Gabby Cinnamon (Host): Welcome back to the Well Within Reach podcast. I'm your host, Gabby Cinnamon. And today, I am very excited to be joined by Dr. Alex Rugino, a neurosurgeon at Riverside, to discuss different types of brain-related traumas.

My Chart ad: Healthcare can be confusing, but thanks to your myRiverside myChart, you can easily manage not only your care, but your family's as well. With a single click, your myRiverside Mychart lets you stay well-connected to the same information your provider sees. You can view your health history, get test results, request prescription refills, pay your bill, or make an appointment. Manage your care from anywhere, our laptop, phone or tablet. Learn more and enroll today at riversidemychart.org.

Host: Thank you so much for coming on the podcast today, Dr. Rugino.

Dr. Alex Rugino: Absolutely. Thank you for having me.

Host: So, this is your first episode with us. Can you kind of tell our listeners who you are and a little bit about your background?

Dr. Alex Rugino: Sure thing. So, as you already said, I'm Dr. Alex Rugino, neurosurgeon at Riverside. Honestly, my Neurosurgery journey started when I was a physician assistant back in Danville, Pennsylvania. Then, I decided I just wanted to be the surgeon. So, I went to med school in Lake Erie College of Osteopathic Medicine in Erie, Pennsylvania, and then went through residency in Columbus, Ohio. And it's brought me here to Bourbonnais/Kankakee, Illinois. And I'm happy to be here and starting up my neurosurgery practice here, as well as developing a neurotrauma program.

Host: Well, we're very excited to be talking about this topic with you today. So, can you kind of tell us what is, you know, neuro/brain trauma, you know, for those listening who might not know?

Dr. Alex Rugino: Sure thing. So, neurotrauma refers to pretty much any injury to the nervous system. That includes brain, spinal cord, peripheral nerves, as well as surrounding structures like the skull, the spine. And yeah, it can result from various causes like accidents, falls, sports injuries, things like that.

Host: What are some of the most common neurotraumas you see come through the ER at Riverside? I know you just mentioned some of the things that can cause it, but are there specific types of injuries that you see most frequently?

Dr. Alex Rugino: Riverside does have the capacity to see and treat just about all the neurological traumas that come through. But most commonly, I'd have to say I see a lot of spine fractures, whether it be someone with osteoporosis who falls and has a back fracture or, more rare, a like healthy, otherwise 20 something year old who gets in like a car accident. Those are the most common.

Host: So, on the topic of brain-specific injuries, can you talk about the difference between concussions TBI and some of the other common ones that you see?

Dr. Alex Rugino: Absolutely. Ultimately, honestly, they both fall under the same umbrella of traumatic brain injury or TBI. A concussion is a type of mild traumatic brain injury. Usually, concussions, one of the defining features of concussions is that they actually don't show up on imaging. So, it results from, you know, a blow to the head or a sudden jolt that shakes the brain inside the skull. And symptoms can include headaches, confusion, dizziness, temporary loss of consciousness. And as I mentioned, they're generally considered mild and resolved with time and rest.

Now, there are different types of concussions and there are many lectures that tell us what kind of concussions there are, whether it be cognitive, speech, or like mathematical even. But from a general traumatic brain injury standpoint, that's basically the umbrella term that encompasses the broader range of brain injuries all the way from mild/concussion to severe traumatic brain injuries where they're completely like unconscious for instance. And with the more serious ones, it can cause more lasting permanent damage.

Host: Why is it so important for patients who have a neuro brain spine-related injury to get medical attention right away? I'm sure, you know, if you've been in a car accident, likely ambulance is going to be called. But more on the subject of you're playing a pickup basketball game and you hit your head and you think, "Oh, maybe it's nothing," why is it still important for you to seek medical attention?

