Latest / Broken Brains with Bruce Parkman / Brigadier General (Ret.) Kathleen Flarity on TBI, PTSD & Brain Trauma Recovery

Transcript

Brigadier General (Ret.) Kathleen Flarity on TBI, PTSD & Brain Trauma Recovery · Broken Brains with Bruce Parkman

• 0:06
  Speaker 1: Howdy folks, welcome to another edition of Broken Brains with your host, bruce Parkman, sponsored by the Mack Parkman Foundation, where we look at the issues of repetitive brain trauma in the forms of repetitive impacts from contact sports and repetitive blast exposure from our combat veterans, and what these conditions are doing to the brains of our athletes, kids, and repetitive blast exposure from our combat veterans and what these conditions are doing to the brains of our athletes, kids and our soldiers, and the corresponding epidemic of mental illness that goes untouched in this country and untrained, resulting in large amounts of mistreatment, misdiagnosis, and is arguably the largest preventable cause of mental illness that we have right now in this country.
• 0:44
  Speaker 1: So we reach out to researchers and athletes and doctors and all kinds of folks from this walk of life in order to inform you on the issues of repetitive brain trauma and why you must protect yourself and others, because this is not taught and we're just becoming aware of this in the military as well as in the civilian society.
• 1:02
  Speaker 1: So let's move on in the military as well as in the civilian societies.
• 1:06
  Speaker 1: So let's move on.
• 1:06
  Speaker 1: Today we've got another great guest.
• 1:08
  Speaker 1: It's Brigadier General Kathleen Flaherty, who has a whole bunch of DNP, phd, but I understand USAF United States Air Force staffed her name and she's the Executive Director of the Marcus Institute for Brain Health and the Co-Founder and Deputy Director of the CU Center for Combat Research, the Director of Combat Research Scholar and Fellow Program and Associate Professor of Emergency Medicine.
• 1:32
  Speaker 1: She is an experienced researcher, nurse practitioner and emergency and critical flight care nurse with over 41 years of military service, from Army combat medic all the way up to Air Force general.
• 1:44
  Speaker 1: Her service includes multiple deployments and commands, most recently serving as the mobilization assistant to the command surgeon Air Mobility Command at Scott Air Force Base, illinois.
• 1:54
  Speaker 1: She's published 16 book chapters and no less than 38 journal articles, including 20 peer-reviewed research manuscripts, and has delivered hundreds of national, internationally invited lectures or keynote addresses.
• 2:07
  Speaker 1: We're going to have to talk about our summit coming up in September.
• 2:09
  Speaker 1: Dr Flaherty's passion for treatment and research, interest in PTSD, tbi and resiliency for our nation's heroes.
• 2:18
  Speaker 1: She's provided her resiliency intervention grounded in positive psychology, neuroscience, cognitive psychology and human performance science to over 30,000 military and civilian heroes.
• 2:28
  Speaker 1: General, welcome to the show and thank you for the time that you're taking to be here, ma'am.
• 2:33
  Speaker 2: Thank you so much, Bruce.
• 2:34
  Speaker 2: I'm honored to be here.
• 2:36
  Speaker 1: Ah, no, man, Honor's all ours.
• 2:38
  Speaker 1: Man, we love brain people here.
• 2:40
  Speaker 1: Man, we got so much to talk about, so how did you get in?
• 2:44
  Speaker 1: So tell us about the current position that you're in right now.
• 2:47
  Speaker 1: What is the Marcus Institute?
• 2:50
  Speaker 2: So the CU Anschutz Marcus Institute for Brain Health it's here on the CU Medical Campus in Aurora, denver was founded in 2017 by Dr Jim Kelly.
• 3:01
  Speaker 2: It was donated money, donated by I should tell you, I also had my own TBI, so you'll see as we go, the word flow right.
• 3:09
  Speaker 2: So, from the Home Depot department, bernie Marcus donated money to provide this incredible service to our veterans and first responders.
• 3:19
  Speaker 2: So it started in 2017.
• 3:21
  Speaker 2: I took it over about 15 months ago based on my success of co-founding and running the CU Center for Combat Research.
• 3:29
  Speaker 2: We do military medical research so we fill the gaps where the DOD can't fill those gaps and, unlike taking decades to get the science out there and the clinical practice changes, we get those in three years, which is unheard of when you do research.
• 3:46
  Speaker 2: So last February, the chancellor asked me, based on my leadership and success, if I'd take over the Marcus Institute for Brain Health.
• 3:54
  Speaker 1: Wow, and so what do you focus on?
• 3:56
  Speaker 1: So, when you talk about brain health, is it a service provided entity, or is it research, or is it both?
• 4:02
  Speaker 2: It's both.
• 4:02
  Speaker 2: It's both.
• 4:03
  Speaker 2: So we provide assessment and treatment for veterans, first responders, and I recently started a which I think you'd be really interested, a two-week program that goes from assessment to treatment, called a brain assessment and treatment for lifelong excellence, and started just with the South Ranger Regiment looking at mortar men, because you know all the things that you know, the repetitive blast injury, the repetitive blast exposures can set them up for a lot of negative effects, and so I believe, like you, that I think we need to prevent and mitigate.
• 4:37
  Speaker 2: But back to the Marcus Institute for Brain Health.
• 4:39
  Speaker 2: So we, at no out-of-pocket cost to the individuals, we fly them out to this campus and we house them.
• 4:48
  Speaker 2: We have colonel's housing, old colonel's officer housing that we converted into a home that they live on, and we provide evaluation.
• 4:56
  Speaker 2: So we have this amazing co-located, integrated team of PhDs and doctors and therapists that help evaluate the patients.
• 5:06
  Speaker 2: To evaluate, you know, is it PTS, is it traumatic brain injury, is it vestibular, is it ocular, motor, is it cognitive, what pieces, where's their areas of growth?
• 5:16
  Speaker 2: And then we also have a three-week intensive outpatient program where they spend again, they live with us and they can get 32 hours of treatment of this amazing integrated, co-located team and they just walk across the hall.
