the patient's brain because we're obligated to make sure that we have good control of intracranial pressure. So we want to make sure that we know what a patient's intracranial pressure is, and we need to keep it below certain thresholds.

We clearly know what the patient's brain perfusion is in terms of what's the state of blood pressure to brain tissue. So we monitor a patient's systemic blood pressure, their body's blood pressure well, and have to get the brain perfusion pressure in a particular range.

That's a quick summation of the management principles of a patient with severe traumatic brain injury. Not every patient requires a big-time operation and removing part of the skull or sucking out blood, but when we do place brain monitors, we do have to drill a small hole in people's skull to place these monitors. We have to remember that brain injury comes in many different flavors, even severe traumatic brain injuries.

Interviewer: So you just keep an eye on all the things that are going on with your monitors and everything to see whether or not there's injury?

Dr. Gandhi: Absolutely. And we use CAT scans liberally to help us understand more about the evolution of the brain injury. Zoe did have blood in her head, no question about it, but we did not feel that this blood would require us to take her to the operating room for an emergent surgery to remove the blood.

Interviewer: It's my understanding that Zoe then was a part of a study dealing with neuromonitoring. So for someone who's listening right now, what exactly is neuromonitoring, and why is it so important that we do research with it?

Dr. Gandhi: Whenever someone is classified as having a severe traumatic brain injury, we know from years of research and guidelines and a lot of work from really experienced, savvy, thoughtful leaders in the field that patients should get particular things monitored.

As I had said, we want to get invasive arterial blood pressure monitoring so that we can get a good second-to-second, moment-to-moment gauge of what a person's blood pressure is not using one of those expandable blood pressure cuffs. So this is something that allows us to know on a moment-to-moment basis what a person's blood pressure is doing.

We also ensure that the patient has adequate ventilation using a breathing tube. We study their intracranial pressure via an intracranial pressure monitor.

Finally, one of the things that has been important recently in the care of patients with severe traumatic brain injuries is the concept of whether brain tissue oxygenation can help guide therapy for a patient with a severe traumatic brain injury.

So historically, many university centers across the world, many experienced Level 1trauma centers have been using brain tissue oxygenation monitoring, basically almost as though you had a pulse oximeter of brain tissue. Many folks around the world have used brain tissue oxygenation monitoring as another way to help manage their patients with severe traumatic brain injury.

Here at the University of Utah and also many sites throughout this country and across the world in a separate study have decided to do a randomized controlled trial on this and understanding whether it will bear out in a huge patient population of improving outcomes. And Zoe was enrolled in that trial, and the trial is called BOOST-3.

Interviewer: So what exactly is BOOST-3 looking to do?

Dr. Grandhi: What we're looking for in the BOOST-3 trial is to determine whether using brain tissue oxygenation monitoring in the care of patients with severe traumatic brain injury improves outcomes at six months.

This is over and above using traditional monitoring techniques such as intracranial pressure monitoring and cerebral perfusion pressure monitoring that are already used commonly as part of guidelines that have been established in taking care of patients like Zoe.

Interviewer: So, Zoe, we've been talking a lot about kind of the medical side of things. I want to go back to you. What was it like when you first had Dr. Grandhi or any of the other specialists kind of explain the condition to you and what was going to be expected moving forward?

Zoe: I think in all the research that I've done and the people around me have done and then my discussions with Dr. Grandhi initially and shortly thereafter, and from what I gather from all of that, is that it's largely unexpected. The results and the things that come of it are known and yet unknown, right? It's things that they know come from a severe traumatic brain injury and then there are things that you don't really know will come up until they come up and until you experience them.

So from what I've been able to dissect from this injury is kind of pick apart, or notice rather, the moments in my own life where the thought comes into my head saying, "No, this isn't really you. This isn't really the Zoe that has made it to this point." "This is the TBI speaking," I guess, for lack of a better term or phrase.

An example would be if I'm feeling really, really agitated one day or even one hour and then the next hour I'm back to feeling normal again. So it's really quite a rollercoaster, I would say.

Interviewer: But what did it feel like to kind of hear that? I mean, as an outsider, as someone who's never experienced this kind of thing, that sounds kind of scary to me.

Zoe: Well, I would say more jarring than frightening. As the patient or as the person with a severe TBI, you don't necessarily . . . or I didn't, at least, necessarily believe the things that were being told to me. Not that I would think, "Oh, Dr. Grandhi is a liar," but I didn't necessarily believe it until those things started to show up for me in my own life later on and as time went on.

So months later, it's coming up on a year, so a full year later, I notice things that they told me initially that I might feel or that may come up. And at the time, I was thinking, "Well, I feel fine now, so we're good. We're all good here. Have a nice day." So it wasn't until up to this point that I think, "Oh, okay. I see what they mean by this progression and regression of things that may come and go," and things that I might feel that I didn't think I would feel at the time.

So it was definitely helpful to hear that then, and thinking about it now, "Oh, okay. They were right all along. They know what they're talking about."

Dr. Grandhi: I think it's really important to understand that while we as physicians, particularly as neurosurgeons who take care of patients with severe traumatic brain injury, I look at Zoe, and we raise our hands and we run a victory lap saying that she is a success.

And first things first is just in the acute setting, there's more research coming out that shows that if you are able to get a patient through the acute brain injury setting and manage them correctly and take care of them, we should not be nihilistic about where they will be one year later.

There's new research using big data sets that show that patients such as Zoe who come in with severe traumatic brain injury can have favorable outcomes at one year. Part of this data set also shows that 20% of patients can perhaps have no disability at one year.

But that being said, Zoe's experience alludes to the fact that we cannot forget about our patients. They still sometimes experience some sequalae that are hard to just kind of put a finger on. Like Zoe talks about, just agitation, maybe irritability, maybe memory issues.

So this is a process, an evolution, and it's really important for us to be able to support our patients, get them the correct resources, and really kind of steer them and continue to shepherd them through the process, which may take many more years.

Again, the concept of neuromonitoring for patients with traumatic brain injury only pertains to patients with severe traumatic brain injury, patients who are in a coma, patients who come into a hospital in a comatose state.

And I think we're going to learn a lot through this study as well as over the next years of how to really target various treatment thresholds and really tailor a patient's care to perhaps the type of pathology that they're coming in with.

So this is really important to patients with severe traumatic brain injury, but for the audience out there who is interested in traumatic brain injury in general, because most of the patients who experience a traumatic brain injury don't come in like Zoe in a coma, we're learning a lot about traumatic brain injury in general.

We're learning that there are so many different components to living with a traumatic brain injury. We are understanding that there are perhaps new ways of diagnosing patients and understanding what's called biomarkers and their role and understanding whether they're different symptoms, sequalae, or phenotypes that people experience after a traumatic brain injury.

Finally, it's really, again, very important to support our patients because it's not just the acute recovery stage. One of the people who trained me told me the biggest misnomer in patients who come in with mild traumatic brain injury, which is sometimes called a concussion, is there's nothing mild about it if you experience headaches two months after the fact, or if you have problems with staring at your computer screen if you're a person who works on computers and have eye strain after that, or have problems with balance. There's nothing mild about it.

And now the question is, "How can we support our patients better and get them the needed resources they need to get back on their feet and get their life back in order?"

Interviewer: So, Zoe, you're 25 now. It's been a year since the initial incident. How have you felt along the process? And how do you mark your own success and, I guess, healing from this particular incident?

Zoe: It actually took quite a while for me to recognize my own success, my own progress. It's really been just recently, actually, that I've been able to think to myself, "Oh, okay. You can actually do that thing now that you weren't able to do three months ago, four months ago."

It's more so just the ability to recognize those things. And I wasn't able to recognize those things previously. So it's been really difficult to measure my own progress based on what that looks like or what that has looked like in the past year.

I mean, highs, overall, I would say the ability to remember. Honestly, my short-term memory was completely restarted, completely obliterated in the beginning, and I wasn't able to hold a memory for several minutes. I would forget the thing before. So my working memory and my short-term memory have improved significantly.

Luckily, nothing really ever happened to my long-term memory, so I was able to remember years past. I could tell you where exactly I was and who I was with, especially right in the early beginning.

One of the most difficult things, but probably does not top the list, that I've experienced from the fallout, if you will, is the changing of relationships in my life. Friendships and various other things that have been really difficult to not only maintain, but to offer my lived experience as it is and as I see it and as I experience it. It's extremely difficult to explain the mindset that I have and where my brain is at on any given day.

And luckily, some of them have had extreme understanding and extreme patience with me. And that's really all I ask of the people in my life now, is, "Please be patient with me and my progress and the things you likely don't see on a day-to-day basis." On hour-by-hour basis even.

I've told the people closest to me, "This could be a years-long journey process, if you will, for my mental state, so the patience is so appreciated."

And then the highs . . . To be quite frank, I think the highs for me personally, they've been recognized by the people in my life for a while now, for the last year, but I personally have not been able to see or really process or digest those highs.

So it's really just been very recent in the last few months that I've been able to look at myself and say, "Wow, you can do that now after being completely immobile for nearly two months," or, "Wow, you can move that way again," or, "You can stretch that way again."

I used to and would eventually like to get back to very, very involved in hot yoga. I used to do hot yoga frequently. And before that, I was a gymnast and a dancer. So in the beginning, it was very excruciating for me to, say, not even touch my toes. And that was a huge blow more so to my ego than anything else, but a huge blow nonetheless.

And so I think the highs now are being able to recognize that, "Hey, I am able to touch my toes," and I stretch, and I exercise, and I do all these things every single day to better myself.

