Episode 27 – Revisiting traumatic brain injury with Dr. Lyn Turkstra and Veteran and CFL player Ryan Carey

MIND BEYOND THE MISSION EPISODE 27 — REVISITING TRAUMATIC BRAIN INJURY WITH DR. LYN TURKSTRA AND VETERAN AND FORMER CFL PLAYER RYAN CAREY

Brian McKenna

We’re on again, and we’re going to be talking about traumatic brain injury. Obviously, my partner in crime, Laryssa, is here, and we’re joined by Dr. Lyn Turkstra, who is working out of McMaster University and is a speech pathologist. Let’s go there. Lyn, explain to people in your own words, what’s your background and why is it that a Veteran and a Veteran Family peer support specialist, the two of us, are talking to a speech pathologist today?

Dr. Lyn Turkstra

Thanks very much. I’m really happy to be here. Thanks for inviting me. I have been working with people with traumatic brain injury for about 30 years, mostly with people with more severe injuries because those injuries often result in cognitive impairments that affect people’s ability to read, write, listen, speak, and participate in all the communication activities they need in their lives. I’ve been in the US for my whole working career until I came back to Canada.

Laryssa Lamrock

You have a wealth of experience. I’m looking forward to our conversation with you today and where we’re going to go. I think I want to start with some basics, if that’s okay. I’m going to ask some basic questions to build from there. What is a traumatic brain injury and what’s the difference between a traumatic brain injury and a concussion, if there is a difference?

Lyn

A traumatic brain injury is basically damage to the brain from applied force. That can come because you hit your head. That can come because you hit your body and it jolts your head. It can be very mild so that people just have a very temporary change in their thinking or balance or have a headache or vomit, all the way up to very severe when a person could be in a coma. It’s really the range of consequences of force applied to the brain. It can also be so mild that people don’t pay much attention to it. If you have a lot of those accumulated injuries over time, that can also cause damage to the brain.

There are symptoms at the moment and then there are long-term symptoms. At the moment, I would say the mildest thing would be that– we say some kind of a neurological symptom, meaning I had tunnel vision, felt nauseated, felt dizzy. You hear people say a lot sensitive to light, sensitive to sound, and that usually doesn’t show up immediately. It usually plays out over 24 hours. We hear a lot, especially from student-athletes, we hear a lot of people saying they didn’t know anything was wrong. They went back in the game. Then over the course of a day, they had more and more symptoms.

Brian

In the theme of you learn something new every day, as you were speaking about a minute ago, you mentioned that it could actually be a body blow.

Lyn

Yes.

Brian

I’ve been looking at this for a while. As a patient, I’ve been concerned about it for a while. I’d never thought that strikes to the body could be that way. I think here’s what some people go through is, are you telling me that a body blow that I take today can affect my ability to communicate five years down the road? That sounds like a bit of a stretch. Why is it not a stretch? Why is that a reasonable connection to make?

Lyn

It’s physics. Basically, the neurons, the main cells in your brain are connected with each other by these really fine, fine arms, processes. They’re delicate. If you shake them up, they can tear. You can shake them up by shaking a body. Where our head is, we say it’s like a popsicle or like a lollipop. Your head is this heavy thing that’s sitting on a neck that’s attached to your body. If you think of —

Brian

Bigger-headed people like me.

Laryssa

That explains a lot.

Brian

Not funny.

Lyn

There’s an expression we have in brain injury. We say it’s not just the injury. It’s the brain you bring. For example, we see more women with long-lasting consequences. That’s probably physics because women have thinner necks.

Brian

Here’s an interesting thing to think about when it comes to women Veterans. You could say, when you look back at shell shock, when you look at what we used to call PTSD as we knew it in World War I, you could look back and go, well, the history of looking at these things goes back a century or wherever it goes. I would add into that, that since it’s only been about 30, 35 years of full integration of women in the Canadian forces, we haven’t studied a lot of women brains.

A lot of the helmet is probably designed based on studying men. I’ve got to imagine that there’s a gap in knowledge about what’s going on with women Veterans and just women in particular when it comes to TBI. Is that a concern when it comes to your line of work, gathering information, making sure we’ve got balanced input?

Lyn

It absolutely is. There’s a bunch of us who do research really focused specifically on outcomes for women. There are hormonal differences between men and women. There are role differences often in everyday life between men and women. We actually don’t know very much at all about brain injury in women in the military and among Veterans.

Brian

In some ways, it could be considered that this is a woman’s issue in so much as we just don’t know much. We don’t have the data. It’s not in.

Lyn

That’s correct.

Laryssa

I’m just curious then how many women are misdiagnosed. We’ve had conversations about how — for my spouse, who we suspected traumatic brain injury for quite a while, he’s been medically released for more years than I care to mention. We knew for sure that he had posttraumatic stress disorder. It was only until recently after we advocated and asked and asked and suspected that he was finally assessed. I guess you could say diagnosed.

For many men, there seems to be a delay or a misdiagnosis for traumatic brain injury. I’m wondering even for women, are they being diagnosed with depression or other things? I guess it’s a two-sided question. In your observation, are many people diagnosed or is there a delay in diagnosis, and what the implications might be on the women that you’re seeing as well?

Lyn

We actually don’t know that.

Brian

How do we not know that?

Lyn

Diagnosis in women in the military. Nobody asked the question. That’s how we don’t know that. I know if you look at who we see for cognitive rehabilitation, we see a lot of women and they certainly will report not having been diagnosed. Yes, but we’ve never compared men and women. It’s a really good question. I can’t imagine it’s better for women because I feel like if your Family doc’s not asking, they’re not asking anybody.