• 5:31
  Speaker 2: This building that I'm in is a 77-year-old old Air Force Army barracks here on campus because the center of this campus was the old Fitzsimmons and we saw the most amount of patients coming out of Pearl Harbor, so they all came here.
• 5:41
  Speaker 2: So there's the most amount of patients coming out of Pearl Harbor, so they all came here.
• 5:46
  Speaker 2: So there's the busiest hospital in the world at that time.
• 5:49
  Speaker 2: So we have a lot of military history and legacy here.
• 5:52
  Speaker 2: So this amazing treatment I've had Vietnam vets who said just in the evaluation, the assessment process, I got in three days what I didn't get in 30 years.
• 6:03
  Speaker 2: And so with the integrative team as well, it's amazing the hope and because, as you know, for too long traumatic brain injury has been misunderstood and poorly treated and TBI is often misdiagnosed as a mental health condition such as PTSD, and if it's misdiagnosed right then you're never going to address the underlying injury.
• 6:29
  Speaker 2: So so many people, yeah, just, and a lot of times, you don't have that one big TBI right.
• 6:37
  Speaker 2: You didn't have that one IED explosion.
• 6:39
  Speaker 2: You didn't have that one car crash and for too long, researchers, academia, that one car crash and for too long researchers, academia, dod hasn't understood the magnitude of that low level cumulative blast injuries, just in training and in combat operations, but in training.
• 6:57
  Speaker 2: So we address that too.
• 6:59
  Speaker 2: So you don't have to have that one big TBI to come here.
• 7:01
  Speaker 2: Our amazing intake team looks at the history and says what's your MOS, what's your Air Force specialty code?
• 7:09
  Speaker 1: How are?
• 7:09
  Speaker 2: you exposed to these things, what are your symptoms?
• 7:12
  Speaker 2: And then we have validated tests before they come here that will help us guide us that maybe it's this behavior health, it's this psychological health issue, but, as you very well know, bruce, that the TBI alone can cause anxiety and depression and is an independent risk factor for suicide.
• 7:33
  Speaker 2: So amazing team here.
• 7:36
  Speaker 2: We also have a multitude of research that we're doing and we're collaborating with industry, academia and our military partners.
• 7:42
  Speaker 2: We're doing and we're collaborating with industry, academia and our military partners Through the Center for Combat Research.
• 7:47
  Speaker 2: We have about 100 scientists, if you will, clinician scientists.
• 7:57
  Speaker 2: About 30% of those are active duty, and so for all our studies, we partner with military and we bring in clinicians active clinicians who are seeing the ill effects.
• 8:07
  Speaker 1: So I mean you've just uncorked a whole bunch of stuff here because you know, I mean this is amazing.
• 8:13
  Speaker 1: So I mean the fact that you know, we know, you know this focus on TBI like that one big incident is the same problem we have in contact sports.
• 8:22
  Speaker 1: To focus on concussions right incident.
• 8:25
  Speaker 1: It's the same problem we have in contact sports to focus on concussions right, where we didn't look at those smaller hits, like we didn't look at the smaller impacts of repetitive blast exposure.
• 8:31
  Speaker 1: Can you explain to our audience, like what does you know low-level blast exposure do to the brain over time and what kind of occupations in the military is subject to this type of this type?
• 8:44
  Speaker 2: of Sure.
• 8:45
  Speaker 2: So any brain injury is caused usually from external forces and that can be the contact spores, motor vehicle crashes, it can be all of those but also the blast overpressure.
• 8:55
  Speaker 2: So we know, like if you're firing a weapon, if you will, and so with that there's a blast that comes out and I always think of the brain as like a really thick gelatin structure.
• 9:06
  Speaker 2: But as you know, you can feel the percussion, especially with some of those bigger artillery mortars, grenades, even shoulder fired rockets.
• 9:15
  Speaker 2: You feel that percussion.
• 9:16
  Speaker 2: And so for a long time we were very aware of the percussion to the eardrums or to the lungs with the blast over pressure.
• 9:24
  Speaker 2: But it's only been more recently that we're really taking into account that that blast also will reverberate the brain as that blast kind of goes through it.
• 9:34
  Speaker 2: And so one of my scholars through the Center for Combat Research his name is Corey McAvoy and he was working with Dr James Mayburn out of the VA in Seattle as well as University of Washington.
• 9:47
  Speaker 2: He was a 18 Delta, so special forces medic in the army.
• 9:52
  Speaker 2: He was getting his master's here at CU so that qualified him to become a scholar.
• 9:57
  Speaker 2: It's an unpaid position but it's just somebody who's interested in military research.
• 10:01
  Speaker 2: So he did one of the first low-level cumulative blast injuries studies, if you will.
• 10:07
  Speaker 2: And so he took the NATO silhouette and put pressure gauges in them and looked at a blast room or a breaching of room right and who in what one of those positions, how much force they got, and so what he found in just that practice, if you will.
• 10:21
  Speaker 2: And so what he found in just that you know practice, if you will.
• 10:25
  Speaker 2: I know most of your audience is military, so they understand all of that.
• 10:28
  Speaker 2: But just the we call it.
• 10:32
  Speaker 2: You know the jelly rolls and the different blast explosions.
• 10:34
  Speaker 2: We call them pretend, but they give they whack up, you know a lot of pressure.
• 10:38
  Speaker 2: So he found, in the course of one day of training, 27.1 PSI and over the course of, like some of our special operators, like SEALs or combat controllers or, you know, rangers, they can get up to 2,700 PSI within that training period.
• 10:58
  Speaker 2: None of this was ever calculated in anybody's military medical history.
• 11:04
  Speaker 2: It was not even considered.
• 11:05
  Speaker 2: It was like did you deploy, how many rounds did you fire?
• 11:09
  Speaker 2: Not even that it's like-.
• 11:10
  Speaker 1: Not even that Nope.
• 11:14
  Speaker 2: So now the DOD did come up with a list of MOSs and Air Force specialty codes, but if you think about it and I know you know this data, but an average mortar man, in the course of just training, can shoot off 1,000 rounds in a year or four years, that's 4,000 rounds, and so that exceeds the four PSI, which is really.
• 11:39
  Speaker 2: We need to study it better, because that's an arbitrary number in my opinion.
