Neurodegeneration with Dr. Patricia Walicke
Show Notes:
The fear of brain degenerative diseases is a concern that many concussion survivors carry. Joining us today to address this important topic is Dr. Patricia Walicke, who believes that widely available and relatively inexpensive interventions, such as nutrition and natural supplements are key to real-time real-world approaches to maintaining and improving health. Dr. Walicke earned her Ph.D. from the Harvard Department of Neuroscience in 1980 and has nearly 40 years of experience working in university medical centers, private practice, and biotechnology companies, including serving under Dr. Robert Katzman, a pioneer in Alzheimer’s research. While there simply isn't enough data on preventing dementia, Dr. Walicke shares her vast expertise on the relationship between brain injuries and neurodegeneration, before diving into the two types of relevant inflammation related to that acute phenomenon of feeling like your head is on fire.
You'll hear some reassuring advice that worrying if you have Alzheimer's or not is often a sign that you don't – those who experience cognitive change significant enough to be diagnosed have usually lost the ability to feedback on themselves and don't notice the symptoms anymore. We also cover the six pillars that you can address to support the aging process and discuss the common culprits in your medicine cabinet that are known to impair memory in addition to being highly addictive. To discover the best supplements for brain injury recovery and support, tune in for another informative episode with a leading expert today.
Key Points From This Episode:
• Introducing Dr. Walicke and how she got into the field of memory.
• Discussing the question of long-term risks of brain degeneration after a brain injury.
• Hear about a study that looks at the relationship between dementia and mild TBIs.
• Why the VA is a great setting for these types of studies.
• Some common medications that impair memory in addition to being physically addictive.
• Dr. Walicke recommends some great herbs and affordable supplements for memory circuitry.
• Discussing CTE, including onset age and symptoms.
• Some advice for those who are worrying if they are developing dementia or Alzheimer's.
• The two types of inflammation: neuroinflammation and inflammation in other tissues.
• Addressing the phenomenon where survivors feel like their heads are on fire.
• How to track and describe the type and location of head pain.
• Hear about the six pillars to address aging, plus another option to assist head injury recovery.
Learn More About Blue Lake
Schedule a One-On-One with Bella Paige
Post-Concussion life can be extremely difficult to manage. These one-on-one meetings are not only for survivors but their family and loved ones as well!
Get help with navigating post-concussion life, retiring from a sport, finding specialists near you, next steps, and much more!
Follow Post Concussion Inc on Social Media to stay up to date on the podcast
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]
[00:01:03] BP: Welcome to today’s episode of the Post Concussion Podcast, with myself, Bella Paige, and today’s guest, Dr. Patricia Walicke. Dr. Walicke earned her MD from Harvard, MIT Health Science and Technology Program and her Ph.D. from the Harvard Department of Neuroscience in 1980. She has nearly 40 years of experience working in university medical centers, private practice and biotechnology companies. From 1984 to 1989, Dr. Walicke was on faculty at University of California, San Diego with a joint appointment at the Salk Institute, providing clinical neurology care and pursuing research on growth factors for CNS regeneration. She served under Dr. Robert Katzman, a pioneer in Alzheimer’s research.
In 1989, she started a clinical neurology practice where participation in clinical research sparked a new passion for the development of medications. In 1996, she joined the biotechnology industry and contributed to programs for development of medications for neurological disorders like Alzheimer’s disease, and multiple sclerosis, as well as autoimmune disorders. She was an active member of the startup community in the San Francisco Bay Area, serving in roles from consultant to chief medical officer in more than 25 companies. She served as a consultant to the National Institute of Neurological Diseases and Stroke for two years. Dr. Walicke has published 40 papers, five book chapters and holds three patents. She retired in 2017 and moved to Sedona, Arizona, where she has a small wellness coaching practice. The vicissitudes of drug development have led her to believe that widely available and relatively inexpensive interventions, such as nutrition and natural supplements are key to real-time real-world approaches to maintaining and improving health, a path which led her interest in beta caryophyllene, also known as BCP.
Welcome to the show, Dr. Walicke.
[00:03:06] PW: Thank you very much, Bella. I’m delighted to be here. Thank you for inviting me.
[00:03:10] BP: So to start, do you want to tell everyone a bit about your background and how you got into the field of memory?
