The Young Stroke Service Project with Professor Julie Bernhardt from The Florey Institute
Welcome to Season 2 of The Brain Game Changer podcast. I am your host, Melissa Gough. We kick the season off by speaking with Professor Julie Bernhardt from The Florey Institute of Neuroscience and Mental Health here in Melbourne, Australia. Julie is co-leader of The Florey’s Stroke division and one of Australia’s top stroke rehabilitation clinical trialists, continually pioneering the way in developing more effective treatments and post-recovery resources and support for stroke patients.
We discuss Julie’s journey into the medical field, the AVERT Early Intervention Research Program and receiving funding for the upcoming Young Stroke Service Project.
She has also been awarded the Member of The Order of Australia, "for significant service to medical research, and as an advocate for women in science."
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Melissa Gough 0:04
Welcome to the Brain Game Changer: where heartfelt stories, awareness and education can change the game. My name is Melissa and in each episode, I talk with inspiring humans and organisations from across the globe, who share significant adversities, triumphs after tragedy, and those game changing moments to provide you with some useful tools and resources to take with you into your everyday life. Welcome to Season Two of The Brain Game Changer podcast. It is great to be with you after having a well deserved break and promising more insightful, inspiring interviews from amazing humans and organisations.
We kick the season off by speaking with Professor Julie Bernhardt from The Florey Institute of Neuroscience and Mental Health here in Melbourne, Australia. Julie is CO leader of The Florey Stroke Division, and one of Australia's top stroke rehabilitation clinical trialists. Continually pioneering the way in developing more effective treatments, and post recovery resources and support for stroke patients. We discussed Julie's journey into the medical field, the AVERT Early Intervention Research Programme, and receiving funding for the upcoming Young Stroke Service Project. She's also been awarded Member of the Order of Australia for significant service to medical research, and as an advocate for women in science. Let's get into the interview.
Melissa Gough 1:41
Good morning, Julie, and welcome to the Brain Game Changer podcast. It's a real honour to have you with us today.
Julie Bernhardt 1:47
It's great to be here, Melissa, thank you for asking me.
Melissa Gough 1:50
I'm talking with Professor Julie Bernhardt, who is the clinical head of the Stroke Division of The Florey Institute of Neuroscience and Mental Health. Probably as the interview goes on, you'll hear us just refer to it as The Florey, as we continue our conversation. To give our listeners a little bit more of a lens into who you are, we always ask for a bit of a backstory. So I'm going to ask you to talk about how you first entered the field of science.
Julie Bernhardt 2:22
Mine's very relevant because I had a personal experience of someone having a stroke when I was 16, and that was my uncle. He was only 52, and I knew nothing about stroke. I knew nothing about rehabilitation. I knew nothing about physiotherapy. And I suddenly started to learn a lot about all of those things, watching him slowly recover. He had a very large brain injury. Over the next 25 years, he had a very full and active life. I was very motivated by watching his journey early. It’s really what prompted me to become a physiotherapist. Before that I didn't know anything about it, then I pursued physiotherapy. While I worked in many areas, early in my career, when I'm finished, I worked in an ICU for quite a long time. I worked in surgical areas, a number of other areas, but I just kept gravitating back to neurology, and I've never left it.
Melissa Gough 3:35
Thank you for sharing the personal lens and reflection about your uncle. What I've observed in speaking in the interviews, there's usually been some personal event that occurs, whether it's personal, whether it's to a loved one that has projected people into the direction that they decided to go to. Was science, already an interest of yours before this occurred with your uncle, or were you already considering veering off into a totally different direction.
Julie Bernhardt 4:06
I was looking at teaching. I think I was interested in education. I had to actually pick up science subjects to be able to get into the physiotherapy course. But why did I do research later? I did research later after I'd been practising for a number of years, because I got really frustrated by not being able to help people with brain injury get better. I would be able to get them to a certain point and I could see the value of what it was that I was doing. I would just start asking questions. Why can't this person be helped to improve more? Why am I struggling here? What is the evidence base and the more I started looking at evidence based interventions, the more I felt that there wasn't enough understanding of brain injury. There wasn't enough understanding In your treatments that would work effectively with people with brain injury. That's what made me go back to the books and learn how to do research.