• 11:46
  Speaker 1: Yeah, it's like the OSHA number right.
• 11:47
  Speaker 1: I mean that's what the OSHA OSHA.
• 11:49
  Speaker 2: Right, and that has to do more with the ears and the lungs and the air-filled, you know, organs in your body that have a response to that pressure.
• 12:00
  Speaker 2: So we are just on our I think our infancy of learning more in this realm.
• 12:08
  Speaker 1: And no, I mean, and so, in your opinion, you know, why did it take?
• 12:12
  Speaker 1: And this is, you know, a question that all of us soldiers have, and whether we're parents of athletes is like why has it taken so long to understand that low-level blast exposure is an issue?
• 12:25
  Speaker 1: I mean, we've been studying TBIs since 2003.
• 12:30
  Speaker 1: The wars before we didn't have IEDs, really these wars here it's been game on right 9-11.
• 12:37
  Speaker 1: So we've had 2001, actually.
• 12:41
  Speaker 1: So we've had decades of combat experience, yet we've never considered, we've always looked at that big incident.
• 12:49
  Speaker 1: Why haven't we focused on this?
• 12:52
  Speaker 1: Why has it taken us so long, as the military not pointing fingers, but why have we overlooked this?
• 13:03
  Speaker 2: Well, I think you've talked about this before.
• 13:04
  Speaker 2: You have to train like you fight, and I'm a firm believer in that.
• 13:08
  Speaker 2: But I think there's a lot of ways to prevent and mitigate.
• 13:12
  Speaker 2: It was really 2003.
• 13:14
  Speaker 2: I was deployed to Iraq at the time and that was my really first exposure to what a regular TBI was, not even noticing it.
• 13:22
  Speaker 2: So it's only been 20 years.
• 13:25
  Speaker 2: So if you think about cancer therapy or some of the others, 20 years is not very long, but for us it's 20 years that we've worn our uniform and so that 20 years is our career and that's huge.
• 13:36
  Speaker 2: So I think there's multitude of factors.
• 13:40
  Speaker 2: One is we don't show the chink in our armor, right.
• 13:43
  Speaker 2: So, like when we got our bell rung, we didn't tell anybody we hit it.
• 13:48
  Speaker 2: I had 23 years of in-flight status, right, and so, like special operators, you don't want to be pulled from a mission, so you don't always divulge everything right.
• 13:57
  Speaker 2: Not thinking clearly.
• 13:58
  Speaker 2: I have anger, irritability and low frustration tolerance.
• 14:01
  Speaker 2: That's why it's also often misdiagnosed, right, Because those are PTS symptoms and they're also TBI symptoms.
• 14:08
  Speaker 2: So typically the medical community would just say, oh, yeah, well, with that job and what you've seen, yeah, that's PTS, and really not get into the weeds of it, and also even as a medical provider and I've taught trauma teaching for a long time.
• 14:23
  Speaker 2: So, medical providers, we really didn't even conceptualize that that is a problem Even thinking about.
• 14:29
  Speaker 2: We teach with blast.
• 14:32
  Speaker 2: You have your primary, secondary, tertiary, even quaternary where the IED explodes and you get the pieces of the suicide bomber in you, right, yeah, those pieces.
• 14:42
  Speaker 2: But really it would make sense If we're looking in the ears for a ruptured eardrum or tympanic memory, if we're assessing the lungs, it would make sense, right, but it wasn't conceptualized and I don't think it was intentional on anybody's part to correlate those things.
• 14:59
  Speaker 2: But now we know, Now we know enough that we have I think we're just in a great place right the momentum, the people knowing about it, congressmen and people who want to move the bar right and they want to make a difference.
• 15:14
  Speaker 2: I think we're at a great place right now to find the science and how to mitigate it and then how to take care of our nation's heroes who have been exposed to these things.
• 15:27
  Speaker 1: And I think you're right.
• 15:28
  Speaker 1: I mean, I do think the pendulum swung and I think, while we have critical momentum from key stakeholders, leaders and entities like you, 90% of the country still is not aware that this is an issue.
• 15:41
  Speaker 1: And that's the challenge right now, and I think what you're talking about here is the difference between you know.
• 15:46
  Speaker 1: What I love to hear is you know that you're researching and in three years you're publishing paper because we talk about research for research sake, let's research sake, let's research this, and then you know what this needs to be further validated.
• 15:58
  Speaker 1: So let's go get some more grant money and research it and we don't turn it into action.
• 16:02
  Speaker 1: Talk to us a little bit about the research that you've been part of and when that has been.
• 16:08
  Speaker 1: You know that has turned into something that's actionable to help you know, treat our you know treat our service members and first responders.
• 16:17
  Speaker 2: Yeah, and that was one of the reasons that I, dr Vic Babarda, who is the founder of the Center for Combat Research, because as a commander, multiple commands and a general officer, sometimes Congress would just say go do right, suicide prevention.
• 16:33
  Speaker 2: We got to say we're doing something, but like we don't know that it helps, we don't know if it hurts, we don't have the science and sometimes, as you know, we just go do stuff right, we're going to have this safety down day or we're going to do whatever, but we don't know that it works.
• 16:49
  Speaker 2: So I was very interested in doing science and doing research that's going to help.
• 16:55
  Speaker 2: I always said our warriors and our warrior medics, because I have a special interest for warrior medics and so that was the impetus for it.
• 17:03
  Speaker 2: And so, like you said, publishing the papers is important because that's how you disseminate the information and everybody can now have that same common language and then you can repeat it across the world.
• 17:16
  Speaker 2: But for me, changing clinical practice guidelines so years ago the Army would do their own research, the Air Force and the Navy, but really we need collective.
• 17:27
  Speaker 2: That's why, to me, the partnership with academia, military industry, really to get after the solutions, I think is really important.
• 17:37
  Speaker 2: So one of the really good studies that we've done and it's not specifically TBI but it's oxygen, it's called Strategy to Avoid Excessive Oxygen.
• 17:47
  Speaker 2: So Special Operations Command came to us and said carrying oxygen downrange, and for me as an air medical evacuation specialist, taking liquid oxygen in 115 pound container that converts liquid to gaseous, the amount of money taking that on an aircraft, the amount of money to maintain that in a dusty downrange where it doesn't work, so civilian did not know.