[00:03:18] PW: I’m a neurologist, which is a medical doctor who takes care of people with nervous system diseases. I also have a PhD in neuroscience. When I was a medical student at Harvard Medical School, I had the good fortune of having a gentleman named Dr. Norman Geschwind for my mentor, who’s widely considered the Father of American Cognitive Neurology. So I took several courses from him. I then went to the Montreal Neurological Institute for training, which was the place where Roger Penfield was a neurosurgeon. Most people have seen his work, he did that mapping of the motor cortex onto the brain that shows this homunculus. So they were very interested in cognition in the brain have a lot of involvement with neuropsychology.
From there, I went to faculty on University of California, San Francisco, which was a major Alzheimer centre, and I had an interest in brain regeneration, so the neurodegeneration and the cognition all came together for me. And I continue to work to some extent in drug development or treatment development for Alzheimer’s for the rest of my career.
[00:04:33] BP: Well, it’s quite the impressive resume that you have, and I’m so glad you’re here today. We have a lot of survivors that listen to this show and something that they have is a fear of is those brain degenerative diseases, because a lot of the time, some of the research shows that after a concussion, it’s more likely that you’re going to get one of them and you’re predisposed for those. How can a brain potentially affect your long-term health after an injury?
[00:05:06] PW: Well, traditionally, going back to some studies like I participated in in the ’80s and ’90s, it was said that a moderate to severe traumatic brain injury increased your risk of developing Alzheimer’s about two to three-fold. However, I think now, people don’t necessarily believe that. You have to remember, those studies were done before there had been a lot of research into head injury. Chronic traumatic encephalopathy, CTE wasn’t even recognized to exist at that point.
In more recent studies, it appears that a head injury does not increase the risk of Alzheimer’s itself, but it does still increase the risk of dementia. Dementia being a medical name for a loss of a previous stable level of function, which usually involves at least two cognitive domains, one usually being memory, and the other can be all kinds of different things; language, judgment, visual spatial orientation. I’m sure most of the people know what dementia means. But sometimes when you use a medical word, it’s good to take a second and to actually define it.
It’s still thought that there is an increase in dementia. I got rather interested when you asked me to do this about mild head injury, because I assume a lot of your listeners actually probably had mild TBI, not severe TBI. It’s quite hard to come up with whether or not mild TBI is a risk factor for dementia. It takes a long time for these studies to get done. I did find a couple that I thought were possibly informative. Or perhaps I’ll say it’s two from the VA that maybe illustrate some of the challenges in this type of work. The VA hospitals, like a really good setting for this type of study, because people who are in the military, as we all know, are an increased risk for suffering everything from mild to severe TBI during their years that they’re in service. Then many of them will go to the VA for decades after for care, so you have quite good follow up.
The first study I looked at had 800,000 people, and they came up with the finding that there was a very small increase in the risk of dementia at about the age of 55, which goes along with the fact that CTE has an earlier onset than Alzheimer’s. Actually, the authors in there, discussion of their papers say, they’re not even sure that’s real.
[00:07:50] BP: Kind of love the brain. I always tell people, they get really upset and I used to get upset too, when especially when I was younger and this all started with all my daily headaches and symptoms. It’s a very tough thing to research. It’s very not – it’s very qualitative, not quantitative data that you receive. It’s very opinionated. It’s very tough to measure a lot of the things about the brain, and everybody’s brain injury is different. So that creates a whole another issue in itself, so it’s interesting to hear you say that. They don’t even know because that’s kind of how it is. That’s how a lot of the therapies are. There are a lot of these things. Everyone’s trying their best to learn as much as we can. But every year, all of the information tends to change.
[00:08:39] PW: When you’re doing dementia studies, it’s also a problem because the event, and the symptom can be separated by 20 or 30 years and how the person lives their life in that intervening period also affects the risk of dementia.
[00:08:55] BP: Yes, for sure.
[00:08:56] PW: There’s a lot of confounding. But there was a somewhat better design study that came out of the VA after, where they did what’s called match groups. So they went through their huge database and they found people who had a head injury, and then they would go through everything they knew about their medical history, know if they’re hypertensive, diabetic, did they have substance abuse issues. And then they would try to find somebody in the database who did not have a head injury, but match them most of those other features. That does give you a better apple-to-apple comparison.
