Posted on Jul 15, 2020

Kelsey Boyer is professional snowboarder and Founder of Save a Brain,Inc. Kelsey has been featured in Snowboarder Magazine, is a sponsored athlete with K2, Giro and Roxy and travels the world both filming her snowboarding feats and helping to inspire other girls and women to take up the sport through her work with Beyond the Boundaries, a company focused on promoting females to get into the mountains through the sport of snowboarding.

Kelsey started snowboarding at the age of 13 and quickly advanced in the sport, first competing at age 16 and one year later, winning the Nike Chosen, which sparked her desire to become a Professional Snowboarder. With this goal in mind, she packed her bags and left her family in Pennsylvania to pursue a snowboarding career in Utah. She became a sponsored athlete at age 18. However, in 2016 Kelsey suffered a traumatic brain injury that required brain surgery, which was thought to sideline her from snowboarding for the rest of her life not to mention from being a normal human being. However, after four years of therapy and struggle, Kelsey returned to the sport and regained her professional status with a new goal in mind.

Kelsey is now focused on helping others gain the education and financial support to heal from their brain injury through her non-profit foundation, Save A Brain,Inc.

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Transcript:

Dr. Tim:                      Hey, welcome everybody. This is Dr. Tim Speicher. You're with us at The in with Dr. Tim. We provide a podcast to provide you cutting edge topics and health and performance, and we are so fortunate here tonight to have Miss Kelsey Boyer. Kelsey Boyer’s a professional snowboarder and founder of Save A Brain, Incorporated. Kelsey has been featured in Snowboarder magazine, is a sponsored athlete with K2, Giro, and travels the world, both filming her snowboarding feats and helping to inspire other girls and women to take up the sport through her work with Beyond the Boundaries, a company focused on promoting females to get into the mountains through the sport of snowboarding.

 

                                    Kelsey started snowboarding at the age of 13 and quickly advanced in the sport, first competing at age 16, and one year later winning the Nike Chosen which sparked her desire to become a professional snowboarder. With this going on, she packed her bags and left her family in Pennsylvania to pursue a snowboarding career in Utah. She became a sponsored athlete at age 18. However, in 2016, Kelsey suffered a traumatic brain injury that required brain surgery, which was thought to sideline her from snowboarding for the rest of her life, not to mention from being a normal human being.

 

                                    However, after four years of therapy and struggle, Kelsey returned to the sport and regained her professional status with a new goal in mind. Kelsey’s now focused on helping others gain the education and financial sport to heal from their brain injury through her non-profit foundation, Save A Brain, Incorporated. So, Kelsey, thanks so much for being here tonight. I think your story is very powerful and could potentially help really just thousands and thousands of individuals struggling with a similar thing that you went through. And so, maybe you can just maybe start off with telling us about your story and what happened and how you got here.

 

Kelsey:                        Well, thanks for having me on here. It’s new that I’m starting to tell the story because I’m just like, “You know what? We need to start talking about this.” But basically, how I got here… was… through my brain injury. My whole career just kinda shifted really quick; had my brain surgery, and next thing I knew, was kinda just living this different life.

 

Dr. Tim:                      Well, lemme ask you, Kels, how did it happen? Do you even remember? What were you doing at the time when it occurred?

                                   

Kelsey:                        It was a heavy competing season. People were trying to start hooking up points for the 2018 Olympics. So, you start two years in advance, so I had pretty much back to back to back contests. And I started my year out in January in Canada, and I knocked myself out cold in that contest.

 

Dr. Tim:                      Were you on slopestyle, halfpipes?

 

Kelsey:                        Yep, yep. I was doing slopestyle… so yeah, jumps and rails and that. Basically, my whole season after that knockout consisted of me [inaudible] [00:003:30] air a lot, I remember. I was learning how to fix it because it was so new, and I probably hit my head like eight more times within a two-month period… pretty

 

[Crosstalk]

 

Dr. Tim:                      You sound like you were trying for Shaun White.

                                   

Kelsey:                        – bad. I don’t know what I was thinking. I don’t know –

 

[Crosstalk]

 

Dr. Tim:                      Lemme ask you this, Kelsey. Is it pretty common for snowboarders at your level to be hitting their head on a regular basis as they're training?

 

Kelsey:                        Oh, yeah. I think that’s kinda the hidden injury with the whole action sports industry is just, we fall all the time and you can sustain concussions through hitting your head, hitting your butt, whiplash, and it’s probably our – that and ACL are probably our No. 1 injuries… for sure.

 

Dr. Tim:                      Were you wearing a helmet at the time?

                                   

Kelsey:                        I was. Probably should have had a new one...  because most of them are meant for one impact only and this one went with me through all of them. So, I probably should have had a new one but I just kept wearing the same old one.

 

[Crosstalk]

 

Dr. Tim:                      Sure, and that’s, I guess, a really good point that you just brought up that – so you're in action sports, or even you're just snowboarding or skiing at the resort, you bang your head on a rail or even on the snow, and from my understanding, and I think you understand this too, that your brain can actually get shaken inside your head. It doesn’t even have to hit anything. Like what you said, you can fall on your butt, and then your head shakes and your brain moves inside your skull, and then you get a concussion. But with that being said, I know that there's individuals out there who have probably hit their head once or twice, even the kids in the park trying to kinda do your tricks and model you, right?

 

                                    They may not know this. They should probably have a new helmet, right?

 

Kelsey:                        For sure. And that’s definitely something that – I don’t know. You read it and you know about it but you just, “You know, it’s fine. It’s fine. Everything’s fine.” And then, before you know it, everything is not fine. And I don’t know. They have all those protocols for helmets for a reason, so it’s serious.

 

Dr. Tim:                      Do you remember what type of trick you were trying to pull off?

                                   

Kelsey:                        Honestly, I think… the one that really – so, basically what happened was after probably like eight concussions in two months, one of them, when I fell, it was a really bad one. I literally just think I was just doing an easy trick, a safety trick… on the last jump… and I –

 

Dr. Tim:                      But Kelsey, can I stop you [inaudible] [00:06:28] – Crosstalk] because I just heard something kinda crazy?

 

Kelsey:                        – oh, yeah. Yeah.

 

Dr. Tim:                      So, before the concussion, right, you had had, you think, up to eight prior to your big one? Is that correct?

                                   

Kelsey:                        Yeah, probably.

 

Dr. Tim:                      Okay. Okay, so… keep going.

 

Kelsey:                        It was a lot. I just kept pushing myself and falling because clearly something – my equilibrium was so off because I kept just falling, spinning in the air on spins that I was doing all the time. So, it didn’t make sense to me, but I just kept pushing, kind of ignored it, and then I fell really bad, caught my toe edge of my snowboard on the ground, hit face-first. My googles exploded. It was pretty bad but I got up anyway… and I –

 

[Crosstalk]

Dr. Tim:                      Were you going pretty fast or were you…?

                                   

Kelsey:                        – oh, yeah, I was going pretty –

 

Dr. Tim:                      What would you estimate?

 

Kelsey:                        You're fast because the last jump of a slopestyle course is usually always the biggest and you have to clear it or you're gonna hit that knuckle and you're gonna get hurt. And so, I was going pretty fast into it and it was maybe a 50 to 60-foot jump. So, not too big but big enough.

 

Dr. Tim:                      Well, for some of us, 50, 60 feet is quite high. I’m more of a two-footer, that’s – but I’m old. I’m trying to preserve my body.

                                   

Kelsey:                        I look back on it and I’m like, “That was just – those are just too big.” But so, I was going pretty fast into it… just tipped over mid-spin, and just pretty much slammed straight down with my body and my head. So, there’s a lot of acceleration and velocity in that.

 

Dr. Tim:                      Sure.

 

Kelsey:                        But then, I remember I picked myself up, got back on the chairlift and was like, “I have to take my second run,” and clearly was shook. And I kinda had this weird ringing in my ears and my head and I just had this weird gut feeling and almost voice that was like, “Your brain is bleeding.” Like, it told me. And I rushed right to ski patrol and they were like, “You're fine. You're just concussed.” And I was like, “Okay,” but then I couldn’t even stand. So, they hooked me up to oxygen, went down to ski patrol again, and they said, “You're fine. You're just concussed.” So, two weeks goes past. I go to maybe four – three to four other doctors, everybody tells me I’m fine –

 

[Crosstalk]

 

Dr. Tim:                      Well, lemme ask you this, Kelsey, because you finished that day. So, what were you feeling that really kinda promoted you to seek help to – from other healthcare professionals beyond the ski patrollers?

                                   

Kelsey:                        It honestly was everybody around me was telling me that I wasn’t okay and that were kind of forcing me, taking me to these doctors.

 

Dr. Tim:                      What did they notice?

Kelsey:                        Because they were like, “You're just not acting right. Something seems wrong,” and I was having pretty aggressive headaches where I was taking a lot of Ibuprofen to even just exist… for the day. So, I went to a few doctors. Everybody was still like, “It’s post-concussion syndrome. That’s normal. Your head’s gonna hurt.” So, I kept snowboarding because everybody was saying I was fine. So, I took two weeks off, went on a filming trip in Jackson Hole, Wyoming… and –

 

[Crosstalk]

 

Dr. Tim:                      Now, Kelsey, can I stop you for just one second? [inaudible] [00:10:31] – Crosstalk] because –

                                   

Kelsey:                        – oh, yeah. Yeah, please, please.  

 

Dr. Tim:                      – I wanna make sure that our listeners know something [inaudible].

 

Kelsey:                        Totally.

