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Brain Trauma in Sports: Dr. Joseph Maroon on Preventing Concussions & TBI · Broken Brains with Bruce Parkman

• 0:11
  Speaker 1: Hey folks, welcome back to another episode of Broken Brains with Bruce Parkman.
• 0:15
  Speaker 1: I'm your guest and your host, bruce Parkman, sponsored by the Mack Parkman Foundation, where we look at the issue of repetitive brain trauma in the form of repetitive head impacts in sports and repetitive blast exposure in our veterans, and what this exposure is doing to their brains in the form of mental illness and brain damage, and how it's impacting their lives.
• 0:36
  Speaker 1: So what do we have to do as a society to make sports safer, to improve the lives of these individuals?
• 0:41
  Speaker 1: As we go forward from a medical and psychological perspective?
• 0:45
  Speaker 1: We reach across the globe, talk to researchers and scientists and patients and advocates, and do our best to make you, the viewer, more informed on this issue, as this is the largest preventable cause of mental illness in America and we need to do more about it.
• 1:01
  Speaker 1: Today we have another amazing guest, dr Joseph Maroon.
• 1:04
  Speaker 1: Dr Maroon is a world-known neurosurgeon with extensive experience in neurosurgery and specializes in minimally invasive surgery to speed recovery for his patients.
• 1:14
  Speaker 1: He's a sports medicine expert and an innovator, as well as an Ironman athlete.
• 1:20
  Speaker 1: He's a board certified clinical professor of neurological surgery and his clinical and research interests have been in the areas of development of minimally invasive surgical procedures to the injuries, especially to the central nervous system, which is very important, what we're going to be talking here and innovative approaches to brain tumors and pituitary tumors and other complementary approaches to inflammatory diseases, which is the most significant impact of these sports on the brain from a neuroinflammation perspective.
• 1:51
  Speaker 1: And for the last 20 years he served as a neurosurgical consultant to professional and collegiate athletes in football, baseball, golf, hockey, soccer, and was the team neurosurgeon to the Pittsburgh Steelers for over 40 years.
• 2:06
  Speaker 1: He's been around the world, he's been honored and it is our honor to have him as a guest on our program today.
• 2:12
  Speaker 1: Dr Maroon, thank you so much for being here.
• 2:14
  Speaker 1: Sir, can't thank you enough.
• 2:18
  Speaker 1: So I think we met a little bit earlier this year.
• 2:22
  Speaker 1: So talk about it here.
• 2:25
  Speaker 1: You know the focus here repetitive brain trauma and we do not have a lot of positive ways to diagnose and treat this pretty severe outcome from people that have played sports or been in military service for a long time.
• 2:42
  Speaker 1: In military service for a long time, you've seen this from every perspective.
• 2:47
  Speaker 1: You know as an athlete, you know as a doctor, as a neurosurgeon, being on the sidelines.
• 2:50
  Speaker 1: Why are we today, at 2025, a society that still is pretty much ignorant of the risk of neuro, of subconcussive impacts on the brain, and the damage is done to our children, our athletes and our veterans.
• 3:06
  Speaker 2: Well, I challenge you just a little bit on that, bruce.
• 3:09
  Speaker 2: I think we really do know quite a bit about it.
• 3:12
  Speaker 2: You know, when I started in the NFL back in the 80s actually, as you recall, when someone had a concussion, the return to play criteria was holding up two fingers and ask the athlete how many fingers do you see?
• 3:28
  Speaker 2: If they said two, they could go back in.
• 3:31
  Speaker 2: Well, we subsequently learned that much more had to be assessed, and that's in the 1990s.
• 3:41
  Speaker 2: I, along with Mark Lovell, a neuropsychologist, were challenged by Coach Chuck Knoll to find out.
• 3:49
  Speaker 2: You know, if you want somebody to go back into a game, that's not the right test.
• 3:53
  Speaker 2: I want objective data, he said.
• 3:54
  Speaker 2: So we devised a test called the IMPACT test Immediate Post-Athletic Cognitive Testing which is now a computer-based test, also online, and we've tested now 25 million athletes.
• 4:10
  Speaker 2: And it's still the standard of care in the NFL and all contact sports, including NASCAR, nba, et cetera.
• 4:18
  Speaker 2: I tell you that because Hippocrates the father of medicine Hippocrates the father of medicine said the first responsibility of a physician is to prevent disease.
• 4:27
  Speaker 2: If that be impossible, to cure it and if that too be impossible, to relieve pain.
• 4:49
  Speaker 2: Warner to the NFL have been doing because of our knowledge of the consequences of multiple traumatic brain injury is initiating preventive measures, reducing the impacts, improving the equipment, improving and changing the rules.
• 4:57
  Speaker 2: So we have learned a lot and we're doing everything we can to prevent the brain injuries that do occur from contact sports.
• 5:06
  Speaker 2: So you know, if you know your son goes out and rides a bike or falls off of a swing, there's danger of getting hit in the head and having a problem.
• 5:18
  Speaker 2: In fact, for adults, falls are the most common cause of head injuries and disability Falls in the home.
• 5:28
  Speaker 2: So it's all about prevention and then making the correct diagnosis when something does happen and uh and proceeded with appropriate treatment but, doc, we know that the largest issue here is subconcussive trauma.
• 5:43
  Speaker 1: Okay, and the nfl and all of our sports leagues have not done.
• 5:47
  Speaker 1: There's really nothing you can do with subconcussive trauma except prevent exposure.
• 5:53
  Speaker 1: Yet you know the NFL has made changes, or it does.
