Episode 16

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Published on:

5th Apr 2025

Kelly Tuttle - #16 - Apr 5, 2025

Overcoming Traumatic Brain Injury: Insights and Strategies with Kelly Tuttle

In this episode of the Neurostimulation podcast, host Michael sits down with Kelly Tuttle, an expert in traumatic brain injury (TBI) and author of 'After the Crash'. Kelly shares her personal journey through TBI, the challenges she faced, and the strategies that helped her heal. She provides valuable insights into symptoms like neuro fatigue, light and sound sensitivity, and the importance of holistic care involving sleep, nutrition, and mindfulness. Kelly also emphasizes the significance of journaling for symptom management and offers practical advice on how patients can advocate for their own recovery. Tune in to learn about her five pillars of recovery and hear inspiring messages of hope and resilience for anyone suffering from TBI.

00:00 Introduction and Guest Welcome

00:59 Kelly's Traumatic Brain Injury Journey

03:28 Challenges and Symptoms Post-Injury

04:36 Path to Recovery and New Career

05:29 Writing the Book: After the Crash

10:06 Strategies for Healing and Coping

13:11 The Importance of Sleep and Other Pillars of Recovery

15:27 Invisible Injuries and Social Impacts

19:53 Managing Specific TBI Symptoms

27:04 Holistic Approach to TBI Recovery

27:19 The Puzzle of Healing: Integrating Specialists

28:05 The Power of Journaling and Symptom Tracking

28:39 Stressless Medical Sheet: A Gift for Listeners

30:04 Maximizing Doctor Visits with Preparedness

31:47 Messages of Hope and Encouragement

34:14 The Role of Creativity in Healing

38:46 Managing Pain and Lifestyle Factors

42:36 The Importance of Sleep and Mental Health

44:06 Behavioral Aspects and Therapy

45:06 Where to Find More About Kelly Tuttle

Transcript
Mike:

Welcome back to the Neurostimulation podcast.

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I'm really excited today to have

a conversation with Kelly Tuttle.

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Kelly is an expert in traumatic

brain injury, and she's written a

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book called After the Crash that

chronicles her own journey and her

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expertise in this very important area.

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So Kelly, I wanted to

welcome you to the podcast.

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I really appreciate you being

here, and I'm looking forward

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to the conversation today.

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Kelly: Michael, I'm excited to be here

and to get to speak to your listeners.

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This is really great.

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Thank you.

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Mike: Thanks again.

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So I was curious, can you share with us

some aspects of your personal journey

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with traumatic brain injury and how that

has both impacted you, but also inspired

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you to write a book and to help others?

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Kelly: Sure.

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So my story begins with a thunderous

clap of crunchy metal and shattering

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of glass, the deployment of airbags.

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I was in a car accident, a car

had pulled out in front of me

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suddenly, and I t-boned them.

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And even though my engine was smoking

and my car was totaled, I thought

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I'd be able to shake it off the

car crash and go on with my life.

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And in fact, I actually went to work

the next day and since I was a nurse

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practitioner, I work with nurse

practitioners and nurses and they quickly

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picked up on changes in my behavior

and my speech, and encouraged me to

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see my primary provided the next day.

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Which I did.

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And I was diagnosed with a

concussion and taking off work

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for a couple weeks and felt like I

should be better in a couple weeks.

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And then three months later, I,

my symptoms are getting worse.

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I actually end up falling asleep at

the wheel on the way home from work

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and, doing so I mentioned that to

a colleague of mine who at the time

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was a neurology nurse practitioner.

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I was a cardiology nurse practitioner,

and she was curious to see how

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I was doing with my concussion.

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And I mentioned falling asleep at

the wheel, and she said that's not I.

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A good thing.

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And I she said I should see

a physical medicine and rehab

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doctor and get a brain scan.

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So I hadn't had any of that.

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I hadn't had a brain scan very

little follow up from my general

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practitioner and had not even had

a referral to a neurologist or the

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physiatrist, which is the PMR doctor.

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And once I saw the physical medicine

rehab doctor, she knew right away

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that I had a serious brain injury,

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Mike: a

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Kelly: mild concussion isn't really mild.

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And she sent me on the

right rotary recovery.

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And then I finally started, she took

me also off work for three months.

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And then I started on the right

rotary recovery and seeing the

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right specialist and getting better.

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Mike: Yeah, that's good for you

for overcoming that challenge.

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It must have been, I can imagine

particularly, in the first number of

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weeks and months even, that there were a

lot of questions, a lot of uncertainty,

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that, you were probably faced with.

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Is that true?

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Kelly: Yes.

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I didn't realize a lot of the symptoms

that I was having, for instance falling,

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feeling drowsy while I was driving.

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I didn't know that driving is

highly cognitively draining.

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I stopped being able to listen to music

because I had sound sensitivity and I had

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started, getting really bad headaches and

it was because of light sensitivity being

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under the fluorescent lights at work.

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So it was really it was really difficult

in the beginning 'cause I didn't know what

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was wrong and then I was sleeping so much.

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And the other thing too was I was a

martial artist prior to the car accident

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and I used to be able to train for two

hours at night after a full day of work.

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And when I started to go back to

practicing, I found I would get

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winded and exhausted and have a

pounding headache after two minutes.

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That was very bizarre.

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And with being on the road to

recovery and having a fantastic speech

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therapist and neuro therapist and

seeing a behavioral neurologist and

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a behavioral optometrist, I learned

different aspects of the brain and my

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fascination with the brain and getting.

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Better led to me becoming very

passionate about neuroscience.

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And a friend of mine when I was telling

her this, said, Hey, you should go

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and be a neurology nurse practitioner.

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You'd be really good provider.

