Unfortunately, concussions and traumatic brain injuries, or TBIs, are far too common in cycling. Whether training on open roads, racing at high speeds, or facing off with rush-hour traffic on your bike commute, cyclists often place themselves in vulnerable situations. Head injuries are becoming increasingly diagnosed among the two-wheeled crowd.
What’s more, there’s a good deal of misunderstanding about what exactly the terms concussion and TBI mean. Are they the same or very different? How should you manage each condition? What are the potential long-term repercussions of concussions, if any? We’ll tackle all of these questions, and many more, in this episode.
We turn to Dr. Steven Broglio, the director of the University of Michigan Concussion Center and the director of the NeuroTrauma Research Laboratory, for guidance on this complex subject.
Dr. Broglio has spent much of his adult life studying the causes of concussion, the effects of concussion on the brain, the short- and long-term concerns, the best course of management, and the use of helmets. His experience and knowledge on the matter make for a compelling discussion. (Furthermore, he’s also a former elite cyclist, so he is able to come at this discussion from that angle as well.)
Add to that the conversations we include with Timmy Duggan and Hannah Finchamp, two athletes who have each suffered head injuries.
Timmy’s story is well-known: While racing at the Tour of Georgia, he was involved in a horrific crash which led to a severe traumatic brain injury. He shares his experience, from the injury to the acute aftermath and rehabilitation, to the long-term and psychological impact the injury had on his life. You’ll hear from him throughout the episode.
And Hannah walks us through how being hit by a car led to her concussion, and how that impacted training and life.
All that and much more on this episode of Fast Talk.
Join the conversation about concussions, CTE, helmets, and TBIs on our Forum; join as a Listener Member.
Finally, we want to let you know about an organization devoted to helping people heal and recover from traumatic brain injuries. It’s called Beacon of Hope TBI and it was founded by a Fast Talk listener who has suffered three cycling-related brain injuries.
For more information, visit Beacon of Hope TBI online or visit their Facebook page.
Chris Case 00:12
Hey everyone, welcome to Fast Talk your source for the science of cycling performance. I’m your host, Chris Case.
Chris Case 00:20
Unfortunately, concussions and traumatic brain injuries, or TBI, are far too common in cycling. Whether training on open roads, racing at high speeds, or facing off with rush hour traffic on your bike commute, cyclists often placed themselves in vulnerable situations; Head injuries are becoming increasingly diagnosed among the two wheeled crowd.
Chris Case 00:44
What’s more, there’s a good deal of misunderstanding about what exactly the terms concussion and TBI mean. Are they the same or very different? How should you manage each condition? What are the potential long term repercussions of concussions, for instance? If any? We’ll tackle all these questions and many more in this episode.
Chris Case 01:05
We turn to Dr. Steven Broglio, the director of the University of Michigan Concussion Center, and the director of the NeuroTrauma Research Laboratory at the university, for guidance on this complex subject. Dr. Brogliohas spent much of his adult life studying the causes of concussion, the effects of concussion on the brain, the short and long term concerns, the best course of management, and the use of helmets, of course. His experience and knowledge on the matter make for a compelling discussion.
Chris Case 01:35
Add to that the conversations I had with Timmy Duggan and Hannah Finchamp, two athletes who have each suffered head injuries. Timmy’s story is well known: while racing at the Tour of Georgia, he was involved in a horrific crash which led to a severe traumatic brain injury. And today he shares his experience from the injury to the acute aftermath and rehabilitation to the long term and psychological impact the injury had on his life. You’ll hear from him throughout the episode. And Hannah walks us through how being hit by a car led to her concussion and how that impacted training and life.
Chris Case 02:10
All that and much more on today’s episode of Fast Talk.
Trevor Connor 02:17
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An introduction to Dr. Steven Broglio
Chris Case 02:45
Well, we welcome Dr. Steven Broglio to the episode today. Thank you for joining us on Fast Talk.
Dr. Steven Broglio 02:51
Great, I appreciate the invitation to be here and talk about my two favorite subjects: concussions and bikes.
Chris Case 02:58
Give everybody out there a sense of your immense experience and background in this this area of concussions, TBI, and that sort of thing.
I started in the space around 2000. For those that were in and around athletics at that time, they will probably remember that that was a period when somebody had a concussion and they would walk to the wrong sideline, you would chuckle and send them back into the game. I continued with the work through grad school, which I finished up in 2006 and right around that time, I think that the national conversation around concussion shifted quite dramatically – That was when those kind of first modern CTE case or chronic traumatic encephalopathy case was identified.
Dr. Steven Broglio 03:43
It’s just been a whirlwind since that point, we’ve been pretty fortunate to have pretty good funding and try to contribute to the literature on trying to understand injury identification and management and what are the long term effects. I’ve been doin that since 2006, in a formal way. I was at the University of Illinois to start and now I’m finishing up my 10th year here at the University of Michigan.
Chris Case 04:04
And you are the director of the Michigan Concussion Center and the director of the NeuroTrauma Research Laboratory there?
Dr. Steven Broglio 04:11
That is correct. So the lab has been here as long as I’ve been here. So we started that when I came in. And then the center we’re coming up on our second anniversary year in a month or two, which is funded by our University President, Dr. Schlissel. He saw something in that and we’re just trying to make sure that we do the good work and get the message out.
Chris Case 04:33
And it should also be mentioned that you were a bike racer at an elite level, cat 1 you said, bike racer. Not sure how much you ride these days because of all this work that you’re doing, but you have a background in this sport. So you you know it from that angle as well.
Dr. Steven Broglio 04:51
Yeah, so I started riding/racing in my teen years and I would say I kind of officially hung up the wheels, I don’t know, probably in my 30s when work and family kind of got too much to handle. But still ride pretty much on a daily basis in my basement. A lof of a Zwift World Championships type of things going on at five o’clock in the morning down there.
Trevor Connor 05:17
You might have just coined a new COVID term: “daily basement”.
Chris Case 05:23
Dr. Steven Broglio 05:24
There you go, there you go.
Defining concussions and various head injuries
Chris Case 05:26
Well, let’s jump into this what I know will be a fascinating conversation about these two things: cycling and concussions. It is a serious concern for cyclists. There is a lot of misunderstanding out there I’m certain about the different terms that are thrown around, about the different symptoms that people see. We will also get into the fact that it might not necessarily present the same way in a cyclist as it would in another athlete from a different sport, football or soccer or something like that. But maybe we should really start at the very beginning, which is defining some terms: concussion, TBI – give us the very basic definition of those terms, if you would.
Traumatic brain injury (TBI)
Dr. Steven Broglio 06:15
TBI is traumatic brain injury. And probably the easiest way to think about it is that’s the umbrella term for all injuries that occur to the brain. And then within TBI, we have three large buckets, if you will, mild traumatic brain injury, moderate traumatic brain injury, and severe traumatic brain injury. When we talk about moderate and severe, we’re talking about varying degrees of structural damage to the brain. And then the cognitive and other impairments that come with that. Mild traumatic brain injury, or the least severe, obviously, is often used interchangeably with concussion. And there’s a bit of a debate around that to be quite honest. So some people will use them hand in hand. Concussion is just a little bit easier when you’re talking to individuals, concussions is an easier way to express that. Others feel that concussion is its own entity separate from mild traumatic brain injury, and it might be the mildest of the mild, if you will. So that’s kind of on a large scale as a way to think about it.
Dr. Steven Broglio 07:18
I think when we talk about concussions, specifically, at least the way it’s conceptualized in the sporting context and cycling; to be honest, there’s over 100 definitions in the literature that are out there. I was in a group, we published a paper last fall that yes one definiton, I’m in another group that probably is going to have another definition later this year. And so part of that is a lot of groups want their own definition and then part of that is just how the science has advanced over time. Just because you wrote a definition yesterday, doesn’t mean it’s going to stand up for all eternity. So we learn more, and then we revise the things that we learn.
Dr. Steven Broglio 07:55
But really, the way to conceptualize it is: it is a traumatic brain injury, and it’s induced by a biomechanical force and that force can be either a direct impact, and the easiest one is like a helmet, head to the ground, in cycling case, or helmet to helmet in a football case, or sometimes it can be an indirect impulse. So not so much in cycling. But if you think about a football player being tackled around the chest, you know, running down the field, big tackle around the chest, almost this impulsive force that comes up through the neck and into the brain. And really what that results in is really rapid onset of neurological or impaired neurological function that will resolve on its own over time. And that resolution, it varies, we might get into this, I think maybe a little bit more. But on average, it’s about two weeks. But really, I think up to a month is probably more of a normal recovery period for most people.
Dr. Steven Broglio 08:48
That outward expression of clinical signs and symptoms, so the headache and nausea, the fatigue, the mental impairment, is representative of a functional disturbance within the brain and not a structural disturbance, at least on a macro level. So if you were to take someone to the emergency room and put them in a CT scanner, MRI scan, there wouldn’t be damage to the soft tissue of the brain, you wouldn’t see anything. But at the cellular level, the way the cells are functioning, that has been altered, the neurons get stretched, you get this imbalance in the ions between the inside of the cell the outside of the cell and it just doesn’t function properly. The signal doesn’t propagate that neuron as it should. And that’s the slow to respond, that’s the increased reaction time, the inability to remember thing,s that’s kind of where that comes from.
Dr. Steven Broglio 09:40
The other thing to think about, this is more from the medical side of things, the other thing to think about is when someone suspects this has happened they need to make sure that it can’t be explained by something else that’s going on. So drug use, alcohol use, medications, cervical injury, vestibular injury, like all those sorts of things can happen simultaneously while the other injuries can happen simultaneously and they may present like concussion, xo vestibular disorders, people get dizzy, they may have headache, you can have neck injury that results in headaches. So those may present like concussion but aren’t actually concussions. So the medical practitioner needs to make sure that they can differentiate between the cervicogenic headache or a vestibular headache, and a concussion based headache. So it gets very complex, particularly in the world of cycling, you’re on the side of the road, and you have to make a decision in 30 seconds so they can get back into the group as opposed to – even on the football side we see this all the time where symptoms evolve over time, and they get it wrong, and somebody comes back into play. It’s not as clear cut, I think, as most people would would like it to be. It’s not like a broken bone where you can put them in an X ray, you see the broken bone, and it’s a done deal. There’s a lot more that goes goes into it from that perspective.
