MIke: 00:00:10

Welcome back to the Neurostimulation Podcast, the show where we explore

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the science and clinical practice

of non-invasive neurostimulation,

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interventional mental health, and

innovative approaches to improving

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general mental health and wellness

in order to help treat complex

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neurological and psychiatric conditions.

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I'm Michael Passmore, psychiatrist

and clinical associate professor

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in the Department of Psychiatry at

the University of British Columbia

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in beautiful Vancouver, Canada.

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Today's conversation focuses in on a

topic that is very common and often

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deeply misunderstood, concussion and

persistent post-concussion syndrome.

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My guest today is Dr.

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Ayla Wolf, a clinician and researcher who

has spent more than two decades working

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with complex neurological cases, including

things like traumatic brain injury.

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Chronic migraine dysautonomia

and vestibular disorders.

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Dr.

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Wolf's path into this

field is quite personal.

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After sustaining multiple concussions

herself, she experienced many neurological

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symptoms, things like depression, anxiety,

insomnia, brain fog, chronic pain.

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But instead of accepting that as her

new normal, she stepped away from

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her clinical practice and return

to school to study applied clinical

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neuroscience and functional neurology.

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And so that journey ultimately led

her to develop a highly integrative

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approach to neurological rehabilitation

that combines things like neuroscience,

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functional neurology, as well as

holistic approaches like acupuncture.

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Dr.

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Wolf is the author of the book, the

Concussion Breakthrough: Discover The

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Missing Pieces to Recovery, and she's

also the host of the podcast, Life

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After Impact, The Concussion Recovery

Podcast, where she interviews experts

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working on brain injury and recovery.

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Dr.

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Wolf is an associate professor

at the Kerrick Institute and

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the founder of Healing Response

Acupuncture and Functional Neurology.

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Dr.

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Wolf, thanks so much for joining

us and welcome to the podcast.

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Really looking forward

to the conversation.

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Ayla: Neuromodulation is what I

do all day long, so I was excited

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to be, be a guest on your show.

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MIke: Fantastic.

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Yeah.

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So I'm really curious.

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So many people working in brain

injury care arrived there because

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of a personal experience, and so,

really interested, to hear your story.

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So perhaps you could, help us

to understand that and explain

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a bit about that background.

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Ayla: Sure, I'll try to do it in a shorter

period of time 'cause sometimes in telling

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stories I can be a little long-winded.

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I think the best way to start out

is when I graduated from my master's

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program in Chinese medicine, I opened

up an acupuncture clinic and I actually

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specialized in fertility at the time.

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And so I was very interested in

functional medicine and functional

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endocrinology and, the crossroads of

how do you utilize acupuncture and

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Chinese medicine to support people in

hormonal bAylance who are trying to

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grow their families and get pregnant.

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And so I've always.

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I've always loved science.

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I've always loved functional approaches

to things, and so that my mindset was

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already thinking in that way of kind of

functional medicine meets acupuncture

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and Chinese medicine, which you could

say that Chinese medicine and Ayurvedic

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medicine really are the oldest forms

of functional medicine out there.

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So my brain was very much already thinking

in these terms, and over the years I

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had, I had several sports concussions

that I walked, I walked away from, I

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never had a concussion that had me back

boarded out of somewhere, or, you know,

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had immediate go to the urgent care and

get checked out because most of my sports

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were individual sports like mountain

biking, where when you crash, you crash

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15 miles in the forest and there's no

sideline athletic trainers watching you.

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Mm-hmm.

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And so a lot of my concussions were,

at Mount Bachelor, snowboarding,

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or in the woods mountain biking, or

on a lake somewhere wakeboarding.

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And then on top of that, I've got a

25 year history of martial arts where

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I've taken a lot of sub-concussive

hits to the head, getting choked out in

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jiujitsu, hypoxic injuries and insults.

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And so I think that my history of

sports concussions, created a situation

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that was a bit of a slow burn in

terms of symptoms and there were two

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concussions that happened 10 days apart.

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And in that moment, that was when I

experienced actual kind of speech aphasia.

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So for, I was flying, home and

I had three legs of my flight.

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And I remember after that second

concussion that had happened 10 days after

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the first I was at the airport and I just

couldn't figure out how to order a salad.

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Like I didn't have the words.

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And so I kind of remember just handing

the person my boxed salad and them

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asking me if I wanted a beverage

and I just kind of shook my head and

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handed them money and walked away.

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I couldn't even handle, you

know, like waiting for my change.

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And so that was the moment where.

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My symptoms kind of became more real

and turned into, you know, two months

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of not sleeping at all, a very much

kind of cognitive symptoms of brain fog,

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feeling very overwhelmed very easily.

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I was running a large clinic with

two different locations and a big

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staff of acupuncturists, massage

therapists, medical billers, front

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office, you know, the whole thing.

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And so my experience of having concussion

symptoms was that I was, I was very

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much in the fog of it and I didn't

know that that's what was happening.

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I just knew that I was struggling and

I didn't even recognize that what I was

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dealing with was post-concussion syndrome

until I, this is kind of a very strange

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event that happened, but somehow I heard

about this book called The League of

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Denial, which was the, the journalistic

book that the movie concussion with

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Will Smith was kind of based upon really

the same story of, the researchers

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who were, who were studying chronic

traumatic encephalopathy and looking at

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NFL players and, and that whole thing.

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So I read that book and it was like

a light bulb went off in my brain

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and I started to think back to.

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I remember that time I got kicked in the

head and I ended up on the floor with

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nausea and dizziness and headaches and

oh, I remember that time I was learning

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how to wakeboard and I got really dizzy

and I was out of it for a few days after

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I crashed over and over and over again.

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And oh yeah, there was that one time

when I crashed my mountain bike and

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I started to think back and I just

realized, oh wow, I can count probably

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seven definite concussions that I've had.

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and like I said, two of them

that were 10 days apart.

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And so that's what led me to decide

to, I mean, make a radical decision

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on shutting down my entire life as it

existed and moving to Texas, going back

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to school, studying brain injuries,

and getting my doctorate degree.

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And so my.

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My education after about eight

years of being in practice

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just took a complete 180.

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And instead of specializing in fertility,

I've now been studying neurology and

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neuroscience and, clinical neuroscience.

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And that's been the focus

of my, my personal practice

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too, for the last 10 years.

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For sure.

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MIke: Hmm.

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Yeah, that's, it's so interesting when,

you know, the pieces of the puzzle start

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to kind of come together and with that

additional personal realization, sort

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of kindling the passion to really get,

interested and involved in translating

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the challenges that you went through

into your helping other people to

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overcome similar challenges, right?