• 5:56
  Speaker 1: They don't do contact drills during the season, but most of our colleges do, all of our high schools do.
• 6:03
  Speaker 1: And then when you talk about kids playing these contact sports at a young age, they're still strapping on helmets when their brains are just starting to develop.
• 6:12
  Speaker 1: So how do we take what you know in the NFL right?
• 6:16
  Speaker 1: The NFL has made some good decisions.
• 6:17
  Speaker 1: They obviously understand that subconcussive trauma is an issue because now they've shortened, you know the kickoff starts to minimize the collisions.
• 6:26
  Speaker 1: You know they started wearing them crazy things on their helmets which do nothing from a subconcussive trauma preventative standpoint, because the brain still moves.
• 6:34
  Speaker 1: So how do we take that knowledge that the NFL has gained and push that down range?
• 6:41
  Speaker 1: Because subconcussive trauma is still impacting our kids and we're not seeing the movement to go ahead and to reduce the amount of exposure?
• 6:54
  Speaker 1: We can track it better.
• 6:55
  Speaker 1: We are more knowledgeable about concussions than we've ever been in the history of this country.
• 6:59
  Speaker 1: Yet when it comes to subconcussive trauma or pediabetic impacts, we are still allowing our children to get impaired.
• 7:06
  Speaker 1: So how do we fix that?
• 7:07
  Speaker 1: I mean, where do we, how do we get the NFL to go ahead and help us fix that?
• 7:13
  Speaker 2: Well, bruce, again I go back to society and to the thing called risk-reward ratio.
• 7:21
  Speaker 2: Everything we do has some risk.
• 7:25
  Speaker 2: Driving to work today in Pittsburgh at minus 15 degrees, in the snow and ice, was a significant risk to me to get here in the hospital, so there's a risk of me doing that.
• 7:38
  Speaker 2: There's a risk to playing sports.
• 7:40
  Speaker 2: There's a risk to riding a bicycle.
• 7:42
  Speaker 2: There's a risk to riding a skateboard.
• 7:45
  Speaker 2: There's a risk to getting on a swing when you're five years old or six years old.
• 7:49
  Speaker 2: So again, it's balancing.
• 7:51
  Speaker 2: What are the rewards of playing sports?
• 7:55
  Speaker 2: What are the value of playing sports versus sitting at your home eating Fritos, drinking Coke and playing playboy?
• 8:03
  Speaker 2: Your home eating Fritos, drinking Coke and playing.
• 8:06
  Speaker 1: Playboy, I'm sorry.
• 8:06
  Speaker 1: I mean I am a semi-professional rugby player, but when you drove to work today, you drove to work today with a possibility of you getting injured.
• 8:12
  Speaker 1: When you put in a helmet, that possibility is 100% that you are going to suffer repetitive head impact as a child.
• 8:20
  Speaker 2: Yeah.
• 8:21
  Speaker 1: And that level of risk tolerance is unacceptable.
• 8:23
  Speaker 1: Yeah, we cannot accept the fact that children are being injured, so how do we prevent that?
• 8:30
  Speaker 2: Well how you answer that question?
• 8:31
  Speaker 2: You don't let your kid play football.
• 8:33
  Speaker 1: You don't let them play, you'd have.
• 8:35
  Speaker 1: You have flag football till the brain starts develop.
• 8:37
  Speaker 1: What is what is wrong with that?
• 8:39
  Speaker 1: With flag football till, say 14, when the brain starts to develop, and then initiating brain contact Is that something that?
• 8:48
  Speaker 2: we could all agree on when does the brain stop developing?
• 8:51
  Speaker 1: About age 25.
• 8:52
  Speaker 1: About age 25.
• 8:55
  Speaker 2: Eliminate all contact sports.
• 8:58
  Speaker 1: No, sir, and that is the you know.
• 9:01
  Speaker 1: There's no reason to eliminate contact sports.
• 9:04
  Speaker 1: We're talking about making contact sports safer.
• 9:06
  Speaker 1: I am 63, and I still play rugby.
• 9:09
  Speaker 1: Okay, I started when I was 29.
• 9:12
  Speaker 1: The point is critical brain structures.
• 9:14
  Speaker 1: As you well know, the prefrontal cortex doesn't start developing until at least 14.
• 9:18
  Speaker 1: The only sports that have severe tragedies in form of mental illness, suicidality, homicidal and suicidal ideation are contact sports Rugby, football, lacrosse, wrestling, whole nine yards.
• 9:33
  Speaker 2: So we're not just talking football Navy SEALs going 60 miles an hour over heavy waves that we see what's that.
• 9:41
  Speaker 2: Navy SEALs who are on boats going.
• 9:44
  Speaker 2: You know the military as well.
• 9:46
  Speaker 1: Oh yeah, I'm a retired Green Beret Sergeant Major, who was diagnosed with general anxiety disorder as a result of trauma to my brain from thousands of explosions being shot in the face, the nine yards.
• 9:57
  Speaker 1: The whole thing is, doc, is we're saying that?
• 10:00
  Speaker 1: You know we're not.
• 10:02
  Speaker 1: Nobody wants to eliminate contact sports.
• 10:04
  Speaker 1: We love our contact sports, but we you, have to make them safer, and the only way to make them safer is from an exposure perspective, not from sports.
• 10:13
  Speaker 1: We love sports, we should have sports all over the place, but our children are being harmed because every time they put on that helmet, every time they check in hockey, every time they, they and they play these sports months for years.
• 10:25
  Speaker 1: You have parents right now that have their kids in pop Warner.
