In this episode, Neurosurgeon Dr. Joseph Maroon tells us about his life journey, the physician brain, the benefits of exercise on the body and the brain, neuroplasticity and new horizons plus so much more.
“One day I was doing awake brain surgery on patients with tumors in eloquent parts of their brain and the next week I literally was working in a truck stop, bequeathed to my mother, heavily mortgaged in Wheeling, West Virginia in the dead of winter. I was filling up 18-wheelers, flipping hamburgers, and wondering, how in the world did this happen to me?”
-Dr. Joseph Maroon, Clinical Professor and Vice Chairman of the Department of Neurosurgery at the University of Pittsburgh
In this week’s episode, Dr. Jen Barna speaks with Clinical Professor and Vice Chairman of the Department of Neurosurgery at the University of Pittsburgh, Dr. Joseph Maroon. Along with being the team neurosurgeon for the Pittsburgh Steelers, Dr. Joseph Maroon is also highly recognized as a co-developer of the ImPACT neurocognitive test, the only FDA approved test for concussion assessment and now the standard of care in most amateur and professional sports organizations.
During the podcast, Dr. Maroon shares his personal journey with stress burnout and clinical depression. He notes that his recovery was mainly dependent on natural physical activity that worked to re-stimulate the relationship between the body and the brain. As discussed in his book Square One- A Simple Guide to a Balanced Life, Dr. Maroon talks about how physicians can create a balanced life of work, family, spirituality, and physicality. Dr. Barna and Dr. Maroon also discuss the topic of physician vulnerability and how physicians may feel challenged to hide any signs of personal health struggles. This week’s episode provides a meaningful conversation to confront this mindset.
Dr. Joseph Maroon is Clinical Professor and Vice Chairman of the Department of Neurosurgery and the Heindl Scholar in Neuroscience at the University of Pittsburgh Medical center, Pittsburgh, PA. Along with being the Senior Vice President of the American Academy of Anti-Aging Medicine, he has also published over 290 peer reviewed papers, 56 book chapters, and 6 books. In 1990, Dr. co-developed the ImPACT neurocognitive test which is the only FDA approved test for concussion assessment and is the standard of care in most amateur and professional sports organizations. He was the first neurosurgeon directly appointed to the NFL, serving as the team neurosurgeon for the Pittsburgh Steelers for 35 years. In 2017, his book on overcoming adversity and “burnout”, Square One- A Simple Guide to a Balanced Life, was favorably reviewed by Dr. Sanjay Gupta and others. In his personal life, he has completed 8 ironman distance triathlons and in 2021 he placed first in his age group in the St. Petersburg Olympic distance triathlon. An inductee to the Lou Holtz Hall of Fame, he was selected as the 2019 “Man of the Year” by the Jerome Bettis Foundation and in 2020 was honored with the Physician of Courage Award by UPMC.
To learn more about Dr. Joseph Maroon, please visit his website at josephmaroon.com and follow him on social media.
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Podcast produced by: Mara Heppard
Please enjoy the full transcript below
Dr. Maroon: One day I was doing awake brain surgery on patients with tumors in eloquent parts of their brain and the next week I literally was working in a truck stop, bequeathed to my mother, heavily mortgaged in Wheeling, West Virginia in the dead of winter. I was filling up 18-wheelers, flipping hamburgers, and wondering, “How in the world did this happen to me?”
Jen: Welcome to DocWorking: The Whole Physician Podcast. I’m Dr. Jen Barna and I’m thrilled to be here today with guest, Dr. Joseph Maroon, Clinical Professor and Vice Chairman of the Department of Neurosurgery at the University of Pittsburgh, who co-developed the imPACT neurocognitive test, which is the only FDA approved test for concussion assessment back in 1990 and who is the team neurosurgeon for the Pittsburgh Steelers and first neurosurgeon directly appointed by the NFL. He has published more than 290 peer review papers, 56 book chapters, six books, and most recently, published Square One: A Simple Guide to a Balanced Life. Dr. Joseph Maroon, welcome to DocWorking: The Whole Physician Podcast. I’m excited to talk with you because we share an interest in how to live a balanced life. Thank you so much for joining me.
Dr. Maroon: My pleasure, Jen. Looking forward to it.
Jen: Dr. Maroon, you’ve had such a significant career and accomplished so much. I know that you took a lot of sacrifice on your part as well as on the part of your family. What happened that you described in the book leading up to the time when you were around 41 years old when suddenly things changed for you?
Dr. Maroon: Well, Jen, excellent question, and when I came out of my residency hundred years ago, I was very intent on doing well, on being successful. Most of us have heard that the three A’s for success are availability, affability, and ability. I was available, I was affable, and I thought I was pretty able and I still think that of course. But I also was hell bent on being the very best that I could at almost the sacrifice of many other aspects of my life. Within the course of a week, after doing very well at the University of Pittsburgh, my father died of a heart attack at age 60 prematurely. My family broke up because of my pursuit of success if you would and I had to quit neurosurgery. Because I realized I was not able to continue to operate quite frankly in a safe way and I left neurosurgery.