Trevor Connor 10:55
And we’re certainly going to get more into that. But something I want to bring up right now with your definition of concussion and TBI. I found this really interesting, you wrote a review; so back in 2015, you had a conference about concussions in Michigan and wrote a great review of what was discussed at that conference. And something that really caught my attention, at first surprised me, but then made sense, was, on the one hand, you talked about all the great awareness in the last 10-15 years about concussion and all the great research that’s leading to, but did point out a negative to this, which is a large percentage of concussions are going to resolve in two to four weeks. And there does seem to be this perception now, at least in the media, that kid gets a concussion and this is for life.
Dr. Steven Broglio 11:53
Yeah. I’m glad you brought that up. So I think there’s two things: I think, commonly we hear that the normal time to recover is 14 days. And I said the average time to recovery, and I’ll stand by that. So I think a lot of medical providers relay that information, if somebody comes into their office, and they’re diagnosed with a concussion, and they say, “Oh, you know, within two weeks, you should be fine.” And then immediately on day 15, when they’re not fine, the athlete, and potentially the parents, for that matter, start to panic. What’s wrong? I’m not recovered. Things aren’t right. But the reality is, it’s 90% of people recover within a month. So 50% within two weeks, 90% within a month. So if you just happen to be in the 51st percentile, then you’re extending beyond that two week window, then the psychology starts to play into this, right? You start to think about why do I have these symptoms or what’s not going right, and people can go down a rabbit hole and cyclist spend a lot of time on the bike and you know, you start to become very internally focused, and you know that your left pinky toe is off a little bit today and things don’t feel right. So people start going down this rabbit hole and all like the psychology starts to overlay with the biology of the injury. And then maybe you have a parent this kind of “Johnny, are you okay, today? Or Jane, are you okay, today?” And so then you get the social aspect that overlays with this of you should be okay, but you’re not okay. So all this stuff starts to interplay with each other.
Dr. Steven Broglio 13:25
The other side of that is there is definitely a fear. We see this all the time, because the way that the injury is portrayed in the media, including a major motion picture titled “Concussion”, that if you have an injury, you are destined to have some sort of long term neurodegenerative outcome. And that is simply not the case. We do not see it. I would never recommend go hit your head, I think that’s bad, but we have absolutely no reason to believe that one, two concussions that are identified quickly and managed well, that the patient should have any reason or any cause for concern for a poor outcome. Now, there are cases, I think we’re going to talk about this later on, where people have an injury, and it’s not managed well, maybe they return play too quickly, or they’re never removed from play, they have multiple head impacts, particularly while they’re still injured, or more severe injuries that have long term consequences. But a routine concussion in and of itself, we have no real reason to believe that there’s a long term issue.
Chris Case 14:27
I think that the other side of this media, looking at it from the media’s point of view, I guess, they’re trying to make stories, of course, or not make stories, but they latch onto stories and sometimes turn them into something that they’re not. And you’ve seen maybe the terminology, “a concussion epidemic”, from your point of view, is that something that exists?
Dr. Steven Broglio 14:49
No, I don’t think there is an epidemic. I think what’s happened, particularly since around 2006 – 2007 when concussion became a common terminology within everybody’s vernacular, is that we’re starting to pay attention to the injury a lot more and deal with the injury a lot more. So when I talk to the athletic medicine folks here at Michigan, some of them have been on sidelines for 30 plus years, snd they’ll tell you, there’s no more injuries than there’s ever been, we just don’t ignore them. Particularly, you think back to the 80s, and the 90s, like I said, somebody would have a concussion, they’s walk to the wrong sideline, and you would laugh and pull them back and on to the next play. And now we recognize that as a brain injury, and they’re removed from play, and they’re managed, and it gets documented. So it’s more about recognizing the injury and treating the athlete for the injury as opposed to just ignoring them and really treating it as a blow off type of thing.
Timmy Duggan’s experience having a traumatic brain injury
Trevor Connor 15:51
As Chris mentioned, at the top of the show, Timmy Duggan agreed to sit down for an interview about his experience having a traumatic brain injury. Here he is now with the story of what happened.
Chris Case 16:00
We’ll just start by having you describe, for those that don’t know, how you suffered a TBI. Take us through, if you’re willing to, what happened to you in that race.
Timmy Duggan 16:14
My incident was in 2008. I was racing the Tour of Georgia at the time with Team Garmin. And so they tell me, I don’t remember any of this, so everything I’m going to say is all I guess hearsay. I think it was stage four or something and I remember lining up at the start on that day, I think and that’s kind of where it ends. But anyways, like halfway through the stage, we’re descending some big descending, we’re going like 60 miles an hour or something, at the bottom of the descent there’s this bridge with these expansion joints in it or something. Somebody in front of me got their wheel stuck in that and crashed in front of me. And then, I guess, I was unable to avoid it. So I crashed into them and basically did a 60 mile an hour swan dive into the pavement. Like I said, though, I don’t remember anything.
Timmy Duggan 17:09
Thankfully, we were really close, at that moment in the stage, to Athens, Georgia, where they have a world class medical facility. So I didn’t even have to get in a helicopter or anything.
Timmy Duggan 17:21
Kind of my next memory was, I don’t know, probably over a week later – I wasn’t in a coma, I just don’t have any memory. My next memory was probably a week, week and a half, later. I was waken up when they were wheeling me in to do surgery to fix my collarbone and my shoulder that I had also broken.
Timmy Duggan 17:43
So I had what is called as sub arachnoid hemorrhage and subdural hematoma. Most people that have that kind of injury are dead, I was very lucky in that they did not have to do any surgery, or drilling into my head to release the pressure from the bleeding in my brain. Right as they were about to do that actually, it basically started sort of subsiding sufficiently on its own. So I didn’t have to do any of that.
Timmy Duggan 18:10
A handful of riders, friends, whoever that saw it, they said it was one of the craziest things, just gnarliest crashes they’ve ever seen. More than one person was like, “Yeah, I almost quit cycling after seeing that.” Alan Lim, my coach at the time, he was like one of the first on the scene there with me, apparently. He said it was pretty brutal, pretty crazy scene. Like, apparently, I crashed and then right away, I like got up, stood up or something, but then I like fell over. And then I was like out and had convulsions… I mean, I don’t really even want to imagine it. Like I don’t have any qualms about talking about it. Like, I don’t remember anything. So there’s nothing that like triggers some bad feeling about it.
Chris Case 18:58
That’s probably a very good thing, right?
Timmy Duggan 18:59
Totally, totally. Like, I think it affected other people far more than me in terms of sort of post traumatic stress or trauma or whatever because I was just like, ‘oh, okay, this is how I am now and what I have to do to move forward?’ I don’t remember exactly what happened. So there was nothing I was afraid of moving forward.
Moving forward after the accident
Chris Case 19:23
Let’s go there. How did you move forward? What were the initial experiences like? That acute period where you’re wrestling with the fact that this has happened to you, but also the rehabilitation.
Timmy Duggan 19:37
So let me back up. I was in the hospital for a couple weeks just resting and having surgery for the shoulder and everything. And then I had to hang out like another week before they would let me fly because of the pressure on my brain and everything. So I was there in Athens for like three weeks or something. Finally got home and then that was when things kind of started becoming a little less foggy. And I could kind of start assessing what was going on and where I needed to go from there. And I started rehab at Craig Hospital at that point once I got back. So that’s world class nationally known brain and spinal cord Trauma Center in Denver. I was inpatient there, or outpatient, rather, so I’d go there, like five days a week, but I wasn’t like staying there in the hospital.
Identifying the occurrence of concussions in cyclists specifically
Chris Case 20:31
Well, that segues well into next question that I would have for you, which is getting into this identification of a concussion in an individual. And maybe we start by asking the question, are all concussions built the same? If a concussion is presented on the sideline of a football game, does that look like one at a soccer game or in a cycling event?
Dr. Steven Broglio 21:00
So I think the the biology of the injury is the same no matter the context. So a certain amount of force is applied to the brain. We talked about the stretching of the neurons, the shifting of the ions within the neuron and this dysfunction that follows – so that biology is the same no matter the athletic setting. I think what changes is the context under which that happens. So within a cycling event, within a football event, within a soccer event, the psychology that the athlete brings with them. And then as we touched upon, kind of what’s the sociology around all of that. So the biology is the same, but how that athlete may internalize their symptoms, or think about their symptoms, their resiliency around injury in general. You know, what are they’re hearing from coaches and parents and their teammates, and then the culture that kind of surrounds all that may alter the way that they progress after the injury has occurred. I would even say, you could go so far as to say, even outside of the athletic context, that biology is the same of a slip on the ice, or somebody in a dorm room that wakes up too quickly and hits their head on the ceiling. That biology is the same, but it’s all the things around it that causes how it manifests and how it is managed and to propagate change.
Trevor Connor 22:27
One thing I found really interesting, certainly when you hear about concussions in the press, they’re talking about the impact sports, so soccer, football, things like that. But I’m looking at a study right now from 2019, looking at concussions, so they were trying to do a review of concussion research in cycling and bike races. And they looked at 94 studies, they only included two of them, one of them was a single case, the other was an opinion piece. So basically, they said there has been almost no research in cycling. But then they had kind of a sobering line here, which is, “These statistics show that approximately 1.4 million persons are treated for TBI’s annually in the US. And of these, an estimated 207,830 are related to sports and recreation. Cycling is reported to account for 40,424 or 19.45% of cases, the highest number in any sport.”
Dr. Steven Broglio 23:36
I’ll challenge some of their numbers. So broadly, what we cite for sport and recreation related injuries is 1.6 to 3.8 million per year. And partly why we cite that number is that somewhere around 50%, we don’t know the real percentage here, but around 50% of injuries go unreported. So you can imagine, I mean we’ve probably all seen it happen, you’re at a weekend criterium, somebody crashes, they bang their head, they’re “ehh I’m going to go home.” And then by Monday, Tuesday, they feel okay, and they never see anybody, they don’t get reported or documented. So, the numbers are probably a little bit higher.
