Remaining True to Yourself Post-Concussion with Dr. Cheryl Mitchell
Show Notes:
One of the biggest problems for concussion survivors is the loss of feeling like themselves. Today, we are joined by Dr. Cheryl Mitchell, a physical therapist who specializes in concussions and post-concussion syndrome. Dr. Mitchell suffered for five years after experiencing a concussion and was dissatisfied with the treatment (or lack thereof) that she received at the time. She has made it her mission to educate and treat concussions to ensure that survivors can recover and get back to being themselves as soon as possible!
In this episode, Dr. Mitchell explains what poly impact syndrome is and tells us what her opinions of the medical system are today. Next, we discuss the fundamentals of concussions that survivors should be aware of before going through the four Ps of recovery. We find out why stimulation can be overwhelming for survivors, delve into why remembering that you are still human and maintaining your sense of self is imperative when faced with any illness, and Dr. Mitchell outlines the differences between the two types of concussions before explaining what the vestibular system is. You’ll also discover how important it is to have personal goals when recovering from a concussion and why choosing the right physical therapist is important and Dr. Mitchell gives survivors hope that they will recover! Join us to gain some insight into maintaining your identity post-concussion!
Key Points From This Episode:
• Introducing Dr. Cheryl Mitchell and her personal experience with concussions.
• What poly impact syndrome is.
• Dr. Mitchell’s opinions of the medical system today.
• Fundamentals of concussions that survivors should be aware of.
• The four Ps of recovery: plan, pace, place, and prioritize.
• Why stimulation can be overwhelming for people suffering post-concussion.
• The importance of maintaining your identity as a person when you get ill.
• What concussion connect is all about.
• Discussing the often ignored labyrinthine (inner ear) concussion.
• How to know the difference between a labyrinthine and cortical concussion.
• What the vestibular system is and why survivors need to address it.
• Special topics that Dr. Mitchell gets into with concussion survivors.
• The importance of having goals when recovering from a concussion.
• Choosing the right physical therapist to help you recover.
• Dr. Mitchell provides survivors with a sense of hope that they will recover!
Get in contact with Dr. Cheryl Mitchell
Email: dr.cheryl.pt@gmail.com
Website: inspirationptc.com
Instagram: @inspirationptc
LinkedIn: https://www.linkedin.com/company/inspiration-physical-therapy-and-consulting
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Transcript - Click to Read
[INTRO]
[00:00:05] BP: Hi. I'm your host, Bella Paige. Welcome to the Post Concussion Podcast; all about life after experiencing a concussion. Help us make the invisible injury become visible.
[DISCLAIMER]
The Post Concussion Podcast is strictly an information podcast about concussions and post-concussion syndrome. It does not provide, nor substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice, or delay in seeking it because of something you have heard on this podcast. The opinions expressed in this podcast are simply intended to spark discussion about concussions and post-concussion syndrome.
[EPISODE]
[00:01:04] BP: Welcome to today's episode of the Post Concussion Podcast, with myself, Bella Paige, and today's guest, Dr. Cheryl Mitchell. Dr. Mitchell is a graduate of Chatham University, Doctor of Physical Therapy Program. Cheryl has been a leader in her field with more than 10 years of experience dedicated to providing the highest quality of care. She has achieved multiple certifications and concussion-related management. Passionate about concussion management after sustaining a concussion herself. Cheryl has made spreading the word on concussions, prevention of concussion, and post-concussion management a priority and focus. She co-designed and pioneered a concussion program to increase awareness of concussions to the community, physical therapists, occupational therapists, MDs and more.
She has written numerous credentialed continuing education courses and continues to make it one of her goals to continue to promote proper evidence-based management of concussions. With the founding of Inspiration Physical Therapy and Consulting in 2022, Cheryl is dedicated to using her physical therapy skills, leadership program resume, concussion knowledge to help others achieve their own goals. Welcome to the show, Cheryl.
[00:02:14] CM: Thank you so much for having me today, Bella.
[00:02:16] BP: To start, do you want to tell everyone a little bit about your own concussion experience?
