Rehab Your Brain with Your Body with Dr. Joyce Mikal-Flynn
Show Notes:
Joyce Mikal-Flynn was a family nurse practitioner when she suffered a brain injury in an unusual swimming accident. After experiencing significant aphasia and cognitive delays, a doctor helped her to realize that she needed to rehabilitate her brain.
Today Dr. Joyce is a professor in the School of Nursing at California State University, Sacramento. She holds a Doctor of Education from St. Mary's College and a Masters of Science in Nursing at CSUS, focusing on trauma-informed care with an emphasis on building resilience and posttraumatic growth. She developed the word “metahabilitation” to describe a more optimistic and productive outcome in the aftermath of trauma and her research has provided a strengths-based clinical pathway to guide individuals towards posttraumatic growth. She has also written two books on the subject of overcoming trauma.
Dr. Joyce shares some very helpful advice on how to rehab your brain, the importance of cross-training your brain with your body, and the vital role of your mindset on your neural networking and brain chemistry during recovery. Tune in to find out why she recommends a therapist, the importance of taking control of what you can control, and how not to let your injury define you.
Key Points From This Episode:
• An introduction to Dr. Joyce Mikal-Flynn and her expertise in trauma.
• The strange swimming accident that resulted in Dr. Joyce’s brain injury.
• The significant aphasia and cognitive delays she experienced as a result of her brain injury.
• How she lost the three things most important to her, her family, her brain, and her exercise.
• How she had the revelation that she had to rehab her brain.
• The help she sought from a communication science disorder specialist, a cardiologist, and a therapist.
• How your brain and your body loves to cross-train.
• How her doctoral research led to her first book Turning Tragedy Into Triumph.
• Her interest in posttraumatic growth and how it led to her second book Anatomy of a Survivor.
• The influence of your mindset on your neural networking and brain chemistry during recovery.
• The importance of taking control of whatever you can control and how this affects your mindset.
• The vital role of physical activity in getting over any brain issue.
• How Dr. Joyce transitioned from a ‘yes’ person to someone who has to say ‘no’.
• Advice for survivors on how to change your mindset and not let your injury define you.
• The importance of finding adaptations to successfully engage in life.
• Why Dr. Joyce always recommends a therapist.
• Dr. Joyce reiterates the importance of cross-training in rehabbing your brain.
Connect with Dr. Joyce:
Website: www.drjmf.com
Instagram: @dr.jmf
Linkedin: @joycemikal-flynn
Facebook: facebook.com/dr.jmf
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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]
[00:00:22] BP: 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]
[00:01:03] BP: Welcome to today’s episode of the Post Concussion Podcast with myself, Bella Paige, and today’s guest Dr. Joyce Mikal-Flynn. Dr. Joyce, professor in the School of Nursing at California State University, Sacramento received her Doctor of Education from St. Mary's College and Masters of Science in Nursing at CSUS, focusing on trauma-informed care with an emphasis on building resilience and posttraumatic growth. She developed the word metahabilitation to describe a more optimistic and productive outcome in aftermath of trauma and her research provided a strengths-based clinical pathway guiding individuals toward posttraumatic growth.
Her postdoctoral research focused on how traumatic experiences also built resilience, bring forth PTG in secondary and vicarious trauma survivors as well as communities. Along with the course she created at CSUS, Traumatology: An Introduction to Posttraumatic Growth, she continues to research, lecture and directly apply metahabilitation in a variety of rehabilitation and recovery settings. Her second book on the subject, Anatomy of a Survivor: Building Resilience, Grit and Growth After Trauma was released in April 2021. Welcome to the show. Dr. Joyce.
[00:02:17] JMF: Thank you so much for having me. It’s quite an honor to be here.
[00:02:20] BP: To start, do you want to tell everyone about your injury and what occurred?
[00:02:25] JMF: With regard to my injury, is a little different. This is many, many years ago, but I am a very active person and I do – I was marathoning, doing triathloning, very, very physically active. I’m married, I have three children. At that time, they were two, seven, and eight and we were at a championship swim meet. My two daughters, seven- and eight-year-olds were swimming at this meet. I have no memory of any of this. There’s about three weeks where I actually have no memory. But there was a fun adult relay and I’m very competitive, so I grabbed my husband and a couple of my friends and said, “Come on! Let’s go swim this and we’re going to win this and I’m going to just swim the last leg of the relay because I’m the fastest. I’ve been doing a lot of training.” I did just that, and I swam the last leg of the relay.