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Ayla: Yeah, absolutely.

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MIke: And so I guess for maybe for viewers

and listeners who don't necessarily have

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a significant background in neuroscience,

maybe help us understand certain

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fundamentals like, what would be a way

of understanding what happens to the

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brain physiologically after a concussion?

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Ayla: Yeah.

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And we can absolutely talk about kind

of what happens in the acute stage

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and then what can happen afterwards,

which is be where it becomes

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kind of infinitely more complex.

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I always say that, you know, a

brain injury is the most complicated

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injury you can have because the brain

does so many different functions.

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And so for every single person,

their experience of a brain injury

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can be completely different.

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But initially after a brain injury,

there is a metabolic crisis where

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because of changes in blood flow

and changes in, blood brain barrier,

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permeability and changes in all these

ions in the brain between sodium and

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potassium, you can have a huge amount

of, influx of, calcium into parts of

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the brain where it doesn't belong.

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That creates problems with

the sodium potassium pump.

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And so you have this huge

neurotransmitter imbalance that

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causes a lot of neurons to depolarize.

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And so you've got this huge amount

of metabolic activity that happens

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all of a sudden, and that's what

creates this energy deficit.

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And so there's an energy deficit in

the brain, which then is why many

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people over maybe 10 days to maybe 30

days, feel like they've got brain fog,

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difficulty focusing, concentrating.

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They've got all these kind of

cognitive symptoms, they've got the

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light sensitivity, the headaches,

the sensitivity to movement.

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All of that is because the brain

is in a hyperexcitable state.

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And that should calm down.

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Like a lot of that stuff is

supposed to calm down and kind

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of return back to baseline.

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And the reality is that most

people, if they get a concussion,

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they have a whole health history

behind that concussion, right?

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Some people might have Lyme disease,

other people might have an autoimmune

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disorder, somebody might suffer from PTSD.

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And so what happens is that when

we look at the literature, a lot of

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times the literature is looking at

healthy young athletes that maybe

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don't have that medical history, right?

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They're healthy, and then

they got a sports concussion.

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And so I think for the longest time.

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we were looking at concussions through

this athletic lens and saying, oh, people,

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they generally get better pretty quickly

and, and they can go back to eventually

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like, playing their sports again and,

they're good, they're back in school.

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But the reality and the demographic

of people that I work with are the

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people who have a whole health history

that was there before they got their

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car accident or their slip and fall

on the ice or, whatever it might

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be that caused their concussion.

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And so most of the people I work with

are maybe women in their forties,

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fifties, and sixties, that you're never

just treating an acute concussion.

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You're obviously treating the whole person

with everything that comes with that.

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So there are these very well-defined acute

things that happen after a concussion.

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And when people are lucky, they can

get back to baseline and their symptoms

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just get better and better and they're

able to go back to work, go back to

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school, and return to their normal lives.

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Those are generally not the

people that I see in my practice.

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The people that I see and the people

that I work with are the people who,

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have symptoms that maybe come on

gradually or their symptoms come on

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right away and they just never go away.

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And they kind of actually

get worse over time.

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And so the people that I work with,

often struggle in many different ways.

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They may have chronic daily post-traumatic

headaches, chronic neck pain, light

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sensitivity, sound sensitivity.

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Lots of cognitive symptoms where they

struggle with, doing multitasking all day

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long, things that maybe they used to be

great at their job are now very difficult

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being in front of screens all day long,

having to process auditory information,

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visual information, all of their kind

of cognitive processing is skewed.

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And then they may have, some

people have a lot of autonomic

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instability and so they've got

abnormal responses to being upright.

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So they have orthostatic intolerance

or they've got problems with, how

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their brain is controlling their

blood pressure, or they're sweating,

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or all kinds of autonomic functions.

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And so we have to start looking at

people, and saying, this is, they've

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had a concussion or they've had some

type of brain injury, and so we almost

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have to kind of set that aside and

say, let's run this person through all

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kinds of functional exams to see how is

that manifesting for this individual.

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And so that's where the functional

neurology brings a level of individualism

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to the treatment plan, to, to the

assessment and the treatment plan that I

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think is, can be very profound for people

because you're never just implementing

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one specific protocol for everybody.

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Everybody is getting a very individualized

treatment plan based on what you see

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in that functional neurological exam.

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MIke: Yeah, I appreciate

your explanations.

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You know, it's understandably complex.

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'cause this is such a

complex challenge, right?

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I mean, I think the width and

breadth of the symptom distribution

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that you're describing and the

complexity, it's incredible.

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And it's interesting though in terms

of your background with starting out

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with that interest and expertise in

the holistic, the Chinese medicine

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background and, and sort of bridging

that with the cutting edge neuroscience,

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expertise in terms of, the functional

neurology that you're just talking about.

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That makes total sense in terms

of the best way to approach

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that kind of thing, right?

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Because people are so complex and they're

bringing their complex histories to

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this, as you say, not necessarily as

healthy and clean as high performance

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athletes who get concussions.

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Right?

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So that's, it makes sense also

that that's just that the athletic

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concussion piece is just a very small

slice of the overall pie in terms of

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post-concussive syndrome and then this

persistent post-concussion syndrome.

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It's such a challenging topic, isn't it?

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Because I think, I can imagine that a

big challenge as well for many people is

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the sense of stigma around, having such

complex and sometimes nebulous kind of

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vague symptoms and then, considerations

like insurers or employers not buying

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into the idea that they're so impaired

because they don't maybe seem so impaired

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from the outside objectively, and there's

all those sorts of considerations and

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challenges that then also feed into

the mental health problems, right?

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Like the demoralization and

the anxiety and the depression.

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So it's so complicated.

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Ayla: It's very complicated.

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And that's exactly, it is sometimes

it's frustrating to feel like.

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Just because the research says, well, 70%

of people that get a concussion, go on.

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They heal and they can

go on with their lives.

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And then the insurance kind of pretends

that that other 30% doesn't exist.

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And so those people that have those

persistent concussion symptoms

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do often feel abandoned by.

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The insurance model.

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And the other thing I see happen

a lot 'cause I do work with people

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that have had say, motor vehicle

or workers' compensation claims,

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is that in those, in instances, a

lot of their treatments are siloed.

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And so somebody that has a concussion

and has a lot of different symptoms, they

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might see a neurologist that's prescribing

medications for their headaches or their

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nausea and then they see, uh, an eye

doctor to address some of the vision.

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Issues, and maybe they're put in prisms or

they're, taught different eye exercises,

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or they go to an occupational therapist

who maybe gives them some eye exercises,

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and then they go to a speech therapist

that does some cognitive exercises,

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and then they go to a vestibular

therapist who works on their balance.