[00:02:22] CM: Absolutely. That's actually why I treat concussions now. I was actually at work. I'm a doctor of physical therapy and I was only about a year out of school. I was assisting with a patient and ducked under the parallel bars, but didn't actually make it under the parallel bars and instead hit the side of my head on the parallel bars really hard. They're the sturdy ones that don't move at all. I immediately kind of fell to the ground, I pulled myself up onto a low mat table. I had three patients I believe I was treating at the time, and being a relatively new graduate, I didn't want them to know that there was an issue. I finished out the hour even though I couldn't see straight. Then, I went home for lunch and decided to pull out my graduate textbooks and try to look up concussions because I was dusting off some cobwebs. Went back to work, finished out the day, thought I was going to be fine.
Two, three days later, I realized that I still had nausea, I still had headaches, I still was a little bit dizzy. I just wasn't quite feeling right. I talked to my husband and we decided to take me to a walk-in clinic. This injury had happened at work, but because I was again a new grad and had just started with this company, I didn't want to go through the work comp system if I didn't have to. I went to a walk-in clinic and got the advice that would change the rest of my life for the worse, but hopefully change other people's life for the better. The doctor took a quick look at me said, "Concussions are nothing to worry about." I said, "Can I run? I'm a runner." He said, "If you can balance, you can run." I said, "Great." I went home and the next day, I went for a run, which is probably the worst thing that I possibly could have done.
Now, looking back on it, I understand that I gave myself poly impact syndrome because I was still in that recovery phase post-concussion, still was extremely symptomatic, but I really thought that if I could push through that run, then I could go ahead and do it. That obviously didn't go so well. The next week, I ended up reporting it and started the work comp system of the doctor telling me to, "Wait and see. Here's some medication. Wait and see. Here's some medication." That's how the next nine months of my life went.
[00:04:46] BP: The merry-go-round.
[00:04:47] CM: Yes.
[00:04:47] BP: Because you just get on and off with different meds.
[00:04:50] CM: Yes, 100 percent yes. The neurologists would enter my room. My husband always went with me because my memory was terrible and he would not remember anything from the prior session. This is coming from a concussion patient saying this. It was, "Why are you here again?" I would explain why I was there, the symptoms I continue to have, I had them all written down, my husband was there to support me. He would say, "Just wait and see. What do you want me to do? Here's some more medication." He continued with that until I eventually requested my one-time change of physician, and I went to a different doctor.
Long story short, it took me five years to recover from my concussion. That included having to mitigate my work schedule, having to change what I was doing throughout the day and for the week. Because by the time I got to the weekends, I was completely spent, and my symptoms were flared up, and I'd have to spend the entire weekend resting and recovering before trying to go back to work. I wasn't able to go to church because of the music and the sound, wasn't able to run, walk, go for workouts. When I did eventually get better five years later, which was just time. I said, "I'm not going to let this happen to anyone else. I'm going to do everything I can as a doctor of physical therapy to try to change how concussions are viewed in the medical system, and to hopefully help prevent this from happening to somebody else, so nobody else loses five years of their life."
After that, I wrote a concussion program for the company that I was working for, and proceeded to present that along with one of my colleagues, his name is Brian Anderson in six different states in our first year. We presented it for nurse case managers, physicians, marketers. We started to write a continuing education for lawyers as well. But then COVID happened, so that [inaudible 00:06:43] that. Now, we're actually working on a certification, or we did launch the certification portion of that. Now, in order for our program to be complete, you do a level one fundamentals of concussion, a level two, which is vestibular, and then level three, which is advanced concussion and certification. Then we present that throughout the eastern part of the United States.
[00:07:07] BP: Yeah. I think it's wonderful that you've turned it into something so helpful and beneficial for others. I thought it was really funny when you mentioned you pulled your textbooks out, because mine are in the basement at my mom's house in bins and I've never pulled them out. I still question why I still have them sometimes. You mentioned poly impact syndrome. Can you explain that a little bit more in detail, so our listeners understand what that means?
[00:07:35] CM: Absolutely. Originally, poly impact syndrome was called second impact syndrome, but actually changed the name of it in the literature recently, because they realized that they don't actually know how many potential injuries you have. The second impact syndrome makes it sound like you only had two injuries. Whereas anytime you actually have a second concussive or subconcussive, which means that you didn't quite have enough of a movement or an impact to create another concussion, but just below it. That can all impact. It has to do with how your brain is metabolizing and the different mechanics that are going on in the brain after a concussion.
With poly impact syndrome, anytime you have that second concussive or subconcussive event after your original concussion, while you're still symptomatic, it can completely multiply the effects of the original concussion and cause your brain to go even to more of kind of a tail spin metabolically while it's trying to recover.