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And I said, oh my gosh,

that's a really great idea.

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So I did everything I could the next

two years to qualify for a position.

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And I did get a position and when

I was sitting there taking care of

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those patients, I realized they were

also struggling with the same things.

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I struggled with.

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And so you asked me like,

why did I write the book?

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After that three months of being off

from work, I was, two weeks before

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going back to work, I was freaking out.

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I was like, how am I gonna support

my brain when I go back to work?

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I don't even know what to do.

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And, it was hard for me to find strategies

and compensatory tools because they were

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like in various books and on websites.

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And I still had a significant amount

of cognitive fatigue, difficulty

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with memory after reading something.

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So that endeavor was really hard

and it was very anxiety provoking.

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And so when I wrote my book, I didn't

want someone to go through that.

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I wanted them to be able to look in

one spot, find some easy to apply

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strategies and use the compensatory

tools I used to help me continue

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to work while my brain healed.

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Mike: Yeah.

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No, that's fantastic.

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No, I think that it it

makes a lot of sense.

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It's really interesting to hear you

talk about how there were those.

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Seemingly subtle things, but that

turned out to be very impactful

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in terms of functioning like you

say, the degree to which something

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like driving is cognitively taxing.

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There's so many things it strikes

me that we do during the day

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that we take for granted from a

cognitive performance perspective

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because it seems almost automatic.

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And then as you say, if something comes

along that complicates that somewhat,

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it's pretty amazing how quickly

things can become much more difficult

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because of the need to focus in more

intentionally on something and the degree

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to which we then become more aware of

how tiring something ends up being.

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Kelly: Exactly.

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Exactly.

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And so sometimes like I'll explain to

my patients the neuro fatigue, what

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happens is that if you have a brand

new car, it has great mileage, takes

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very little gas to get from A to B,

but if you have an older car, the tires

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are a little bit flat, the hoses are a

little bit dried out and cracked, it's

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gonna take more gas to get from A to B.

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And that's, you still can get from A to

B, but it's gonna be a little bit harder.

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And so there needs to be that support

if you are having issues with cognitive

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fatigue to get you from A to B, but

also the an understanding that you

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may feel slow, you may feel stupid,

but that's not necessarily true.

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You're still smart.

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You just have to do things

a little differently.

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I.

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Mike: Yeah, I'm sure it's very valuable

for your patients to, and for you as

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well in terms of being able to relate

to one another and to have the ability

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based on your own experience to really

empathize with what patients are going

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through and to coach them in that way.

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That's very personal.

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Kelly: Yeah.

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I really felt like I was a, I was this

ambassador bridging that gap between

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the patient and healthcare because they

had the symptoms, but had difficulty

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articulating what the symptoms were

in ways that a healthcare provider

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would understand to attach that to a

specific test or specialty or referral.

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And they really did appreciate me being

able to articulate for them on, they would

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say my husband tries to talk to me and

I am having a hard time with my hearing.

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I can't hear.

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And I'll say is the TV on?

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Are you in the kitchen?

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Are the people moving around you?

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And they would say, yes.

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And I said you have, you may be having

what's called is hearing overload.

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And that's when you're, he, you no longer

have the ability your brain no longer

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has the ability to differentiate sounds.

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And so every sound it

gives 100% attention to.

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Whereas someone who has a healthy

brain, they can go, the TV's not

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important to listen to this person

is now I'm gonna focus my, the

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listening on this person talking.

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And then just explaining that

and saying, Hey, when you have

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a conversation with someone.

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It's not that you can't hear, it's

because you're not able to focus on the

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sound you're supposed to be hearing.

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So cut back those sounds.

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Mike: Yeah.

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And you

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Kelly: could do that by turning

off the TV or even implementing

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technology such as active noise

counseling, earbuds or headphones.

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Mike: Yeah, that's a really great idea.

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I really appreciate the metaphors that

you've used, such as the car metaphor.

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We'll often use that in work with

elderly people in terms of this

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notion of decreased cognitive reserve

that happens later in life that

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cause similar kinds of challenges.

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And and also, that's a great.

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Tip that you've just mentioned

in terms of using technology like

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the noise canceling headphones.

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I'm curious to know I'm sure it's well

detailed in your book, but do you mind

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sharing with us some other kinds of

strategies that helped you with your

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own healing journey and that you often

will coach patients in terms of using

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those strategies as well for themselves?

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Kelly: The number one thing I'd like to

see people do immediately is journal.

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Because the journal is going to help

you in several ways, several aspects.

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It's gonna help you hone down to

where your symptoms are coming from.

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And then once you know the

symptoms, then you can figure out

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what's making the symptoms worse.

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Then once you know that, then you can

apply a strategy and see if that works,

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journal, if it does, or if it doesn't.

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And then the journal also allows you

to see how far you've come in your

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recovery, because sometimes if the re,

if your recovery is prolonged, you know

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you're going on two years plus it gets

very frustrating, depressing, and sad.

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But if you can look back in your journal

and see how far you've come, then you

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can definitely pat yourself on the back.

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And then the journal is a great way

to process emotions because emotional

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modulation can be difficult after

a head injury or brain injury.

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And you can process them in your

journal and if you're not able

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to get past 'em cope with them,

then you can reach out to friends,

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your support group a psychologist,

a counselor, get talk therapy.

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And then the other thing about the

journal is it allows for practicing

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of mindfulness and gratitude.

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And both of those two things have been

found to be very helpful in the healing

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of the brain and, that's one of the

things, when you've had a brain injury,

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you do tend to get locked in your brain.