• 10:28
  Speaker 1: They go to the play for the schools, they play for the town and this is too much trauma.
• 10:32
  Speaker 1: Even you must recognize this as a neurologist, that there is too much trauma that the brain just can't recover from and so it comes down to exposure.
• 10:42
  Speaker 1: And the way to eliminate that exposure is to eliminate that mostly in practice.
• 10:47
  Speaker 1: Save it for game day.
• 10:48
  Speaker 1: That's Pop.
• 10:50
  Speaker 2: Warner.
• 10:50
  Speaker 2: You mentioned Pop Warner.
• 10:52
  Speaker 2: The incidence of concussions is under 1% in Pop Warner and the precautions that they've taken to minimize practice and to minimize concussions has been really, really marked.
• 11:05
  Speaker 2: I mean they've done everything you're suggesting.
• 11:09
  Speaker 1: They have not.
• 11:10
  Speaker 1: They're still practicing during the week.
• 11:13
  Speaker 1: They're still at the children.
• 11:17
  Speaker 2: They're not having head impacts.
• 11:19
  Speaker 1: They cannot stop having impacts, doc, they've got a brain inside a helmet that's shaking violently every time they get hit.
• 11:26
  Speaker 1: You cannot reduce that, you cannot eliminate that, unless you just don't do it.
• 11:31
  Speaker 2: That's exactly right.
• 11:32
  Speaker 2: Now, bruce, do you know which sport has the most concussions?
• 11:35
  Speaker 2: Rugby, rugby.
• 11:38
  Speaker 2: Now you're, you're, you're.
• 11:40
  Speaker 2: How old are you?
• 11:41
  Speaker 2: Well, you're, you're.
• 11:42
  Speaker 2: You're a little younger than I am and you're still playing rugby, having had multiple traumatic head impacts yourself yes, sir, yeah, but I started at 29.
• 11:55
  Speaker 1: okay, the the issue is.
• 11:56
  Speaker 1: The issue is that this is this is all preventable rugby, football, hockey, lacrosse, wrestling, all that.
• 12:04
  Speaker 1: Okay, we have been groomed.
• 12:05
  Speaker 1: The other day I watched an NFL game that had a Nickelodeon commercial in it.
• 12:11
  Speaker 1: Spongebob and Patrick were on NFL talking about how great football is, when we know that football and all these contact sports to a developing brain is the greatest risk and the largest cause of preventable mental illness in this country and it all comes from shaking the brain.
• 12:27
  Speaker 1: So, regardless of the sport not just talking about football here what are we going to do to eliminate that contact?
• 12:34
  Speaker 1: That means flag football till 14 and getting Pop Warner off this contact drill and get them into flag.
• 12:42
  Speaker 1: I mean, you cannot condone kids having helmets on with their brains in such a fragile perspective.
• 12:48
  Speaker 2: I'm not condoning it at all, bruce.
• 12:50
  Speaker 2: Do you know it's a significant incidence of concussions in flag football too?
• 12:56
  Speaker 1: But we're not talking concussions, doc.
• 12:58
  Speaker 1: We're talking about the repetitive subconcussive exposure of children, the concussions we can heal from a concussion.
• 13:04
  Speaker 1: I mean a concussion is an injury but we're talking about a lifestyle of subconcussive exposure that our children are experiencing from parents that are unaware that more is better.
• 13:16
  Speaker 1: We're in America, right, more is better, so you're going to practice or you're going to play back-to-back sports better.
• 13:20
  Speaker 1: We're in America, right, more is better, so you're going to practice.
• 13:22
  Speaker 2: You're going to play back-to-back sports.
• 13:23
  Speaker 2: I think what's been done to date by the NFL, by Pop Warner that I'm very familiar with, and the preventive measures that they've made, from my perspective, there's very little more significant things that can be done in terms of prevention.
• 13:39
  Speaker 2: I mean teaching coaches.
• 13:42
  Speaker 2: They must pass a test now in order to be a coach.
• 13:45
  Speaker 2: They have to recognize the problems.
• 13:47
  Speaker 2: They have to be aware of all of these things and then do the.
• 13:51
  Speaker 2: The only way I know the line we're questioning, we're going down, is to eliminate the sport, don't play it.
• 13:57
  Speaker 1: No, and that's not the case.
• 13:58
  Speaker 1: What's wrong with flag?
• 14:01
  Speaker 1: Definitely do not play contact sports when you're a child.
• 14:04
  Speaker 1: I mean, what's wrong with flag, football, doc.
• 14:09
  Speaker 2: I'm telling you, there are concussive injuries.
• 14:13
  Speaker 1: You cannot right, but it's not an inherent part of the sport.
• 14:16
  Speaker 1: You don't get hit on every play and I think we can agree that if we're going to value our children in what we know now, not back in 1980, I mean, chuck Knoll was one of the greatest coaches ever to coach the sport, no doubt about it, and we love our football.
• 14:30
  Speaker 1: I mean, I've got tons.
• 14:31
  Speaker 1: I got NFL players, I got rugby players.
• 14:33
  Speaker 1: All my friends, man, a lot of them, are suffering severely.
• 14:43
  Speaker 1: The mental illness rate in the NFL right now is through the roof of retired people that are out there, retired players, and it's all because of exposure.
• 14:47
  Speaker 1: If we want to make football the beauty, if we want to even enhance football, which is a religion in this country, all these men, if they would have started at 14 instead of six and we could have changed and we could have, you know, just minimize the aggregate exposure, they'd be in a better place.
• 15:02
  Speaker 1: You have done amazing things in the sport right now to make it safer.