Dr. Steven Broglio 24:13
The other thing is just about everybody in the United States learns to ride a bike at some point in their life. And if you look at the age at which concussions occur, you see a really high number in the kind of late single digit years, kind of still ticks up into the teen years, it flattens somewhere in the 20s and starts going back down and it’s pretty low, late 30s all the way through like the late 60s or so, and then it starts to go back up again. So if the early end of the age spectrum, you have kids wanting to ride bikes, kids falling off a playground equipment, all those types of things. Then you get teenagers, largely boys, men participating or engaging in high risk activities, so automobile accidents, contact sports, contact collision sports, those types of things. And then that obviously tapers off once college and the early 20s. Flattens out through our adult years, and then goes back up in the 70s as older adults, when we start having balance issues and start tripping on rugs and those types of things, so we see another spike at the tail end of the lifespan. So that is the number, the percentage you cited, that goes close to 20% is largely because of people learning to ride bikes.
Dr. Steven Broglio 25:33
And I can just say, I’ve learned to ride a bike, probably late 70s, early 80s, with no helmet, right? We didn’t wear helmets back then. It wasn’t until I was a teenager, we started wearing helmets. So that has been, I know we’re gonna talk about how helmets save lives, I think they’re important things, but you know that in and of itself, just how we engage with safety equipment in the modern era, is much different than it was. And even as I go through my town, I see a lot of kids without helmets, or probably, as many of us remember as teenagers before driver’s licenses, you may wear your helmet out the door, but as soon as you get around the corner, Mom and Dad don’t see me so – It’s like *comical toss* because ‘not cool’. Which I do not recommend, of course. But so that explains the number I think that that you just cited there.
Trevor Connor 26:21
I would also attribute this to the fact that this is a sport that a lot of people use for commuting. And I think when they were looking at those numbers, they were extending it beyond just participating as a sport, I think they were looking at a lot of commuters. There was another study that I looked at that we’ll probably bring up at some point looking at concussions in cyclists and most of the cases of concussions they had were people getting hit by cars, somebody walking out in front of them on the bike path, things like that. And so sports like football, even though they might have a potentially a higher rate of concussion, I couldn’t find anything on that. But you just don’t have the the volume of people participating in football that you have riding a bike.
Dr. Steven Broglio 27:05
Exactly. The percent of football depends on what you read. But it’s somewhere in the seven that let’s say 10% per season.
Hannah Finchamp’s experience with a concussion
Trevor Connor 27:17
Hannah Finchamp, a pro who races mountain bikes for the Orange Seal Off-road team has had a concussion as a cyclist. Sadly, her experience being hit by a car is not an isolated one in our sport.
Hannah Finchamp 27:30
I think it’s tough. I think that I might have a little bit different perspective on this than many athletes because I am a certified athletic trainer. So concussion is something that I learned about extensively in school. So for me, when I had my concussion, I was fully aware of what was going on and what needed to be done. But, on that note, I think that even as someone who knows exactly what’s going on, who understands the risk of post concussion syndrome, and second impact syndrome and all of those things, it’s still incredibly challenging as a professional athlete, because this is what we do for a living. We ride our bikes for a living. So anything that takes us away from doing that is scary. And so it’s very difficult, especially when you first sustained the concussion, it makes sense, “Okay, yes, I need to stay off the bike.” But it’s in those steps were “Okay, you know what, now I’m feeling good, but I get on my bike. And then I have symptoms.” I think that time period is the most dangerous and the most difficult because as athletes, we’re taught to push through pain, we’re taught to push through discomfort and when it comes to concussion, that is absolutely something you cannot do. And concussion is the invisible injury. It’s the one thing that really no one else can tell you whether you have it or not. There, of course, are specialists and there’s all kinds of baseline tests and all these things that we can do that better our abilities. But most of our diagnosis of concussion is signs and symptoms. And so as an athlete, you have to be really, really honest with yourself and others and doctors and whoever you’re working with and be open and vulnerable and say like “hey, here are the things that I’m experiencing.”
Chris Case 29:44
Did having a concussion change you as an athlete in any way? Did you come back a different person or a different athlete?
Hannah Finchamp 29:56
For me, in terms of lasting symptoms, the concussion that I sustained was from getting hit by a car. So that experience as a whole certainly changed me. Just because, sadly I think, too many cyclists have been hit by cars. But for me having that experience and coming out the other side safe is a moment where I had to stop and remember any day on the bike is a good day. Concussions are a functional disturbance of the brain, that alters ionic balance and metabolism. So I’m sure you guys know, it’s not a bruise to the brain. It doesn’t necessarily involve bleeding of the brain, you know, it’s none of these things that we can physically see. iIt’s functional, non structural. So the best analogy I’ve ever heard is thinking of a snow globe. It’s like when you shake the snow globe, everything inside gets all confused and fuzzy, but nothing breaks. And I just love that analogy because I can picture our brain as that really fuzzy snow globe.
Signs to look for if you think you have a concussion
Chris Case 31:14
Let’s get back to cycling, specifically. What are the signs for cyclists to look for? They’ve had an accident on a training ride, they’ve hit their head, their helmet isn’t cracked, it’s scuffed a little bit… How do they know if they have a concussion? How do they know if they should go see a doctor? When do they make that decision? Is it too late if it’s been a couple of weeks, and then they start having cyst Symptoms? So this is maybe a complex question. But take it away Dr. Broglio!
Dr. Steven Broglio 31:46
It is a complex question. So I would say if you’re out on a ride, and you have a crash, whether your helmet is scuffed or not, I think the “I don’t feel right” feeling is the easiest way to say it. And that’s assuming you’re not a medical professional and can kind of be self aware about it all. Clearly if there’s any loss of consciousness or if you’re with somebody and they crash – and I’ve seen this happen. I was in a race a number of years ago and guy crashed, I crashed into him. He goes “what happened?” And then you told him what happened and then two minutes later, he’s asking the same question “What happened?” So repeating that same question again, and again, going in and out of consciousness, of declining mental status, we see a lot sort of repetitive vomiting would be a pretty big red flag that you want to be worried about. But if you’re alone, or really just if you have suspicion and concern, I would say there is no harm in going in and then coming out of the physician saying like “nothing to see here.” Better to be checked and understand what’s going on than not.
Dr. Steven Broglio 32:57
Beyond that I think from the medical provider standpoint, the providers clinical exam and impression of the athlete is the gold standard for diagnosis. So I cannot put you in a scanner of any form, I cannot give you a specific computer test, I cannot give you a balanced test and say with 100% certainty you have a concussion or you don’t – it just doesn’t work that way. Now this just happened last week so I don’t have a lot of information on it yet but, a company announced a blood test for concussion that supposedly is 90% accurate. But I haven’t seen the data. I don’t know anything about it. But like I said, it just happened last week. So I’m really curious as to what that’s going to look like and how close to the time of injury you can get this blood test. How fast is the processing of the blood so you can get an answer? But I do think, I mean we’ve been talking about this sort of thing for a long time in the research community, that blood biomarkers are probably the next frontier and seems like we’re getting there. So it’s very exciting, but I just don’t have a lot of information I can share at this point, because I just don’t know.
Potential testing for concussion diagnosis
Chris Case 33:58
But you do know that there are blood biomarkers that could indicate when somebody has a concussion, what do those things indicate?
Dr. Steven Broglio 34:07
So really, it’s just this one. I believe it is a combination of two blood biomarkers, one is called g fat and one is UCHL-1 there’s other blood biomarkers that people are interested in. But really it is when we talk about that stretching of the neuron it’s released because of that stretching, and these markers come from various parts of the neuron, and so part of my questioning around that is I don’t know how fast or how close to the time of injury that can be used because if this marker is released within the brain, it has to cross out of the brain over the blood brain barrier into the bloodstream and be in the blood in sufficient quantities that can be picked up on the panel. So that may take some time and I don’t know the timeframe that that would occur in and how sensitive the panels are on those types of things. But that’s the kind of high level of what they’re looking at. People are looking at different markers all the time to try to understand: is there a single one that we can use that shows up in, really, ideally, it’d be seconds after injury. I’m not sure we’ll ever get to that point. But people have looked at saliva, people have tried to look at urine, people have tried to look at sweat. I mean, there’s a lot of people dedicating a lot of time and resources to try to figure this out, because I think the rapid and very accurate diagnosis is what we’re all chasing. Seconds after injury, do some sort of test, have a yes or no answer that 100% perfect so we can make a decision. Sport is very different. It’s very different than walking into a physician’s office 48 hours after the fact and he or she has half an hour to make a decision, or half an hour to do the exam, and then two days to have a blood test run. Sport and cycling is very unique. If you’re in a team car and your rider goes down, you have to make a decision in seconds, so they can get back on the bike and back into the caravan and then back with the group. So it just has a lot of challenges around it that you don’t have in civilian life.
Testing cyclists for concussions during a race
Trevor Connor 36:11
That was something I was about to bring up. And that was the study that I was just quoting, which I should give the title it’s “Sports related concussion (SRC) assessment in road cycling, a systematic review and call to action”. They bring that up that cycling poses unique challenges that you don’t see another sports. So I’m sure you can talk more about this, but they bring up this SCAT-5 test for a concussion and say, that’s great, if you’re a football player, where they can bench you for five to 10 minutes, do an analysis on you and then decide to put you back in, but in a bike race, you’ve got 30 seconds, or you’ve missed the field. And you can’t do the full analysis. So they actually, at the end of this paper, do a call to the UCI to say if there’s a danger of a concussion, you should do a full analysis. And then if they’re cleared, actually drive them back to the field so you can take the time. Well, what your feeling about all this?