Melissa Gough 5:09
That's amazing that you've done that. As you're explaining, through the lens of a practitioner, I guess being the patient on the other side, I can resonate with your words, when you sit, and you can tell everyone has the best intention, and we have the best goals in mind and the best progress, but we're restricted or we don't know where to go next. We don't know what the next moves are. So I'm just going to add that between these, and please correct me if I'm wrong. This is my research, between the use of 1999 and 2008, you're a senior therapist with two different hospitals. However, in 2004, and this is really fascinating, you became the principal investigator of the AVERT Early Intervention research group. Can you tell us about that?
Julie Bernhardt 6:04
Yes. When I finished my PhD, which I very much took as a learning experience. I did my PhD in a different area. Then when I finished that, I actually struggled for a little bit, because I needed to work out what I wanted to dedicate my life to, from a research perspective, and I was, yes, still working clinically at the time as well. I was lucky enough to really finally get that reflection, what is my purpose, and I wanted to do research that would help make a difference to patients. I didn't want to do academic research, I wanted to do applied research. I wanted to do research that would try to push the boundaries, develop new treatments. Once I identified that, I was lucky enough to have a conversation with Neurologist Geoffrey Donnan, who is an eminent clinician and scientist here in Australia, and asked him if I could come and work with him, if I could get a fellowship, and he said, for sure, Julia, you, you'd be very welcome.
I joined the National Stroke Research Institute, which became The Florey later on. It was really having people like Geoff and others around me, who said, ‘Julie, if you really want to make change happen, you have to do something really big, foundational, impactful. So that really started the trip for me because I went, ‘Okay, where is my area of focus.’ I came upon some very interesting research that was proposing that if we could move rehabilitation efforts into a much more acute environment, I'd be mostly working in rehab in post acute care. So downstream, if you could move rehabilitation up into an upstream system, then you'd be able to have more people who would get some, because not everyone gets to rehab. That it's the right kind of moment in a person's brain recovery for them to try and start doing rehabilitation. So that really kicked off this sort of early rehabilitation focus, and I've kept in that zone, as well as doing lots of other things since that very first beginning.
Melissa Gough 8:35
So it was the largest acute stroke rehabilitation trial in the world at the time. You had over 1000 clinicians and researchers with also over 2000 patients recruited in Australia, UK, New Zealand, Malaysia, and Singapore. How long did this trial go for?
Julie Bernhardt 8:54
It ended up going for eight years. It’s funny, because Geoff said to me, ‘Julie, you know, if you're going to tackle a really big problem, it's going to take you 10 years, you have to dedicate 10 years of your life.’ I went, Oh, that's fine. I'm happy to be here for 10 years. Here I am 22 years nearly later, and I'm still working on things. It took eight years because no one had done acute rehab trials before. There was no network, it took a long time to get the buy-in from doctors and nurses, as well as physiotherapists, although they tended to be the easier group to convince.
Just to set it up because there's no network to set up a project of this scope and to go international, and we're still really one of a handful of studies that have ever gone international in terms of trying to recruit across different countries. In fact, we still have the largest trial that's ever been done in rehab in the world . That was a big achievement.
Sadly, despite a lot of really great early development, we overcooked things. In fact, we found that by applying a lot more mobility based rehabilitation, which was the focus of the study early, we actually caused harm, and we didn't help people get better. This was a big shock, because our earliest study was the small one that was published, before we began this large study that had looked really promising. So all it did was convince me that it's really important that we keep doing larger, but very, very carefully developed studies to try and understand what we need to do to help people get better. I think it would only be a year or two later that in fact, we had clinicians who started to say,’ what do we do now?’ How do I interpret your results? What should I be doing? Can you help me work out what we should do next? It was that sort of constant dialogue that we were getting from people that made us go, hang on, I don't think we can just stop here. So let's regroup. Let's look at what we've learnt, and let's create a way that we can try and get the information we need to help them with real protocols. So that's why we kept going after, but it did take a couple of years actually, to rethink and review and get our mojo back in a way.