Dr. Alex Rugino: It's very important, because one of the main and best treatments for traumatic brain injury is early diagnosis, figuring out what it actually is that's the problem. You know, as you said, pickup basketball, I mean, me as a 5'6" male, I'm not really, you know, basketball type, but it's one of those things where you just have to make sure that we diagnose it correctly and are able to monitor how they are for a small time being in the hospital, because we do want to monitor for things like swelling, bleeding, or increased intracranial pressure that can lead to more permanent damage, as I kind of mentioned before, like cognitive impairments, physical disabilities, and emotional or behavioral changes.

Host: So, let's say someone comes into the ER with a neurotrauma. Can you talk about the diagnosis process, treatment, and all of that for that person and kind of talk about your role as the neurosurgeon? I think, if you haven't experienced that and you're listening, it's a lot to think about if you come into the ER, like what's going to happen next?

Dr. Alex Rugino: Absolutely. I'm pretty much at the intervention stage. But when it comes to coming into the ER, initially, it's one of those things that you need to be initially assessed by the ED team, and they undergo the evaluation for determining the severity of injury like a physical exam, neurologic assessment, what have you. And then, of course, they get the appropriate imaging tests. And after they're stable, some people may have heard the term ABCs when it comes to getting into the ER, and that's airway, breathing, circulation. Those things are top priority. You know, I'm more of a secondary or even sometimes a tertiary interventional. So when it comes after stabilization and everything, as I said, ABCs, that's when you get to figuring out any neurosurgical thing that might need to be done, whether it be through the use of imaging, like finding a head bleed on a CT. And then, that's when I get involved and figure out what needs to be done based on the severity of the bleed or severity of fractures or things of that nature.

Host: Got it. That makes sense. Now, we are going to take a quick break to talk about emergency care at Riverside.

In an emergency, you want the most advanced care close to home. Riverside's Emergency Room is proud to offer the area's only on-site full continuum of cardiac care, including heart surgery, the area's only on-site full continuum of neurological care, including brain and spine surgery, and the area's only on-site pediatricians from University of Chicago Comer Children's Hospital. Learn more about Riverside's state-of-the-art emergency room at riversidehealthcare.org/er. Now, back to our episode with Dr. Rugino.

You talked about some treatment options that are available. What specifically can you do at Riverside for neurotrauma patients? I think that there's a misconception in our community that you automatically have to go up north to be treated for any kind of injury. Well, you might have to go there for some things. There's actually a lot that we can do for people, do for our community here. Can you talk about that?

Dr. Alex Rugino: Absolutely. I mean, when it comes to neurotrauma, it's one of those unpredictable things. So, you have to have someplace locally that can treat these all the way from mild to severe issues. So, Riverside itself does provide that wide range of treatment options for neurological trauma. Obviously, the type of treatment depends on what type of trauma and what type of injury. But for instance, if neurosurgery is involved in more than just monitoring per se, like we have to do surgery for something. I mean, we are brain and spine and peripheral nerve specialists, we can do surgery for the brain to decrease intracranial pressure. We can fixate a spine fracture that can potentially make someone paralyzed, and also help correct peripheral nerve injuries to the best of our abilities as well. So, to be all encompassing, you know, I would say that Riverside Medical Center at this point, now that we've gotten our three neurosurgeons, our full complement at 24/7 coverage, you know, we can pretty much deal with it all.

Host: Yeah. And I think that's great too and, you know, just a good reminder for the community, because time is of the essence with a lot of these injuries. It's important that we have this right here and have providers available to treat all of these kinds of injuries. I'm sure it depends on what the issue or trauma is, but what might recovery look like for different types of neurotraumas?

Dr. Alex Rugino: Again, just about everything else I've said, you know, when it comes to the severity and type of injury, but basically, you can break it down into phases: the acute care phase, rehab, followup care, and then just any other general support. And what that basically encompasses is, you know, acute care is the initial hospitalization, possible surgery. Rehabilitation is any kind of recovery program that needs to be done afterwards to either encourage their physical recovery, occupational recovery, speech therapy, things like that. Followup care would then just be my medical supervision and in-office visits and adjustments in treatment as needed. And then, of course, as I mentioned, the support services, when it comes to emotional and mental health of people who have suffered from a neurologic trauma, they have that psychological support and counseling.