• 18:13
  Speaker 2: So nobody knows exactly the right amount of oxygen that our critically ill and injured patients need.
• 18:18
  Speaker 2: We EMS, throughout the military EMS is emergency medical services and through an emergency department if somebody is critically ill or injured, we give them high flow, 100% O2.
• 18:30
  Speaker 2: We just flow it through them.
• 18:33
  Speaker 2: So SOCOM really wanted to know how much oxygen do they need?
• 18:38
  Speaker 2: Because if you think about a medic downrange, you could carry oxygen in the tanks and all of that.
• 18:43
  Speaker 2: And so we did a small, just a small study with that.
• 18:46
  Speaker 2: And then we did a bigger one looking at and this was Dr Adit Gandhi who is the primary investigator, but 17,000 patients during COVID in the ICUs, seven big hospitals, including the Brook Army Medical Center, the biggest military hospital, the level one trauma all these patients.
• 19:07
  Speaker 2: And what we found is too little oxygen is bad.
• 19:10
  Speaker 2: Too much oxygen is actually bad.
• 19:12
  Speaker 2: There's what's called normoxia between 90 and 96%.
• 19:16
  Speaker 2: So meanwhile the Army, air Force, navy, the people who get acquisitions they were waiting for our study because maybe we just need an oxygen concentrator instead of the big oxygen tank.
• 19:31
  Speaker 2: So what we found is 95% of critically ill patients do not need that high flow too.
• 19:39
  Speaker 2: And we had a subset of TBI, we had a subset of burns to look at and they all did better with that 90 to 96% of oxygen and with that they also decreased length of stay.
• 19:54
  Speaker 2: So they spent less time in the hospital and they recovered better.
• 19:59
  Speaker 2: So this was profound for the world because so long, everywhere, every ambulance, everything, every hospital, every country in the world gives everybody that high oxygen and we found that that was not needed.
• 20:15
  Speaker 2: So with that we changed 12 clinical practice guidelines in, like the TCCC, and disseminated that.
• 20:23
  Speaker 2: But how we did that is we brought the stakeholders in early.
• 20:27
  Speaker 2: So we told them this is coming out.
• 20:29
  Speaker 2: We went to the Military Health Systems Research Symposium.
• 20:33
  Speaker 2: We collaborated with white stakeholders from each of the branches so they knew it was coming.
• 20:38
  Speaker 2: They're waiting for it, and then the industry then was waiting too, because maybe they can.
• 20:44
  Speaker 2: So what they create for the medics for the next battle for large scale combat operations might look differently based on that one study for large-scale combat operations might look differently based on that one study.
• 20:57
  Speaker 2: So it typically takes 17 years from the time you have your idea for research to get it to the bedside.
• 21:04
  Speaker 2: So that study with 17,000 critically ill and injured patients in ICUs across the United States was done in three years.
• 21:16
  Speaker 1: So it's unheard of.
• 21:17
  Speaker 1: No, I mean that is and that's what we need with.
• 21:21
  Speaker 1: You know, right now we're trying to change the pendulum on repetitive brain trauma so that we can get action, because we'll talk about, you know, suicides here in a little bit, which is, you know, kind of, unfortunately, part of the focus of you know what we're talking about.
• 21:33
  Speaker 1: But you know, on the mental illness side I mean, you said that you know a lot of the mental illness that we see that is attributed to PTSD could also be caused by low-level blast exposure, repetitive blast exposure.
• 21:45
  Speaker 1: How do we, you know, what tools are you doing to evaluate and make the determination that LLB or repetitive blast exposure could be having an impact on the mental illness that these soldiers are suffering when they come to you?
• 22:01
  Speaker 2: Yeah, and it's hard to say.
• 22:03
  Speaker 2: I think if you have a TBI and that alone, so a lot of times you have comorbidities, right.
• 22:11
  Speaker 2: So if you have had a TBI and now your cognitive is affected, your speech language is affected, your executive functioning is affected, your balance, you know every.
• 22:25
  Speaker 2: I always call it a life altering functional disability, right, because it can negatively affect every aspect of your life.
• 22:33
  Speaker 2: It's still functional, like if you look at me, you don't know I had a TBI, right, most people, 99% of people, wouldn't know until I stumble.
• 22:41
  Speaker 2: And then you, just you know people, just you know, wave that off, and so it's not unusual to have that alone cause depression, like why, you know this is people always say is this my new normal?
• 22:54
  Speaker 2: And I don't like that term.
• 22:56
  Speaker 2: I like I'm not there yet.
• 22:58
  Speaker 2: Right, because I am on my path to recovery.
• 23:00
  Speaker 2: I am on my path to, to, to total healing.
• 23:04
  Speaker 2: It's just a process, right, and even though I can't do that yet, it's going to come Right.
• 23:09
  Speaker 2: But part of it is if you were misdiagnosed in the first place and it was never, it was, you know, so that piece of the traumatic brain injury was missed then you're never going to get the right therapies, because talk therapy, cpt, cbt, emdr, they're all great things but they won't treat the traumatic brain injury.
• 23:30
  Speaker 2: They'll teach, they'll work on the psychological health aspect, but you still need the cognitive therapy, the speech language that helps me with my executive functioning, helps me with my word finding or those other pieces and the neural balance to have a neurophysical therapy.
• 23:47
  Speaker 2: Because the interesting thing with our, when the range rangers come and we've had others, we have had SWCCs and Navy SEALs and 10th and 20th Special Forces Group come here too and they're fun because they're so competitive.
• 24:02
  Speaker 2: So some of the neural testing I know right.
• 24:05
  Speaker 1: It's like what's your number?
• 24:06
  Speaker 2: What's my number?
• 24:06
  Speaker 2: I improved by this much.
• 24:08
  Speaker 2: I improved by this much funny thing is we have sophisticated machines that our neurophysical therapists use.
• 24:15
  Speaker 2: That can kind of it's almost like I think of it as like a fronking bronco, but you're standing on it right, and so your body is reacting to all this movement.