Dr. Steven Broglio 37:10
Yeah, so I have not seen that paper, but I’m glad that you highlighted that last sentence because that’s always been the challenge, right? If you give the medical team enough time, roadside in our case, to do that evaluation then how do you get the athlete back into the groove? Right now, at least the way the current regulations work, I think as we all know, is basically get the athlete back on the bike as fast as possible and then maybe let them hang on to the side of the medical car – if there is a medical car – and then they kind of do it while you’re rolling. But that poses all sorts of risks because if the athlete is concussed, there’s a really high chance they have impaired decision making, impaired motor function, and if anybody’s ever had to hang on to the side of a car at 100K an hour to get back into the groove, it gets scary enough when it’s normal, you’re 100% healthy, and let alone if that athletes impaired you don’t want them going down again. So I like that idea and heard it before. I would encourage USA cycling to think about it if they want and obviously the UCI for that matter.
Dr. Steven Broglio 38:18
The UCI did announce concussion protocol, I think it was late last year, which largely included the SCAT-5 that you mentioned, and I’ll talk about here in a second, but I don’t recall anything about allowing for a full roadside eval, and basically getting a backup to the group.
What is a SCAT-5
Dr. Steven Broglio 38:37
The SCAT-5 is a product of the International sport concussion group. It’s essentially, which full disclosure I’m part of that group, we’re not paid, we’re just part of a scientific community, and really what it does is it combines the most common concussion assessment tools into a single packet, which is the SCAT tool, and then the five is just the fifth version. So within it, there are what they call screening for red flags. So these are signs, symptoms from the athlete that would indicate that it’s a medical emergency, and they need to be transported. So after that, there’s some orientation questions. But then it’s basically a symptom screening, a mental status check, and then a balance and motor control exam and then that’s interpreted by the clinician and a decision is made.
Dr. Steven Broglio 39:36
So the symptom checklist is exactly what you would think it is: Do you have a headache? And if you do, can you rate it for me zero to six? Fatigue? Nausea? Vomiting? Does the light bother your eyes? Does noise bother you?
Dr. Steven Broglio 39:49
When you get into the mental status screening, there’s an orientation section so: Do you know where you are? It’s largely geared for contact sports or field sports, Do you know what the score? Do you know who we played last week? Then it gets into an immediate recall. So remembering a list of five words. Then there’s a concentration section. So repeating a list of numbers in the reverse order they were given to you. And then there’s a delayed recall. So five words I gave you two minutes ago, can you repeat them back?
Dr. Steven Broglio 40:19
In theory, all that can be done while you’re hanging on to the car, driving down the road. But the one that couldn’t be would be the motor portion. So that’s a balanced exam. And then there’s a heel, toe tandem gait type of test that goes with it. So that one would have to be dropped from cycling if it were to be implemented during a race. I do think that the SCAT could be used after an event, if there’s a suspected injury. You could do it after the event, whether it’s just over the finish line or at the hotel afterwards. The really nice part about it is it can be done in about 10 minutes, maybe a little bit longer, couple minutes longer. But not for roadside, that’s not so good, but at a hotel or something. But it’s free of charge, there’s no cost to it. So one of the things that have been used over the last two decades are these computer based tests, and they carry a pretty big cost. And the SCAT is as good if not better than the computer test and it’s free of charge, just download the PDF and print it off and off you go. So I think we all know that cycling has a lot of funding issues, particularly at the non pro level, and some teams that are looking for something, that need something to use, I think it’s a good alternative for them.
Chris Case 41:36
And on this SCAT-5 to be clear, I would assume you do not have to meet criteria for every single thing in there. There’s a threshold you must reach. Is that correct?
Dr. Steven Broglio 41:46
Yeah, so each section is scored, but there’s no composite score so this, I’m just going to make a number up like, if you cross below 60 then you have a concussion. So it’s really up to the medical provider administering the test to say, “Oh, they have a high symptom score,” or “They have a really impaired motor function and their mental status screening is really bad. So yes, he or she has a concussion.” Or “Yeah, they’re reporting high in the symptom, but they also just did a 200K race in 100 degree heat, of course they’re fatigued and they’re grumpy, right? So, that’s where we say like the assessment itself doesn’t give the diagnosis, it’s up to the provider because there’s a lot of context that comes into all this. And so, do they have impaired motor function? Yeah, when they crashed they hurt their hip so they can’t stand or walk as well as we would hope under normal circumstances. So that’s why there’s no cut score on these things to say above the score is good below the scores bad.
Trevor Connor 42:48
Well, it really sounds like, while you have an effective tool here, what’s just as important is who’s administering it. As you said, you could download the PDF, but I wonder if a lot of coaches would have the ability to take an athlete through this test, and then say, “Yes, you have a concussion” or “No, you don’t.” And I’m just thinking, I know what state I’m in three, four hours into a hard race, I think I’d fail three quarters of this test even if I didn’t fall over.
Chris Case 43:15
Trevor likes to bury himself. He goes into cognitive debt at certain point in a race.
Dr. Steven Broglio 43:20
Leave it all out there!
Dr. Steven Broglio 43:21
Yeah, so glad you said that because it is, I don’t remember the exact language, but I’m pretty sure there’s language on the form that says this is for medical providers only. And so unless the coach also happens to be an EMT, and athletic trainer or a physician, whatever, probably not appropriate. I would also just say that the coaches have a conflict of interest. And that’s not to say that they don’t mean well and everything, they do, but they’re there to win. That’s their primary goal. And so then asking them to make a medical decision on a marquee player, marquee athlete, or just not even any athlete, for that matter. There’s a conflict there. And I don’t think we – I don’t think I could endorse that.
Trevor Connor 44:05
Look, the athletes have complex too. I’m just picturing a cyclist who’s three days into the Tour de France, they’ve spent their whole year getting ready for the tour, fall over hit their head, they have a concussion. They don’t want to pull out of the race. They’re gonna do everything possible to convince whoever’s testing them that “Yeah, I’m fine. Put me back in the race.”
Dr. Steven Broglio 44:26
And I feel like that happened. I’m trying to remember, I may get the names wrong on this, but I feel like the story is something to the effect of this, I think Bonin crashed early in one of his later tours. And finished the stage and kept riding the next couple days. But then I think it was Cancellara that basically called him out and was like, “Dude, you’re danger to everybody out here.”
Chris Case 44:48
I think you actually have it right. I do remember a moment in time like that, where the rider was sort of just not acting the right way in the peloton and becoming a danger and Cancellara spoke up. Certainly the story that is maybe even more famous in a way is Chris Horner really knockin his head, getting back on the bike, finishing the stage, not really knowing where he was or what he was doing hours later after finishing the stage and all of that. So, yeah, complicated issue.
Dr. Steven Broglio 45:27
And the stage racing is a whole other level, right? Because obviously, if you don’t finish today, you don’t race tomorrow, and you don’t always know in the moment, roadside, how that athlete is going to be. We haven’t talked about it, concussion is an evolving injury. They may present fine when you pull up next to them and put the new wheels on or give them the new bike and send them on an hour later, they may have raging headache. So it’s not, I think, as simple as it is often made out to be. It’s not as clear cut for sure.
Timmy Duggan’s TBI symptoms
Trevor Connor 46:03
Timmy Duggan shares a bit more detail about the symptoms of his TBI as well as the initial steps he took to recover.
Chris Case 46:09
The difference between concussion and TBI is a significant one. But you had a relatively severe if not very severe.TBI. Does that also mean you had a very, very severe concussion on top of that? How does that work? From your point of view?
Timmy Duggan 46:26
I mean, I would say some of the general or ultimate symptoms would be similar. But I think, again, I’m not a doctor or anything, but I would say the defining feature of migraine injury or traumatic brain injury versus a concussion would be you’ve got some level of severe bleeding in your brain that’s caused by your brain like shearing against your skull, spinning effectively, within the skull…Some of the ultimate repercussions of a concussion or multiple concussions can be similar to some of the ultimate repercussions that maybe I’m dealing with or have dealt with.
Timmy Duggan 47:06
It was interesting in the years later, talking to other people that had a brain injury or even just several concussions like how similar, at least some of the things were. Like, you can kind of relate to it, even though you didn’t have like the exact same injury or even close to the same injury, but a lot of sort of ultimate repercussions can be pretty similar.
Chris Case 47:30
Can you take us inside what some of those symptoms are?
Timmy Duggan 47:35
So initially, I didn’t have any problems with like balance and coordination, which I think you would imagine would be sort of a standard thing when you hit your head that hard. I didn’t have any problems with that. I think the first day of rehab at Craig, I was literally, on one of those balance boards, and juggling three balls, and reciting every third word of the Pledge of Allegiance.
Chris Case 48:03
Wow. I don’t know if I could do that normally, right?
Timmy Duggan 48:08
So I was like I’m fine, but then other things were just totally off the scale. Like my spatial reasoning and ability to sort of plan things, some emotional stuff, like all of that was really messed up – even if my vision coordination, balance, all that stuff was totally fine. So it’s definitely interesting to talk to other people who have any level of head injury. The symptoms just have no rhyme or reason. It’s just so individual, per per person. You talk to somebody else that has a similar or even less severe injury, and they might have long term bounce coordination or vision issues. I have this injury that almost killed me and like I never had anything on that.
What doctors will never understand about having a concussion or TBI
Chris Case 49:02
That’s wild. One of the things that I know, I want you to talk about today is something you mentioned to me when we were setting up this interview, which is the fact that you could meet with 1000 specialists that each have studied a 1000 different cases of TBI or concussion or whatever, but they can never really understand what it’s like for you to go through it as you did.
Timmy Duggan 49:29
Chris Case 49:30
Tell me about that experience. The friends that reached out to you or the people that you reached out to help you understand what it was gonna be like for you. And how important that was.
Timmy Duggan 49:41
Probably kind of the initial sort of big shocker I had in coming back was in working with my neurologist, neuroscientist, brain surgeon guy at Craig. I mean, he’s absolutely world class best of the best. He was really pessimistic about my, not necessarily my outcome, but he was like, dude, you should not race a bike ever again, like that idea. Because if you hit your head again, you could be a vegetable – or you could be totally fine. But, you know, in his professional opinion, he thought, racing again, for me, and even just riding a bike was going to be too risky. And I didn’t like hearing that. So I didn’t really listen to that.