[00:08:36] BP: Yeah. Well, thank you so much for explaining. I just like to go over terms that I think of and I'm like, "Some people might not know what that means," so always important to go over it. That is why it is so important, especially for athletes to take breaks after concussions, because that's where you definitely increase your risk of that other impacts. It took five years to get better, you put a lot of the credit to time as I do as well for a lot of my recovery. I was just wondering, what are your current views on the medical system? Do you think it's gotten better since you started or how do you think it's going?
[00:09:17] CM: I actually do think that it is better than it was. I think that we still have a long way to go. I think that 10 years ago when I had my concussion, it still was very unknown that physical therapy could even help people post-concussion. It was still a lot of that old wait and see, sit in a dark room for two weeks, which are now has been completely disproven as to be effective. You still want to have those periods of rest, but it's certainly not going to help you to lay in a dark room for two weeks. Who wouldn't be depressed or anxious after laying in a dark room for two weeks?
I think that we continue to have a battle in front of us with getting the information out there to the medical professionals, but also to your athletes, your elderly, your family of elderly, your people post car accident, post dirt biking accident, perhaps may have had an effect of a concussion. There's still a lot of myths out there with concussions as well, such as the, don't fall asleep after a concussion, whereas the brain actually needs a lot of rest after a concussion. That's more to prevent somebody who cannot physically stay awake, which means that there's something more going on than just a concussion in their brain, that that's a medical emergency you need to take them to the ER. If you just go home, and you're tired, and you need to take a nap, that's a good thing for your brain to recover.
[00:10:41] BP: Now, I like that you point that out. I also think it's better. I started this about 10 years ago, as well and all of my concussions, the majority of them occurred before that 10 years. Nobody said anything about any of them. You have to make that piece of paper in the ER that said, about two weeks, and it was like a rest for this, do this. I remember I got a concussion and I was at a horse show the week after, riding and competing all week long. Because it said like a week to two weeks, so I rested the week before and went back to it the week after. I'm very lucky I didn't fall off or get hurt that week. But it's interesting how much it's changed, I'm glad it's changed.
Cheryl did mention the dirt biking because I'm in a sling right now as most of you would know if you follow the podcast on social media because I crashed your bike the other day and put myself in the hospital. Sometimes that happens, but I really want to get into – you're talking about this program and course that you run, and I wanted to start and kind of go through the stages of it, actually. But in snippets, a little bit more of layman's terms of what we can offer to our listeners. We're going to start with fundamentals of concussion that you think survivors should be aware of.
[00:12:03] CM: First of all, the most important factor in any concussion management is education. Understanding that your injury is real, even though it is a functional injury and not a structural injury, which means it's not going to show on a CT or an MRI. It has to do with how your brain talks to each other and how it communicates and all the different molecules in your brain, and what has too much or too little of the different molecules affects how the brain can operate. One of the first things that I tell my patients is to use your four P's, which is planning your day, pacing your day, thinking about the place that you're doing, your activities, and then prioritizing the activities in your day that are important to you. Then I use a battery analogy, where you start your day with a full charge, and a normal battery and somebody who isn't post-concussion might last for the whole day before you need to go to bed.
Somebody who has a very severe concussion, that battery might last from the time that they wake up to the time that they come out and get their coffee from the kitchen. Then they might need to go and take that rest break. So yes, dark rooms are good for concussions, but in small amounts. As soon as that battery level goes down, that's when you want to go take your break. By prioritizing your day, you want to think about what's important to you as a person. It might be a doctor's appointment, it might be your child's soccer game, it might be a dinner with your spouse, it's whatever is important to you. You want to make sure that you're okay for those activities. Depressions are highly correlated with depression and anxiety. The more you can let yourself be a person, the easier recovery is. You don't want to take yourself out of all of the activities that you love doing. You need that passion, and you need that drive, and you need that connection and that support in order to continue to get better.
However, you don't want to be doing the activities that might put you in that poly impact phase. Go to football practice with sunglasses, and a visor on, and sit on the sidelines and chat with your friends. Don't go play tackle football. There's a difference between mitigating the symptoms. Kind of a long answer to a short question, the fundamentals of concussion course focuses on, first of all, the importance of that education and how to talk to your patients post-concussion, what to look for, how to advise them. Then I teach our physical therapists to look at concussions in kind of a multifaceted approach. They're going to look at the cognitive aspects.