Brian

You work in this space. You’ve been around this for a while. You worked with Veterans. These are hard jobs. They’re tough on the body. Why are we at this position sometimes of thinking, “Well, it’s just tough on the body?”

Lyn

It’s a military mindset, right?

Brian

Right.

Lyn

You tough it out. People are there to serve. They don’t want to let down their peers in any situation, in combat, in training. At least that’s what I’ve encountered. It’s difficult though because there’s been such a firewall between military and civilian information. If you think about — I think, Laryssa, you were mentioning in your previous podcast about seeing the video. I think Ryan was also mentioning see a video of what blast is. I can tell you, we don’t see those videos in the civilian sector. It was a good 10 or 15 years before I was allowed to see a video of what happens in a breach. We just didn’t know.

Brian

Here’s one thing I want to ask you. There’s a lot of different ways we come towards an issue, like you’re a professional, you’re also a citizen. You hear things. When someone says, “My grandpa was in the war, and he doesn’t talk about it.” What does the speech pathologist in you hear?

Lyn

I think the first thing I would hear would be the psychological trauma. I think that’s where probably most people out in the general public would think, “Oh, the psychological trauma of the war.” I think the thing that I would hear that would make me wonder about brain injury would be my brother, cousin, spouse, dad did military service and it’s just not the same person they were. Is having trouble managing everyday things that used to be difficult. Can’t tolerate it when there’s a lot of people in the room talking. Has these outbursts of temper for reasons I don’t understand that seem really out of proportion, or seems really depressed. Those are the things that would make me think, “I wonder if that person had a brain injury and it didn’t get picked up.”

Laryssa

Yes. I think in our experience, as I mentioned, my spouse has PTSD and I’m learning more. These conversations are really teaching me a lot that there can be a little bit of overlap in symptoms. I think many Veterans don’t understand the differences or the overlap or the similarities, and certainly, Family members don’t. Just as you were chatting, something that I picked up on with my spouse was that we would be in a conversation and I would convey something to him. I’d say something to him and there’d be a delay, and then he would respond.

I assume that was part of PTSD that he maybe was symptomatic and he was trying to deal with his symptoms or whatever the case is. I learned that I give him information. He has to stop and process and then formulate his answer, and then respond. It’s sounding like the more that I’m learning, maybe that wasn’t PTSD. Maybe that’s traumatic brain injury.

Lyn

That’s a very common complaint after a mild traumatic brain injury. I would say one of the most common findings across military and civilian sectors is slow thinking speed. You might hear slow speed of processing, that’s the term you’ll see in the research literature, but what you’re describing is exactly that. This delay in putting together what someone has said. It shows up in lots of different ways. It shows up in forgetting, because you went on to the next thing and I was still thinking about the first thing, so I missed the next thing you said. It shows up in I can’t follow you in a conversation. I don’t want to be around a lot of people, because when they’re all talking I can’t keep up.

Brian

I wonder, is there circumstances with the wounded brain that I might actually have the thoughts in my head, but I can’t actually spit those out into words? That happens to me. I’m wondering if is that part of this or is that just a Brian problem?

Lyn

[chuckles] I can’t say if it’s just a Brian problem. I will say that word-finding problems are up there in the top three things people complain about. It might be part of the same issue of speed. You’re trying to process what the person’s saying, you’re trying to get your own thoughts in order, you’re trying to find the right words, and it’s not happening fast enough. For a lot of people, if they have extra time, they can find the words, it’s in the moment. Then you get frustrated. The more frustrated you get, the worse it gets.

Brian

What can we do about this?

Lyn

I work in cognitive rehabilitation. It’s unfortunately named, because cognitive rehabilitation sounds like we’re fixing your thinking. There isn’t a lot of evidence that this training your memory helps people in everyday life. There have been a few studies looking at things like brain games, and do they actually help? They don’t seem to transfer to solving your everyday problems. People get better at the games for sure. When you’re playing the game, you might realize, “Oh, you know what? I’m better if I turn the TV off in the background while I’m playing the game.”

Playing the game might teach you there’s a strategy you could use. What’s really helpful is learning strategies to help just manage your everyday thinking. That’s where people like me, speech-language pathologists, also occupational therapists, can really make a big difference.

Laryssa

That’s so hopeful to me, because I’m thinking about the experience of someone with a brain injury, a TBI, lots of them can be younger. Experiencing memory loss, not being able to find the words, knowing that their thinking is slowed down, that must be pretty scary for a younger person thinking, “Okay, I’m losing it here.” To hear that there are ways to mitigate that, that you can learn strategies, I think that would be so hopeful for so many people. What would you recommend? How does a Veteran or a Family member, how do they know what questions to ask to be able to obtain those types of services and support?

Lyn

I think it’s really good to ask if you’re going to the Family doctor, your Family doctor, to just say, “I’m having trouble with everyday thinking, can I be referred for cognitive rehabilitation?” We have such a strained healthcare system at the moment that it’s difficult to get it. If people don’t ask for it, we’ll never get it. Also, the brain injury associations are amazing. The National Brain Injury Association of Canada, the Provincial Brain Injury Associations, they are a great resource for referral out to people in the community.

