Why Your Brain Wants Jelly Beans with Dr Matthew Galati

Losing Your Grip And Finding Hope

0:04 Michael Mackniak: Welcome to Holding It Together.

0:06 Michael Mackniak: Kinda.

0:06 Michael Mackniak: I'm Michael McNak.

0:08 Michael Mackniak: We've all had those moments in life where it feels like everything is just kind of slipping through our fingers.

0:16 Michael Mackniak: A bad day, lost job, lost car keys, lost wallet, you know, the momentary overwhelm.

0:25 Michael Mackniak: But how about those days that come along when hopefully we haven't all experienced this, but sometimes it feels like you're losing your mind, right?

0:34 Michael Mackniak: What happens when the experts tell you that the person you used to be is gone for good?

0:42 Michael Mackniak: Today's guest is living proof that the experts aren't always right.

0:47 Michael Mackniak: Dr.

0:48 Michael Mackniak: Matthew Galati was a medical student when he was in a real nasty car accident, which gave him, you know, left him with severe TBI, traumatic brain injury.

0:58 Michael Mackniak: He didn't just survive it.

1:01 Michael Mackniak: I mean, he thrived from it.

1:04 Michael Mackniak: He overcame it and rebuilt himself.

1:07 Michael Mackniak: He finished his MD.

1:09 Michael Mackniak: Now he's founded Brain Changes Initiative that really helps to bridge the gap between standard medical care and lifestyle changes that actually trigger brain recovery.

1:21 Michael Mackniak: So today we're going to talk about the day after the accident, the daily grit of a traumatic brain injury, and how to fuel the brain when it's ready to make its changes and heal.

1:43 Michael Mackniak: I get really excited when I get to meet people and have conversations with them because of their lived experience and what they can, what lessons they can impart on us as listeners and you know students.

1:59 Michael Mackniak: And today is no exception.

2:01 Michael Mackniak: I'm here with Dr.

2:02 Michael Mackniak: Matthew Galati, who I'm gonna let him tell his story.

2:06 Michael Mackniak: But Matthew is not only a physician, but he is also a survivor of a horrific accident that gave him a traumatic brain injury.

2:15 Michael Mackniak: And Matt, when I start out, I ask people, you know, tell us about yourself, but also tell me what you have going on.

2:23 Michael Mackniak: And I know what you have going on.

2:24 Michael Mackniak: So I'm curious to hear your perspective on it.

2:26 Michael Mackniak: What do you have going on that you really fired up about that?

2:29 Michael Mackniak: I don't know, maybe coming up in a month or so.

Brain Health Summit And Big Mission

2:32 SPEAKER_02: Well, thank you so much for that introduction, Mike.

2:35 SPEAKER_02: And and yeah, I'm Dr.

2:36 SPEAKER_02: Matthew Galladi.

2:37 SPEAKER_02: I'm a brain injury survivor, I'm a medical doctor.

2:40 SPEAKER_02: I'm also the founder of a not-for-profit called Brain Changes Initiative.

2:44 SPEAKER_02: And we started Brain Changes myself and my family following my own journey recovering from a severe traumatic brain injury.

2:53 SPEAKER_02: And my organization, this, you know, in these next few months, June 18th and 19th, we have something called our annual brain health summit, which is a summit or a conference style, TED Talks, it's it's a bunch of speakers, TED Talk style.

3:09 SPEAKER_02: There's brain health eventors, food, workshops, and full immersive two-day summit of brain health.

3:18 SPEAKER_02: So really exciting.

3:19 SPEAKER_02: That's at York University in Toronto, Canada.

3:24 SPEAKER_02: So if if any of you listeners are in the Toronto region, June 18th and 19th, this is an event that you don't want to miss.

3:32 Michael Mackniak: Yeah, the thing that's unique about it, and that that I think is really impressive is the immersive aspect of it.

3:38 Michael Mackniak: It's not like a typical conference where you pick and choose what you go to.

3:42 Michael Mackniak: This is you're going to everything, and you're going to be part of this, man.

3:45 Michael Mackniak: And you're going to you're going to live it along with everybody that's living it too.

3:50 Michael Mackniak: Absolutely.

3:51 Michael Mackniak: Pretty cool thinking outside the box way to put these things together.

3:55 Michael Mackniak: So I to you and your sister Olivia, I give you credit.

3:59 Michael Mackniak: And I will be there, folks, in the flesh.

4:03 Michael Mackniak: But yeah, tell us about okay, so your your background and and you're a physician, and what are the what what I mean?

4:11 Michael Mackniak: I know how that comes about, but you what kind of doctor are you?

4:14 Michael Mackniak: And and where what's your practice focusing on now?

4:16 SPEAKER_02: Yeah, so I I practice family medicine, but because I have this unique experience as both, you know, a brain injury survivor and a medical doctor, I also practice rehab medicine where we uh both in clinic and in the hospital setting, where we help people recover from brain injury, stroke, etc.

4:39 SPEAKER_02: So my practice is kind of divided between family medicine and rehab medicine.

4:44 Michael Mackniak: And the and the great thing, this is why I get excited to talk to folks like you, is that you can really help the listeners that I'm reaching, the caregivers, the family members that are out there that are struggling to hold it all together, because they have a new normal in their house.

5:04 Michael Mackniak: And now they have a diagnosis of mental illness, traumatic brain injury, terminal cancer, or long-term dementia, anything along those lines, there's a new normal in the house, and they're going to be on a journey.

5:19 Michael Mackniak: And I try to really point out to folks that the journey that you're on is unique, but there are other people who have had like experiences that you can learn from and that you can impart lessons to.

5:32 Michael Mackniak: And so coming from your perspective as not only a survivor, but also as a physician caught up now in the system, the very system that sometimes feels so broken and opaque to many people, maybe many family members.

5:49 Michael Mackniak: I think that you can offer us a really unique perspective.

5:52 Michael Mackniak: So thanks again for being here and thanks for the work that you you are doing.

5:57 Michael Mackniak: Thank you, Mike.

5:58 Michael Mackniak: What what's just can you just quickly tell the story about accident?

The Crash And The Coma

6:06 SPEAKER_02: Absolutely.

6:07 SPEAKER_02: So I was a second-year medical student at the time, and I was I had just finished writing my second year, first semester medical school exams, and I was back home visiting some friends and family for the weekend.

6:20 SPEAKER_02: My medical school was in Windsor, Ontario, which is about four hours from where my family lives in in Vaughan or close in the greater Toronto area.