Initially, it was very much like, "Wow, you aren't able to do this? What happened?" And then it was up to a few months ago that I started telling myself, "No, you have to be much more patient to yourself, much more kind to yourself," than the completely and constant berating myself for why I'm not able to do something, or accomplish something, or say something in the way that I want to say it, etc.

Dr. Gandhi: I think that was just incredible to hear. As I said before, we run laps when we look at Zoe, but to hear her personal experience and understand that this is not over for her and understand what she goes through and also understand what defines us is the little things that make us who we are. Zoe touching her toes, doing hot yoga, it's incredible. It makes us really take a step back and understand this as a human experience, understand this as a personal experience.

The privilege of being able to be involved in Zoe's care and the care of others is not lost when you hear these things. The story of Zoe and patients like Zoe is not done in December 2021. It's an experience that she's going to live through and get through for the rest of her life.

She's sitting 10 feet away from me right now and her mom is right here as well. She's going to get there, and we just have to do everything we can to support her. She's just incredible. And to just hear Zoe, hear her voice come through in this experience is just profound for us. As many times as I've seen Zoe, I've never known these little things about Zoe, and it's amazing to hear.

Interviewer: To find out more about traumatic brain injury as well as the services offered through the brain injury program at the Craig H. Neilsen Rehabilitation Hospital, visit the link in the episode description.

Interviewer: According to the Centers for Disease Control and Prevention, more than two million Americans experience a brain injury each year. While some of these injuries result in relatively short-term impact on a day-to-day function, others can lead to long-term challenges or even a permanent disability.

Today, we'll be speaking with Zoe, a young woman who experienced a traumatic brain injury after an accident and the long journey of her recovery and the daily experience of overcoming the long-term challenges of life after an accident like this.

And to help us better understand the medical side of a traumatic brain injury, joining us is associate professor of neurosurgery at University of Utah Health, Dr. Ramesh Grandhi, the doctor who helped stabilize Zoe after her accident.

Zoe, why don't we start with what kind of led to your traumatic brain injury in the first place? What exactly happened?

Zoe: Yeah. Well, interesting story. I had just moved to Salt Lake City in August of 2020, and this occurred . . . or rather, my accident occurred December 5, 2020. So I had just shy of five months in the state, really.

So I hadn't experienced a lot, but a friend and I really wanted to ski together. I bought a season pass at Alta, was really excited to get up there. And it was day one, in fact, of the ski season that this happened. So really did not get any other skiing in, obviously, but this was day one.

Yeah, I mean, I don't remember a whole lot about the day itself. I have spotty memories of the drive up to Alta, getting to Alta. I actually have some spotty memories of being on the lift up to the first run. After that, I don't remember anything. I remember a bit of skiing, and that's really about it in terms of the day.

And then subsequently, upon waking up, I have absolutely no memory of the remainder of December. My memory is really spotty from about Thanksgiving up to December 5th. So Thanksgiving, I would say, is the last clear memory that I have and everything else is kind of spotty. It appears in my head almost as if I made it all up.

I've had to ask a lot of people, especially family members, "Did this really happen? Can you describe this thing to me or remind me who was at Thanksgiving again?" I never would have guessed something like this when I first started skiing with my dad 10-plus years ago.

And I was maybe 500 yards behind several of my friends, so I was alone during the actual collision. I ran into this group of trees that sat right in the middle of the run that I was on at Alta.

In this tree well, it was icy. I slipped on the snow evidently and collided with some trees in the tree well. What I would assume happened at that point is I was knocked unconscious by the collision and then fell and was hidden by this tree well and this group of trees. And then because I wasn't found until about four hours later, I had become buried or covered by snow by people skiing by, obviously.

Interviewer: Sure. So you're spotty memory-wise from Thanksgiving to . . . When did you start to remember things again?

Zoe: Right. So really, my lucidity, I would say, started to come back right around January 6th, 7th, 8th, right in that area. This is purely what I was told, is that I woke up somewhere mid to end of December. The rest of December went by. I was then transferred to a long-term care facility outside of Salt Lake City. And right around that, again, 6th, 7th, 8th of January is when I have memories that I'm able to go back on and say, "Oh, yeah, that was right in the beginning of January." Before that, though, I have no memories.

Interviewer: Wow. So, Dr. Grandhi, I want to go to you at this point. When did Zoe come into the care of you, your team, the University of Utah Hospital?

Dr. Grandhi: As I recall it, I didn't find out about Zoe until Sunday morning first thing. I know that she presented as a transfer to our hospital, and clearly, she had traumatic injuries. And the first principle of what we do is just stabilize the patient. The trauma surgeons and a number of other services are super important and are our partners in making sure that a patient is appropriately stabilized.

And then my partner was actually on call and received the first call about her. He then got in touch with me. We do a really nice job within our department about communicating about patients with traumatic brain injuries, and specifically, patients with severe traumatic brain injuries.

So I remember that Sunday morning very well because she was downstairs in our surgical ICU. I went and saw her and just looked at her images, and then went out and talked to her dad who was sitting in the waiting room all by himself.

I remember the exact seat he was seated in early on that Sunday morning, probably around 8:00 a.m. or 9:00 a.m. And he was just by himself. I just walked up to him and told him what my assessment was of the situation based on looking at her head CT and things like that.

And at that point, it was just me trying to tell him that we're going to do our best to take care of her, that she presented with what we call a severe traumatic brain injury, and what the principles of managing patients with that are, and also, honestly, giving him hope.

Interviewer: When we talk about traumatic brain injury, is it a lot of skiing injuries, sports injuries? What is the most common type of traumatic brain injury?

Dr. Grandhi: Traumatic brain injury is a significant burden in the Western world. It's the number one cause of death amongst young folks in the Western world.

Traumatic brain injury falls into three buckets: severe traumatic brain injury, moderate traumatic brain injury, and mild traumatic brain injury. And oftentimes, patients with mild traumatic brain injuries don't even come into the hospital. We call it a concussion. And oftentimes, a patient may stay at home after hitting their head, or being involved in a sports injury, or a motor vehicle collision, or falling and hitting their head.

The burden of traumatic brain injury in the United States today is about 2.5 million patients per year. So many patients don't even come into the hospital. Many patients are discharged from the ER.

Interviewer: Zoe and her accident, of those three buckets, what did hers fall into, and why?

Dr. Grandhi: Zoe had a severe traumatic brain injury. And the way we diagnose severe traumatic brain injury is quite simple. We just gauge it in terms of what their neurologic exam is when they come in. So are they able to open their eyes? Are they able to speak? Are they able to follow commands?

Interviewer: And Zoe was unable to do those things?

Dr. Grandhi: Correct.

Interviewer: Wow. Zoe, do you remember any pieces or parts of the story? How did you feel when you were first, I guess, coming out of it?

Zoe: Yeah. Again, like I said before, the first memories I have are really in the long-term care facility that I was transferred to after leaving The U. I think it was sort of a slow realization.

And then since then, I would say I've noticed things that are sort of side effects or fallouts from having a severe traumatic brain injury: getting frustrated much more easily, being able to jump to anger much more easily, having very little patience, amongst many others. So it was very much a slow realization and slow rollout. And then still to this day, new things come up.

So it was much more slow. It wasn't similar to if you broke your arm and someone said, "Oh, you broke your arm," and then they casted it up right then and there. It was much more prolonged than that and slow realization.

My initial thought, honestly, was because I was awake and lucid and conscious, "Oh, my brain is fine. Well, everything is good. I can speak. I can see. I can hear. I can eat. I have my motor functions." And so, initially, I didn't think too much about the effects on my brain, and that did come up much later and still continues to this day.

Interviewer: Dr. Grandhi, when it comes to treatment of a case like Zoe, what was done to help Zoe get from the accident to where she was stabilized and in, I guess, a longer-term facility to kind of monitor her?

Dr. Grandhi: Well, I think we need to kind of dial it back a little bit to understand the management principles of patients with severe traumatic brain injury. And it starts, honestly, in the pre-hospital setting in which those who are on the first line understand how to manage a person, particularly with a pathology as significant as severe traumatic brain injury.

So first things first, getting the patient stabilized in the field, making sure that people are very cognizant of taking care of the patient, immobilizing their neck. Again, we don't know if a patient has had an injury to the cervical spine. Zoe clearly hit trees, so she could have very easily had damage to her neck, to the bones of her neck, spinal cord, etc. So getting a patient stabilized at the point of injury, then making a decision of where the patient goes.

There is data to show improved outcomes in patients who have a severe traumatic brain injury who are taken to Level 1 trauma centers. So understanding where to send the patient when the patient comes in.

Again, we have a huge bevy of services that are there in the ER, in the trauma bay awaiting a patient, because there's pre-hospital notification. And so if a person is coming in as a Level 1 trauma to a Level 1 trauma center, we do have orthopedics right there. Neurosurgery is right there in the trauma bay. Obviously, trauma surgery, the ER doctors, a number of different services and specialties are there awaiting the patient.

Airway management is important, worrying about circulation, blood pressure, ensuring that there's no intra-abdominal injuries. After that, there are a lot of scans that are ordered inclusive of CT scans that are literally performed head to toe to make sure that we're not missing significant injuries that need actionable treatment, such as rushing a patient up to the operating room for an intra-abdominal injury.

That being said, once that is done and there's nothing imminent that needs to be treated emergently, the patient is generally taken up to the ICU. And in Zoe's case and a patient with a severe traumatic brain injury, they're ventilated, and then there's a lot of management that occurs then predicated on blood pressure management, good oxygenation for the patient.