Melissa Gough 11:38
It's almost like you don't know what you don't know. You wouldn't have had these results, you wouldn't have been able to get to even where you are now, without these different types of, I guess, results taking place. I can only imagine that even though you say you personally reflected on whether what you were doing was a right or just cause, it's these examples that help pioneer and project you to know. Okay, well, we, we've tried that, we've sort of tried that area. Now we can collate all that and move it forward.
Julie Bernhardt 12:17
Yeah, absolutely. I've just started to travel again, post pandemic. I was in Switzerland. I had a doctor there who I had met a couple of years ago, however, it's been a while since I first met her. She introduced me to someone and said, ‘this is the person that convinced me to change my practice from keeping stroke patients resting in bed for seven days; that was during the trial.’ During the trial, we were challenging the notion that you should leave people resting in bed for a long period of time after a stroke. Instead, we were saying, look, we've got early evidence that shows, in fact, getting up early and starting rehab early can be beneficial. She has flipped her model of care from being seven days into a more active one, while at the same time not over activating. So I just went, ‘oh wow, like, that's actually great!’ That's an impact that we've had and challenging the notion of how you should treat people as part of the research process. So you're quite right, Melissa, I think we are in a period of not knowing what we don't know. And as we do these sorts of bold studies, we do learn, and we're hopeful for this new trial that's running now that we will be able to develop protocols that are the best evidence, the safest, the most effective. That's our goal.
Melissa Gough 13:50
I guess I can give that example. When I was in the hospital, obviously ICU the very first, you know, 24/48/72 hours, I was very bedridden, because, you know, the state of my being at the time was very serious. When I got transferred through to the High Vision Neuro Ward Unit, you know, I got settled. However, pretty much the next day after being there, they're like, ‘right, we're going to see if you can at least walk to the toilet.’ I remember thinking, should I do this? Can I do this? I needed support, I couldn't do it on my own, and it was literally probably 15 steps. But I guess from a patient's lens, it sort of gave me a little bit of hope. In that sense of my recovery. I mean, I was fragile. I was walking like Bambi, and I needed to hold on to people. But the ability to be able to do that in that moment, those little milestones, helps every aspect of your recovery.
Julie Bernhardt 14:57
Absolutely. I think we've had stroke survivors involved in collaborating in our research from year dot. I think if you've had lived experience, which I would say, you know, as a person who's been very, very much involved with my family, my uncle and auntie who were very, very special people, you appreciate the importance of having a consumer voice in what you do. So to me, that was natural. I've only realised later that it's not natural for lots of people. In fact, it's something that we're trying to promote that more researchers really learn how to work with consumers, because they can give you such insights. Hope is something that really came out from our consumer consultation early. We didn't actually ask the question we asked about being involved in an early rehab study. So being in the arm of the study that started rehab early, and in a much more sort of intensive manner, versus the usual arm, which was slower, whether or not it might make people depressed, or make them happier, because it could have gone either way. You know, Melissa, if you're a person who, early on, you haven't quite recognised the extent of your impairments and the big road, the hill, you have to climb, maybe we worried that we would actually make people depressed, in starting early. We really didn't find that. So we did find in that smallest study that in fact, people felt more optimistic, starting their rehabilitation early.
Melissa Gough 16:49
I know that when I was in hospital, I knew I was in the safest place, and there's this optimism. It was probably when I went home. I know this is also where you're tying in a lot of your research. Besides the fact that I knew that I had to have another MRI in about six weeks, and I was under very strong guidance to continue taking particular medications to prevent further stroke, I really did not have a clue about what to expect. And besides also seeing my GP nine days after, which was great. But the state that I was in, I was still incredibly fragile. My body was doing all these different things that I'd never experienced before, and I did not know where to turn or who to ask.