Brian

One of the things I’m happy to hear in this discussion is you’re not necessarily saying it’s these massive endeavors people can’t do. You’re picking up on the fact that it’s the daily living. I remember one day for me when I was very recently back from overseas, and people were trying to figure out what’s wrong with me, I was trying to figure out what was wrong with me, I had to change a tire on the highway, and on the driver’s side. As I pull over, it’s somewhat dangerous, cars are flying by, no problem at all, slap that tire on, do it, handled it quite fine. Where I was going, I was going to a shop to get a frame done. It’s for a photo or something like that.

When I got in there, and they started asking me, “What mat do you want? Do you want it this big, that big, this contrast, this color?” That took me down. It was the fact that I was being asked three or four questions at once, not in a brain space that I was in. Some people might look at that and go, well, that changing the tire by the side of the highway thing is what would be the most bothersome. Actually, no, for me, I was quite calm there. I was almost breaking down in tears, as I’m trying to figure out this minor task. Is that common with people that have had a physical injury to the brain?

Lyn

Yes, it’s unfortunately very common. So easy to address in some ways, if you understand what the problem is. For you, Brian, you wouldn’t have the perspective to step away and say, “Oh, I see, I understand the factors that make this situation bad and this situation easy.” I feel like that’s another part of where talking to someone like me can be helpful, because it can make something that seems overwhelming and complicated really pretty simple.

For example, people should write things down for you. You know what I mean? Sure, you could do a lot of exercises to say, “Oh, now I can listen to multi-steps.” That’s another common thing. People will say, “I can’t take multiple steps of information at once.” Perhaps your Family member can just write it down.

Laryssa

I’m doing some introspection. Thank you very much, as we’re chatting. Brian, you sharing your experience about trying to make all the decisions for picking the picture frame mat, and how I’m presenting information to my spouse. To be honest, sometimes I get frustrated with it. Because what seems to me like what should be a simple to do or a simple task, or I’m just giving information. Maybe I’m overwhelming my spouse in that process, and then potentially he’s shutting down or getting worked up, maybe, who knows.

I think it’s important to be able to give strategies to Families and education to Families as well. I don’t know if you have any recommendations or strategies for Families, Dr. Turkstra. Maybe it is not just about information for Brian on how he best communicates, but for Families or even in day-to-day things. I really appreciated what you said about maybe making short lists.

Lyn

Absolutely. We’re doing this cognitive rehab study in the US right now with the VA and the Department of Defense. We have transcripts of these therapy sessions. We’re looking now at what the people, the service members and Veterans are saying about their lives with this mild TBI. What we’ve really noticed is a lot of the process of treatment is them educating their Family members on what works for them. Some of it is them recognizing that what Family members are trying to do can be helpful.

Just to give you an example, I was looking at a session the other day where a Veteran was saying, “Yes, my wife makes a calendar, but I never really feel like I need it.” Then he just forgets to pick up the kids. Part of that process is– You know what? That calendar is actually pretty helpful. We can see by the end of the therapy that the Family together is using the calendar. We see a lot of stress and conflict with Families where either the Family doesn’t recognize the problem, or the Family does, and the person doesn’t recognize the problem.

Brian

At home, my wife and I are a blended Family. There’s four kids, and they’re at different schools. Then you have the elementary and the high school. Something that — when my kids hear this, they already know where I’m going to go with this. I’m going to talk about Wednesday morning. One school’s got late start, the other’s got early start, the other one’s got early dismissal, this one’s got a late dismissal, and then they stagger. It got to a point where it’s like, “Honey, Wednesday, you got it. I’ll do all this other stuff. I’ll pick up the dog turds in the backyard. I’ll just do things that aren’t Wednesday.”

This is not a complicated thing, by the way. I used to run a platoon of 34 people with some pretty in-depth who’s where, and he’s at the medic, and these folks are on leave. You just constantly feel like you’re the band conductor with these folks, and you get good at it. Now I can’t figure out who’s going where on a Wednesday. I’m not a dumb guy. I can manage things. Yet I find myself sometimes falling apart. Now, this happens. I don’t have a lack of care or love for my kids. I just screw it up all the time.

Lyn

That’s such a great example of the difference between before and after you’ve had an injury or multiple injuries. We think about it like a jar full of pennies, that when you have an injury, you need all your pennies. I don’t want to say marbles, because that sounds like you’re losing your marbles. If you need everything in that jar, you have brain injury, and you’ve scooped out a bunch of those pennies. For us, what cognitive rehabilitation does is help you make the best use of the pennies you have to take some tasks that were costly before, make them automatic.

If you can offload your multitasking to a calendar that’s on the wall, you have more brain resources left to think about other things in your life, but if you’re spending all those pennies trying to figure out where the heck your kids are going to school, you don’t have a lot left.

Brian

Then what happens relationship-wise? What would you think if Steve goes to the wrong place that he’s supposed to have gone every day?

Laryssa

I appreciate what you said is that, you are an intelligent guy and you’re a loving father.

Brian

Thank you.

Laryssa

You’re committed to your kids.

Brian

Great looking, too.

Laryssa

I didn’t go there, and I just realized it’s recorded that I said that you’re intelligent. Even as you were saying that, I know that about you, but as a Family member, maybe as the spouse, I would be frustrated like, isn’t it important enough to you that you would remember where to pick your children up in each place? Yes, potentially it could create frustration within the Family dynamic. It could create maybe resentment within the Family dynamic. I think that’s where it’s so important to include and educate Family members along the way because that resentment could be like, “Now I have to do everything on Wednesday.”