And for patients with severe traumatic brain injury, when we know a patient has a severe traumatic brain injury, we place particular monitors in the patient's brain because we're obligated to make sure that we have good control of intracranial pressure. So we want to make sure that we know what a patient's intracranial pressure is, and we need to keep it below certain thresholds.

We clearly know what the patient's brain perfusion is in terms of what's the state of blood pressure to brain tissue. So we monitor a patient's systemic blood pressure, their body's blood pressure well, and have to get the brain perfusion pressure in a particular range.

That's a quick summation of the management principles of a patient with severe traumatic brain injury. Not every patient requires a big-time operation and removing part of the skull or sucking out blood, but when we do place brain monitors, we do have to drill a small hole in people's skull to place these monitors. We have to remember that brain injury comes in many different flavors, even severe traumatic brain injuries.

Interviewer: So you just keep an eye on all the things that are going on with your monitors and everything to see whether or not there's injury?

Dr. Gandhi: Absolutely. And we use CAT scans liberally to help us understand more about the evolution of the brain injury. Zoe did have blood in her head, no question about it, but we did not feel that this blood would require us to take her to the operating room for an emergent surgery to remove the blood.

Interviewer: It's my understanding that Zoe then was a part of a study dealing with neuromonitoring. So for someone who's listening right now, what exactly is neuromonitoring, and why is it so important that we do research with it?

Dr. Gandhi: Whenever someone is classified as having a severe traumatic brain injury, we know from years of research and guidelines and a lot of work from really experienced, savvy, thoughtful leaders in the field that patients should get particular things monitored.

As I had said, we want to get invasive arterial blood pressure monitoring so that we can get a good second-to-second, moment-to-moment gauge of what a person's blood pressure is not using one of those expandable blood pressure cuffs. So this is something that allows us to know on a moment-to-moment basis what a person's blood pressure is doing.

We also ensure that the patient has adequate ventilation using a breathing tube. We study their intracranial pressure via an intracranial pressure monitor.

Finally, one of the things that has been important recently in the care of patients with severe traumatic brain injuries is the concept of whether brain tissue oxygenation can help guide therapy for a patient with a severe traumatic brain injury.

So historically, many university centers across the world, many experienced Level 1trauma centers have been using brain tissue oxygenation monitoring, basically almost as though you had a pulse oximeter of brain tissue. Many folks around the world have used brain tissue oxygenation monitoring as another way to help manage their patients with severe traumatic brain injury.

Here at the University of Utah and also many sites throughout this country and across the world in a separate study have decided to do a randomized controlled trial on this and understanding whether it will bear out in a huge patient population of improving outcomes. And Zoe was enrolled in that trial, and the trial is called BOOST-3.

Interviewer: So what exactly is BOOST-3 looking to do?

Dr. Grandhi: What we're looking for in the BOOST-3 trial is to determine whether using brain tissue oxygenation monitoring in the care of patients with severe traumatic brain injury improves outcomes at six months.

This is over and above using traditional monitoring techniques such as intracranial pressure monitoring and cerebral perfusion pressure monitoring that are already used commonly as part of guidelines that have been established in taking care of patients like Zoe.

Interviewer: So, Zoe, we've been talking a lot about kind of the medical side of things. I want to go back to you. What was it like when you first had Dr. Grandhi or any of the other specialists kind of explain the condition to you and what was going to be expected moving forward?

Zoe: I think in all the research that I've done and the people around me have done and then my discussions with Dr. Grandhi initially and shortly thereafter, and from what I gather from all of that, is that it's largely unexpected. The results and the things that come of it are known and yet unknown, right? It's things that they know come from a severe traumatic brain injury and then there are things that you don't really know will come up until they come up and until you experience them.

So from what I've been able to dissect from this injury is kind of pick apart, or notice rather, the moments in my own life where the thought comes into my head saying, "No, this isn't really you. This isn't really the Zoe that has made it to this point." "This is the TBI speaking," I guess, for lack of a better term or phrase.

An example would be if I'm feeling really, really agitated one day or even one hour and then the next hour I'm back to feeling normal again. So it's really quite a rollercoaster, I would say.

Interviewer: But what did it feel like to kind of hear that? I mean, as an outsider, as someone who's never experienced this kind of thing, that sounds kind of scary to me.

Zoe: Well, I would say more jarring than frightening. As the patient or as the person with a severe TBI, you don't necessarily . . . or I didn't, at least, necessarily believe the things that were being told to me. Not that I would think, "Oh, Dr. Grandhi is a liar," but I didn't necessarily believe it until those things started to show up for me in my own life later on and as time went on.

So months later, it's coming up on a year, so a full year later, I notice things that they told me initially that I might feel or that may come up. And at the time, I was thinking, "Well, I feel fine now, so we're good. We're all good here. Have a nice day." So it wasn't until up to this point that I think, "Oh, okay. I see what they mean by this progression and regression of things that may come and go," and things that I might feel that I didn't think I would feel at the time.

So it was definitely helpful to hear that then, and thinking about it now, "Oh, okay. They were right all along. They know what they're talking about."

Dr. Grandhi: I think it's really important to understand that while we as physicians, particularly as neurosurgeons who take care of patients with severe traumatic brain injury, I look at Zoe, and we raise our hands and we run a victory lap saying that she is a success.

And first things first is just in the acute setting, there's more research coming out that shows that if you are able to get a patient through the acute brain injury setting and manage them correctly and take care of them, we should not be nihilistic about where they will be one year later.

There's new research using big data sets that show that patients such as Zoe who come in with severe traumatic brain injury can have favorable outcomes at one year. Part of this data set also shows that 20% of patients can perhaps have no disability at one year.

But that being said, Zoe's experience alludes to the fact that we cannot forget about our patients. They still sometimes experience some sequalae that are hard to just kind of put a finger on. Like Zoe talks about, just agitation, maybe irritability, maybe memory issues.

So this is a process, an evolution, and it's really important for us to be able to support our patients, get them the correct resources, and really kind of steer them and continue to shepherd them through the process, which may take many more years.

Again, the concept of neuromonitoring for patients with traumatic brain injury only pertains to patients with severe traumatic brain injury, patients who are in a coma, patients who come into a hospital in a comatose state.

And I think we're going to learn a lot through this study as well as over the next years of how to really target various treatment thresholds and really tailor a patient's care to perhaps the type of pathology that they're coming in with.

So this is really important to patients with severe traumatic brain injury, but for the audience out there who is interested in traumatic brain injury in general, because most of the patients who experience a traumatic brain injury don't come in like Zoe in a coma, we're learning a lot about traumatic brain injury in general.

We're learning that there are so many different components to living with a traumatic brain injury. We are understanding that there are perhaps new ways of diagnosing patients and understanding what's called biomarkers and their role and understanding whether they're different symptoms, sequalae, or phenotypes that people experience after a traumatic brain injury.

Finally, it's really, again, very important to support our patients because it's not just the acute recovery stage. One of the people who trained me told me the biggest misnomer in patients who come in with mild traumatic brain injury, which is sometimes called a concussion, is there's nothing mild about it if you experience headaches two months after the fact, or if you have problems with staring at your computer screen if you're a person who works on computers and have eye strain after that, or have problems with balance. There's nothing mild about it.

And now the question is, "How can we support our patients better and get them the needed resources they need to get back on their feet and get their life back in order?"

Interviewer: So, Zoe, you're 25 now. It's been a year since the initial incident. How have you felt along the process? And how do you mark your own success and, I guess, healing from this particular incident?

Zoe: It actually took quite a while for me to recognize my own success, my own progress. It's really been just recently, actually, that I've been able to think to myself, "Oh, okay. You can actually do that thing now that you weren't able to do three months ago, four months ago."

It's more so just the ability to recognize those things. And I wasn't able to recognize those things previously. So it's been really difficult to measure my own progress based on what that looks like or what that has looked like in the past year.

I mean, highs, overall, I would say the ability to remember. Honestly, my short-term memory was completely restarted, completely obliterated in the beginning, and I wasn't able to hold a memory for several minutes. I would forget the thing before. So my working memory and my short-term memory have improved significantly.

Luckily, nothing really ever happened to my long-term memory, so I was able to remember years past. I could tell you where exactly I was and who I was with, especially right in the early beginning.

One of the most difficult things, but probably does not top the list, that I've experienced from the fallout, if you will, is the changing of relationships in my life. Friendships and various other things that have been really difficult to not only maintain, but to offer my lived experience as it is and as I see it and as I experience it. It's extremely difficult to explain the mindset that I have and where my brain is at on any given day.

And luckily, some of them have had extreme understanding and extreme patience with me. And that's really all I ask of the people in my life now, is, "Please be patient with me and my progress and the things you likely don't see on a day-to-day basis." On hour-by-hour basis even.

I've told the people closest to me, "This could be a years-long journey process, if you will, for my mental state, so the patience is so appreciated."

And then the highs . . . To be quite frank, I think the highs for me personally, they've been recognized by the people in my life for a while now, for the last year, but I personally have not been able to see or really process or digest those highs.

So it's really just been very recent in the last few months that I've been able to look at myself and say, "Wow, you can do that now after being completely immobile for nearly two months," or, "Wow, you can move that way again," or, "You can stretch that way again."

I used to and would eventually like to get back to very, very involved in hot yoga. I used to do hot yoga frequently. And before that, I was a gymnast and a dancer. So in the beginning, it was very excruciating for me to, say, not even touch my toes. And that was a huge blow more so to my ego than anything else, but a huge blow nonetheless.