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And so they do all of these things

and they have all these appointments,

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and then they're still not better.

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And so that person, when they walk into

my clinic, they've already had their

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symptoms for maybe two to five years.

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They've already worked with all

the kind of different providers

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that they've been told that they

have to go work with, because if

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they don't, they're not compliant.

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And then their case gets dropped, right?

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Mm-hmm.

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And so by the time they see me,

they're confused because they're

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like, I've done all this therapy,

like, why am I not better?

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And mm-hmm.

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What I'm really discovering over and over

again is that there is a problem with this

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siloed way of thinking of, I'm gonna have

you sit here and just do an eye exercise.

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I'm gonna have you go over here

and just work on balancing.

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I'm gonna have you then go over here and

just do some kind of cognitive exercises.

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And so a lot of what I do is this kind

of integrative work of maybe we're

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doing, we're having you move your head

one way and your eyes one way while

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you're bouncing on a foam pad and we've

got music in the background and I'm

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asking you to do simple math equations.

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Or maybe I'm having you balance and like

I'm tossing up different colored scarves

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and you have to name the colors of it and

then you have to go do this other thing.

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And so a lot of like the

active rehab that I do.

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Is kind of engaging all these different

parts of their brain at the same time.

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So they're having to think cognitively

balance, turn their head, move

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their eyes, be exposed to, you

know, sound or lights or whatever,

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and, it's, and all of a sudden they

start to get better and, mm-hmm.

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So the, the thing that I think is

frustrating is that all of those

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other therapies weren't wrong.

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They weren't bad therapies, they

were just not integrating all

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the different parts of the brain.

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They were kind of, people's

brains learn how to compensate.

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And so if you have them just do one

exercise at a time, like an eye exercise,

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maybe you're just fueling a compensation

pathway and you're not actually

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getting the brain to kind of think

differently about how to do something.

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And so, I think there's just the

cases that walk in my door are kind of

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these complex persistent cases where

they've typically done a lot of other

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therapies and I get to come in and

just say, okay, how do we do things

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very differently that gets all these

parts of the brain firing at once.

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MIke: Yeah, that's fantastic.

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I think it's super interesting,

but it totally makes sense because

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it must be just, modeling how.

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We just have to react to our

environment all the time without

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really thinking too much about it, it's

simulating more of like a real world

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kind of rehabilitative experience.

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: 00:19:08

Right.

300

: 00:19:08

As opposed to just

301

: 00:19:09

Ayla: being compartmentalized as you say.

302

: 00:19:11

Because we don't live for the most

part in a very compartmentalized

303

: 00:19:14

way or so intentionally like that.

304

: 00:19:16

So that, that totally makes sense.

305

: 00:19:18

So I'm curious, it makes me think that

the whole idea of functional neurology

306

: 00:19:22

kind of relates to exactly that.

307

: 00:19:24

Is that correct?

308

: 00:19:26

How would you help us to understand this?

309

: 00:19:28

Yeah.

310

: 00:19:28

Concept of functional neurology.

311

: 00:19:31

Yeah.

312

: 00:19:31

I like to explain it that it's

functional neurology is a, a mindset.

313

: 00:19:35

and just like with, with functional

medicine, you know, I would say, you

314

: 00:19:39

know, a great example is, is the thyroid.

315

: 00:19:42

so in kind of our modern biomedical

system, people come in, they say,

316

: 00:19:45

man, I'm, I've gained weight.

317

: 00:19:47

I can't lose it.

318

: 00:19:48

I'm lethargic.

319

: 00:19:49

I, my metabolism sucks.

320

: 00:19:51

And so then the, the doc maybe does some

basic lab work and just looks at their

321

: 00:19:55

TSH and says, oh, your TSH is fine.

322

: 00:19:58

Your thyroid's fine.

323

: 00:19:59

And so that's kind of like this

very, I would say, outdated, lazy

324

: 00:20:03

model of assessing the thyroid.

325

: 00:20:05

Then that same person might go to a,

a functional medicine provider and

326

: 00:20:09

they say, oh, we're gonna run, you

know, TSH and T three and T four and

327

: 00:20:14

free T three, and we're gonna look

at reverse T three and we're gonna

328

: 00:20:16

look at infl inflammation markers.

329

: 00:20:18

We're gonna look at your in, see

if there's any anemia, and then

330

: 00:20:21

maybe even if their levels are

kind of within the normal range.

331

: 00:20:26

That functional medicine provider

might say, well, you know, you're

332

: 00:20:28

still symptomatic and so maybe this

normal range is actually too large

333

: 00:20:32

and we have our functional ranges

where we really would like to see you.

334

: 00:20:36

And so now we're gonna do some tweaking to

kind of get you into these more functional

335

: 00:20:39

ranges where you actually feel better.

336

: 00:20:42

And so functional

neurology is the same way.

337

: 00:20:44

It's not, let me just run you

through a basic cranial nerve exam

338

: 00:20:49

and say, you know, can you feel my

finger on your trigeminal nerve?

339

: 00:20:53

And can you follow my

thumb back and forth?

340

: 00:20:55

And, well, your pursuits, they're,

they're intact even though

341

: 00:20:57

maybe they don't look great.

342

: 00:20:59

you know, functional neurology is

really about assessing the person.

343

: 00:21:04

With all these kind of individual,

systems like the autonomic system

344

: 00:21:09

and the ocular motor system and the

vestibular system, but then also

345

: 00:21:12

saying like real world scenario.

346

: 00:21:15

Well, you might be able to bAylance just

fine standing there with your eyes closed.

347

: 00:21:18

But what happens if I start

playing music in your ear?

348

: 00:21:21

Do you lose your bAylance?

349

: 00:21:23

you know, we can like have somebody walk

down the hall and look at their gate and

350

: 00:21:27

then have them walk down the hall and

say every other letter of the alphabet

351

: 00:21:32

and all of a sudden they're falling

over and they're freezing and they've

352

: 00:21:35

lost their arm swing and they're like

doing weird thing bobblehead things.

353

: 00:21:39

And it's like you watch

their gate completely change.

354

: 00:21:43

When you just ask them to walk down the

hall and, and think at the same time.

355

: 00:21:47

And so functional neurology is about,

let's take this person, do all of these

356

: 00:21:52

tests in isolation, but then also do

them in these kind of contexts of what

357

: 00:21:58

happens to your eyes when you, your

head is tilted into a certain like, you

358

: 00:22:03

know, semi-circular connect position

or what happens to your motor system.