In a study, they did find that mild TBI did have a small increase in the risk of dementia, perhaps like one and a half fold or so. But it’s worth remembering, you’re talking at this age only, about 2.5% of their population of TBI patients had any evidence of dementia. So you’re talking very small numbers of people absolutely. I guess the same in a balance statement, I think, everybody should pay attention to brain health because we’re all at risk for dementia, potentially a little bit more, if you’ve had mild head injuries. Moderately more if you’ve had a severe head injury. Still, 90% of people going into their 60s are probably going to be fine.,
[00:10:19] BP: Well, it’s interesting then to talk about, and memory is really interesting to me because my memory used to be very poor from not remembering a paragraph that I just read, to not remembering a lot of events in my life that were occurring when my head aches and things were very severe. What are some of your recommendations related to memory-related things like medications and supplements? What do you think people should not take? What do you think they could take? Anything related to that.
[00:10:52] PW: Well, maybe we’ll start with things that are common medications that can actually interfere with memory.
[00:11:00] BP: For sure.
[00:11:00] PW: During the part of my career when I was in practice, I was dealing a lot with dementia patients, but people thought I was just almost a wizard when I take them off of some blood pressure pill that was interfering with their memory, they suddenly feel so much better. I think it’s important to be aware of those types of issues and to talk with your doctor if you’re taking some of the medicines that are well recognized to impair memory. One of the big offenders there are common medicines used for anxiety and sleep that are called benzodiazepines. Those are things like Xanax or Valium and will interfere with memory particularly with chronic daily use. They also are physically addictive. If you have been using them daily, you should work with your doctor to get off them. Don’t just stop and cold yourself. Okay?
[00:11:55] BP: Yeah. I’ve done cold turkey off meds and it was often really bad. Certain medications for sure.
[00:12:02] PW: But with benzodiazepines, you have a risk of having a withdrawal seizure. It can be quite severe. Then some of the newer sleep medicines, which are often called Z drugs. They’re kind of not really benzos, but they’re related to them. Like Lunesta or Ambien. Also with chronic use will interfere with memory. A fair number of people, when they get off of drugs, like they will start using over the counter sleep aids. Things like Tylenol PM or Mucinex Night. I’m not choosing those brands as particularly bad, just as examples. But a lot of those contain old style antihistamines, like Benadryl, also called diphenhydramine. Those also interfere with memory, particularly if you’re using them chronically. They’re another set to avoid. Some of the seizure meds like Tegretol, gabapentin, which are Neurontin, carbamazepine, or their other names interfere with memory.
[00:13:03] BP: Those are very common for concussion survivors to be put on, or seizure meds that have other effects to possibly benefit symptoms like headaches and things?
[00:13:12] PW: Yes, and emotional ability, they can be – and seizures are a problem with some people with more severe head injuries.
[00:13:20] BP: Yes, for sure.
[00:13:21] PW: There’s good reason to take them, but also to be aware that that can be a side effect. Finally, and this is a hard one because so many of you have pain. Opiates, Oxycontin, things like that interfere with memory. Trying to find non-opioid managements or at least minimizing the opiates is helpful for clearing your thinking and your memory.
[00:13:44] BP: For sure. We always talk a lot about how that tends to happen that opioids and things like that, I take them myself, and when you do take them, it’s all about taking them when you need them, not taking them early when you think you need them, because you think you’re going to have a headache. Because that can be a really bad habit to getting addicted to these medications that you’re taking it before you need it. We try to really push, try other treatments, try different alternatives. But if you need them, you need them and that’s okay too, because that’s why they exist.
[00:14:20] PW: Yeah, exactly. Just in general, it’s good to remember that after an injury, you’re just going to be more sensitive to a lot of drugs’ side effects. Even not just drugs. Your tolerance for alcohol and the effects of alcohol on your clarity of thought are going to be much more than before you had your head injury.
[00:14:47] BP: Yes, for sure. Especially if you’re taking medications, you really have to be careful about that. Most of them do have a recommendation to not mix with alcohol. I know not everyone’s great about that, but it’s something important to remember. What about supplements? I know we touched on supplements a few times on the show, but there’s so many different ones out there. Which ones do you think could help with memory?
