Post-Concussion Syndrome: A Neurology Provider’s 2-Year Road Back | E72

Why do some concussion symptoms last for months—or even years—and what can you do when your recovery seems to plateau? In this episode of Life After Impact, I sit down with neurology nurse practitioner and traumatic brain injury specialist Mandi Swanson, who spent nearly two years recovering from her own TBI after a motor vehicle accident.

Mandi went from running half-marathons and practicing neurology to struggling with severe post-traumatic headaches, brain fog, memory loss, balance problems, vision dysfunction, anxiety, PTSD, and an inability to read more than a few sentences at a time. Her CT showed no brain bleed, yet her concussion ultimately changed nearly every aspect of her life.

Now back in clinical practice treating patients with concussion and persistent post-concussion symptoms, Mandi brings a rare perspective: she understands concussion recovery from both sides of the exam room. 

Mandi shares what happened when traditional rehabilitation helped—but only to a point—and why hitting a plateau didn't necessarily mean a therapy had failed. Throughout her recovery, physical therapy, occupational therapy, neuro-optometry, speech therapy, red-light therapy, PEMF, neurofeedback, and eventually work targeting autonomic function each played different roles at different stages.

One of the most important lessons she learned was that concussion recovery isn't one-size-fits-all—and sometimes the right therapy delivered at the wrong time may not produce the same results as it does later in recovery.

We also dig into post-traumatic headaches, including why persistent headaches after concussion shouldn't automatically be treated as migraines. Mandi explains why understanding the location, quality, timing, and triggers of a headache matters, and we discuss medication-overuse or “rebound” headaches that can develop when medications such as ibuprofen or acetaminophen are used too frequently. 

Mandi also shares practical lessons she now brings into her own concussion clinic, including the importance of hydration, nutrition, magnesium and vitamin D assessment, vision evaluation, appropriate exercise, sleep, stress management, and looking beyond symptoms to identify the systems that may still be struggling.

But some of the most powerful parts of this conversation aren't about treatment at all.

Mandi describes losing access to medical knowledge she had accumulated over decades, wondering whether she would ever practice medicine again, and realizing how deeply her identity was tied to being a nurse practitioner. She talks candidly about anxiety, depression, financial stress, PTSD after her car accident, and eventually learning that accepting where she was in that moment did not mean giving up on getting better.

We also discuss something that doesn't get nearly enough attention in concussion care: the importance of having a healthcare “quarterback.” Mandi explains why coordinated medical care, thorough documentation, and advocacy can become especially important for people navigating workers' compensation or auto insurance while simultaneously trying to recover from a brain injury. 

In this episode, we discuss:

•  Why some concussion recoveries take much longer than expected 
•  Brain fog, memory loss, cognitive fatigue, and difficulty reading 
•  Post-traumatic headache versus migraine 
•  Medication-overuse and rebound headaches 
•  Vision problems and neuro-optometry after concussion 
•  Autonomic dysfunction and dysautonomia 
•  Why concussion rehabilitation can plateau 
•  Why a treatment that didn't help before may be worth revisiting 
•  PTSD and emotional recovery after a traumatic accident 
•  Returning to work after a prolonged brain injury 
•  Navigating workers' compensation and auto insurance 
•  The importance of coordinated concussion care 
•  Emerging concussion diagnostics and treatments 
•  Why recovery may require multiple therapies at different stages 

Perhaps the most important message from Mandi's story is that a plateau does not necessarily mean you've reached the end of your recovery.

Sometimes it means it's time to ask a different question, investigate another system, change the timing or combination of therapies, or find a provider who approaches the problem differently.

Mandi cannot promise her patients exactly how quickly—or how completely—they will recover. But her experience as both a patient and clinician has given her something equally important to offer:

A long recovery is still a recovery.

And nearly two years after wondering whether she would ever be able to practice neurology again, Mandi returned to medicine with an entirely new mission: helping other people find their way through the complicated journey she once had to navigate herself. 

Mandi Swanson LinkedIn

Brain Wellness Podcast

The Mother's Day Episode

My new book The Art of Concussion Recovery: Following the Thread is available as an audiobook, paperback, hardcover, and Kindle on Amazon. 

Save $30 on Brain Ritual - A daily brain energy-support drink like none other. https://www.brainritual.com/AYLA94359

Save 20% on your first order of Puori Protein:  https://affiliate.puori.com/LIFEAFTERIMPACT

The Art of Concussion Recovery - Audiobook Available on Audible and Apple Books, Paperback and Hardcover on Amazon

Concussion Breakthrough: Discover the Missing Pieces of Concussion Recovery is now available on Amazon!

Follow us on YouTube & Instagram @lifeafterimpact

Website: lifeafterimpact.com

Medical disclaimer: this video or podcast is for general informational purposes only, and does not constitute the practice of medicine or other professional healthcare services, including the giving of medical advice. No doctor patient relationship is formed. The use of this information and materials included is at the user's own risk. The content of this video or podcast is not intended to be a substitute for medical advice diagnosis or treatment. Consumers of this information should seek the advice of a medical p...

Transcript

When A Headache Isn’t A Migraine

Mandi Swanson FNP-BC 1:29

If you have a headache from sunup to sundown and it feels like your head is going to explode all the time, that's not a migraine. That's a post-concussion, post-traumatic headache. And I used to have migraines before my injury. I have post-concussion headaches now. They are a different beast. They don't respond the same. You can't treat them the same.

Meet Mandy Swanson And Her Work

Mandi Swanson FNP-BC 1:47

Welcome to Life After Impact, the Concussion Recovery Podcast. I'm Dr. Ayla Wolf, and I will be hosting today's episode where we help you navigate the often confusing, frustrating, and overwhelming journey of concussion and brain injury recovery. This podcast is your go-to resource for actionable information. Whether you're dealing with a recent concussion, struggling with post-concussion syndrome, or just feeling stuck in your healing process, know that you are not alone. This podcast can be your guide and partner in recovery, helping you build a better life after impact. Mandy Swanson, welcome to the show. Thanks for having me. I'm so excited to be here. Yes, you are. You are an award-winning nurse practitioner. You've been in practice for 20 years, and you currently see patients at the Minneapolis Clinic of Neurology where your entire practice is helping people with traumatic brain injuries and post-concussion syndrome, correct? Correct. Yes. Amazing. We need more quarterbacks like you in the world. I agree. I agree. Sometimes I say that wish we can clone some of us. So yes.