359

: 00:22:08

one of the tests I love to do is, you

know, there's the classic, you know,

360

: 00:22:11

touch your finger and then touch my nose.

361

: 00:22:14

Well, I like to have people, you know,

touch their nose and then touch my finger

362

: 00:22:18

and go back and forth three times and

then I have 'em close their eyes and

363

: 00:22:22

do it again with their eyes closed.

364

: 00:22:24

And then I compare that to what

happens if your head is tilted

365

: 00:22:27

back into the right or straight to

the right or down into the right.

366

: 00:22:31

And so I start testing that

exact same test with their

367

: 00:22:34

head in different positions.

368

: 00:22:36

And sometimes you find that their motor

coordination completely breaks down

369

: 00:22:41

when they're biasing a semi-circular

canal that's maybe under firing.

370

: 00:22:45

And so functional neurology is the process

of kind of running all these scenarios

371

: 00:22:50

to say, what happens if we do this?

372

: 00:22:52

What happens if we put

you in that situation?

373

: 00:22:54

What happens if you have to do

this and that at the same time?

374

: 00:22:58

And then we start to figure out,

ooh, here's where the system breaks

375

: 00:23:01

down and here's how we can craft a

creative individual kind of rehab

376

: 00:23:06

strategy to, to work these kinks out

and to get your system to be able to

377

: 00:23:10

operate in those environments better.

378

: 00:23:13

MIke: Hmm.

379

: 00:23:14

Yeah.

380

: 00:23:14

That's awesome.

381

: 00:23:15

I mean, the, the, the term

that stands out to me is the

382

: 00:23:17

individualized kind of approach, right?

383

: 00:23:20

Because I think part of what, you

know, and I think this is part of a

384

: 00:23:23

frustration particularly, dare I say

in the Canadian healthcare system,

385

: 00:23:27

where it's kinda like, take it or

leave it to a certain extent with, in

386

: 00:23:30

terms of like how you get investigated

and what treatments get offered.

387

: 00:23:34

And I think as you say, part of it

is, it's kind of an institutional

388

: 00:23:38

barrier as far as, you know, trying

to, there's a reason why it's important

389

: 00:23:43

to a certain extent to kind of.

390

: 00:23:45

Try and put people into these cubby

holes in terms of diagnostics.

391

: 00:23:49

But, but that, that doesn't mean to say

that you're always gonna be capturing

392

: 00:23:54

their true symptoms or putting them on a

path to getting relief of those symptoms.

393

: 00:23:58

Right.

394

: 00:23:58

So this kind of approach that you're

describing is much more, attentive to

395

: 00:24:02

those individual symptoms and these

individual client stories as opposed

396

: 00:24:07

to the actual lab result number, right?

397

: 00:24:10

It's like, treat the client,

not, not the number that you get

398

: 00:24:13

back on the lab result, right?

399

: 00:24:15

Ayla: Mm-hmm.

400

: 00:24:16

Yeah.

401

: 00:24:16

Yeah.

402

: 00:24:16

And a lot of these people are people who

have, you know, graduated from something

403

: 00:24:21

like vestibular physical therapy because

they were able to kind of pass all the

404

: 00:24:25

tests, but then they'll say, well, by the

end of the day when I'm tired, like I'm

405

: 00:24:29

still just falling all over the place.

406

: 00:24:31

Or when I go into the grocery store,

all of a sudden my bAylance falls apart.

407

: 00:24:35

And so they might be able to perform

certain tests just fine, but then

408

: 00:24:39

you put them in a different situation

and then they wouldn't be able to,

409

: 00:24:43

And the reality is that the work

that I do is very time consuming.

410

: 00:24:47

You know, I spend, I do spend a ton

of time with each individual person,

411

: 00:24:52

and I know that our medical system

just isn't necessarily designed

412

: 00:24:55

for, for that type of care, so,

413

: 00:24:59

mm-hmm.

414

: 00:24:59

MIke: Yeah, sure.

415

: 00:25:00

That, and that's a very

valid point for sure.

416

: 00:25:02

It's a matter of suppose of finding

that bAylance, but, yeah, no, I'm sure

417

: 00:25:06

your clients really appreciate the

attentiveness and the time that you

418

: 00:25:10

spend with them, and I'm sure that

has a lot to do with the outcomes that

419

: 00:25:14

you find, you know, the improvements,

the, the ability to individualize the

420

: 00:25:18

rehabilitation programs for people.

421

: 00:25:21

I'm super curious about, you know,

these, these more holistic approaches

422

: 00:25:24

like the acupuncture and how it might

optimize things like cerebral blood flow.

423

: 00:25:29

I understand that that's a, a, a

specific aspect of your research

424

: 00:25:33

and your clinical interest.

425

: 00:25:34

Could you explain a little

bit about that for us?

426

: 00:25:37

Ayla: Yeah, that was, a big part of kinda

where I started on my journey of, of

427

: 00:25:42

learning all of this and, and studying

the brain, was that I was trying to

428

: 00:25:47

figure out is there a, a place, is there

a role for acupuncture in brain injuries?

429

: 00:25:53

And a lot of the research that

existed was more on stroke because

430

: 00:25:58

in China, acupuncture is, very much

heavily utilized in stroke recovery.

431

: 00:26:04

And so a lot of the, the

research was looking at the, the.

432

: 00:26:08

Mechanisms of acupuncture for

people that have had, strokes,

433

: 00:26:11

which is a type of brain injury.

434

: 00:26:13

And also, there was research

on acupuncture for spinal

435

: 00:26:16

cord injury as well.

436

: 00:26:18

And so I was looking at a lot of that

literature and then looking at a lot

437

: 00:26:23

of the literature on does acupuncture

improve blood flow in the brain?

438

: 00:26:27

And if so, kind of what are

the different mechanisms?

439

: 00:26:30

And so, basically to kind of not get

too technical, our, our trigeminal

440

: 00:26:37

vascular system is a pretty vast

network of interaction between the, the

441

: 00:26:42

branches of the different trigeminal

nerves and, and all of their offshoots

442

: 00:26:47

and then all of our vasculature

within our, our skull and the dura.

443

: 00:26:51

And so.

444

: 00:26:52

What they're finding is that acupuncture

on the scalp and on the face,

445

: 00:26:57

really does have a neuromodulatory

effect on that trigeminovascular

446

: 00:27:02

system in a way that it does help

to improve blood flow to the brain.

447

: 00:27:07

And so you can use acupuncture as one

tool for not just improving kind of

448

: 00:27:15

what we might call global blood flow,

but also regional blood flow as well.