I love what you were talking about, Dr. Turkstra, about that program that you were chatting about where the Veterans, you encourage them to include and discuss it with their Families and hopefully giving them the tools and strategies on how to do that because how do you have that conversation? Yes, absolutely. I can see where it can impact Family dynamics and relationships, not just between the spousal partners, but what are the children thinking, “Dad forgot me at the school kind of thing.”

Lyn

I want to go back to something you said about PTSD versus TBI and symptoms. I don’t think we’ll ever resolve that. You might know —

Brian

That doesn’t give me too much hope, doc.

Lyn

No, there’s a follow-up hopeful comment. There’s been a massive effort in research to come up with biomarkers that will separate PTSD versus mild TBI. In the complicated lives that Canadian Armed Forces members and RCMP members live in their training, I don’t know that it will ever be possible to disentangle them. They have similar effects on the brain. However, we have treatment strategies for both. The PTSD treatment, we know we have effective treatments. If the PTSD treatment isn’t resolving the person’s everyday cognitive challenges, we’ll do cognitive rehab. If the cognitive challenges are the big ones, we’ll start with that and then we’ll see if that alleviates the stress.

Laryssa

As we’re ending our conversation, thank you so much. I’ve learned so much and have some considerations to make when I’m supporting my spouse. He’ll be happy to hear, I’m sure. Where can a Veteran or Family member get started? If they’re listening to this and it’s resonating with them and they have more curiosity or they want to pursue it, what are some first steps that they can take? What are some resources that they may be able to tap into as well?

Lyn

I mentioned the brain injury associations. I think that’s a really great first stop. You could just google brain injury association of whatever province you happen to be in. They’re all good starting points.

Brian

I hope people in your profession, but also on the clinical side, start to realize when you encounter a Veteran, please start thinking about this right away. I’m of the belief that a couple of years in the forces, we should be pretty much assuming that you’ve been knocked around a little bit. That’s only going to get worse as science progresses because it’s going to do both things. It’s going to make better helmets. It’s going to make better bombs. We’re going to keep working. We’re going to keep working together.

As I reached out to people in the community and I said, “I need to know more about this. Who’s the guy?” They all said, “You got to phone Ryan Carey.” We’ve got the man, Ryan Carey in person. We’re here talking about TBI and Ryan’s going to introduce himself. I’ll give him a little plug here. Obviously, he’s here because he’s a Veteran and used to wear a jersey. One we might recognize. Why don’t you start there?

Ryan Carey

Yes. I was pretty lucky to play football most of my life. I played all through high school, played at university, Katie University, and then was drafted and played in the CFL, played for Winnipeg and Saskatchewan. A dream come true and lots of head injury. Lots of head contact up until — before joining the military.

Brian

For yourself, you’re not coming here because this is something you heard about. This is something that’s happened.

Ryan

Yes. It’s something that I’ve lived through personally. Through the struggles of post-Afghanistan. Looking back, obviously, back then, there was no conversation on head injury at all. It was just, shake your head and get back in the game. If you have a concussion, they had some protocols, like, “Go sit in a dark room.” They’re nowhere near– I would say the information almost doubles every year on what we know about the brain. We’re just learning more and more and more about the effects of head injury on the brain.

The important point here is that I think we do a good job with what people would think is a traumatic brain injury, where someone’s knocked unconscious, where there’s a brain bleed, where there’s penetration of the skull. Then they’re in the pipeline to do physiotherapy to get their brain functioning again. What we’re overlooking are these repeated blows to the head throughout a lifetime.

Brian

You know what’s the first thing that put me down was pugil fighting. For those that don’t know what that is, yes, the army still trains with bayonets. Some people will laugh at that, but it’s the truth. Now, do we poke each other? No, we get the world’s biggest Q-tip and we basically wallop each other with it. If you’ve got a really safety-conscious outfit you’re working with, then there might be padding and helmets, not always.

Ryan

When I took the close quarter battle instructor course, what they did, which was brilliant actually, is all morning they would take us to the obstacle course and they would just drill us into the ground, and we would do casualty work. When we did our pugil stick fighting in the afternoon, we did it tired. We were really tired when we did it. Stuff like that’s smart, but going off into a unit and just having the Friday afternoon beat each other up.

Brian

If I’m tracking, you’re saying that you got tired, so you’re not hitting each other with so much force.

Ryan

That’s right. Yes. It’s a good way to do it now. There were still some pretty good shots in there, but we know this from football that a football helmet doesn’t protect your brain from that. It protects it from obviously getting penetrated by something, but it doesn’t stop the concussion, and a bigger helmet and more padding and — it doesn’t work.

Brian

There I am, I’m on an armory floor and we’re pugil fighting. I win my first round, I’m chest out, I’m the man. Win the second one against a guy that’s a lot bigger than me, and I walked out on the third one, and I don’t think that match was on for four seconds. I was on the ground, I was out, the ambulance was on the way. I was staring up at people that I recognized, but I didn’t know exactly who they were. I was released from hospital about a day and a half later.

The next thing you know, I’m going down to the medic because we were about to start workup training, and I was given a clean bill of health, off to Bosnia. Years later when I started asking about, “Hey, what’s going on?” Headaches, neck pain, all this, the answer I actually got was, “You got better. You got good enough to deploy.” How bad could it be? I’m watching as I’m saying this and Laryssa’s eyes are starting to realize, “You guys do what to each other? What are you beating each other up with Q-tips for?”