• 15:07
  Speaker 1: What?
• 15:08
  Speaker 1: But from a subconcussive exposure perspective, which is the actual risk?
• 15:12
  Speaker 1: Neuroinflammation, long-term neuroinflammation and the damage it does to critical brain structures is the risk to what you know, our, to our, both our military and our athletic populations, and we just got to make it a little bit safer.
• 15:26
  Speaker 1: The NFL is running down that road.
• 15:28
  Speaker 1: Unfortunately, 99% of our high schools today have contact practices all week long.
• 15:35
  Speaker 1: The NFL doesn't.
• 15:36
  Speaker 1: They've set the example.
• 15:37
  Speaker 1: Most of our colleges still have contact practices, unlike the NFL.
• 15:42
  Speaker 1: And then if you go down to the Pop Warner leagues, they practice all the time.
• 15:47
  Speaker 1: And so, to your point, we have been focused on concussions and their impacts for years.
• 15:52
  Speaker 1: We need to look at sub-incussive impacts, and we're all here to make our players and children safer.
• 15:57
  Speaker 1: So I think, like you said, there's compromise in how we start and play these sports and what we can do, and there's huge advances and you're on the top of them.
• 16:08
  Speaker 1: What are the advances you've seen?
• 16:10
  Speaker 1: From a medical perspective, that is, addressing, you know, the issue of some of the damages that the brain has undergone, or to help diagnose some of the damages that the brain is is undergone, or or or to help diagnose some of these players and get them back on their feet, cause you've gotten a large amount of players back on the field, haven't you?
• 16:28
  Speaker 1: I sure have.
• 16:30
  Speaker 2: And I've also told a few.
• 16:31
  Speaker 2: It's time to hang it up.
• 16:34
  Speaker 1: Good for you, cause when it's time to hang it up.
• 16:37
  Speaker 1: It is time.
• 16:38
  Speaker 2: Very high profile athletes that I've seen.
• 16:40
  Speaker 2: I've said it's time to go.
• 16:42
  Speaker 2: I don't want to go.
• 16:44
  Speaker 2: Well, it's your choice, but you know it's time.
• 16:47
  Speaker 2: You're going to end up with significant problems.
• 16:50
  Speaker 2: So again't go back until you get back to your baseline in terms of your memory, your processing of information, your reaction time.
• 17:21
  Speaker 2: In terms of your memory, your processing of information, your reaction time Before Bruce, as you know, athletes would go back into the game when their brain wasn't healed when it was still in flame and less force, less trauma led to more damage.
• 17:45
  Speaker 2: So by preventing that and with the NFL you have the blue tent you know this past week, you know the Steelers against Cincinnati the start fullback was pulled because he got hit in the head, didn't lose consciousness, but it needed to be evaluated.
• 18:00
  Speaker 2: Key player off, that's it.
• 18:03
  Speaker 2: So I think that's part of the prevention.
• 18:07
  Speaker 2: The other major advance I see coming and here is instrumented mouthpieces.
• 18:14
  Speaker 2: And when I say so, what's the significance of that?
• 18:18
  Speaker 2: So there's a company called Prevent Biometrics yes, sir, a couple of neurosurgeons and a bioengineer at the Cleveland Clinic and it's a mouthpiece, a mouth guard that everybody wears and contacts should wear and contacts sports.
• 18:33
  Speaker 2: It has triaxial accelerometers.
• 18:37
  Speaker 1: Yes, sir.
• 18:37
  Speaker 2: So it tells you, number one, where you got on an iPad or your iPhone on the sidelines.
• 18:45
  Speaker 2: It tells you where they got hit, the G forces of the hit in terms of linear and axial rotation, and also the number of hits.
• 18:58
  Speaker 2: So you have, from whatever age you start if it's 14, you have a diary of every hit.
• 19:08
  Speaker 2: You've had the G-forces of every hit and the location of that hit.
• 19:13
  Speaker 2: This is now available.
• 19:16
  Speaker 2: It's available.
• 19:16
  Speaker 2: World Rugby, bruce, to your credit and to your college credit, has adopted this now, universally, has adopted.
• 19:28
  Speaker 2: So it's mandated that rugby players at the international leagues wear these so you can see the cumulative hits and you have.
• 19:39
  Speaker 2: You know what a dosimetry badge is an x-ray yes, sir, I used to.
• 19:44
  Speaker 1: Well, I used to wear them for, uh, when I was looking for nuclear bombs during the invasion of iraq how much radiation you're getting.
• 19:54
  Speaker 2: yes, this mouthpiece is a dosimetry badge for concussions how many subconcussive hits you've had, the G-forces of those hits, and I think you know we will get to the point where we say, hey, it's time for you to hang it up.
• 20:12
  Speaker 2: You've had too many subconcussive hits.
• 20:16
  Speaker 1: And that's going to be an interesting conversation.
• 20:18
  Speaker 1: Doc, where do you think that range would be?
• 20:19
  Speaker 1: Because, like in dosimetry, I mean, there's's an agreed to limit that, all right, you can only have this many rads per year, right, once you hit that rad level, you can't.
• 20:30
  Speaker 1: You can't be around the machine, you can't be in the environment.
• 20:33
  Speaker 1: Uh, we're talking about, you know, sports, and this is.
• 20:36
  Speaker 1: This goes back to why we should be starting later in life, because if there is a cumulative amount that says, all right, you can't play sports anymore, we don't want that to happen in high school, we don't want to hit that limit in college.