449

: 00:27:19

I do think that there's a bit of a, a

wisdom there where blood flow can be

450

: 00:27:24

directed to certain parts of the brain.

451

: 00:27:26

based on kind of your point location, and

at least at, at the very least we can say

452

: 00:27:31

there's certain acupuncture points that

improve blood flow through the anterior

453

: 00:27:35

circulation, through that carotid,

and then also, through the posterior

454

: 00:27:39

circulation through that basal artery too.

455

: 00:27:42

So

456

: 00:27:44

MIke: that's, that's so fascinating.

457

: 00:27:45

Yeah.

458

: 00:27:46

Really, really interesting.

459

: 00:27:47

I mean, I guess the other thing that I

was wondering about is in terms of, you

460

: 00:27:52

often hear these, I suppose to a certain

extent, myths, I guess I'm not quite sure,

461

: 00:27:57

but I'd like your, thoughts about that.

462

: 00:27:59

But myths or, or sort of like, you know,

for example, one of the most common

463

: 00:28:05

pieces of advice that I think people

might often hear after sustaining a

464

: 00:28:08

concussion is to just kind of go to

a, sit in a dark room and rest and,

465

: 00:28:12

and have like a lower stimulation

kind of experience for a while.

466

: 00:28:16

I was understanding from reading some of

your writings that that's not always the

467

: 00:28:20

best advice after the first few days.

468

: 00:28:22

So I guess maybe help us

understand then, Yeah.

469

: 00:28:25

In practical terms, what might be

some, I know you can't, you know,

470

: 00:28:28

provide specific advice, you know,

and it's complicated, but in general

471

: 00:28:32

terms, like why might prolonged

rest be actually counterproductive?

472

: 00:28:37

Ayla: Yeah, there's pretty clear

research now that if people sit in a

473

: 00:28:41

dark room, that they create a lot of,

negative or maladaptive, neuroplasticity,

474

: 00:28:46

the kind that we don't want.

475

: 00:28:48

Hmm.

476

: 00:28:48

And so what can happen is that if

somebody, well, well, I'll say right

477

: 00:28:53

now, the, in the literature, both,

you know, western medicine, biomedical

478

: 00:28:58

model, everybody is now pretty

much on the same page and saying,

479

: 00:29:02

we understand that rest is not the

answer beyond like 48, maybe 72 hours.

480

: 00:29:08

So if you get a concussion kind of

immediately in that 48 hours, you do want

481

: 00:29:14

to remove yourself from too much stimuli.

482

: 00:29:17

And then after that.

483

: 00:29:18

this, it's not okay now you can kind

of go back to work full time or now you

484

: 00:29:23

can like go play video games all day.

485

: 00:29:24

It's not that, but it's saying,

you do want to get outside and, and

486

: 00:29:29

just go for a short walk if you can.

487

: 00:29:32

You do want to kind of expose yourself

to some amounts of conversation and

488

: 00:29:38

inter interaction with people, and you

wanna move your body in a, in a safe way.

489

: 00:29:43

And so now the recommendations are

more of these kind of graded, gradual

490

: 00:29:49

return to daily activities and mm-hmm.

491

: 00:29:52

also kind of as someone

can daily movement as well.

492

: 00:29:58

Because the autonomic

nervous system becomes more

493

: 00:30:01

deconditioned, the less we move.

494

: 00:30:04

And so the, when we, when we look at

dysautonomia and dysfunction of the

495

: 00:30:09

autonomic nervous system exercise is, is

really one of the most powerful ways to

496

: 00:30:14

condition the autonomic nervous system.

497

: 00:30:16

And so that's where it is

really important to just say.

498

: 00:30:19

Hey, even if you have a headache,

can you go for a super slow walk

499

: 00:30:23

or can you just get outside?

500

: 00:30:24

Can you move your body a little bit, in a

way that isn't like making your headache

501

: 00:30:29

go from a five outta 10 to a 10 outta 10?

502

: 00:30:33

And so we kind of take this like two point

increase of pain on that, you know, zero

503

: 00:30:38

to 10 scale and say, can you do something

up until the point where maybe your

504

: 00:30:42

headache goes from a five outta 10 to a

seven outta 10, then maybe we back off.

505

: 00:30:47

and knowing that some, a little

bit of exacerbation of symptoms

506

: 00:30:51

is kind of gonna be that cue of,

okay, I need to take a break.

507

: 00:30:55

But it's okay to push a little bit.

508

: 00:30:58

as long as you're not putting yourself

in a situation where you could

509

: 00:31:01

potentially hit your head a second time.

510

: 00:31:03

right.

511

: 00:31:03

So obviously safe

controlled environments, but

512

: 00:31:07

Gradually returning to

activities is really important.

513

: 00:31:11

even if symptoms do exacerbate just a

little bit, there is research that says

514

: 00:31:16

the people who did kind of go back to

work part-time at least, ended up with

515

: 00:31:21

better outcomes than the people that like

didn't go back at all and, and really

516

: 00:31:25

just sat and did nothing for six months.

517

: 00:31:27

And so it's important to use the brain.

518

: 00:31:30

It's important to move the body.

519

: 00:31:32

it's important to get nutrition in, and

during those kind of acute initial stages,

520

: 00:31:37

even if it does cause a little, you know,

some increase in symptoms, the outcomes

521

: 00:31:43

are just better than sitting in the

dark room and not doing anything at all.

522

: 00:31:48

MIke: Yeah, that's really

helpful to understand, this

523

: 00:31:50

whole idea of dysautonomia and

the autonomic system regulation.

524

: 00:31:54

Maybe, if you don't mind, you

know, explaining a little bit

525

: 00:31:57

about the autonomic system and

what dysautonomia is and, and what.

526

: 00:32:02

Strategies can be helpful to,

to help with rehabilitation

527

: 00:32:05

regarding that particular system?

528

: 00:32:08

Ayla: Yeah, I think it's important

to kind of differentiate between

529

: 00:32:13

what we might call autonomic nervous

system dysregulation, versus a, a

530

: 00:32:19

medical condition of dysautonomia.

531

: 00:32:22

Okay.

532

: 00:32:22

because many people are walking around,

very stressed out, you know, traumatic

533

: 00:32:27

experiences, post-traumatic stress.

534

: 00:32:29

There's a lot of people that probably

do have some level of autonomic

535

: 00:32:33

dysregulation, but maybe not a, a

medical diagnosis of dysautonomia.

536

: 00:32:37

So those are two separate things.

537

: 00:32:40

dysautonomia has gotten a lot more,

eyes on it lately because of COVID

538

: 00:32:46

and the fact that an exposure to

a virus can cause dysautonomia.