 

Dr. Tim:                      Because I’m a medical professional, AT by trade and training –

                                   

Kelsey:                        Sure.

 

Dr. Tim:                      – and ATs are some of the highest trained individuals, at least mid-level care providers in concussion. Well, I just wanna let everybody know that’s not normal, everybody. Okay? And 2016 is not too far from now. We know that post-concussion syndrome is a very serious deal. Most individuals who have had a concussion, okay, and their brain’s not healed yet and then they get hit again and they have post-concussion syndrome, they stand a huge chance of dying or being a vegetable. Right? So, it’s a big deal. And unfortunately, what I’m hearing from Kelsey is that she probably ran across from healthcare providers that just weren’t really that clued into how significant of an issue this was.

 

                                    And so, just to let everyone know that if any provider says that to you, you should really then seek additional help from someone. Maybe an AT, maybe a physician, someone who’s really schooled in concussion management, diagnosis and treatment. Thank you, Kelsey. I just wanted to make sure everybody knew that that wasn’t normal.

 

Kelsey:                        No, that’s good. This is good. No, and that’s the thing. It’s like I kinda went a full, different rogue route, so it’s – that’s good that you say that kind of stuff. I dunno. Where was I –?

 

[Crosstalk]

 

Dr. Tim:                      You were shopping around, I guess, for help, that’s what it sounds like. But you couldn’t get any help. You knew something was wrong with you, but everybody’s telling you there's nothing wrong with you. They said you had a concussion but…

                                   

Kelsey:                        Everybody’s, “You're fine. You're fine,” and you hear that from a handful of doctors, so you're like, “I’m fine” –

 

Dr. Tim:                      Lemme ask you, did they ever do any neurocognitive testing or run you through balance testing or do anything?

 

Kelsey:                        No.

 

Dr. Tim:                      Wow. Man, that’s like the first [inaudible] [00:12:37] – Crosstalk] thing –

           

Kelsey:                        No. No.

 

Dr. Tim:                      – that you gotta do. There’s even [audio cuts out] [00:12:40] – Crosstalk] called –

 

Kelsey:                        For sure.

 

Dr. Tim:                      – the SCAT-5 and standard concussion assessments. So –

                                   

Kelsey:                        Totally.

 

Dr. Tim:                      – that’s mind-blowing to me as a professional who deals with this on a regular basis. Wow.

 

Kelsey:                        I don’t know. And all my friends that were going with me and taking them were like, “Check her head, check her head” and they just kept saying, “She’s fine. It’s just post-concussion syndrome. It’s normal to have head pain after a bad concussion,” and I was like – it was throbbing. I was just like, “I don’t know.” And I honestly don’t remember most of the appointments either –

 

Dr. Tim:                      So, definitely memory loss there, for sure.

                                   

Kelsey:                        Totally, and after they – I don’t know. Now that we bring it up, kinda leading up to where everybody told me I was fine, I’m back on the road. “Gotta keep going, gotta keep filming. It’s still winter. Gotta push through.” And as we’re filming – so, now, this is two weeks after that one head slam that was pretty good, and I don’t remember those two weeks at all really.

 

Dr. Tim:                      Wow.

 

Kelsey:                        Very foggy, and I was driving cars and doing things but I don’t remember because that was basically after Wyoming, after we filmed. Everybody I was with was like, “You're not okay.” Like I was gagging a lot out of nowhere which – and I had zero appetite, nothing… and –

 

Dr. Tim:                      So, those of you out there wondering “Why was Kelsey gagging?” Okay, well, when there's pressure placed on cranial nerves, okay, particularly the glossopharyngeal nerve, which is basically just your throat nerve, and sometimes a few others as well, that’s likely why she was gagging. She was – had a lot pressure, a lot of fluid on her cranial nerves, the nerves inside your head. So –

                                   

Kelsey:                        I love that.

 

Dr. Tim:                      – did doctors ever say anything about that, did they – like, “Why are you gagging?”

 

Kelsey:                        It kinda happened after. I basically got the clear from a handful of doctors. They just said, “It was post-concussion syndrome. You're fine. Just take time off.” And that’s when it started progressively getting worse and worse.

 

Dr. Tim:                      Have you ever thought about, Kelsey, why maybe they – I don’t know. I don’t know. Do you think they maybe thought, “Well, hey, this is a professional athlete and she’s gonna deal with it” or do you think they just – I don’t know. Have you reflected on that at all; why didn’t they give you the right assessment, treatment care? Have you processed that at all?

                                   

Kelsey:                        I do think about it a lot. I feel like I honestly don’t go or trust doctors that often anymore because of the situation… because I just feel like I was never heard. I literally told them, “Something is wrong. I know something is wrong,” but by the books they were like, “You fit under this category,” and I was like, “Okay but –” I’m just like, we know our bodies –

 

Dr. Tim:                      Right.

 

Kelsey:                        – better than anyone and –

 

Dr. Tim:                      Definitely pro-athletes, for sure. And I think most patients and most individuals do, Kelsey. Because I just had this conversation with one of my patients today, and she said the same thing. She’s like, “They're not listening to me. They're not hearing me. I know something was wrong with me and they came up with another diagnosis and they kind of brushed me off.” And I just said to them, I said, “In expertise research,” right, “we know that what happens is that when you go to the doctor, you go to anybody, clinician, therapist, whatever, sometimes they don’t hear you because they’ve already kind of created a story inside their head.”

                                   

Kelsey:                        For sure. That’s the best way to put it. It was just like someone created the story for me, that’s what it was, and there was nothing else. And then you believe it. After a while, you believe their story… because you don’t know. You're trusting these people. And it's kinda sad because you're just – I don’t know. That’s kinda what really turns me away from healthcare and a lot of athletes, I think, is it’s hard to find someone that you can trust, that has your best interest. And I definitely do look back on it and I’m like, “Do they know – they have no idea that they almost killed me?”

 

Dr. Tim:                      You very well could have died, for sure.

 

Kelsey:                        I seriously think about that all the time. I’m just like, “These people have no idea that what they said that day almost ended my life.” If I wouldn’t have finally just walked –” I walked into the emergency room after two weeks and was like, “I need a CAT scan” and [inaudible] [00:17:51] – Crosstalk]

 

Dr. Tim:                      What prompted you to go to the –

                                   

Kelsey:                        – oh, go ahead.

 

Dr. Tim:                      – emergency room? I’m just curious.

 

Kelsey:                        What led me to go in there?

 

Dr. Tim:                      What prompted you? Yeah because you had – a story had been created for you had multiple people telling you the same story… and you're kinda believing it, but then, all of a sudden, you end up in the emergency room. So, what finally clicked for you that took you to the emergency room?

                                   

Kelsey:                        I’d say the two weeks of, after that head hit, everybody around me – I was with the same people – were just like, “You're not okay. You're acting weird.” And then when I started gagging, I finally was like, “Something’s not right. This isn't okay.” So, we drove eight hours back, and my roommate at the time, her name was Micah, and she was just like, “That’s it. Get in the passenger side of the car. I’m driving you to the emergency room right now. Something is wrong.” And I was fighting her about it. But she basically saved my life because if I didn’t go into the ER that night, they were just like, “We don’t think you would have survived another night.”

 

Dr. Tim:                      Wow. Wow. That’s a good friend.

 

Kelsey:                        Oh, straight up. I’m like, “Oh my gosh, thank you for forcing me.” And that's the biggest thing, I’m just like people have your best interest and – that love and care about you, and at some point, you just gotta go for it. Because I did not wanna go in there, but – and even then, when we went into the ER, the nurse was just like – she literally said the same thing. She was like, “It seems like post-concussion syndrome,” and then she’s like, “but just in case, we’ll take a CAT scan just to check.”

 

Dr. Tim:                      What’d they find?

                                   

Kelsey:                        So, they found that – she came back in and her face was – I could tell something was wrong. But she said, “This is a miracle. We don’t know how you're alive. Your brain has shifted 11 millimeters.”

 

Dr. Tim:                      Wow.

 

Kelsey:                        So, basically my head was just – my brain was bleeding for two weeks, and I was still just living a normal life, snowboarding, driving, everything, and just like you said, became so much pressure that my body was then just gagging as a reflex. And next thing that I knew, she was giving me an apron was like, “You have to go –” I was in Colorado at the time and she was like, “You need to go down to Denver for immediate brain surgery,” and I was just in an ambulance and just off I went.

 

Dr. Tim:                      Wow. So, I’m assuming they probably cut skull then or drilled some holes in it to let some pressure out. Is that what happened?

Kelsey:                        Yeah. I was diagnosed with a subdural hematoma, but because I was bleeding for two weeks they didn’t know if – so, basically, they drilled a hole in my skull and put tubes in it and were trying to drain the blood. And then the next surgery was cutting out a chunk of the skull to scrape some of the dry blood out, and then they just stitched everything and stapled everything back up. And –

 

Dr. Tim:                      Wow.

 

Kelsey:                        – luckily surgery went very smooth, but I just – it’s all kind of like a blur because obviously they were like, “This is a problem,” so they were just trying to get me to just relax and almost like sedate me so I’m not talking as much. And they flew in one of the top three brain surgeons, I think it was, to come work on me, so I had to wait like 24 hours to – for him to arrive… but –

 

Dr. Tim:                      That must have been nerve-racking for you? Were –

                                   

Kelsey:                        Yeah.

 

Dr. Tim:                      – you cognizant of the situation you were under? People were operating on your brain.