And so I think the highs now are being able to recognize that, "Hey, I am able to touch my toes," and I stretch, and I exercise, and I do all these things every single day to better myself.

Initially, it was very much like, "Wow, you aren't able to do this? What happened?" And then it was up to a few months ago that I started telling myself, "No, you have to be much more patient to yourself, much more kind to yourself," than the completely and constant berating myself for why I'm not able to do something, or accomplish something, or say something in the way that I want to say it, etc.

Dr. Gandhi: I think that was just incredible to hear. As I said before, we run laps when we look at Zoe, but to hear her personal experience and understand that this is not over for her and understand what she goes through and also understand what defines us is the little things that make us who we are. Zoe touching her toes, doing hot yoga, it's incredible. It makes us really take a step back and understand this as a human experience, understand this as a personal experience.

The privilege of being able to be involved in Zoe's care and the care of others is not lost when you hear these things. The story of Zoe and patients like Zoe is not done in December 2021. It's an experience that she's going to live through and get through for the rest of her life.

She's sitting 10 feet away from me right now and her mom is right here as well. She's going to get there, and we just have to do everything we can to support her. She's just incredible. And to just hear Zoe, hear her voice come through in this experience is just profound for us. As many times as I've seen Zoe, I've never known these little things about Zoe, and it's amazing to hear.

Interviewer: To find out more about traumatic brain injury as well as the services offered through the brain injury program at the Craig H. Neilsen Rehabilitation Hospital, visit the link in the episode description.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: All right. Going to talk about physical activity today on "Who Cares About Men's Health." It's funny because if we saw an ad for a pill that offers all the benefits of physical activity, everybody in the world would take it. But a lot of times it can be a struggle to get in that physical activity. A lot of us have overloaded schedules, maybe sedentary jobs, maybe you don't know where to start, you just don't enjoy it.

This is episode number 2 of 5 of our Core Four Back to Basics series, Physical Activity. So if you struggle with getting enough physical activity or don't know where to start, this episode is for you.

So today's crew, you've got me. My name is Scot Singpiel. I bring the BS. The physical activity I like to engage in is I like to strength-train, run, and chase my dog, Murphy. The MD to my BS, Dr. Troy Madsen, what kind of physical activity do you like?

Troy: Scot, I resolved a long time ago I wasn't going to talk about running anymore on this podcast, but since you're baiting me into doing that, I'll say I like to run.

Scot: Yep. A lot. He likes to run a lot.

Troy: A lot.

Scot: We also have Mitch Sears on the show. What do you like to do?

Mitch: I'm still figuring it out.

Scot: Okay. And nutritionist Thunder Jalili, who, by the way, his idea of physical activity is saving babies from oncoming buses and he does it daily. What else do you like to do, Thunder?

Thunder: That about sums it up. It's a very tedious task. No, I like to ride mountain bikes and road bikes. I like to ski and I also like to strength-train. So those are my main ones.

Scot: All right. And before we get into this, I think it's important to say we choose physical activity over exercise very intentionally because some people don't like to exercise, but you can still get physical activity without exercising. And we'll get into a little bit of that later along with some of the things that have worked for us to try to get more physical activity in our life.

So let's, first of all, before we get to the advice, start with Thunder and Troy. I think most men understand the benefits of physical activity. We know we have to move, but for whatever reason, if we're not, there's some reason. But let's go down a quick list to some of the benefits, because it's amazing.

Troy: It is amazing, Scot. And I love that you said if we had a pill that claim to do what physical activity can do, we would all take it. And I am more and more convinced . . . because I work in the ER and I take care of people who maybe haven't had a lot of activity, are coming in with heart attacks, or diabetes, and complications of that. I'm more and more convinced that, yeah, we can do certain things and we can give certain pills to treat these things, but the best remedy . . . It's kind of cliché, the best remedy really is prevention, and that's what physical activity does.

So just a few of the things that I've found just in searching through the literature and looking at different studies that are very clear is that physical activity reduces your risk of cancer. And that's a huge thing because most people . . . maybe not most, but 45% or so of people in the course of their lifetime will get cancer, and half of those cancers are going to be fatal. Anything you can do to reduce that risk is definitely time well invested.

There's also the brain health. We've talked about that before as well, just helping you think more clearly, helping with mental health, helping you sleep better. I think we all know those things. And I think a lot of us like to exercise because we just feel better. We have a better mood. We're happier. We have a better outlook. We feel more optimistic, and we're tired and we sleep well at night.

And then, of course, the other obvious thing I think we all think about with exercise is it reduces your blood pressure. Again, I think it's much more effective than medication at reducing blood pressure. If I were to tell anyone anything who comes in with high blood pressure in the ER, my first recommendation is focus on diet and exercise. Heavy emphasis on exercise. It's going to reduce your blood pressure, potentially avoid medication.

Thunder: So there are also a few other benefits of physical activity that we should highlight. One is it improves insulin sensitivity, and that's a really important one. As we get older, we tend to become a little bit insulin resistant, especially if that's accompanied by weight gain. And so physical activity improves insulin sensitivity and keeps us from gaining weight. So that can prevent diabetes. And actually, even people that have Type 2 diabetes can improve their insulin sensitivity by physical activity that helps them lose weight.

And one other one that we haven't mentioned is people who exercise regularly, particularly aerobic exercise, actually are better at burning fat too. So they have this enhanced efficiency of burning fat. And I think that's something that everybody would like to have.

Troy: And one other thing too, Thunder, I love about exercise . . . And this isn't just something you say, like, "Wow, people who exercise look younger." On a molecular level, studies have actually looked at what happens when people exercise. If you take people who aren't exercising and you look at them after exercise, it reduces the aging process. So if you want to stay young, exercise. It's really remarkable what happens just on a cellular level with exercise.

Thunder: Yeah, that's definitely true. And I want to throw in a really quick cool example that relates to the blood pressure comment you made, Troy. So exercise improves the function of the cells that line your blood pressure and it changes them at this molecular level to allow them to make the factors that allow your blood vessels to dilate, and that lowers your blood pressure. So it's the exercise that's causing these molecular changes in those cells that line the blood vessels. Very cool stuff.

Troy: Yeah, it is so cool. And along with that, any time you're talking about that sort of process, you're talking about reduced risk of heart attack, reduced risk of stroke, decreased risk of crazy, awful diseases or processes like aortic dissection, where the aorta can tear. These sorts of things, any time you're exercising, you're improving that blood vessel and, like you said, the lining of the blood vessels, and you're reducing your risk of these other disease processes.

So tons of benefits. Like you said, Scot, it really is a miracle drug. If we marketed this, this would be a . . . Talk about these blockbuster drugs. This would be the blockbuster drug.

Scot: Right? And it comes back to our thesis of this podcast, the Core Four. If you focus on nutrition, activity, sleep, your emotional health, and then take a look at your genetics, that can go a long way to making you feel good now and in the future. And I think you just really outlined how powerful exercise is.

What is physical activity or exercise? I think that that word is important, because exercise can limit how we think about getting out and moving around. We might go, "Well, I don't have time to exercise because that means going to a gym," or, "That means this scheduled thing in my day." But it's really about physical activity. It's about moving more, finding opportunities to move around more, and also incorporating some of those other things into our life. But what does exercise mean to you, Thunder? Or physical activity, I should say.

Thunder: Yeah. So it actually means what you were saying. I engage in physical activity. Some of it is kind of necessary physical activity. If I have something I need to do around the house or around the yard, let's say I have to do vacuuming, it's my turn for that, or I have to mow the lawn, or planning something, that's physical activity. Now, that's not necessarily fun for me. It's a necessary evil. I have to do it, but I recognize that counts as my physical activity.

And then, for me, exercise is usually something that's fun. I like to ride my bike. Yeah, it's exercise, but I do it because it's also fun. Skiing is another example. So that's kind of how I approach the whole realm of physical activity and exercise.

Scot: Mitch, how about you? What does physical activity mean to you?

Mitch: Well, for me . . .

Scot: You're kind of searching a little bit, so I'm interested to hear what your answer is here.

Mitch: Well, it's interesting because it used to be exercise is what made you the most banging. That was like the goal of . . .

Scot: The most banging?

Mitch: The most banging. That was kind of the goal from high school through college, and it has shifted. And for me, making sure that I get enough physical activity is ultimately kind of investing in myself because I do not want to be feeble. I do not want to be old and decrepit. I want to be able to continue to live my life to the fullest for the rest of my life.

And I know that by getting more active, by making sure that I prioritize physical activity, even now in my 30s, it's going to pay off a lot later and going to keep me mobile, keep me able to walk, keep me strong. And for me, that's the real focus these days, is to make sure that I can continue to live the life I want to live.

Thunder: Mitch, you and I are trying not to see Troy in a professional capacity.

Troy: That's right. That should be your goal in life, honestly. Do not see me in a professional capacity.

Scot: Troy, what does physical activity mean to you?

Troy: To me, I think that's really kind of evolved over time in terms of how I look at physical activity. One of the biggest challenges I see . . . I just feel like so often we just feel like physical activity has to be dedicated time at the gym, and that's kind of what Thunder and Mitch have both talked about, that it had to be like, "Okay, I'm going to the gym. This is my physical activity." I think now I like to look at it just as more it's your lifestyle, it's what you do.