Julie Bernhardt 17:40
Yeah.
Melissa Gough 17:41
I've been interviewed to share my story. One thing I didn't share was, again, probably about two weeks into being home. This may sound strange, but it's like all of a sudden you feel your brain. We don't walk around knowing that our brain is, you know, moving around and doing its thing. We can feel our arms and our legs and our eyes and ears and things, but you don't, you cannot physically feel your brain. But that's the way I describe it. I just started feeling all these unusual sensations. My body was doing all these different things, and I was feeling all these different tingles. I went through some worries, like am I, is this happening again? Because I was really happy, healthy, and really physically active. I did not fit a box. I don't drink, I don't smoke. I'm physically active, I am cognitively active. You know, even by the time I left the hospital, they still could not give me a real detailed reason as to why this happened. So I surrendered to the fact that it happened. However, I was still constantly confused.
Julie Bernhardt 18:51
It's a great segway into why we've been doing, pitched for and I guess also why we've been successful in this Young Stroke Service Development project. We've been hearing this, while I've been hearing this for decades. Patients call it the black hole to me, and it's sort of pretty common as an expression. So this is, they finish with their care in a supported environment and then are alone when they leave. And look, I started hearing this really early in my practice as well, and it did influence me really early. It made me realise that there is something in a way problematic with clinicians like me, building a level of dependence between myself and a patient such that when you say bye, I hope life goes well for you. They really feel as if they've been abandoned. Yet our health system is unable to sort of accommodate that ongoing contact. So that's always stayed with me, and I think it's really interesting. We started studying young people, specifically about seven years ago, because we felt that they were missing out. That led us down some really interesting pathways. We started talking to some of the cancer groups to hear how they were looking after their young people, and really that idea, that maybe we needed something that would be more dedicated to a younger cohort emerged quite early, but we had to learn what young stroke survivors' unmet needs were. So we've done quite a bit of work in that over the years, we also then wanted to ask our young stroke survivors how they wanted their unmet needs met, because we shouldn't assume that younger people want their needs met in the same way as older people.
I've always wanted to blow up rehab. That's one of my other projects. But I think empowerment to me is such a biggie. We really pitched this grant, which was from the Federal Government, it's a medical research, future rapid translation grant. This was a group of people, between the ages 18 to 45, although we will take people who are a bit older than that. They are a group of people that we need to focus on to look at how we can create a new model of care for them. So the Young Stroke Service idea is that through a digital platform, we're gonna try and create an interconnected service that can address a whole range of unmet needs.
Obviously, we can't meet all needs, but what we're really conscious of is that depending on where you are, and at the moment, the Service Pilots going to happen in Victoria and in South Australia, so that we can try and show that if we could get this working across two very different states of Australia, it might be able to be ramped up and apply across the whole country. Iff we can make this work where someone comes in, logs into the pathway, or into the platform, and then starts on their journey down the pathway, where we're trying to, we get them to tell us what their unmet needs are, or their ongoing support needs. Then we try to create pathways for them to get those needs met, and then we follow people for up for five years.
So if we follow up and send a little message every six months, and go, Hi, how are you doing? Do you need any help? What are your unmet needs? Do you want to come back and talk to us about that? That's sort of the idea that will sit behind this, we're going to focus on returning to work or study, because that's a big gap in services. And we're also going to focus on psychological support, and trying to get people connected into peer support early. Those are a couple of key areas that we're going to start with, it's going to be really interesting to see how this unfolds over the next five years. But we want to try and make a go of it.