• 24:24
  Speaker 2: And as your body's reacting, our vision takes over, right, and so we learn to compensate.
• 24:31
  Speaker 2: And so what happens with the people with TBIs?
• 24:33
  Speaker 2: They've compensated, but they don't realize they're compensating.
• 24:36
  Speaker 2: So we'll put these soldiers on there and they're doing great and they're like, yeah, I'm crushing this.
• 24:42
  Speaker 2: And then we'll say, okay, close your eyes so they get rid of the visual compensation that they've been using and not even realizing they're using that visual compensation and so they'll get that piece.
• 24:53
  Speaker 2: And then we also do co-treatments and so like they can walk, but they can't walk and talk at the same time, or walk and talk and do some cognitive functioning, and that's kind of an under-simplification, but when it gets to something that's really hard, it can make a big impact.
• 25:10
  Speaker 2: And so we might have the neurophysical therapists challenging them physically, and then the cognitive specialists, our speech language pathologists, doing cognitive exercises, and so it challenges.
• 25:25
  Speaker 2: And so most of the time with the TBI we do avoidance right, because I get overstimulated.
• 25:32
  Speaker 2: So somebody with a TBI will go into a restaurant.
• 25:36
  Speaker 2: Instead of just having that being present and having a conversation with you, bruce, they can hear the conversation at the next table, they hear the music being played, they hear that dish being dropped, and so somebody without a TBI can filter all of that out and they can be present.
• 25:53
  Speaker 2: And so with the TBI, their head is having to switch from all those things and it causes cognitive fatigue so they can be so exhausted just from that conversation so they're really not enjoying it and so that's why they'll avoid things like concerts or live music or going to the mall or even going shopping can be an event because of all that overstimulation.
• 26:19
  Speaker 2: So the team works to give you precision medicine, because every TBI, even if they're repetitive blast, even if you're mortar man, you have the same OS, mos.
• 26:31
  Speaker 2: Everyone is different and so every TBI requires precision, targeted therapy by integrated team.
• 26:41
  Speaker 2: Because typically what happens if you have you might be seeing a neurologist here and a speech there.
• 26:47
  Speaker 2: They don't talk to each other and they don't work collaboratively together to have you recover.
• 26:55
  Speaker 1: And that's all great, but what I was looking for is, like you know, is there.
• 26:59
  Speaker 1: Are there any tools?
• 27:00
  Speaker 1: Are you scanning the brain?
• 27:02
  Speaker 1: Are you doing a G?
• 27:03
  Speaker 1: I mean, I know that you're looking at their MOSs, that's great.
• 27:05
  Speaker 1: But what else?
• 27:07
  Speaker 1: Are there any other tools or technology you're using to validate that?
• 27:11
  Speaker 1: Look, your brain's been impacted.
• 27:13
  Speaker 1: Dti scans, functional MRIs, QEGs and then a G-Bev.
• 27:17
  Speaker 1: Are you doing G-Bev calculations at all?
• 27:19
  Speaker 1: Generalized blast exposure variable calculations.
• 27:22
  Speaker 2: We're not.
• 27:23
  Speaker 2: But I think some of this needs to be standardized.
• 27:27
  Speaker 2: I always say standardized, repeatable process that everybody kind of does it the same and has that same assessment Absolutely agree, and so we do have.
• 27:35
  Speaker 2: Dr Jeff Hebert is our director of research here at the MIBH and so he has several studies that's going on, going on that he's doing currently, and they do involve a functional mri and what is like irritability looking at that and it's there's something great about having that correlation.
• 27:52
  Speaker 2: When you have those mris that you can say, yes, I can see this you can see it right you can see it.
• 27:58
  Speaker 2: But even without seeing it, we so like you can see it.
• 28:01
  Speaker 2: But even without seeing it, we so like you know.
• 28:02
  Speaker 2: So like, after my TBI, right, I had the CAT scan.
• 28:04
  Speaker 2: Right, we do a CAT scan in the emergency department, not to say you have a TBI, but to rule out the bad things that require immediate intervention, like subdural hematoma or subarachnoid or all those things that need to be fixed right now, so a structural integrity issue within the brain, and so everything else is fixed and then you're kind of sent out.
• 28:25
  Speaker 2: So I think there's a lot of modalities out there that we need to incorporate, other than just the traditional and, I think, the diagnostic.
• 28:34
  Speaker 2: I think we need to be better at that and do more research in that area.
• 28:38
  Speaker 2: But, like you, I don't want to wait 17 years.
• 28:41
  Speaker 2: I don't even want to wait three years.
• 28:43
  Speaker 2: You know some things.
• 28:44
  Speaker 2: It makes sense, right, the?
• 28:46
  Speaker 2: You know, when they say anecdotal information, that might be a one patient, an N of one, right, or it might be in my clinical experience as a, you know, expert clinician, I've noticed this, you know.
• 28:58
  Speaker 2: So it's some of those that I think we need to share as best practices as well.
• 29:03
  Speaker 2: So there's a lot of modalities out there.
• 29:05
  Speaker 2: The problem is they're very expensive, right.
• 29:08
  Speaker 2: So all of that in one location.
• 29:10
  Speaker 2: And for me, one of the things is like, if you go to drug and alcohol, right, we will send you to rehab 12 times, right, but it's inpatient, it's expensive, but insurances, the VA, will pay for it, but insurances will not pay for this type of modality.
• 29:30
  Speaker 2: So I think you know, because I always, like you, think about how do you make it scalable?
• 29:35
  Speaker 2: You know, great, we see, you know, we've seen a thousand patients which saves their lives and their families and helps communities.
• 29:42
  Speaker 2: But how do we make all of these modalities scalable to everybody, the 2.8 million Americans who suffer annually a TBI, you know, and all the sports related, and the militaries and the veterans, and so a lot of?
• 29:58
  Speaker 2: To me, that opinion comes down.
• 30:01
  Speaker 2: One you have to have science that says it works, right, and, and so we are part of Marcus Institute for brain health, is part of the Avalon Action Alliance, so there's oh, you are?
• 30:12
  Speaker 1: Okay, I didn't know that.