 

Kelsey:                        I was terrified. My family lives across the country in Pennsylvania, so I pretty much was on my own besides my friends. And it didn’t seem real almost. They of course gave me so much drugs that I don’t remember the ambulance ride, and I came to, I’ll never forget it, in the MRI machine. And I remember I woke up, of course, I’m freaking out, and they're like, “Kelsey, you have six more minutes. Just lay – just relax. You're okay.” And then, it’s kinda like all a blur because of all of the drugs that they were giving me. But I remember just being terrified when, at one point, I remember the brain surgeon coming in and he has papers.

 

                                    So, I have to sign these papers, and he’s telling my roommate Micah – and she’s signing my life away because my parents aren’t there, so she’s like my guardian at this point. And he’s just like, “She could wake up not knowing how to talk, how to walk, not knowing who you are.” And I remember just hearing all of that and I was like, “Holy crap. I –”

 

[Crosstalk]

 

Dr. Tim:                      You might not come back.

                                   

Kelsey:                        – and it’s like you die if you don’t get it, or you take a risk by trying to get the surgery. So, it’s kinda like you have no choice almost but to just trust them and give it a go.

 

Dr. Tim:                      Well, I do wanna mention something that Kelsey kind of highlighted. Athletes are pretty darn good at hiding – not hiding, that’s not the right word. Athletes kind of present a little differently with concussion most often because they're really good at adapting to their injuries, to what’s going on around them. And they are able to switch different kind of functions in their brain and also bodies to kind of make up for other problems and that’s probably maybe some of why – and I’m just hypothesizing here but maybe why you didn’t really present like you're really bad but you really were.

 

Kelsey:                        For sure. No, what you said is on point. It’s just like, you get an injury, you adapt, you keep going. Nothing is gonna hold you back from “Just keep going” and –

 

Dr. Tim:                      [Inaudible] [00:24:55] – Crosstalk] very apropos there's an ambulance in the background going by you right now.

                                     

Kelsey:                        – oh, there is.

 

Dr. Tim:                      Everyone, that was not planned.

 

Kelsey:                        It’s a sign.

 

Dr. Tim:                      Maybe so. All right. From my understanding, Kelsey, too you had this immense, I guess, struggle to even get appropriate assessment and care. But it didn’t end there, did it?

                                   

Kelsey:                        No.

 

Dr. Tim:                      That struggle didn’t end there.

 

Kelsey:                        Sadly, no.

 

Dr. Tim:                      What happened after your surgery?

                                   

Kelsey:                        So, after my surgery, I was in the ICU for a bit just having to pass walking, talking cognitive functioning test basically. And then, I moved up to the recovery floor, was there for a minute as well. Pretty much they released me and just said, “Okay, you're good to go. Come back in a couple of weeks to get the staples out and for a follow-up.” And basically, after that too they didn’t tell me anything. They just released me and were like –

 

Dr. Tim:                      Did you feel like you were good to go at that point? You just had your brain surgery and skull cut open and – did you feel like you were good to go?

 

Kelsey:                        Now that I look back on it, I think they were so casual about it that I was so casual about it. I was like, “I’m good to go. I had brain surgery. They said I’m cleared,” as if it was like an ACL, and it wasn’t the case at all. Little did I know that – there were things that they told me that I was like – I couldn’t have caffeine or sugar for, I wanna say like nine months, I think it was.

 

Dr. Tim:                      Bet you lost weight.

                                   

Kelsey:                        Honestly, it was probably the healthiest I’ve been. And I also couldn’t look at screens. So, all I literally did healing was sleep and coloring books; anything books, like crosswords and – but even that would become too much, at some point.

 

Dr. Tim:                      And, everyone, the post management of concussion – post-concussion syndrome, of brain surgery like this is now vastly different. It should be. It should have probably been in 2016 as well, but it wasn’t for Kelsey and it didn’t end there.

 

Kelsey:                        No. They didn’t tell me too much; how to – normal, standard packet of things to follow for a little bit. “Follow them.” Still couldn’t really work out or elevate my blood pressure a lot, or heart rate because it would hurt my brain. But after I followed all of that, went to my follow-up appointment, they said, “Everything looks fine,” took the staples out of my head and were like, “Okay. You're cleared.” And I was all of a sudden just cleared a few months after my brain surgery to snowboard. And never did any cognitive testing or anything like that. All the doctors were just like, “Yeah, you're fine.”

 

Dr. Tim:                      “You look good. You look fit.”

                                   

Kelsey:                        Literally, that was it. They were just like, “You look healthy. You look great. Scar’s healing fine. Have a good time” type thing. I just had the weirdest experience, I feel like. Everybody was just so mellow about this brain surgery, which makes you think, “Oh, this is standard. This is mellow. This is normal,” but it’s not at all.

 

[Crosstalk]

Dr. Tim:                      No, [inaudible] [00:28:58] not normal to have your cranium scraped and holes drilled in your skull and chunks of your skull taken out.

 

Kelsey:                        They treated it like it was a broken arm.

 

Dr. Tim:                      Okay. Great. And did you try to snowboard at two months then?

                                   

Kelsey:                        I did. I went – yeah.

 

[Crosstalk]

 

Dr. Tim:                      You did. And what happened? Was it like it was, the old days or – what occurred?

 

Kelsey:                        Honestly, it was. It kinda came back like riding a bike, for a bit. Some things were different. I couldn’t remember how to do some tricks. And after kind of a couple of weeks, I – it was getting worse. My memory was getting worse. I was having really bad PTSD on my snowboard, where every time I fell I would think that my brain was bleeding, and that was a-whole-nother, “What’s going on? Why does my head hurt when I fall almost?” And I kept going back to doctors and they just kept saying everything was still fine. So, they just said every brain injury is different, which I understand that it is, so they don't know what exactly is gonna be the outcome for everyone. But for me, mine just got progressively worse as the months went past.

 

Dr. Tim:                      In what way?

                                   

Kelsey:                        The worst thing were my mood swings. I’m a pretty positive, happy person and I never experienced anything like them. Something would trigger them, and I would almost just go red and I wouldn’t remember what I was angry about or yelling about, and I would snap out of it, and I would just start crying because I was like, “This is not me. This is not who I am.” So, that was the worst of it. But then, on top of that, as the months went past, my cognitive function went down. Like, I was slurring. It was really hard to – the process of talking, thinking of words and trying to do it at a normal pace was hard. My sleeping was pretty much non-existent. I was probably sleeping like – I was lucky if it was like three hours a night. And then, my eyes. It hurt to move my eyes, pretty bad.

 

Dr. Tim:                      And all of those, everyone, the functions she’s talking about that got impacted are heavily impacted by cranial nerves. And so, even though Kelsey’s pressure had been taken off, her nerves had not healed and were still shaken. And so, some of these post-concussive syndrome effects that she’s talking about can be pretty severe. And they can affect your emotions, and many people get violent; not only depressed but they also get violent. And we have to kind of keep that in mind. Some people even act like they're drunk. But they're not. They have a brain injury.

 

Kelsey:                        Now that I look back on it – I think about it a lot – and it’s definitely just impacted me and I’m – it’s so real.

 

Dr. Tim:                      But you're recovered now for the most part, I understand. How did that happen? Because I think I remember us talking about that you even had a hard time searching out and finding people to help you with concussion-based rehab, which is mind-boggling for me because that’s what – we specialize in that here at the institute. And there's other institutions around there that do, and they're all across the nation. But you seem not to be able to find anybody, so what – why was that, Kelsey, now that you look back on it? Tell us about that.

 

Kelsey:                        It’s definitely been a journey trying to find help the whole time. I don’t know what it was. It was kinda just like I didn’t know who to turn to, so I tried some psychiatrist to maybe help with the emotional effects. That didn’t work out. They basically just told me, “You should be done snowboarding and move on,” and I was like, “This is not it.” And so, I kept trying to seek out help, kept trying to seek out help, still couldn’t find any, which like you said – it's baffling to me how I couldn’t find any help. And I think it’s a process; it’s a process to try to get in with a neurologist, and they don’t make it easy. They make it hard. It takes months to get in with one, so I think it just turns you away from wanting to almost.

 

Dr. Tim:                      You said “hard”. I’m curious about that. Obviously, lots of people are busy, and they're specialists and so forth, but did you experience barriers? Did you feel like somebody was putting a – some barriers in front of you to getting appropriate care? It’s kind of what I’m hearing. I’m just curious what – in your perception, what were those barriers that made it hard?

 

Kelsey:                        For me, it just didn’t seem like they cared. I would tell them all these issues that I was having, and they wouldn’t have an answer to it, so they didn’t really know what to do with me, I think. And I kinda just was like, “You know what? If I can’t rely on these doctors, then I’m gonna try to do the best that I can and heal myself.” So, I started doing yoga and meditating to help with the whole emotional mood swings and I changed my diet a lot, just eating good foods for the brain, and that seemed to kinda start the direction of my healing, I wanna say.

 

Dr. Tim:                      Did it seem to help with the emotional aspect of things for you?

                                   

Kelsey:                        Oh, yeah. Yeah. It was pretty much like night and day as soon as I started doing that. But then, yeah, it’s like I’d still get the mood swings here and there and I would kinda cry for like two hours and I was like this is, “This is – okay, this isn't healed. I need actual help. I’ve everything I can on my own but I need professional help.”

 

Dr. Tim:                      Think about this just for a quick second, right? She has nothing really to cry about for two hours. She’s a professional snowboarder, you get flown all over the world, and people pay her money. And you’re getting free [inaudible] [00:36:27] and snowboards and so it’s [inaudible]. Right.