[00:15:15] PW: Sure. I guess to talk about something more positive now after all that other stuff.
[00:15:18] BP: Yes, of course.
[00:15:21] PW: Actually, there’s a neurotransmitter named acetylcholine, which plays a major role in memory circuitry. And actually, there’s a number of drugs for Alzheimer’s disease that improve memory by increasing the acetylcholine and at least one of them, called Donepezil, has been tested in a small study in some people with severe head injury, where it did improve their memory. There is a prescription possibility there if someone would want to look into that. But there are supplements, there’s a number of supplements that would do the same thing in the sense of increasing levels of acetylcholine in the brain.
One is a chemical that was actually produced specifically to increase acetylcholine is called citicoline. It’s been tested. There’s been multiple small clinical trials in elderly people or Alzheimer’s patients showing that improves memory. It was tested very widely for a number of major indications like improve stroke recovery. Unfortunately, it did not work out there. But it’s still available without a prescription. It has very few side effects and is very easily tolerated.
Getting back a bit more into traditional sources of herbs that increased acetylcholine, there’s two. One is called Bacopa, also known as Brahmi. This is from the Ayurvedic tradition. It’s been used in India for centuries to improve memory, insomnia, mental stress. There are a couple of small studies in, again, people with more age-related memory loss showing that benefit. The other is called huperzine. Those all are kind of a cluster that are related to acetylcholine. But there’s other types of supplements with other approaches that also have been shown to benefit memory.
One of those is phosphatidylserine, which I believe my colleague will perhaps talk a bit more about memory chocolates in Blue Lake. That’s one way of taking phosphatidylserine. It’s been tested in perhaps half a dozen trials again, in elderly or Alzheimer’s patients. Very well-designed placebo-controlled trials where it was shown to improve memory, and also other cognitive domains like attention, judgment, problem solving and probably has some of the strongest evidence of benefit. Then there’s the more traditional medications. One of my favorites, because I’ve used it myself quite a lot is ashwagandha, which again comes out of the Ayurvedic tradition, which is the Hindu-Indian medicine tradition. They use it as a nerve tonic, which means sort of the same cluster of problems like anxiety, memory, mental stress. It’s also called an adaptogen, meaning that it helps your body to do things better. The Hindus say it increases longevity. There are small scientific studies showing that it will make nerve cells grow, or it can protect nerve cells from certain stresses.
The next one in my list of traditional medicines gotu kola, which was used both in Ayurvedic and Chinese medicine to stimulate the brain. Again, there’s several small western studies showing memory benefit in elderly people. The next one is lion’s mane, which is a type of mushroom. Familiar with that?
[00:19:06] BP: We’ve heard of that one. It’s really pushed in the brain concussion world right now. Things go in fats, so that’s one of them right now that you hear about a lot.
[00:19:17] PW: How about saffron?
[00:19:19] BP: Yes, that one has been mentioned as well. Yeah.
[00:19:21] PW: Okay. So those are my list of good herbs and supplements that can be helpful for people trying to improve their memory. Fortunately, they’re all quite widely available. They’re not very expensive. They have very few side effects. So you might try it, whether you might not get benefits, but at least you won’t have any injury to your physical health or your wallet.
[00:19:46] BP: Low side effects is something I’ve talked about a lot because I’ve tried a lot of different therapies and a lot of different treatments, including both physical medications and even more after that. I do like things that don’t have a lot of side effects or things that you can stop taking. And once you stop taking it and it’s out of your system, you kind of just go back to the way you were, and that’s okay too. I always think those things are really good for individuals who are just trying to figure out something that works. These things very, like, unlikely will hurt you, so it doesn’t hurt to try it. But you have given us so much good advice. We’re going to talk about CTE next. But with that, let’s take a quick break.
[BREAK]
[00:20:37] BP: Wow! I can’t believe it’s been one year, the support from everyone has been truly amazing. Due to reaching our one-year anniversary, you can now book one-hour sessions with myself Bella Paige. I offer help with understanding loved ones, finding your new normal, and finding specialists near you. Find the work with Bella link in our episode description. I am looking forward to another great year.