6:32 SPEAKER_02: So I originally had planned on leaving this the Sunday night to make it back to my medical school because I had a mandatory small group session on the Monday morning, but the weather conditions were so bad that I thought, you know what, it's probably safest that I leave the Monday morning instead.

6:48 SPEAKER_02: Woke up Monday morning, weather conditions were even worse.

6:52 SPEAKER_02: So I had a passenger with me and we started our drive.

6:55 SPEAKER_02: And the weather was so bad that there was a detour route off the highway at about the halfway point in a place called Woodsock, Ontario.

7:03 SPEAKER_02: And on this detour route, I hit black ice, car spun out of control, collided with the tree, completely crunched around the tree, smacked my head either on the side of the tree or on the side of the car, and had, you know, a number of injuries.

7:18 SPEAKER_02: I had skull fractures, I had rib fractures, I collapsed both my lungs, I severed a nerve in my face.

7:25 SPEAKER_02: So for months it looked like I suffered a stroke.

7:28 SPEAKER_02: And most critically, I had this bleed inside my brain with a critical, severe traumatic brain injury that was life-threatening.

7:35 SPEAKER_02: And and yeah, luckily for me, my passenger, my side had absorbed all the impact.

7:41 SPEAKER_02: And he was, you know, he's he's kind of my my my guardian angel.

7:46 SPEAKER_02: He was able to get out of the car and and call an ambulance, and lucky he was able to do that, or else I would probably not be talking to you today.

7:54 SPEAKER_02: So the ambulance showed up, they removed me from the car using the jaws of life, and I was transported to the nearest hospital, and I was in a comatose state.

8:03 SPEAKER_02: And I remained in a coma for three days, woke up from that coma, couldn't talk, couldn't walk, had to pretty much relearn everything from the basics, including like how to tell time.

8:15 SPEAKER_02: And yeah, this was at a time when not a whole lot was known about the brain, you know, brain injury recovery, the neuroplasticity, or the brain's ability to adapt, rewire, and change.

8:27 SPEAKER_02: And as you can imagine, the prognosis was terrible.

8:31 SPEAKER_02: The the medical providers were very guarded in any expectations they were giving my family about me returning to medicine or having a career in medicine.

8:41 SPEAKER_02: So yeah, it was a trying time to say the least.

8:46 Michael Mackniak: I have two friends that well, not I mean friends.

8:52 Michael Mackniak: I I know two people very well who both met trees in in unwelcome circumstances, both of whom had traumatic brain injury.

9:02 Michael Mackniak: One, I I one happened when I was young, maybe 14, 15 years old.

9:07 Michael Mackniak: So I don't even know back then if they were calling it that.

9:11 Michael Mackniak: And the other was just a few years ago.

9:13 Michael Mackniak: A friend of mine was in a motor snowmobile accident.

9:16 Michael Mackniak: And I will tell you that you, my friend, are a miracle just seeing you, knowing you, talking to you, interacting with you on this level or on any level.

9:30 Michael Mackniak: You're a miracle.

9:30 Michael Mackniak: And I know you appreciate that.

9:32 Michael Mackniak: And you, as you said, you called your buddy a guardian angel for for, I mean, having having the phone and being able to call and survive and saving you because my friends are not highly functioning at all, and they are not the people that they were before their their accident, and they never will be, and that's really sad.

9:53 Michael Mackniak: Now, I also have experience as one of the one of the very first when when the ABI TBI waiver came out, and we could talk about what that means, one of the very first people who received the money under that waiver in the state of Connecticut was my client.

10:09 Michael Mackniak: So so I I learned a lot about acquired brain injury, traumatic brain injury, then through that work.

10:17 Michael Mackniak: And since then, I've had several ABI TVI clients come through my doors.

10:23 Michael Mackniak: So I I I know it.

10:25 Michael Mackniak: I was at one time a brain injury specialist.

10:28 Michael Mackniak: As I said to Matt before we hit record, I've that certificate has lapsed and I forgot more than I knew probably at the time.

10:36 Michael Mackniak: So he will remind us of a lot of terms and things like that here along the way.

10:40 Michael Mackniak: But you know, kudos to you, man.

10:42 Michael Mackniak: You are you are a miracle.

10:45 Michael Mackniak: So I I really encourage everybody to follow Matt's work and to to check out brain changes for sure.

10:51 Michael Mackniak: Matt, what are some of the symptoms of brain injury that are different?

Symptoms That Nobody Expects

10:59 Michael Mackniak: Number one, than the textbooks would tell us, but also than your typical, let's say, mental illness or typical concussion or anything along those lines?

11:09 SPEAKER_02: Well, I think that there's you know two major subheadings of symptoms that are related to brain injury.

11:19 SPEAKER_02: This is very general.

11:20 SPEAKER_02: Obviously, there's more symptoms than uh categories of symptoms than this, but in general, there are physical symptoms.

11:27 SPEAKER_02: So that includes, you know, your your headaches, your dizziness, your your nausea, you know, maybe some balance difficulties.

11:34 SPEAKER_02: And then there's cognitive symptoms, which is your difficulty with memory, attention, speed of processing.

11:41 SPEAKER_02: And I think one of the most pervasive symptoms of brain injury that maybe people don't think about when it comes to, you know, when they're thinking of your average brain injury, is uh cognitive fatigue.

11:54 SPEAKER_02: It is far and away one of the most common symptoms of brain injury.

12:00 SPEAKER_02: You know, uh brain injury uh demands a lot of resources from your brain.

12:06 SPEAKER_02: And it's also playing catch-up.

12:08 SPEAKER_02: It's trying to circuits aren't firing the way they were firing before.

12:11 SPEAKER_02: It's trying to, you know, take up more energy to make connections.

12:16 SPEAKER_02: So anything that you do demands like a higher level of resources from your brain.

12:23 SPEAKER_02: And that leads to exhaustion from even simple tasks that you know before may have seemed, you know, just day-to-day or that you know you didn't even think twice about.

12:34 Michael Mackniak: Well, and I think that's really important for for people who are living in the family to understand that, yeah, it's not that I don't want to take the garbage out.

12:44 Michael Mackniak: I want to be helpful.

12:46 Michael Mackniak: It's just it's and this is maybe a horrible example, but you know, I can't cognitively put together right now the the effort to do it, number one, or number two, I'm exhausted from trying to figure out I don't know how to what I cooked earlier this morning.

13:01 Michael Mackniak: And that's those are small level examples, but they are indicative or an example exemplify perhaps larger examples.