 

[Crosstalk]

 

Kelsey:                        For sure.

 

Dr. Tim:                      So, you knew you still were not where you needed to be?

                                   

Kelsey:                        No. No. So, it’s been in March. It was four years since my brain surgery and it took me three years of searching and trying to do things on my own to finally seek professional help that cured my –all of the symptoms I was living with.

 

Dr. Tim:                      And my understanding is that you somehow stumbled across a cognitive rehab center here in Utah and – how’d you find them? Was it via the internet or just talking to other people? How did that happen for you, that miraculous sort of find?

 

Kelsey:                        I was pretty silent. Of course, I dropped the sponsors that I was with and was like, “You know what? I’m done competing. I’m just gonna snowboard for myself. I don’t want that external pressure there.” And I kind of opened up about my injury on just social media platforms and people were reaching out to me. And another snowboarder, she went to this clinic. And she’s from Australia and goes to the – comes to the States a lot but she heard about it. She went there and recommended it, and so I was like, “You know what? I have nothing to lose. I need help.”

 

Dr. Tim:                      I know of this clinic because actually we, at times, collaborate together on concussion cases. And as you mentioned before how an athlete or how an individual handles their brain injury is very, very, very different. The brain doesn’t always play by the rules. However, they really heavily focus on kinda reorienting your neurons and your brain and kind of really getting things functioning again from a cognitive aspect. We, on our side, we work on more of the pain, the neuroactivity and kinda getting things aligned and calming the neurologic system. So, it’s interesting to me that these places are not more well known. Why do you think that is?

                                   

Kelsey:                        The only thing that I have come up with to – because I’m like, not only are they not known, very popular, but they're also not covered by health insurance, and if they are, it’s little to none. I could be wrong, but I just think it’s because it’s – they're new treatments and they're outside of the scope of medicine that’s on health insurances. I could be wrong but that’s what I can come –

 

[Crosstalk]

 

Dr. Tim:                      No, you're not wrong. It’s true, many of the therapies we do here, somatic-based therapy, [inaudible] [00:39:51] therapy, whatever it might be, a lot of insurances won’t pay for it. They don’t recognize it. They're just not there yet.

 

Kelsey:                        That’s what I gathered.

 

Dr. Tim:                      So, you had your therapy. You didn’t have it here, which I just wanna point out to everybody. I didn’t know Kelsey at this time, but sure wish I had; would love to have helped her along with the clinic that she got help from. How long did you go for therapy and what did it kinda involve that really helped bring you back?

                                   

Kelsey:                        I went for one week which –

 

Dr. Tim:                      One week, that’s it? One week?

 

[Crosstalk]

 

Kelsey:                        – seems – yeah, seems bizarre –

 

[Crosstalk]

Dr. Tim:                      After four years?

                                   

Kelsey:                        – after four years. I went for a one-week treatment that – they take a functional MRI of your brain and they see where your brain is lacking oxygen and blood flow, which could be causing a lot of the issues. They found in mine that my brain was not functioning as a normal brain, obviously. I wanna say my amygdala wasn’t firing a lot, which is why my eyes hurt to move because it was pulling from my occipital lobe, a lot of – the brain, as you know, finds new pathways to navigate and mine just found new ones that were not the correct way, so they –

 

Dr. Tim:                      Did you play computer games and did you – what did they have you do that helped kind of reorient your amygdala and occipital lobe, I guess?

 

Kelsey:                        Now that I look at it, I’m like, “Wow, I can’t believe that all worked.” But it was basically a lot of physical therapy, like balance and we did – they do cardio sessions because obviously exercise and the brain. I did a lot of frustrating games throughout the day where – it would be memory games. They would give me 20 cards and I would have to make a story with them, and the next day when I came in, I had to say the story with the cards in that order. And just a lot occupational therapy…

 

Dr. Tim:                      It sounds like they were giving a workout for your brain?

                                   

Kelsey:                        Yeah, 100%. My brain has never worked – in all of my school, high school and college career, I feel like my brain had never worked as hard as it did in this one week. You're pulling like 8:00 to 6:00 of brain workouts.

 

Dr. Tim:                      And just so everyone knows out there, it’s a very standard kind of therapy that is done. We do it here as well. It’s ocular, motor, and vestibular training, really trying to reorient the brain to vision – sort of vision tasks but also balance tasks, hearing tasks and so forth. This particular clinic definitely was doing a little more computer-based, functional MRI, really trying to tap into where her deficiencies were. But it’s amazing, just in one week of therapy, she was able to turn herself around in four years. Now, with that, how has this brain injury, I guess, to this point affected your life? And maybe you can speak to this new goal that you have in helping others with that – the way it’s affected you?

 

Kelsey:                        Totally. My brain injury has affected me in ways that I never thought it would. My life was basically put on hold for four years. I was living with all of these issues that it was hard to even live a life – a fulfilled life. And that led me to create Save A Brain because, after four years, I’m just like, I don’t want people to ever have to go through that and the more – like I said, the more I talked about it, the more people were reaching out and were like, “I’m dealing with this. I don’t know where to go. I’m having concussion issues. What do I do?” And it’s just like, you see everybody coming to you and you’re like, “I have to do something. This, it’s not okay.”

 

Dr. Tim:                      Well, tell us this – is it a foundation, a company, Save A Brain? What is it? And then, maybe what's the purpose of it, I guess? How do you see it helping people?

                                   

Kelsey:                        Save A Brain, it’s a 501(c)(3) non-profit organization, and our mission is to spread awareness of the long-term mental and physical effects caused by traumatic brain injuries and concussions. Along with providing education, we aim to connect individuals to treatment centers and provide financial support, so they have the opportunity to heal and treat their brains to continue living that fulfilled life and –

 

Dr. Tim:                      That is awesome. Well, you mentioned before, for some people, they may not be able to afford the care that’s gonna heal them.

 

Kelsey:                        Totally. I feel like that’s – people affording the care is what’s wrong, in my opinion, with the whole stigma of brain injuries. It’s like people have a brain injury and they think that this is their new normal, but little to they know that there’s treatment out there but unfortunately it costs a lot of money; like my treatment was $10,000. And I was lucky enough to get a grant for that from another non-profit.

 

Dr. Tim:                      Kelsey, I should go back to a clinic like that. I am –

                                   

Kelsey:                        Seriously. No.

 

Dr. Tim:                      joking. But seriously, we provide concussion-based treatment here, however, we also charge money for it. Not $10,000, of course.

 

Kelsey:                        Well, the $10,000. I think it’s just so sad that people have to live this life that they're not happy with if there are resources out there that can maybe help them, and all because of money; all because our health insurance won’t cover it.

 

Dr. Tim:                      Well, it’s a general theme that obviously has been coming up in politics and all across the media that we do have a serious problem with our healthcare system. What the solution is that’s going to allow individuals to receive the care that they need both to survive but also thrive, that’s the great enigma that we’re under right now. And your foundation, I’m just so excited about, thrilled about because I know those individuals. I have several of my patients who could not go get care from that particular clinic and others because they just didn’t have the money.

 

                                    And now, we can at least refer them to Save A Brain so they can become educated about what's out there, but also potentially to benefit like you did from a grant or some financial assistance so that they can live a full life and return to sport or return to life in general like you did.

 

                                   

Kelsey:                        And that’s our goal, is just – I don’t know. I’ve learned personally that’s it’s like we literally only get one brain, so we need to take care of it. And three million traumatic brain injuries happen a year, and yet we have no education for how to even treat a concussion, which is crazy to me.

 

Dr. Tim:                      Right. Well, concussion has become kind of a spotlight over the last probably, I would say, 10 years, particularly in the field of sports medicine. We are starting to get a grasp on how best to approach not only evaluation but also the management and treatment and rehab of these vital injuries that are happening to individuals of all ages. And they're even more significant for the young. And that’s something I see. I don’t know if you’ve seen this, Kelsey, as a snowboarder, as a advocate in the sport for women and so forth, but when – I’m a ski patroller, and when I’m at ski patrol, I see a lot of young individuals not wearing helmets.

 

                                    And I don’t know if they just think – they may be able to afford it, but I’m wondering if – why is it they're not wearing helmets. Is it because they just wanna look cool or they wanna look like an action star? I can’t get my head wrapped around that and – have you seen that? Have you noticed that among the young? Because getting a concussion when you're young is even more traumatic than when you get one as an adult.

 

Kelsey:                        That's one of the biggest things in the action sports industry that I think Save A Brain can change, is the stigma around helmets. Like you said, it’s like children look up to the professionals yet the professionals only where a helmet when it’s required and –

 

Dr. Tim:                      Why do you think that is? Because they're pros; they obviously wanna keep doing what they're doing.

                                   

Kelsey:                        Like you said, I think athletes just don’t – at one point, it just became not cool to wear a helmet. It doesn’t look cool. And then, people feel weird and then feel bulky and they can’t find a good fit, or like you said, they're expensive. But I feel like people just don’t feel comfortable in them. They think that they look funny. It’s kind of like an ego-driven thing, I feel like, and I’m like this is – we gotta cut it out.

 

Dr. Tim:                      So, beyond the education and beyond the money, it sounds to me too that we’ve got sort of a task of changing the culture about wearing a helmet in snow sports?

 

Kelsey:                        For sure. Obviously, we’re starting with snow sports because that’s just where we are but we’re kinda reaching out to all action sports right now because, yeah, it’s just like, we’re all doing the same thing, we all love what we’re doing, so why wouldn’t we wanna protect our brains so we can do it longer, for our whole lives?