• 20:50
  Speaker 1: We want to hit that limit when we're in our eighth year or tenth year in the NFL and we've got billions in the bank and, all right, I can go right.
• 20:57
  Speaker 1: And that's one of the aspects of starting exposure later on in life is we minimize damage to the brain, especially what is developing, and then we also we create this, you know gap where the brain can, while it's developing, gets less exposure.
• 21:15
  Speaker 1: So when it hits that cumulative amount now, they've already made their money.
• 21:19
  Speaker 1: But I think that you know, but those devices right now are only available at the team level.
• 21:28
  Speaker 1: You cannot buy them as a parent.
• 21:28
  Speaker 1: You can't get them, you know you can't make those available, but I think they.
• 21:32
  Speaker 1: That is a great start on understanding the importance of subconcussive trauma and tracking that.
• 21:39
  Speaker 1: What do you think the?
• 21:40
  Speaker 1: You know we've seen studies where you know a high school football team you know they've hit, you know 10,000, you know tens of, you know thousands of G-force, cumulative G-force, in just one season a year.
• 21:54
  Speaker 1: What do you think Is there and I'm not saying I'm not talking about the amount, I'm like do we have an idea of what that amount might be?
• 22:03
  Speaker 2: Doc, first, of all, bruce, let me help clarify things a bit.
• 22:07
  Speaker 2: The data that you're referring to 10,000 hits and all this stuff.
• 22:11
  Speaker 2: We're using accelerometers placed in helmets, which are now recognized as being very inaccurate.
• 22:20
  Speaker 1: Yes sir.
• 22:21
  Speaker 1: I understand that, yes sir.
• 22:22
  Speaker 1: I understand that, yes sir.
• 22:25
  Speaker 2: The hyperbole that has been used around, that in quotes data has been very misleading.
• 22:33
  Speaker 2: So that's why on a mouthpiece that's attached to your head, the accuracy is very, it's very accurate and they've compared them to the helmets with these hyperbole, hyperbolic numbers to the mouthpiece huge difference okay so we have, for the first time, accurate information.
• 22:59
  Speaker 2: world rugby, to its credit, has looked at hundreds of thousands of hits in rugby players and they've established the threshold.
• 23:11
  Speaker 2: For men it's around 70 g's.
• 23:15
  Speaker 2: If you're playing rugby and on the sidelines your trainer sees you had a 70 G hit, you're pulled.
• 23:25
  Speaker 2: And this is world rugby today You're pulled and you're examined.
• 23:30
  Speaker 2: Yes, sir, and they found individuals who denied they had a concussion because they wanted to play.
• 23:37
  Speaker 2: But when they're examined and asked what day of the month is it?
• 23:41
  Speaker 2: Who are we playing?
• 23:42
  Speaker 2: Who did we play last week?
• 23:44
  Speaker 2: What did you have for breakfast?
• 23:47
  Speaker 2: they've had a concussion, so they're out right I mean, I'm trying to, you know, put it in perspective for you, where oh?
• 23:54
  Speaker 1: no, I got, but for every 70 g hit and I think the nfl for concussion correct me if I'm not is 90 or 95G.
• 24:02
  Speaker 2: Let me clarify that 70G hit.
• 24:05
  Speaker 2: That's not a definitive figure.
• 24:08
  Speaker 2: It's a number that you look at the athlete.
• 24:11
  Speaker 2: You can get a concussion from a 35 or 40G hit.
• 24:17
  Speaker 1: Okay, very important.
• 24:18
  Speaker 2: Very, very important.
• 24:20
  Speaker 2: What does it mean to have a glass jaw in boxing?
• 24:26
  Speaker 1: It's the uppercut, you can't take a hit.
• 24:30
  Speaker 2: It's the uppercut you get hit in the jaw, your head rotates up quickly.
• 24:34
  Speaker 2: That causes rotational, actual rotation in the head and the brain.
• 24:39
  Speaker 2: That can cause a concussion and that's why that movement is more susceptible to producing a concussion.
• 24:47
  Speaker 2: So yeah, but we now have an accurate way to measure it and that's got to be continually refined.
• 25:02
  Speaker 1: But world rugby is leading the charge in this.
• 25:03
  Speaker 1: No, and there's I mean the, the there's no doubt that we need that type of data.
• 25:07
  Speaker 1: But when we have 170 g hit, or even 35 g hit, we also have all the other subcust of hits that take place during that time and hopefully there'll be, you know, one day, this number that we can accept.
• 25:19
  Speaker 1: That is going to either, you know, end a rugby player's season or possibly their career, in the benefit of, you know, saving their lives or, you know, enhancing their future.
• 25:30
  Speaker 1: So those are a remarkable, you know, I mean that's a remarkable improvement in how do we track this?
• 25:36
  Speaker 1: And then we, if I may, may.
• 25:40
  Speaker 2: I know our time's limited, but I I wanted to bring something up else up.
• 25:44
  Speaker 2: Yeah, in terms of so I'm all with you, a million percent.
• 25:49
  Speaker 2: How do we prevent it?
• 25:50
  Speaker 2: What can we do to make it safer?
• 25:51
  Speaker 2: My whole 45 years in sports has been to do that yes, sir.
• 25:58
  Speaker 2: The other question is how do we diagnose CTE?
• 26:02
  Speaker 2: How do we diagnose the problem when we know CAT scans and general MRIs are normal, despite significant neurological deficits?
• 26:12
  Speaker 2: So I've been working with a brilliant neuroscientist from India by the name of Pravat Mandel, neuroscientist from India by the name of Pravat Mandal, and we've published several papers now showing that in patients with mild cognitive impairment, alzheimer's disease and Parkinson's disease, there's a marked deficiency of glutathione in the brain.