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And when you're locked in your brain,

you're sitting there with, the bullies,

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telling you negative thoughts and your

remini about this or that, and the journal

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helps you get out of that so that you

can see where you're at, be more present

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in the moment, and be grateful for the

things that are occurring now, rather than

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reminiscing about, oh, that car accident

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Mike: and

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Kelly: I can't do this now

and those kinds of things.

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Really the biggest tool is the

journaling that I would say.

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Mike: Yeah, that makes a lot of sense

because I can imagine that, for a

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number of reasons, the emotional toll

of this kind of journey is really, ends

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up being a big part of what ends up.

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Creating obstacles to overcome in terms

of healing, not only because of the stress

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of the disability and the symptoms, but

also because the actual organ that's

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been affected is where the emotions are

processed, presumably and experienced.

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So then it ends up becoming

all tied up together.

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And yeah, it makes a lot of sense

that with what you've described, those

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practices in terms of helping with the

emotional processing is really critical.

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And I can totally understand why

that would be an important part of

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your recommendation for patients.

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For sure.

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Yeah.

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Kelly: Yeah.

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And then the other I have the five pillars

to your recovery and one of them is sleep.

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I heard in your last podcast you guys

talked about the importance of sleep.

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That was great.

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When you go to sleep, a lot of people

think the brain is not doing anything,

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but it's actually doing tremendous

amount of work for your brain health.

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It's cleaning out toxins and waste

and it's modulating those emotions.

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So when you hear that saying, oh,

let's just sleep on it, it's true.

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If you sleep on it, your brain processes

your stress and then softens the edges so

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you can cope with it better the next day.

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Yeah.

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And then, while you're sleeping,

your hippocampus which is your memory

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center that gathers all the new stuff

you've learned in your memories from

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the day downloads those memories into

the cortex while you're sleeping.

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If you are short on sleep, I.

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You short that ability to,

that process of happening.

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And so your memory won't be so good

unless you're getting that seven

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to nine hours of recommended sleep.

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And let's see, I talked about the emotions

and all that stuff, but, so anyway,

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going back to the five pillar, sorry I'm

very big promo prop, proponent of sleep.

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So sleep exercise the mindfulness

that we talked about and nutrition.

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And then the fifth one

is financial wellness.

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Because having a concussion or

whenever you have an, a chronic

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illness or a big injury, it can

impact your ability to make, to go

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to work and continue your income.

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I do talk about strategies on how to

protect your finances while you're

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healing and maybe away from work.

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Mike: Yeah, no, I can imagine how I really

appreciate that you commented on that last

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part because it's not something that many

people will incorporate into therapeutic

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program, but it's really important and I

think it makes me consider something I had

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a thought about just now, which is that

when we were talking about how, an injury

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like a TBI can really uncover things

that we might normally take for granted

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in terms of our cognitive workload from

day to day, like driving, for example.

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That seems automatic, but

when that gets interrupted, I.

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And we realize, just how taxing it can be.

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I think another part of that is that

how does that kind of feed into the

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stigma that arises often when other

people who don't have that experience

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might put judgment on what they see as

someone who doesn't seem to have a major

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illness because it's on the inside.

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Kind of like mental illness in general,

and so I think it would be, so with

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the financial piece then I can imagine

that there are these kinds of dynamics

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that would come up with employers

and perhaps insurance adjusters.

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And so all of that ends up, leading

to most likely risks for a lot of

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complications in terms of someone's

occupational wellness and their social

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wellness with relationships perhaps being

strained because say a significant other

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is feeling as though maybe someone's not

trying hard enough or something like that.

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I.

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Kelly: And it, you're right.

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You hit it on the nail.

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It is an invisible injury and if you

haven't been through it, you, it's very

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hard to wrap your own brain around it.

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And I do have these kind of discussions

with my caregivers and their

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frustrations, and I explain the reason

why they're not motivated is because

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that's a higher executive function.

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Takes a lot of energy to power

and your care, your loved

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one doesn't have that energy.

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And so it needs to be broken up.

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And I give strategies, how does

kickstart it and sustain it.

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But.

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I also say that if they are

there, there's gonna be some with

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some individuals, irritability,

grumpiness, and even bursts of anger.

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And I explained to my caregivers when

that happens, you have to remember that

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isn't the person that is doing that.

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They still love you and they

appreciate all you're doing.

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Their brain is the one that's saying

those things and doing those things

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because it's tired, it's overwhelmed,

it's overstimulated, and it needs a break.

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So if you can balance when you start

seeing those symptoms occur and then

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take them away from whatever is causing

the overstimulation of the brain,

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then you can minimize the effects.

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Maybe just have a grumpy husband

and not one having an angry outburst

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that they're not un control of.

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Mike: Yeah, that makes And

that, I'm sorry, go ahead.

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Yeah.

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Kelly: Oh, I was gonna say that.

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And then that spills into the employment.

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So the individual will be told by

the doctor, Hey, you're better.

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You can go back to work.

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And they go back to work, but they're

not aware, Hey that my job's cognitively

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of demanding, I'm a knowledge worker.

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I and I'm unable to sustain that type

of demand for the full eight hours.

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And so they go back to work.

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They try to be the same

worker they were before.

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Highly proficient and enthusiastic.

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And they end up getting

grumpy and irritable.

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Maybe they snap at someone

and then this can escalate.

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Everyone in the office is

like, Hey, Joe's kinda grumpy.

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What's wrong with him?

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And then you could find yourself

in HR and be terminated.

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But if we could send these people back

to work with the tools and strategies

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that they need to help prevent these

behavioral issues then they'll be able

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to keep working as a brain heal and

and then stay in healthy in society.

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Keep your job, you keep your

relationships, you keep your home.

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Mike: Yeah.

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That's, yeah, that, that makes sense.

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I guess it also makes me think again

about that, how that whole dynamic

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with the emotional toll ends up being.