Host: Are there any long-term effects, maybe that some that people might not think about from a neuro-related trauma that a patient might experience?

Dr. Alex Rugino: Well, as you had mentioned, you know, the ones that you would think about of neurological trauma would be something like weakness, paralysis, something like that. But you can have a whole slew of different symptoms and syndromes based on what is damaged. You can have cognitive impairments like memory loss, difficulty concentrating. Then, again, as I mentioned, the physical disabilities, the weakness, paralysis, or coordination, even balance.

Also, you can have emotional and behavioral changes as well as permanent, long-term lifelong issues with like depression, anxiety, and mood swings just based on the-- honestly, they're all interconnected in a sense where, if you have like permanent physical disabilities and permanent, frustrating cognitive issues, like memory loss, you know, it's like, "Where'd I put my keys?" I suffer from that, I suppose all the time. But for like emotional and behavioral changes, it all kind of feeds into itself, because it's hard to get back to a "normal life" when you've had these permanent disabilities that occur.

Host: Kind of on a little bit of a happier note, are there any advancements that you would like to talk about related to the treatment of neurotraumas? Thankfully, medicine has come a long way and continues to advance every day. Is there any that you'd like to discuss or any that you've seen recently?

Dr. Alex Rugino: I would say in the general scheme of things, you know, all medicine, not just neurotrauma, not just neurosurgery is advancing through the use of research and with technology advancing as quick as it is, you know, it's one of those things where there are many different conferences that we go to, to learn about the new upcoming techniques that are available to us. And, you know, some things along those lines are like minimally invasive surgery. Well, open surgery has its place. Minimally invasive to not disrupt as much of the surrounding tissue is certainly warranted in a lot of cases. Neuroimaging advances can tell us what parts of the brain are injured and what exactly we need to do, or how we can address those issues. And maybe, as I've kind of mentioned, you can't really see a concussion on imaging. Maybe at some point, we'll get to the point where neuroimaging is able to do that. Rehabilitation technology is another one of those. Use of robotics to help people from one area to another to even-- I know that there are some tests and things having to do with implanting an electrode in the brain to make use of an otherwise paralyzed arm or leg or something like that. It's there. It's coming about. It's not perfected yet, but it's all coming about.

Host: I was just in a meeting, like, actually today, and they're talking about brain surgery. And when people think of brain surgery, at least, and I was like, I didn't even realize I thought like this, they automatically think, "Oh my gosh. They're going to have to open your entire brain." But so much of this stuff is now minimally invasive, which is good, I'm sure. But I think for a lot of people that comes to mind, automatically, that's just what's going to have to happen.

Dr. Alex Rugino: Yeah. And when it comes to trauma, I will say a good majority of it like, for instance, by the way, correct me if I'm being too graphic or something. If it is something like it's a head bleed, you do need to open up and give that brain space because it will swell. It will get injured if you don't open up a good portion of it, at least. You know, people do have big scars. And, as I said, there's a place for minimally invasive, there's a place for open surgery as well.

Host: Right. Yeah, I know that makes sense. Before we go, is there anything else you would like to add?

Dr. Alex Rugino: Coming from a neurosurgery/neurotrauma podcast, it's one of those things I just want to make sure that everyone's staying safe. Some of the most important things are wear your helmet while you're on a motorcycle. Wear seatbelts when you're in a car. You know, these are life-saving things that sometimes we just take for granted.

Host: That's a great reminder to end off on. Thank you so much, Dr. Rugino, for coming on the podcast today.

Dr. Alex Rugino: Absolutely.

Host: And thank you listeners for tuning in to Well Within Reach, brought to you by Riverside HealthCare. To learn more about Dr. Rugino and Neurosurgery at Riverside, visit riversidehealthcare.org. Also, make sure to rate and leave a review for our show on Apple, Spotify, or wherever you listen to podcasts.