 

Dr. Tim:                      And be normal.

                                   

Kelsey:                        Literally, I’m learning about – lately, I’ve been learning about brain disease and dementia and Alzheimer’s and it’s like – CTE even. And it’s just like action sports, athletes – all athletes honestly are at risk of a lot of these brain diseases whether we want to know it or not and [inaudible] [00:51:50] – Crosstalk]

 

Dr. Tim:                      Or just admit it or just sort of acknowledge that – what you had said earlier, like, “Okay, I had – it’s normal. I got eight concussions and I’m gonna keep going.” Well, much like a boxer getting punch-drunk, and we think about Muhammad Ali and others, where you receive those repetitive traumas – and it may not even be enough to really show symptoms, but now what we’re seeing in the research is, even these repetitive traumas over time may have long-lasting effects and damage your brain, almost scar it from those repetitive traumas, and then show up later in life.

 

Kelsey:                        And I think that’s where I personally am like, “The action sports world, we need to wake up.” Because people are becoming in their 30s, and they haven’t worn a helmet for their whole career, now they're noticing all these effects that they're having and they’re trying to find treatment. And what if we could prevent this? My brain surgeon, when I went back to snowboarding, he was like, “You need to wear a mouthguard more than anything because a mouthguard is gonna help stop the concussions.” And it’s just, action sports, like football players, hockey players, butt pads, mouthguard, helmet. Action sports players which are easily –

 

Dr. Tim:                      Sunscreen, sunglasses…

                                   

Kelsey:                        – I’m like, “What –” we should be doing the same thing. I wear butt pads, mouthguards, helmet always now when I snowboard, and I’m like, “Everybody should wear a helmet,” but if you don’t wanna wear a helmet wear a mouthguard. Do anything to try to prevent – I just like brain health. I think it’s a scary topic for people, so it’s like people would rather just brush it under the rug and not talk about it. And from Save A Brain, I’m like, “All right, let’s create a conversation. Let’s start talking about mental health. Let’s talk about how we can protect our brain, feed it good things –

 

Dr. Tim:                      For everyone. Let’s join the conversation with Kelsey and Save A Brain. So, Kelsey, where do people find you? How do they connect with you and Save A Brain? Where do they – how do they connect with you?

 

Kelsey:                        So, Save A Brain, we’re fairly new. We just launched three months ago, but we do have a website: saveabrain.net. Also, follow us on Instagram, just: @saveabrain. We are working on finishing up our Facebook. We had a few issues, but you will be able to find us on Facebook soon as well. And feel free to email us. We want Save A Brain to be a safe space for anyone who is struggling and feels alone to come to about their head injuries because there's just not enough support out there.

 

Dr. Tim:                      I agree. And if anyone’s been listening today, there's not enough support. There's not enough education. We need to make this a conversation, bring it to the forefront. So, with that and the work that you see yourself doing with Save A Brain in the future and even currently, what impact do you wanna have on humanity with your new endeavor Save A Brain?

                                   

Kelsey:                        I think about this a lot and it evolves every day. I get really excited about what we can do who we can help, but I just hope that we can impact humanity by having people be vulnerable and care about their brain. We only get one brain and I think that’s so important to understand. And if we can create a movement where everybody feels comfortable and safe, what doors that could open. And I one day – this is down the road – we wanna run educational clinics at action sports camps about head injuries, and what – if they see someone get a concussion, how they can help, whether it’s staff or a kid or a parent. And we’re looking – this is super down the road but if we could one day get health insurance to change, where it’s “mental health insurance” and people can receive the care that they need and afford it…

 

Dr. Tim:                      That would be amazing. And we thank you for the impact that you're trying to have on humanity, saving lives, saving brains, and we look forward to being part of that conversation as well as that goal. And so, what you’ll find on “The in,” tagged with Kelsey’s information and this podcast, we’ll be posting up relevant, informative articles that are standard in the community of sports medicine and how to take care of the brain, things to look for, and we’ll also be posting up some resources from Kelsey as well. So, we hope that you take advantage of those and really look to save a brain.

 

                                    Thank you so much, Kelsey for your time and your – just your passion to help others. And it’s unfortunate that you had to go through this struggle to get here but I’m fairly confident that your struggle is gonna allow others not to struggle and to save their brain. Thank you, Kelsey.

 

Kelsey:                        Thank you for having me, Tim.

 

 

Dr. Tim:                      All right. Everyone, take care of your brain, wear a helmet, be educated, and look out for one another. We’ll see you next time on The in.Dr. Tim:                      Hey, welcome everybody. This is Dr. Tim Speicher. You're with us at The in with Dr. Tim. We provide a podcast to provide you cutting edge topics and health and performance, and we are so fortunate here tonight to have Miss Kelsey Boyer. Kelsey Boyer’s a professional snowboarder and founder of Save A Brain, Incorporated. Kelsey has been featured in Snowboarder magazine, is a sponsored athlete with K2, Giro, and travels the world, both filming her snowboarding feats and helping to inspire other girls and women to take up the sport through her work with Beyond the Boundaries, a company focused on promoting females to get into the mountains through the sport of snowboarding.

 

 

                                    Kelsey started snowboarding at the age of 13 and quickly advanced in the sport, first competing at age 16, and one year later winning the Nike Chosen which sparked her desire to become a professional snowboarder. With this going on, she packed her bags and left her family in Pennsylvania to pursue a snowboarding career in Utah. She became a sponsored athlete at age 18. However, in 2016, Kelsey suffered a traumatic brain injury that required brain surgery, which was thought to sideline her from snowboarding for the rest of her life, not to mention from being a normal human being.

 

                                    However, after four years of therapy and struggle, Kelsey returned to the sport and regained her professional status with a new goal in mind. Kelsey’s now focused on helping others gain the education and financial sport to heal from their brain injury through her non-profit foundation, Save A Brain, Incorporated. So, Kelsey, thanks so much for being here tonight. I think your story is very powerful and could potentially help really just thousands and thousands of individuals struggling with a similar thing that you went through. And so, maybe you can just maybe start off with telling us about your story and what happened and how you got here.

 

Kelsey:                        Well, thanks for having me on here. It’s new that I’m starting to tell the story because I’m just like, “You know what? We need to start talking about this.” But basically, how I got here… was… through my brain injury. My whole career just kinda shifted really quick; had my brain surgery, and next thing I knew, was kinda just living this different life.

 

Dr. Tim:                      Well, lemme ask you, Kels, how did it happen? Do you even remember? What were you doing at the time when it occurred?

                                   

Kelsey:                        It was a heavy competing season. People were trying to start hooking up points for the 2018 Olympics. So, you start two years in advance, so I had pretty much back to back to back contests. And I started my year out in January in Canada, and I knocked myself out cold in that contest.

 

Dr. Tim:                      Were you on slopestyle, halfpipes?

 

Kelsey:                        Yep, yep. I was doing slopestyle… so yeah, jumps and rails and that. Basically, my whole season after that knockout consisted of me [inaudible] [00:003:30] air a lot, I remember. I was learning how to fix it because it was so new, and I probably hit my head like eight more times within a two-month period… pretty

 

[Crosstalk]

 

Dr. Tim:                      You sound like you were trying for Shaun White.

                                   

Kelsey:                        – bad. I don’t know what I was thinking. I don’t know –

 

[Crosstalk]

 

Dr. Tim:                      Lemme ask you this, Kelsey. Is it pretty common for snowboarders at your level to be hitting their head on a regular basis as they're training?

 

Kelsey:                        Oh, yeah. I think that’s kinda the hidden injury with the whole action sports industry is just, we fall all the time and you can sustain concussions through hitting your head, hitting your butt, whiplash, and it’s probably our – that and ACL are probably our No. 1 injuries… for sure.

 

Dr. Tim:                      Were you wearing a helmet at the time?

                                   

Kelsey:                        I was. Probably should have had a new one...  because most of them are meant for one impact only and this one went with me through all of them. So, I probably should have had a new one but I just kept wearing the same old one.

 

[Crosstalk]

 

Dr. Tim:                      Sure, and that’s, I guess, a really good point that you just brought up that – so you're in action sports, or even you're just snowboarding or skiing at the resort, you bang your head on a rail or even on the snow, and from my understanding, and I think you understand this too, that your brain can actually get shaken inside your head. It doesn’t even have to hit anything. Like what you said, you can fall on your butt, and then your head shakes and your brain moves inside your skull, and then you get a concussion. But with that being said, I know that there's individuals out there who have probably hit their head once or twice, even the kids in the park trying to kinda do your tricks and model you, right?

 

                                    They may not know this. They should probably have a new helmet, right?

 

Kelsey:                        For sure. And that’s definitely something that – I don’t know. You read it and you know about it but you just, “You know, it’s fine. It’s fine. Everything’s fine.” And then, before you know it, everything is not fine. And I don’t know. They have all those protocols for helmets for a reason, so it’s serious.

 

Dr. Tim:                      Do you remember what type of trick you were trying to pull off?

                                   

Kelsey:                        Honestly, I think… the one that really – so, basically what happened was after probably like eight concussions in two months, one of them, when I fell, it was a really bad one. I literally just think I was just doing an easy trick, a safety trick… on the last jump… and I –

 

Dr. Tim:                      But Kelsey, can I stop you [inaudible] [00:06:28] – Crosstalk] because I just heard something kinda crazy?

 

Kelsey:                        – oh, yeah. Yeah.

 

Dr. Tim:                      So, before the concussion, right, you had had, you think, up to eight prior to your big one? Is that correct?