[INTERVIEW CONTINUES]
[00:21:07] BP: Welcome back to the Post Concussion Podcast with myself, Bella Paige and today’s guest, Dr. Patricia Walicke. Something I wanted to get into a little bit is CTE, which is sort of a scary topic I think for a lot of people and a lot of survivors, especially those involved in military and sports. What makes CTE more likely?
[00:21:31] PW: Ah, that’s a very good question. Again, just the current state of science and medicine, there are some distinguishing qualities of CTE and there’s some imaging that can distinguish CTE, say from Alzheimer’s. But for most people, in most situations, I think still the definitive diagnosis is not going to be until they’ve died and they have an autopsy, which is discouraging.
[00:21:56] BP: It is, yeah.
[00:21:58] PW: There is a PET scan dye that binds to the tau tangles, and that can be used to look at CTE. And there are small studies, looking at even some young athletes who’ve had multiple concussions and showing that they have some of those types of tangles, though not always in the classical CTE distribution. That distinction between distribution on PET scan and on autopsies also seen an Alzheimer’s with a beta. It appears to be just inherent into the way – the differences in the ways the two are done. CTE, I wish I could give you a risk level, but data is just not there. There’s the autopsy studies, NFL players with very high rates of CTE. But nearly all of those people were selected by their families, self-selected or by their families who thought they had brain damage. It’s going to be much higher than it would be if it was a non-selective group of people.
[00:23:11] BP: It’s skewed right, a little bit.
[00:23:13] PW: Very skewed. Well, the onset for symptoms for CTE is somewhat younger than Alzheimer’s, perhaps in the mid-50s. The VA study I mentioned where maybe there were 5% of people who showed evidence of dementia, of which a portion of that would be CTE might be some more realistic idea of the of the real frequency.
[00:23:37] BP: Yeah, I think it’s really interesting. I think, a lot of people, I think if you think you have it, I think you have to stop thinking that you think you have it, and carry on because I think the anxiety that comes with it and the mental health effect is kind of detrimental if you’re really scared about it. And I know it worries quite a few people, but I think it’s important to not stress that you have CTE and maybe look at more proactive measures about the symptoms and things you’re experiencing instead. But I know it creates a lot of fear in people and that’s okay, too. I know, something that happens when you think all of the – they make it – you see in the media and CTE looks really scary. I get that and I think it’s important for people to realize that maybe there’s a chance that you could have CTE. I don’t know the number because I think like you said, we need to study a lot more brains.
[00:24:37] PW: And a lot more people.
[00:24:38] BP: Yeah, and a lot more people that maybe had one a head injury or no head injuries and all these types of things, for sure. Something else that survivors often feel, which is actually something that I used to always tell my parents was that my head felt like it was on fire, and not sort of on fire like somebody was holding a flame to my head.
[00:25:01] PW: I was struck by how you were talking about that fear of having CTE and my experiences more with dementia is like Alzheimer’s. But I think this is a very true clinical pearl, that the people who come in, and they’re extremely worried that they’ve forgotten a couple of words, or they’re extremely worried that they’ve lost their car keys, and they think they’re getting Alzheimer’s, don’t have Alzheimer’s. Because by the time you have reached a significant enough change in your cognition to be diagnosed with dementia, you’ve usually lost that ability to feedback on yourself. So you’re not noticing it anymore and you’re not that worried about it anymore. I just would encourage the people who are so worried to reflect that, that actually may be a sign that they don’t have it.
[00:25:51] BP: Yeah. That’s a great way to look at it. Because yeah, sometimes when adult with dementia and Alzheimer’s, personally with family and friends, usually, in my experience, they didn’t realize it was happening. But of course, there’s different circumstances. But yeah, for sure, it’s definitely something important and I think anxiety in those types of things can be really powerful. I think it’s important to try to not let it control all of our thoughts, when we do have fears.
[00:26:23] PW: High levels of anxiety will affect your memory. People who are calm and able to focus calmly, have better memory performance, and people with high levels of anxiety [inaudible 00:26:35] prophecy.
[00:26:38] BP: Yeah, that would make sense. On to inflammation, often survivors feel like their heads are on fire. I used to always feel like my head was so hot, like somebody was holding a flame gun on the side of my head and I couldn’t handle it. That inflammation is something that we’ve talked about before on the show, because it’s something that people can try to manage. So could you try to explain why our heads feel like they’re on fire?