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Really relevant factor in terms

of the recovery and how things may

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or may not be going so well in the

broader kind of social environment

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and particularly with work.

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'cause I think these dynamics

can be very subtle but also

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very kind of self-reinforcing.

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Because I guess the more that someone's

struggling in fulfilling their role where

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they previously were high functioning

and feeling as though things were

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going well and then now not so much and

perhaps still somewhat puzzled about

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what are the underlying reasons, I can

really see how the importance of just

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helping them and their family members to

understand and advocate for themselves

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as much as possible really, so that,

people in their circle can get a sense

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of that understanding as well, and to

not be as judgmental and to provide

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them with this space and time and space

that's necessary for that healing.

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Kelly: Exactly, yes.

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Mike: Yeah.

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Are there I'm just curious if as far

as other specific symptoms of TBI, like

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you've mentioned, the irritability.

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I guess it strikes me that there's

probably groups of symptoms, like the

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emotional symptoms and then perhaps

more of what we might call somatic

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symptoms, like actual headache.

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I'm just wondering if you could

give us a rundown of those

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symptoms and some strategies for

managing those specific symptoms.

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Kelly: Yeah.

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I think, let's see, I guess my favorite

symptom to help with I've spoken about

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a little bit is sound sensitivity.

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And and the aspect, what it is that

the brain doesn't have the energy to

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put filters to, to filter out sound.

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Sounds can sound very loud.

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To a brain injury survivor, normal

everyday sounds, the refrigerator

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popping on the fax machine, a

phone ringing a conversation.

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The conversations to me sound like

people are yelling at each other

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sometimes, especially when I'm really

tired or really trying to focus.

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And just realizing that.

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And then things that you can implement,

like what I talked about is utilization

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of active noise counseling technology.

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There are earbuds and headphones where

they'll connect to your phone on your

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app and you could actually control the

amount of the noise counseling levels.

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So if you're in a

conversation with someone.

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You can put it down to maybe three or

four, but say you're flying on an airplane

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and the air jet's really loud you can bump

it up to a 10, and that way you're not,

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you're applying external filter for your

brain and then saving the energy it would

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normally expend to power those filters.

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Mike: Okay.

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Yeah, that makes a lot

of, sorry, go ahead.

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Yeah.

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Kelly: Oh, I was gonna

say light sensitivity.

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If you're having headaches you may

be having some light sensitivity

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and the like can be from outside.

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I've had people difficulty going outside.

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They wear hats and

sunglasses to cope with that.

360

:

It's been helpful.

361

:

But in your normal office work

environment, they utilize fluorescent

362

:

lighting to light buildings and offices,

and that can be very hard on the brain

363

:

because that light's not constant.

364

:

It's flickering.

365

:

You may not see it.

366

:

Your brain perceives it as such.

367

:

And when you work with computers laptops,

tablets phones, they're sending out light.

368

:

And that the light from that is

is blue light and that can you're

369

:

sensitive to blue light that can

be irritating, exhausting to the

370

:

brain and then cause headaches.

371

:

And so with those I recommend

you could wear dark glasses.

372

:

If you're in the office, you could,

there are fluorescent light covers that

373

:

you can put over fluorescent lights.

374

:

You could ask your employer to dim the

light or just turn it off and use concent

375

:

lighting light bulbs instead, right with

a warm glow rather than a pure white.

376

:

Is helpful.

377

:

And then turn turning down lights

at home creating a, a quiet

378

:

cozier type environment at home.

379

:

So when you are at home,

you can really rest.

380

:

So that's some of the things that I

recommend for the light sensitivity.

381

:

If you're having difficulty with

reading or and again, headaches that

382

:

can read or dizziness, difficulty

maintaining a balance, you really

383

:

should have your eyes evaluated.

384

:

And of course, everyone starts off

with the optometrist and optometrists.

385

:

Make sure that your eye clarity is

good, that you see things clearly.

386

:

But if you're having double vision.

387

:

Or dizziness, you may wanna consider

getting a referral to an ophthalmologist

388

:

and they can if you have double

vision, they can prescribe prism

389

:

glasses to help correct with that.

390

:

And then there's behavioral optometrists.

391

:

Now they, look to see how well

the eyes function together.

392

:

And if you have a misalignment with

your vision, that can cause headaches.

393

:

It could cause neck pain 'cause

you're tilting your head either

394

:

way to kinda level out that vision.

395

:

It's called binocular vision dysfunction.

396

:

And if you have that, some of the

symptoms are neck pain headaches visual

397

:

difficulty decreased reading tolerance

decreased screen time tolerance.

398

:

Anxie did I say anxiety?

399

:

Yeah, I think I said anxiety.

400

:

Those type of things that you

would not put with your eyes, you

401

:

wouldn't associate with your eyes.

402

:

So yeah, if you're having difficulty

with the reading and the memory and

403

:

you're feeling anxious, you have

headaches, get your eyes checked out.

404

:

Mike: Yeah, no, thanks for

summarizing all of that.

405

:

It makes perfect sense.

406

:

And I think, again, it's almost,

it comes back in some sense to what

407

:

we've been talking about the function

that our body allows us that seems

408

:

automatic and that we take for granted,

like the seeing and the hearing.

409

:

And it's not when, it's not until

things get off balance that way that

410

:

we either get sensitive to light and

or sound, that we have to think more

411

:

carefully about that and adjust how we're

interacting with the environment in order

412

:

to make it as comfortable as possible.

413

:

But I think, yeah, in particular, it

makes a lot of sense given how much we

414

:

rely on screens and technology for most

of what we're doing at work these days.

415

:

A lot of folks, in terms of just.