                                   

Kelsey:                        Yeah, probably.

 

Dr. Tim:                      Okay. Okay, so… keep going.

 

Kelsey:                        It was a lot. I just kept pushing myself and falling because clearly something – my equilibrium was so off because I kept just falling, spinning in the air on spins that I was doing all the time. So, it didn’t make sense to me, but I just kept pushing, kind of ignored it, and then I fell really bad, caught my toe edge of my snowboard on the ground, hit face-first. My googles exploded. It was pretty bad but I got up anyway… and I –

 

[Crosstalk]

Dr. Tim:                      Were you going pretty fast or were you…?

                                   

Kelsey:                        – oh, yeah, I was going pretty –

 

Dr. Tim:                      What would you estimate?

 

Kelsey:                        You're fast because the last jump of a slopestyle course is usually always the biggest and you have to clear it or you're gonna hit that knuckle and you're gonna get hurt. And so, I was going pretty fast into it and it was maybe a 50 to 60-foot jump. So, not too big but big enough.

 

Dr. Tim:                      Well, for some of us, 50, 60 feet is quite high. I’m more of a two-footer, that’s – but I’m old. I’m trying to preserve my body.

                                   

Kelsey:                        I look back on it and I’m like, “That was just – those are just too big.” But so, I was going pretty fast into it… just tipped over mid-spin, and just pretty much slammed straight down with my body and my head. So, there’s a lot of acceleration and velocity in that.

 

Dr. Tim:                      Sure.

 

Kelsey:                        But then, I remember I picked myself up, got back on the chairlift and was like, “I have to take my second run,” and clearly was shook. And I kinda had this weird ringing in my ears and my head and I just had this weird gut feeling and almost voice that was like, “Your brain is bleeding.” Like, it told me. And I rushed right to ski patrol and they were like, “You're fine. You're just concussed.” And I was like, “Okay,” but then I couldn’t even stand. So, they hooked me up to oxygen, went down to ski patrol again, and they said, “You're fine. You're just concussed.” So, two weeks goes past. I go to maybe four – three to four other doctors, everybody tells me I’m fine –

 

[Crosstalk]

 

Dr. Tim:                      Well, lemme ask you this, Kelsey, because you finished that day. So, what were you feeling that really kinda promoted you to seek help to – from other healthcare professionals beyond the ski patrollers?

                                   

Kelsey:                        It honestly was everybody around me was telling me that I wasn’t okay and that were kind of forcing me, taking me to these doctors.

 

Dr. Tim:                      What did they notice?

Kelsey:                        Because they were like, “You're just not acting right. Something seems wrong,” and I was having pretty aggressive headaches where I was taking a lot of Ibuprofen to even just exist… for the day. So, I went to a few doctors. Everybody was still like, “It’s post-concussion syndrome. That’s normal. Your head’s gonna hurt.” So, I kept snowboarding because everybody was saying I was fine. So, I took two weeks off, went on a filming trip in Jackson Hole, Wyoming… and –

 

[Crosstalk]

 

Dr. Tim:                      Now, Kelsey, can I stop you for just one second? [inaudible] [00:10:31] – Crosstalk] because –

                                   

Kelsey:                        – oh, yeah. Yeah, please, please.  

 

Dr. Tim:                      – I wanna make sure that our listeners know something [inaudible].

 

Kelsey:                        Totally.

 

Dr. Tim:                      Because I’m a medical professional, AT by trade and training –

                                   

Kelsey:                        Sure.

 

Dr. Tim:                      – and ATs are some of the highest trained individuals, at least mid-level care providers in concussion. Well, I just wanna let everybody know that’s not normal, everybody. Okay? And 2016 is not too far from now. We know that post-concussion syndrome is a very serious deal. Most individuals who have had a concussion, okay, and their brain’s not healed yet and then they get hit again and they have post-concussion syndrome, they stand a huge chance of dying or being a vegetable. Right? So, it’s a big deal. And unfortunately, what I’m hearing from Kelsey is that she probably ran across from healthcare providers that just weren’t really that clued into how significant of an issue this was.

 

                                    And so, just to let everyone know that if any provider says that to you, you should really then seek additional help from someone. Maybe an AT, maybe a physician, someone who’s really schooled in concussion management, diagnosis and treatment. Thank you, Kelsey. I just wanted to make sure everybody knew that that wasn’t normal.

 

Kelsey:                        No, that’s good. This is good. No, and that’s the thing. It’s like I kinda went a full, different rogue route, so it’s – that’s good that you say that kind of stuff. I dunno. Where was I –?

 

[Crosstalk]

 

Dr. Tim:                      You were shopping around, I guess, for help, that’s what it sounds like. But you couldn’t get any help. You knew something was wrong with you, but everybody’s telling you there's nothing wrong with you. They said you had a concussion but…

                                   

Kelsey:                        Everybody’s, “You're fine. You're fine,” and you hear that from a handful of doctors, so you're like, “I’m fine” –

 

Dr. Tim:                      Lemme ask you, did they ever do any neurocognitive testing or run you through balance testing or do anything?

 

Kelsey:                        No.

 

Dr. Tim:                      Wow. Man, that’s like the first [inaudible] [00:12:37] – Crosstalk] thing –

           

Kelsey:                        No. No.

 

Dr. Tim:                      – that you gotta do. There’s even [audio cuts out] [00:12:40] – Crosstalk] called –

 

Kelsey:                        For sure.

 

Dr. Tim:                      – the SCAT-5 and standard concussion assessments. So –

                                   

Kelsey:                        Totally.

 

Dr. Tim:                      – that’s mind-blowing to me as a professional who deals with this on a regular basis. Wow.

 

Kelsey:                        I don’t know. And all my friends that were going with me and taking them were like, “Check her head, check her head” and they just kept saying, “She’s fine. It’s just post-concussion syndrome. It’s normal to have head pain after a bad concussion,” and I was like – it was throbbing. I was just like, “I don’t know.” And I honestly don’t remember most of the appointments either –

 

Dr. Tim:                      So, definitely memory loss there, for sure.

                                   

Kelsey:                        Totally, and after they – I don’t know. Now that we bring it up, kinda leading up to where everybody told me I was fine, I’m back on the road. “Gotta keep going, gotta keep filming. It’s still winter. Gotta push through.” And as we’re filming – so, now, this is two weeks after that one head slam that was pretty good, and I don’t remember those two weeks at all really.

 

Dr. Tim:                      Wow.

 

Kelsey:                        Very foggy, and I was driving cars and doing things but I don’t remember because that was basically after Wyoming, after we filmed. Everybody I was with was like, “You're not okay.” Like I was gagging a lot out of nowhere which – and I had zero appetite, nothing… and –

 

Dr. Tim:                      So, those of you out there wondering “Why was Kelsey gagging?” Okay, well, when there's pressure placed on cranial nerves, okay, particularly the glossopharyngeal nerve, which is basically just your throat nerve, and sometimes a few others as well, that’s likely why she was gagging. She was – had a lot pressure, a lot of fluid on her cranial nerves, the nerves inside your head. So –

                                   

Kelsey:                        I love that.

 

Dr. Tim:                      – did doctors ever say anything about that, did they – like, “Why are you gagging?”

 

Kelsey:                        It kinda happened after. I basically got the clear from a handful of doctors. They just said, “It was post-concussion syndrome. You're fine. Just take time off.” And that’s when it started progressively getting worse and worse.

 

Dr. Tim:                      Have you ever thought about, Kelsey, why maybe they – I don’t know. I don’t know. Do you think they maybe thought, “Well, hey, this is a professional athlete and she’s gonna deal with it” or do you think they just – I don’t know. Have you reflected on that at all; why didn’t they give you the right assessment, treatment care? Have you processed that at all?

                                   

Kelsey:                        I do think about it a lot. I feel like I honestly don’t go or trust doctors that often anymore because of the situation… because I just feel like I was never heard. I literally told them, “Something is wrong. I know something is wrong,” but by the books they were like, “You fit under this category,” and I was like, “Okay but –” I’m just like, we know our bodies –

 

Dr. Tim:                      Right.

 

Kelsey:                        – better than anyone and –

 

Dr. Tim:                      Definitely pro-athletes, for sure. And I think most patients and most individuals do, Kelsey. Because I just had this conversation with one of my patients today, and she said the same thing. She’s like, “They're not listening to me. They're not hearing me. I know something was wrong with me and they came up with another diagnosis and they kind of brushed me off.” And I just said to them, I said, “In expertise research,” right, “we know that what happens is that when you go to the doctor, you go to anybody, clinician, therapist, whatever, sometimes they don’t hear you because they’ve already kind of created a story inside their head.”

                                   

Kelsey:                        For sure. That’s the best way to put it. It was just like someone created the story for me, that’s what it was, and there was nothing else. And then you believe it. After a while, you believe their story… because you don’t know. You're trusting these people. And it's kinda sad because you're just – I don’t know. That’s kinda what really turns me away from healthcare and a lot of athletes, I think, is it’s hard to find someone that you can trust, that has your best interest. And I definitely do look back on it and I’m like, “Do they know – they have no idea that they almost killed me?”

 

Dr. Tim:                      You very well could have died, for sure.

 

Kelsey:                        I seriously think about that all the time. I’m just like, “These people have no idea that what they said that day almost ended my life.” If I wouldn’t have finally just walked –” I walked into the emergency room after two weeks and was like, “I need a CAT scan” and [inaudible] [00:17:51] – Crosstalk]

 

Dr. Tim:                      What prompted you to go to the –

                                   

Kelsey:                        – oh, go ahead.