Ryan

There’s no pre-test. They can’t determine that. If there’s no pre-test that you do and then a cognitive test that you do, how can they say that you’ve gotten better or not gotten better. These are types of things that we should be talking about. I’ll reference, I think pugil stick fighting is excellent. It’s great for a lot of things. It comes down to coaching. Do you have to hit in the head? No. You’re teaching people to fight with a bayonet. I’m an instructor. There’s things besides hitting the head because then people start focused on hitting the head, and then it turns into that.

Brian

Laryssa, your eyes just got a little wide there about a minute ago as we’re talking about beating each other up with Q-tips.

Laryssa

Yes, and I think I was curious a little bit, Ryan, about your — we touched on your career in the CFL and you’ve just skimmed around your military experience. I think that’s something that I just wanted to explore a little bit because you mentioned lifetime of injury and head injury. Yes, I’m just curious about what came first, your experience in the military, just for folks to understand a little bit more about your experience. Then I do have a question about those injuries and people either just saying you’re good now or to shake it off. If you can tell us —

Ryan

Yes. I think what happens, when I went through training, obviously, was exposed to weapon signatures from the 84, from the 25 millimeter, and don’t forget also us bouncing around in the back of light armored vehicles. We did pugil stick fighting in training as well. Then that doesn’t really stop. It’s actually worse for NCOs. I was an officer. I get away from that, but still, as an officer, was exposed to it, was exposed to all kinds of head injury. We sometimes focus on the person that’s firing the weapon. Anyone that’s fired an 84 before will be like, “Yes, we know it almost tears your head off.”‘

Don’t forget, you’ve got a number two on the 84. You always have a number two with you. Then you have an ARSO, an assistant range safety officer. They’re all getting it. If you take someone that’s been in the ranks, they’ve been a private, they’ve been a corporal, which they shoot way more because that’s their job. My job is to deploy the weapon system, their job is to shoot it. Then they become a corporal and they start training to become a master corporal, to become an ARSO in a range. Then as a master corporal, they’re in an ARSO range.

As a sergeant, it’s not until they’re a warrant officer, but they’ve had all this exposure. Not to mention, just think of all the other things, they could very well have been paratroopers. You don’t land softly when you jump out of a — you come down like a lawn dart. How many of them are whacking their heads?

Brian

Your helmet keeps following you till it hits your head.

Ryan

There you go.

Laryssa

Yes. We were talking earlier about that cumulative effect that could also be a traumatic brain injury. It’s not necessarily just like that one specific incident or accident. It sounds like the picture you’re painting for me is that pugil stick fighting, which is over the course of a career as you’re developing that skill and that training, but also all of these other things that are just drops in the bucket, another drop in the bucket, another drop in the bucket.

Ryan

There you go. That’s exactly it. Yes.

Laryssa

Then on top of that, maybe there is the fall out of the back of a vehicle or a blast injury.

Ryan

Oh yes. Don’t forget, a lot of the doors that are on these, they are heavy — I know of a girl who got hit by a door, a metal door, they’re just — it’s an environment where there’s danger. I think a lot of people too may listen to this and go, “We have to get rid of pugil stick fighting.” No, it’s not that. It’s letting commanders know and letting people in leadership know that, look– We always talk about, there’s a general who said, “How long does it take to train a warrant officer that’s in the military for 20 years?” I’m like, “20 years.”

That’s when you’re going to start seeing these cumulative effects. Then there, what happens is they go in, they start– because it’s easier now for people to come forward, to start saying, “Hey, I think I’m having some problems here. I need to speak to somebody,” but nobody’s identifying the head injuries. Now they start to get treated for PTSD and they get all these pharmaceutical, and nothing’s working, and they get frustrated, and they can’t– that can lead to all kinds of problems because the side effects of anxiety and depression are similar, but the treatments are different. There’s different treatment.

Brian

There’s a couple of things you said I want to pick up on here. I’m going with the most bare-bones honesty, shooting the 84 is fun, right?

Ryan

Absolutely. I just want to pile on there so I don’t forget that we’re talking combat arms specific because we’re combat arms specific, but the Navy bouncing around in the ship. I’ve heard of– Navy guys have told me getting strapped in and bouncing around in a ship because the ocean can toss a huge ship around. In the Air Force, the G forces that the pilots are facing, or the people on the ground that are around the boulder blades of choppers. This isn’t just a combat arms thing.

Brian

You mentioned the door. We’re not talking about the door in your kitchen cabinet. We’re talking about a 240-pound door designed to keep out a blast that’s trying to kill that tank or that carrier. I like the fact that you’re admitting that a good army is still going to pugil fight tomorrow. It’s going to shoot its weapons. It’s not going to not do that. We’ve got to do these things because if we don’t, then we’re sending people into circumstances where they’re not trained. They’re not ready.

Ryan

Let’s take breaching. Do the breachers need to be right by the breach in training every single time it goes off? I don’t have the expertise in that, I’ll let the commanders decide that. I know when you breach, you want to get in as soon as possible. It’s talking — these are the conversations we need to start having.

Brian

When you’re breaching, you’re actually taking advantage of the concussion you just created and you want to be the next thing that happens to them. They got concussed and now you’re in there on top of them, dominating the room.

Ryan

The other side of that is commander saying, “This is how I got here.” They don’t want to change that. I get that. You’ve also got instructors now that are peeing blood because they’re exposed to the blast as well. It’s like, again, what is the cost associated with training someone in the special forces that’s doing that? It’s not only a cost in training, but they have a special skill set. That’s why they’re there. We want to be able to save that and give them a long career, and give them a life after the military as well. It’s not–

Laryssa

Can I ask — we’re going to shift gears a little bit because we’ve been talking about a number of mechanisms for people to sustain a traumatic brain injury. Can I ask you, Ryan, when did you first notice symptoms? When did you start to suspect? Many Veterans are diagnosed with other physical or mental health conditions before TBI is even considered.

