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| Q&A: Dr David Hartman on Head Injuries (824 Posts)
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Dan & Son: The Helmet Story
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On 7/3/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Dan,
A couple of things. First, your forcing the issue with your son on helmets probably saved him a serious brain injury. As it was, it sounds like he had a concussion. Even the best helmet can't prevent the brain from rattling around in the skull case and getting shaken up.
Second, keep an eye on your son. Many brain injuries only begin to show up on scans days after the impact. Also, in my opinion, CAT scans are almost worthless. They only show massive bleeding or shifting of brain contents. If any symptoms persist, I would insist on an MRI with contrast. If there are cognitive problems, a neuropsychological exam can identify them.
Finally, as far as helmets, the two things that are important are the fit - if it's not comfortable, it's not going to be worn, and looking for a CPSC or Snell rating. The latter is better, but most sk8 helmets don't have it. Some bike helmets and motocross helmets will, however, and if you can find one with good back, front and side of the head protection, it's a keeper. Readers, want to recommend any particularly good, safe helmets? Here's your forum.
Also chuck the old helmet. Its served its purpose. Bury it with honors.
drdh
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Head injury prevention
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On 7/3/2003
Dan Hughes
wrote in from
(162.78.nnn.nnn)
Last night my son (age 17) "Wilsoned" (fell backwards) off his board, and slammed the back of his head. You may remember some of my comments from a couple of months ago, where I relayed my experience of trying to "make" him wear a helmet, even though he didn't want to. One time were nose to nose at the park, helmets are not worn by his peers, hence helmets are not cool.
Well, he fell, and hard. He was wearing a "S-One" helmet. It has the same dense foam that Protect's have (though a little thicker). He didn't go unconscience, however, at least not completely. Right after he slammed, he said that he thought he was dreaming he was skating, that is until three or four of us jumped into the bowl, and he looked up and saw us.
Due to his head pain, and vomiting and trouble walking, I took him to the ER. I gave him Tylanol, but that didn't seem to do anything. They gave him some heavy pain killers and some anti-nausa drug, and did a CAT scan. The Doc said that there were no fractures, and no blood (on the brain, I think is what he ment, because we could all see there was no bleeding on the outside). Well, the Doc said that Jeremy was going to be fine, so he sent us home (after three hours) with some Perkaset.
I talked with the Doctor about helmets, and he recomended finding a better one. Needless to say how bad of shape he would have been without a helmet all together.
Any solid recomendations on helmets. I know we talked about this before, but it's been a while, so maybe there's some other helmets out there to consider?
Doc?
thanks,
dan
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2 things, tendons and marathons
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On 7/2/2003
Zack Lessley
wrote in from
(67.5.nnn.nnn)
After I have been pushing my board for a while (an hour or so) my achilies tendon,is that how you spell it? Well anyway, the tendon connecting your heel to the rest of your leg will pop to the side. it is slightly painful. I am only fourteen so it's not like I have worn down tendons. I was also wondering what I should do to prepare for a trip across the USA on my longboard.I'm not in peak physical condition because I store fat well but I have never gone very far on my board. I'm not sure if I can get into the right condition to go 150 miles per day by august.
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Archly speaking
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On 6/24/2003
Dr. Dave
wrote in from
(68.74.nnn.nnn)
Boomer, Arch pain is pretty common - it's often caused by a common condition called plantar fasciitis. Foot.com (believe it or not) has a description below, but the bottom line is that if rest and shock absorbing sk8 shoes aren't doing it for you, then you may need an orthotic. Check out a sports podiatrist and let us know how it works out. Good luck, drDH
"The plantar fascia is a broad band of fibrous tissue located along the bottom surface of the foot that runs from the heel to the forefoot. Excessive stretching of the plantar fascia, usually due to over-pronation (flat feet), causes plantar fasciitis.
The inflammation caused by the plantar fascia being stretched away from the heel often leads to pain in the heel and arch areas. The pain is often extreme in the morning when an individual first gets out of bed or after a prolonged period of rest.
If this condition is left untreated and strain on the longitudinal arch continues, a bony protrusion may develop, known as a heel spur. It is important to treat the condition promptly before it worsens.
Treatment and Prevention
This is a common foot condition that can be easily treated. If you suffer from arch pain avoid high-heeled shoes whenever possible. Try to choose footwear with a reasonable heel, soft leather uppers, shock absorbing soles and removable foot insoles. When the arch pain is pronation related (flat feet), an orthotic designed with a medial heel post and proper arch support is recommended for treating the pain. This type of orthotic will control over-pronation, support the arch and provide the necessary relief."