 

Dr. Tim:                      – emergency room? I’m just curious.

 

Kelsey:                        What led me to go in there?

 

Dr. Tim:                      What prompted you? Yeah because you had – a story had been created for you had multiple people telling you the same story… and you're kinda believing it, but then, all of a sudden, you end up in the emergency room. So, what finally clicked for you that took you to the emergency room?

                                   

Kelsey:                        I’d say the two weeks of, after that head hit, everybody around me – I was with the same people – were just like, “You're not okay. You're acting weird.” And then when I started gagging, I finally was like, “Something’s not right. This isn't okay.” So, we drove eight hours back, and my roommate at the time, her name was Micah, and she was just like, “That’s it. Get in the passenger side of the car. I’m driving you to the emergency room right now. Something is wrong.” And I was fighting her about it. But she basically saved my life because if I didn’t go into the ER that night, they were just like, “We don’t think you would have survived another night.”

 

Dr. Tim:                      Wow. Wow. That’s a good friend.

 

Kelsey:                        Oh, straight up. I’m like, “Oh my gosh, thank you for forcing me.” And that's the biggest thing, I’m just like people have your best interest and – that love and care about you, and at some point, you just gotta go for it. Because I did not wanna go in there, but – and even then, when we went into the ER, the nurse was just like – she literally said the same thing. She was like, “It seems like post-concussion syndrome,” and then she’s like, “but just in case, we’ll take a CAT scan just to check.”

 

Dr. Tim:                      What’d they find?

                                   

Kelsey:                        So, they found that – she came back in and her face was – I could tell something was wrong. But she said, “This is a miracle. We don’t know how you're alive. Your brain has shifted 11 millimeters.”

 

Dr. Tim:                      Wow.

 

Kelsey:                        So, basically my head was just – my brain was bleeding for two weeks, and I was still just living a normal life, snowboarding, driving, everything, and just like you said, became so much pressure that my body was then just gagging as a reflex. And next thing that I knew, she was giving me an apron was like, “You have to go –” I was in Colorado at the time and she was like, “You need to go down to Denver for immediate brain surgery,” and I was just in an ambulance and just off I went.

 

Dr. Tim:                      Wow. So, I’m assuming they probably cut skull then or drilled some holes in it to let some pressure out. Is that what happened?

Kelsey:                        Yeah. I was diagnosed with a subdural hematoma, but because I was bleeding for two weeks they didn’t know if – so, basically, they drilled a hole in my skull and put tubes in it and were trying to drain the blood. And then the next surgery was cutting out a chunk of the skull to scrape some of the dry blood out, and then they just stitched everything and stapled everything back up. And –

 

Dr. Tim:                      Wow.

 

Kelsey:                        – luckily surgery went very smooth, but I just – it’s all kind of like a blur because obviously they were like, “This is a problem,” so they were just trying to get me to just relax and almost like sedate me so I’m not talking as much. And they flew in one of the top three brain surgeons, I think it was, to come work on me, so I had to wait like 24 hours to – for him to arrive… but –

 

Dr. Tim:                      That must have been nerve-racking for you? Were –

                                   

Kelsey:                        Yeah.

 

Dr. Tim:                      – you cognizant of the situation you were under? People were operating on your brain.

 

Kelsey:                        I was terrified. My family lives across the country in Pennsylvania, so I pretty much was on my own besides my friends. And it didn’t seem real almost. They of course gave me so much drugs that I don’t remember the ambulance ride, and I came to, I’ll never forget it, in the MRI machine. And I remember I woke up, of course, I’m freaking out, and they're like, “Kelsey, you have six more minutes. Just lay – just relax. You're okay.” And then, it’s kinda like all a blur because of all of the drugs that they were giving me. But I remember just being terrified when, at one point, I remember the brain surgeon coming in and he has papers.

 

                                    So, I have to sign these papers, and he’s telling my roommate Micah – and she’s signing my life away because my parents aren’t there, so she’s like my guardian at this point. And he’s just like, “She could wake up not knowing how to talk, how to walk, not knowing who you are.” And I remember just hearing all of that and I was like, “Holy crap. I –”

 

[Crosstalk]

 

Dr. Tim:                      You might not come back.

                                   

Kelsey:                        – and it’s like you die if you don’t get it, or you take a risk by trying to get the surgery. So, it’s kinda like you have no choice almost but to just trust them and give it a go.

 

Dr. Tim:                      Well, I do wanna mention something that Kelsey kind of highlighted. Athletes are pretty darn good at hiding – not hiding, that’s not the right word. Athletes kind of present a little differently with concussion most often because they're really good at adapting to their injuries, to what’s going on around them. And they are able to switch different kind of functions in their brain and also bodies to kind of make up for other problems and that’s probably maybe some of why – and I’m just hypothesizing here but maybe why you didn’t really present like you're really bad but you really were.

 

Kelsey:                        For sure. No, what you said is on point. It’s just like, you get an injury, you adapt, you keep going. Nothing is gonna hold you back from “Just keep going” and –

 

Dr. Tim:                      [Inaudible] [00:24:55] – Crosstalk] very apropos there's an ambulance in the background going by you right now.

                                     

Kelsey:                        – oh, there is.

 

Dr. Tim:                      Everyone, that was not planned.

 

Kelsey:                        It’s a sign.

 

Dr. Tim:                      Maybe so. All right. From my understanding, Kelsey, too you had this immense, I guess, struggle to even get appropriate assessment and care. But it didn’t end there, did it?

                                   

Kelsey:                        No.

 

Dr. Tim:                      That struggle didn’t end there.

 

Kelsey:                        Sadly, no.

 

Dr. Tim:                      What happened after your surgery?

                                   

Kelsey:                        So, after my surgery, I was in the ICU for a bit just having to pass walking, talking cognitive functioning test basically. And then, I moved up to the recovery floor, was there for a minute as well. Pretty much they released me and just said, “Okay, you're good to go. Come back in a couple of weeks to get the staples out and for a follow-up.” And basically, after that too they didn’t tell me anything. They just released me and were like –

 

Dr. Tim:                      Did you feel like you were good to go at that point? You just had your brain surgery and skull cut open and – did you feel like you were good to go?

 

Kelsey:                        Now that I look back on it, I think they were so casual about it that I was so casual about it. I was like, “I’m good to go. I had brain surgery. They said I’m cleared,” as if it was like an ACL, and it wasn’t the case at all. Little did I know that – there were things that they told me that I was like – I couldn’t have caffeine or sugar for, I wanna say like nine months, I think it was.

 

Dr. Tim:                      Bet you lost weight.

                                   

Kelsey:                        Honestly, it was probably the healthiest I’ve been. And I also couldn’t look at screens. So, all I literally did healing was sleep and coloring books; anything books, like crosswords and – but even that would become too much, at some point.

 

Dr. Tim:                      And, everyone, the post management of concussion – post-concussion syndrome, of brain surgery like this is now vastly different. It should be. It should have probably been in 2016 as well, but it wasn’t for Kelsey and it didn’t end there.

 

Kelsey:                        No. They didn’t tell me too much; how to – normal, standard packet of things to follow for a little bit. “Follow them.” Still couldn’t really work out or elevate my blood pressure a lot, or heart rate because it would hurt my brain. But after I followed all of that, went to my follow-up appointment, they said, “Everything looks fine,” took the staples out of my head and were like, “Okay. You're cleared.” And I was all of a sudden just cleared a few months after my brain surgery to snowboard. And never did any cognitive testing or anything like that. All the doctors were just like, “Yeah, you're fine.”

 

Dr. Tim:                      “You look good. You look fit.”

                                   

Kelsey:                        Literally, that was it. They were just like, “You look healthy. You look great. Scar’s healing fine. Have a good time” type thing. I just had the weirdest experience, I feel like. Everybody was just so mellow about this brain surgery, which makes you think, “Oh, this is standard. This is mellow. This is normal,” but it’s not at all.

 

[Crosstalk]

Dr. Tim:                      No, [inaudible] [00:28:58] not normal to have your cranium scraped and holes drilled in your skull and chunks of your skull taken out.

 

Kelsey:                        They treated it like it was a broken arm.

 

Dr. Tim:                      Okay. Great. And did you try to snowboard at two months then?

                                   

Kelsey:                        I did. I went – yeah.

 

[Crosstalk]

 

Dr. Tim:                      You did. And what happened? Was it like it was, the old days or – what occurred?

 

Kelsey:                        Honestly, it was. It kinda came back like riding a bike, for a bit. Some things were different. I couldn’t remember how to do some tricks. And after kind of a couple of weeks, I – it was getting worse. My memory was getting worse. I was having really bad PTSD on my snowboard, where every time I fell I would think that my brain was bleeding, and that was a-whole-nother, “What’s going on? Why does my head hurt when I fall almost?” And I kept going back to doctors and they just kept saying everything was still fine. So, they just said every brain injury is different, which I understand that it is, so they don't know what exactly is gonna be the outcome for everyone. But for me, mine just got progressively worse as the months went past.

 

Dr. Tim:                      In what way?

                                   

Kelsey:                        The worst thing were my mood swings. I’m a pretty positive, happy person and I never experienced anything like them. Something would trigger them, and I would almost just go red and I wouldn’t remember what I was angry about or yelling about, and I would snap out of it, and I would just start crying because I was like, “This is not me. This is not who I am.” So, that was the worst of it. But then, on top of that, as the months went past, my cognitive function went down. Like, I was slurring. It was really hard to – the process of talking, thinking of words and trying to do it at a normal pace was hard. My sleeping was pretty much non-existent. I was probably sleeping like – I was lucky if it was like three hours a night. And then, my eyes. It hurt to move my eyes, pretty bad.