416

:

Recognizing, again, see, it strikes me

that the education piece is so critical

417

:

because then the more that people

understand about what they're suffering

418

:

from, the more that they're then able to

get help for it, but also advocate for

419

:

themselves and to educate others who may

not have the same degree of awareness.

420

:

Kelly: Exactly.

421

:

And that's where that journaling comes

in and pinpointing your symptoms and

422

:

then being able to better articulate it.

423

:

So say if you go to your doctor

and you say, I have dizziness.

424

:

Dizziness is non-specific symptom and

lots of things can cause dizziness.

425

:

But if you go to your doctor

and you say, I have dizziness.

426

:

Every time I scroll up and down

on my phone, I watch action movies

427

:

where things are flying by, then

the doctor's gonna go, oh, they're

428

:

having difficulty with eye tracking.

429

:

So I'm gonna send them to a neuro

therapist to help with the eye tracking.

430

:

So see how important it is to really

get down to the nitty gritty to

431

:

help your provider understand what

you're feeling, and and then send

432

:

you to the right therapist or.

433

:

Specialists to, to take

care of that symptom.

434

:

Another thing is patients will say,

I'm dizzy, and if I pinpoint it,

435

:

I'll say or they'll say they're

dizzy and their legs feel weak.

436

:

And which is like, why would

they have these symptoms?

437

:

And what they're describing

is dise equilibrium.

438

:

And that is because the connection between

the feet, the communication between the

439

:

feet and the brain have been knocked off.

440

:

Balance.

441

:

And so that's why they feel weak in

the legs, because they're just not

442

:

getting this solid co confirmation

from their muscles and stuff.

443

:

And then they're dizzy because

they're getting misfiring

444

:

of information to the brain.

445

:

If you're, if you've injured your neck

and you have whiplash and your neck

446

:

is not aligned, that's gonna make it

difficult to control your headaches

447

:

and your symptoms of dizziness Also.

448

:

It's just, it's really it's it's really

a whole, it's a generalized injury that

449

:

requires a holistic approach in care.

450

:

A lot of my patients will

say, why can't I just see one

451

:

provider just to take care of me?

452

:

And I'll say 'cause the

brain's complicated.

453

:

Yeah.

454

:

And people specialize in various issues

of the brain, and you just have to go

455

:

and see them to create the whole picture

of your healing and your recovery.

456

:

I'll often say, your speech

therapist is a piece of the puzzle.

457

:

Your physical medicine doctor

is a piece of the puzzle.

458

:

I'm a piece of your puzzle.

459

:

In neurology, your general practitioners,

the piece of puzzle, you put 'em

460

:

all together and that makes the

picture of your plan of care.

461

:

Mike: Yeah, I think that's an

important point to emphasize,

462

:

but I really appreciate that.

463

:

'cause I think, yeah, it's important

for people again, to just not be

464

:

afraid to advocate for themselves

and to request the referrals and

465

:

if necessary, the second opinions.

466

:

And just to be able to talk to people who

have the expertise to be able to recognize

467

:

the symptoms and make the diagnosis.

468

:

But as you say, it starts with just

having that inventory of the symptoms.

469

:

And I really love the idea of journaling.

470

:

I think it's a good idea in general for

when, for people who go to see their

471

:

physician for whatever reason, to have

to bring something in writing and just

472

:

have something that they can refer to.

473

:

'cause it's often hard when you

go to, I know personally you go

474

:

to see my doctor and then it's

jumbled up a little in terms of the

475

:

chronology of what's been happening.

476

:

And so to have things written down

ahead of time is a really good strategy,

477

:

especially I guess in the context of a

condition that's already causing some

478

:

difficulty with concentration and memory.

479

:

Kelly: Exactly.

480

:

In fact I brought a gift for your

listeners, if they wanna go to

481

:

my website, kelly tuttle.org.

482

:

I've created a I call it a

Stressless medical sheet.

483

:

And on that sheet is the exact

questions your doctor's gonna

484

:

need to make a diagnosis.

485

:

So it's called old car.

486

:

That's what we use in medicine.

487

:

So the on the onset the, duration of the

time that you've had it, the location of

488

:

the the pain or whatever you're bringing

in, the characteristics, what you know.

489

:

Is it a stab?

490

:

Is it a stabbing headache?

491

:

Is it a tight headache?

492

:

What makes it worse?

493

:

What makes it better?

494

:

And have you had any treatment?

495

:

Now my form will walk you

through that information.

496

:

You fill it out, you can, ans you

can tell the doctor right away.

497

:

I've had dizziness.

498

:

It's worse when I'm

under fluorescent lights.

499

:

It's better when I get good sleep.

500

:

And I'm sorry, brain fart.

501

:

Mike: That's okay.

502

:

Yeah, I know.

503

:

Kelly: And let's see here.

504

:

Okay, we'll just leave at that Is.

505

:

On the form.

506

:

It also has space for you to

write notes and when your next

507

:

any recommendations, and then when

your next follow up appointment is.

508

:

'cause you should be, have a follow

up before you, you leave the office.

509

:

Mike: Definitely.

510

:

That's awesome.

511

:

I really appreciate that.

512

:

I'm gonna use that for myself and

that's fantastic and generous of

513

:

you to make that available for

viewers and listeners, I would

514

:

encourage everyone to check that out.

515

:

Su super interesting because

I think this is where, this

516

:

is where care starts, right?

517

:

It's making sure that your

provider has the best information

518

:

possible to be able to help you

in the best way possible, right?

519

:

And so if it's disorganized

and vague, then it becomes more

520

:

challenging on the diagnostic side,

but the more details, the better.

521

:

And if it's written, it just helps

people to be able to present that

522

:

in a concise form that's gonna

be helpful for their provider.

523

:

And then, by.