Dr. Ayla Wolf 2:56

Yeah. Well, I definitely want to dive into more of your role and what that looks like. And then also your role as a board member of the Minnesota Brain Injury Alliance. I would love to hear more about what that organization is doing as well. You are a certified brain injury specialist. You've received numerous professional honors, including the 2025 Marquee Who's Who Top Nurse Practitioner Recognition, and then the Eleanor D. Hands Outstanding Achievement Award from the Minnesota Brain Injury Alliance. Congratulations. Thank you. I'm glad you're being recognized for all your work. And part of what makes you so special is that you've been on both sides of this equation. You had a traumatic brain injury in 2023. And so you understand what it is like to actually go through this kind of heavy recovery that can be a long road. So I'm going to give you the floor. Give us a little bit about your background.

Mandi Swanson FNP-BC 3:56

Yeah.

From Stroke Care To TBI

Mandi Swanson FNP-BC 3:56

So I've been in healthcare since 1999. It's I watched the turn of the century. I was working in the hospital when we turned 2000. Everybody thought that the computers and everything were going to blow up or something. And all of my experience has been in neurology. I've always been in neurology to some aspect, whether it was in nursing before I was a nurse practitioner. And then as a nurse practitioner, I worked in both hospital settings and clinic settings. And most of what I did prior to my injury was stroke care. So I was a stroke stroke neurologist. I, uh, when I worked out in La Crosse, Wisconsin, I did education for our entire area. We went out to all of the emergency departments, taught them how to use TPA, the clotbuster, to stop strokes from happening. I did education everywhere for stroke. And that's kind of what I thought I would, what I thought I would do for the rest of my life. And when we moved back to the Twin Cities, again, I worked hospital and clinic and saw some TBIs in the hospital, because of course you see a little bit of everything. As a neurologist, you do general neurology in addition to stroke. So we we did a little bit of everything. And I thought I was doing a really good job with my TBI patients in the hospital. They'd come in and uh I always gave myself a pat on the back. Neurosurgery would consult us when they had somebody that had a bleed and then they had neurological symptoms. Well, why do they have neurological symptoms? And I'd go in and say, Well, your patient hit their head hard enough to cause a bleed, therefore they also have a concussion. Like you don't get out of a head bleed without also having concussive symptoms. So I'd go through everything that the textbook taught us. Take some brain rest, don't get back into physical activity right away, take your rest, make sure you're staying off of screens, yada yada. Do the things that school always taught us to do. And I thought I was doing a really good job with those. I had actually just switched from neurology to neurosurgery a month before my accident because I wanted to expand my experience a little bit. I had seen neuro neurology or excuse me, neurosurgery as a nurse at the bedside. And I thought, you know what, that'd be really cool. I'd always wanted to see a brain surgery. So I was kind of putting that out in the universe. I'd always wanted to see one, and this opportunity opened up, and it was amazing.

The Crash And The First Symptoms

Mandi Swanson FNP-BC 6:02

The day of my accident, I wasn't supposed to see surgery yet. I was in orientation still. I was uh shadowing one of the surgeons, and he had a brain brain surgery added to his clinic schedule or a schedule at the end of clinic. So I got to go watch him remove this good-sized brain tumor. I was from here to my computer away from this person's brain. It was the most amazing experience being able to watch this. And you always have to be careful what you put out into the universe because I got to see that experience. And three hours later, I was in an ambulance on my way to the hospital after getting in a car accident. My uh husband at the time and I were, well, he was my fiance at the time. We had just gotten engaged a week prior to uh this, and we were going out to dinner that night. It was date night. We were supposed to go there. I was on cloud nine talking about the surgery that I had seen the whole time on the way to the restaurant, and there was one car coming from the other direction that didn't stop and sheared off the front of our vehicle, and I was the passenger in the car. And I don't remember a whole lot after that. And I was taken to the ER, we were there for a while, they did imaging, I had no head bleed, I had no fractures. So they sent me home on crutches with a shoulder that I didn't know how I was going to do crutches with a bad shoulder, too. Because seatbelt, airbags, everything. I had bruises all over the place. The next morning I woke up with a whopper of a headache. That's all that I knew that I had. I had no idea of the whole host of other symptoms that would be uncovered over the next several months because I just had this really bad headache. I remember I reached out to one of my neurology colleagues and I said, you know, we were in a car accident this weekend. I have a really bad headache. Do you have time to kind of check me out and make sure I didn't get a concussion? And I went in, he squeezed me in on one of his lunch breaks, and I couldn't track with my eyes. And when I closed my eyes, I couldn't stand up straight. And he asked me if I was aware of either of those things, and I said, no, I had no idea. So that started the whole marathon of uh PT, OT, neurooptometry, going to all the things. We didn't think I needed speech therapy yet because we thought all of my cognitive issues were related to my headaches. The headaches didn't subside for quite some time. Six months in, we thought, okay, we've done everything inside, inside the box, quote, and let's try things outside the box now. So I started adding red light therapy and PEMF and neurofeedback and everything that I could potentially get experience in that was gifted to me because I had no money at this point. And I finally started seeing improvements.

Losing Cognitive Speed And Identity

Mandi Swanson FNP-BC 8:41

And then we added speech therapy, and then I did neuropsych testing, and I was low average or below on everything.

Dr. Ayla Wolf 8:51

And here must have been scary because you've been an educator now for your most of your career.

Mandi Swanson FNP-BC 8:57

Yeah. Yeah. So I sat there and I thought, there is no way. Thank goodness I had a really good neuropsychologist, and she looked and she said, Now, given your level of education and experience, I wouldn't expect that these are not your normal scores. And I said, No. Like I literally was one of those people that was annoying in school. I never had to study. I could look at something and it was in my head. I had a fairly photographic memory. If I couldn't remember the answer to a test question, I could imagine the page that it was on and find the answer. Like I was that annoying person that could do those kind of things. And now I couldn't remember details of a sentence that she was giving me. And it was crazy. The experience was exhausting. I I went home and I had to take a three-hour nap from a four-hour test because my brain was fried. And it just it highlighted all the things that I never thought were possible with concussion. I'd had concussions growing up. I played sports. I grew up on a farm. I climbed trees. I fell out of them. I fell off my bike. I fell off a horse. I did all the things. I crashed a snowmobile. I crashed cars as my teen a teenager. Uh none of them ever gave me any lasting symptoms. I always bounced back immediately. No headaches, no dizziness, no cognitive issues, no balance troubles. I kept going. I kept pushing. I had run 12 half marathons before my accident. I was training for a full marathon. I was training for grandma's full marathon for my first full marathon. And I went from running six, seven miles at a time to not being able to walk around the block.