539

: 00:32:52

and one specific type of it is postural

orthostatic tachycardia syndrome.

540

: 00:32:57

And so, POTS as a subtype of

dysautonomia got a lot of attention

541

: 00:33:02

in the last five, six years, because

of the fact that it could be triggered

542

: 00:33:06

by a virus and by an illness.

543

: 00:33:09

And so, that is like a very

specific form of dysautonomia.

544

: 00:33:14

Where when you stand up, your heart

rate goes up more than 30 beats

545

: 00:33:17

per minute, and it's gonna have an

inaccurate response to someone just

546

: 00:33:22

going from laying down to standing.

547

: 00:33:25

And that increased heart rate is

actually a compensation for other

548

: 00:33:29

things that are going wrong within

the autonomic nervous system.

549

: 00:33:33

And so that's also part of the problem

with pots is that simply just trying

550

: 00:33:38

to squash an elevated heart rate isn't

necessarily fixing the root problem.

551

: 00:33:43

'cause the heart rate is really

just a compensation for other things

552

: 00:33:47

that aren't happening correctly.

553

: 00:33:48

and there's different subtypes

of pots to get into an even more

554

: 00:33:51

kind of complex, picture there.

555

: 00:33:53

But our autonomic nervous system.

556

: 00:33:56

I like to explain it like it, you

know, we talk about parasympathetic

557

: 00:34:00

as this rest and digest and feeling

relaxed and, and the sympathetic

558

: 00:34:04

is kind of like being stressed out.

559

: 00:34:07

But in reality, the sympathetic

nervous system is just as

560

: 00:34:11

important as the parasympathetic.

561

: 00:34:12

And we, we need to have a

sympathetic response if we

562

: 00:34:15

want to be able to exercise.

563

: 00:34:17

And so a, a highly responsive, intact,

autonomic nervous system is making

564

: 00:34:24

appropriate responses to the moment.

565

: 00:34:27

And so the example I like to use is, I

know I live out in the country, there are

566

: 00:34:32

dear everywhere, and so I can't tell you

how many times I'm driving home from work.

567

: 00:34:36

The sun has just gone down and a deer

jumps out right in front of my car, right?

568

: 00:34:40

Mm-hmm.

569

: 00:34:40

And so a normal response is I slam on

my brakes, my heart starts pounding.

570

: 00:34:46

I maybe like, stop

breathing for a second, but.

571

: 00:34:50

If I have an intact autonomic nervous

system, I can say, okay, the deer's gone.

572

: 00:34:56

Nobody's hit me.

573

: 00:34:57

I didn't hit the deer.

574

: 00:34:58

I'm fine.

575

: 00:34:59

Everybody's fine.

576

: 00:35:00

I'm gonna keep driving and I can get, I

can get my breath under control and I can

577

: 00:35:04

bring my heart rate down pretty quickly.

578

: 00:35:06

And so that is my autonomic nervous

system, having a normal response to

579

: 00:35:11

having to slam on my brakes and a

very quick return to baseline where

580

: 00:35:16

I'm like, okay, I'm safe, we're good.

581

: 00:35:19

Everything's fine.

582

: 00:35:20

Mm-hmm.

583

: 00:35:20

Somebody with dysautonomia that

happens and boom, they might

584

: 00:35:25

have extreme headaches, nausea,

dizziness, neck pain, fatigue.

585

: 00:35:29

They might have to go lay down

for four hours and their system

586

: 00:35:32

can't get back to that baseline,

because it's so dysregulated.

587

: 00:35:36

And so we have to think about our

autonomic nervous system as just.

588

: 00:35:40

When it's working well, it's

responding appropriately to the moment.

589

: 00:35:45

and if the moment requires that

we run away from the, the grizzly

590

: 00:35:48

bear, then we really need to

have that sympathetic output.

591

: 00:35:52

and so it makes all these beat to beat

adjustments of the heart rate, the blood

592

: 00:35:57

pressure, the sweating, pupil size.

593

: 00:36:00

And then the autonomic nervous system

also is, has a long-term control over our

594

: 00:36:06

immune system and our circadian rhythms.

595

: 00:36:09

And so a lot of people with dysautonomia,

they have circadian rhythms that are

596

: 00:36:13

off, they have very poor sleep, they

have maybe, an autoimmune component,

597

: 00:36:19

because of that kind of failure of the

long-term regulation of immune function.

598

: 00:36:23

So there's a lot of overlap between

autoimmunity and dysautonomia.

599

: 00:36:29

and that's where, again, like

infections can be something that

600

: 00:36:32

just triggers that change and kind of

throws people over the edge as well.

601

: 00:36:37

MIke: Hmm.

602

: 00:36:37

Yeah.

603

: 00:36:37

Thanks for explaining that.

604

: 00:36:38

It's, it's so interesting and it

makes me really think that, the way

605

: 00:36:43

you explain it in the wide ranging

cascading effects really does help to

606

: 00:36:47

under help people to under, hopefully

it helps me to understand, hopefully

607

: 00:36:51

it's helping viewers and listeners to

understand that's, this is why, because

608

: 00:36:54

it's so pervasive and, and there are

these cascading effects, it makes me

609

: 00:36:59

think that that helps to explain the

reason why there can be such significant

610

: 00:37:03

and chronic functional impairment.

611

: 00:37:05

That kind of seems a bit nebulous

because it's so far reaching.

612

: 00:37:10

Does that make sense?

613

: 00:37:12

Ayla: Yeah, it does.

614

: 00:37:13

And there's a questionnaire

called the Compass 31.

615

: 00:37:17

It was developed by the Mayo Clinic, and

it started out as 168 questions where they

616

: 00:37:23

were trying to figure out like, here's

all the possible things that could go

617

: 00:37:26

wrong with the autonomic nervous system.

618

: 00:37:29

They came up with 168 questions,

and then over the course of

619

: 00:37:33

using it and finding out, okay.

620

: 00:37:35

Which people with dysautonomia, how did

they answer the questionnaire versus

621

: 00:37:39

people that didn't, they were able to

narrow it down to 31 key questions.

622

: 00:37:44

And those 31 key questions center

around orthostatic intolerance.

623

: 00:37:49

You know, what happens when you stand up?

624

: 00:37:50

Are you getting dizzy?

625

: 00:37:52

Are you having cognitive symptoms?

626

: 00:37:54

do you have light sensitivity?

627

: 00:37:56

Again, because the, the

pupils are very autonomic.

628

: 00:37:59

That pupilary light reflex

is an autonomic reflex.