13:11 Michael Mackniak: Am I close with that analogy?

13:13 SPEAKER_02: Yeah, I mean, for sure.

13:14 SPEAKER_02: I I think that with brain injury, as with chronic fatigue syndrome, which is you know another major cause of cognitive fatigue, I think that it's I always tell my patients that one of the most important things you could do is pace yourself.

13:30 SPEAKER_02: And that's not something, it's not like a sexy term that people think about, oh, like treatment pacing.

13:36 SPEAKER_02: Well, if you look at the analogy, if you use the analogy of like a jar of jelly beans, you know, with brain injury or chronic fatigue syndrome or you know, chronic fatigue in general, every time you remove a jelly bean from that jar, those jelly beans represent your energy level.

13:51 SPEAKER_02: Your system can't replete those jelly beans.

13:54 SPEAKER_02: So by the end of the day, or even after like, you know, a few simple tasks, you're left with an empty jar.

14:00 SPEAKER_02: So I encourage people with cognitive fatigue to rest preemptively.

14:06 SPEAKER_02: So in advance of doing any activities, or maybe just pick a few activities, key activities to do a day, and then you know, rest before, rest after, and you kind of that's what you have to do to keep up your momentum and to pace yourself to balance your day so that you're not crashing.

14:24 Michael Mackniak: I love I love that you use the word proactively.

14:26 Michael Mackniak: I mean, you're using a proactive approach to a to an issue that you see or can foresee in the future, and that's so unheard of in our medicine in so many aspects, and that's a whole discussion for another day.

14:40 SPEAKER_02: But um, but I would say I I just want to say that like I would say that that probably is maybe the most universal symptom of brain injury in general.

14:53 SPEAKER_02: Like, in in general, when you when we talk about brain injury and symptomatology, there's a common saying when you've seen one brain injury, you've seen one brain injury because they all present completely differently in terms of the symptomatology and the issues that people face.

15:08 Michael Mackniak: Right.

15:08 Michael Mackniak: Yeah, and that and that is a great way to see it.

15:12 Michael Mackniak: When you see a brain injury, you've seen one brain injury.

15:14 Michael Mackniak: That's a really great way to say it.

15:16 Michael Mackniak: And I I say that with schizophrenia, I say it with schizoaffective disorder, with cancer, you know.

15:23 Michael Mackniak: I mean, frankly, my prostate cancer was different than what my brother just went through, right?

15:28 Michael Mackniak: I mean, his they were just different cancers, they were in the same place, they're couched under the same heading, but everything's different, it presents itself different.

15:38 Michael Mackniak: The the biosphere that is your body tra creates a different response to it, if you will.

15:46 Michael Mackniak: And that's absolutely and and you know what your son or daughter may be going through in terms of their brain fatigue, or you know, maybe different than what another son or daughter is going through, you know, from another family.

16:01 Michael Mackniak: So you cannot make those comparisons.

16:03 Michael Mackniak: Just it's important that folks understand that this is a very common side effect or result or manifestation of brain injury.

16:13 Michael Mackniak: And and this goes beyond brain fog, right?

16:15 Michael Mackniak: Or is it a is brain fog a good symptom of of this brain fatigue?

16:21 SPEAKER_02: Well, brain fog is definitely a a symptom of cognitive fatigue and and yeah, also you know very pervasive in terms of brain injury.

16:32 SPEAKER_02: Yeah, so I would I would you know categorize it in a similar category as cognitive fatigue.

16:38 SPEAKER_02: It's part of it.

16:41 Michael Mackniak: I'm gonna use a really bad example here.

16:43 Michael Mackniak: And if this doesn't work, I promise I'll edit out.

16:46 Michael Mackniak: But you know, when you when you tie one on at night and you get yourself good and had a f had had more than you should.

16:54 Michael Mackniak: I mean, I know from when I was a little kid in my health class that they say, you know, the drop of alcohol does damage to your brain.

17:01 Michael Mackniak: Yes, and and you you wake up the next morning and you feel like crap, and you you're in brain fog for sure.

17:10 Michael Mackniak: You got that brain fog, and it takes your your you throughout the day, you get sharper and sharper and sharper as you go because your brain is recovering, I believe.

17:21 Michael Mackniak: Is that correct?

17:24 SPEAKER_02: Yeah, for sure.

17:25 SPEAKER_02: I mean, it alcohol also depletes a lot of like vital nutrients and vitamins that your your brain would need.

17:34 SPEAKER_02: Your and and yeah, like like B12, B12 deficiency is is a common, you know, a common cause of it is is alcohol misuse, right?

17:44 SPEAKER_02: And and yeah, but your your brain and neurons require B12 to to fire properly.

17:50 Michael Mackniak: So yeah, well, I'm telling you folks, don't go out there and try to get the supplements and take the B12 before you go drink and it doesn't work.

17:57 Michael Mackniak: I've tried it.

17:58 SPEAKER_02: Well, it's funny that you you mention alcohol because one of the pillars that we stand by at brain changes is limiting harmful exposures.

18:06 SPEAKER_02: And yes, that includes things that you know most people understand have a negative effect on the brain, like alcohol and smoking, because you know, it's always talked about by medical providers.

18:18 SPEAKER_02: But there's also some things that maybe people don't commonly think about that can also be harmful to your brain that you should probably avoid, like you know, the effects of harmful pesticide residue on on the brain.

18:30 SPEAKER_02: So, yeah, a lot of the the pesticides that are used in produce are actually neurotoxic.

18:37 SPEAKER_02: They they target the nervous system of the insects that they are meant to ward off.

18:44 SPEAKER_02: But you know, there's there's little research on, and we know that these these pesticides are neurotoxic to humans in in high doses.

18:53 SPEAKER_02: There's very little research on chronic low dose exposure that you'd be getting through, you know, consuming uh produce.

19:02 SPEAKER_02: But interestingly, the American Pediatric Society has put out an issue, a warning to parents about the potential harmful effects of pesticide residue on a developing brain.

19:15 SPEAKER_02: So you could only extend that to something like a brain injury that's very, you know, somebody with a brain injury, their brain is very vulnerable.

19:23 SPEAKER_02: That, you know, pesticides and you know, all these harmful exposures would would also be very harmful to a recovering brain.

19:31 Michael Mackniak: No, no question about it.

19:33 Michael Mackniak: I was trying to come up with my own horrible analogy to to go along with your jelly bean analogy, but I guess I kind of missed the mark.