524

:

By definition for themselves really.

525

:

And also just again, that point

that you make about making sure

526

:

that, other qualified, professionals

as necessary become involved.

527

:

It's super interesting to hear your

story about how, specific kinds

528

:

of clinicians, like behavioral

optometrists become involved.

529

:

I hadn't naturally heard of that

particular specialty until now, but

530

:

I can see how it's really important

in these specific areas for sure.

531

:

Kelly: Yes.

532

:

And then, and that's the, I can

speak to US medicine but here in

533

:

the US doctors and providers have

a limited time with their patients.

534

:

Some of them only 10 minutes, and it

could take you 10 minutes just to get your

535

:

vital signs done by the medical assistant.

536

:

So very little time.

537

:

And and they're under a lot of

pressure to stay on time and see many

538

:

patients in a short period of time.

539

:

So if you can come in and be concise

and have everything ready to go, you

540

:

can take advantage of that little

time and get the most out of it.

541

:

Mike: Yeah, definitely.

542

:

No, that's really helpful.

543

:

I'm curious to know, there, there may well

be people listening and watching who have

544

:

struggled with or maybe are continuing to

struggle with these kinds of challenges.

545

:

What would be some, perhaps some messages

of hope and encouragement that you might

546

:

be able to offer people who themselves

are struggling or that have loved ones

547

:

or acquaintances that they know are

struggling with these kinds of challenges?

548

:

Kelly: Everyone's recovery is

different as it's different and

549

:

unique as their personality.

550

:

And so their treatment and their

symptoms will be di different

551

:

from one person to the next.

552

:

And then the recovery doesn't.

553

:

I know like a lot of my neurology

colleagues would say you'll see the

554

:

most improvement within two years.

555

:

And then that what the patient

hears is if I'm not better in two

556

:

years, I'm never gonna get better.

557

:

And and just to realize that

you will, you can get better.

558

:

There is this new information coming

out about neuroplasticity and maybe your

559

:

brain won't be the same after your injury.

560

:

Highly.

561

:

Most likely it won't.

562

:

Because it's so delicate and the anate

processes that occur that can be knocked

563

:

offline with a stroke or a concussion.

564

:

But if you support the health

of your brain, you're gonna

565

:

support neuroplasticity, which is

rewiring around dead cells, dead

566

:

tissue, scar tissue in the brain.

567

:

And if you encourage that with

learning, being social exercising,

568

:

getting that sleep, eating a a healthy,

low fat, anti-inflammatory diet then

569

:

you're gonna encourage that process.

570

:

And over time you will see incremental

improvements as the years go by.

571

:

Mike: Yeah, no, I appreciate that.

572

:

It's probably important to give

people, or to encourage people to

573

:

give themselves the permission to

pay attention to self-care as well.

574

:

Because there's probably an inclination

for people to feel like they just

575

:

need to keep working harder or keep,

adding stress to themselves in terms

576

:

of their expectations to get where to

where they were, perhaps pre-injury.

577

:

But the self-care piece and allowing

that therapeutic space and time

578

:

strikes me as really critical.

579

:

Kelly: Exactly.

580

:

That's what I do a lot of education on the

fact that the brain and the nurse heal.

581

:

They take a lot longer to heal

and they take their own time.

582

:

So there's nothing you can

do to speed up the process.

583

:

Unlike if you sprain your ankle, you could

do your physical therapy, you can ice.

584

:

You could be really good at your

stretches, but with a brain, it's

585

:

more like you're just gonna support

optimal health and have patience.

586

:

Mike: I'm curious, what about the

role of creative pursuits, anything

587

:

that someone might be interested in,

perhaps as part of a self-care routine?

588

:

Do you think creativity has a role

and is that something that you might

589

:

suggest for patients to consider?

590

:

I.

591

:

Kelly: Oh, definitely.

592

:

And this goes this I usually

put under mindfulness.

593

:

So when before my head injury,

I did the martial arts.

594

:

And when you do a kata, you were

practicing my mindfulness because you're

595

:

thinking about the move, how your body

feels, you're really in the moment.

596

:

When I had my car crash, I lost that

practice and I had to discover it again.

597

:

And fortunately I talked to a counselor

and they recommended adult coloring.

598

:

And through adult coloring, I was

able to learn how to sit and do

599

:

my mind, my mindfulness practice.

600

:

And yes, the arts are perfect.

601

:

Listening to music is great for the brain.

602

:

Learning how to play an instrument

crafting, whether that's knitting or

603

:

creating art or even going to a museum.

604

:

And looking at the art there and

thinking about it, all of that

605

:

stuff helps the brain grow and heal.

606

:

Mike: Yeah, for sure.

607

:

I'm curious if you have, as usual for

viewers and listeners, the content here

608

:

is intended for educational purposes only

and not so much as advice for individuals.

609

:

We would encourage you to see your own

individual providers for that kind of

610

:

specific advice, but I'm just curious in

general terms as an educational piece,

611

:

if if someone's struggling with certain

symptoms or functional problems if they've

612

:

recently had some sort of a concussion

or other type of TBI, are there any

613

:

things that you might, provide them with

in terms of just information that might

614

:

help them through that difficult time?

615

:

Kelly: Yes.

616

:

So gen definitely keeping your

general practitioner in the loop

617

:

and letting them know what's going

on because as you are healing, your

618

:

symptoms can change too, right?

619

:

Yeah.

620

:

Especially if you've had an injury

to the neck or the shoulder,

621

:

that pain will cover up symptoms.

622

:

And so you really need to do a

check-in with your provider I

623

:

recommend follow up to be two weeks

after the injury, the head injury.

624

:

And then a month after that, and then

every three months after that, sorry.