[00:27:08] PW: That’s really interesting. I guess let’s separate inflammation into two areas. Brain inflammation or neuroinflammation, and inflammation in other tissues. So something that your – the brain itself doesn’t feel pain. This is pretty well demonstrated by neurosurgeons who will operate on conscious people. And once they’ve gotten through the skull and the lining, they can stick needles into the brain, and nobody feels it. There is no pain sensation within the brain itself. But there is neuroinflammation after head injury, which is important because the inflammation can release toxic substances which interfere with neuronal function. Over time, it can even lead to death of some of the neurons.
The neuroinflammation is of a lot of interest for treating head injury and other types of dementia. All of them have neuro inflammation. Unfortunately, things that you would use for regular inflammation, like ibuprofen or Aleve, have been tested, and they just don’t work in the brain. People are looking – say Blue Lake, we’re looking at one compound that we hope might help neuroinflammation called beta [Inaudible 00:28:30], and many other people are looking for that too.
But going back to your original question, some of that could be due to damage to all those different tissues, your scalp, your muscles, which the blood vessels all of which do feel pain. Or there’s also good evidence from brain structural studies that some of the pain pathways in the brain tend to be prone to that axonal shearing issue, that's the damage that happens with head injuries. That seems to correlate if there’s quite a bit of shearing in those areas that seems to correlate with really bad headaches or other types of head pain.
[00:29:11] BP: Yeah, it’s interesting to talk about it and talking about how it can feel. I think it’s interesting because some people feel that fire feeling that I did, and other feels like stabbing pains and throbbing pains. It’s interesting how a type of pain can be diagnostic. I always try to tell people that when they’re trying to track symptoms and things and this, to include the type of pain. Not just, “My head hurt.” Because there’s a lot more to it than that.
[00:29:42] PW: Also, the location of the pain, if it’s a physical problem to do is say, the muscles that are attached to the head, knowing exactly where it is can help improve treatment.
[00:29:53] BP: Yes, absolutely. I think you’ve been very helpful today. Is there anything else you would like to add before ending today’s episode.
[00:30:02] PW: There are a couple of things I wanted to add. Now unfortunately, even though there’s so many people with head injury, there aren’t that many studies on preventing dementia. Not even good evidence of how many people get dementia, much less preventing. So I suggest it would be good to look at what’s done as part of normal aging to prevent Alzheimer’s and other dementias. This is usually a collection of items. Blue Lake likes to refer to them as the six pillars. It’s nutrition, physical exercise, sleep, stress control, mental stimulation and social interaction. The nutrition is pretty much what you do for your heart anyway. It’s, eat more vegetables and fruits. Don’t eat so much meat. But I did run across something interesting that I wanted to share.
There’s a difference in the chemical changes in the hippocampus, that part of the brain that’s important for memory. In people with head injury or animals with head injury, more of this is preclinical work. In animals with head injury versus Alzheimer’s. In Alzheimer’s, there’s too much of a transmitter called glutamate, where in head injury, there’s too little. One way you can increase glutamate is by giving its precursors which are called branched-chain amino acids. These have been used a lot by bodybuilders to build up muscle. There are several animal studies showing the supplementation with those appears to help with cognitive recovery. There was one small human study in severe head injury than at a rehab facility, which showed the people who received supplemental branched-chain amino acids recovered faster into higher levels. Again, another one to add to the list of possible things to consider to try.
[00:32:00] BP: Absolutely. Thank you so much for all of the information you’ve given. I think it gives people a place to come up, start looking and where to start with some of this or what to bring up to their physician. Because there’s so much research out there and it can be really overwhelming, and reading through actual studies is something most people don’t know how to do. Blog articles are often not detailed enough. Thank you so much for joining us today and sharing your experience and knowledge of brain health.
[00:32:35] PW: Thank you for inviting me. It was really a pleasure and I hope some of the information would be helpful to your audience.
[END OF EPISODE]
[00:32:46] BP: Support the podcast. If you truly love the podcast, please consider supporting us through our tip jar. Find the support the podcast link in our episode description. All tips are greatly appreciated.
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]
OTHER CONTENT YOU MAY LIKE