19:41 Michael Mackniak: But uh what um when you were waking up from your coma, I mean, how old were you about 20 late mid to late 20s, right?

19:50 Michael Mackniak: No, uh well, I was early 20s, 23.

19:53 Michael Mackniak: 23.

19:54 Michael Mackniak: Okay.

19:54 Michael Mackniak: Oh, that's right.

19:55 Michael Mackniak: You didn't go to law school between you went from college to med school.

19:58 Michael Mackniak: I'm thinking yes.

20:00 Michael Mackniak: Yeah, okay.

20:00 Michael Mackniak: Because I have a second, I graduated when I was 24.

20:02 Michael Mackniak: If I was in med school, I would have been about 25, 26.

20:05 Michael Mackniak: So you're 23 years old when this happened.

20:07 Michael Mackniak: Your executive functioning in your brain hasn't even completely developed yet, and now you've had this tremendous insult to the brain.

20:15 Michael Mackniak: And you're laying there in the bed, and all of a sudden, I don't know if you were cognizant of this or not, but what did it feel like?

20:24 Michael Mackniak: Or what is it like when you experience that you want your brain or your body to do something and it's not responding the way that you're used to just having it respond?

20:36 Michael Mackniak: I can't even imagine what that must have been like.

20:39 SPEAKER_02: It's a very interesting, and actually, nobody's ever asked me that question, but it is very interesting and like it's something that you you never think about until you're in that situation.

20:50 SPEAKER_02: Like you there's certain things that you take for granted on a daily basis, like the ability to articulate or the ability to, you know, you know, walk a straight line, but like these things suddenly they're they're ripped from you, and you're like you have no idea how to react.

21:09 SPEAKER_02: And it's very frustrating, it's it's demoralizing and debilitating, especially when you're you're the only thing that you that you're being told by medical providers and you know the people around you is how hard this is to recover, and you may not ever make it back to what your function your functioning was before.

21:30 SPEAKER_02: So yeah, a lot of it is not only trying to field the response that you're getting from everybody else around you, but then you're also trying to, you know, navigate your own mental health around this situation and your own limitations.

21:48 Michael Mackniak: Yeah, and you just brought up a really interesting point because I mean, you're feeling dejected because you can't do the things, you know, or frustrated.

21:58 Michael Mackniak: I remember working with some.

22:00 Michael Mackniak: Specialized needs clients who were just getting so frustrated because they couldn't get their point across.

22:05 Michael Mackniak: And I mean, it must be and just oh, it's almost anger, you know, it's just this high level of frustration because we couldn't understand what you needed or what you wanted.

22:15 Michael Mackniak: So that's that's one thing that sticks out to me.

22:17 Michael Mackniak: But so you went from being a medical student to now a patient, which has to give you tremendous insight that I want to know about later on, but for right now, when you're being told, or you probably knew this in your, I mean, you're an intelligent guy, you probably knew that this injury could be something that that may be a something that you're never gonna fully recover from, right?

22:43 Michael Mackniak: And when these people were saying that to you and you were feeling frustrated at the time, that had to be really demoralizing.

22:53 Michael Mackniak: Absolutely.

Mindset As The First Treatment

22:54 SPEAKER_02: It's I think that you know we talk about the six pillars of brain health that brain changes, you know, and we'll get we could get into that after, but I really think that even before that, the first step or the first stage to recovery is really mindset.

23:12 SPEAKER_02: And if you can't get yourself into the mindset where you're ready to focus on recovery when where you're ready to have that grit and you know, overcome the adversity and to push yourself to do the things that you need to do to get better, then you've already lost.

23:30 SPEAKER_02: So, you know, that's why as a medical provider, I don't think that there is any merit in not giving hope to somebody because hope is the foundation of recovery, it's the foundation of everything.

23:43 Michael Mackniak: You know what's so funny?

23:44 Michael Mackniak: I it's like you're reading my mind.

23:46 Michael Mackniak: I wrote this down here.

23:47 Michael Mackniak: Like so what you just said is so inspirational because I I've seen elder relatives basically not decide that they they don't have the the courage, the strength, the wherewithal to to to fight back and to overcome.

24:05 Michael Mackniak: And and that's where they're lost.

24:07 Michael Mackniak: You're absolutely right there.

24:08 Michael Mackniak: And it made me think that you thinking about that purposely, planfully thinking about that, made you realize that you aren't through this yet.

24:23 Michael Mackniak: You're not through fighting yet, you're not through growing back again yet.

24:27 Michael Mackniak: And hopefully none of us ever are.

24:29 Michael Mackniak: But I also wrote down that that word yet is so powerful, and yet in this case equals hope.

24:35 Michael Mackniak: That's what I wrote right here.

24:37 Michael Mackniak: I can even show you on my page.

24:38 Michael Mackniak: I don't know if you could see it, but yet equals hope.

24:41 Michael Mackniak: And that that yet and that that ability to to pull yourself up, that courage and that strength is what gives you hope.

24:50 Michael Mackniak: Otherwise, I mean, man, you you're really shooting yourself in the foot in terms of losing that hope, right?

24:58 SPEAKER_02: Yes, for sure.

24:59 SPEAKER_02: I mean, for me, it was like at the time, this was this was 13 years ago.

25:05 SPEAKER_02: And as I said, there there wasn't a lot out there.

25:08 SPEAKER_02: There weren't a lot of examples or people who were talking about their brain injury and and returning back to you know highly functioning programs or demanding programs like medicine or or law.

25:19 SPEAKER_02: Like I couldn't find it because there was such a stigma around it.

25:23 SPEAKER_02: So when I was going through it and I couldn't find anything, and I was receiving all this negative feedback from people around me, or not, I'm sure I don't hold it against them.

25:35 SPEAKER_02: I don't think that it was something that you know they cognizantly were like trying to be.

25:40 SPEAKER_02: I think that you know, everybody they they had their own guarded approach.

25:44 SPEAKER_02: They didn't want to give false hope.

25:46 SPEAKER_02: But what I where I drew my courage and inspiration was was, you know what?

25:52 SPEAKER_02: If I'm the first person to recover from something like this and return back to a program like medicine, I'm showing people that anything is possible and I will be a ray of hope for the next survivor who wants to overcome and become a doctor or you know, achieve their dreams, goals, aspirations.

26:13 Michael Mackniak: Uh yeah, I mean, and if you are, and you're all that, man.

26:16 Michael Mackniak: I mean, you're such a you're such an inspiration, and you're right.