Dr. Ayla Wolf 10:34

Yeah. I hear that from a lot of my patients where they express confusion on why did it happen this time, right? I had all these other concussions. Why did it happen this time? One of the things that I often say to people is our brains are so phenomenal at compensating, and we can compensate and compensate and compensate our whole lives for maybe some dysfunction that has occurred in from past concussions, but then it's like the that big one that then all of a sudden all the ways that you have been compensating have now also been taken away and everything just falls apart. Yeah. Yeah. You kind of you finally hit that that uh the straw that broke the camel's back, as they say.

Mandi Swanson FNP-BC 11:17

You hit that one that that one is not going to be the same as the others. It's the equivalent of you bend down to pick up your toothbrush and your back goes out. Yeah. Yeah. Exactly. So why did it happen this time? Who knows? Maybe I I had primed my brain with all of these previous ex uh experiences, even though my most recent hadn't been for 10 years. So it had been a long time since I'd hit my head and never had any lasting symptoms from any of those. And then this one was so different. I thought it was going to be a weekend. I was out of work. Nope. Yeah. It took me nearly two years to get back to work.

Dr. Ayla Wolf 11:53

That's what I was going to ask. And that whole process must have been so scary for you because I can tell you're passionate about your job. You love it. And to have two years of probably trying to battle to get back to the point where you could return to work. What was that like?

Mandi Swanson FNP-BC 12:08

Yeah, it was um, it was a mental marathon, that's for sure. So even though I couldn't do my physical marathon, I was doing a mental one. Uh a few months in, I started having really bad anxiety and depression because I had been the breadwinner of our family. I made twice as much as my husband. So there, there was no income at that point. Short-term disability was there for 12 weeks. It was supposed to roll into long term. It didn't automatically roll into long term. Getting the car insurance money was a whole process in itself. So we financially were not doing well. And I think that's the thing that hit me first before everything else. But as time went on, I started thinking, am I ever going to get back to doing what I was doing? And I had no idea how much I identified with my title of nurse practitioner until I couldn't do it. And my my memories, my memory was gone.

Therapies That Move The Needle

Mandi Swanson FNP-BC 13:58

I couldn't remember long-term things, even that I knew. And my medical memory was unattainable. I would hear a medical term and I would think, you know, I know I should know what that means, but I can't remember what that means. And I taught nursing school for several years before becoming a nurse practitioner and even after for a little bit. And I pulled up some of my PowerPoints and I thought, okay, I'll retrain myself. But I'm one of those people that on PowerPoints, I don't put paragraphs, I put bullet points to remind myself of what I want to talk about. So I'd pull up my PowerPoints and I looked at them and I thought, I don't even know what I mean. I have no idea, I have no idea what I'm talking about on that slide. So I couldn't retrain myself. And I couldn't access that medical knowledge. I sat here and I thought, am I ever going to be this person again? What am I going to do? Because I can't learn, I can't read, I can't understand what I'm reading, and I can't retrain myself and I can't remember all the things that I've done for 20 plus years. And so I know you just mentioned that you had done a lot of kind of standard therapies and you started pulling in a lot of accessory therapies. Was there any one thing that you felt like suddenly moved the needle for you cognitively, or did over time all of it just really start to make a difference? Truly, I think it was all of it over over time. The the red light therapy, the place that I went that had red light therapy, PEMF, exercise with oxygen therapy, it definitely moved the needle for a bit. And then I would hit a plateau again. And then I added the neurofeedback and it moved the needle and I hit a plateau. We added different kinds of vision therapy. So I moved from one clinic to another that was more highly specialized in TBI and did more advanced vision training and did more of the new techniques from neurooptometry, and everything kind of pushed me up a little bit, and then I would sit for a little while. And then the last thing I did was add a functional neurologist, neurological chiropractor, and we worked on my autonomic nervous system. In one month, I went from being able to read two sentences at a time to being able to read an entire page and then a chapter. And all of a sudden, I was that was like the final, the final thing that really kind of put me over the edge and made everything start functioning again. My d my autonomics are still completely shot, but uh there's there's a lot of benefit that came from adding all of those things at different times.

Dr. Ayla Wolf 16:27

But I think that brings up a very good point. A lot of times what I hear from people is they say, well, I did this thing and I felt like it helped for a little bit and then it stopped helping. And so then they stopped completely, or they never revisit that thing or try that thing with a different provider. And so what I'm hearing you say is that you were doing things, you were getting better, you'd hit a plateau, but you never just were okay with the plateau. You're saying, okay, well, what can I try next? What can I do next? Do I need to revisit this, but with somebody else? And I think that that is oftentimes, like you said, the thing that does keep moving the needle forward is you just have to keep trying different things, working with different people. What is the next thread of this process?

Mandi Swanson FNP-BC 17:11

Yeah. I tell my patients that all the time now. I say, if if we hit a plateau, it just means we have to try something different. Maybe we try something that you did before, but with a different person. Maybe we tried the same thing. I did neurofeedback twice. The second time, my brain function improved 40% over the two months that I did the treatments. Same treatment I did previously, but this time it moved the needle so much farther. So it's it was a different pairing too. So I had the neurological chiropractor and the uh neurofeedback at the same time. Whereas previously I did the neurofeedback with the red light therapy. So trying different things at different times is super important. And I'm one of those people, I'm a little OCD, I'm a little type A. I was not okay with being what I was at that level. Um being a little bit stubborn, I guess, too. So yeah.

Dr. Ayla Wolf 17:59

Well, and I think that speaks to sometimes it's maybe the right therapy, but the wrong time or in the wrong order. And that's something I try to pay attention to as well. If I have somebody whose whose nervous system is very dysregulated, they're probably not going to do great in like full visual field confrontation at a vestibular rehab clinic with a moving floor and red and white bars flying everywhere. It's like maybe we need to stabilize the autonomics first before throwing somebody in the deep end of vestibular rehab. Yeah.