625

:

Mike: Sorry, I have some background

noise outside the window here.

626

:

I don't, I apologize for the interruption.

627

:

That's, I'm gonna just mute

myself while you're talking.

628

:

Sorry.

629

:

Yeah.

630

:

Carry on.

631

:

Kelly: And then follow up every three

months and then for six months and then

632

:

every six months or a year, and then every

year after, because things can change.

633

:

And I think that answers your question.

634

:

Mike: Definitely.

635

:

Yeah, it does.

636

:

Sorry.

637

:

And I'll edit this and make

it so that it's smooth here.

638

:

So sorry about this background noise.

639

:

I'm like, it's there's a window here and

there's some, must be some construction

640

:

that's just started out there.

641

:

So sorry about that.

642

:

That's okay.

643

:

We'll just wait till it pauses

and then try and get rolling.

644

:

I can, I'm pretty good at

editing this kind of thing out

645

:

and making it appear smooth.

646

:

I'm just gonna mute myself here

for a minute until it stops.

647

:

Maybe I'll just see if I can step

out and ask them to stop in a minute.

648

:

If it doesn't stop.

649

:

Hi.

650

:

Sorry about that.

651

:

It looks like they're gonna just hold off

for a few minutes here when we finish up.

652

:

Okay.

653

:

So just trying.

654

:

Yeah, sorry about that.

655

:

We had a little interruption there, but I.

656

:

Yeah, no.

657

:

What you were just saying, Kelly was

interesting to me as well because

658

:

it reminded me of something I was

gonna ask about earlier on in our

659

:

conversation, which is the issue of pain.

660

:

We haven't really talked about that, but

as you said earlier, because it's such a

661

:

general kind of a disorder that involves

many different physiological systems,

662

:

obviously pain is a big part of that.

663

:

And so I'm just curious, what would be

some of your comments regarding, the

664

:

common experiences of pain, perhaps

beyond headaches and maybe neck pain

665

:

and also some strategies on how you

help patients to manage that pain.

666

:

Kelly: I don't, I do have some

experience managing the headache portion.

667

:

But other joint issues, I

really rely on physical therapy.

668

:

To help.

669

:

To help with it.

670

:

And then I do recommend acupuncture

for both headaches and neck issues.

671

:

And and then massage therapy too.

672

:

But the key, the, the really interesting

thing about headaches is that when you see

673

:

a headache specialist and they prescribe

medication, now they can prescribe

674

:

you with an abortive medication to get

rid of the headache such as Imitrex.

675

:

And then they can prescribe

medications that you take on the

676

:

daily called preventative medications.

677

:

To help.

678

:

And the goal of that is to lower your

headache frequency from down 30%.

679

:

That's not a lot if you're having

headaches most days of the week.

680

:

And what I have seen that is

that if you're a patient that's

681

:

not willing to do the lifestyle.

682

:

Aspect of managing of

headaches and chronic pain.

683

:

It doesn't matter what medications you

take, it's gonna, it's not gonna be great.

684

:

Yeah.

685

:

It's not gonna be what you want.

686

:

And so I'm really a big proponent

that you really need to get the

687

:

seven to nine hours of sleep.

688

:

If you have sleep apnea, you need to be

100% compliant with your CPOP machine.

689

:

You've gotta exercise in

whatever form that may be.

690

:

It could be chair yoga to

going outside and walking.

691

:

And you've got to be managing your

stress and practicing mindfulness.

692

:

And your finances, need to be healthy

too, because if you're worried about

693

:

your bills, it's gonna be really

hard to control chronic pain issues.

694

:

And then nutrition, you really wanna

be like on a anti-inflammatory ed.

695

:

Diet.

696

:

So you wanna be avoiding things

that have preservatives in them.

697

:

Yeah.

698

:

Dairy products are highly inflammatory.

699

:

And so you really wanna just eat closer to

the ground to get that the nutrition more

700

:

of a trench and nutritionally di dense.

701

:

Diet.

702

:

Rather than something that is like

potato chips, it is low on the nu

703

:

nutritional value as compared to

the potato having a baked potato.

704

:

And so I often tell my patients

it's best to eat the orange rather

705

:

than drink the orange juice.

706

:

The farther away from the factory you get

and the closer to the ground the better.

707

:

And that can also, that's also

very helpful with pain control.

708

:

Yeah.

709

:

So really staying away from processed

foods, really staying away from

710

:

anything that's in the package.

711

:

If you can just eat it fresh and, and

that's not always easy, especially

712

:

if you are trying to work and you

only have so much energy, just do

713

:

the best you, the best that you can.

714

:

Mike: Yeah, definitely.

715

:

Try to, at the grocery store, try to

stick to the perimeter as much as possible

716

:

and not so much to the middle halls.

717

:

Yes.

718

:

Or corridors.

719

:

Yeah, exactly.

720

:

Yeah, no, I love that educational piece

around lifestyle factors for management

721

:

of pain, chronic pain in particular.

722

:

'cause I think there are a lot of

potential pitfalls when it comes to

723

:

prescription medication for pain.

724

:

And we wanna just try and help people to

avoid getting, dependent on medications

725

:

for pain after any kind of injury.

726

:

But particularly TBI for sure.

727

:

Kelly: Exactly.

728

:

And if you're not sleeping well to to

seek care from your general practitioner

729

:

to help you with that sleep, let

them know you're not sleeping well.

730

:

I if, if your sleep is being disrupted

by neck pain or back pain or you just,

731

:

have fragmented sleep or you wake up

in the middle of the night and you're

732

:

unable to go to sleep for two or three

hours, they can help you with that.

733

:

And then if they get to a point

where they're, it doesn't,

734

:

what they're recommending isn't

helping ask to see a psychiatrist.