629

: 00:38:02

And so sometimes when people have light

sensitivity, it's kind of, there's

630

: 00:38:06

some dysfunction within that reflex.

631

: 00:38:08

And then, what we call like secret

credo, motor and vasomotor symptoms.

632

: 00:38:12

So things like flushing, like

inappropriate flushing or

633

: 00:38:16

hives or things like that.

634

: 00:38:18

That occur or an inability to sweat.

635

: 00:38:21

Many people with concussions and

post-concussion syndrome will say they

636

: 00:38:25

develop heat intolerance, and I think

a big part of that is that underlying

637

: 00:38:29

DYS adenoma and the failure to regulate

vasomotor and secret motor functions in

638

: 00:38:35

relationship to venting heat from the body

through the opening and closing of the

639

: 00:38:39

pores and through sweating mechanisms.

640

: 00:38:42

Then there's a whole gastrointestinal,

component to that as well.

641

: 00:38:46

And people often develop what we might

call like functional gastrointestinal

642

: 00:38:50

disorders where there's no actual

physical obstruction or blockage, but

643

: 00:38:55

people have more of like these irritable

bowel type presentations in a lot

644

: 00:38:59

of nausea for, for maybe no reason.

645

: 00:39:01

Or they eat and they don't feel good.

646

: 00:39:04

And the, and so a lot of people

will deal with these kind of

647

: 00:39:07

functional GI symptoms as well.

648

: 00:39:10

Mm-hmm.

649

: 00:39:10

And so the Compass 31 is kind of this

like beautiful tool that can, highlight

650

: 00:39:16

the degree to which somebody might have a

higher kind of autonomic symptom burden.

651

: 00:39:21

MIke: Mm-hmm.

652

: 00:39:23

Yeah, it's, it's very interesting.

653

: 00:39:25

Yeah.

654

: 00:39:25

It makes me think that, I think, you

know, historically there is kind of a

655

: 00:39:28

bias against paying attention to the

autonomic system or even understanding,

656

: 00:39:32

even having knowledge about it,

like in western medical training.

657

: 00:39:36

So it's, it strikes me that, that,

you know, that there's such importance

658

: 00:39:39

there as, as understanding and, and that

representing kind of a bridge to, yeah,

659

: 00:39:44

things like how, you know, in psychiatric

terms, maybe the unconscious as well,

660

: 00:39:48

because our autonomic functioning is

kind of outside of our, you know, waking

661

: 00:39:52

consciousness to a large extent, right?

662

: 00:39:54

How the unconscious actually also in

is involved with various different

663

: 00:39:59

aspects of mental health and wellness,

but physical health and wellness also.

664

: 00:40:03

And furthermore, how these alternative

holistic options like the acupuncture,

665

: 00:40:09

you know, Chinese medicine approaches

does in, in a way maybe more inherently

666

: 00:40:14

recruit or pay attention to the autonomic

system issues and how to correct those.

667

: 00:40:21

Ayla: Yeah, the, there's a, a big kind

of a link between the limbic system

668

: 00:40:26

and our autonomic nervous system.

669

: 00:40:28

And when people, maybe do feel very

unsafe in their own body because of

670

: 00:40:34

a, a history of past trauma that can

keep them in kind of a dysautonomia

671

: 00:40:39

state because of that integration of

the limbic system into the autonomics.

672

: 00:40:44

And so people's emotions and feelings

and, and history of, of trauma can play

673

: 00:40:51

a huge role in, in dysautonomia patterns.

674

: 00:40:55

And yet, yeah, a lot of times.

675

: 00:40:57

That's not how medicine

always looks at it.

676

: 00:40:59

They just kinda look at, oh, here's

this, here's this very stressed out

677

: 00:41:02

hypochondriac who has, you know,

a list of 40 different complaints.

678

: 00:41:07

And it's like, well, when you look

at those 40 different complaints,

679

: 00:41:10

probably 35 of them are related

to autonomic functions, you know?

680

: 00:41:14

Mm-hmm.

681

: 00:41:15

And so a lot of times I think people can

get gaslit into thinking that, there's

682

: 00:41:20

really nothing wrong with them, and

they're just making it up and they're

683

: 00:41:22

confused and then they lose hope.

684

: 00:41:24

And so I think that my goal with writing

my book was really to give people hope.

685

: 00:41:30

You know, my book was written

for the people who have, you

686

: 00:41:34

know, probably already seen a

number of different doctors.

687

: 00:41:36

They've been dealing with these

lingering symptoms for a long time.

688

: 00:41:40

They've probably tried a lot of

medications, and I'm not anti-medication,

689

: 00:41:45

but there are no FDA approved

drugs for post-concussion syndrome.

690

: 00:41:50

And so every single drug

that is being prescribed.

691

: 00:41:54

Is symptom management.

692

: 00:41:56

And so I'm not being anti-medicine, I'm

just saying this is what, that we don't

693

: 00:42:01

have a post-concussion syndrome drug yet.

694

: 00:42:03

Mm-hmm.

695

: 00:42:05

And all of the pharmaceuticals are,

are more treating a symptom, whether

696

: 00:42:09

it's a headache or nausea or anxiety.

697

: 00:42:12

And in some cases that works.

698

: 00:42:14

But when that doesn't work, my book was

written for the people who are like,

699

: 00:42:18

I feel like I've run out of options.

700

: 00:42:20

Like what else is out there?

701

: 00:42:21

mm-hmm.

702

: 00:42:23

And that kind of brings us to the whole

topic of, you know, neuromodulation.

703

: 00:42:27

And, in some cases acupuncture can be

a very gentle tool for modulating the

704

: 00:42:33

autonomic nervous system and, helping

to promote more parasympathetic tone.

705

: 00:42:38

If you look at the research over the last

20 years, the systematic reviews that

706

: 00:42:43

have done that work have really said yes.

707

: 00:42:46

The totality of acupuncture

research shows that it can shift

708

: 00:42:50

people from a sympathetic state

into a parasympathetic state.

709

: 00:42:54

Mm-hmm.

710

: 00:42:56

That's where I think

also frequency matters.

711

: 00:42:59

and what else is somebody also doing

to help kind of with stress management?

712

: 00:43:04

And I often refer people out

for EMDR and counseling and, and

713

: 00:43:09

all these other therapies that,

that address all of this stuff.

714

: 00:43:13

So it's like mm-hmm.

715

: 00:43:14

Acupuncture is just one tool and it's, it

can be very effective for certain things,

716

: 00:43:20

but I, I always look at it as really just

one tool amongst many that exist and often

717

: 00:43:26

we have to have a, a multidisciplinary

approach to, to helping people.