Mandi Swanson FNP-BC 18:30

Yeah, absolutely. It's and there's no one size fits all treatment. Every single person that I see. So now that I'm back at work, I do concussion care all the time. That is all I do is see patients that have had concussion slash TBI. And no two patients are the same. So even though I see eight, nine patients in a day, it's all different. So there might be some themes that run across there. Just about everybody needs some vitamin D and magnesium. Everybody needs hydration, everybody needs electrolytes, all those things. But beyond that, it's very individualized. So you can't look at two concussion patients and give them the exact same treatment and expect them to have the exact same recovery. Yes, absolutely. And for those who don't know, you and I both practice in the Twin Cities. And so literally just

Work Comp Delays And The IME Trap

Mandi Swanson FNP-BC 19:20

this week, I referred somebody to you because they they were in a motor vehicle accident. It's been about, I think maybe four or five months at this point. And they were saying, I'm concerned that at some point the insurance company might try to pull some shenanigans and stop paying for these things that are working. What should I do? And I said, Well, one of the biggest things is that you need to have a quarterback on your team with a medical degree who can be the person that authorizes and approves all of the things that you're doing so that that is on paper. Can you talk a little bit about? I mean, you now, again, see both sides of the equation as far as um when people are in motor vehicle accidents or workers' comp injuries and the additional stress of having to deal with the insurance company. Um, can you talk a little bit about that and how you help people from the nurse practitioner side of things? Yeah, yep. Uh honestly, I think over half of my patient population is work comp at this point. Wow. So, yes, I can answer that question. Uh so there's a huge difference between somebody who comes in with private insurance versus somebody who has has had a car accident or workers' compensation. So work comp, auto, they all have to have approval before you can obtain your services. So private pay, you come in, you fall at home, you get a referral to neurooptometry, physical therapy, OT, whatever, you go. You get the referral, you go, you get your treatment, and ideally things kind of progress from there. You come in for work comp or an auto accident, and those things have to be approved. So work comp especially. I can send my referrals off or put place my referrals in the computer, but until they get approved by the work comp adjuster, the patient can't get it done. I've had some patients who come in, I refer them to neurooptometry because they've got significant convergence and sufficiency or accommodation errors, their eyes are not tracking appropriately. They need this treatment. They need glasses, they need therapy because their vision is not going to correct itself at this point. And it's causing headaches, it's causing cognitive fatigue. They can't sleep because of all of this, which leads them to not get better, also. And they're waiting on their adjuster to approve things. So perhaps the adjuster finally approves them to go to neurooptometry. They get their evaluation, they get their per their prescription for their prism glasses, they're gonna help their convergence insufficiency, and then they sit there and they wait. And we don't want to start the vision therapy until they've got their glasses because their eyes are not gonna appropriately respond. So then they wait and they wait and they wait for months. And sometimes after several months, finally the patient says, you know what, I'm just gonna put it on my credit card because I need my glasses. And then finally they might get that maybe work comp might pay them back. Not always. And then there comes a point when I usually recommend that they get a lawyer involved. If their adjuster is not approving things, if they're not getting the treatments that they that they're supposed to be getting, I do recommend that they find a really good work comp injury lawyer to help them push things along. Because sometimes just having that lawyer makes that adjuster act a little bit faster. And now they're getting things done like they're supposed to get done. And then they all get this thing called an IME, which makes me giggle all the time. So IME stands for independent 100%. So it's it technically stands for independent medical exam. There is nothing independent about this whatsoever. They are paid by the insurance company to say that no, you don't have a problem, basically. I in a year and a half, I have had one patient have an IME come back in their favor.

Dr. Ayla Wolf 23:07

I believe it. And one patient, yeah. I even had a patient go to an IME and the doctor injured him in the IME by cranking on his neck in a very incorrect way. Yeah. I mean, it's just I hear the worst.

Mandi Swanson FNP-BC 23:21

Yeah. Yeah. So uh the other thing that I offer my patients now is I write a lot of legal narratives. So they need that. I learned that in my own process that I needed somebody to, I needed a quarterback to write the paperwork for me. I needed somebody who was willing to put the put it on paper and say that I needed the things that I needed. And my neurologist did that for me. So I do that for my patients. Does it take me a little bit longer? Am I at work a little bit longer? Sure. But they need it. They're not going to get the things that they need otherwise. And I've written several letters now. One of them's closed their case. They won the case. Because guess what? You can't argue with medical knowledge from somebody who's watched a patient for months and has documented all of their exams and their scores and their symptoms and reviewed the medical chart from beforehand and they didn't have any of these problems beforehand. If you don't have these problems and then you do after an injury, it's probably related to the injury. It didn't just magically come out of nowhere that this person just so happens to now have these symptoms that they

Dr. Ayla Wolf 24:25

Didn't before. Right. And I think that one of the things that these insurance companies always fight back on is well, you're doing all these therapies and you're not getting better. So either you're making it up or you're just trying to milk the system. And it's like they don't understand that when you injure your brain, this can take a very long time to heal. And it when it comes to brain injuries, the insurance companies are the worst. Yes. Yeah. Yeah.

Mandi Swanson FNP-BC 24:52

I think part of it is our education system, honestly. We set people up for failure. In the textbooks, still it says three to four weeks, people get better. So that's what the, that's what all the IME doctors put in their reports. Three to four weeks, they get better. They should be better at this date. They don't need any more treatment after that. Well, that's baloney. Like everything since 2021, all of the research that has been done to evaluate patients and how long they have their symptoms shows that 30, 30 to 50% of patients continue to have symptoms well beyond a year. That is not most patients getting better in three to four weeks.

Dr. Ayla Wolf 25:25

Right? Yeah. So this all starts with updating the actual medical textbooks and literature so that the comp insurance companies have to now point to those updated textbooks and say, okay, this is what we're dealing with, in order to change some of this policy. I had a mentor who a couple of times, when he was dealing with fighting with insurance companies, he would literally just fax over like 70 pages worth of published research and just start flooding their fax machines with research on brain injuries until finally they're like, fine, we'll pay.

Mandi Swanson FNP-BC 25:59

I love it. I love it. Yeah, every letter I write has a like a page of references at the end of it. And like you can't argue this. This is facts from newest data. We know more now. We need to do better.

Dr. Ayla Wolf 26:12

Right. Well, and I think that a lot of the patients, they think they're going to get better soon too. Everybody goes into this optimistic. And so a lot of times they don't have that quarterback and they don't have the good medical charting right out of the gate. A lot of it has a really long time delay. And then sometimes the insurance companies use that too to say, well, we don't have any like actual documented objective neurological exam findings immediately after the accident. And so I think that that's also where the knowledge needs to improve too, is like in the ER, you know. I mean, you were sent home with, you know, saying, oh, well, there's no brain bleed, so you'll be fine. Just, you know, here's some crutches, but even though you have a shoulder injury. And so we're missing those key points, though those key time points to say, we did a neurological evaluation immediately after. Here's what we found, here's what we documented immediately. And then now we have that.