For me, physical activity is having something I can do every day that's sustainable. I like to have it and I like to do it and I like knowing that even if I'm not feeling well, even if it's raining outside, even if it's late and I'm tired or whatever it is, I can go out and do that and I know I can do it every day. For me, that's what works.

But I think larger than that, again, I think it comes down to it's incorporating that where it's just part of our lifestyle. It's not like I'm just trying to carve out time. Dedicated exercise is like, "Hey, this is what I do. I do it every day and I enjoy it and it's just part of who I am."

I don't know. I feel like to really make it sustainable where it's not just a chore, I think you kind of have to just get to that point hopefully where you can kind of feel that way.

Scot: Physical activity for me is my time. And unlike you, Troy, I like working out in the gym. I like going and lifting weights. Although I don't lift very heavy weights, I think there was a woman next to me squatting more than I could ever squat, but I just enjoy that. I enjoy feeling my body move. And it's also my time when I want to get away from everything else. I know I can do that.

And much like Mitch, I started out wanting to be like Arnold Schwarzenegger, right? Then as I've aged, it has truly become, "I just want to be able to wake up in the morning and get out of bed without hurting."

I see older people, and you see both examples of this. You see older people that have really worked on that and they are vibrant and they're still getting around and they're enjoying their life. And you've seen older people who have not, and it's a whole different situation. I want to avoid being the "or not." So it's the anti-aging part of it, I think, for me as well.

Troy: Yeah. And hearing all this too, I think the definition of physical activity . . . we've all had different definitions. It's different for everyone. I think you just find what works for you to get you moving. If you like the structure, if you like the gym, you do it. If you like to ride bikes . . .

I don't like riding a bike. I'll admit it. I don't enjoy it. I've tried it. I commuted to work on a bike for like a year and a half, and I don't like it. But I think you just find what works for you and what you enjoy and just make it sustainable, make it fun, and make it something you can do every day.

Scot: All right. So a common question that people have is, "How much physical activity do you need, and what's the intensity?" So we're going to talk about kind of the physical activity basics right now. This is for adults. So it's different for kids and older adults and people with chronic disease and pregnant women. So this is for healthy adults. Mitch, why don't you go ahead and cover that?

Mitch: So the research kind of shows five main things that really are there basic, basic stuff that'll really kind of improve your health and make sure that you are getting the physical activity that you need.

The very first one is to move more and sit less throughout the day. So whenever you possibly can, try to get up, try to move a little bit. The body was made to move. So try to make sure that you're moving more throughout the day.

Number two, for the most substantial health benefits, try to shoot for 150 to 300 minutes of moderate activity weekly, kind of anything that gets your heart beating faster, like a brisk walk or going upstairs, something along those lines. So, again, 150 to 300. So that's, what, 30 minutes 5 times a week or more?

Troy: Yeah, 30 minutes. And I like too, Mitch, how you said there just brisk walking. You go out for a 30-minute walk at lunch or maybe you have a couple breaks and you do two 15-minute brisk walks, you're good. Right there. Five days.

Mitch: Yeah, you don't have to go and slam weights at a gym. You can get activity just by moving your body.

And then the kind of thing for people who are maybe a little tighter on time, you can get the same kind of benefits if you do 70 to 150 minutes of what they call vigorous activity. And this is equivalent to a jog, a run, getting your heart rate that much higher. So if you can get a mix of these two, if you can just kind of shoot to try to get 30 minutes a day, you're going to see the most health benefits for yourself.

Thunder: Hey, I'd like to throw one other thought into that. If you're going to do 15 minutes of vigorous exercise like we've been talking about, it is important to build in a warmup period so you don't go from 0 to 100 instantly and pull something.

And that warmup exercise actually kind of goes in that moderate exercise category. So if you're going to do a run, brisk walk five minutes, kick it to a slow jog for five minutes, and then run really hard for 15 minutes, and you've covered a lot of ground there.

Troy: Yeah. Exactly. And then you're looking at an additional 75 minutes of moderate exercise plus 75 of vigorous exercise. So that's a pretty good combination.

Thunder: Yeah.

Scot: And the research has shown that if you do go above that 300 minutes or that 150 minutes, it does provide additional benefits. It was a little unclear as to kind of where the point of no return is on that, but . . .

Thunder: Well, I think the point of no return is if you get in situations where people are exercising so much that they're increasing their risk of injury.

Mitch: Oh, sure.

Thunder: Then they're exercising maybe through injuries like stress fractures, or pulled muscles, or things like that. So I guess there's an upper limit of where common sense kicks in.

Troy: Yeah. Scot, you've talked before . . . I remember when you talked about an article about . . . I think it was a trainer who talked about how we don't necessarily overtrain, but we under-recover. So I think you always need to think about recovery, like Thunder said, stretching, making sure you're balancing that vigorous exercise out appropriately. But if you you're getting over 300 minutes a week, more power to you. That's great.

Thunder: I love that term, under-recover. I'm going to remember that one.

Troy: Yeah. I think about that a lot. I really liked that.

Thunder: And as you get older, that's something that legitimately you should think about, because if you don't recover and you're kind of tweaking knees, or back, or this and that, that's a serious disincentive to exercise.

Mitch: So number three is to try to shoot to get some sort of muscle strengthening activity that works all your muscle groups a little harder than you usually do on a day-to-day basis, two or more days a week. So it's not just getting your cardio, doing well with the stuff we had before, but also making sure that your muscles are staying strong and that you're able to do the things that you want to do.

Scot: And muscle strengthening activities, as we've talked about on the podcast, could be a lot of things. It could be resistance bands. That's doing a little bit more work than you'd normally be doing. It could be kettlebells if you like kettlebells. It could be body weight exercises. I mean, if you can't control your body weight in a squat, which at one point I couldn't, or do a lunge, and at one point I couldn't, then that's working your muscles harder.

So don't just think that that strength training or that muscle strengthening activity has to be you go to the gym and you lift the heavy iron.

Thunder: Yeah, that's such a great point, Scot. I bring that up a lot to older people about the benefits of strength training and try to dispel the myth that, "Look, you're 70 years old, but you should be doing some sort of strength training because it's good for you. It's good for your balance." It doesn't have to be you're going in the gym and trying to lift the weights of a 25-year-old. It can be body weight exercises or those exact things that you mentioned. So that's really cool you brought that up.

Scot: And I'm also going to say I used to volunteer at the YMCA in this room called the Nautilus Room, and it was weightlifting machines. We had some elderly clientele that came in that I . . . There were a couple of instances where these individuals were walking with walkers and they couldn't bend down to pick their keys up off the floor if they dropped them. After six months . . . And they didn't use the whole stack, right? They were using maybe a plate or two. It was astounding how much difference that made. I've seen it with my own eyes.

Thunder: Yeah. And that's supported by studies in the literature too. I think it's underestimated. Like you said, you don't need to throw around hundreds of pounds for that. It can literally be light weights as long as it's a routine.

Troy: Scot, I'm going to share with you my strength training routine, and you guys tell me if I'm off here, but this is all I do. I do pushups every day, I do sit ups, I do some squats, and then I'll do some curls or . . . I've got just a pull-up bar. And then along with that, I'll do stretching, foam rolling.

But that's what I do every day. I can do all that and then stretching, I can do all that in about 10 minutes.

I guess by saying this I'm just trying to say that I feel like you can also incorporate this into your routine and, again, it doesn't have to be a huge time investment. I feel like I get a pretty good yield out of that. I'm not going to the gym. I'm not using machines or anything. And I feel like I'm able to maintain some body mass even though I am running a lot as well.

I'm just trying to say that it doesn't have to be a huge time investment. I think it's easy to do body resistance and just some basic weights or a pull-up bar and get that benefit.

Thunder: Yeah. Troy, I think you hit on a good thing too. In my mind, and see what you guys think of this, but I think there's a difference between exercise for maintaining some level of health and mobility versus exercise to improve performance in a specific task or sport.

So exercise to improve sports performance is different. A lot of weights, a lot more time, a lot more intensity. But physical activity/exercise to maintain a general level of health and mobility is not the same as that.

So sometimes people put both of those in the same category and it makes it a little more intimidating to start exercising because they're imagining the Olympic athlete training for the summer Olympics, or winter Olympics, since they're going on right now.

Scot: Or the commercials for the shoes or any of that kind of stuff. Any of the visual images we're seeing in the movies, magazines, TV.

Thunder: Yeah. Like those commercials for sports drinks. I mean, if I trained that hard, I'd drop dead.

Troy: I know. Seriously.

Scot: I actually don't believe that, Thunder. I think you probably do and you're just trying to make us feel better. So thank you for that.

Troy: Exactly. Thanks, Thunder. For me, I am not going for that. I'm not going for bulk. I'm not going for that kind of look. I just want to maintain some muscle mass and not just running a lot and just losing muscle mass. So that's all I'm going for, maintaining muscle mass, maintaining mobility.

Again, like we talked about, I think you just find what works for you. But I think you can do stuff just with a very short period of time just using body resistance and some basic weights or a pull-up bar or something like that.

Mitch: So number four is if you're just starting out, take it slow. And this is one that I really kind of jive with because when I first started running for the very first time, it's so much nicer to start very, very slow and build up to something. You don't have to be running a six-minute mile at the start, right? That's going to make you more prone to injuries. You're going to wear out faster. Just start where you're at and work from there.

And then number five is to always aim for sustainable. The kind of work that you're doing is a lifetime commitment.

Troy: Yeah. And it's a quick point there, but in my mind, that's the number one thing. I just feel like so often we go out and we want to do things and it's a New Year's resolution or we're just going hard and we're like, "I want to just do this vigorous exercise. I'm going to do this every day," and it's just not sustainable.