I finished at the side of the pool that was 13 feet deep and I was asked if I needed help out, I guess I was told I said no and I just sunk to the bottom of the pool. They realized that I wasn’t coming to the surface and my husband dove into the bottom of the pool, got me to the side, on the deck and [inaudible 00:03:39] there were a lot of children, there were a lot of parents and a couple of them were physicians, one ER doc, there was a cardiac nurse specialist and I received over 20 minutes of CPR at poolside. They got my heart going at poolside, they landed a helicopter in a field kind of close to where I was, got me in the helicopter to fly me to University of California Davis. My heart again stopped in the helicopter, they got it going. I got to UC Davis, was on a respirator in ICU for about a week or so and then off of that.
That’s when the life I knew had completely changed and I had no idea what I was up against. I had no idea how to face all of this, but I just knew my life changed significantly.
[00:04:31] BP: Yeah, for sure. After such a big traumatic experience, you knew – I find a lot of time with a lot of our concussion survivors, they didn't know yet. It wasn’t until later that they realized that their life has been changed forever because it takes a few months to realize that these things aren’t going back to normal. What type of rehab treatments have you done after? Did you try anything?
[00:04:53] JMF: Oh yeah, I did. Just to back up too, as a background of me. I graduated, I got my Bachelor’s in Nursing from University of San Francisco in 1976 and I entered into the nurse practitioner program at UC Davis and finished that in 1981. I already was a family nurse practitioner. I kind of knew that things were off or whatever, but it’s so interesting because this was in – this happened in 1990. At that time, nobody and I’m in the business, nobody ever said to me, traumatic brain injury. I never heard that term, I never did and I am in the business. What I recognized was, I was a mess. I just knew emotionally I was off. I wasn’t making some great decisions, I was forgetful, both long and short term. In general, I just knew I was off and I was really scared and I was really scared to tell people because nobody asked me about it, so I just thought, “I’m a mess.”
What I had to get over initially was a lot of fear and a lot of anger. When I was still in the hospital, they did have me work with a communications specialist or speech pathologist. I could talk but I had significant aphasia, significant. For those of you who are listening to this, you probably know what that is, but it was, I lost my ability to express speech. I could think about things, like my husband would say, “What can I get you?” and I wanted an orange. I could say, “I want one of those round things, and they had juice in them and there’s Vitamin C in them and you can peel them.” He’d say, “Say it. Say it,” but I couldn’t say the word orange. I could even see it in my head. I had a lot of problems with that. Also, some very significant cognitive delays.
Three of the biggest things that were important to me, my family, my brain, and my exercise were gone because I didn’t even recognize my children right away. I didn’t recognize my husband right away. I knew I was associated with them, couldn’t figure out how, and a significant brain problems, and wasn’t going back to work and was told I could never run, swim or do any kind of exercise again. I was really depressed on top of all of that.
The thing that turned it around for me, key, one of the physicians and I get almost emotional when I think of that. Had he not said this to me, one of the physicians, Dr. Bruce Gordon who actually resuscitated me and I know him. We live in the same community, our kids go to the same school, all that. I saw him a couple of months after, and he looked at me and he said, “Hey! How are you doing?” I said, “Well, you know, Bruce, physically, I’m feeling a little stronger. I was feeling stronger like I could –” and I said, “You know, Bruce. I think I have brain damage. I think my brain is damaged.” He smiled and he said, “Hey! I have never resuscitated anybody as long as I resuscitated you who is alive and who is standing up and talking to me.” He said, “You’re an athlete. When you have a physical athletic injury, you have to rehab that injury. He said, you have to rehab your brain. You have to rehab your brain.”
As soon as he said that, I went, “Oh! Right!” I was very frustrated with the first speech therapist they gave me, so I fired her. That was in the hospital, and it wasn’t her, it was me just being afraid and frustrated by them having reduced certain things that I thought were ridiculous. But I went back and I said, “Okay. I have to rehab my brain.” I went back to communication science disorder specialist. I found a cardiologist who is a runner and he said, “This is how we’re going to start things out. I’m sending you to cardiac rehab.” I was kind of out of it, in terms of emotions. I went to a therapist and I started doing what I could do to come back and eventually –
I don't live very far from UC Davis Medical Center, where I went to school to get my nurse practitioner license. I went to them and I said, “Look it—” and they knew what happened to me because I was a student there and they knew what was going on in the ER and everything and they knew. I said, “Can I just come back and sit in class and listen? Can I just start to listen again?” So yeah, I did a lot of that kind of stuff.