Chris Case 50:33
I can understand that.
Timmy Duggan 50:34
But that sort of set off in me, just like, okay, not that the doctors are against me or whatever, but they don’t, they don’t know. For one they don’t know deep down what I’m feeling, what I’m going through, but literally, they don’t know what will happen if you hit your head again, or what will happen if you do XYZ.
Chris Case 50:57
They could speculate, but they couldn’t tell you exactly.
Timmy Duggan 51:00
I mean it’s not like you don’t want to listen to them, you want to listen to their very professional opinion, take that into account, but then you weigh that against the risks, or pros and cons, and you make your own decision. You really do have to take ownership of your care and your treatment and just go the direction you want to go because if you just listen to everybody else, and especially on the medical side, which is gonna obviously be very conservative, you’re not gonna do anything. You’re gonna play it safe and just sit there and yeah, you’re not gonna hit your head at 60 miles an hour on the pavement ever again, but there’s a whole lot of cons that comes with quitting your previous career or not being healthy from an athletic standpoint anymore. So you really have to take charge yourself, which is really scary at that time when there’s just so many unknowns and all this is new – I don’t know how to come back from a brain injury. All these people are telling me this and that. None of it is what I want to hear, what I agree with maybe and I kind of have… you kind of have to like forge your own path.
How Timmy Duggan got back into racing
Chris Case 52:15
And for those who don’t know your story, you did come back to racing. And you won a national title. So you can do these things that maybe doctors said you shouldn’t do.
Timmy Duggan 52:28
Exactly. And again, like it’s their job to play it safe and be conservative, and I get it. But it’s my job as an athlete to not do that. So that was April of 2008. It was the week before I was supposed to start the Tour de Talia, so that’s a bummer timing. My team went on to win the team time trial that year, and would have been some pretty cool to be part of. So that was April. Basically didn’t do anything physical for a few months. And then just slowly started getting back into it, riding the trainer, eventually by the end of the year, I was riding outside, but just very carefully. And yeah, it’s just weird, because I felt totally fine.
Chris Case 53:11
Was there anything inside of you that was like, I hope I don’t do these first set of intervals and have an aneurysm or something because of the damage that’s in there? Was there any part of you that had that anxiety?
Timmy Duggan 53:24
No, I wasn’t afraid of that. And that was one of their concerns of getting back to exercise too soon, blood pressure and everything on the brain, in addition to the risk of crashing on their head again, both those were the kind of the main concerns with getting back to exercise and risk too soon, or ever. But yeah, you know, just took it easy step by step. And if anything, looking back, I probably could have been even more aggressive with things.
Chris Case 53:57
You didn’t race until, was it the following season?
Timmy Duggan 53:59
Oh, yeah. I was at Tour Down Under the next season in January.
Chris Case 54:04
So it was less than 12 months that you went from hospital bed and severe brain injury to racing again. That’s amazing.
Timmy Duggan 54:14
Yeah. So that next year, training camp, getting into the start of a season, it was like getting blasted by the fire hose the whole time. I was like, “Woh, I’ve been basically doing nothing for nine months. Here we go, back in it.” I mean, that was definitely a bigger challenge, just physically kind of re-adapting to all that, kind of learning how my body operated a little bit differently at those intensities. And most of all, just how my brain operated within the race. I really had to go through a period of, that first few months of the season, sort of going through all the motions and kind of reliving all these situations where, maybe it’s like, we get into a crosswind section, it’s like how do I approach that mentally. The first few months of that season, maybe I would be more hesitant to just like dive into where I need to go or hold the wheel or whatever. And so I would go through all these situations and sort of mess it up, make a mistake, and then I’d be like, “Oh, yeah, that’s right. I remember how I approached this mentally before.” And then the next time, it would be there again. It’s kind of like I had to relearn a lot of things that had become automatic or instinctual. But it didn’t take much. I mean, I just had to kind of relive all those things once or twice, and then it was kind of ingrained in me again.
Potential long-term repercussions of a concussion
Chris Case 55:38
Earlier in the show, Dr. Broglio, you said that things will resolve when it comes to concussion. You stated 50% will resolve in two weeks 90% will resolve in a month, that leaves 10% that are unresolved after a month, but what are the potential long term repercussions of concussion?
Dr. Steven Broglio 56:02
Like I mentioned, I think, from a single or maybe even two concussions, I wouldn’t personally have any real concerns about long term effects. So I’ll kind of split your question up into two parts; I think the 10% that don’t recover within the four week window, I don’t remember the exact numbers, but I feel like another 5% recover within the next month, and then maybe another 2%, a month after that or something. And so it starts to taper down.
Dr. Steven Broglio 56:30
There are certainly people, and you see the news stories about them, that they have a single injury and they have persistent headache for however long, a year later let’s say, and my personal belief is that anything that extends beyond a month, maybe two months, the biology of the injury is healed by that point, and something else is going on. So for example, you may have an athlete that has a concussion. Two months later, they continue to complain of headaches, that may be related to a neck injury that happened concurrently with the concussion. So imagine a lot of force to the head, the neck is attached to the head, as it turns out, and so there may be something that got out of alignment, and you can actually have a headache that starts from a misalignment in the neck. Or they may have ongoing dizziness, same timeframe. And maybe it was a vestibular injury that occurred simultaneous with the concussion. So as athletes start getting around that one month period, if they aren’t showing good progress, I’m not gonna say they have to be absolutely recovered. But if they aren’t showing good progress towards recovery, then that’s probably the time you can even go in earlier. But I would say by one month for sure you want to go in and make you know. Go see somebody and say, “Hey, maybe something else is going on here? What are our options? And can we get somebody else involved.”
Dr. Steven Broglio 57:53
The other thing is, as we go through the management process, even early on the theory about a month, or excuse me about 10 years ago, was that the injury happened, shut the athlete down, put them in a dark closet, turn the lights off, don’t let them out until all the symptoms go away. And really what we found was that when that happens, that athlete feels isolated or removed from their team. They’re removed from school if they’re a student athlete. And the psychology, we talked about this earlier, the psychology starts to overlay with the injury. So as the concussion symptoms start to wind down the biology-induced symptoms start to wind down, the psychological symptoms start to wind up. And disentangling those two actually becomes a problem.
Dr. Steven Broglio 58:40
The other thing is, particularly with high level athletes, is that they like to work out. And if they don’t work out, they don’t feel right. And so what we’re seeing and what we’re learning is that yes, you probably need to shut somebody down for 24, 48, maybe 72 hours, but after that point, you want them to start doing a little bit of activity. Now a little bit of activity is not 200K with two on two off 10 times over. So a little bit of activity is go for a walk around the block. If that feels okay, then tomorrow maybe a little bit longer walk, or maybe we put the bike on the trainer, not the rollers, but the trainer where it’s bolted in, and just turn the pedals over super light. And let’s see how this goes. And then it’s kind of that gradual progression as we move increasing intensity and duration to get back into, and there’s actually really good evidence that’s come out of Buffalo, John Letty and his team. They’ve been doing this work for a long time. They’re really the first ones to show that exercise as a therapeutic modality really works well for this group of people, both in the short term, that kind of initial recovery period, but then also these individuals that have ongoing symptoms at a month, getting somebody back on their bike, or getting them back to their sport in general, in a safe environment, I’m not recommending like, ‘hey, football athlete, you have ongoing symptoms at one month, let’s throw you back into the game,’ that’s not what I’m saying, but get them back engaged with some physical activity, it really works well for a lot of people. They respond really well to it and it brings those symptoms back down too.
Dr. Steven Broglio 1:00:27
So let’s call it a kind of the immediate we have the acute stage, let’s say zero time point zero out to one month and we get this intermediate stage one month out, then the bigger question is long term plan, long term, long term long term like years decades later. So the this idea, this idea of long term effects around concussion or mild TBI, it’s actually it was first put into the literature right around the turn of the 20th century, the first papers 1928 or something, and it came out of the boxing community. So the idea of the punch drunk, which I think a lot of people have heard of or dementia pugilistic, I think people heard that phrase as well. And really what they noted, there’s, there’s a researcher in New Jersey, Pearson marvelman, that that first identified this as it was hand tremor and some impaired cognitive function. And then these boxers that had a high number of fights and a high number of knockouts, which would just lead you to believe that they lost a lot. And so that was kind of the first reported case. Then kind of moving forward, there were various research articles that kind of were in the sporadic in the literature, but up not until 2005, or 2006. The first modern CTE chronic traumatic encephalopathy was identified by Ben into malu. in Pittsburgh, when he did the autopsy on Mike Webster, the former Pittsburgh Steelers lineman, the idea here is that concussion and now what we think is head impact without concussion causes of the tau proteins that are in the brain attack is a naturally occurring substance in the brain, it breaks loose, it gets a bunch of phosphate molecules attached to it, and it gets really sticky, and then it deposits. And so I’m sure a lot of people have seen the the brain slices where you’ll see this kind of like pinkish, yellow healthy brain tissue. And then you see this, like dark brown black spots, this dark brown, black spots that are the towel deposit. And the idea is that these things build up and they cause cognitive impairment, impaired motor function, kind of depending on where it lays down in the brain. And that’s the thing that I think, has drawn the idea of CTE or modern CTE, that’s what’s drawn the most attention to concussion. It’s what the movie was based on that first case. And I think that’s where people are concerned about long term effects. But like I said, you this is not something you do not get brain wide talent deposits from one to concussions. These individuals that have these high levels of tau are typically most earliest, most most heavily researched, or the former NFL players. So they have decades of exposure to concussion to head impact without concussion that causes us. The other thing I will say is, it is not clear by any stretch of the imagination, how many people will get this and why. So if you look at if you look at all NFL players, some not some will end up with CTE and will have cognitive impairment. That’s definitely a thing. But it is very clear it is not all of them. And NFL players live longer than the average population. They have better or they have lower all cause mortality than the general population. So they have fewer cancer deaths and fewer heart attacks and all those types of things. So it is not as simple as you played football, you’re going to get CTE or you had a concussion, you’re going to get CTE, we really are just this was just identified in 2005 2006. So we’re 10 or 15 years into this and in the scientific world, we’re just at the beginning of trying to understand who and why this happens.
