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Coordinated TBI Care Helps Pediatric Anesthesiologist Get Back on Her Feet After Running Accident


For Jenny Rhoads Larkin, running is more than just exercise. It's a time to release stress and think. It's something she has done since a young age, when she and her dad—as well as her coach and running partner—would go out on runs to chat and discuss their goals. Both she and her dad are extremely competitive, and Jenny's mom would often declare a "winner" after watching through the window.

In early August 2019, Jenny was out on one of those runs. It was a hot day in Las Vegas, but she wanted to get some fresh air after spending a significant part of the past few months inside while undergoing treatment in her second battle with cancer. As a mom of two young children and a pediatric anesthesiologist, her run during the lunch hour that day was a chance to escape and clear her head.

A few hours later, her husband Bryce arrived home a little earlier than normal. He saw Jenny's car in the garage, which he immediately thought was unusual, and his anxiety only increased when he went inside and their nanny was surprised to see that Jenny was not with him. He panicked, looking for her in the house and then calling friends. He tried to find her location using her cell phone and Apple Watch data. When none of that worked, he called the police. Normally, they wouldn't respond to a report of an adult who was missing for less than 24 hours, but an officer came to his house and informed him that a woman was hit by a vehicle not far from their house. She didn't have any ID on her run—she has since gotten a runner's ID bracelet for outdoor exercise—but Bryce was able to identify her from a tattoo and a piece of jewelry she often wore.

The initial news was not good: she was completely unresponsive with a severe traumatic brain injury (TBI), internal bleeding and damage, and numerous orthopedic injuries. On the Glasgow Coma Scale (GCS), commonly used to help determine the extent of a brain injury using a scale of three to 15, Jenny scored a five (a GCS score of 8 or less classifies a severe head injury).

In the immediate aftermath of her accident, Jenny was treated for several broken or fractured bones: pelvis, left scapula, right humerus, right elbow, and orbital bone in her right eye. She also had internal bleeding, along with swelling and bleeding in her brain that required doctors to drill a hole in her head to release the pressure.

Jenny doesn't remember the first several weeks of recovery, but Bryce does. "It was bad," he said. "She was non-responsive, and we didn't know—when it comes to brain bleeds and TBI, you have no idea what her personality would be like—if she was even paralyzed for about a week. And there's nothing you can do."

Eventually, Jenny recovered enough to leave intensive care, but she was not ready to return home. As a result of her head injury, she was still suffering a lot of trauma, and she and Bryce thought she needed more intensive rehabilitation care than what was available in the Las Vegas area. Bryce, along with close friends and colleagues, researched top rehabilitation centers and discovered the program at University of Utah Health in Salt Lake City. Jenny was accepted as a patient and transported on a medical flight in early September.

Her first stop when she arrived was the Moran Eye Center to see Dr. Bradley Katz, a professor of ophthalmology and neurology. Six weeks after the accident, Jenny's right eye still had no vision and wasn't moving properly. Dr. Katz saw that her right eye was bulging out a little and the eyelid was down. Underneath, her pupil was fixed and dilated; her eye would not "track" up, down, right, or left; and her optic nerve was pale instead of the usual pink or orange color. There was also bleeding in the back of her eye.

"These things indicate the nerve that constricts the pupil is broken," Dr. Katz said. During the exam, Dr. Katz determined Jenny likely had three or four damaged nerves, which implied damage to a part of the brain called the cavernous sinus. He ordered an MRI to get a better look.

What he didn't expect to find was a large traumatic aneurysm in the carotid artery at the base of the skull. Without treatment, the aneurysm could have grown larger and compressed other neural structures; worse, it could have ruptured and caused massive bleeding inside the skull around the brain. Fortunately, the collaborative environment at University of Utah Health gives Dr. Katz access to multi-disciplinary specialists who are just a phone call away, including Dr. Ramesh Grandhi, an assistant professor of neurosurgery.

Dr. Katz sent Jenny's MRI to Dr. Grandhi, who immediately identified a large aneurysm in the carotid artery. The aneurysm was so large that it was pressing on many of the nerves that would normally control her eye movement, causing her eye to bulge and her eyelid to droop.