• 30:13
  Speaker 1: All right, you know Mike Hartman and the.
• 30:16
  Speaker 1: Yeah, mike's a close friend and works closely with Asthma Effect.
• 30:21
  Speaker 1: We just got funding from the state of Florida to run a brain supplementation and ketamine study on veterans.
• 30:28
  Speaker 2: I know Florida is progressive.
• 30:30
  Speaker 2: And then one of our partners there's a Haley Brain Wellness Center.
• 30:33
  Speaker 1: Yeah, they're awesome, dr Marissa over there, mccarthy, so I mean a lot of what you're talking about, general, is exactly what we need.
• 30:42
  Speaker 1: I mean, there's a lot of modalities out there and a lot of them are not expensive.
• 30:45
  Speaker 1: When you start talking about psychedelics, you start talking you know TMS, you know a lot of these machines that are out there photobiomodulation, vagus, nerve stimulation, all that.
• 30:54
  Speaker 1: The issue is we can't get the VA or TRICARE to cover them and that is.
• 30:59
  Speaker 1: And when you know and I guess let me pose this question to you when we have a veteran that is thinking about taking their life, why does something have to be FDA approved when we have thousands of veterans that have been through each one of these modalities and you can pick one right.
• 31:17
  Speaker 1: I mean there's thousands of veterans that have been through HBOT, they've been through psychedelics, they've been through TMS, they've been through electronic Dr Mark Gordon's brain supplementation vag, you know stelae ganglion blocks, and over 80 to 90% of these veterans said this has helped me.
• 31:33
  Speaker 1: And at what point do we say look, we're not waiting for FDA, we are going to open up these modalities to these veterans.
• 31:42
  Speaker 1: And yes, to your point, how do we make them scale?
• 31:44
  Speaker 1: Are we going to come up with one therapeutic model?
• 31:46
  Speaker 1: We can't because, as you said, every brain injury is different, right?
• 31:50
  Speaker 1: We have no idea what combination of these modalities will work.
• 31:54
  Speaker 1: What we do know is that these modalities, instead of therapy and instead of pharmaceutical interventions, can impact brain health, can keep people from taking their lives, can improve their mental health.
• 32:08
  Speaker 1: So what's the problem?
• 32:10
  Speaker 1: Why is somebody as advanced in terms of medical support, research and science saying, look, we need these modalities, what can we do to work with?
• 32:25
  Speaker 1: I have legislation in Congress right now with Congressman Van Orden to cover, and I'd love to work with you on this list of modalities, to take all these modalities and we don't care.
• 32:35
  Speaker 1: The veteran's going to go when they have mental health problems where therapy and drugs cannot do it, and we all know that that's mistreatment of a, you know, biologically caused or physiologically caused mental illness.
• 32:49
  Speaker 1: You know, how do we, how do we get over this block that's preventing, you know, progressive organizations like yours of giving that next edge of care to these veterans that you know could keep them?
• 33:04
  Speaker 1: You know.
• 33:05
  Speaker 2: Yeah, and that's.
• 33:05
  Speaker 2: It's complicated.
• 33:07
  Speaker 1: It is no doubt.
• 33:10
  Speaker 2: But, as I mentioned and one of our partners is through the Avalon Action Alliance is Warriors Heart, which you can go for drug and alcohol treatment, right, and so just to expand on that, we can send them 12 times, but for a TBI.
• 33:23
  Speaker 2: So if you're getting that cold, it's not reimbursed.
• 33:25
  Speaker 2: It's not reimbursed.
• 33:31
  Speaker 2: So this is a very expensive, very efficient, well, the model works.
• 33:32
  Speaker 2: We have science that knows what model works, but it's very expensive and so, like if you're doing a co-treatment, so you have a speech language pathologist and you have a, you know, doctorate of physical therapy working with you, we can't bill it for that, we don't.
• 33:44
  Speaker 2: We can't bill for 32 hours.
• 33:46
  Speaker 2: So I'm trying to like even build a TRICARE for this program, but we don't even get 10 cents on the dollar.
• 33:52
  Speaker 2: So, through the Avalon Action Alliance and our six TBI centers across the United States, we're doing a study that is being funded by philanthropic so it can be faster, right, that shows, here's the efficacy and then we can go.
• 34:07
  Speaker 2: That's what the legislators want.
• 34:08
  Speaker 2: They want to know the science right and we know the typical medical science model of.
• 34:14
  Speaker 2: You also have Big Pharma who is funding a lot of those research studies, some of the smaller research studies, like even the hallucinogenics, the psychedelics started, and I think you probably know this, bruce, but in 1970, nixon stopped all research on psychedelics Right.
• 34:30
  Speaker 2: So really only for the last two years have we been able to have DOD.
• 34:35
  Speaker 2: So now currently serving military members can participate in some of these studies, and so I believe there's a lot of efficacy in it and a lot of potential.
• 34:47
  Speaker 2: So the CU in CU Denver they just stood up a center for psychedelic research.
• 34:52
  Speaker 2: Dr Jim Grigsby and he met with us so we had collaboration to look to see if there are future collaborations that we can do, because previously nobody could even do it right.
• 35:04
  Speaker 2: And right now the biggest psychedelic conference is being held right here in Denver this week.
• 35:11
  Speaker 2: Looking at all, those modalities and so, even though you don't have the exact science right, you don't have the medical model of randomized double-blind placebo-controlled study there's been so much anecdotal and there's been enough small studies that really showed great impact.
• 35:28
  Speaker 2: And if you can do one treatment of ayahuasca or ibogaine and that's equivalent to 10 years of therapy, wouldn't that make sense to do that Because it can aid in neuroplasticity?
• 35:41
  Speaker 2: But part of it is being able to think outside the box, being able to think and nobody wants meds right.
• 35:49
  Speaker 2: Nobody wants a medication, plant-based medicine that is conducted with a ceremony and the ancient history of how to do it correctly, I think is different than somebody's basement doing psilocybin right.
• 36:03
  Speaker 2: I think there's a medically supervised I would agree with that.
• 36:09
  Speaker 1: I would say there's different.
• 36:10
  Speaker 1: You know there's, there, are, you know there should be approved, like even in ketamine.