Trevor Connor 1:04:21
So bringing this back to cycling. So here’s another thing that caught me by surprise. Here’s a you’d probably know these people. A study that was just published this year out of Toronto, looking at the post concussion syndrome in adult cyclists, and basically said we were pretty sure were the first study on looking at the long term effects of concussion and cyclists. And it was encouraging to hear you give the the the timeline that you gave, because this study was a little more pessimistic. So they said the same thing that approximately 80 to 90% of cash. are short term with symptoms dissipating within about 28 days of injury. But in that 10 to 20%, they get the post concussion syndrome, they were saying that there’s a greater mean duration of about 23.7 months. But their definition was, if any, even if just a single symptom is maintained. So for example, headache, fatigue, sleep disturbance anxiety. So it’s, as you say, well, that might not actually be the concussion, it could be other effects.
Dr. Steven Broglio 1:05:38
Yeah. And so I don’t I don’t know that study. And so I don’t want to be critical. I will just say that there is definitely there’s research on this. Grant Iverson was at Harvard has done some of this work. And what he turns it’s the good old days bias. So basically, it’s I never had one symptom in my entire life before this injury occurred. Now, because of this injury, I have all these symptoms. So right, which we all know is not true. So I don’t want to I don’t want to this group, this paper, you decided maybe on inaccurate, and so I’m not saying that they’re wrong. I’m just saying as an alternative explanation, there may be some recall bias and their participants.
Trevor Connor 1:06:18
Yeah, well, I was about to say I was reading their whole list of symptoms, and it just went well, I think even though I’ve never had a concussion, I have post concussion syndrome, because I have a lot of those symptoms every day.
Dr. Steven Broglio 1:06:30
Yeah, as it turned out, when I woke up on Tuesday morning, I was fatigued and had a headache. But my birthday was Monday night. So that might have explained it. That Happy birthday.
Trevor Connor 1:06:37
Thanks. learning from others that have gone through a similar trauma can be comforting and cathartic. And this is something Timmy found to be true in the aftermath of his crash.
Timmy Duggan 1:06:55
It’s not that I wouldn’t take as much risk anymore. But I definitely would take more calculated risks. You know, I get this on in the senate 60 miles an hour diving into a corner. I was just more aware of like, does this really matter that much right now? And if it did, then yeah, I would take that risk. And I wouldn’t hesitate. And it would be fine. But I just wouldn’t take stupid risks. You know, I was more more aware of
Chris Case 1:07:21
that level that that kind of difference. Do you think that being the caliber of athlete that you are were at that time helped you recover at the rate that you did? Was that it? Or was it a double edged sword? The fact that you weren’t you wanted to get back to that level so quickly that that was the the risk. I mean, like,
Timmy Duggan 1:07:41
so many injuries and ailments and sicknesses, like a big predictor of how well you’re going to recover is how healthy you were in the first place. Right? So yeah, I was obviously healthy, physical, very strong, mentally very strong, sort of the mental side of things is something I always devoted a lot of focus and attention on throughout my career. And so that was a huge tool, like moving forward and working with the psychologists that I’ve always worked with, and being able to kind of break things down and take things step by step. Moving forward from there, especially this case, where it came to just dealing with sort of handling negativity and all the, there’s a lot of stuff pushing back on me. And as I was recovering, and I didn’t really have any, like breakthroughs for a while is to sort of like, kind of felt like I was just banging my head against the wall for a long time. So just still being strong through that. having faith through that, you know,
Chris Case 1:08:38
other question I had for you was about the The, the, maybe the chronic effects of this, do you still are you a different person now, because of this? And will you forever be a different person because of this, in some ways,
Timmy Duggan 1:08:53
a few things change, my wife could probably chime in chime in on this better than I could. Probably the biggest thing and actually, a helpful thing that happened was, I became just like, hyper aware of how much energy my brain was using, I think when you’re healthy, and everything’s fine, like you don’t consider the toll that mental energy or stress or whatever takes on your brain and your body as a whole. And when I was super compromised, as far as recovering, and I realized, like Geez, even like going out to the grocery store, and run errands and just the stimulus and, or like go into some little event and having to talk to six people, just how much energy that took, you know, I’d come home and I’d just be exhausted, you know. And obviously that became better and better as time progressed. And I could let you aware
Chris Case 1:09:48
of that now which right a lot of us probably take it for granted that it you don’t even take it into consideration when we’re thinking about the stress that we’re going
Timmy Duggan 1:09:58
we’re putting ourselves under Exactly. And, you know, at that time, obviously, the big books, my life is racing. What really helped me in bike racing and in the race itself was, I started thinking of things in terms of managing my mental energy, even more so than my physical energy, you know, say you’ve got this five hour long race. And I found it was more taxing on me to be like, maybe fighting for position all the time, you know, that’s taking mental energy, even if that’s saving you physical energy, because you’re just in better position, right. But if you’re fighting all the time, and just stressing them, the whole race or whatever they want, it is time to like, really be there and be at your best. Like, you might be just so fried mentally, you don’t want to fight anymore, at the point where it actually matters, right? So I really sort of compartmentalize the race and the sections were I was really on or sections where I was off. And then that way I could sort of have the confidence that okay, turn my brain off for a little bit because I got some chill time here. I’m not gonna fight for position is gonna chill wherever I end up. That’s great. But I’ll tell you what, at 35 K to go when we get to whatever little town it’s frickin go time. Yeah. And I would like oh, that to myself for sort of taking that rest and, and have the confidence like, okay, I’ve been chilling this last hour mentally. So I’ve got no excuses. But to just be totally on it when it when it matters, you know? So yeah, just being hyper aware of this, my mental energy with within the race, I think really, really helped me a little bit about memory issues they linger or anything like that, even now, just you know, remembering small details, again, like I joke, but it’s partially true. Or maybe it’s just an excuse, I don’t know. But I do feel like I have a limited brain capacity. I mean, like, like all of us, right? But I’m just aware of what that is. And I’m aware of what happens when my brain gets too full of non important things. And I start screwing up, I start making mistakes. So I just can’t process like, all this useless information that’s always coming out.
Chris Case 1:12:17
It sounds like a good thing. Yeah, a lot of ways. Yep.
Timmy Duggan 1:12:20
Yeah. To have that awareness. Totally, totally. Like, in my career. Now, in real estate, I think it really helps me feel filtered down what matters and what doesn’t. I am extremely forward with people. I know you like to communicate with these really long text messages or emails, or you’d like to talk a lot and blah, blah, blah, but I’m not gonna like read it all. Because I just can’t process all that. So if there’s something you really need me to know, or you really want me to do, like, make sure that’s very, very clear, because I just can’t sort through all this stuff, you know, yeah, just how you set up your life and structure your life and how you keep organized. That’s still something I really have to pay attention to, and manage even now, years later, to stay an organized and keeping things simple. Because, again, it’s just really easy for me to sort of get disorganized. So I structure my all my systems around, making that easy for me and like the team I work with in real estate now. You know, having certain things delegated to others, so I can focus on what I need to do. And not not letting it get like all mixed up. You know,
Chris Case 1:13:31
I don’t know if anybody has come to you that has had a TBI in their life. Or if you wanted to speak to those out there that are listening. But what would you say to somebody if they they, they, they do come to you or if they’re listening?
Timmy Duggan 1:13:44
Yeah. And kind of back to when we were talking about, I kind of trailed off on something else. That’s another thing, like I get kind of distracted pretty easily. And I forget what I was talking about in the first place. Again, like, it’s not like nobody else has that problem. But it’s just something I’m hyper aware of, and I think is pretty different with me. Yeah, we are talking about the neurologist I was working with, and he was pretty pessimistic about, you know, what I should be doing moving forward. And yeah, kind of the biggest challenge I found was, you know, it’s easy to find information and stories of people that had some significant brain injury in a car accident or whatever, and took them this many years. And they did X, Y, and Z. And now they’re back working at the desk selling insurance or something like that. It’s great and all but he was a elite athlete, you need that last two 3%. Whereas if you’re kind of a regular person, you’re not even gonna notice maybe that you’re missing, even 10% maybe, because you’re not just on the limit physically and mentally like you are as as an athlete. And just because of sheer numbers. I mean, there’s just not that much data or information or stories out there from other athletes who have maybe had a similar incident. A similar injury, and then you know, it’s a public story or you have a way to get get in touch with them and talk to them about it. So that was like the biggest challenge for sure that I, I had, I was just like, okay, like, I’m 90% there, but like, how do I get the rest of the way? And there’s like, nobody can tell me doctors can’t really tell me. And by far, the most helpful thing I found was just talking to other athletes that had gone through something similar. And again, it’s not going to be the same thing. You’ll know, no, two athletes are going to have the same experience. But hearing their stories and being empathetic with them was like, Oh, yeah, I totally feel that too. I talked to a couple of ski racing athletes quite a bit. That’s my kind of initial background is from alpine ski racing. So I still have a foot in the door in that world. When athletes Scott McCartney, on the US ski team, he had an unbelievable crash, and the kids feel downhill, maybe two years before my crash. I mean, just Google it, it’ll be all over the internet. And he was, yeah, he was in bad shape for a while. And he was also ultimately able to come back, be on the World Cup for a few more years before he ultimately moved on to other things, but talk to him quite a bit on the phone. And he was super helpful kind of sharing his experience, even though his recovery and the injury of self were really not at all, like mine whatsoever. Like he had kind of the whole opposite sort of range of symptoms that I did. So it’s hard to relate to, you know, his experience, specifically, but it was helpful. I talked to another us Ski Team athlete that I had become friends with long after my recovery. I mean, this was like 2014 15. So I retired from the sport at that point. And she had a significant crash, ski racing and training in 2007, I believe, very similar injury. And in talking to her a bunch, I found out she had, you know, very similar symptoms. So that was really cool to relate to her on that. In one, one thing that was kind of life changing in, you know, hearing her story, and her sharing everything with me, was, you know, at that time, I was really struggling with a sort of undiagnosed depression. And some other things I didn’t even know was like, wrong. But she was telling me about how she was feeling really similar and was in pretty dark place. But she started trying to find a right like medication combo to manage that mental health issue. And she was like, Yeah, I finally found the right combo with my doctor. And it was like, the fog like, lifted and like this, and this was better. And I’m just like, what, like, I hadn’t even considered that. And a doctor never really pushed that on me, like doing the medication route. And it’s also something like, I’m like this badass, tough, happy, like, I don’t need to take drugs to make my frame feel better. Like, I’ll just write
Chris Case 1:18:06
it out. Yeah, no endurance athlete mentality of just pushing through, I can do this. Yeah. And
Timmy Duggan 1:18:13
I’m super aware and work on my mental state all the time. And yeah, be fine. Didn’t even cross my mind. And I wish the doctor had pushed that on me more to sort of try out because it is true that it’s oppression is like a huge, very common symptom of traumatic brain injury survivors, you know, just because, like, in my case, my brain’s ability to make endorphins and all that kind of stuff is really limited, literally is like a chemical imbalance. It’s not just some you can just talk about and like, tough it through, you know, right. But anyway, she was telling me about what a great experience she had, like finally figuring out the right medication. I kind of blew my mind like, what you’re like this badass, stoic athlete and like, you have to take happy pills, like make it all better. All right, I’ll give that a shot. I mean, I trust you. So I did and figure it out with my doctor and same freakin thing man, like the fog lifted and like my life was like, totally different from from that point on from managing like the depression and kind of another big thing that I didn’t really realize while I was racing, but in retrospect, it makes total sense. But it also my injury also kind of gave me a good bit of like ADHD like, hence, you know, how I’m still can get distracted or lose track of things fairly easily. But that is hugely managed now with like, the medication that I take. And yeah, looking back, it was like, you know, I used to be one of the best time trial is in the country and after my head in I’ve never, literally I can’t think of a single time travel result I ever had the rest of my career that I was like, proud of. Oh, yeah.