Is the patient having problems remembering, concentrating, doing schoolwork, reading? Are they having problems with their emotional? Are they more irritable than they were before? Are they anxious? Are they depressed? How about physically? Are they having headaches? If they're having headaches, what type of headache are they having? Is it a migraine? Is it coming from the cervical spine? Is it in the temples from something going on with the jaw? And how to differentiate those different headaches out, looking at the vestibular system, which is kind of your system of your inner ear that helps you with balance and knowing where you are in space. Is that a deficit? Looking at the overall balance system. Then, of course, the cervical spine itself. It's really breaking it out.
I would encourage your viewers or your listeners, that if they're looking for a physical therapy program to make sure that it's going to affect the whole body, and it's going to look at everything, not just somebody who knows how to treat the vestibular or the inner ear system. Because a concussion is so much more than that. If they're only treating vestibular, they're missing a lot of your recovery.
[00:15:51] BP: Now, it's important to understand how technical it is, and how much it really does affect everything you do. I love the four P's. Can you say them again? It was planning –
[00:16:03] CM: Pace.
[00:16:04] BP: Pace.
[00:16:05] CM: Place.
[00:16:06] BP: Place That's the one.
[00:16:08] CM: And prioritize.
[00:16:09] BP: I love that.
[00:16:11] CM: The importance of place is because one of the issues post-concussion is that your brain can no longer filter out stimuli. What that means is, you walk into a rose garden, somebody not concussion, you smell the beautiful roses. Five minutes later, you don't even smell them anymore. Your brain filters out that stimuli. Or if you go to a restaurant, and the AC is really loud, you hear it for the first few minutes and then your brain filters it out. Post-concussion, you can't filter out like that. All of those little things that normally you don't even notice become overwhelming to the brain. That's why walking into a mall with high ceilings, and all of this stimulation hitting you all at once can be so overwhelming and so triggering. Or why walking into a noisy restaurant can be so overwhelming. Whereas, walking outside isn't as bad, because it's not all the sound and everything bouncing off the wall.
Place kind of symbolizes, okay, well, if you need to work, if you need to be able to produce money to be able to pay your mortgage, to be able to put food on your own table, then what can you change about the place that you're working? Not meaning quit your job. That might be warranted too, but can you set up your computer in a dark room away from noise and stimulation? If you're a receptionist, are you able to work in the back on authorizations or some back-end stuff instead of being patient or client focused? Changing those little things about your environment can help to decrease those triggers and help your battery to last longer.
[00:17:48] BP: For sure. Another thing that really helps is getting rid of overhead lights if you can, especially if you work in your own office or a setting like that. Get some lamps and put them lower, because I find that makes a huge difference for myself as well. When working, I rarely put the overhead lights on. I usually just have lamps in the corner. I really like the prioritizing, because we talk about that a lot on the podcast. For myself, being an athlete is really important. It's a really big passion of mine to have a hobby, or a sport that I'm working towards other than my work and the rest of my life and I like that escape. Sometimes, it's a lot of give and take if I want to dirt bike. Nowadays, I don't really have to stress about it. But before, if I chose to do dirt biking for one day, well, that's okay. But that means I'm doing nothing tomorrow.
Where now, I'm in that place I can do it a few days in a row and be totally okay, which is a great feeling. Didn't used to be like that. Or you talked about that filtering. That was something where I started to learn that I was doing better because I could sit on the vacation I just went on where I got hurt in a room. I have a very large family and everyone was talking, and making dinner and my brother comes over to me and he's like, "You couldn't read right now." I was like, "I can. How exciting is that?" He's like, "I can't with all the noise." I was like, "I used to be able to." As a kid, I used to sit there with all my loud siblings and I was a book nerd, so I would just sit there and read books and I could not hear any of them. I finally got that back where I could filter them all out, ignore them all, and carry on with my book. It's a really good feeling, but it takes time to get there.
You have to be really honest with yourself. I know I pushed myself way too many times way too far. Because one day would be good, and then I kind of started in this file where I would just think every day was good, and I just ignore all my symptoms, and then I'd crash in about a month or two. Whoa! I've been doing way too much. Pacing yourself is really important. You are a person, very important point that you mentioned. Do not forget. Sometimes we get carried up in our own illness and forget that we are human as well. You can actually learn more about Dr. Cheryl Mitchell's work and connect with her at inspirationptc.com, which of course you can find in our show notes, episode description and everywhere else. But with that, we're going to take a quick break.