As I like to tell people, your brain, your body loves to cross train. Let’s cross train. Likes to do a little exercise, let’s do a little thinking, likes to do a little rehab, likes to do a little nutrition. It cross trains. Once you start looking at all the things you can do to not only manage your system symptoms, but improve your condition. You also have to realize that I learned that as Dr. Gordon said to me, he said, “Look it. All those pathways are still there, they’ve been damaged and they’re slowed. Either you get in there and start rehabbing your brain so that can reconnect them or get bypass pathways, neuropathways.” I knew that about cardiac stuff. Cardiac does that all the time and so it makes sense to me. I really in earnest got into it, but it was still – I got to tell you, it’s a pretty deep, dark hole to climb at because things don't improve overnight.
[00:11:02] BP: I love the rehab your brain theory, because that's really what you're doing and it's hard because it’s slow. Like you said, there's no – it's hard to see progress at the bigger level, like the progress you want to see, especially when you are a high-functioning individual before because that's who you want to be. Because you're still not that person, it feels like you haven't made that much progress even though you probably have. It definitely takes time to get through that and mentally, it is – I find the mental health part of it can be even bigger than the physical. Do you want to tell us about your book, Anatomy of a Survivor?
[00:11:40] JMF: Sure. One of the things that I did do to get my brain back and I really appreciate you talking about the timeframe. Because I think people, if they know that, they won’t get as frustrated and they’ll just keep going, just to see any little progress they get. But I ended up – it was two years. I went back to school to get my Masters and studied people who had – because I want to get even more of my brain back and I was curious about people who’ve gone through death defense, had they gone through the same thing I had. Then several years after that, I went back to get my doctorate. I specifically studied people who had gone through significant traumas, challenges and adversities end up come out of it doing better. Not the same, but they actually healed and were in a better place in a lot of ways, spiritually and emotionally. That’s what my first book, Turning Tragedy Into Triumph was a result my doctoral research in organizing the system of metahabilitation. Meta, going above and beyond. Habilitation, restoration.
My second book really is kind of the advanced version, because I was able to not only continue to write about the research that I did, noticing how people in a variety of different traumas, including traumatic brain injuries do move through and can experience posttraumatic growth in the aftermath. But I really was very curious as to how this is has happened and how deep does it go. I found through my research and the research of others that you develop this mindset, like focus on what I can do, recognize how your body and brain needs to cross train and become fit. And you start moving through, you realize that that influences things at a very deep level, at a cellular level and there are changes that are made in your neural networking, in your brain chemistry. Your brain has all sorts of great little drugs in it, you just need to pull them out. You do that.
Then also, looking at even from a genetic point of view, this makes a difference at a very deep level. Engaging with, taking on these situations, moving forward, getting some strategy. It makes a difference. My second book is called Anatomy of a Survivor: Building Resilience, Grit, and Growth After Trauma. It does profile the science, the neurobiology, the genetics, the science behind gratitude and happiness. It goes through the stages and the whole metahabilitation system. I used not only current science, but also really amazing stories of people who have gone through this to profile these concepts. It’s pretty complete work on how people go through bad things and not overnight, but over time, take control, make good decisions and master their faith.
[00:14:58] BP: Yeah, I really enjoyed it. Everyone, you can learn more about Dr. JMF and her book on her own website, drjmf.com, as well as at Dr.JMF on Instagram. Both will be found in our episode description and show notes. With that, we’re going to take a break, but make sure you stay tuned to all the things I learned while listening to your book.
[BREAK]
[00:15:24] BP: I just wanted to say thank you. The podcast is just over six months old and I couldn’t be happier with the response. If you truly love the podcast, please consider leaving a tip in our support the podcast tip jar found at the bottom of our episode description. All tips are greatly appreciated and help cover costs of the show.
[EPISODE CONTINUED]
[00:15:49] BP: Welcome back to the Post Concussion Podcast with myself, Bella Paige and today’s guest, Dr. Joyce Mikal-Flynn. Something in your book, you mentioned getting to decide how to live your life. There was something really important that I learned and it's a doctor you had mentioned gave you control because you had to make the decisions in how you were going to live your life. How did that make a difference for you?