Ryan

Comorbidities.

Laryssa

Comorbidities. Wondering when you first started noticing symptoms and what were they?

Ryan

First of all, there was no education on it. I didn’t know until Tim Fleiszer, who is the director– He played in the CFL for 10 years, and he’s the director of the Concussion Legacy Foundation Canada, which is the umbrella organization for Project Enlist and the work that I’m doing right now with the military. We met through a mutual coach, Sonny Wolfe, Coach at Acadia. Sonny’s from Montreal. They ran into each other and he said, “Hey, Sonny, do you know somebody on the military side because we’re trying to branch into the Canadian military?” He goes, “Yes, I got someone for you.”

Tim and I met, and his first question to me over lunch was, “What’s going on in the military? Is there head injury?” I’m like, “Are you kidding me?” Are you — obviously, someone from the outside doesn’t know that. In and around that time and in the years before that, I started making myself the connection between these football players that I knew growing up and were my heroes and getting diagnosed with CTE and following that story and seeing the same behaviors and the same stuff happening with Veterans. I’m like, “There’s got to go be a connection here.”

Where it really hit me was — and this was after the fact, but I was being treated for posttraumatic stress. Nobody looked at any of my head injury. This is a guy who’s played professional football and been in the infantry. No one even asked the question, and just went immediately to, “Here’s a bag full of medications. Now go talk to a psychologist.” I found that whole process, not only did the medication not work, it was frustrating because I was trying to express that it’s not working. The psychiatrist wasn’t listening to me to the point where the mother of my children had to step in and literally fire her because they just kept piling meds on and none of it was working.

That made me reject the system. Made me reject the Western medicine model. That’s the position I was in. It wasn’t until I started having that conversation and started focusing on what would eventually become our operation brain health, which I know we’re going to talk about. When I started focusing on that health, found a psychologist that I resonated with that basically said in the interview, “If you’re on a lot of medication, I can’t treat you. I need to get into your heart. I need to get into that space.”

Western medicine has been great for me in a lot of ways, but I know where that disconnect was. As soon as I started treating my mental health challenges physically with physiotherapy, with exercise, with nutrition, with cognitive reserve, like using my brain, being social being. It was just when I started focusing on those things started to get a lot better.

Brian

One of the things that is in my background here, I remember when I came back from overseas, I was having a lot of problems. What I find shocking now is, nine years after that was the first time someone started to look at my history from a physical damage point of view to my head. You talked about the warrant officer, it takes 20 years to get there. Say you get there in 12, which is actually pretty quick. What have you accumulated over that time? This is one of the things that happened to me was when I came back and I was having trouble, of course, all the questions I went through were about what I just went through. “What happened to you in Afghanistan?”

Of course, I’m answering the questions like, “Here’s how it went.” No one ever, even to this day, asked me, “What was the cumulative effect of all the things that went bang and knocked you in the head from 1994, all the way up until this point?” I think we need to be in a place where we’re looking at a 10-year career, and we’re assuming damage will have been accumulated. That’s some of the stuff we’ve talked about. I think from a football perspective, how many hard tackles did you take from elementary school, first time you played football, to the time you left? You’d lose count. That’s what we need to be looking at.

Ryan

Yes, exactly. I think also giving– since we’re talking about Veterans, we’ll talk about Veterans that are struggling with their mental health, giving them things that they can do so that they are preparing themselves for their therapy, whatever that therapy may be. You have, what’s your 50% or your 25, whatever? What are you going to be putting into that that’s going to help you recover from what you’re dealing with? Then you can let the professionals sort out, “Okay, is this coming from head injuries?” The challenge is, like you just said, it’s still not even on a lot of doctors’ radar screen.

That’s why the Concussion Legacy Foundation is developing education package for medical doctors to start bringing this issue to light and start saying, “Look at this.”

Brian

I think, we don’t think we’re acting in an arrogant point of view when we say we have something to educate doctors on.

Ryan

No, not at all.

Brian

I’m not going to teach them a thing about medicine, physiology, that’s them. What I want to do is I want to give them the back picture. I want them to get a vision of who I am and what I’ve been through over the entirety of my career, and then they can look at it and go, “Okay, maybe we should start testing for this.”

Ryan

Stuff’s moving in regards to this. It’s moving slower than I want it, but I think that it’s going in the right direction anyways. Like you said, it is about education. These are really smart people, obviously, and they listen. When you start saying when I started showing them videos of Afghanistan and them watching someone shoot an 84, watching people beside the M777, watching a building getting demoed and seeing the shock, the blast wave come across and hit the troops that are standing in the trench. They’re protected from the blast, but are they protected from that blast wave?

Then they start going, “Oh, wow, okay, we see where this is occurring.” Then again, now you’ve got that’s the people that are in the space, that are in the head injury mental health space. Then you’ve got general practitioners out there that are trying to plug holes in the dam. The medical system is stressed right now, and it’s triage. How do you train doctors in this? Because they’re busy. This is all the stuff that we’re trying to figure out.