 

Dr. Tim:                      And all of those, everyone, the functions she’s talking about that got impacted are heavily impacted by cranial nerves. And so, even though Kelsey’s pressure had been taken off, her nerves had not healed and were still shaken. And so, some of these post-concussive syndrome effects that she’s talking about can be pretty severe. And they can affect your emotions, and many people get violent; not only depressed but they also get violent. And we have to kind of keep that in mind. Some people even act like they're drunk. But they're not. They have a brain injury.

 

Kelsey:                        Now that I look back on it – I think about it a lot – and it’s definitely just impacted me and I’m – it’s so real.

 

Dr. Tim:                      But you're recovered now for the most part, I understand. How did that happen? Because I think I remember us talking about that you even had a hard time searching out and finding people to help you with concussion-based rehab, which is mind-boggling for me because that’s what – we specialize in that here at the institute. And there's other institutions around there that do, and they're all across the nation. But you seem not to be able to find anybody, so what – why was that, Kelsey, now that you look back on it? Tell us about that.

 

Kelsey:                        It’s definitely been a journey trying to find help the whole time. I don’t know what it was. It was kinda just like I didn’t know who to turn to, so I tried some psychiatrist to maybe help with the emotional effects. That didn’t work out. They basically just told me, “You should be done snowboarding and move on,” and I was like, “This is not it.” And so, I kept trying to seek out help, kept trying to seek out help, still couldn’t find any, which like you said – it's baffling to me how I couldn’t find any help. And I think it’s a process; it’s a process to try to get in with a neurologist, and they don’t make it easy. They make it hard. It takes months to get in with one, so I think it just turns you away from wanting to almost.

 

Dr. Tim:                      You said “hard”. I’m curious about that. Obviously, lots of people are busy, and they're specialists and so forth, but did you experience barriers? Did you feel like somebody was putting a – some barriers in front of you to getting appropriate care? It’s kind of what I’m hearing. I’m just curious what – in your perception, what were those barriers that made it hard?

 

Kelsey:                        For me, it just didn’t seem like they cared. I would tell them all these issues that I was having, and they wouldn’t have an answer to it, so they didn’t really know what to do with me, I think. And I kinda just was like, “You know what? If I can’t rely on these doctors, then I’m gonna try to do the best that I can and heal myself.” So, I started doing yoga and meditating to help with the whole emotional mood swings and I changed my diet a lot, just eating good foods for the brain, and that seemed to kinda start the direction of my healing, I wanna say.

 

Dr. Tim:                      Did it seem to help with the emotional aspect of things for you?

                                   

Kelsey:                        Oh, yeah. Yeah. It was pretty much like night and day as soon as I started doing that. But then, yeah, it’s like I’d still get the mood swings here and there and I would kinda cry for like two hours and I was like this is, “This is – okay, this isn't healed. I need actual help. I’ve everything I can on my own but I need professional help.”

 

Dr. Tim:                      Think about this just for a quick second, right? She has nothing really to cry about for two hours. She’s a professional snowboarder, you get flown all over the world, and people pay her money. And you’re getting free [inaudible] [00:36:27] and snowboards and so it’s [inaudible]. Right.

 

[Crosstalk]

 

Kelsey:                        For sure.

 

Dr. Tim:                      So, you knew you still were not where you needed to be?

                                   

Kelsey:                        No. No. So, it’s been in March. It was four years since my brain surgery and it took me three years of searching and trying to do things on my own to finally seek professional help that cured my –all of the symptoms I was living with.

 

Dr. Tim:                      And my understanding is that you somehow stumbled across a cognitive rehab center here in Utah and – how’d you find them? Was it via the internet or just talking to other people? How did that happen for you, that miraculous sort of find?

 

Kelsey:                        I was pretty silent. Of course, I dropped the sponsors that I was with and was like, “You know what? I’m done competing. I’m just gonna snowboard for myself. I don’t want that external pressure there.” And I kind of opened up about my injury on just social media platforms and people were reaching out to me. And another snowboarder, she went to this clinic. And she’s from Australia and goes to the – comes to the States a lot but she heard about it. She went there and recommended it, and so I was like, “You know what? I have nothing to lose. I need help.”

 

Dr. Tim:                      I know of this clinic because actually we, at times, collaborate together on concussion cases. And as you mentioned before how an athlete or how an individual handles their brain injury is very, very, very different. The brain doesn’t always play by the rules. However, they really heavily focus on kinda reorienting your neurons and your brain and kind of really getting things functioning again from a cognitive aspect. We, on our side, we work on more of the pain, the neuroactivity and kinda getting things aligned and calming the neurologic system. So, it’s interesting to me that these places are not more well known. Why do you think that is?

                                   

Kelsey:                        The only thing that I have come up with to – because I’m like, not only are they not known, very popular, but they're also not covered by health insurance, and if they are, it’s little to none. I could be wrong, but I just think it’s because it’s – they're new treatments and they're outside of the scope of medicine that’s on health insurances. I could be wrong but that’s what I can come –

 

[Crosstalk]

 

Dr. Tim:                      No, you're not wrong. It’s true, many of the therapies we do here, somatic-based therapy, [inaudible] [00:39:51] therapy, whatever it might be, a lot of insurances won’t pay for it. They don’t recognize it. They're just not there yet.

 

Kelsey:                        That’s what I gathered.

 

Dr. Tim:                      So, you had your therapy. You didn’t have it here, which I just wanna point out to everybody. I didn’t know Kelsey at this time, but sure wish I had; would love to have helped her along with the clinic that she got help from. How long did you go for therapy and what did it kinda involve that really helped bring you back?

                                   

Kelsey:                        I went for one week which –

 

Dr. Tim:                      One week, that’s it? One week?

 

[Crosstalk]

 

Kelsey:                        – seems – yeah, seems bizarre –

 

[Crosstalk]

Dr. Tim:                      After four years?

                                   

Kelsey:                        – after four years. I went for a one-week treatment that – they take a functional MRI of your brain and they see where your brain is lacking oxygen and blood flow, which could be causing a lot of the issues. They found in mine that my brain was not functioning as a normal brain, obviously. I wanna say my amygdala wasn’t firing a lot, which is why my eyes hurt to move because it was pulling from my occipital lobe, a lot of – the brain, as you know, finds new pathways to navigate and mine just found new ones that were not the correct way, so they –

 

Dr. Tim:                      Did you play computer games and did you – what did they have you do that helped kind of reorient your amygdala and occipital lobe, I guess?

 

Kelsey:                        Now that I look at it, I’m like, “Wow, I can’t believe that all worked.” But it was basically a lot of physical therapy, like balance and we did – they do cardio sessions because obviously exercise and the brain. I did a lot of frustrating games throughout the day where – it would be memory games. They would give me 20 cards and I would have to make a story with them, and the next day when I came in, I had to say the story with the cards in that order. And just a lot occupational therapy…

 

Dr. Tim:                      It sounds like they were giving a workout for your brain?

                                   

Kelsey:                        Yeah, 100%. My brain has never worked – in all of my school, high school and college career, I feel like my brain had never worked as hard as it did in this one week. You're pulling like 8:00 to 6:00 of brain workouts.

 

Dr. Tim:                      And just so everyone knows out there, it’s a very standard kind of therapy that is done. We do it here as well. It’s ocular, motor, and vestibular training, really trying to reorient the brain to vision – sort of vision tasks but also balance tasks, hearing tasks and so forth. This particular clinic definitely was doing a little more computer-based, functional MRI, really trying to tap into where her deficiencies were. But it’s amazing, just in one week of therapy, she was able to turn herself around in four years. Now, with that, how has this brain injury, I guess, to this point affected your life? And maybe you can speak to this new goal that you have in helping others with that – the way it’s affected you?

 

Kelsey:                        Totally. My brain injury has affected me in ways that I never thought it would. My life was basically put on hold for four years. I was living with all of these issues that it was hard to even live a life – a fulfilled life. And that led me to create Save A Brain because, after four years, I’m just like, I don’t want people to ever have to go through that and the more – like I said, the more I talked about it, the more people were reaching out and were like, “I’m dealing with this. I don’t know where to go. I’m having concussion issues. What do I do?” And it’s just like, you see everybody coming to you and you’re like, “I have to do something. This, it’s not okay.”

 

Dr. Tim:                      Well, tell us this – is it a foundation, a company, Save A Brain? What is it? And then, maybe what's the purpose of it, I guess? How do you see it helping people?

                                   

Kelsey:                        Save A Brain, it’s a 501(c)(3) non-profit organization, and our mission is to spread awareness of the long-term mental and physical effects caused by traumatic brain injuries and concussions. Along with providing education, we aim to connect individuals to treatment centers and provide financial support, so they have the opportunity to heal and treat their brains to continue living that fulfilled life and –

 

Dr. Tim:                      That is awesome. Well, you mentioned before, for some people, they may not be able to afford the care that’s gonna heal them.

 

Kelsey:                        Totally. I feel like that’s – people affording the care is what’s wrong, in my opinion, with the whole stigma of brain injuries. It’s like people have a brain injury and they think that this is their new normal, but little to they know that there’s treatment out there but unfortunately it costs a lot of money; like my treatment was $10,000. And I was lucky enough to get a grant for that from another non-profit.

 

Dr. Tim:                      Kelsey, I should go back to a clinic like that. I am –

 

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