735

:

Because people don't realize that

psychiatrists are great at med

736

:

management and sleep management.

737

:

So those are the people you want

to see when you need medication

738

:

management for mental health.

739

:

If you've got a tricky anxiety or

depression mix, it's difficult to control.

740

:

Or if you're having difficulty.

741

:

Difficulty with sleep, that is

a referral you wanna ask for.

742

:

Mike: Yeah, definitely.

743

:

I would echo that recommendation

as a psychiatrist.

744

:

I know a lot of colleagues who have

who, who look after people who've

745

:

had traumatic brain injuries,

and you're absolutely right.

746

:

I think because of that overlap with

the emotional piece and the cognitive

747

:

piece that we've been talking about, it

really does make sense to, if necessary,

748

:

to have a psychiatrist involved.

749

:

So definitely agree with that one.

750

:

That's, oh, yeah.

751

:

And the behavioral

752

:

Kelly: aspect too.

753

:

Mike: Therapy wise.

754

:

Yeah.

755

:

Kelly: Yeah.

756

:

Yeah.

757

:

The psychiatrists are that's

who I send my patients to,

758

:

who had difficulty with sleep.

759

:

The mood or the behavior.

760

:

Very helpful.

761

:

I love you guys

762

:

Mike: yeah.

763

:

Yeah.

764

:

Let's just, we're running a bit short

on time, but I'm curious, just maybe

765

:

if you don't mind just expanding on

a little bit on that behavioral piece

766

:

in terms of the relevance there.

767

:

And not only perhaps in the sense of

problematic repercussions of A TBI,

768

:

but also on the therapeutic side.

769

:

Kelly: So you can have, so what I've seen

in my own practice is a bursts of anger.

770

:

Arguing.

771

:

Arguing so they get stuck in

this loop of arguing, this is

772

:

why I wanna do it motivation.

773

:

So maybe not wanting to get up

in the morning to take a shower.

774

:

These things are exhausting

for these people.

775

:

And or just to help out

around the house that.

776

:

Can be helped with a psychiatrist if it

needs to be treated with medication as

777

:

but also counseling family and counseling

to help with other non-pharmaceutical

778

:

recommendations and therapies.

779

:

Mike: Yeah, for sure.

780

:

It makes sense.

781

:

It makes sense.

782

:

So that's an important part

of the overall treatment plan.

783

:

That's great, Kelly.

784

:

Thanks so much.

785

:

I'm curious where can viewers

and listeners find more about

786

:

your content or your practice if

they're interested in connecting

787

:

and learning more about your work?

788

:

Kelly: You can go to kelly tuttle.org.

789

:

That's my website.

790

:

You can find my book.

791

:

I have an online program.

792

:

I'll be publishing soon.

793

:

I have a YouTube channel myself.

794

:

It's Brain Loving Advocate.

795

:

Kelly Tu Kelly Tuttle, brain

Loving Advocate, Kelly Tuttle.

796

:

And I'm also on Instagram Facebook for

kind of just short spurts of information.

797

:

The best place to go is to my YouTube

if you want more of my content.

798

:

And my book is also on Audible, if

you're having a hard time reading.

799

:

And yeah.

800

:

Oh, and I have a Substack, so if you go

to my website, then I'm gonna be creating

801

:

more content through Substack too.

802

:

Mike: That's awesome.

803

:

That's great.

804

:

It's great that you have

the audio book available.

805

:

I'm a big fan of Audible.

806

:

I think it's a great way to access

books and so yeah, really encourage

807

:

viewers and listeners to check

out all of what you have to offer.

808

:

It's so great and we will put

links to all of that, what you just

809

:

mentioned Kelly, we'll, for viewers

and listeners, we're gonna put links

810

:

to all of that in the show notes.

811

:

So I would really encourage you

to check out Kelly's content.

812

:

And again, Kelly, thank you so much for

spending your valuable time with us today.

813

:

Really appreciate your expertise and

you sharing your personal journey.

814

:

And I'm just so impressed with

how you've translated that.

815

:

It's really inspiring how you've

translated that into all of this

816

:

productivity and this content and

how you're, you retrained and you're

817

:

helping out your patients now who have

had similar challenges just to really

818

:

help them to have the best health and

wellness possible, even though they've

819

:

had these significant challenges.

820

:

So thanks very much.

821

:

Kelly: Thank you for having me.

822

:

It's been a great conversation.

823

:

Mike: Super.

824

:

Okay, take care.

825

:

Thanks again.

826

:

Bye for now.

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About the Podcast

The Neurostimulation Podcast
Welcome to The Neurostimulation Podcast, your go-to source for the latest in clinical neurostimulation! Here, we dive deep into the revolutionary techniques that are shaping the future of health care.

Whether you're a healthcare professional, a student, or simply passionate about neuroscience, this podcast will keep you informed, inspired, and connected with the evolving world of neurostimulation.

Subscribe for episodes that stimulate your mind and enhance your understanding of brain health and treatment.

About your host

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Michael Passmore

Dr. Michael Passmore is a psychiatrist based in Vancouver, BC, with expertise in neurostimulation therapies. Having completed specialized training in multiple neurostimulation modalities, including electroconvulsive therapy at Duke University and transcranial magnetic stimulation at Harvard University, Dr. Passmore brings a robust clinical and academic background to his practice. Formerly the head of the neurostimulation program in the department of Psychiatry at Providence Health Care, Dr. Passmore now serves as a clinical associate professor at the University of British Columbia’s Department of Psychiatry. From his clinic, ZipStim Neurostimulation (zipstim.com), Dr. Passmore offers private, physician-supervised, home-based transcranial direct current stimulation (tDCS) treatments tailored to clients across Canada.​