• 36:14
  Speaker 1: I mean there are clinicians out there that should not be applied, not be given this drug.
• 36:18
  Speaker 1: There is a set setting for it, there is a proper way to administer the drug and then to make sure that these veterans are doing the integration work afterwards to process a lot of what they've learned.
• 36:31
  Speaker 1: But to your point, even what you're doing at the Marcus Institute might be considered expensive.
• 36:38
  Speaker 1: But when you look at the alternative, which is a lifelong life of therapy and pharmaceutical drugs, pharma is all in this.
• 36:45
  Speaker 1: Pharma is the last organization in this country that wants to see us fix this mental health problem because they are making billions of dollars off it and it's just wrong.
• 36:55
  Speaker 1: I mean we've had more kids die, you know, as a result of pharmaceutical intervention on mental illness than looking at especially when low-level blast exposure has been involved.
• 37:08
  Speaker 1: Then you know.
• 37:10
  Speaker 1: Then I mean we lose the equivalent of 20 years of war every year to suicide and that our point is talking to folks like you and we recognize that there are modalities out there that, yeah, they haven't done the gold standard of studies, but we've got a suicide rate that is just it's not dropping and it's just not acceptable.
• 37:34
  Speaker 1: Can we start looking at administering these therapies when we've had thousands of veterans?
• 37:39
  Speaker 1: Veterans say this has changed.
• 37:39
  Speaker 1: I know they've impacted my life.
• 37:41
  Speaker 1: You know they have absolutely impacted my life and I was diagnosed with brain injuries and damage as a result of my 21 years, and you've had a TBI and so and you understand the importance of this, but you know it'd be nice to see, you know the military, you know take that next step Right and to get that going.
• 38:03
  Speaker 1: So, speaking of next steps, where do you think we go from?
• 38:06
  Speaker 1: Here?
• 38:06
  Speaker 1: Administering a model program, you're treating thousands of veterans.
• 38:11
  Speaker 1: Let me ask you a quick question.
• 38:13
  Speaker 1: I ask everybody this so what percentage of veterans that go through your program say that they have had a positive impact on their mental health?
• 38:21
  Speaker 2: Right now it's 98 percent, but I know 100.
• 38:23
  Speaker 2: Because I meet and I do group therapy with everybody that comes through here and just watching them from the beginning to the end and the light and how many parents and family members who I've said you know, you gave me back my child, you gave me back my husband, and it's a journey and that's the thing about all these modalities.
• 38:45
  Speaker 2: There's no quick fix with a TBI, it is a wellness practice and so I think about whole, you know, brain health optimization and some of the things that are often left off or not even identified is things like nutrition supplements.
• 39:03
  Speaker 2: You know, like one of the things that Dr Andy O for the 75th Ranger Regiment is doing as soon as they get a concussion.
• 39:10
  Speaker 2: Instead of saying, go buy these five $200 worth of supplements, we're issuing this soldier these and we're pulling you out of play.
• 39:19
  Speaker 2: So we're doing the nutrition piece with it too.
• 39:22
  Speaker 2: We know that for like for me also at the markets we do registered dietician, we do.
• 39:27
  Speaker 2: We have a PharmD that goes over all their meds because you know it's funny, because in the elderly population if you have six or more drugs, medications is considered, polypharmacy increases the risk factor for falls, all these other comorbidities.
• 39:41
  Speaker 2: If you have six or more, most of the people you know I look at the meds that they're on coming in right and there's so many of them right.
• 39:50
  Speaker 2: So looking at how do you optimize without the meds?
• 39:54
  Speaker 2: And so for us, we also talk about nutritious eating, your gut microbiome there's a brain-gut axis and so if you take care of your gut, so 90% of your serotonin, which is one of your feel-good hormones that helps with depression, anxiety, comes from produced in the gut.
• 40:15
  Speaker 2: And so if you're eating crap and you're not taking care of your belly, also inflammation Although if you look at how many autoimmune diseases are out there now, it's because we have poor nutrition.
• 40:27
  Speaker 2: So we talk about how to heal the gut microbiome and it's going to help with your brain health.
• 40:32
  Speaker 2: So everything's connected.
• 40:35
  Speaker 2: I have a vagal nerve stimulator.
• 40:38
  Speaker 2: I use it a couple of times a day and that helps me, and it's not a med, but also for I do transcendental meditation, 20 minutes twice a day.
• 40:47
  Speaker 2: So there's no quick fix.
• 40:49
  Speaker 2: That's out there and it is a journey and it's a continuous journey.
• 40:53
  Speaker 2: And so there's my favorite quote is I want to die young as late as possible.
• 40:57
  Speaker 2: My favorite quote is I want to die young as late as possible.
• 40:59
  Speaker 1: So I am looking at Sign me up for that one man, I like that.
• 41:01
  Speaker 2: I'm looking at my health years.
• 41:02
  Speaker 2: How can I take, you know and I heard on one of your podcasts and I'm going to steal it from you is that you know we've taken good care of us physically, but I prioritize my brain, my brain health, as much as I prioritize my physical health now, and that's doing all of those wellness practices.
• 41:20
  Speaker 2: So I don't think just one modality, so that the integrated of all these disciplines, I think, is really important.
• 41:27
  Speaker 2: I think learning how to down-regulate when you're here, right, so how do you do that?
• 41:34
  Speaker 2: Parasympathetic dominance.
• 41:35
  Speaker 2: So I think those are things that need to be learned too.
• 41:39
  Speaker 2: So one HBOT, one psilocybin, one is not going to fix it.
• 41:45
  Speaker 2: It really is changing your mindset of I am in control of this right and I have the power to move me forward, but it's getting them out of the one.
• 41:57
  Speaker 2: I think the biggest thing is saying, yes, you have a TBI, and they say what?
• 42:01
  Speaker 2: I'm not crazy, it's not just in my head, it's not this, Yep.
• 42:05
  Speaker 1: Closure.
• 42:05
  Speaker 2: One is diagnosing what the underlying piece is, and one of the big things you mentioned, Bruce, is for so long you didn't have that one TBI, so it was all labeled as psychological health issues, mental health issues, and had nothing to do with the job that you're doing.