Mandi Swanson FNP-BC 27:07

Yeah. Yeah. Oh, yeah. I went to a level one trauma facility, by the way. They didn't even use the word concussion. I believe it. So there's that. Um, I'm always really happy now when I see patients that their ER note at least mentions head injury. So my thank you, thank you for at least putting that in there so that there's something to cover the patient. But yeah, it's regardless of when I see them, I do a very thorough uh HP. Like my history going through the review of systems, your brain can touch anything in your body. I ask about every single body system. Sometimes people look at me and they're like, wow, that's a lot of questions. I say, Yeah, because literally, again, your brain touches every cell in your body. So any of these things can be affected. 100%. Yeah. Well, I failed to mention a very important thing, which is that you have your own podcast called Brain Wellness, the podcast.

Communication After Brain Injury Changes

Mandi Swanson FNP-BC 28:02

Yes. And I I love your podcast. I listened to an episode that was absolutely heartwarming, and it was a conversation with your son. I I think you did that one around Mother's Day. Yes. And I that I I'm gonna put a link to that episode in these show notes because I just want everybody to go listen to it. And A, he sounds amazing. He has an amazing son. But you two had a very honest conversation about what it was like for him as as you were going through this brain injury and and recovering. And one of the things that you guys talked about was um being careful about comedy, because sometimes sarcasm can be misinterpreted when people have a brain injury. And I I would love to just kind of talk about that episode a little bit more because it was so good. But you that was such a good point that that you guys talked about because I see too with my patients that you have to, when you're interacting with somebody, really make sure that they are interp like not misinterpreting what we're saying in the office as well. And sometimes things can be misinterpreted. Sometimes I might say, you know, I'm seeing some, you know, signs here that maybe aspects of your parietal lobe are are struggling. And then they they in their brain, they're like, my parietal lobe is broken. Right. And so now that you've been on both sides of this equation, are have you really approached these patients differently in terms of how you communicate and how you engage with people and what you see as far as um patients' interpretations of their experience? Yes. Yeah. I do often kind of stop and ask my patients, how does that feel? How did how did that land when I say things? Because I also recognize that my filter broke in the accident. So sometimes I'm a little bit more blunt than I mean to be, and I just kind of put things out there. And then I I watch body language a lot. So my when I went to school to be a nurse practitioner, my favorite course was our assessment course, and our teacher had us do 007 assignments all the time. So we were watching people. I watch people like a hawk. I catch things that other people miss all the time because I'm watching body language. I watch their responses, I watch how how things land as much as I can try to interpret. And my ability to interpret some of those things has changed because of my own brain injury. But I do always try to stop and say, well, how did how did that come across to you? How do you feel about that? Because especially when I kind of sense that they've shut down, I will let them know that I apologize if I come across a little bit like rough at times because I just say things as they are. And normally people say, No, I really appreciate that because everybody else has been sugarcoating things. And I don't sugarcoat, so I don't do that, but I do often check in and say, well, how are how are we doing with this? Are you what have you understood from this so far? Do you need me to explain something further?

Dr. Ayla Wolf 31:02

Well, I think that's the perfect example of being able to be open, honest, blunt, and compassionate at the same time. Yeah.

Mandi Swanson FNP-BC 31:11

Yeah, I haven't lost the compassion. I just do respond a little bit differently than I used to. Yeah. Yeah. So yeah. And um comedy doesn't always hit the same. It's it still doesn't three years later for me. Uh so my kids have have really learned a lot in this process. Um, so the my son that did that episode with me, he's my now 17-year-old. Oh my gosh, I can't believe I'm saying that. But so three years ago when the accident happened, he was 14. And he he's very impressionable. He's my empath. He understands people. He he gets sad when when other people get sad. And he was the first one. So I wrote a book about the first year of my recovery, just very honest, kind of shared everything. When I first started doing the treatments with the red light that actually started improving my cognition, he was the one that gave me the title of that book because he looked at me and said, Welcome back, mom. Because we we were able to have a conversation. I was driving into swim practice all the time. I had to drive through the intersection where I had the accident. So he saw me cry multiple times as we went through that intersection. And that the day that I had my first session, I couldn't stop talking. And he just laughed in the passenger seat. He's like, Welcome back, mom. Like I said, it was it was so funny. So he he observed so much. So when we did that Mother's Day episode, it was it was all about kind of how how we grew together. Because my kids have been able to identify concussions in their friends now and tell them what to do. I'm pretty impressed with how well they they really paid attention. And he he does just catch things and can have a really good conversation. So it was it was nice to get his feedback. And I had gotten all my kids' feedback. There's a chapter in that book that talks about kind of their perspective. So I had them each share what they had learned at that point from it. But I really wanted to see, like now that he's older, what did what are were his thoughts? And I was really, I was really kind of floored by the the interview. I was almost in tears by the end because he did such a really good job, like just articulating things.

Dr. Ayla Wolf 33:23

He was very articulate. I was impressed for a teenager and a boy. I was like, wow, he's very well spoken, very articulate, deep thoughts.

Mandi Swanson FNP-BC 33:33

Oh, yeah, that kid has a lot of deep thoughts. So but just don't just don't text him any deep thoughts. He doesn't like it doing that in text.

Dr. Ayla Wolf 33:41

Got it. Well, I thought it was really funny when you talked about, you know, like asking, like, hey, can you go downstairs and see if there's toilet paper down there? And then like he goes down and comes back up and said, Yep, there is. Yep. And it's like, no, I I meant bring it upstairs. So I I have to always do the follow-through.

Mandi Swanson FNP-BC 33:58

What is the thing I want you to do after checking?

Speaker 34:03

Yeah. Yeah.

Mandi Swanson FNP-BC 34:04

That's a classic. Well, and so you also talked about in the episode that at I think in hindsight, you kind of recognize that at some point you

Acceptance, Pacing And EMDR For PTSD

Mandi Swanson FNP-BC 34:12

were getting in your own way because you just wanted the old you to come back, and that that was actually kind of preventing you from becoming who you are now.

Speaker 34:22

Yeah.