"This aneurysm formed because of her trauma, which probably caused a small tear in the carotid artery," said Dr. Grandhi, who is a specialist in cerebrovascular neurosurgery and director of the division of neurotrauma at U of U Health. When blood travels through the arteries, it flows like a river. If it doesn't have a clear path to flow, as is the case with an aneurysm, clots can form.

The extent of Jenny's trauma after her accident—what doctors call "polytrauma"—means the treatment path isn't always as straightforward as it might be for someone with no other injuries. Dr. Grandhi's role in both cerebrovascular care and neurotrauma surgery allows him to approach a problem from multiple angles, considering the risks before deciding what treatment will work best. For Jenny, he looked at the constellation of injuries and decided to insert a flow-diverting stent and platinum coils. With the stent diverting blood away from the aneurysm walls, the carotid artery could heal over time.

After recovering from surgery, Jenny's next stop was the rehabilitation center (these services are now offered at the Craig H. Neilsen Rehabilitation Hospital at U of U Health), where she worked with Dr. John Speed, a professor in the division of physical medicine and rehabilitation and the medical director of the TBI rehabilitation program.

"TBI is across an enormous spectrum," Dr. Speed said. "On the more severe end, it can cause death, or a person can have quite severe physical, cognitive, emotional, and other problems that are essentially permanent." On the other end, it can cause mild cognitive impairment that can be overcome with proper treatment and therapies. The benefit of being in a rehabilitation center like the one at University of Utah Hospital is the individualized treatment plan to address the patient's specific needs.

When she arrived in the unit, Jenny was unable to walk and couldn't bear weight on her legs because of the pelvic injury. She also had gastrointestinal issues that required tube feeding for a period of time. Even though it was about eight weeks after her accident, she was still disoriented and experiencing symptoms of post-traumatic amnesia.

With her low GCS score, Dr. Speed immediately started her on a medication that would help with brain recovery. She also started in all the therapy disciplines right away: physical therapy (PT), occupational therapy (OT), and speech-language therapy. Physical therapy helps someone overcome physical barriers and challenges after an accident. Occupational therapists help with functional activities—often referred to as "activities of daily living"—like putting on clothing in the right sequence or taking a shower. Speech therapists can help with speech challenges, as well as cognitive impairments that make eating and speaking more difficult.

"You have trillions of connections in your brain, and that's what makes it work," Dr. Speed said. "If they're physically torn or ruptured [after a TBI], they are damaged forever. But the brain has enormous capacity to heal, and often different parts can take over function from the injured parts, allowing some degree of healing."

Despite the severe injuries she experienced, Jenny's brain and body were healing quickly. She checked into the rehabilitation center on October 7 and, by October 22, was ready to return to Las Vegas, where she could continue outpatient therapy and be with her family.

"I think the quick recovery was a direct result of the above-and-beyond care provided by the entire U of U Health team," Jenny said, "as well as the incredible outpouring of support and prayers from friends and family from the time of the accident through the entire recovery."

"It was great to have her home, and thank goodness that she wasn't paralyzed," Bryce said. "We were very grateful to be at the U of U—the treatment they provided was amazing to help her recover. Knowing where she was to where we're at now is an absolute miracle."

Today, Jenny is doing remarkably well in her recovery. She still feels some of the mental effects, like a little fuzziness in her brain from time to time, and definitely gets tired faster. Her physical injuries have healed, but she never regained sight in her right eye and had to learn how to perform daily tasks with vision in one eye (monocular vision). She recently returned to limited work and started running again. In fact, she decided to run the same route as her accident on the one-year anniversary in August to prove there is nothing she cannot do.

"It's hard realizing that sometimes you have limitations, but for most things, there's nothing I can't do," she said. "I try not to blame TBI—I just do what I can regardless of the past."

Her doctors, therapists, and other care providers in Utah are rooting for her every step of the way. "We developed a wonderful bond with her," Dr. Grandhi said. "She has touched the hearts of many here. It's just been great watching her get stronger and better and get back to work and lead a fulfilling life."

"I can't even imagine [what treatment would have been like] without the doctors at University of Utah," Jenny said. "You can definitely tell the difference at this renowned facility. The care that they showed, I have not seen that anywhere else. I think that was very instrumental in my recovery. It was amazing."