We're working a lot with younger stroke survivors to help build this system. If we can convincingly show that this adds significant value into the healthcare system, to individuals, but also to the health system that we might be able to see it embedded in the long term. Just to pick up on your point earlier, Melissa, about you not knowing why this is common, and it applies to 40 to 50% of younger people, that there is no clear diagnosis. Well, there is a diagnosis, but there's no clear cause. That's why we also think focusing on young stroke for a while is important because we need to make that much lower in numbers. We need information about young people and their experience of stroke to help us learn more about why some young people have strokes. If we can do that, and have a really clear diagnostic pathway, give that information back to young people, then they have it in their hand and they can see that. Yep, we've done all of these tests. All of the obvious things are not things that you have, your chance of another stroke is very low. We just don't know why. It's still not satisfactory, but it might be something much better than what people can get now?
Melissa Gough 25:01
I'm so happy that you're also working alongside is it Dr. Vincent Thijs, or Professor Vincent Thijs
Julie Bernhardt 25:09
Professor, he's a Neurologist.
Melissa Gough 25:11
I'm so excited that you're both working together in collaboration. I'm just going to add some bits for our listeners. So the Young Stoke Service is a collaborative $10 million project, and it's funded by the Medical Research Future Fund. I'm just going to explain what that means, because I didn't know what it was, for our listeners. It's a $20 billion long term investment, supporting Australian Health and Medical Research. It aims to transform health and medical research and innovation to improve lives, build the economy, and to contribute to health system sustainability. When I read that you received this grant for the Young Stroke Service, I was gobsmacked at hearing that a quarter of all strokes in Australia are experienced by people between the ages of 18 and 45. I just could not believe that, that's what I was reading. And 9 out of 10 of those young people living with stroke reported that their needs of treatment and care, we're not always met. It's concerning that those statistics and facts are out there.
Julie Bernhardt 26:20
Yeah, and I think the Stroke Foundation has done a good job of trying to raise awareness about the fact that strokes do occur in young people, because it is one of those things that is deeply frustrating for a young person. We found this in our research with young people. It's so frustrating to them, when people say, ‘Well, you can't have had a stroke, you're too young.’ We call that sort of an invalidation of the experience, and how annoying is that? It just shows people's ignorance.
I think the other thing that we really want to profile and it's part of the plan to build awareness around the diagnosis of stroke in younger people, as well as that sometimes when young people present at the hospital, the emergency staff will say the same thing. Well, no, you can't have a stroke, because you're too young. Whereas in fact, they need to be investigated, and they need to be investigated right now. So that if they're eligible for any of the acute treatments, which we now have that need to be applied in the first hours after a stroke, they are applied. They then have that opportunity to have complete resolution of their problem. If they get the right treatment. There's also a message there for young people themselves, who also will say I can't be having a stroke. That any sudden onset of a neuro, neurological nature is an emergency and should be dealt with as an emergency.
Melissa Gough 27:54
That's so true. Because I do feel like, I should say I was 48 years old when it happened last year. I think the biggest thing that has surprised people that I know, they would have expected me to be in hospital because I broke my leg doing a ride or a run or a hike or travelling. That was the biggest thing that I found in explaining to people what had happened to me. Constantly, asking why Or how, how could that have been? Why did that happen? You know, what's the reason? Also when you're trying to explain what's going on you're not always received with, I guess the support that you need and the words that you need. People don't understand and I still feel like there is a little bit of draconian language, and there's still a bit of stigma that comes around the word stroke, like stroke is a very broad word anyway. As I'm learning more about going through it, I was just like, gosh, this is a massive umbrella. Even though my official diagnosis was subarachnoid brain haemorrhage, not caused by an aneurysm. To most people, they're like, what does that mean in English? And you're right, I was met with people saying, oh, but you're too young to have that or there was so much confusion. It's just great that you're doing this and when does it start? Where does the Young Stroke Service start?