[BREAK]
[00:20:21] BP: It has now been over two months since Concussion Connect has launched and it is continuing to grow every day. Just like last month, we have a new topic. This month's topic is depression. Though a very sensitive topic, I believe it is so important for us to talk, be open about our mental health. If you have questions about your mental health, or need someone to talk to, join concussionconnect.com today or find the link in our episode description.
[EPISODE CONTINUES]
[00:20:54] BP: Welcome back to the Post Concussion Podcast with myself, Bella Paige and today's guest, Dr. Cheryl Mitchell. We were talking on the break a little bit about how when you get ill, something that I've noticed with a lot of survivors is we start to over identify with our illness, and start to not be able to step away from it, especially when you are starting to get better. I was going to let Dr. Mitchell talk a little bit more on that.
[00:21:22] CM: It's really important with anything going on in your life, whether it's a concussion, or whether you were diagnosed with Parkinson's or Ehlers-Danlos Syndrome that you maintain your identity as a person. It's called being like patient-first language. You're not a concussion, you're not a broken shoulder, you are Bella, who happens to have a concussion right now that's going to be temporary in nature and you are going to get better. That being said, it's so important to have supportive communities, like Bella. But at the same time, when you want to find that camaraderie with your fellow post-concussion, people don't forget that you're still your own person. Don't lose your interests, don't lose your family interactions, your sports interactions, those things that you love. That's where the four Ps comes in, that we were talking about earlier, where you can really plan your day, so you can prioritize those things that are so important to you and that make you you.
What makes you you for Bella might be reading a book or doing dirt bikes. What makes me me is playing with my little kids, or going for a walk outside. Maybe it's going to the beach, maybe it's going on a porch swing. You might not want to rock too much if you're having dizzy symptoms. But to remember that you are still you, and you are not your illness, and you're going to get over this, and you're going to get better and there's a light at the end of the tunnel.
[00:22:51] BP: Yeah. There really is. I like that you mentioned a lot of that because on Concussion Connect our support social network. We actually do a weekly check-in and it's not just about your symptoms and your injury. It's about just your life, you as a person. Just the other day, we had one about a wind from the week and some of the winds were totally unrelated. People went to concerts, and had fun things that they got to do with family and just remembering all those other aspects of her life other than therapy and being ill.
The next thing I want to talk about, you mentioned the vestibular system, but I'd like if we could talk a little bit more on what the vestibular system is and kind of why we address it as survivors and as clinicians.
[00:23:38] CM: Okay. Before we get into the vestibular system, if it's okay, I'm going to take a quick step backwards. Most people think about concussions as being what's called a cortical concussion, which is kind of the main part of your brain and the main part of your head that everyone pictures when it comes to concussions. But you can actually have a concussion on your inner ear too, and that's called a labyrinthine concussion. You don't need to know that term, don't worry. We just know that there are two types of concussion and you can have both types. You can have both the cortical and a labyrinthine concussion, or you can have just a cortical or just labyrinthine.
How do you know the difference? Cortical concussions is probably what you're mostly thinking about with the difficulty concentrating, remembering, the brain fog, the not feeling right. A labyrinthine concussion is immediate dizziness. That dizziness is not affected by the position of your head in space. To treat that, you need a specific type of labyrinthine physical therapy. That's definitely something to screen for. Okay. Now that we're back to the question that Bella asked us, was about the vestibular system, the labyrinth is part of that, but really what I believe that you all will want to know is about the peripheral vestibular system, or your inner ear. Your inner ear has three, what are called semicircular canals.
Those semicircular canals are basically loops that go in different directions. One of them goes straight up, one of them goes off to the side and one of them kind of goes in a diagonal. At the base of each of those canals or those loops, there are crystals with little hairs in them and they're called otoconia. Again, there's no quiz, you don't have to know that. As you turn your head in space, so say you turn your head to the left 30 degrees, and then you tilt your head 30 degrees, the crystals on one side activate and the crystals on the other side deactivate, and they tell your brain exactly that. You rotate your head 30 degrees to the left, and then you side bent it 30 degrees to the left. That's a normal working vestibular system or peripheral vestibular system. Peripheral just means towards the outside, so not your brain.