26:21 Michael Mackniak: I don't know where the literature would be about and who has done studies of of folks like you have gone through these accidents.

26:27 Michael Mackniak: I mean, maybe there are now because of the work you've done, and maybe you can enlighten us on that.

26:32 Michael Mackniak: But you've already explained a couple of ways that your experience, your TVI, has really impacted your the way you practice, the way that you approach not only life, but approach your professional practice and the way that maybe families can approach their ongoing caregiving for a loved one with traumatic brain injury or acquired brain injury.

ABI Versus TBI And Listening Better

27:02 Michael Mackniak: And maybe we should could you just quickly just tell the difference between an ABI and a T B and a TBI?

27:08 SPEAKER_02: Yeah.

27:08 SPEAKER_02: So an acquired brain injury and ABI is kind of like an umbrella term.

27:13 SPEAKER_02: There, there's there's lots of different ways you can acquire a brain injury, which is, you know, it could be through trauma, which is a traumatic brain injury, it could be through infectious causes like meningitis, it could be through metabolic dysfunction, like you know, your electrolytes are off, or you, you know, you you suffer uh a diabetic coma.

27:36 SPEAKER_02: It could be anoxic, which means your brain isn't receiving enough oxygen for a period of time.

27:41 SPEAKER_02: So the way I put put it very simply is like a ABI is this umbrella term, and TBI is you know a spoke within that umbrella.

27:54 Michael Mackniak: I was when I first started doing work, and this is 30 years ago, when the waivers first came out, the ABI, TBI, Medicaid waivers.

28:05 Michael Mackniak: The way that they really dumbed it down back then, and I I based upon what you just said, I think it's probably different, but they looked more at an ABI as being something that you were born with, and a TBI is something that you acquired during postnatal, right?

28:24 Michael Mackniak: Interesting.

28:25 Michael Mackniak: What's that?

28:27 Michael Mackniak: Interesting, yeah.

28:29 Michael Mackniak: No, I I I distinctly remember that because I I always drew that distinction.

28:33 Michael Mackniak: But as we said before, we came on.

28:35 Michael Mackniak: I mean, a TBI is an ABI, you know, and so I don't know why that that distinction stuck in my head.

28:42 Michael Mackniak: Maybe it was just an easier way for me to remember it when I was studying it, but but now I know even even as I was doing some work in that field, they were looking for the causal effects on a fetus in utero to to pinpoint the cause of the brain injury.

29:04 Michael Mackniak: So, you know, I I could I'm probably knowing me, I'm probably way off.

29:09 Michael Mackniak: And this is just the way that I've remembered in and rem tried to remember to help me pass a test, you know, one of those little trick things.

29:16 SPEAKER_02: But but maybe it's possible that you're confusing it with a congenital brain injury because an acquired- I've never heard of that before.

29:24 Michael Mackniak: No, no, I don't know.

29:27 Michael Mackniak: No, but but I yeah, but a congenital, I I uh based upon this conversation, I understand what that probably means.

29:35 Michael Mackniak: But let's just get back to the my initial my initial point because you already talked about you and your practice and communicating with your patients and never wanting to give them a place where they didn't feel like they had hope, courage, strength, resilience.

29:53 Michael Mackniak: And I think that's number one great lesson because I think that we really need to get back to that caring feeling, that bedside manner that I think we're so lacking in in medicine these days.

30:06 Michael Mackniak: So kudos to you for that.

30:07 Michael Mackniak: Do you think it it's made you a better listener to your patient's stories?

30:13 Michael Mackniak: Do you think it's made you a better and more disciplined practitioner in that regard?

30:19 SPEAKER_02: I think so.

30:20 SPEAKER_02: I think that what I've learned, one of the main things that I've learned through my own experience is that you know what?

30:27 SPEAKER_02: You yes, you always have to respect the doctors, and you know, they have years of education, they've they've seen lots of cases, they've read the textbooks.

30:38 SPEAKER_02: But what I've learned through my own experience is that you can never discount the patient and the symptomatology and what they're expressing because people are to a large degree their own best doctor because they understand what they're going through and experiencing the most.

30:55 SPEAKER_02: So I think one of the main ways it's changed my practice is that, you know, I really try to listen to the patient and not come at things from a paternalistic standpoint and always try to understand where the patient is coming from and recognize that, like, you know, like we said before, every case is completely different and never to dismiss what something somebody is is saying because they're the ones that are living with themselves 24-7.

31:27 SPEAKER_02: We're seeing as as medical practitioners, we're seeing a very short snapshot of that person.

31:32 SPEAKER_02: Yep.

31:33 Michael Mackniak: And as I say, they're living the entire Star Wars saga every single day.

31:38 Michael Mackniak: We're seeing a little picture, right?

31:41 Michael Mackniak: Exactly.

31:42 Michael Mackniak: And and you know, and they say it all the time, you know your body better than anybody.

31:46 Michael Mackniak: And if you're feeling off, you're off.

31:50 Michael Mackniak: And yeah, and and so it makes you you certainly from what I glean from this conversation, is you've you've become much more of an empathic listener to that.

32:01 Michael Mackniak: I mean, it must have really helped you get through the rest of med school, right?

32:06 SPEAKER_02: Yeah, for sure.

32:07 SPEAKER_02: I mean, in in some regards, in in the in terms of like that empathy building for sure, and that that ability to connect with somebody, absolutely.

32:17 SPEAKER_02: Obviously, there were struggles upon returning to medicine so soon after my my injury, which were hurdles that I had to overcome.

32:25 SPEAKER_02: And you know, my my brain was I thought my brain was fully healed when I returned back to medicine, but in retrospect, when I look back, it probably was still healing.

32:34 SPEAKER_02: And and maybe returning back to such a demanding program was the best type of cognitive exercise I could give my brain for its recovery.

32:41 SPEAKER_02: That was actually probably probably part of my rehab and the reason why I'm functioning at the level that I'm functioning today.

32:48 Michael Mackniak: That's pretty that's interesting.

32:49 Michael Mackniak: Yeah, I mean, you super challenged your brain to get its get itself kick itself in the rear end and get going again, right?

32:56 Michael Mackniak: Yeah, for sure.

32:57 Michael Mackniak: That's pretty that's that's a really cool way to look at it.

32:59 Michael Mackniak: And and you just made me think of another question that could be a great ending question, but I'm gonna put throw it out here now.

33:06 Michael Mackniak: Is do you feel like your brain is completely healed now?

33:10 Michael Mackniak: 13 years later?