• 26:38
  Speaker 2: Glutathione is the primary antioxidant in the brain.
• 26:43
  Speaker 2: So if there's a deficiency and this has not been shown before if there's a deficiency of glutathione, what does that mean?
• 26:54
  Speaker 2: Well, what that means are you familiar with free radicals, oxidative stress, when you're hit in the head, when I'm hit, anybody's hitting the head, oxidative stress is a major component of tbi.
• 27:12
  Speaker 2: Okay, yes, sir.
• 27:14
  Speaker 2: So if what that means is your mitochondria take oxygen and glucose to make energy, atp.
• 27:24
  Speaker 2: In doing so, these free radicals, which damage DNA, protein and fat, these free radicals are equalized with antioxidants.
• 27:36
  Speaker 2: This is oxidation and these are antioxidants.
• 27:40
  Speaker 2: This is oxidation and these are antioxidants.
• 27:42
  Speaker 2: Lutathione is an antioxidant that squelches the free radicals and prevents brain damage With me.
• 27:48
  Speaker 2: Yes, sir.
• 27:50
  Speaker 2: So if oxidative stress is one of the main factors in TBI, what we intend to do and what we're doing with a grant from the Chuck Knoll Foundation, by the way.
• 28:05
  Speaker 2: We're going to take a cohort of NFL players who have symptoms behavioral symptoms or neurocognitive symptoms and we're also going to take a group of Navy SEALs or other military personnel.
• 28:26
  Speaker 1: I'll find you all the green berets you need.
• 28:29
  Speaker 2: I'm telling you this for a reason.
• 28:30
  Speaker 2: We're going to do this study.
• 28:34
  Speaker 2: We're going to put them in an MRI scanner, them in an MRI scanner and, with the technique that's been developed by Dr Mandel, measure the glutathione in the brain.
• 28:48
  Speaker 2: We anticipate our hypothesis is just like in Alzheimer's disease the oxidative stress from TBI is going to have a low glutathione.
• 29:01
  Speaker 1: No doubt.
• 29:02
  Speaker 2: If the low glutathione is there, number one, that's never been documented non-invasively before.
• 29:10
  Speaker 2: Okay.
• 29:10
  Speaker 2: Number two can we replace the glutathione and maybe have some therapeutic effect?
• 29:18
  Speaker 2: Okay, so in Parkinson's disease, what's the deficient neurochemical, the neurotransmitter?
• 29:27
  Speaker 2: It's dopamine.
• 29:30
  Speaker 1: Okay.
• 29:31
  Speaker 2: In Parkinson's.
• 29:32
  Speaker 1: Yes, sir.
• 29:33
  Speaker 2: What is given to treat Parkinson's is L-dopamine, a precursor to dopamine.
• 29:38
  Speaker 2: Because dopamine won't get through the blood-brain barrier.
• 29:42
  Speaker 1: Okay.
• 29:43
  Speaker 2: Well, there's a precursor also for glutathione called gamma-glutamylcysteine.
• 29:49
  Speaker 2: So again, I'm telling you this because we are going to be recruiting to the University of Pittsburgh for an IRB approved.
• 30:03
  Speaker 2: We are submitting the IRB now but we're going to be looking to evaluate.
• 30:11
  Speaker 2: I don't know if you saw that article in the New York Times about the Navy SEALs in the high-speed boats.
• 30:18
  Speaker 2: Yes, sir 0.60 miles an hour over waves.
• 30:23
  Speaker 1: Shaking their brains.
• 30:24
  Speaker 2: You talk about subconcussive blows.
• 30:27
  Speaker 1: Absolutely sir.
• 30:28
  Speaker 2: Bam, bam, bam, bam, bam, bam bam.
• 30:30
  Speaker 1: Yep.
• 30:30
  Speaker 1: Just like rugby, just like football, just like hockey.
• 30:34
  Speaker 1: It's bam bam bam.
• 30:35
  Speaker 1: Yes, sir, absolutely.
• 30:37
  Speaker 2: And these poor military.
• 30:39
  Speaker 2: As you said, it's epidemic in terms of cognitive and neurobehavioral problems.
• 30:47
  Speaker 1: Yes, sir.
• 30:47
  Speaker 1: Well, I think that's going to be.
• 30:49
  Speaker 1: When's that study supposed to take place, sir?
• 30:52
  Speaker 2: We hope to do this beginning in February, march of this year, so I'll let's you and I be in contact, okay.
• 31:02
  Speaker 1: Absolutely that's going to be.
• 31:04
  Speaker 1: I mean because you're talking about addressing the number one problem that we have from what we call RHI or RBE, which is that neuroinflammation, that toxic environment that degrades the critical structures of brain and leads to those behavioral, psychological and cognitive disorders that you're identifying?
• 31:23
  Speaker 2: You know better than I, there are 20 to 22 veterans a day commit suicide.
• 31:29
  Speaker 1: Dude.
• 31:29
  Speaker 1: I mean, yeah, I know very well and we're trying to address that.
• 31:33
  Speaker 1: And part of that problem is we're not looking at that component of their military service.
• 31:39
  Speaker 1: We're giving these guys tons of drugs.
• 31:41
  Speaker 1: They're mentally ill.
• 31:42
  Speaker 1: I mean, you know the NFL players that we talk to all the time.
• 31:46
  Speaker 1: You know they've got anxiety, they got a lot of, they got a lot of disorders that are treatable, but they're not being treated correctly because we give them the FDA approved there is some SSRIs, snis, whatever instead of looking, hey, man, we got to address this toxic environment.