Chris Case 1:20:11
I wrote I take focus, and you just didn’t have it. Right, exactly.
Timmy Duggan 1:20:15
And I always thought it was like a physical thing like, Oh, my ability to do whatever, whatever lactate threshold something was limited. But yeah, it was absolutely more of a focus thing. So anyways, the moral of that story is, in addition to like sharing my story about my head injury, also sharing that, like, there’s no shame and like, go on the medication route, if you need to, whether that’s because of a head injury, or because of whatever other mental health route or mental health issue. I mean, it makes it makes a huge, huge, like life changing, in my case difference.
Chris Case 1:20:54
When you go beyond concussion, what are the signs that it’s more than just just me, I shouldn’t say just a concussion, because these can change people’s lives, at least in a short term.
Dr. Steven Broglio 1:21:07
We talked about this earlier, where TBI broadly is bucketed into mount traumatic, moderate and severe brain injury. And from a clinical standpoint, the way we think there’s a clinical rating scale called the Glasgow Coma Scale, where depending on your score, you get bucketed into one of these three history groups. So mild traumatic brain injury concussion is is 13 1415 to the highest possible scores, moderate and severe, obviously fall below that. And they’re largely based on duration of loss of consciousness and Indonesia, length, or amnesia, and things of that nature. That’s from the clinical standpoint. So if you just were to talk to a medical provider, if that’s how it would be evaluated. So the Glasgow Coma Scale was invented, before MRI and CT were available, couldn’t do it. In the modern era. And I’m not aware of classification systems. But the way I think about it is anything that shows up on a CT scan as a structural injury to the brain tissue, then you get automatically bucketed, into moderate severe depending on how severe severe. And so when we talk about long term effects of moderate and severe brain injury, you know, we’re talking about somebody that had a head structural change to their brain, not a function, we talked about concussion or mild traumatic brain injury as a functional change. Right. So it’s like, the software is not working well, but we can reboot. Now we’re talking about structural change heart, the hardware itself has changed. And depending on the magnitude of that change, the brain may or may not be able to compensate for it. So the brain is amazingly plastic, it can recover from all sorts of things, there’s redundancy, and it can handle a lot of injury and self injury. But there is there’s a point when it can’t do it. And so some people, depending on where the injury occurred, and the extent of that injury, they just may have persistent effects that just go on, you know, they may see some degree of improvement, but they may never get back to where they were.
Chris Case 1:23:18
When somebody has you say structural changes must take place. If there’s bleeding on the brain, does that naturally indicate that there has been a structural change? Or is that a gray area here.
Dr. Steven Broglio 1:23:33
So we’re getting a little bit out of my area, since everything I deal with has no bleeding and no structural damage. So I’m just going to give opinion at this point and not any if one of your listeners wants to phone in or right and correct me I’ll be very humble and agree with them. But if you have bleeding then something there was structural damage, right, the vessel was ruptured. And so you know, there’s there’s damage there. Now that bleeding depending on where it occurs, it can be handled in a way that there’s no long term damage. And so if you have bleeding kind of on the very periphery of the brain, the space between the brain and the skull, you can not to be too graphic here, but you can drill into the skull, or remove a section of the skull and relieve that pressure, stop the bleeding and then depending on how fast it happens, and other things are involved, there may be a very positive outcome. If it is deeper and the brain can’t get to it, or it is so severe, there may be more permanent consequences that come with that.
Chris Case 1:24:44
Strangely, from my point of view, some people think that helmets don’t help but let’s let’s talk about helmets specifically do do they help? How do they help and and, and I don’t know if you can speak to this, but where Where the shortcomings and cycling specifically here,
Dr. Steven Broglio 1:25:05
so how much for sure help and they help on many levels. So I mean, we’ve touched on this you know, I grew up learning to ride a bike without a helmet. I don’t think I went on until my teen years. I remember I never wore a hairnet but I had friends that wore them. So kind of teach me a bit.
Chris Case 1:25:23
And Jana, Jen, our producers looking at us like why would the man be wearing a hairnet? That’s the style of a helmet from from yesteryear? It wasn’t actually flyers.
Trevor Connor 1:25:33
Yeah. What do you have to watch American flyers?
Chris Case 1:25:35
Yeah, right. It was basically like four pieces of very thin padding. Essentially, it did. I don’t know that it did all that much. Right.
Dr. Steven Broglio 1:25:46
They were they were, I think they’re more for abrasion. And they were for Yeah,
Chris Case 1:25:49
Dr. Steven Broglio 1:25:50
right. Helmets initially, were not designed for concussion helmets are designed to prevent skull fracture. And within, I’m going to bounce back and forth here. But within the football context, they are really good at that head preventing skull fracture. And largely, they were invented or designed to prevent skull fracture, because that’s what people were worried about. They were worried about skull fracture, and then moderate severe TBI because, as I said before, people weren’t largely concerned about concussion, then as a group, there was concern around concussion, newer technology started being invented, to help dissipate some of those forces that we see kind of at the lower end that cause concussion. So, you know, technologies and myths technology, the wave cell technology, that that is specifically designed to try to mitigate forces that that can cause concussion, and the data would suggest that they do that. Definitely the newer football helmets, there’s very clear data that that the newer football helmets are better than the old ones, and concussion rates are down because of that. They are not there will never be a helmet that is 100%, concussion resistant, or concussion proof for whatever term you want to use it, it just will not happen just based on the way we are designed as human beings, the brain sits inside the skull, there’s a little bit of fluid around the brain, that kind of is Christianson in some level, but we can’t stabilize the brain directly. So there’s just no way we’ll ever develop a concussion proof home. But the technologies will get better, and, you know, help mitigate more and more of these forces. But but the new helmets are good, they definitely help. And I would, I would tell everybody to wear one under all circumstances. I’m not. I’m not immune to riding through town and asking people where their helmets are. I’m not gonna say I do it a lot. But I have done. So. You know, because it to me in this day and age, it’s a little ridiculous that you’re not wearing a helmet. And I would say a massive pet peeve of mine is you’ll see a family out riding the kid or kids will have helmets on and then mom and dad don’t. And apparently gravity doesn’t affect the parents the same way it affects the kids. So I’ve been known to make a comment or two.
Trevor Connor 1:28:18
I bet I was surprised by that. So first of all, say getting ready for this episode, I started to do my research on concussion and just went this is such a complex subject. There’s, I’m glad we have a good expert because I can’t even pretend to be an expert on concussion. So I just focused on the research looking at cycling, specifically in concussion. And obviously a lot of helmet research came up and I went into it with that mindset of Yeah, the helmet perfect fracture, as you said, but it can’t do much for a concussion because that’s your your brain moving around inside the skull. And it really sounds like that’s a myth that I was believing that’s that’s a myth. It’s I’ve looked at one study right now. So it would look to the effects of a helmet versus non helmet head and said this resulted in a reduction of the risk of concussion of up to 54%. The stress to the skull bone went from a fracture level of 80 MPa down to 13 to 16 MPa. When a helmet was included in the skull fracture risk was reduced by up to 98%. There was also another study out of England, or Great Britain sorry, that looked at leaven 1192 patients who had been in some sort of cycling accident that had been reported at the trauma units and showed that patients who wore helmets so it says here cycling helmet use was also associated with a reduction in severe traumatic brain injury. 19.1% versus 47.6% So I was actually quite surprised the difference a helmet can make.
Chris Case 1:30:04
Dr. brolio. I don’t know if you can speak to the different technologies, but I think that some of them are an attempt to reduce these shearing forces and some of these things. So maybe maybe you could talk a little bit about that.
Dr. Steven Broglio 1:30:17
I’ll just put in a picture real quick, just since we’re talking about helmets, in particular to so all helmets have to pass a national standard in order to be certified and put into the marketplace. So anybody buying off the shelf helmet like it’s going to meet this minimum scoring or testing. I think for people that are interested in finding the most concussion resistant helmet, I would encourage them to go look at the work being done at Virginia Tech. So Stephen Duma and Steve Rouse, and they developed this the star rating system, and they started with football, but and they’ve gone into other sports, but they do cycling, evaluate cycling helmets, and they will test and rate cycling helmets based on their ability to mitigate the forces associated with concussion.