One day I was doing awake brain surgery on patients with tumors in eloquent parts of their brain and the next week I literally was working in a truck stop, bequeathed to my mother, heavily mortgaged in Wheeling, West Virginia in the dead of winter. I was filling up 18-wheelers, flipping hamburgers, and wondering, “How in the world did this happen to me?” And clearly, pathologically depressed, unable to think clearly. My salience network, my executive network, my default mode networks were all scrambled if you would. I was this way for several months. One day, the banker who held the mortgage on the truck stop called me and said, “Hey, Joe, you need to go for a run.” I said, “Run? I’m 20 pounds overweight. I can’t walk up a flight of steps without being dyspneic.” But I found a pair of old scrubs, and sneakers, and went down to the local high school track, made it around four times, and said, “Never again.” I was exhausted, hurt, winded.
But that night, something very strange happened. I slept for the first time in about four months. The next day, I went down and did a mile and a quarter, then a mile and a half, and then two, and then three. As the unintended side effect of running and subsequently learning to swim and bike, my neurotransmitters were getting rebalanced. I was rebooting my brain. My serotonin levels went up without drugs, my acetylcholine increased, so I started to think better, my dopamine and my endocannabinoid system was functioning at a better level without THC, and I learned to swim and bike. I started entering triathlons, and I’ve completed eight Ironman distance races, and 70 or 80 other Olympic and other kinds of triathlons, and it continues to this day because I discovered the mind-body connection. The mind clearly can make the body very sick, atherosclerosis, stress, cortisol, cardiac events, irritable bowel.
But also, what I’ve discovered is that the body can heal the brain. This is something that people simply, conceptually don’t really grasp. You can heal your brain through physical activity, which we know now is the best antidepressant. In head-to-head studies, psychiatric studies with serotonin reuptake inhibitors and other drugs versus exercise, exercise wins every time. Aerobic activity. You don’t have to do triathlons. But aerobic activity wins every time. So, for years, for decades, three, four decades, I’ve plucked tumors from the brain, removed blood clots, I dealt with the structural problems of the brain, but nothing with the functional. I can’t help but recall the lines from Macbeth, when his wife was suffering from PTSD from murdering King Duncan. Macbeth went to the physician and said, “Doctor, how does one pluck from memory some rooted sorrow, erase the written troubles of the mind and with some sweet oblivious antidote cleanse the heart of that troublesome stuff?”
We’re very good, at technically removing, as I said, tumors, blood clots, aneurysms from the brain, but the functional aspect of the brain, we’re so deficient. In this period of the pandemic, 80% of people have anxiety and are depression, overworked, overcommitted, overwhelmed, overstressed, and burned out. I’ve come to the four epigenetic factors of diet, exercise, avoiding environmental toxins, alcohol, drugs, smoking, and controlling stress. Those four epigenetic factors can increase longevity, reduce cancer, heart disease, and stroke, and really put people into a balanced state. That was the essence of why I wrote the book, Square One: A Simple Guide to a Balanced Life. Sanjay Gupta of CNN said, “It’s already changed his life.” It’s something about personal experiences, saying that data is one thing, but personal stories are another. The personal story, for not only me, but for so many other people, can be motivational. So, that’s my preamble, [laughs] if you would, Jen.
Jen: First of all, I really commend you for coming forward and talking about your personal story because what I’ve found from talking with physicians all over the country is that it’s difficult for us to be vulnerable. We’re trained not to be vulnerable. I think that certainly does contribute to putting ourselves on the path to burnout. So, I really appreciate the fact that you tell your story, and that you’re willing to step forward, and show an example of hitting the end of the road, but then finding a way to turn that around. Something else that I really enjoy talking about and exploring on the podcast is the concept of hidden stress and what effects that can have to our health. There Are some really fascinating turns that have been made, it seems in the last several years, in new ways of thinking about neuroscience. And so, as a neurosurgeon, it’s fascinating to hear you speak about some of those ideas that are coming to the forefront and that you have personally experienced. Have you also incorporated that into your practice of medicine?
Dr. Maroon: Yes, I have. Jen, you’ve touched on several points. Number one is neuroplasticity. The ability of the brain to heal itself and to change. Heraclitus, the Greek philosopher 2,400 years ago said, “You could never put your foot into the same river twice.” Why is that? Because the river is constantly moving. Your brain is actually the same way, because of our five senses and the constant input of smell, taste, touch, hearing, we’re constantly neuromodulating our brain structure and function. On my website, I made a video with the students here in the Video Science Department of the University of Pittsburgh called “Calming the Brain.” It’s on my website josephmaroon.com. It’s a 12-minute video on calming the brain where I discuss exactly what you’re talking about: neuroplasticity, retraining the brain, and also the significance of new things like transcranial magnetic stimulation, photobiomodulation, psychedelics, and hyperbaric oxygen therapy. All these are techniques for neuromodulating either upregulating or downregulating the synaptic connections that determine in our limbic system, mood, behavior, thinking, etc. It’s really worthwhile watching along the areas that you’re discussing.