[00:16:12] JMF: Let me just also tell you, since I am a behavioral scientist and I love science. I looked at what is the science behind control. It is clear that taking control puts you in a mindset that allows you to make good choices. Also, there is research out of University of Colorado in Boulder, Dr. Steven Maier talks about, his research has shown, even people, even if there is the perception of control over a situation, people do better, so it does make a difference.
What needs to happen as you sit down and you surround yourself with good people, optimistic people. Not foolish optimism, but good, straight, optimistic people who will help you decide, “Okay. What seems like an uncontrollable situation, what do I have to control? What choices can and should I make?” You start in that direction and let's be honest, part of the control just may be, what am I going to eat? How am I going to exercise? Which by the by, I got to tell you, there is no getting over any brain issue. There is no keeping your brain healthy and well without physical activity. That is the number one thing you can do. You can take control over your sleep patterns. You can take control again over your nutrition, who you’re going to see as a doctor, what are you going to do. Focus on what you can do and what control you can take. You start you mind, then start shifting into that focus.
[00:17:59] BP: Yeah. It’s so important because when you’re going through this, especially with traumatic brain injuries, brain injuries in general, you feel like you have no control all of a sudden. Absolutely everything going on in your life. Creating control even over small things, like you said can be a huge step in your recovery. Going along the same lines, you reminded me of my mom in your book when you said that you are a busy, high-functioning person and you are kind of a yes person, because you can always get it all done. Something that you learned after injury was how to say no and that's a big step for a lot of survivors. How do you find this affected your life, being able to say no for once?
[00:18:42] JMF: Oh my gosh! That is such a good question and such a good insight. I found that that was one of the growth aspects for me in the aftermath of this. Because in saying yes to everything, I had spread myself so thin. Actually, I think that added or contributed to what happened to me. I was completely overwrought, overdone and all that. I had to step back and say, prioritize. What is the most important thing to me?
When I started giving myself permission to organize my life in a way that was good for my family, for me, for my profession, there was a freedom in that. It was like a freedom. Then, I would never try in— It sounds crazy, but I just love telling people the truth. They’d ask me to do something and I’d say, “You know, I can do that but I can't do it until this time because I need to get my run in” or “I need to get this done” or “I need to get that done.” Or I would look at and say, “You know, I’d really love to do this, but it's just not going to work for me, and stop feeling bad about myself for not doing things, and feeling better about myself because I was an authentic person.”
I don’t know about you, but the other thing I think that happens is when you say yes too much, then you start to ridicule the people that are asking you to do things and you go, “They’re just asking you, you’re the one that said yes.” You need to say, “I’d love to do that, but it’s just not going to work out.” And the freedom and feeling authentic and recognizing self-compassion allowed me give that gift to others as well.
[00:20:30] BP: Yeah, I think that's so great and I like the authentic piece that you mentioned because it’s really hard when you go from saying yes to everything to, “Oh! I can say no.” I think I was – like I've been dealing with my injury for half my life. I’m a no person instant. I say no before I say yes, and I always thought it was so funny because my mom is the opposite. I think I say no because of my health, because I have to say no first because then I have to think, “Okay. Can I do this and everything else that I have going on? Will this work? Will I burn myself out? Is it worth burning myself out for?” Because some things are, some things aren’t. It was just finding a balance for myself, and not letting your injury define who you are is so important. Do you have any advice for survivors suffering with this?
[00:21:17] JMF: First of all, I think to me, words are so important. One word changes everything and I’m going to give you an example. That’s why I’m going to go after the suffering thing with you. I happen to be presenting at a conference at Cambridge when the Olympics were in London. This is at least two Olympics ago, I think. Anyway, it was about sports obviously, and I was talking about athletes who had been through a season-ending, or career-ending injury or just retired out of their sport and they have all sorts of issues associated with that. I talked about how to organize that and how you can grow and become resilient, blah, blah, blah.
I go to this one talk and it was about disabled athletes. What they did is they shifted it and they didn’t use the word ‘disabled’. They use the word ‘adaptive’. This was about adaptive athletes. I went, “Oh my gosh! One word gives you a completely different mindset around this.” It isn’t like, you're a disabled skier. No, you’re an adaptive skier. You’re not a disabled cyclist. You’re an adaptive cyclist.