Julie Bernhardt 29:25
We started the project, the planning and the project, only this February 2022. We are hoping that we'll actually have the service started in its infancy, and it's going to be really important that we explain to our early users that it is a developing project, so we can't offer everything to everybody. How we manage expectations is going to be really important, but we will have the service up and running before the end of this year. We will start to be offering certain components of gaps and unmet needs in the service already this year. We're working with a digital developer partner called Curve Tomorrow in helping to build some of the technology that's going to sit and support the platform. We're really enjoying working with that group. We have a large number of people from a whole range of different organisations and universities and clinical groups and the Stroke Foundation and lots of stroke survivors who are going to be involved in the development of the project. So before the end of this year, we'll be able to let you know that the service is up, we are going to have it open to people at different times after their stroke, I think within that first five years of their stroke, to start with, ultimately, we actually hope that we are integrated. So in your case, Melissa, after you were finishing your time in the hospital, someone would have referred you into the service, and we would pick you up there after you finished so that you knew you had a pathway, beyond that. That's what we hope you will do. When we start we will be taking people who can come in from the community.
Melissa Gough 31:17
So you'll be collating a lot of your data with some of the organisations that you've mentioned, as well as some of the hospitals who are also on board. This research will collate all different forms of stroke that take place?
Julie Bernhardt 31:30
Yep. So you know, stroke with its depth, its sudden neurological onset of a vascular nature, you know, so something to do with the blood vessels in the brain. With a sudden onset, that's really the definition that we're going to be using. So we'll include people who had that sudden onset brain injury. We're going to limit the service again to adults and young adults, because children also have strokes, and babies have strokes. But to build something with that paediatric, or that sort of not adult perspective is a whole nother domain. But we certainly will be keen to talk to people who provide services for children, at some point in the future.
Melissa Gough 32:20
It's great that this is happening, because, as I've said earlier, stroke, it's profoundly disruptive for a young person's identity, their productivity, their relationships, and their emotional well being. I've talked about it was probably around the six month mark, where I started to feel that was probably my darkest place, I was just so confused. And six months on, you start to sort of see that some elements of your world are coming back to how they were beforehand. And then there's other parts of your world that just speak so much unknown. That was probably emotionally a really hard time for me and I did not know where to go. I know with my GP that we are trying to seek some trauma treatment because of the circumstances surrounding the brain haemorrhage that occurred with me. Ithappened very suddenly, very quickly, very aggressively, you know, the paramedics hospital. Even in the hospital, in the ICU, its ICU, is not a calm and relaxed place, you know, let's all have a latte and have a chat. It's busy, everyone is medical everywhere, time is precious. Everyone's busy. There's a lot of commotion, there's a lot of codes going off over speakers all the time. And there's even trauma within that.
Julie Bernhardt 33:39
Yeah, look, I am surprised in a way that there hasn't been more discussion about PTSD or Acute Brain Injury; it is becoming more common now that there's recognition of it. I still have a profound memory of a patient that I had many, many years ago. So as you know, stroke can affect people in so many different ways, and some people's thinking is really affected. They really can't process information in the same way, and there's a lot of brain injury associated challenges there.
Melissa Gough 34.37
Right.
But I still remember a lady that I had, who had a very specific kind of motor stroke. So the rest of her brain was okay. What was injured was a part of her system that helped to generate movement, and she was so sad. She would be crying in the rehab unit, and I spent a lot of time talking with her. I remember someone saying she's got depression. I said, I actually don't know that she has depression. I think she's just dealing with the trauma of what this means and she's really aware, she's aware of what she's lost. She's aware of the challenges, and maybe that might become clinical depression. To put it straight into that label, rather than thinking of it as someone adjusting to trauma, seemed to be the wrong approach to me. And that was a long time ago that I had this experience. So I think it's underrecognized.
Melissa Gough 35:29
The terminology that you just used "adjustment to trauma," I think that just resonates so much. Because post brain haemorrhage, I've done everything that I can physically do and to keep active and keep going, every aspect of my life got flipped on its head. I think it's really hard to explain to people, I will never forget this, this will be with me for the rest of my life. I know time heals the elements and layers of it. However, trying to explain to people it is a trauma, I nearly lost my life. Unless you've also experienced it, it's really hard to explain that in its true context. I love that terminology that you've said it's an adjustment to trauma every day, every week can present itself in a different way of how to deal with it.