Jen: I’d love to hear more about the different neuromodulators that you just mentioned, the newer ways that surgeons are using these new techniques. So can you tell us a little bit, you mentioned I think four there.
Dr. Maroon: Yeah. Well, I gave a talk recently to the society for brain mapping and engineering on the connectome, which is the wiring diagram of the brain from psychosurgery to neuromodulation, psychedelics, and hyperbaric oxygen therapy. A rudimentary understanding of the neuron, the neuronal theory, the synaptic connections, the transmitters, and that the brain is an electrochemical organ, not a computer, which is zero and one that works in series. The brain works in parallel electrochemically, with various mental disorders, anxiety, depression, particularly depression, there’s either upregulating or downregulating various neurotransmitters and electrical transmission in the various networks that I alluded to before the executive network, the salient network.
What we’re able to do with various energy sources now is to modulate that electrochemical transmission. People who are depressed, who fail depending on your insurance, one, two, or three psychotropic antidepressants, transcranial magnetic stimulation can be used, which is placing literally, a magnet over the prefrontal cortex, and then either upregulating or downregulating the pathways subserving emotion, thought, behavior. It really is a very effective option. When the next option is electroshock therapy, which is still done in this country about 100,000 patients a year for intractable depression. There are now many studies going on with photobiomodulation using near infrared stimulation, transcortical, transcutaneously to do the same thing in terms of neuromodulating, the neurotransmitters that are active in these various networks.
It’s a burgeoning new area of science that very few people are aware of. It’s fascinating to me to go as I said for years. I’ve modulated, if you would, the structural aspects of the brain that I’m even more fascinated now by functionally, how the brain works in health and in disease. What can be done to pluck from memory rooted sorrows and erase the written troubles of the mind like PTSD that is horrible in so many people, not just our soldiers. So, it’s a burgeoning area of neuroscience that is just so exploding and I’m fascinated by it.
Jen: Do you think that PTSD plays a role in physician burnout?
Dr. Maroon: Yeah, it does. But I think the other thing is moral outrage in the way health systems function now economically. Physicians are generally not appreciated as they were in the past. There’re various factors both ways on that. But being on a stopwatch and stop clock for how many patients you see, the electronic medical record being more important for billing in terms of the economists who run the hospitals rather than patient care. Everything, it’s about balance. Aristotle said, “Hit the mean between extremes in everything. Don’t eat too much, not too little. Don’t exercise too much, not too little.”
Jen: You’ve mentioned before that when you were prioritizing your career over everything else that it impacted your family and I’m curious about what your thoughts are about physician families?
Dr. Maroon: Hugely important. And again, we could go on for a long time, but the thing that I neglected was the Buddhist talk about awareness or mindfulness. I was not aware or mindful of what I was doing in my pursuit of “success, status, pecuniary awards, power, authority,” all these things that we associate with success. Only when it’s attained does its hopelessness become aware. Early on in my career, you’re right, you don’t want to divulge your weaknesses to your colleagues or your administrators. But where I am now, [laughs] I used to say, “I was in the fourth quarter. I’m now in overtime.” it doesn’t matter too much who I offend at this point.
Jen: So, now, you’re in a place where you feel that you can be more vulnerable.
Dr. Maroon: More open, more helpful. Kahlil Gibran who wrote the book, The Prophet, said, “We give but little when we give our possessions. It’s when we give of ourselves that we truly give.” That’s what you do as a physician. That’s what I do. That’s what all physicians do. We give of ourselves as well as our possessions. In the Bible, “It’s in giving, we shall receive” and there’s absolutely no doubt about that. It’s in reaching out to others that we find contentment.
Whoever’s listening to this, I want you to right now, draw a square in your mind. Work, family, spiritual, and physical. Now, I want you to draw a line and commensurate with how much effort you put on each of these on a daily basis. How long is your work line, your family, your spirituality, and your physical? My line was all work. There was no family essentially. My spirituality was completely atrophic after 12 years of Sisters of Charity and coming and growing up. There was no physicality. That nomogram, I’ve given hundreds of talks, Jen, that’s the only thing anybody ever remembers of anything I’ve said, is the square. That’s why the title of the book is Square One. Getting back to square one, getting back to balancing your life on the work, the family, the spiritual, and the physical. It’s just essential.
What are the three most important things in life to you? Number one, is physical and mental health. Without those two, you’re in shallows and in misery. Number two is relationships with God, family, friends, and colleagues. And number three is carpe diem, seize the day. So, I appreciate the opportunity to share this time with you and look forward to future talks.
Jen: Thank you so much. Dr. Joseph Maroon, we really appreciate you coming and sharing your wisdom on DocWorking: The Whole Physician Podcast. As you said earlier, if people want to find you and find out more information about you, they can go to josephmaroon.com. We will also post information in the show notes with some links and we’ll post your video as well on our blog. Thank you so much for joining me here today. It is really a meaningful conversation.
Dr. Maroon: Thank you so much. I appreciate it.
Amanda: I’m Amanda Taran, producer of DocWorking: The Whole Physician Podcast. Thank you so much for listening. Please don’t forget to like and subscribe, and head over to docworking.com to see all we have to offer.
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