I would like to suggest maybe with the word people suffering with this, I would like to address people who are managing and working on moving in a productive manner in the aftermath of this. Management and productivity as you go through. Suffering, there is no question. Suffering is part of this. There’s pain and all that. But my focus is and you said this, Bella, how does it define you? Don’t let the fall define you, let the rise define you. When you start adapting that mindset, you go a long way.
[00:23:12] BP: For sure, and words are so powerful. I still remember. I've mentioned it on the podcast before. I had one doctor asked me if my headaches were in my head. Then I kind of went crazy for about a month thinking that maybe they were in my head, and it just shows like how words can be powerful in both ways. It's really important to come with ways like I don't consider myself brain injured, like it's not something – I don't say brain damaged. I just say like, “I’ve had head injuries. I have an invisible illness. I live with this, but I live happily with this.” That took a lot of time to get where I am now, but it doesn't mean it's not possible. I wouldn't say that my life is normal. If I go to the dentist, I cancel my day after. I bring these headphones with me everywhere I go for noise, because I need them in a lot of places, but that is all okay. That doesn't mean that in my mind that there's something wrong with me. It's just, I live a little differently so that I can still live happily.
I think it's really important in finding what works for you and defining it in a way that makes you feel happy and that you can improve with your recovery, because recovery is huge and it just keeps going and it's like a lifetime thing sometimes.
[00:24:30] JMF: Let me just stop for one second, Bella and say everything you just said, see, the thing is, you figured out adaptations to successfully engage in life, and those worked for you and that’s awesome.
[00:24:44] BP: Yeah. It’s so important to find what works for you, because there is no point in – otherwise, the mental health part kind of eats you, and then you dwell on it. That doesn't help you in any way or the people around, which I learned the hard way.
[00:24:59] JMF: Well, you know, that’s a good point. Really quick too is to just, I don't know if other people do this, but I ended up going to a counselor, a therapist.
[00:25:08] BP: Yeah, we push it hard.
[00:25:09] JMF: That was really a good thing because that wasn’t something, even though I was a nurse practitioner, it wasn't something I did, but I was just doing some kookie things and my husband just said, “I don’t know what’s wrong with you, but something’s wrong. You need to go and see.” One of my physician friends sent me to a therapist and I got to tell you, it isn’t that they fix anything, but talking it out and feeling safe in discussing some issues was huge. I always recommend that for people.
[00:25:43] BP: I also recommend it as a way to get tools to handle things like bad mental health thoughts, because I was really against therapy when I was going through a lot of this. I was also a really stubborn teenager going through a lot of this, and I was against the mental health therapy because I had a really good siblings, and great friends and great parents. In my brain, I was always like, “Well, I can just talk to them, why would I talk to a stranger.” Then I ended up being placed in therapy and I learned that it wasn't about that. It was about talking with a professional who is educated on how to talk about these things and also give me the tools, actually handle all the bad thoughts that were going through my brain. Because I couldn't have done it without my therapist and I thank her daily in my brain, but it's so important. Is there anything else you would like to add before ending today's episode?
[00:26:34] JMF: Yeah. I think the last part that I’d like to add again is just to give people hope, and when you take on hope, you can reduce your fear and that helps you again take control to refocus, to refocus. Once more, the brain is an amazing organ. It is plastic. I teach a course surprisingly when I started teaching at SAC State, I started by an intro course to neuroscience, which is great because I learned a ton about the brain. One of the things I learned is, it is malleable, it’s not fixed. You can change it and you need to do again, let me just be organized and say, “You need to do cross-training.”
The number one thing is find some physical exercise to do every single day. Make sure that you rest appropriately, that you have appropriate nutrition. I also recommend staying away from any substances, drugs, alcohol, especially while your brain is healing. Stay away from that. You need to socialize and do things. Lastly, you need to push yourself. Your brain will tell you, “I’m tired. I’m done” then you stop, but you need to push it so your brain can start doing things. Like if you want to get stronger biceps, you can’t just sit around hoping they get better, you have to work them out. When they get tired, you stop and rest and go to it another day. There's a lot you can do, so that’s what I want you to focus on. And you can— as I say in my book, I always say this to my students and everybody, “You got this.” Alright? You got this!
[00:28:21] BP: Well. Thank you. Thank you so much for joining us today and sharing your insights on working with and life after trauma.
[OUTRO]
[00:28:30] 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. 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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