Chris Case 1:31:05
This is kind of like a kind of like a JD Power rating for crash testing in vehicles, they get a star rating correct,
Dr. Steven Broglio 1:31:13
exactly. And so really the, you know, they get it for more scientific inquiry and knowledge and all that. But really, what it’s done is it’s driven the industry, because everybody wants to be the top of the list. And that causes people to innovate and get better. And we saw this with tracking the wave cell. And I’m aware of other things if you click on a cell right now, but you know, that they were trying to innovate and be better and do better than MIPS, which came before them, and somebody will come out with something better than that. And that’s that type of, you know, indirect pressure on the industry will make these things get better. But back to your question. So largely, we can think of kind of the forces of the acting on the head and the brain kind of into large buckets and one of these linear forces, that’s just force applied really straight through the center mass of the brain. So just in a straight line, the other of these rotational acceleration, rotational forces that are occurring, this is more of the twisting and the shearing, that that happens with impact. And neither one of them occur in isolation of the other, they always occur in parallel with each other. They’re really highly correlated for that matter, we will sometimes hear that it’s 90 G’s of linear accelerations is most likely to cause concussion, there’s no threshold concussion, as it turns out, we spent 10 years trying to find one, you could do it. And but it’s very easy. When we talk to people, it’s very easy for someone to conceptualize 1980s as opposed to 5500. grads. So we talked about linear just because conceptually, it’s easier. And the correlation between the two linear and rotational is pretty tight. But those are the two into the traditional helmets were largely built around our understanding of linear acceleration and his work on the brain or an influence on the brain, the newer technology nips wasl, and others. That’s, that’s largely around rotational and trying to mitigate some of those rotational acceleration of the rotational interaction that occurs after impact. So that’s the differences have kind of started addressing this other component of the impact that results in injury.
Chris Case 1:33:29
Could you explain what those rotational forces are? It’s essentially the the, the helmet contacting the ground, the and then the brain rotating within the skull, which would lead to the neuron stretching and so forth. Is that correct?
Dr. Steven Broglio 1:33:45
Exactly. So there’s some there’s some data to suggest that it’s, it’s the rotational component of the injury that actually causes the injury and don’t linear, if you could have a pure linear impact, it wouldn’t do anything. Or you would, you would end up with a skull fracture before anything else would happen. So it’s always that rotational which you know that the brain is fixed at the bottom to the stem of the brainstem. And so you can imagine this kind of the head is sloshing inside of the skull with the base fix it. I don’t know if you can see my hands, but it twists and rotates. And that’s what causes the neurons to stretch. And then we talked about the ion change that happens from that. So if you can reduce the amount that it rotates that rotational acceleration, then then you can reduce the risk for injury.
Trevor Connor 1:34:37
Let’s go back to Timmy one last time. Looking back on his experience, there are some things he would have done differently.
Timmy Duggan 1:34:44
Like I was saying, I was, you know, coming back in the 2019 season, just kind of back in the deep end training camp, to down under and then it was just full on in Europe from there. And the whole time I just felt like I was beating my head against the wall and racing was going okay. You know, as do my job as a Domestique, and it was okay, I was performing Okay, it wasn’t terrible. I felt okay, but I didn’t feel great. And I was just kind of always how it was. And by mid season by June, I was just over it. I’m like, this is going nowhere. This sucks. I feel like ass all the time. I can’t do this anymore. Um, yeah, I don’t know. So then we’re at the dole finais. And again, that race is going well do my job, like, every day is just so
Trevor Connor 1:35:33
Timmy Duggan 1:35:35
I’m just like dying. But I again, I’m like, doing my job. It’s fine. But just sucks so badly day before the last stage. I’m just like, yeah, screw this, I’m done. I like tomorrow literally is gonna be my last day of racing. And I’m gonna quit. I’m gonna go back to school, get my real estate license, whatever, whatever. You know, I was thinking moving on. And yeah, I remember just being fully committed that to that the night before stage nine or whatever. And then on the bus on the way to the race, I was just totally checked out. I think I almost Miss signing, maybe I didn’t sign in, I don’t know, line up at the race. And then again, you know, I do my job covering breaks in the current moves on the first part of the race. And I find myself in this like 30 man’s split, that ends up getting some big time. The whole time. I’m just like, sitting on the back waiting to get dropped, basically. And we’re just rolling, rolling, rolling, and blah, blah, blah. You know, 20 k to go we’re coming into the last climbs like this cat one climb in the Alps, and then descend and then flat to the finish real quick. And we start going up the climb. And again, I’m just waiting to get dropped. And then we’re going up in that first kilometer, and like guys are just like going backwards everywhere. I mean, and there’s some serious firepower and let’s move to in before I knew it, I was like, on the front with like, God even trying, I’m like, it was like this weird, surreal experience. What like, I literally thought something was like wrong with the world. Like, how is this happening? Like, Oscar Pereiro is like, dropped. Like what’s going on? Well, I guess I might as well attack I was the only guy from my team and the move. So I just lit it up. And only one guy could stay with me. eventually caught me like just at the top. And then the two of us like ripped down to the cent time trial to the finish. And we’re sprinting for the win on state, you know, the last stage of doping. And literally, at the, you know, 200 years ago, I was like waiting for the peloton to just like, catch like, no way. is this happening? Yeah. And I frickin didn’t win sprint. I got second by like a tire with
Chris Case 1:37:55
almost a perfect ending.
Timmy Duggan 1:37:57
Yeah. But yeah, that would have been a big win. But I mean, at that time, that was as good as it was a win for me. Because it was like, in one day, like, right after I literally quit in my mind. Like, everything changed. Like, Oh, I can’t like racing is Yeah, that was literally my best result of my career. And I felt amazing. So maybe it’s not over. And then the rest of the season just went, you know, took off from there. Because that that mental switch was flipped, you know? So yeah, from from there on, it was kind of a lot easier to, you know, focus ahead and move forward and not be feeling like, you know, my injury was holding me back anymore.
Chris Case 1:38:39
Awesome. That’s a great story. I don’t remember that.
Timmy Duggan 1:38:44
Chris Case 1:38:46
was you said 2009. That would have chosen nine. Yeah,
Timmy Duggan 1:38:49
yeah. Um, and yeah, you know, I race for five more years and kept getting better and better results and see on the outside and on paper, like, everything was getting better and better for Timmy Dugan. You know, my career is progressing. I was writing for amazing teams. But like, internally, inside my head, it was just getting worse and worse, I was more and more miserable. I just freaking hated it. I was super depressed but didn’t realize it. And ultimately, you know, that feeling is what led me to retire and move on, you know, everything was going so well, right. And for the best teams making more money than I ever had had, you know, having the best better results than I ever had. But I was still just miserable. So I thought quitting cycling was gonna be fixed to that. But it wasn’t. So they keep working through stuff. And yet, it wasn’t until that point, I figured out the medication thing. If I figured that out while I was racing, I would probably still be racing. So that’s kind of a bummer, but too late at this point. Yeah. Again, if there’s anything I can impress on people is there’s definitely no shame or harm in trying the medication route if that’s what you need to do for you. recovering from your head injury or your mental health, taking matters into your own hands, despite you know what your brilliant neuroscientist might have to say about your case, specifically, just doing what, what you feel you need to do.
Chris Case 1:40:13
Awesome. Thank you. Yep. Dr. brolio, we like to close out the show with one minute take homes. Yeah, I know, it’s a complex subject a lot to talk about. But if you could try to encapsulate the biggest message you’d like people to take home with them from this show?
Dr. Steven Broglio 1:40:33
Yeah, happy to do it. I think the biggest thing I would I would tell your audience is, you know, certainly you want to take concussion or suspected concussion very seriously. But at the same time, and please go get checked out by medical providers. But at the same time, I really do not think that if it’s rapidly identified and managed appropriately, that there’s significant concern for any long term effects. And so really, what we’re trying to do at the Michigan concussion center is helping people understand that and letting them get back to their sport and live their best lives.
Chris Case 1:41:11
Trevor, what do you have to say,
Trevor Connor 1:41:13
this is a tough one, because as I said, I started to dig into the research and just went, I don’t even know where to start. This isn’t like an injury where you get a skin abrasion, and I can tell you exactly what to do to. to address that. As we said, with everybody expresses differently, the recovery is different. So it’s an extraordinary challenge you you have ahead of you trying to give any sort of standards that people can use to disseminate to the sport. So I think you really hit on the two points that I would say I learned from you in this episode, which is a if you get a concussion, it’s not the end of the world. But be take it seriously and be careful and make sure you recover. Recover correctly. Chris,
Chris Case 1:42:03
I think I would add something that I learned from from talking with with Timmy Duggan and some others, and that is kind of the support. We haven’t really we didn’t really talk about that in this show. But he had a hard time understanding what life was going to be like after his crash after the injury. And all the people in the world that had science degrees and medical degrees weren’t able to get inside his body and tell him what what what to expect. So if you have a concussion, if you have a TBI, I think one of the best things you can do is to talk to others that have gone through this and have them try to help you understand what it’s going to be like how long it you know not to bite by no means just say Oh, their case was like this so I can expect this. But they they can serve as a great support system and help you along the way helps you to set expectations and deal with some of the psychological ramifications that you might have to address later on because of the injury.
Trevor Connor 1:43:09
was Dr. Brogan Thank you. It was a real joy having you on the show. I hope we can talk with you again. Anytime.
Chris Case 1:43:19
That was another episode of FASTA subscribe Fast Talk wherever you prefer to find your favorite podcasts. Be sure to leave us a rating and review of thoughts and opinions expressed on Fast Talker those of the individual. As always we love your feedback. Join the conversation at forums dot Fast Talk Labs.com to discuss each and every episode. join in on this one as well. Become a member of Fast Talk laboratories at Fast Talk Labs.com slash join and become a part of our education and coaching community. For Dr. Steven brolio. Timmy Duggan hanifin champ, Trevor Connor and Chris case thanks for listening