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foot hurts!!!
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On 6/24/2003
Boomer
wrote in from
(160.83.nnn.nnn)
For a few months now the arch of my push foot back near the heel has been killing me after skating. I don't really feel any pain while I'm out pushing around but in the morning when I wake up it is stiff as hell and really hurts to walk when i go through a step and attempt to push off with the front of my foot. I feels like a really deep pain and it just isn't going away. What gives? and what can I do short of not skating to make whatever I did to myself better? thanks.
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Your Wound in Lights
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On 6/20/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Well, it's interesting, but maybe a bit premature for everybody to strap on an LED bandaid. Medline has about 4 studies on animals, with most of the promising results coupled with hyperbaric oxygen therapy (a little unwieldy to keep in your house, unless you're Michael Jackson). Also, all of the studies are from Whelen and company. I'd wait before investing in LED futures, if I were you. . . DrDH
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Your name in lights?
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On 6/19/2003 psYch0Lloyd
wrote in from
(24.148.nnn.nnn)
Here’s a subject which I just posted about in the Misc Equipment forum…
…then when my curiosity brought me to this source: http://www.mcw.edu/whelan/index.html I thought it would be worth presenting it here for the honorable Dr.DH to review…
Special Operations
Special Operations are characterized by lightly equipped, highly mobile troops entering situations requiring optimal physical conditioning at all times. Wounds are an obvious physical risk during combat operations. Any simple and lightweight equipment which promotes wound healing and musculoskeletal rehabilitation and conditioning has potential merit.
NASA LED's have proven to stimulate wound healing at near-infrared wavelengths of 680, 730 and 880 nm in laboratory animals, and have been approved by the The U.S. Food and Drug Administration (FDA) for human trials. Furthermore, near-infrared LED light has quintupled the growth of fibroblasts and muscle cells in tissue culture. The NASA LED arrays are light enough and mobile enough to have already flown on the Space Shuttle numerous times.
LED arrays may be used for improved wound healing and treatment of problem wounds as well as speeding the return of deconditioned personnel to full duty performance.
Examples include:
1. promotion of the rate of muscle regeneration after confinement or surgery.
2. personnel spending long periods of time aboard submarines may use LED arrays to combat muscle atrophy during relative inactivity.
3. LED arrays may be introduced early to speed wound healing in the field.
4. hyperspectral sensors being developed at NASA Stennis Space Center by ProVision Technologies may provide early evidence of wound healing problems and monitor the effectiveness of LED treatment.
Our laboratory gratefully acknowledges the contributions of LT Christopher J. Cassidy, who serves as the U.S. Navy SEAL Advisor to this project.
Submarine Squadron ELEVEN Medical Consultant:
LT James A. Caviness
Naval Special Warfare Group TWO Medical Consultants:
CDR Alan F. Philippi
LCDR William R. Graf
LT Mark D. Erhardt
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Solidad's Herbs and Supplements
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On 6/7/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Solidad,
I can't speak to comfrey as a poultice, but DON'T INGEST IT! There's a pretty fair consensus that it damages the liver, sometimes to the point of needing a transplant. So no Comfrey tablets, teas, etc.
See the following:
Public Health Nutr. 2000 Dec;3(4A):501-8.
The efficacy and safety of comfrey.
Stickel F, Seitz HK.
Herbal medication has gathered increasing recognition in recent years with regard to both treatment options and health hazards. Pyrrolizidine alkaloids have been associated with substantial toxicity after their ingestion as tea and in the setting of contaminated cereals have led to endemic outbreaks in Jamaica, India and Afghanistan. In Western Europe, comfrey has been applied for inflammatory disorders such as arthritis, thrombophlebitis and gout and as a treatment for diarrhoea. Only recently was the use of comfrey leaves recognized as a substantial health hazard with hepatic toxicity in humans and carcinogenic potential in rodents. These effects are most likely due to various hepatotoxic pyrrolizidine alkaloids such as lasiocarpine and symphytine, and their related N-oxides. The mechanisms by which toxicity and mutagenicity are conveyed are still not fully understood, but seem to be mediated through a toxic mechanism related to the biotransformation of alkaloids by hepatic microsomal enzymes. This produces highly reactive pyrroles which act as powerful alkylating agents. The main liver injury caused by comfrey (Symphytum officinale) is veno-occlusive disease, a non-thrombotic obliteration of small hepatic veins leading to cirrhosis and eventually liver failure. Patients may present with either acute or chronic clinical signs with portal hypertension, hepatomegaly and abdominal pain as the main features. Therapeutic approaches include avoiding intake and, if hepatic failure is imminent, liver transplantation. In view of the known serious hazards and the ban on distributing comfrey in Germany and Canada, it is difficult to understand why comfrey is still freely available in the United States.