Brian

I think there’s also some general understandings too. If you would take us back to the ’90s and some 25-year-old walks into a hospital and says, “I’ve been blown up in a war.” You might think that he’s making it up. They’re not. They really have happened. We have 20-year-old Veterans in this country. Now we start adding into that the whole brain discussion. One of the things that we’ve mentioned, you certainly have as one of your main topics you’re tackling, you call it Operation Brain Health. I would say, how do I make sure that the guy that sits down in that doctor’s office is as ready to be helped as he can possibly be?

If I’m the guy going through some therapy, I’m going through some treatment, I’m going to the doctor, what do you coach people to do to make sure they’re as healthy to be helped as they possibly can?

Ryan

Call it living a healthy lifestyle, but what does that mean? We broke it down into four pillars just to simplify it, and that’s exercise, nutrition, sleep, cognitive reserve. Most people, when you fix your exercise and your nutrition, your sleep gets better for obvious reasons. You fix your exercise and nutrition, your brain starts working better. I’m saying it could be something as simple as walking every day, the importance of that, getting fresh air, and it might be as simple as that.

If you can’t exercise for whatever reason, then see a physiotherapist. To say that, “I can’t exercise because I’m injured or I can’t.” No, you have to do some type of movement. You have to move your body, and we can go down the rabbit hole on each of those pillars but something like sleep, for instance, everybody knows sleep hygiene, everybody knows you shouldn’t be staring at the TV up into bed or watching the news or putting on, sorry for the term, war porn on your YouTube– getting your central nervous system all ramped up to go to sleep doesn’t make sense.

Everybody knows what to do, you just got to do it. Cognitive reserve means, yes, it means training the brain. I like music for a whole bunch of things. Cognitive reserve also means, besides the brain games and training your brains and maybe going to physiotherapy to do ocular work, it also means being social. It also means maybe doing some volunteer work. Now, you may need to get there. That might be a pillar that’s a bridge too far for you right now, but the Veteran themselves can exercise.

Laryssa

Tell me a little bit more about the cognitive reserve. Is it a way of stimulating different parts of the brain?

Ryan

Absolutely.

Laryssa

You talked about playing music and things, but tell me a little bit more about it.

Ryan

It’s defined quite broadly, and again, it can mean different things. For me, I get a lot of the cognitive reserve piece out of music because when I’m playing the guitar, my left hand’s doing something, my right hand’s doing something different. I’m trying to sing between the notes, where’s the pauses, so I sometimes play harmonica. It also makes me social, because I go out and I play with other musicians at open mics and I promote music for vets, like any type of music for vets.

There’s a way of taking something that is obviously good for your brain, but it’s also tied to something. Again, if you’re going to isolate it — one of the most dangerous things is isolation, we know that. To isolate at home — say it’s woodworking you want to get involved in, and then you just isolate in your shop and — sure, part of that is that isolation. That’s the practice part, I guess. Then you could turn that into going out and doing that with Veterans and something and maybe in peer support. Have some type of a new mission, a new task, a new purpose in your life. You can do that through the cognitive reserve pillar.

Again, each of them can mean something a bit different. It doesn’t have to be like, “Oh, this is what exactly cognitive reserve is.” These are all easily looked up on the internet as well. I can tell you from experience in peer support over the years, when someone’s falling off, I always go right back to, “Okay, are you doing those four things on a daily basis?”

Brian

I wonder if as we’re going through this discussion, it’s almost a little bit scary. You’re the mom of a reservist. You got a young lad there that’s embarking on what we’re just describing is potentially injurious —

Ryan

What happened before, a lot of people that join us are athletes. They were athletes before. They played hockey or rugby or soccer. Soccer’s a culprit for head injury that people overlook all the time, but young kids hitting that ball is a problem.

Laryssa

Yes, exactly. We don’t want to talk about the motocross accident. Thanks for bringing it up.

Brian

This is part of the whole experience is that you’ve got this daunting task when you look at a career. I’m going to do all these things, and then what someone’s telling me is like, “Okay, the best thing I can do is healthy living.” I’ve gone through other health concerns over the last couple of years. The same thing’s true there. The best version of that patient sitting on that bed is what I want to deliver to the docs.

Ryan

Right now, if you’re struggling, if the treatments that you’re under, if you think if they’re not working, okay, that’s okay, but turn the evaluation on yourself. Are you exercising? Are you watching what you eat? How’s your sleep? What are you doing in the cognitive reserve space? Assess yourself on that. Then from there, and I’ve seen this happen so many times that when Veterans start focusing on those things, they use less medication. Whether it’s cannabis, whether it’s pharmaceuticals, whatever medication they’re using, they start using less of it because they don’t need as much.

That also forces a conversation because when you start focusing on yourself like that, we can start talking about — within those four pillars, we can start talking about, “Hey, you need to have an encounter with yourself to heal these old wounds.” It’s going to be a lot easier to do that if you’re physically prepared for that. One thing I do after my psychologist meeting each week or every week when I see her, is I get up and I go for a walk. I got to move that energy, because sometimes they’re heavy, but you got to find a way to go move it, get that energy moving, and that’s best done through exercise.

We hear it all the time. Exercise is the best antidepressant. It is. I can’t tell you how many times I’m freaking out in my house anxious or depressed and I go out for this long walk and I come back, I’m like, “What the heck was I even– what was I anxious about?” Something as simple as a walk can change your whole day. It can literally change your whole day.

Brian

We’re not talking about you have to have 20 years in the infantry for this to happen to you. In fact, it might actually be someone in your Family, a car accident can do this, right?

Ryan

Yes.

