As Grand County resident Julie Mahoney focused on walking in the tire tracks left by a car, she looked up to find she was not the only one on the snow-covered road. 

With half a foot of fresh snow covering the nearby pine trees, Mahoney was startled at the sight of a deer, causing her to lose her footing and slip backward.

With her arms full of kindling for her fireplace at home, Mahoney crashed to the ground, hitting her head on the road and knocking her unconscious. 

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“I woke up to my dog licking my face,” Mahoney said. 

She got through the weekend alone in Grand County and returned back to work in Denver. When symptoms from her fall persisted for weeks, Mahoney decided it would be best to see a physician.

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“At this point, it was a month or two after, and I was still symptomatic — still with horrible headaches,” Mahoney said. “I don’t think I was aware of how many symptoms I had.”

Mahoney’s condition was so bad that she had to take periodic naps to get through her workday.

When she went in to see a doctor, tests were able to determine that she had been living with a brain injury for the past several months. The diagnosis forced Mahoney to leave her career as an OB-GYN and made her recognize she was experiencing severe symptoms. 

“I stopped working, and that was like the first time I really paused,” Mahoney said. “I started seeing kind of what a mess I really was.”

What Mahoney did not expect was how slow her recovery process was going to be. With the injury taking place in January 2022, Mahoney is still facing challenges.

While she realizes that recovery looks different for everyone, she believes one of the reasons she is still struggling through her brain injury is because of a lack of access to care.

“It is a slow process — all of this,” Mahoney said. “… It might be because we are still sort of in the infancy of figuring this disorder out.”

Overcoming barriers in rural health systems

While Summit and Grand counties are equipped with medical facilities and experts who can help traumatic brain injury patients, the path to recovery can be difficult due to a variety of factors. 

Most symptoms of a traumatic brain injury — headaches, lethargy, dizziness, confusion — overlap with other common ailments, making diagnosis challenging. Symptoms may be delayed or worsen over time, depending on the circumstances, and there’s no single test a doctor can run to definitively diagnose a TBI, according to the Brain Injury Association. 

A 2022 study published in the National Library of Medicine, titled “Challenges and opportunities in diagnosing and managing mild traumatic brain injury in rural settings,” explored why patients in rural areas often have higher risk associated with TBIs and worse outcomes than patients in urban settings.

Though Grand and Summit counties are bursting at the seams with millions of visitors annually, both areas are considered rural. The 2022 study found that a lack of public awareness of TBIs in rural communities was a top factor for why patients see poorer outcomes. Public awareness about TBIs is key to helping physicians reach a diagnosis. 

Similar to Mahoney, Stephanie Zavilla — the director of sports performance at the Winter Park Competition Center — had difficulty finding care after she was involved in a tubing collision. Zavilla said it took about three years to secure a TBI diagnosis for her significant injury.

Need help navigating a traumatic brain injury and finding resources? Here’s a guide to connect with experts.

Summit County’s Drew Petersen had a similar experience with getting a definitive diagnosis for his serious traumatic brain injuries. Though Petersen was able to treat many of his symptoms through an intensive brain injury rehab program, the professional skier believes there is still not enough research and understanding in the neuroscience space.

According to “Traumatic Brain Injury: A Roadmap for Accelerating Progress,” a study published by the National Library of Medicine, gaps and challenges in current TBI care and research exist because of the variably of symptoms, fragmented care systems with multiple handoffs, a variability in care patients receive, insufficient access to care, a gap in the knowledge base and a lack of therapies for treating TBIs.

Not only do these shortcomings lead to unstable TBI care nationwide, they also expose rural areas that do not have the same resources as metropolitan areas. This challenge with access to care also leads to a higher rate of TBI related deaths in rural vs. urban areas.

According to the Centers for Disease Control and Prevention, individuals living in more rural areas are at a greater risk of dying from TBI compared to people in urban areas because of the time it may take to travel to emergency medical care and the lack of access to a Level 1 trauma center — the highest level of medical care. 

People living in rural areas also struggle to get the services they need in order to treat their condition. In the case of brain-injury patients, where specialized care is extremely prudent, this can lead patients to have a limited number of options for advanced care.

Bolstering traumatic brain injury care in rural communities

Despite challenges of providing advanced care in rural areas, health care providers are working to bridge the gap by focusing on ways to improve their brain injury programs in the Colorado High Country. 

CommonSpirit nurse and trauma program specialist Lizzy de Guia is just one of the many people who are on the frontlines of bringing high-level brain injury care to the High Country.

Over the past several years, de Guia has helped shape a trauma program in Summit County that not only focuses on education, but also prevention. While a program like this was hard to find nearly a decade ago, CommonSpirit has responded to the need for an increase in care options in the mountains.

With a network of medical professionals and telehealth advancements, many physicians can help ensure patients get the care they need if they suspect they have a TBI — even if they can’t get it locally. 