Julie Bernhardt 36:19
Some people depending on their personality, but their previous life experience and also their brain injury, to be frank may not experience trauma, they might be very accepting of what's happening. You just can't make assumptions, I think, and it is very much a person to person experience.
Melissa Gough 36:41
I'm very aware that your time is of importance. So I'm gonna segue to a moment that happened in your life, and I can only imagine it would have been a really wonderful moment. You became a Member of Order of Australia, in 2019, for significant service to medical research, and as an advocate for women in science. Congratulations on that honour.
Julie Bernhardt 37:04
Thank you.
Melissa Gough 37:05
Before we finish up, can you just give us a little bit of your advocating for women in science? What have you observed about that in your time in research and science?
Julie Bernhardt 37:16
When I moved into the Florey Institute, a bigger Institute, then where I'd started, I started interacting with a lot of basic scientists and discovery scientists. I started to look around and realise that while I was on a path that felt supported as a female in research, there were not the same opportunities for women who are working at the coldface of discovery. So that's really what prompted work in that domain. As I like to do, I see great value in collaborating with others. So I initiated a collective impact approach to starting the conversation. That meant we brought together five research institutes to sort of work together on the issue, and that established a Women in Science Precinct Initiative. I guess this is the stuff you do outside of your work. That's what the Order of Australia is about. It recognises the work you do outside of your paid work. It was really nice to be recognised for my stroke advocacy, as well as for my gender and diversity advocacy.
Melissa Gough 38:36
What else does Julie do in her downtime? I mean, you work tirelessly to help others improve their life or get the resources and the tools and the support that they need for their life. What does Julie do in her downtime in her life to help fulfil her in other ways?
Julie Bernhardt 38:55
I almost think of myself as a cup. When my cup is full, I can apply myself to a million things with great energy. In fact, I'm told that I'm very tiring to be around. But when my cup gets low on energy, I need to have a break, and it's actually really critical. I think it's critical for everyone that you recognize when your energy cap is low, and for me, I have to completely disconnect. So I sail and I'm very lucky my partner, Tony loves sailing, I disconnect my phone. I go places where there's no internet. I completely disconnect and just stay with nature, to me, that's the best thing. But anything nature based but particularly being on the water is my real go to where I just love to be with nature, seeing the waves, seeing the dolphins, seeing the birds, not thinking about work, not thinking about my phone, not thinking about my internet. I do that on a regular basis because I have to.
Melissa Gough 40:06
It's so good. You do that. And I resonate with you, I find water very healing. It's very therapeutic, and it's being at one with nature. We're all interconnected. So it just helps fuels as you say it fills the cup, fuels the soul. What a great way to spend your downtime. I'm going to finish on one more question. So the name of the podcast is called The Brain Game Changer Changer: where heartfelt stories, awareness and education can change the game. If there was one vital piece of information or that sort of golden nugget that you'd like our listeners to know, what would it be?
Julie Bernhardt 40:41
You're not alone. I think the more people connect with each other, the more they find things like the podcast, others like themselves, can really help. Don't stay alone, reach out, find the connection, because you're really not alone. There's actually so many people that we all need to be connected. So that's the main thing. If you feel like you are, then you need to do something about it and make some connections.
Melissa Gough 41:13
That is such valuable advice. Thank you so much, Julie, and thank you so much for being with us today.
Julie Bernhardt 41:19
Thanks so much.
Melissa Gough 41:22
Thank you for listening to this episode, and I hope you found the show really valuable. If you'd like to learn more about the podcast, our guests and the topics we discuss, please head over to our Instagram page @thebraingamechanger and make sure to subscribe and tick those five stars so you never miss an episode. In the meantime, continue embracing those game changing moments. Have a great week and see you again soon. Take care.