Brian

Absolutely. We were going up to the north. I was actually flying up to Mazar-i-Sharif, town up in the north. Well known as one of the hottest places in the world. I remember we clocked it in at 56 degrees in the shade.

Ryan

Oh, very nice, yes.

Brian

Unpleasant. We landed in a place called Camp Marmal. Then we went over to this place called Mamena. When we hit the ground, I thought we broke the plane. Now, of course, I’m not an Air Force guy. I have no idea what stress or hurt it can take, but I thought we crashed. No, it was just a hard landing. That experience sticks with me because in some of the work I’ve been able to do at Atlas, I’ve been able to remind people, smashing into the ground for hard tactical landings, that can cause injury.

You’ve mentioned the door slamming onto you. One of the things that one of the gentlemen that’s helping us on one of our research projects has brought up, small boat teams in the Navy, they’re hitting those waves and just slamming and it’s coming up through their heels, up through their spine and what’s on top of that. I really want people that are listening to this to realize, “Whoa, I didn’t have to be in Afghanistan. It’s not about shooting the 84. It’s anything that can cause these injuries.”‘

Ryan

We have soccer players that are demented in the UK that played in the World Cup that don’t even remember the games. They’ve done tests for CTE on soccer players and found stage three, which is equivalent to what the football players in the NFL. Start doing that self-assessment and say, “Yes, no one’s asked me about this. I played soccer all my life, and then I joined the military. I was in the Navy. I was in the —” and then start thinking about, “I don’t know what it’s like to be —” I wasn’t in the Navy, but I know talking to people in the Navy like, “Oh yes,” they identify with it right away. They’ve got weapon systems that they’re firing as well. Air Force as well.

You start asking yourself that question. I do want to offer that Project Enlist does offer a support line. You can go and it’s basically a patient navigation system where people can go and they can sign up, and they can get sent to wherever they live, a physiotherapist, get the proper assessments done, and get the proper treatment if that’s a course of action.

Brian

If there’s a Veteran or people that are around them, their Family, their close personal friends, and they’ve got some questions and they want to know more about what you know, where would you direct them?

Ryan

They can reach me through projectenlist.ca. They can go to the support line if they — anyone can fill that out, whether it’s a loved one or a caregiver, it doesn’t matter. They can fill that information out. Yes, but I can be reached through projectenlist.ca. We’re on Facebook as well, on Instagram.

Brian

We’re going to stay connected and create working together. If they reach out to us at the Atlas Institute, we’d find a way to make that connection.

Ryan

Yes, for sure.

Brian

That’s where we’re at is, we’re at this place where science will push and we’re going to help push it. Awareness, that’s where we need to be. I really hope that when there’s a Vet out there and there’s people that live with them and people that love them, and there’s running up against the wall, this treatment isn’t working. I’m trying to get better, but I’m not getting better. That I hope that they can see this as something that, “Maybe we ought to look at that.”

For those people out there that are medical practitioners, clinicians, what have you, I really hope that you can hear this and just start looking at this a little sooner. If we have no new science, but you know when a guy comes in front of you, when a woman comes in front of your table and says, “I served in the Canadian forces, I served in the RCMP,” I would really like it to be a reflex that you start thinking about what’s going on to that brain.

Ryan

Yes. For the Veterans that are out there, peer support is so important. Get involved in peer support. It really does help.

Laryssa

Yes, I did have two last questions that I wanted to ask. One of them was, maybe you just touched on it. What’s one thing that you wish more Veterans knew about TBI?

Ryan

The physical treatment, what they can do themselves, instead of looking out and maybe– What they can actually do themselves on a daily basis to have their brain perform better. Yes, we’re talking about performance, but again, we’re not talking about you competing against anybody else. You’re competing against yourself. Wherever you are along those four pillars, that’s okay. Just keep trying to improve on that on a daily basis.

Laryssa

What’s one thing that you wish more Families knew about traumatic brain injury?

Ryan

That’s where the best information comes from. They need to be involved in this conversation equally because someone who’s suffering, potentially like a Veteran suffering from a brain injury, may not be able to even figure this out. I’ve gone online with Veterans and helped them fill out the form. They can’t process the information. It might be a caregiver doing that. Then the caregiver starts going in and starts seeing the information and starts — it probably starts to help them identify, “Oh yes, okay. That’s why he or she is doing, acting, or behaving in this manner.” Everyone needs to be involved in this conversation. Not only the — let’s call them the patient, but like everyone that’s surrounding that.

Brian

I want to thank you for being here. This is expertise. There are a lot of forms of experts out there, but getting yourself ready to be helped is what you can do. I really think, from the Family perspective, because we’re all in the brotherhood, if you will, I think I’ve got a better vision now of, “Hey, what might be going on with that guy that’s disconnecting, the hermitting?” It’s just another thing for me to start considering. It’s also another thing to give people hope, because when you’re struggling, when you’re trying to get better, man, there was a while that I was trying to just protect my job. I would say I was fine and everything’s good to go. There was a period where I was really trying to get better. Then I’m retraining and I’m going through the vocational rehab and it’s not working. Man, that was when I was at a tough point in my life. I wish I’d have known then that there were people on the file, that someone cares, that other people like sport and people that deal with accidents are also looking at it going, “Hey, what do the Veterans have to say about this?” That actually makes me feel a lot better to know that.

Ryan

Oh, definitely — Veterans in this country have a voice in this space. The voice is the leadership that Veterans bring to it. Athletes always respect that. Athletes and Veterans work very well together. This ties into a bigger piece to the Canadian public health. It’s not just for Veterans.