• 32:02
  Speaker 1: That's been creative because of your dedication to the sport.
• 32:05
  Speaker 1: So let's do, let's look at this, and that's what you're doing, doc, is you're addressing that environment and making it better, which is going to have an enormous impact on these players.
• 32:14
  Speaker 1: It's uh, and again, hats off to you.
• 32:17
  Speaker 1: That's going to be an amazing study and I'll definitely um, you know, I'll definitely be reaching out to you on that to see what we can do to work together.
• 32:25
  Speaker 1: And and what else are you saying you're heavily involved?
• 32:28
  Speaker 1: Were you heavily involved with HBOT or did I see you at the?
• 32:33
  Speaker 2: that's the other thing I really would urge consideration.
• 32:37
  Speaker 2: I've seen personally a Navy SEAL who was in Iraq for destinations and a Navy SEAL who was in Iraq for destinations and he was a breacher and lots of exposure and just hundreds of and he taught breaching and really significantly affected with PTSD and post concussion syndrome.
• 33:05
  Speaker 2: I mean very, very significantly.
• 33:06
  Speaker 2: And he was treated at the Aviv Hyperbaric Center in the villages in Florida and really a very dramatic response to that.
• 33:18
  Speaker 2: And the scientists there one is another neurosurgeon, amir Hadani, who's a brilliant neurosurgeon, have written papersdani, who's a brilliant neurosurgeon, have written papers and published peer-reviewed articles on the treatment of PTSD and post-concussion syndrome with hyperbaric oxygen therapy.
• 33:37
  Speaker 2: So it's something that the government and the insurance companies will pay for.
• 33:44
  Speaker 2: Hyperbaric oxygen if you have a diabetic wound, an ulcer that won't heal of your foot or a fracture that won't heal of your extremity, they're not covering wounds of the brain and it's wounds of the brain that I think also hyperbaric oxygen therapy has tremendous value and again, when used properly, the right number, the right atmospheres and hyperoxia.
• 34:15
  Speaker 2: So again, these are areas of, I think, improvement that can really change people's lives improvement that can really change people's lives.
• 34:27
  Speaker 1: Oh, absolutely.
• 34:28
  Speaker 1: I mean when we met, we were with you know, an NFL player who's absolutely said his life was, you know, changed from hyperbaric oxygen photobiomodulation.
• 34:36
  Speaker 1: You know all these non-FDA approved modalities that are out of pocket for everybody in this country.
• 34:41
  Speaker 1: And your comment that insurance will only pay it for this but not for the brain is one of the problems that I think we need to address in this country is that we know that we create these toxic environments through sports and military service.
• 34:56
  Speaker 1: Nobody can doubt that.
• 34:57
  Speaker 1: The science there, the research there, no problem.
• 35:00
  Speaker 1: How do we make this better?
• 35:01
  Speaker 1: And it's not drugs, it's treatments like you're talking about, innovative treatments that are coming in with new technologies, new modalities, different uses of common nutraceuticals or whatever to improve the brain health so that the damage stops and, of course, hopefully the individuals stop beating their brains around too.
• 35:21
  Speaker 1: Right, that doesn't hurt, but sometimes, when we're in the middle of our NFL career or we're an active duty service member, there is no stopping.
• 35:29
  Speaker 1: Okay, we still got to do our time, we still got to play our game.
• 35:32
  Speaker 1: All we can do now is focus on making this better, and it's efforts like yours that are doing that.
• 35:37
  Speaker 1: And that's what's important to our viewers to know that if they are that kid that started way young and he's in his 30s or 40s and he's got psychological or behavioral challenges, well you're not crazy.
• 35:51
  Speaker 1: To your point, nobody touched you when you were a kid.
• 35:54
  Speaker 1: You have a damaged environment that needs to be addressed and there's new ways to do that now and that's what we're hoping that doctors like you can succeed in not only providing these modalities, but now we got to work with and just so you know that you know doctors like you can succeed in not only providing these modalities, but now we got to work with.
• 36:07
  Speaker 1: You know, and just so you know, doc, I mean TBI is now listed as a chronic condition, right?
• 36:13
  Speaker 1: So now you know TBI and especially repetitive exposure to TBI from contact sports and military service should now allow us to start covering under the TBI billing codes HBOT, photobiomodulation you know some of these other.
• 36:29
  Speaker 1: You know, like you're talking about nutraceuticals, right Precursors, so that the body can naturally develop chemicals that can get across the blood-brain barrier and improve the brain health of their individual.
• 36:42
  Speaker 1: So we're hoping are you having any luck with these, you know getting any kind of coverage for brain health under the TBI codes or super billing or anything like that.
• 36:53
  Speaker 1: Have you had any success?
• 36:54
  Speaker 2: Because a lot of people there are a couple of states I think Florida is one that's going to be leading the charge Kentucky and others who are approving it for veterans.
• 37:05
  Speaker 2: You know we start with these.
• 37:07
  Speaker 2: I mean you're people like yourself, who I'm sitting here in a free country, able to express whatever opinion I want.
• 37:16
  Speaker 2: People like you and myself.
• 37:19
  Speaker 2: I served as well, but you know my heart goes out to these veterans that I meet.
• 37:27
  Speaker 2: Who I mean?
• 37:29
  Speaker 2: Look at the recent catastrophes this fellow recently introduced.
• 37:36
  Speaker 1: Clearly yeah.
• 37:38
  Speaker 1: It's tragic and thank you for your service, by the way, but he's been.