Mandi Swanson FNP-BC 34:23

Yeah, a hundred percent. Uh, in that whole grief process of of not thinking I was ever going to get back to being a nurse practitioner and not knowing what my future held, I was pushing myself so hard. And you you can do too much of a good thing with anything. And if you push yourself too hard in your recovery, you will slow the recovery because your brain can't tolerate all that pressure you're putting on it. And I put my I put a lot of stress on myself. So I, as I pushed through and I did all the things I did, I was like the model OTPT patient. I did all of my exercises exactly as I was told to do, regardless of how I felt with it, because I thought it was going to make me get better. Until my OT at one point sat down with me and she said, How about we take a break because you're working too hard and we're not getting anywhere? I said, Okay, that's uh that's valid. Let's do that. And it was my uh my EMDR therapist, actually. So I had PTSD from the car accident and I added EMDR, the movement desensitization reprocessing. For anybody who doesn't know what that means, that kind of trauma-specific therapy to get over the car accident because I could not drive down the road without having a panic attack if an emergency vehicle drove by me, even without their lights on. And it's I had to go through that intersection, like I said, to get my kid to swim. I I was driving all the time and I could not control my emotions when I was in the car. So I did this EMDR, and she's actually the one that told me that I was getting in my way. Okay. She brought out her little, her little book of tricks, and we talked about, um, I have this in my book, I've talked about it on my podcast. So if anybody's listened to that part, they'll they'll hear this again, and I've shared it with several of my patients. She brought out this book and we talked about acceptance. And it struck me, and I'll tell you why, because in this little statement about acceptance, acceptance, it talks about pain, whether it's emotional or physical. If you have pain and you have non-acceptance, meaning you're not accepting where you are, it leads to suffering. That same pain, whether it's emotional or physical, and you accept where you are, you don't have to like it, you just have to accept it, just leads to pain. That suffering part is optional. And me and my little nerd brain, uh, we do a lot of Star Wars in my house. So it reminded me of the path to the dark side. So my new goal was to avoid the dark side. And in order to avoid the dark side, I had to accept where I was. So I had to accept the fact that right now I can't read more than one or two sentences. Right now, I can't remember my medical knowledge. I can't do all the things at home that I want to do. I can't get the dishes done and the laundry and and this and this and this and this. And I can't get back to work right now. But it's a right now thing. It's not a forever thing, it's a right now thing. And once I came to that conclusion and I realized that I just had to accept where I was right now so that I could work on it, I actually started to heal.

Dr. Ayla Wolf 37:22

There there are lots of universal truths in Star Wars. Yes. There are, yes. And that's a very good point that you make. It reminds me of I had a patient come in and she said, Well, I finally started doing some stress management and it's really helping. And sometimes we hear words like acceptance or stress management, and they just kind of sound like words or sound bites or concepts. But when we do legitimately put these things into practice, they really do make a difference. Yeah. Yeah.

Mandi Swanson FNP-BC 37:57

So I share that with my patients all the time. And we we find what sticks to them. What does that mean to you? What can you attach to that so that you can realize that right now you are where you are? And I don't make a lot of promises to my patients, but I do promise them that they can get better. I can never promise how much. I can never promise how fast. But I I can promise that in in a year and a half of running my concussion clinic now, I have not had one patient come in that hasn't gotten better to some degree. So if you do something, you will get better. But if you do nothing, maybe you will. I think that's a very good way of framing that for people. Because people do often want definitive answers. And we can't give people definitive answers when you have uh injury that's as complicated as a brain injury.

Speaker 38:47

Yeah.

Mandi Swanson FNP-BC 38:47

I always said I wanted a broken bone. Out of that car accident, I wish I would have broke just broken my arm or something. Because a broken arm has a set mark. You can put a star on your calendar when that date is going to be that your arm is gonna be healed. You can't do that with a brain injury. Yeah, yeah.

Dr. Ayla Wolf 39:05

What has it been like having your podcast? Because you did start that when you were, I mean, that was maybe what, a year after the injury.

Mandi Swanson FNP-BC 39:11

I actually started it six months before the injury.

Dr. Ayla Wolf 39:14

Oh, okay.

Mandi Swanson FNP-BC 39:16

So I had the podcast and it was meant to be all things related to brain health and wellness. I had um MS, Parkinson's, dementia, motivational stuff, whatever could help your brain. We we talked about a little bit of everything. I had some TBI patients on there as well. Didn't even think anything of it at the time. And then I, when I started my new neurosurgery job, I actually had six months of interviews already recorded that I just had to put out because I wanted to be able to focus on my orientation. And I'm so thankful that I had those because to anybody looking at my podcast, there was never a break.

Dr. Ayla Wolf 39:53

Wow. Yeah.

Mandi Swanson FNP-BC 39:54

I had six months ready to go. I just had to remember where to find it on my computer each week to post it. That was a trip. But I did ultimately get that all out there. And at that six-month mark, when I ran out of those interviews, I reached out to one of my girlfriends who's a motivational speaker, coach, all the things. And she'd been wanting to start a podcast. I'm like, hey, you want to get some practice? Be the host, interview me. We'll talk about my experience. And from there on out, it was mostly TBI. So I think almost every episode since then has mentioned the word concussion or TBI at least once in it, if it's not the whole thing. And it's it was very therapeutic, I think, moving toward that direction. There are still sometimes I get pitches from people that that want to be on the show for other things related to brain brain health. And I thought that'd be kind of cool. But my new population that listens probably wouldn't get a whole lot out of it. Do you have a favorite episode? I don't know. Like every time I record a new one, it becomes my new favorite because I've had some really cool guests on my show. Um, I think my most recent favorite is literally the one that just came out this past week. Um, Kelsey Boyer is my my guest on it. She is a former snowboarder, Olympic snowboarder, and she created her own nonprofit to help support people. And we had so much fun on that interview because she just has so much energy. And and it's it was cool talking to somebody who is this big important person, and it reminds me that yeah, there I'm doing big important things too. So it just kind of reminds me that yeah, I'm doing the things that I'm supposed to be doing. But yeah, I they all kind of have a certain place in my heart that um it's hard to pick just one. Yes.

Dr. Ayla Wolf 41:41

Totally understandable. So can we talk about medications? I find, especially with post-traumatic

Treating Post-Concussion Headaches Better

Dr. Ayla Wolf 41:51

headaches, that they can be very difficult to treat. Sometimes they often get lumped into a category of migraine when they may not be true migraine. How often are you seeing people coming in who are on medications that maybe are not helping, but they don't know any better? So they just keep taking them? A lot.

