She played basketball, soccer and volleyball in high school. She has done rock climbing; she has gone skydiving. These days, Cassandra Witt, 31, is a personal trainer and professional bodybuilder. She is, to summarize, young, coordinated, and wicked-strong. Which makes the adage, “If it can happen to her, it can happen to anyone,” all the more apt.

What happened to Witt? It was November 2017. She and husband Trent were winding down for the night in their Thornton apartment. She was putting on pajama bottoms. She had on the sort of socks that turn a hardwood floor into something like black ice. Her feet got tangled in the pajama legs somehow. And down she went, backwards. Bam.

Trent rushed into the room, Witt learned later. She learned this later because she had cracked the back of her head with such force that she went dark. She came to with her husband leaning over her, asking if she was OK.

She was not OK.

“I’ve done so many extreme things in my life, and I get taken out by a hardwood floor and some socks,” Witt said later.

A traumatic brain injury

She felt dizzy and nauseous. It was as if the apartment had become a funhouse tilt room. Trent suggested they go to an ER. She declined, figuring she’d sleep it off. He agreed to watch and wait, but if things didn’t improve, he would take her anyway.

She slept late into the next morning. She was dizzy when she woke up. And now she had a splitting headache. Trent took her to the UCHealth Emergency Room at Colorado Boulevard and 120^th Avenue in Thornton. The emergency physician ordered CT and MRI scans, some of which Witt slept through, “which tells you how out of it I was,” she said. The physician asked why she had waited to come in. With a traumatic brain injury (TBI) in particular, it’s always better safe than sorry. The doctor in Westminster, concerned with what he saw, transferred her to UCHealth University of Colorado Hospital on the Anschutz Medical Campus. Neurosurgeon Dr. Steven Ojemann led the care team there. The care started with more scans. The scans found a hairline skull fracture, a brain bleed and, in a vein toward the right side of the back of her head, a blood clot (technically, a sinus thrombosis).

Big, risky clots can be removed using a minimally-invasive procedure involving a catheter. Ojemann determined that Witt’s clot was of a nature that a blood thinner – warfarin – would do the trick. She stayed at UCH for two weeks as Ojemann and colleagues found the right dosage (her metabolism, amped up by her bodybuilding, made this a challenge). She would have to take it for another two-and-a-half months when she went home, too, plus twice-daily shots of another blood thinner, enoxaparin (trade name Lovenox).

Risks with blood thinners

The shots weren’t a problem for Witt. The big deal was that she was under strict orders to avoid strenuous physical activity as a result of her traumatic brain injury. That meant no working out. It fell to UCHealth neurosurgeon Dr. Christopher Roark, who took over for the inpatient team when Witt transitioned to outpatient care, to stress the importance of compliance.

“The hardest thing with her, quite honestly, was convincing her that the best thing for her body was to take it easy, because she’s not wired that way,” Roark said. “We had to convince her that, hey, for three months while you’re on blood thinners, you’ve got to take it easy. And if you do that, a year from now, this all will be just an unpleasant memory.”

The risks of working out included that of falling again, which could trigger another brain bleed, this one made worse by the blood thinners. Also, it’s easy to get dehydrated during workouts of the sort Witt put herself through, which can slow blood flow and make a blood clot worse. Going back to bodybuilding too soon risked not being able to go back to bodybuilding at all.

“They put the fear of god in me,” Witt said.

The day she got out of the hospital, she was back at the gym – but coaching, not training.

“It almost made it worse because I had to watch everyone else working out,” she said.

She had, prior to the traumatic brain injury, been building toward her first competition (Witt had only started lifting weights two years earlier, the goal at the time having been to look good in a wedding dress). An Instagram group of friends posting about their training in preparation for it became so hard to read that she “got off Instagram and Facebook,” she said.

Back, bigger after brain injury

At the same time, she recognized that she was still recovering. When she went to fill her Lovenox prescription after leaving UCH, she couldn’t remember her phone number. She’d had it since high school.

“It was a slap in the face: this really happened,” she said.

She noticed a change in her temperament – in particular, that she had become “shorter-fused” when it came to little things that might not have made her angry before. But she gradually got better, and a February 2018 MRI scan showed the clot to have dissolved. She could work out again, Roark told her.

She had lost a lot of strength. She was doing shoulder presses with 30-pound dumbbells before the traumatic brain injury in December. Now she struggled with half that weight. But working out six days a week, she was back to the status quo within six weeks. She wasn’t stopping there: she made her competition debut at the July 2018 National Physique Committee Colorado State Championships at the Buell Theater in Denver.

What a debut it was. Of the three events in which she competed, she placed second in two and fourth in the third.

“It was the most fun I’ve had in a very long time,” she said.

TBI advice

More than a year later, Witt is a successful independent personal trainer and nutrition coach while helping run a nutritional supplement company in Westminster on the side. She hasn’t competed since – but there’s a reason for that.

During that July 2018 competition, she went onstage in the “Figure” class, which requires muscle mass and definition, but not the bulk, muscle striation and popping veins of the next class up – called “Physique.” The five-foot-four-inch Witt weighed 125 pounds on the Buell stage; when she competes again next summer, she’ll be at about 140 pounds and equally lean (she’s shooting for a body fat percentage of about 11%, she says). She figures she’ll be shoulder pressing 60-pound dumbbells by the time she flexes for the Physique judges.

For those who bang their heads – in pajama-related incidents and otherwise – Witt has two pieces of advice. First, get to an emergency room.

And second, have faith, because things, as she put it, “find a way of turning out the way they’re supposed to.” The experience also made her mentally stronger and more determined, which she credits for doing so well her first time on the stage and powering through the long hours and pain involved in building an even more formidable physique ever since.

“Give yourself time to heal, and don’t get frustrated,” she said. “You’ll heal with time. You’ll recover.”