Thunder talked about it too. You've got to ease into it. You've got to have recovery. So I think sustainability really should be the number one goal. As you get into something or you're trying to increase your exercise, make sure it's something you can do and feel comfortable doing in the long term.

Scot: All right. It's time where we're going to talk about three things that have worked for each of us, whether that's a specific habit, or a mindset, or a change. Hopefully, maybe, this might work for you.

So here's how we're going to go. We're going to just go around the circle here. Each person is going to say one and then we'll move on to the next person. So let's go ahead and start with Thunder.

Thunder: Okay. I'm going to start things off by cheating because I have two things, not three. And maybe my two things can be stretched out, but here they are.

So my number one most important thing is things that are fun. Earlier I talked about how there's some physical activity I do because I have to do it. I've got to take care of things around the house. I have to mow the lawn, things like that. So that counts. But the big one for me is things that are fun.

So all the exercises I do, I do them because I actually enjoy doing them. I look forward to getting on my bike and doing a bike ride. I look forward to skiing. Like you, Scot, I like going to the gym. There are definitely exercises I don't like to do at the gym, but there's a lot of stuff I like to do, and I look forward to that.

That is really important because if you put someone on an exercise plan of stuff they don't like to do, guaranteed it is not going to last no matter how badly they want to get fit, or lose weight, or anything. So that's my number one. Fun, fun, fun. Make sure it's fun.

Scot: Yeah, making it fun. Sustainability, as was mentioned earlier, is probably one of the most important things. So if it's not fun, it's not sustainable. Great one. Troy, what do you have?

Troy: I like it, Thunder. Yeah, make it fun. And who wouldn't want to do something fun every day? The thing for me is to do it every day. That's what works for me. And the reason I do it every day . . . I exercise every day. For me, again, it's running. It's because then I don't say to myself, "Well, I'm going to do it tomorrow," because I know I'm going to do it today. So it's not like I'm like, "I'm going to do this three days a week. I'm going to do it tomorrow," and then I keep putting it off, and then by the end of the week, I've done it maybe once or twice. So that works for me. Just do it every day.

Scot: I don't know how you do it, man. I just don't know how you do it. Mitch, what do you have?

Mitch: So I'm going to start with the idea to focus less on the results and more about the practice of doing the physical activity. That's been the biggest change for me and the biggest thing that has kind of led to me getting more physical activity all the time.

Rather than stepping on that scale every day and being like, "Why am I not losing any weight?" or, "Why am I not like getting jacked?" it's just, "Hey, you have an hour to yourself. You have an hour to work on your body, have an hour to invest in yourself." And that is the biggest bit of successful mind change that I've had in the recent years.

Scot: My first one speaks to a bit of how our culture has defined exercise and, as a result, how I had defined exercise for a long time. And I think also, since it's a men's health podcast, we should talk about how masculinity can kind of mess things up. It's been to alluded to before, but it's redefining what strength training is.

Thunder, I thought you talked about just brilliantly there are two different types of strength training. There's athletic training and then there's training just for life, just to maintain, and just to feel good. And for a long time, I relate to what Mitch said. I wanted to have the Arnold Schwarzenegger body, and then later on in my life, my standards got lower and lower as I went.

Sometimes it's not beneficial to your health, because I would go into the gym and I would lift more weight than I probably was capable of doing. I was compromising my form. I was working out probably more often than I should all in pursuit of this ideal of what exercise should do for you.

And when I first realized that strength training is something that should make me feel good and I should feel energized when I leave the gym and I should be able to do the things I want to do in life and not be not able to squat down for four days later, that's more sustainable. I enjoy it and I don't get stressed about how strong I'm getting.

You can apply this to running as well. It doesn't matter how fast you run or how out of breath you might be. It takes a little bit of swallowing the pride and putting the ego aside. But I'll tell you, if you can do that, for me, that has made a huge difference in the enjoyment that I have in strength training.

Troy: Yeah. Scot, I am convinced that for a lot of us, we are just never going to look like Arnold Schwarzenegger. There's just no way we could ever bulk up like that. I mean, I don't know how many times in my life I went through these phases and I went to the gym and I'm just like, "I'm just going hard every day and I'm going to look like that." I don't care what I did. I'm not going to look like that.

But it's a good idea, I think, like you said, just to kind of redefine our goals and not necessarily go for that, but just go for that health, go for that capability to do new things and have range of motion and joint health and all those other things that are really important in the long term.

Thunder: In all fairness, I've got to say that Schwarzenegger doesn't look like Schwarzenegger anymore.

Troy: Yeah, that's true.

Thunder: And the image that we're thinking was pharmacologically enhanced.

Scot: Right?

Troy: That's a good point.

Scot: But that's still a thing, right?

Thunder: It's stuck in our brain.

Scot: That is what's portrayed as the epitome of health. The guy that's on the cover of the "Men's Health" magazine, that is what healthy looks like. We talked to Rashago, the bodybuilder, on the podcast. We've realized that takes a lot of work. It takes a gift of genetics. Also, he could look like a normal guy one day and he has to do all sorts of crazy things with his diet to look like the guy on the cover of "Men's Health" magazine.

So I think getting over this notion that that's what we need to look like and that's the means to the end of strength training, that is what's made a big difference to me.

Who did I start with? Did I start with Thunder?

Thunder: Yeah, you started with me. I want to throw one more point in there for us to talk about, and that is another motivation for me . . . and I know this is the same motivation for you, Scot, because you already mentioned it . . . is the joy of movement and being able to do certain things. I can do a squat without losing my balance. I can do 15 pull-ups, things like that. That's like a lot of satisfaction. That's part of what makes it fun, and it adds this like element of joy and appreciation.

So for me, that's an important part of my exercise routine and, like I said, I know you feel the same way, Scot.

I can go mow the lawn even though I hate to do it. It's not a big deal. It doesn't faze me one way or the other because I do enough exercise to be able to do tasks like that. I can pick up my daughter and it doesn't blow out my back, things like that. The joy of being able to move.

Scot: Troy?

Troy: Scot, also another thing that works for me is to bring a dog. Keeping up with the dog.

Scot: I don't even know if you need to expand on that. I think we could just move to Mitch at this point. Bring a dog.

Troy: My larger point there is accountability. I feel accountable to my dog. And there are times when I've asked my myself, "Why am I doing this?" And she gets on the bed at 5:00 in the morning and she lies right against my legs, so she knows when I get up, and then she just watches me. She watches everything I do because she wants to go running.

So I think whatever works for you. If it's friends, whatever form of accountability, I think having that makes exercise a whole lot easier because then you're like, "Hey, it's not just for me. It's for this dog," or this person, or whatever else. I think it makes a big difference.

Thunder: Troy, can you imagine how fit you would be if your dog had longer legs?

Scot: Yeah. Troy has a corgi.

Troy: That's the crazy thing about this corgi. Thunder, I don't know if you know this, this corgi has run a marathon with me.

Thunder: No way.

Troy: She has run a marathon. She's a crazy little beast. She does five miles every day like it's nothing. Yeah, she's a crazy beast. She did it. She loves to run.

Scot: Mitch, go ahead.

Mitch: So mine that took me a while to figure out is to be skeptical of the bros on Reddit.

Scot: [laughs]

Mitch: That is exactly the response we need, because I have had so many bad experiences when I try the way they like to eat, the way they like to work out, the weird . . . They use acronyms like PPLs, and macros, and whatever. And it's like, "Why don't you just find something that works for you?"

These people on the internet don't necessarily know everything and it is much better to find something that works for you, that feels comfortable for you, rather than measuring yourself up against some people that live on the internet talking about fitness.

Scot: And say, "This is what fitness looks like."

Mitch: Yes.

Scot: It comes back to that again, right? That's really what they're selling, is that this is what fitness looks like. And it's not.

Mitch: No.

Scot: It's not. My second one is if you don't know where to start with strength exercises, know these five body movement patterns and do one exercise a day that focuses on each one of them. We learned this from Ernie on our show back on . . . I think it was Episode 24, something like that.

So the movement patterns are push, pull, hip hinge, squat, and then also loaded carry, which is kind of optional. I don't really do that. But we're talking about push, which is your pushups or your shoulder presses. Your pulls are your back exercises, like your rows. Your hip hinges are you're bending at the hips, like your dead lifts, that sort of thing. Squat, pretty self-explanatory. Those are your leg exercises, or you could do lunges. And then if you want to do this loaded carry, that's where you carry around some heavy weight and you walk around with it.

So you can Google the five movement pattern exercises and find all sorts of great ideas, pick one that you like, and just do it for a period of time for each one of those movement patterns.

Thunder, you said you had two. Do you have one more, or no?

Thunder: I already talked about my second one. That was the joy of movement.

Scot: All right. Great. Then we're going to go on to Troy for number three.

Troy: Number three, I'm going to say give yourself an opportunity to look out from the peaks. And by that, I mean now and then we have these cool experiences with exercise. We had an awesome time with Mitch when we prepared for the 5K. And that was like one of the peaks, having the opportunity to do the 5K. He's got family there with him. We're congratulating him. Give yourself a chance to do that. I think it's kind of fun.

By saying that, I don't want to say go for results. You're not necessarily going for, "Well, I need to run this time or I need to do this certain thing." But I think is having an opportunity . . . For me, it's like running races. I'm not doing what I do so that I'm necessarily running certain races or getting certain times, but those are just something else that's . . . It's a reward to do that, and have that opportunity, and have that social aspect of it.