***************
As far as aborbing more calcium when you take vitamin C, there are several studies that suggest just that: that "old wives" (post-menopausal women) will have greater bone density if they take both calcium and vitamin C supplements. I haven't seen anything related to effects of the combination in the general population, although you don't want to have a deficiency of either.
Best, drDH
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broken bones
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On 6/7/2003
solidad
wrote in from
(65.122.nnn.nnn)
Doc,
Have you had any experience with comfrey? I have used it as a poltice and it seemed very effective. Also, do you really absorb more calcium if you have high levels of vitamin C in your system, or this an old wives tale?
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halfbreed's shoulder
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On 6/6/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
hb,
"Considerable pain" and popping out of place every now and then suggest that your shoulder has taken a pass on healing correctly. . . see an orthopedist and/or orthopedic surgeon. Don't bench press any more until you do.
Reminds me of a conversation I overheard between a guy attempting to "strengthen" a very sore knee ligament by repeatedly squatting 400 pounds. The trainer correctly informed him that ligaments don't get toughened by exercise, but would be in danger of further damage.
Let us know what happens. drdh
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shoulder
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On 6/6/2003 halfbreed
wrote in from
(63.198.nnn.nnn)
4 years ago i took a skate board to the shoulder and it did the same kind of thing, went out and went back in by its own after a few minutes. but to this day it still slips out of place every now and than and it still hurts when i over exhert it, i cant even bench 90lbs without considerable pain.
so you really should have it looked at and maby get some physical therapy
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Doc's a plenty
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On 5/28/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Rich,
Depends on preference and problems, you might see: an orthopedist, a sports medicine specialist, a multidisciplinary care center, a rehabilitation medicine specialist, a rheumatologist a pain management specialist and a physical therapist.
I'd start with one of the first two. You may need an x-ray or CT scan of the area and other fun stuff. Don't not treat it (my first double negative of the day 5:30am. . .) Let us know what you find and best of luck. drdh
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well, how about a bad shoulder slam, then?
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On 5/27/2003
richard marnhout (he of the bionic knees)
wrote in from
(198.81.nnn.nnn)
doc, about three weeks ago, i took the biggest slam of the year award at my local park. i landed on my left shoulder with the result being a mildly separated shoulder(popped back in of its' own accord)and it still hurts. i doubt that i completely tore stuff, as i am still able to use it, albeit gingerely, but, uh...it ain't quite right,if you know what i mean.
my question is this; WHAT kind of doctor--who is NOT a surgeon, deals with muscle and soft tissue injuries?
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foot
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On 5/26/2003 cfavero
wrote in from
(152.163.nnn.nnn)
st louis seemed to get things unstuck .my foot feels a lot better after a weekend of racing,no park action though.now i work through some stiffness and after i warm up its cool.i now wear my pads and helmet when i ride,cf
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More Footnotes
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On 5/16/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
CFavero,
Whoa, dude, you need a new keyboard bad. . . . .If you're going to race anyway on a sprained foot, rest and ice it after. If you're hurting when you start, stop. Re-injury can make things worse and set back your recovery to Count Zero.
p.s. use seaweed and lime and you'll wind up with no feet. How do you think they got rid of Jimmy Hoffa. . .?
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foot
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On 5/15/2003 cfavero
wrote in from
(152.163.nnn.nnn)
al,as regards to skating while injured,nels was in towna nd how,i say how could i pass that sesh up.my fot will be fine to hit the accelorator to st louis.in regards to taking the 540 or the m coupe ,i simply ask tight slalom or gs?cf
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my foot
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On 5/15/2003 cfavero115
wrote in from
(152.163.nnn.nnn)
dr,.thanks for the reply.is the othotic you mention sililar to the one hank used on king of the hill,kidding could not pass that one up.seriously,i plan on racing in st louis and maybe a triumphany return to vert,like i said its stuck.different shoes do make a difference so i will pursue the orthoyic,thanks again cf
p.s. i tied the seaweed lime thing and all i got was worse smelling feet
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Footnote
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On 5/14/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
CFavero,
Foot sprains do take a long time to heal (see the info on sprains in an earlier post). But you may want to see a sports podiatrist if you feel that things are "stuck". They see the most sports-related foot injuries, and if you need some custom orthotic to support your foot while it heals, they're the ones who would make it. Let us know what happens. Good Luck. drDH
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Which doctor?