• 37:44
  Speaker 1: You know, as we find out more and more, this gentleman and I'm not calling him a gentleman, but this person who blew himself in that truck is representative of a lot of veterans out there, not just special operations guys either, that we find that we deal with, that need better treatment and that's why, talking to you and figuring out ways not only to help, you know, our athletic population, but our veteran population, they've done nothing wrong.
• 38:12
  Speaker 1: These kids joined the military to defend us, right.
• 38:16
  Speaker 1: I've been retired 23 years, right.
• 38:17
  Speaker 1: These kids joined after I retired, right, and their only crime was they did what we asked them to do and now they're out there.
• 38:24
  Speaker 1: Everything's out of pocket.
• 38:26
  Speaker 1: You know.
• 38:26
  Speaker 1: We know we know soldiers right now that are mortgaging their homes to get hyperbaric oxygen treatment, to buy their own tanks, to, you know, to do, to go the psychedelic pathway, to do anything to improve their, to their room, to improve their brain.
• 38:41
  Speaker 1: Well, so you know, definitely want to stay in touch with you on that, on the billing part of that, because, yeah, it's they.
• 38:49
  Speaker 1: We lost the estimates right now.
• 38:50
  Speaker 1: We lost a little under 10,000 kids in those two, in my opinion unnecessary wars.
• 38:54
  Speaker 1: We've lost 130,000 plus to suicide, and it's just, and it's because we have not changed how we deal with mental illness and we have to look at modalities.
• 39:05
  Speaker 1: Like you Now, we might disagree on when you can start playing contact sports and the impact of contact sports, but I think we can all agree that we need to do a better job.
• 39:15
  Speaker 1: When we have patients that are suffering either from you know, repetitive impacts in contact sports or repetitive blast exposure, they need better treatment and the treatments are there.
• 39:24
  Speaker 1: That's what's killing us, doc, is that treatments like yours are available if you have money Right, and that's the paradigm that we're trying to shift right now is that we understand that, hey, man, you played a lot of sports.
• 39:39
  Speaker 1: Man, hey, you played a lot of.
• 39:40
  Speaker 1: You know, you were 22 years in the military.
• 39:43
  Speaker 1: Whatever it is right Now, we got to get you back.
• 39:46
  Speaker 1: We got to get you back to your families, get you back to your friends, and you are doing an amazing job at helping these men and women get back.
• 39:58
  Speaker 2: I'm an octogenarian, so I have you by a few years.
• 40:02
  Speaker 1: Just a couple, sir.
• 40:03
  Speaker 1: Yeah, I'm hoping to get there.
• 40:05
  Speaker 2: There's days I doubt I'll get it, but good good to you for helping number sticks in my throat so I have to sell off.
• 40:10
  Speaker 2: But it's what's really motivating me now that the conversation we're having and and what I see in terms of the mental health crisis at every level, at all levels, and how we have so little knowledge of how the brain works.
• 40:34
  Speaker 2: Shakespeare said how do you pluck from memory some rooted sorrow and erase the written troubles of the mind?
• 40:43
  Speaker 2: And pluck, you know, pluck from memory a rooted sorrow.
• 40:48
  Speaker 2: When this gets encoded into our emotional system, our amygdalas, it very little can erase it at this point.
• 41:01
  Speaker 2: Anyway, we get off on tangents, but you're doing and you know we get off on tangents, but what you're doing and you know we're on the same page totally in terms of prevention and also you know what keeps me really motivated.
• 41:14
  Speaker 2: I can't wait to get to work each day because of what I see are just horrific consequences of emotional and traumatic brain injury.
• 41:30
  Speaker 1: Yes, sir, now we know that the leading indicator, the only thing we have to know that the brain's being harmed right now, is that mental, cognitive or psychological state, because we can't see in the brain and you're helping us deal with that and it's amazing what you've done.
• 41:45
  Speaker 1: Dr Maroon, as we close out, tell people how to find you what's next.
• 41:50
  Speaker 1: I mean, obviously we got the study.
• 41:51
  Speaker 1: How do they find out about the Aviv Clinic and the amazing work they're doing down there?
• 41:55
  Speaker 1: Where would they go?
• 41:56
  Speaker 2: The Aviv Clinic.
• 41:57
  Speaker 2: It's online avivclinicscom, and, in terms of hyperbaric oxygen therapy, I can be reached through them.
• 42:18
  Speaker 2: You know online myself, josephmarooncom, my website contact information, and you know I applaud what you're doing and getting information out to those who really need it, and you're obviously very passionate about what you do as well, so we're brothers in that regard.
• 42:35
  Speaker 1: Yeah, we are man and I can't wait to see you again.
• 42:37
  Speaker 1: I live close by, so I'll be out there.
• 42:39
  Speaker 1: Dr Maroon, thank you so much.
• 42:42
  Speaker 1: Congratulations on your amazing journey, your amazing career and what you're doing for those that have been affected by the plague.
• 42:49
  Speaker 2: Thank you, sir All right.
• 42:50
  Speaker 1: Thank you so much.
• 42:50
  Speaker 1: All right, we're going to our viewers today.
• 42:52
  Speaker 1: Thank you so much for another amazing podcast.
• 42:54
  Speaker 1: Don't forget go to the website, Download your free book Broken Brains.
• 42:58
  Speaker 1: Read it so that you're informed.
• 43:00
  Speaker 1: Follow Dr Maroon man.
• 43:02
  Speaker 1: He's on the cutting edge of helping our brains get better.
• 43:04
  Speaker 1: Thank you, Thank you.