33:12 Michael Mackniak: Are you are you back?

33:14 SPEAKER_02: That's an interesting question that you ask because the way I look at the brain is the brain is in everybody, whether you have a TBI or not, the brain is always healing or changing, or you know, people go through different experiences throughout their life, depression, anxiety due to life circumstances.

33:32 SPEAKER_02: You know, your brain is always creating new connections and shedding other connections based on what you're exposing it to.

33:40 SPEAKER_02: So to me, recovery, brain change changing like it's it's all part of the same terminology.

33:48 SPEAKER_02: Never changed, it never stops changing, it never stops changing, yeah.

33:53 Michael Mackniak: Yeah, well, and it's interesting because my next the next thing I have written down here on my my checklist to talk to you about is you brought it up in the very outset of our discussion today.

Neuroplasticity And Growing New Brain Cells

34:04 Michael Mackniak: Is what is neuroplasticity?

34:06 Michael Mackniak: What does it mean from the perspective of the the brain and and what what we hear it all the time, and not too many people really understand what it means.

34:16 Michael Mackniak: And we kind of just got into it a little bit there.

34:19 SPEAKER_02: So yeah, so the neuroplasticity essentially is the brain's ability to adapt, rewire, and change.

34:27 SPEAKER_02: So basically, every feeling, you know, physical sensation, experience that we we go through in life and and we repeat, it triggers and builds thousands of neurons in the brain, forming neural networks.

34:45 SPEAKER_02: And the more you repeat any given new learning or task or you know, experience, the stronger those connections in that neural network, and the more neurons that are recruited to that neural network there are.

34:58 SPEAKER_02: So yeah, it's just essentially the the brain's ability to create new pathways and to strengthen those pathways in the brain.

35:08 Michael Mackniak: It's so remarkable and miraculous that that thing inside our heads that that we'd hardly know even a speck about, right?

35:18 Michael Mackniak: In the grand scheme, we don't know much about it at all, but we know that it just has it's just it's it's it's mind-blowing.

35:26 SPEAKER_02: It is mind-blowing.

35:27 SPEAKER_02: I mean, it's crazy to think that 13 years ago, and I would like to think that like brain changes in my organization was a part of this this big shift in medicine and understanding, but the common dogma of thought that was being taught even as medical students was that the the brain is a fixed organ.

35:45 SPEAKER_02: There's no room to create new brain cells, you know, for the brain to reroute to any large extent.

35:50 SPEAKER_02: So, what was being taught was that the brain is a fixed organ.

35:55 SPEAKER_02: What you're born with is what you die with in terms of brain cells, unless you lose some along the way.

36:01 Michael Mackniak: Yeah, I was always taught that too.

36:03 SPEAKER_02: Yeah, so that's that's which is the complete opposite, yeah.

36:06 Michael Mackniak: Oh, okay.

36:07 Michael Mackniak: I know I knew what you were getting at when you're talking about the neurons and the new connectivity, but I didn't know that we could regenerate brain cells.

36:14 Michael Mackniak: I thought that Oh, yes, yes.

36:16 Michael Mackniak: So that old joke about, well, you lost a bunch of brain cells, it's that's that it's factually false.

36:22 SPEAKER_02: Like most that's factually false.

36:24 SPEAKER_02: So there's two parts to neuroplasticity.

36:26 SPEAKER_02: Neuroplasticity, again, is kind of an umbrella term, so it's it it refers to the brain's ability to change, but within that, you have neurogenesis, which is the creation or genesis of new brain cells.

36:40 SPEAKER_02: And one of the main ways that you stimulate neurogenesis is through aerobic exercise.

36:46 SPEAKER_02: Bar none may be one of the biggest elixir for the brain in general, aerobic exercise.

36:51 SPEAKER_02: So by elevating your heart rate to some degree, a brisk walk, a light jog, your your brain actually it produces a protein called brain-derived neurotrophic factor in the hippocampus, which is the memory center of the brain.

37:08 SPEAKER_02: And that protein essentially acts like miracle growth for brain cells.

37:13 SPEAKER_02: It stimulates the production of new brain cells in the memory center of your brain.

The Six Pillars Of Brain Health

37:18 Michael Mackniak: Well, and now, so let's get into that because I know you did not only your studies and your your your you know the your interest, obviously, your life is based around what when what happened in your brain, and you also just had this obvious passion for it before the in before the accident.

37:36 Michael Mackniak: I mean, smart guy, you want to do something, you're gonna go to med school because that's something you're you're passionate about.

37:43 Michael Mackniak: So, you know, but with the brain changes organization, you talk about six pillars of health and exercise, physical exercise being one of them.

37:54 Michael Mackniak: I'm gonna quiz you if you want me to.

37:56 Michael Mackniak: What are the what are the six pillars?

37:58 SPEAKER_02: Do you yeah?

37:59 SPEAKER_02: So I'm I'm I'm looking at this image that we've created at brain changes wheel.

38:05 SPEAKER_02: It's like you know, ingrained in my my brain with all six pillars.

38:09 SPEAKER_02: So, you know, the first one is aerobic exercise, and really any type of exercise has been shown to help.

38:16 SPEAKER_02: Like there's been more and more research on resistance strength training, even anaerobic exercise to create brain changes.

38:23 SPEAKER_02: The most evidence is around aerobic exercise, but resistance strength training, actually, they say that you know, it has some of the research shows it has a lot of the benefits that aerobic exercise has, including the production of brain cells, albeit maybe to a lesser extent.

38:38 SPEAKER_02: But by combining the two, you're you're actually amplifying the effects of neuroplasticity.

38:45 SPEAKER_02: So you do resistance strength and aerobic exercise together, it's even better than each individually.

38:50 SPEAKER_02: The second one is cognitive stimulation.

38:53 SPEAKER_02: So, you know, once you've created those brain cells, then you have to fill them with meaningful information and connect brain cells together.

38:59 SPEAKER_02: And you do that through, you know, reading books.

39:02 SPEAKER_02: Any type of new learning is going to med school.

39:05 SPEAKER_02: Going to med school, yeah.

39:06 SPEAKER_02: Going back to med school after brain.

39:08 SPEAKER_02: Everybody should go to med school if they get in a car accident.

39:11 SPEAKER_02: Yes, yes.

39:12 SPEAKER_02: Um, and but really any type of new learning.

39:16 SPEAKER_02: Yeah.

39:16 SPEAKER_02: Not the same type of learning, not more because again, those grooves are already reinforced in your brain, but it has to be new learning.