“(We look) through all of the cases who come through our ER and either get admitted or transferred,” de Guia said. “I love to make sure that we are not just providing trauma care up to our policy, but also state policy, so that our patients can get the best care possible.”

De Guia said St. Anthony Summit Hospital does everything it can to maximize successful outcomes.

“We do a really good job for a small hospital, which is really rewarding because most Level III trauma centers in rural areas do not have the resources we have,” de Guia said. “CommonSpirit has been really great to let us foster this Level III facility into something that is meaningful for the community.”

Outside of brain trauma prevention, Summit County has a large network of doctors, medical professionals and physical therapists who are passionate about treating traumatic brain injuries. 

Melissa Volkert, a CommonSpirit occupational therapist “is so passionate about TBI care,” de Guia said. “She has done a lot of the education with staff around traumatic brain injuries, and then a big push for us was getting physicians to diagnose the traumatic brain injuries.”

The push for physicians to readily diagnose TBIs is a shift many hospitals have made in recent years. Previously, a patient could come into the ER with a broken bone, and the fracture may be the only thing that is focused on while in the hospital. Now, physicians are working to diagnose all of the patient’s symptoms.

“Adding in that diagnosis of traumatic brain injury is really helpful,” de Guia said. “One, so we can see prevalence and that it calls attention to the other issue at hand. Traumatic brain injuries are called invisible injuries for a reason. Unless you are talking about your symptoms, people may not know there is something wrong.”

CommonSpirit pediatric Dr. Dana Barnett has been in the Summit County community for the past two years and is blown away by the support network patients have at their disposal when it comes to brain injury care. 

Have headaches and balance issues after suffering a traumatic brain injury? Vestibular therapy can help after a fall.

With knowledge of working in several communities, Barnett said the High Country offers her a sense of teamwork and camaraderie that can be hard to find elsewhere in the medical field.

“When I practice, I am not alone,” Barnett said. “I may have a patient with a concussion, and I know that the athletic trainer is heavily involved in that patient’s care. I know that I can reach out to them personally to help ask questions or make sure they are aware of a student’s progression.”

Barnett also feels confident in referring her patients to local rehabilitation options, such as occupational, vestibular, cranial sacral and visual rehab. 

“I feel like the community does have a lot of resources for patients to get their support and get themselves healed,” Barnett said. “I am not alone and have a really good network here. Hopefully, the patients appreciate the care that they get and the resources that they have here.”

For those who do need a high level of specialty care that reaches beyond what Summit County can currently offer, CommonSpirit has a system of health care professionals who can be seen on the Front Range. 

With both the Middle Park Health hospitals in Granby and Kremmling being Level IV trauma centers, brain injury patients most often receive advanced traumatic life support before being transported to Denver for a more in-depth evaluation.

While the discrepancy in care between Grand County and the options on the Front Range are noticeable, Middle Park Trauma Medical Director and ER Dr. Michelle Lupica is encouraged by the growing amount of brain injury resources present in the rural community. 

“I think there are a lot of really good resources,” Lupica said. “I know there are several different physical therapy departments. Middle Park has one, and there are other ones in the county that can do concussion evaluations and kind of help you with a (return-to-activity) program.”

In her role at the Winter Park Competition Center, Zavilla has made it a priority to prevent further brain injuries. From providing education sessions for parents on concussions to talking about the importance of helmet quality, the Winter Park Competition Center is chipping away at making the slopes a safer place for those young and old. 

“There has been a lot of community outreach from the Winter Park Comp Center,” Lupica said. “I know there have been some with ski patrol and Middle Park about concussions and prevention. So honestly, for a small county in a rural community, I think we do a pretty good job of getting information out there.”

Pushing for more advancements for traumatic brain injury patients

Three years removed from the fall that caused her brain injury, Mahoney is still battling symptoms like extreme fatigue and trouble focusing. 

Mahoney believes more research advancements and increased accessibility to care are needed. 

There are clinical research studies being completed in the brain injury space, but these studies often take years to complete. Some of the major areas of current research include the use of biomarkers to differentiate between different types of brain damage. 

Additionally, researchers are trying to get a more firm understanding of the long-term outcomes of brain injuries. Current studies are focusing on how state-level resources and support can improve outcomes as well as how brain injuries can affect long-term memory.

Mahoney has received the contacts for neuroscience professionals who work with professional athletes but said her health insurance provider isn’t accepted. 

“These are places that do not take insurance,” Mahoney said. “It is $20,000 to walk in the door, and then any treatment modality after that costs more. They are just working with prices that your everyday Joe Schmo cannot really handle.”

Mahoney said the top-end neuroscience practices may have the knowledge and resources many brain injury patients need, but she doesn’t think the majority of the population has access to that level of care.

Mahoney is hopeful that progress continues to be made in the brain-injury space so people like her can get answers and relief.

“Hopefully, in the coming generations, they are going to figure it out,” she said.

Sky-Hi News reporter Emily Gutierrez contributed to this report.