What happens in what's called BPPV, which is probably one of the most infamous issues with the vestibular system is one of those crystals, or a couple of those crystals become dislodged from the bottom portion of your inner ear, or the bottom part of that canal or that loop. They go somewhere else in the canal where they're not supposed to be. Now, when you turn your head 30 degrees to the left, and then tilt it 30 degrees to your left, most of those crystals are telling your brain exactly that. But that little crystal that's in the wrong spot is giving the wrong information to your brain. Your brain then tries to compute that and figure out where exactly your head is in space and it can't. Its reaction to that is to cause what's called vertigo. Vertigo is the sensation that the room is spinning or that you're spinning. That's when you would need to go to an ear, nose and throat doctor, or a vestibular specialist physical therapist who can do a repositioning technique in order to get that crystal back where it's supposed to go.
[00:26:56] BP: Thank you, and thank you for going into the actual details behind, like I always call it, behind the scenes of what's really going on with your body. I think it's really important to know, a lot of the time we hear all these terms and they get thrown around all the time. But understanding them is really important too to a point, especially if you are taking the time to invest into these therapies that can definitely add up, especially if you're unable to work and things like that. So important to know.
Something else that you mentioned before we talked, before recording was the special areas and topics of concussion survivors that you get into. Do you want to address those a little bit?
[00:27:39] CM: We always want to treat you all as individuals, so we want to get you back to the goals that are important to you. Those goals are going to look very different if you're a 13-year-old athlete, or if you're an 85-year-old grandma who wants to go from her living room to her dining room, versus if you're a 55-year-old full time employee, have to drive to and from work every day person. Your goals might be to be able to drive again, which involves a lot of the vestibular system like we had talked about. Or your goal might be to be able to return to sports or your goal might be to be able to just navigate your home safely.
You will also be looking for a physical therapist, hopefully who will listen to you and your particular goals and not just put you into a set protocol. But that system should be working its way towards whatever you personally want to achieve. And yes, a lot of the components are going to be the same, we're probably going to train that vestibular system, whether it's the BPPV, or whether it is your eye tracking not being correct. We're also going to look at your cervical spine, all of your programs should incorporate that. But ultimately, you want to be going towards whatever your goal is.
[00:28:54] BP: I love that you mentioned the goals, because it's really important to get those across for yourself. When you go to therapy, sometimes, we're so focused on our symptoms and things like that, but what are you looking to get out of the therapy and the treatment and you're getting. Because like you said, it might be very different if you're a parent, being around loud, noisy kids might be a really essential thing to get over faster than someone else who maybe has a quieter lifestyle. Those things are really important. I also agree with the protocol things. I have had interesting experiences with a lot of different specialists.
One of the biggest warning signs for me once was, I got a four-page sheet of different vitamins I should go on and I just said, "Well, shouldn't you take my blood first?" I was shocked. I was like, "Well, this is what you give everyone?" "Well, this might work." I was like, "Well, I'm not the same as someone else." All of us are different, which is why it's important to really do those background checks on who you're getting your help from and making sure you feel comfortable with them. Because if you're going to be going through therapy with them, you might be spending a lot of time together. You also need to be able to trust this person, so it's really important. You have given us a lot of different information, a lot of really beneficial information and lots of things that help. Is there anything else that you'd like to add before ending today's episode?
[00:30:20] CM: Just that there's hope. The medical treatment has come a long way in the past 10 years since Bella and I had our concussion and there is hope. There are physical therapists who know how to help you. There are sports MDs who specialize in concussions. Even though they're sports doctors, doesn't mean that they don't treat people who were injured other than sports. Typically, those are the doctors that I find have done the most research and know the most about concussions and post-concussion treatment and getting you back to your goals. Go out there, find a good physical therapist who knows what they're doing, who is going to listen to you. If you have any questions or want any resources, feel free to reach out to me. Bella is going to put my information out there. But I'm always happy to talk and I do consults across the US and then I do telehealth within Florida as well.
[00:31:14] BP: Yeah. For sure. Well, thank you so much for joining us, and there's certainly is hope and thank you for sharing some of your insights on post-concussion life and recovery.
[00:31:24] CM: Thank you, Bella.
[END OF EPISODE]
[00:31:28] BP: Has your life been affected by concussions? Join our podcast by getting in touch. Thank you so much for listening to the Post Concussion Podcast and be sure to help us educate the world about the reality of concussions by giving us a share. To learn more, don't forget to subscribe.
[END]
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