39:23 SPEAKER_02: New learning is what stimulates new connections.

39:26 SPEAKER_02: And so the third one is nutrition or brain-healthy diet, and that's to provide your brain with the best building blocks that it would need to thrive and and recover.

39:37 SPEAKER_02: Sleep hygiene, sleep is actually very essential.

39:40 SPEAKER_02: It's the it's part of neuroplasticity.

39:43 SPEAKER_02: It's it's when the brain consolidates information and and actually creates memory.

39:50 SPEAKER_02: So you if if you're not sleeping properly, you can't learn.

39:54 SPEAKER_02: Limiting harmful exposures, and by harmful exposures, again, things like alcohol, smoking, but also maybe the less commonly thought about things.

40:01 SPEAKER_02: You know, we gave the example of pesticides before.

40:03 SPEAKER_02: And then the last one is mindfulness meditation or stress management.

40:08 SPEAKER_02: And basically, what that allows you to do is to filter out distractive thoughts about past or future.

40:15 SPEAKER_02: So in those negative grooves that are already created in your brain, and focusing on the present so your brain can structure new healthy neural connections.

40:26 SPEAKER_02: So those are the six pillars of brain health.

40:29 Michael Mackniak: And is this something that you developed, learned, pinpointed yourself, or has have you gleaned the research from all different areas, or a combination of all the above?

40:40 SPEAKER_02: I'd say it's a combination of all the above.

40:43 SPEAKER_02: I think that organically, even before I started, you know, reading and synthesizing all this information, I was developing my own treatment regimen.

40:52 SPEAKER_02: You know, this is what I gathered and put together.

40:55 SPEAKER_02: But then more and more research has come out now.

40:58 SPEAKER_02: And, you know, there's there's, for example, the six pillars of preventing cognitive decline, which are very, very similar.

41:04 SPEAKER_02: There's the six pillars of longevity, which are very similar.

41:07 SPEAKER_02: So it seems like, you know, this is a common thread.

41:10 SPEAKER_02: It's not just for healing a brain injury.

41:13 SPEAKER_02: These are really the fundamental six pillars of health in general.

41:18 SPEAKER_02: And, you know, the ones for cognitive decline, again, they're very similar.

41:22 SPEAKER_02: They they may use different terminology, like, you know, for they they talk about social interaction.

41:28 SPEAKER_02: We we talk about cognitive stimulation, but social interaction to me is cognitive stimulation.

41:33 SPEAKER_02: Absolutely.

41:34 SPEAKER_02: They talk about stress management, we talk about mindfulness.

41:36 SPEAKER_02: Again, it's very similar.

41:38 Michael Mackniak: Right.

41:38 Michael Mackniak: Now that makes a lot of sense.

41:40 Michael Mackniak: Yeah, and and the way that all those things are so closely related to each other, it just makes sense.

Picking A Starting Point That Fits

41:47 Michael Mackniak: So I think I already know what you're gonna say to this, but what would be the one if you, you know, because this is about care for the caregivers, too, here, this this podcast, and and recognizing the need for willing and and capable people to care for others in our society.

42:05 Michael Mackniak: There's such a need.

42:06 Michael Mackniak: So, what is the one major pillar that you would say if above all else, work on this one pillar?

42:14 SPEAKER_02: So that's a hard question to answer.

42:17 SPEAKER_02: Number one, because I don't believe and like the literature doesn't support that there is any magic pill for healing the brain.

42:27 SPEAKER_02: And we're talking about lifestyle things, so it's not exactly the same as like a magic pill.

42:31 SPEAKER_02: But really, healing up healing a brain is l analogous to creating a garden, right?

42:39 SPEAKER_02: Like you can't grow flowers in a frozen tundra.

42:43 SPEAKER_02: You need all the conditions, you need fertile soil, you need moisture in the air, you need the sunlight.

42:48 SPEAKER_02: You know, if all those conditions don't come together, you're living on Mars and you know, or Canada for that matter.

42:54 SPEAKER_02: Yeah, or Canada, yeah, exactly.

42:56 SPEAKER_02: So, but so that's that's my number that's my first point.

43:02 SPEAKER_02: Of all the to answer your question in like another way, so do what has the most intense and most immediate and you know most noticeable effect on the brain?

43:14 SPEAKER_02: I would probably say it's aerobic exercise.

43:17 SPEAKER_02: But that being said, there are medical conditions and different types of brain injury, because as we know, no brain injury presents the same way that preclude people from performing aerobic exercise.

43:27 SPEAKER_02: You know, one of the main, as we mentioned, cognitive fatigue and and chronic fatigue syndrome, brain injury is a big cause of that.

43:34 SPEAKER_02: And one of the big symptoms of chronic fatigue syndrome and cognitive fatigue is autonomic instability, which means that people have drastic differences in terms of their blood pressure and heart rate when they're, you know, either doing exercise or with position changes.

43:52 SPEAKER_02: So their symptomatology is actually worse with exercise.

43:55 SPEAKER_02: So there's they may not be able to return perform exercise to the same extent.

44:00 SPEAKER_02: Extent that somebody else may be able to, or you know, they may have to perform a different type of exercise than aerobic exercise to tap into those benefits.

44:09 SPEAKER_02: So, you know, one of with chronic fatigue syndrome, one of the exercises that they talk about is supine exercises.

44:16 SPEAKER_02: So exercises when you're laying flat to prevent the autonomic instability when you're upright doing exercise.

44:24 SPEAKER_02: So, yeah, that's a very roundabout way to answer your question, but it's very multifactorial.

44:29 SPEAKER_02: And at the end of the day, everybody is completely different, their situation is completely different, and there is no magic pill to healing the brain.

44:36 Michael Mackniak: Well, no, right.

44:37 Michael Mackniak: And from the caregiver's perspective, not everybody can exercise.

44:41 Michael Mackniak: You know, some people would be super happy to hear that sleep is important because they love to sleep.

44:46 Michael Mackniak: But yeah, I mean, it is definitely it is it is person-dependent or independent.

44:53 Michael Mackniak: You know, it it just there's no set answer for it.

44:56 Michael Mackniak: And I think that that's important.

44:58 Michael Mackniak: But it's also important to know that there are a bunch of different things that we can all do that, you know, seem like they they're almost universal to every part of our our care and our health.

45:09 Michael Mackniak: Absolutely.

45:12 SPEAKER_02: And and and the more of those things you combine and tap into within your limits, the the better, right?