Scot, it was so cool when you were texting me during the Boston Marathon and saying, "Great job." Just to have those opportunities, I think, brings some reward into it.

So whatever you do, try and find those opportunities to kind of look out from the peaks, and then you're back down in the valley doing your daily stuff. But having that, I think, makes it rewarding.

Scot: Have you guys noticed that Troy's all could be put on T-shirts? Run with a dog. Look out from the peaks.

Troy: Look from the peaks. There you go.

Thunder: He's a master of the slogan.

Troy: These are all things I've seen on posters during marathons, along with things like, "You run better than the government," and, "Don't poop your pants," and things like that. You always see great signs in marathons.

Scot: All right. Mitch, number three. Oh, go ahead. Who's jumping in with what?

Thunder: That was me. I just thought of a third. I don't know why I didn't think about this earlier because it's definitely one of my keys to exercise. That is the social aspect. I have a group of friends I ski with. I ski with my wife. I have a group of friends and my wife that I go biking with. I have friends that I meet at the gym. We may not do the same exercises, but we kind of pass each other and do a high five. So there's a big social aspect that also as a motivator. I would look for that as well.

Troy: Thunder, would you high five me if I came to the gym when you're there?

Thunder: It depends how many people are around us.

Troy: It depends who else is there.

Thunder: Oh, absolutely I'd high five you.

Troy: It depends how few bars I have on my bench press machine.

Thunder: No, I'd be proud. I'd say, "This is Troy, and we're just friends. I don't want to see him in a professional capacity."

Troy: That's right. There you go.

Scot: Hey, Troy. Will Smith squatted the bar. So can you.

Troy: That's right.

Scot: You've got to swallow . . .

Troy: Will Smith made us all feel better.

Scot: Swallow your pride.

Troy: That's right.

Scot: Mitch, number three.

Mitch: So number three for me is just to be a little mindful and remind yourself how much better you'll feel afterwards. For me, I will get in a funk. I will not be feeling my absolute best self. And I know if I just take that hour to walk even, just walk around the block for an hour, I'm going to feel better afterwards.

And I used to be one of those people that rolled my eyes at all those people that were like, "It's the high. I love it." You're not going for a high. I don't get the high. I just feel generally better afterwards.

And if you focus when you do feel that way and remind yourself about that, it suddenly becomes a lot easier to get motivated, to get disciplined, to get out and do something.

Scot: That's right. You'll never regret physical activity.

Mitch: Unless you injure yourself.

Scot: Well, yes. That's true.

Troy: Or get frostbite.

Scot: See, I'm trying to . . . You guys, I'm trying to write shirts like Troy and you're ruining it for me.

Mitch: I'm sorry.

Troy: There are some exceptions.

Scot: All right. My number three, and this speaks to activity as a way to do the things that you want to do, is to get those nagging issues handled that might keep you away from doing the things that you want to do.

Early on in the podcast, we talked about a video from a Hollywood trainer who trains stars that are going to go into the movies, like the Chris Pratts and the guys that play Captain America and Thor and the Angelina Jolies. And he said the first thing he does with all of those people is he finds out what weaknesses, imbalances, or any sort of problems that they have. Bad knee, bad shoulder. You've got to rehab that first.

I've had some things in my life that I've gone to physical therapy for. They gave me the physical therapy exercises. For a long time, I thought they were ridiculous. I didn't do them. But lately, I've been doing them every morning. And I'll tell you what, it makes my experience when I go lift weights better. I'm a stronger runner now as a result of it and I just generally feel better.

So if you've got some sort of a nagging issue . . . Nobody wants to walk when their knee hurts. Nobody wants to do stuff off if it's painful. It's worth the money spend if your insurance doesn't cover it or if you don't have insurance. Get the exercise, get the analysis, and then do them. It's huge. And that's an investment in your future as well so you're not that hunched-over old person.

All right. Well, I think we had a lot of good tips there. Everybody feeling pretty good with theirs, or are you going to want to trade yours for somebody else's?

Thunder: I feel pretty good with mine. I think it's kind of cool, too, to have a dialogue of kind of regular guys talking about physical activity. Not that Reddit moment like Mitch was talking about or things you see in social media, but just regular normal people talking about what works and what doesn't work and what realistic goals are. I think there needs to be more of that conversation out there.

Scot: If you want to be a part of the conversation, it's really easy to do. What works for you? What do you like? What don't you like? What piece of advice would you share?

Troy: Yeah. Email us, hello@thescoperadio.com. We're on Facebook, facebook.com/whocaresmenshealth. Call us on our listener line 601-55SCOPE. Our website is whocaresmenshealth.com. We'd love to hear from you.

Like Thunder said, I think this is the dialogue that needs to happen. Not someone on Reddit, not something like that, just people who are trying to make exercise part of their routine, make it sustainable. Let us know what you're doing and what works for you.

Scot: Be sure to tune in to the nutrition episode, which was number one in our series of five, if you haven't checked that out, the Return to Basics Core Four.

And then the next episode, we're going to talk about sleep. If you're struggling with sleep, what you can do about that.

Thanks for listening. Thanks for caring about men's health.

Interviewer: For patients that have survived a stroke, there could be some worry that they might be at risk for a second stroke.

Dr. Steven Edgley is the Director of Stroke Rehabilitation at University of Utah Health. Dr. Edgley, what can people who have suffered a stroke do to minimize their chances of having another one?

Dr. Edgley: The most robust way to prevent another stroke or heart disease is to control hypertension. If we put these three things into three buckets, controlling hypertension, its own bucket. It's so important. The second bucket is controlling things like cholesterol or diabetes or if you have AFib, which is an abnormal heart rhythm. So these are other medical factors that lead to an increased risk of stroke and heart disease. And so I mentioned three, the three major factors, but everyone should go to their own and primary care physician to outline and identify their personal risk factors.

The third bucket is lifestyle factors. And we can break those into diet, exercise, and what I would call avoidance of smoking, drugs, controlling your alcohol intake, things like that. So lifestyle factors, away from the doctor's office, things that you would do at home.

Interviewer: How do you best control hypertension? Let's go back to that first bucket. Is that diet and exercise? Is that usually some sort of medication?

Dr. Edgley: Both. Usually, medication works best. But diet and exercise play a role in controlling high blood pressure.

Interviewer: Generally, does a stroke, a person who's had their first stroke, do they have the hypertension that would more likely need medications to control as opposed to lifestyle?

Dr. Edgley: Both are truly important. So, certainly, if you have had a stroke due to hypertension, you need to be on some medication for that.

Interviewer: And then the second bucket, cholesterol, diabetes, AFib, or other medical factors you'd be discussing with your primary care physician. Again, is that medication generally to help control those things, or we do know that diet and exercise, again, can control those factors as well?

Dr. Edgley: Yes. So I'm talking about going to your primary care physician and getting on the appropriate medications. And I think of that third bucket, so it does influence a lot of risk factors. But I think of it as its own bucket, diet, exercise, and avoidance of harmful behaviors and substances.

Interviewer: So when we get to that third bucket with lifestyle behaviors, is it more difficult for somebody who's had a stroke to manage and control their diet and exercise? Is that a little bit more of a challenge?

Dr. Edgley: It is. They may have physical impairments that make exercise really difficult. And they may have physical mobility issues that make activity more difficult and leading to the problem of obesity. And so every one of us is on either an upward spiral or a downward spiral. And it's very, very important to, if you are on a downward spiral, to break that cycle. And a downward spiral means, you know, inactivity, leads to overweight, leads to poor muscle strength, leads to more inactivity and down and down we go. And patients can break that cycle, but it's got to be a conscious choice and an active choice.

Interviewer: So in a lot of ways, what you do, which is help stroke survivors with physical rehabilitation, is really important in breaking that downward spiral. I mean, I can speak from my experience, as somebody who has not had a stroke, I know it all comes out of exercise for me. If I'm exercising, then I tend to eat better. I tend to sleep better. I tend to do all those things. And I don't know if that's the case for everybody, but I would imagine that that physical activity component is pretty important.

Dr. Edgley: Yes. And that's true. And what we really try to do, we can't be everywhere for everyone, but we can set them out on a positive course. And so the most important thing is to be on the right uphill track and not a downward track.

Interviewer: For a patient who has experienced any sort of traumatic brain injury, recovery can be something that might seem a little scary. How long is it going to last? What can you expect, etc.?

So to answer some of these questions, we are here with Dr. John Speed. He is a professor in the division of Physical Medicine and Rehabilitation and practices at the University of Utah Health. Now, Dr. Speed, when we talk about a traumatic brain injury, that's a pretty big term. What kind of patients are we talking about here?

Dr. Speed: We're talking about a huge spectrum of people, from an individual that may have sustained a concussion heading a soccer ball all the way to someone that's been in a catastrophic car accident and sustained a brain injury that's left them in a coma for a prolonged period of time.

Interviewer: And what kind of patients do you see the most getting these types of injuries?

Dr. Speed: Well, the most common type of brain injury really is the concussion or mild brain injury that might be seen in the emergency room and sent home. But here at the Craig H. Neilsen Rehabilitation Hospital, we take care of patients in the hospital that have sustained more severe injuries that are perhaps comatose or have much more significant problems that last for a longer period of time.

Interviewer: So someone comes into say the hospital, the emergency room, this particular center with a brain injury, what's the first things that you guys are going to do to, you know, make sure that they're okay?