• 42:23
  Speaker 2: And so, yeah, I think we're at a great place because I think you know there's smart, talented people in all those areas that are moving the bar and figuring out how to take care of our nation's heroes, and I'm thrilled to be part of it to take care of our nation's heroes and I'm thrilled to be part of it.
• 42:40
  Speaker 1: Well, dr Flaherty, you're moving the bar.
• 42:42
  Speaker 1: Okay, you are part of this movement.
• 42:44
  Speaker 1: That's going to get there and I honestly think that we're going to get there.
• 42:48
  Speaker 1: I mean, the support for the legislation is moving.
• 42:50
  Speaker 1: I'd like to work with you on that Love to understand more about that.
• 42:53
  Speaker 1: I will be in Denver for the entire month of August because it gets very hot here in Florida.
• 42:58
  Speaker 1: Denver for the entire month of August because it gets very hot here in Florida, and my grandson's up there, so I got to say hi, yay, yay for you, yay.
• 43:03
  Speaker 1: And so I'd love to come in and check out the campus, check out the program report on it, maybe do a podcast there or something.
• 43:10
  Speaker 1: But you know this has been amazing and look before we go.
• 43:14
  Speaker 1: I always love to have our guests.
• 43:16
  Speaker 1: You know, talk about themselves, the programs, how people can find them.
• 43:21
  Speaker 1: Maybe you know how to diagnose or how to.
• 43:23
  Speaker 1: You know, you know, understand that somebody you love might be suffering.
• 43:27
  Speaker 1: A military veteran might be suffering from mental illness through you know drinkings.
• 43:31
  Speaker 1: You know whatever it is.
• 43:32
  Speaker 1: Say some words about.
• 43:33
  Speaker 1: You know your program yourself.
• 43:35
  Speaker 1: How do people find you?
• 43:37
  Speaker 1: If they have concerns?
• 43:38
  Speaker 1: How can they reach out?
• 43:40
  Speaker 1: What should they be looking for?
• 43:42
  Speaker 2: Great.
• 43:42
  Speaker 2: Thank you for that.
• 43:43
  Speaker 2: So the Marcus Institute for Brain Health follows us on LinkedIn because we post our stories, we post the research we're doing, how we're moving the bar in big and small ways, and then also Avalon Action Alliance.
• 43:56
  Speaker 2: One of our team members here actually does intake for the whole system, and so if you reach out to them and then also one of the things with Avalon Action Alliance they also have Warrior Path, which I went to about 15 months ago in the Pacific Northwest, and it's post-traumatic growth.
• 44:12
  Speaker 2: It talks about how do you turn struggle into strength, and so there's great programs within that, and Boulder Crest, and so again, we're very complicated, our brain is very complicated, so we need a multitude of things to help us get our best brain health, optimization and collaboration, because you can't do it.
• 44:37
  Speaker 2: You know success takes support, failure takes a loan and we will not move the bar.
• 44:42
  Speaker 2: We won't make a difference individually, but collectively.
• 44:45
  Speaker 2: There's so much power.
• 44:47
  Speaker 2: Reach out to me because I'm always excited about working together.
• 44:51
  Speaker 1: Well, General Flaherty, we will definitely be reaching out.
• 44:53
  Speaker 1: I think what you're doing is amazing.
• 44:55
  Speaker 1: It's so important and you understand.
• 44:58
  Speaker 1: You know both the limitations and the possibilities of what we can do with what we know now to improve treatment for our veterans and help diagnose those that are suffering from low-level blast exposure.
• 45:11
  Speaker 1: But to your point earlier, the 2.8 million people that have TBIs every year can also benefit from expanded access to these programs, instead of a lifetime of medication and therapy that doesn't help them, because they too suffer.
• 45:25
  Speaker 1: You know, may it might be just one big event, but they suffer the same outcomes, the same poor outcomes and the same poor treatment through misdiagnosis and mistreatment of their maladies.
• 45:36
  Speaker 1: So thank you so much for what you're doing, Thank you for coming on the show and I will be out there to say hi, and you can count on that Really appreciate it.
• 45:45
  Speaker 2: So thrilled.
• 45:45
  Speaker 2: Yes, thank you so much, bruce.
• 45:47
  Speaker 2: Bruce, it's been a pleasure.
• 45:49
  Speaker 1: All right.
• 45:49
  Speaker 1: Well, another great episode of Broken Brains.
• 45:52
  Speaker 1: Don't remember.
• 45:53
  Speaker 1: Go get your free book.
• 45:54
  Speaker 1: It's on the website, the only book for parents in the country, and I'm actually rewriting this thing to bring another three years of information to it.
• 46:01
  Speaker 1: So go on there, get it.
• 46:02
  Speaker 1: Don't forget about our app, head Smart, on the Google store.
• 46:05
  Speaker 1: It also has the book, but also has probably the most comprehensive list of concussion and repetitive brain or repetitive head impact information for your parents out there on the net.
• 46:20
  Speaker 1: Don't remember, and don't forget our summit on our second summit on repetitive brain trauma.
• 46:25
  Speaker 1: It will be held here in Tampa September 3rd and 4th.
• 46:28
  Speaker 1: Shouts out to all of you that are paying attention.
• 46:30
  Speaker 1: Thank you for the reviews.
• 46:31
  Speaker 1: Don't forget to like us, pass us on to everybody else, post whatever you can on what we're doing out there.
• 46:38
  Speaker 1: As General Flaherty said, this is so important and the time is now to address not only this for our veterans, but also for our kids as well.
• 46:48
  Speaker 1: And a big shout out to our producer, denny Caballero security halt media.
• 46:52
  Speaker 1: You ever looking for somebody that knows about marketing.
• 46:54
  Speaker 1: Always reach out to him Till next time.
• 46:56
  Speaker 1: Thank you so much for listening to another podcast.
• 46:59
  Speaker 1: We'll see you soon on Broken Brains.
• 47:01
  Speaker 1: Remember, you only got one melon.
• 47:03
  Speaker 1: Take care of it.
• 47:03
  Speaker 1: We'll talk to you later, so true.