Mandi Swanson FNP-BC 42:12

So I always tell patients I there is a place for prescription medications, but it's never the first line of treatment from me. So that is that is not going to be the thing that I do first. And oftentimes we're taking things away pretty quickly, uh, especially if they've they've been doing treatment with somebody else for months before they come to see me and they they just get put on things right away because they have a quote unquote migraine. Yeah. And they're not all migraines. Not every really bad headache is a migraine. So it's really important to, as a provider, ask the patient where on your head does it hurt? What does it feel like when you're having that headache? When does it come on? What makes it better? What makes it worse? If you have a headache from sunup to sundown and it feels like your head is going to explode all the time, that's not a migraine. That's a post-concussion, post-traumatic headache. And I used to have migraines before my injury. I have post-concussion headaches now. They are a different beast. They don't respond the same. You can't treat them the same. So when patients are coming in to me and they've been put on the triptan medications of the world, the imitrex, things like that, and it's not taking away their headache, that should be assigned to providers that it's probably not a migraine. Migraines respond to those medications. If it's not responding, probably not a migraine. And also you can't use that every day of the month. So if somebody has that really bad headache every day of the month, you need to do something different for it. Do I start them on a preventive medication? Sure. Vitamin D and magnesium. Those are always my first two. Uh, there's a lot of research to show that if people are low in vitamin D when they have their brain injury, it's going to take longer to recover. It's not just a supplement, it actually helps them get better. So patients always kind of look at me funny and they're like, oh, you so you are one of those providers that like supplements. I'm like, yes, I do, because they work. There's a purpose for them. And then beyond that, if we need to do more, like again, a lot of those headaches can be vision related. So I'm always making sure that I assess their vision. I spent a shadow day with a neurooptometrist so that I know kind of some of those screenings that I should be doing in clinic. So those tools sit on my desk at all times. I screen every patient the first time when I see them, and then we do follow-ups, but I always screen for vision because 85% of patients have vision issues. And a lot of those lead to these post-concussion headaches. So we do the vitamin D, we do the magnesium, we do the neurooptometry. If we still have headaches, then I start talking about preventive medications. And in neurology, we we typically have three classes that we start with uh seizure medication, antidepressants, and blood pressure medications. Well, the seizure medication that everybody goes to is to pyramid. There's a reason people nicknamed it Dopamax, because it gives you brain fog. I don't use that with my brain injury patients because many of them come in with brain fog. And they'll come in because some provider put them on Topamax and now they have worse brain fog. So that's the first thing I do is take them off of that. I'm like, nope, let's find something different.

Dr. Ayla Wolf 45:03

Yeah. And then I also sometimes I am um guilty of thinking that just because I got the memo, everybody got the memo. But um the medication overuse headaches, even just from ibuprofen, things like that. I'm shocked at how many people will come into my office and say, oh, I just pop ibuprofen every day. And I was like, oh no, you can't do that. Yes.

Mandi Swanson FNP-BC 45:27

Yeah. So many people are unaware. Tylenol ibuprofen, they can cause the rebound headaches. So yeah, you don't want to do it every day. And I'm I am shocked by how many primary care providers I see that that say tell the patients to go ahead and keep using that. And then they don't send the patient to neurology for three months. So for three months, this patient has been priming themselves with NCEBs every day.

Dr. Ayla Wolf 45:48

Yes. And I will say, in the last two years, I have had more patients who have gone to their neurologist, and then their neurologist has said, you need to keep better track of how often you are taking Tylenol and ibuprofen. You can't take them every day. This can cause rebound headaches. And so I do see even a lot of the neurologists are paying very close attention to people's use of over-the-counter pain medication in conjunction with all of the prescriptions.

Mandi Swanson FNP-BC 46:15

Yeah. Yeah, absolutely. And uh, so when people ask me about preventive medications, I'm like, well, you're taking tyanol and ibuprofen every day. I don't want you to. We need to give you something that will Pre prevent that need to try to take something like that. And then the other thing I talk about all the time is water. People don't realize how important water intake is. If you are drinking negative water in a day, you add it up and it's negative because you've drank so much soda or coffee or whatever, and you are are running negative on water, you're gonna have a headache. And I have had multiple patients now come back and after a couple of appointments, they finally say, Okay, Mandy, I finally drank the water you told me to. And guess what? My headache is better. And like, huh? If only somebody could have told you that right off the bat, and then they laugh at me.

Dr. Ayla Wolf 47:01

So yeah. Yep. Um, that one, and then also the connection between headaches, anxiety, dizziness, and skipping meals and and going for eight hours or longer without eating. I always have to say, you maybe could get away with that before the injury, but not anymore. You're not the person who needs to be doing this crazy intermittent fasting for 20 hours a day. That's not gonna work for you. Yeah.

Mandi Swanson FNP-BC 47:25

Yep. No, I I'm not a I'm not a fan of intermittent fasting during recovery from a brain injury. And this might be controversial, but I'm also not a super fan of the GLP ones during a brain injury, especially if patients are complaining of reduced appetite already. Because then they're the chance of them getting the nutrition that they need to their have their brain recover is is going to decrease. Yeah. Well, and it's interesting because there's now a lot of research on ghrelin as a hormone for neuroinflammation. And

GLP-1s, Ghrelin And New Trials

Mandi Swanson FNP-BC 47:54

ghrelin essentially is the like doing the exact opposite as the GLP1s in the body. And so it makes me wonder okay, if ghrelin is neuroinflammatory and actually promotes repair of neurons in the brain, and then you have all these people on GLP ones that are essentially doing the opposite of it. Like, what is that doing to the brain? Yeah, yeah. There's there's a lot of research to support that ghrelin use. So yeah, it's crazy that we would try to do that opposite and decrease their appetite. I'm like, mm-mm-mm-mm. So I I had that not so popular opinion conversation with a patient the other day because she asked me, well, I've I've gained some weight and I'm I'm thinking about the GLP one. And I said, not right now. Not right now. Not if you're telling me that you can go days without eating because you're not hungry. Not right now. Right. We're not, we're not gonna make, we're not gonna promote that even more. Yeah, no. Yeah. So yeah, there's a there's a lot of controversial stuff with with all those new medications and and people come in. And that's the other thing as a provider, you have to be aware of those things. Because patients will come in with the questions and you have to have the answers. If you don't know about it and then you just shoot them down right away, you're not gonna get anywhere. It's kind of like with the that the quote unquote outside the box treatments. If if somebody comes and asks you, well, can I do this and you don't know about it, and you just say no, kind of shooting yourself in the foot on that one too.