Dr. Speed: Well, that piece of it really falls to my neurosurgical and emergency room colleagues. They'll do any necessary surgical intervention to, say, remove a blood clot that may have formed. Possibly they'll do a procedure to remove a piece of skull to allow for brain swelling, which can be incredibly frightening for family members because obviously it looks very awful. But then once the person has recovered from a neurosurgical standpoint and they're ready for rehabilitation, they'll transfer over to the Craig H. Neilsen Rehabilitation Hospital and they'll have inpatient rehabilitation here working on all of the problems that they may have as a result of their brain injury.

Interviewer: And what are some of the problems that a patient like this might be experiencing?

Dr. Speed: Well, the brain is awfully complex and it does everything. So it could be emotional problems. It could be cognitive problems. It could be paralysis of one or both sides of the body, swallowing problems, speech problems, visual difficulties, you name it.

Interviewer: So when we talk about emotional or cognitive, what kind of things are we experiencing? Like a change in mood and behavior, lack of memory, what are some of those things?

Dr. Speed: Well, early on a person may still be in what we call post-traumatic amnesia. They have no idea where they are. They have no idea what's going on. They can't process information. They can't make sense of their environment. And I make the analogy that it's somewhat like living inside a kaleidoscope. They're just presented with all of the sensory input that they can't make any sense of. And so, of course, that's a very frightening experience, and oftentimes the reaction is one of thrashing around, being agitated, yelling, screaming, because it's a very frightening and disorienting experience. But as a person continues to recover, that orientation improves and the person can make sense of their environment again and that agitation will eventually settle down.

Interviewer: That sounds like a kind of situation that could cause some anxiety for both a patient and for, say, the loved ones that are looking on. What can, you know, doctors like you or someone at a center like the Craig H. Neilsen Center do to help relieve these kinds of symptoms and get the person, you know, closer to normal?

Dr. Speed: Well, the first thing we do is have the person in a low stimulation environment because the less sensory input coming in, the low light, low sound, the TV is off, blinds are down, etc., and minimize the stimulation. And then if necessary, we may use a person's music that they're familiar with, that they enjoy. That can be calming for lots of people. And interestingly, I had patient years ago, who was a young man who was into head banging heavy metal and that was something that was very calming for him. It was very disturbing for the staff, but it worked to help him feel more comfortable and relaxed.

Interviewer: So after a patient has gone through that post-traumatic amnesia, what are some of the steps that come next, and how long can a patient and their loved ones be expecting the recovery to take?

Dr. Speed: Well, of course, the recovery is incredibly variable, and it depends on the severity of the injury, it depends on the type of injury or injuries, and it also depends to some extent on what the person had in terms of life experience prior to the injury. But once the typical sort of sequence of events is the person will proceed out of post-traumatic amnesia. So they'll be oriented, they'll know where they are, they'll know what year it is, and so forth. They'll know that they're in the hospital and why they're in the hospital.

And our therapists are excellent at working with people to regain physical function, balance coordination, mobility. Our occupational therapists will work on what are called activities of daily living. How does a person get dressed? How do they bathe themselves? And those sound pretty basic, but, you know, if a person has had a brain injury, they may not be able to dress themselves. They may put their pants on and then put the underpants on outside because they just don't know the sequence of events that are necessary and they can't process that. So occupational therapists will work on those kinds of things. And then we also have speech therapists that will work on cognition, memory, and also address any language problems that might exist and also any swallowing difficulties that might result from the brain injury.

Interviewer: So what are the expected outcomes for the types of treatment regardless of what kind of brain injury this individual is having and comes to a center like the Craig H. Neilsen Rehab Center?

Dr. Speed: Well, outcomes, of course, are incredibly variable, but we're very proud of the outcomes that we do achieve here. And more than 80% of the people that we admit to the Craig H. Neilsen Rehab Hospital with brain injury are discharged to home. And that doesn't mean the rehab therapies are finished at that time, but people do go home and continue their therapies in some fashion after discharge to home.

Interviewer: And how long are they typically at a center like the Neilsen Center?

Dr. Speed: Well, our typical length of stay for someone with a brain injury that's admitted here is somewhere between two and three weeks.

Interviewer: Wow. So I guess one of the messages maybe that, you know, with the right help and the right medical assistance, there is hope for someone after a traumatic brain injury.

Dr. Speed: Oh, absolutely. For sure.

Interviewer: Harnessing the power of physical therapy for stroke recovery, Dr. Steven Edgley is the stroke rehabilitation medical director at University of Utah Health.

Dr. Edgley, just first off, what is the importance of physical therapy for stroke recovery?

Dr. Edgley: The reason why physical therapy is so important, and walking specifically, is that physical therapy will facilitate better walking. Better walking will facilitate better function in the home and the community, and better function will facilitate a better quality of life. And that's what we're really after. It's very important to the individual patient to regain walking and moving around capabilities.

Interviewer: Dr. Edgley, in the past few years, from what I understand, the technology or the ways that you help people recovering from a stroke start to walk again has actually changed quite a bit and improved. Tell me more about that.

Dr. Edgley: Over 15 years ago, so many stroke patients did not get the therapy they needed because it was too labor-intensive. Now we are able to use advanced techniques like bodyweight-supported harnesses.

Interviewer: Tell me what that harness does.

Dr. Edgley: Early on in the recovery process, we used to use three and four therapists. Now we can use one, maybe two therapists with the bodyweight-supported training.

We actually have in the new Neilsen Rehab Hospital have the longest what's called the ZeroG track in the world. Also possible is unweighting the body through using a pool therapy, and we now have a treadmill on the bottom of a pool that partially unweights the body. And that is actually going along with the same concept of partially unweighting of the body for increased reps and practice.

Interviewer: What I'm hearing is walking is just that important. That should be your goal, just to get out and do it. It might not necessarily be pretty at first. You've just got to go through the motions. And if you go through the motions, it will get better and your recovery will get better. Is that a fair assessment?

Dr. Edgley: To be able to effectively walk, you typically need to compile a lot of repetitions. And typically, starting from square zero, a lot of people don't really get out of bed and stay in bed for months to years. And so we find it's critically important to ambulate early and often use these advanced techniques to help in the process.

Interviewer: Dr. Edgley, if an individual recovering from a stroke doesn't have access to a ZeroG track or the treadmill that's underwater like you talked about to help them get in those reps necessary for regaining their ability to walk, what would you recommend for that individual?

Dr. Edgley: Everyone should have access to a physical therapy gym or location. Encourage your therapists to actually walk with you. And it may be that you have to have four hands on deck to fully walk safely at first, but that is what it sometimes takes.

Interviewer: I feel like if there is just one thing that somebody should take away from this is just if you've had a stroke, you've just got to start walking and figure out how to make that happen. And if you have access to great technology like the ZeroG track at University of Utah Health . . . and by all means, if you can take advantage of that, great. If not, have those people help you walk on the treadmill that has the sidebars. You've just got to get those legs moving to get that brain muscle reconnection going again and those repetitions. That's what really matters.

Do you have a story that illustrates just how important walking is, getting those repetitions in is, to stroke recovery?

Dr. Edgley: I'm thinking of one young stroke patient who was despondent and discouraged, so discouraged that she really did not walk and put forward the effort that is necessary for recovery. And that went on for months. Couple of years actually.

And when she started to be more receptive to these therapy techniques, her whole life changed as she began to be more able to walk, more able to get outdoors, and more socially active. And now she is married and chasing a toddler around. So it can have very, very wide-ranging impacts.

Announcer: Need reliable health and wellness information? Don't listen to the guy in the cube next to you. Get it from a trusted source, straight from the doctor's mouth. Here's this week's listener question on The Scope.

Interviewer: All right, it is time for our listener question. Today, the listener question is from Renee. Her dad just had a stroke and he's going through physical therapy, and she wants to be sure that she's doing the right things to help him recover. She understands how important physical therapy is and she wants to know what to do, how to help. So we brought in an expert, Randy Carson. He is a new neuro clinical specialist in physical therapy. What can she do to help her dad?

Randy: One of the first things that we talk to people about, families especially, is to actually take care of themselves because they definitely need to be in a position where they could be helpful. So after somebody's had a stroke, they may need help with things like walking around the house, getting in a bed, and doing things like that. And while they're in rehab with us, they're in good care. So this would be the time for them to do things like get their house in order, make sure they've got the time when their dad goes home so that they can actually be in a good position to be helpful.

We do a lot of training with families right before somebody goes home to show them really great body mechanics and things like that so they don't get injured, a lot of good safety things that we teach them about how to assist, in her case her father, so that he wouldn't have a fall or put himself in more harm's way, and definitely, a lot of education on prevention of secondary risk factors so that you don't end up back in the hospital too.

Interviewer: Yeah. That surprised me a little bit. I guess I didn't see that answer coming. I thought your answer is going to be more along the lines of, "While he's doing his exercises, you can do this, this, and this."

Randy: People make tremendous progress while they're in the hospital. So if they're involved a lot and really early on, for one, they usually burn out by the end of the stay if they're there three or four weeks, because that's a long time to be on you're A-game the whole time. And then, the other thing is they're overwhelmed because who they see on the first day in rehab is going to be dramatically different on the person that they take home.

So we don't do a lot of training in the beginning, because that's when they're at their worst. They might need a lot of lifting assistance, they might be a super high risk for fall, and that's the best time to let us take care of them and try to improve them to a point where they can be very manageable to take home.

Announcer: Have a question? Ask it. Send your listener question to hello@thescoperadio.com.