718

: 00:43:31

MIke: Yeah, no, thanks very much for that.

719

: 00:43:33

And I was just gonna ask about your book.

720

: 00:43:34

So, for viewers and listeners,

the concussion breakthrough, and

721

: 00:43:38

it's been called the Concussion

Bible, very comprehensive.

722

: 00:43:41

you know, very, very helpful.

723

: 00:43:42

I really encourage people to take

advantage of, of the wisdom and the

724

: 00:43:46

knowledge that's, that's in there.

725

: 00:43:48

And I think, yeah, I appreciate you

explaining that, you know, these are

726

: 00:43:51

the intended, readers and, and, and

how you're intending to help them.

727

: 00:43:55

What, what would be some, perhaps maybe

some major misconceptions that you're

728

: 00:43:59

trying to correct in the book and,

and, and what would you rather than,

729

: 00:44:03

you know, be hoping that people take

away from the book in, in a nutshell?

730

: 00:44:08

Ayla: Yeah.

731

: 00:44:09

I kind of see it as a bit of a choose

your own adventure in, I think.

732

: 00:44:14

Somebody.

733

: 00:44:15

so in chapter one, people can take a

ques, like a symptom questionnaire,

734

: 00:44:20

and I've divided the book into kind of

symptom categories, but it's a bit of

735

: 00:44:25

a trick because somebody might say, if

they have post-traumatic headaches, they

736

: 00:44:29

might read the chapter on post-traumatic

headaches and realize, oh, well maybe my

737

: 00:44:34

neck injury is partly part of the problem,

so now I have to read chapter two.

738

: 00:44:38

Or maybe there's something wrong

with my, my eye movements and I

739

: 00:44:42

have an undiagnosed eye movement

disorder that's driving my headaches.

740

: 00:44:45

Now I have to go read that chapter.

741

: 00:44:47

So it's a bit of a choose your own

adventure, where I hope that as

742

: 00:44:51

people kind of take the survey.

743

: 00:44:53

And if whatever category they're scoring

highest in, they can go read that chapter.

744

: 00:44:59

But very likely they're gonna learn all

of these different associations between,

745

: 00:45:04

well, maybe my eyes are problematic

because I have some vestibular imbAylance

746

: 00:45:08

that's driving my eyes to have nystagmus.

747

: 00:45:11

Or maybe this is partly why I am

dealing with that, or maybe my

748

: 00:45:14

autonomic dysfunction is what's causing

some of these cognitive symptoms.

749

: 00:45:18

And so my hope with the book is people

start to have a much broader picture

750

: 00:45:24

of what they're dealing with and

what all of these different factors

751

: 00:45:28

are that maybe haven't been fully

addressed yet to give them a new path

752

: 00:45:33

forward if they're feeling stuck.

753

: 00:45:35

And I think that's my, my,

that was my number one goal

754

: 00:45:38

was whoever's feeling stuck.

755

: 00:45:41

If they read this book, I, I imagine

that they're gonna find something that

756

: 00:45:46

they can look further into to help them

take that next step on their journey.

757

: 00:45:51

MIke: That's fantastic.

758

: 00:45:52

That's so amazing and so inspiring.

759

: 00:45:55

thanks so much for writing the book.

760

: 00:45:56

I'm sure that you have helped and

you're gonna continue to help many,

761

: 00:45:59

many people through your clinical

work, through, through the wisdom

762

: 00:46:03

and the knowledge in your book.

763

: 00:46:04

So thanks so much for that.

764

: 00:46:05

Dr.

765

: 00:46:06

Wolf.

766

: 00:46:06

This has been a fascinating conversation.

767

: 00:46:08

what really stands out to me from our

discussion is that concussion recovery is

768

: 00:46:13

certainly far more complex than that kind

of legacy, traditional rest and weight

769

: 00:46:18

model that many people might think about.

770

: 00:46:20

Um.

771

: 00:46:21

Yeah, just, it's so inspiring.

772

: 00:46:23

I mean, your work really highlights

to me how the brain is such

773

: 00:46:25

an incredibly dynamic system.

774

: 00:46:27

You know, one that can heal

when we understand how, you

775

: 00:46:31

know, people are individuals.

776

: 00:46:32

We all have our individual story,

and how that individual story

777

: 00:46:36

needs to be integrated into a

comprehensive rehabilitation plan.

778

: 00:46:40

And, you know, one that supports

things like you've mentioned,

779

: 00:46:43

neuroplasticity, circulation, autonomic

regulation, brain network functioning.

780

: 00:46:49

So thanks again.

781

: 00:46:51

And so, again, for viewers and

listeners who want to learn more

782

: 00:46:53

about your work, we're gonna put

links in the show notes, where you

783

: 00:46:57

can find out how to, get access to Dr.

784

: 00:47:00

Wolf's book, her podcast as well.

785

: 00:47:02

So again, the book is The

Concussion Breakthrough.

786

: 00:47:05

Discover The Missing Pieces to Recovery.

787

: 00:47:07

And Dr.

788

: 00:47:08

Wolf's podcast is Life After Impact,

the Concussion Recovery Podcast.

789

: 00:47:13

Dr.

790

: 00:47:14

Wolf, thank you so much

for joining me today.

791

: 00:47:16

thanks everyone for listening.

792

: 00:47:18

yeah, thanks Dr.

793

: 00:47:19

Wolf.

794

: 00:47:19

Just really, really appreciate

your time and your wisdom and,

795

: 00:47:22

such an inspiring message.

796

: 00:47:23

So thank you.

797

: 00:47:24

Ayla: Thank you for having me.

798

: 00:47:26

I, this is again, my, my favorite topic

to share information on because it is

799

: 00:47:30

so complex and I just hope I can, like I

said, give people kind of one new insight

800

: 00:47:35

that they can take with them and, and

help them on their recovery journey.

801

: 00:47:38

So thanks for that opportunity.

802

: 00:47:41

MIke: Awesome.

803

: 00:47:42

Yeah.

804

: 00:47:42

Thank you so much.

805

: 00:47:43

And so, for viewers and listeners, if

you have enjoyed this episode, please

806

: 00:47:46

like, and subscribe, share the episode

with friends, family members, colleagues,

807

: 00:47:50

anyone you think that might benefit.

808

: 00:47:52

feel free to leave comments, or

review, helps others discover

809

: 00:47:55

these important conversations

about the future of brain Health.

810

: 00:47:59

And until next time, we'll see you,

again on the Neurostimulation Podcast.

811

: 00:48:03

Take care, stay curious and be well.

812

: 00:48:05

Thanks so much.