Dr. Ayla Wolf 49:15

Yeah, exactly. Well, I know you had Michael Wyand on your podcast. Uh I interviewed the chief trauma surgeon uh from Oxia as well, Vishal Bonsal, Dr. Bonsal. And afterwards, you know, I kind of said to both of them, hey, like as you move into these larger phase two trials, you may need to exclude people on GLP ones from your study because you're trying to study the effects of ghrelin. And if you've got people on GLP ones that are doing the exact opposite, it's going to completely confound your study results. So hopefully they take my advice.

Mandi Swanson FNP-BC 49:49

Yeah. Yeah. I did tell them too, I would love to be part of the research. So I, yeah, I would love to have some patience on that study if possible, because it looks really promising.

Dr. Ayla Wolf 50:01

Yeah. I mean, the preliminary outcomes were uh phenomenal and fascinating too that people actually experienced both improvements in post-traumatic headaches and light sensitivity, which to me says this is very much acting upstream uh and having a lot of downstream beneficial effects. So I found that very exciting.

Mandi Swanson FNP-BC 50:21

Yeah. Yeah. Really um they so they didn't use Rivermead, they used a very similar score for the post-concussion symptom questionnaire, and every single one of the symptoms improved. Yeah. Like there's nothing out there that will improve everybody's symptoms of all of those things that we assess at this point. So that could be just literally an an earth-shattering, game-changing treatment.

Dr. Ayla Wolf 50:46

It could be. Yeah. It'll be very exciting to see where that goes. Yeah, I'm anxiously awaiting that next phase. Well, that leads me to my last question.

Mandi Swanson FNP-BC 50:56

Um, where do you see the future of concussion recovery going from a medical perspective and from where

Future Diagnostics And Better Policy

Mandi Swanson FNP-BC 51:03

you sit as a nurse practitioner? Yeah. I think right now I I'm kind of a little pie in the sky, but I also see a lot of really good things happening. So I'm on um the, oh, we didn't talk about the brain injury alliance. So I'm on the on the Minnesota Brain Injury Alliance. We're there's a lot of really good initiatives coming from from that perspective. The there's a policy group that goes to the Capitol all the all the time and talks about all the different policies related to brain injury. We're moving in the right direction. I think even though our government isn't necessarily super supportive of all the things in TBI right now, there's a lot of practitioners around the world who are. In May, I went to the WHA 79, the World Health Assembly, and I spoke at a side event for TBI, shared my experience as a provider and patient. And there were the ministers of health from literally around the globe talking about how concussion affects their resources and their populations. It is not just a United States thing, it is an entire globe thing, and everybody is forming groups to try to improve this. So I think we right now is a really exciting time to be in the concussion field because there's so much going on. Since 2021, we've seen a ton of research blow up. Since 2024, there's been like a double of the research since 2021. So in the last two to five years, so much has happened and so many more people are getting fired up and talking about it. And maybe it's the algorithm, but on LinkedIn, that's all I see now is everybody is talking about concussion.

Dr. Ayla Wolf 52:37

Oh, 100%. I was joking with somebody the other day that my entire Instagram feed is brain injuries, yoga pants, and pet skunks.

Mandi Swanson FNP-BC 52:47

Well, I got the Highland cows in there too on mine, but oh yeah, yeah, yeah. But it's, I think right now is a really exciting time because there's so much happening, there's so much research coming out, there's so much research being done. There's more people like us out there trying to make changes. And I think the more we we band together and create our own little network, I think the the better it'll be for everybody.

Dr. Ayla Wolf 53:14

Yeah. I think the other big change too, which I don't I don't know a ton about, maybe you can shed some extra light on, is the fact that diffusion tensor imaging used to only be in the realm of research. And now we actually do have clinics where you can go get a DTI, which does show more information on what's happening with the axons in the brain. And so are you referring out for that? Are you seeing these images? Is this happening more?

Mandi Swanson FNP-BC 53:38

I haven't seen any of those yet. Um, I did pair up with the A-men clinics to get SPECT scanning as an option, but the closest one to us in the Twin Cities is Chicago. Right. So they're gonna open the Minneapolis one. I know, I know. So we've we've had some kind of preliminary conversations to see what we can do. So in the meantime, if they've got patients that that need a provider and they've had imaging down there, they can at least see myself or somebody up closer because we have that connection. Um, but it's there's still there's still a ways to go. We need we need to get them more readily available. Um, we also have the blood biomarkers coming. So Abbott has created one. Uh, there's a company in France that had reached out to me at one point that they're working on on the biomarkers also. They're acute, it's not gonna help me in clinic. Um, but trying to get our our friends in the ER to consider those, I think would be really important. They're used a lot down in Florida, just not up here in Minnesota yet. Uh so the I think there's so much coming in terms of of diagnostics that it'll be helpful in the future. I don't think it's still gonna answer all the questions, but I think it'll still definitely be helpful.

Dr. Ayla Wolf 54:50

Yeah. Do you have QEG in your clinic or have you thought about adding that in as a, but I I know a couple of places I can refer to.

Mandi Swanson FNP-BC 54:58

So I have uh utilized that a little bit. Um I've thought about it. I have also thought about adding TMS because there's research right now going on to get FDA approval for TMS for concussion. It's already approved for several other indications that are commonly seen with concussion. Right. Um so that's there's so many things I would like to do, and I don't have enough energy to do all of it.

Dr. Ayla Wolf 55:24

Yeah. Well, sometimes just shedding a light on what is available and what's out there helps to just bring that more into everybody's awareness and consciousness. Yeah.

Mandi Swanson FNP-BC 55:33

Yeah, that's true. Amazing. Well, thank you for all of the work that you're doing in this field. And it's great to have you as a local resource. And

Final Takeaways And Where To Listen

Mandi Swanson FNP-BC 55:41

I love your podcast. Uh, I'll share all of that in the show notes. Is there anything we didn't talk about that you want to share? Um, oh gosh, there's so many things on concussion. I'd just say uh definitely link people to my show and you all of your episodes as well. You have some amazing guests on as well. So I love your show also. Um, so I I think if people just listen to all the things that we say on a regular basis, I think it'll be good. Love it. Awesome. Thank you. Medical disclaimer. This video or podcast is for general informational purposes only and does

Medical Disclaimer

Mandi Swanson FNP-BC 56:19

not constitute the practice of medicine or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and materials included is at the user's own risk. The content of this video or podcast is not intended to be a substitute for medical advice, diagnosis, or treatment, and consumers of this information should seek the advice of a medical professional for any and all health related issues. A link to our full medical disclaimer is available in the notes.