45:19 SPEAKER_02: For your brain and your body.

45:21 Michael Mackniak: Well, my mother likes to do those cryptogram puzzles every morning, and my father says that that's her that's her fending off dementia.

45:29 Michael Mackniak: You know, and that's it.

45:31 Michael Mackniak: I you know, I don't doubt it.

45:32 Michael Mackniak: She she'll spend an hour or two doing those puzzles.

45:35 SPEAKER_02: It's new learning, and you know, there people will argue that point and say, oh, well, there's no there's no evidence to support that Sudoku, you know, create, you know, has any has any impact on preventing cognitive decline.

45:48 SPEAKER_02: And my answer to that is, well, again, any stimulation that you're giving to the brain, anything that you expose yourself to, you're rather your brain is either creating new connections or shedding connections.

45:59 SPEAKER_02: So to me, anything that you feed the brain, any type of new learning is cognitive stimulation and it's going to make brain changes.

46:07 SPEAKER_02: It's impossible for it not to.

Wolves Den Support And Real Community

46:09 Michael Mackniak: Well, and if you go over any of your six pillars, how can any of them hurt?

46:15 Michael Mackniak: They certainly aren't gonna hurt.

46:16 Michael Mackniak: So before we wrap up here, tell me about this wolves den that you created.

46:20 Michael Mackniak: Are you still doing that?

46:22 SPEAKER_02: Yes, we do the wolves den.

46:23 SPEAKER_02: So it's our support group at brain changes, and basically it's you know a forum where people can come and they they have a shared experience with traumatic brain injury, but also we use it as an avenue to present solutions to people.

46:41 SPEAKER_02: So it's completely solutions-based.

46:42 SPEAKER_02: We have experts that come and speak to the wolves then participants, and they share insights around you know their knowledge on some of or you know, individual or all of the pillars of brain health.

46:57 SPEAKER_02: And and yeah, the whole premise is to give people tools to add to their life and to help with recovery.

47:07 Michael Mackniak: Well, and getting back to what I said and what I say all the time about these shared experiences, to go through something and to share what you've gone through may be super helpful for somebody who is going through it now, or somebody when they go through it in the future, they can reflect back upon the lesson that they learned from within this group and within the camaraderie that you're building there, right?

47:30 Michael Mackniak: Absolutely.

47:31 SPEAKER_02: Yeah.

47:32 SPEAKER_02: I mean, I think that recovering as a group is, and again, it goes back to like, you know, one of the main pillars of preventing cognitive decline is social interaction.

47:44 SPEAKER_02: We know the brain does not do it as well if it's not interacting, if if you don't have that camaraderie, if you don't have that support, you know, it's it's beyond, it's it's almost combining two pillars because it's stress management and it's it's cognitive stimulation, right?

48:04 Michael Mackniak: It's it's it's just, I mean, we talked about the the interweavings of the neurons and the synapses in the brain, but everything that we've talked about since then is uh more of an interweaving of daily living, health, from your perspective, health care, from my perspective, caregiving.

48:23 Michael Mackniak: It's all so intertwined that it's almost impossible to separate it.

48:28 SPEAKER_02: So intertwined.

48:29 SPEAKER_02: And honestly, we've we factored that in uh when we do our education.

48:33 SPEAKER_02: So if you look at the brain changes page on Instagram, we have colored dots to represent each individual pillars.

48:40 SPEAKER_02: And you could you could look at the story tabs above our posts and it shows which each color represents.

48:46 SPEAKER_02: And on individual posts, when we're talking about like you know, an intervention or something that could help somebody, we talk about which are or there's a dot on those posts to indicate which pillars, either individually or in combination, yeah, that it's touching on.

49:03 SPEAKER_02: And they're all so interwoven.

49:05 Michael Mackniak: Right.

49:06 Michael Mackniak: And I like us, I was just thinking the same thing.

49:08 Michael Mackniak: Like this must this particular example must touch on four of the six posts, right?

49:14 Michael Mackniak: Exactly, yeah.

49:16 Michael Mackniak: Right.

49:16 Michael Mackniak: Well, listen, man.

49:18 Michael Mackniak: I uh Dr.

49:18 Michael Mackniak: Matt Galati, I really appreciate you being here and bringing so much of this information out to the listeners.

49:25 Michael Mackniak: And I'm really I'm inspired by you as a person and by you, the work you continue to do, and your family is all involved, and you're you're real fortunate in that regard.

49:37 Michael Mackniak: So thanks for being here.

49:39 Michael Mackniak: Thanks for taking.

49:40 Michael Mackniak: I know you know you're a doctor, and and I know that there's emergent situations that are probably banging down your door right now, but thanks for taking an hour or so to talk to me.

49:51 SPEAKER_02: Thanks, Mike.

49:52 SPEAKER_02: I I really appreciate the invite, and it was a pleasure to to talk, and we should do it again.

49:58 Michael Mackniak: Oh, I oh, we will.

49:59 Michael Mackniak: We will.

50:00 Michael Mackniak: Don't careful what you wish for.

50:01 Michael Mackniak: You'll be back.

50:04 Michael Mackniak: Sounds good.

50:09 Michael Mackniak: Well, Dr.

Closing Takeaways And Next Steps

50:10 Michael Mackniak: Matt's story is certainly inspiring.

50:14 Michael Mackniak: It reminds us that we aren't fixed entities.

50:18 Michael Mackniak: We we we're all works in progress.

50:22 Michael Mackniak: You know, whether you're recovering from a physical injury or just trying to clear the fog from your head from the stress of your life, your brain has the capacity to change.

50:33 Michael Mackniak: It's the most magnificent computer on the planet.

50:38 Michael Mackniak: You don't have to have it all figured out today.

50:40 Michael Mackniak: You just have to be willing to start the work and to go through the process.

50:46 Michael Mackniak: Character and brain health is built in small, repetitive choices we make when nobody's watching, right?

50:55 Michael Mackniak: Remember what karma always says.

50:57 Michael Mackniak: Karma will say, I saw that, because karma's always watching.

51:00 Michael Mackniak: And karma wants you to engage in these small repetitive choices that make you a better person.

51:06 Michael Mackniak: It's the exercise, it's the sleep, it's the community that you choose to hang with and lean on.

51:12 Michael Mackniak: So make sure that you check out what brainchanges.org is doing and see how they're funding the future for recovery, particularly around uh brain injury.

51:25 Michael Mackniak: And until next time, keep holding it together, even if it's just kinda.