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On 5/14/2003 psYch0Lloyd
wrote in from
(198.160.nnn.nnn)
Chris skated with an injured foot and is wondering why it hurt so much when he stepped off the board onto tranny (they call it pool feet dood). He was instructed to make a small sacrifice to the unwholy ones but all he could do was kick the cat. Now he'll be needing those nine lives to live with all this karmic response. If boiled seeweed soaked in lye is not the solution, maybe a little rest should be the prescrition. Sit back on your Harley 'cause St. Louis is calling - 100 cones burning into yer board!
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my foot
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On 5/14/2003
cfavero
wrote in from
(205.188.nnn.nnn)
doc,my foot was injured amonth ago,to be quite frank,i am glad to be walking.the injury occured stepping off my board and getting turned away from me,the injury is in the part of the foot between the ankle and the toes.it involves my arch and the top of the foot.its seemed to have hit a wall healing,especially in regards top lateral support,i am considering seeing a sports related doctor,does this make sense or should i give it more time to heal first.cf
p.s.i did have medical care when it occured and they called it a bad sprain
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Apologies to Bar et al.
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On 5/11/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Hey Bar,
I really am sorry if I've offended you and I completely understand that the state of health insurance in the U.S. is a horrorshow. Be that as it may, Rich's description of his problem suggested that it WAS NOT going away on its own, and in fact, might leave him with problems later on if he didn't get it looked into. There are teaching hospitals and county hospitals in some places, but as you suggest, there are times when free advice (even mine!) isn't enough. Rich's case sounded like that.
So, please accept my apologies. I was trying to jog Rich into getting his arm looked at, not tweak people with bad insurance DrD
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""Don't you guys ever go to doctors? Sheesh. . .""
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On 5/10/2003 Bar
wrote in from
(68.97.nnn.nnn)
Dr. Dave says "Don't you guys ever go to doctors? Sheesh. . .""
SHEESH!!!!???????
Where do you live? CANADA?
I am one of many self employed americans that scrapes by feeding my 7 children, my wife and myself.
Lowest cost to insure my family on a crappy plan was $8000 a decent plan was well over $10000.
My children go when they need to, my wife goes when she needs to, I go when there is no other choice.
My Dr. is a nice guy and takes into account we are a private pay with not much money and even still most visits cost at least $70. If extra treatment or diagnostics are needed of course it goes way higher.
I have found that most injuries and illnesses get better on their own if you know how to treat them and don't aggravate things by ignoring it.
I am not stupid about my health but when I can get some free medical advice, I will take it.
I may be over sensitive, but SHEESH! from a Dr. doesn't cut it. I thought you had this forum to offer advice
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Alex's Flatspots
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On 5/3/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Alex, I could tell you about getting rid of flat spots on your head after your hit the ground without a helmet, but if you are talking wheels, check out Wheels forum.
drDH
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RIch's Built-In Elbow Pads
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On 5/3/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Don't you guys ever go to doctors? Sheesh. . .
O.K. Rick, you have not healed up from this. Pads and Leathers stop your skin from peeling but don't eliminate the shock. Go see your doc unless you want to wind up with your arm looking like Wiley Coyote after failed use of Acme anti-roadrunner rocket skates. See the following, but get a Sports Medicine Ortho Doc on your case NOW.
http://www.mdadvice.com/library/sport/sport256.html
ELBOW SPRAIN
GENERAL INFORMATIONDEFINITION--Violent overstretching of one or more ligaments in the elbow joint. Elbow sprains are relatively uncommon. Sprains involving two or more ligaments cause considerably more disability than single-ligament sprains. When the ligament is overstretched, it becomes tense and gives way at its weakest point, either where it attaches to bone or within the ligament itself. If the ligament pulls loose a fragment of bone, it is called a SPRAIN-FRACTURE. There are 3 types of sprains:· Mild (Grade I)--Tearing of some ligament fibers. There is no loss of function. · Moderate (Grade II)--Rupture of a portion of the ligament, resulting in some loss of function. · Severe (Grade III)--Complete rupture of the ligament or complete separation of ligament from bone. There is total loss of function. A severe sprain requires surgical repair. BODY PARTS INVOLVED--------------------· Ligaments of the elbow joint. · Tissue surrounding the sprain, including blood vessels, tendons, bone, periosteum (covering of bone) and muscles. {128} SIGNS & SYMPTOMS--------------------· Severe pain at the time of injury. · A feeling of popping or tearing inside the elbow. · Tenderness at the injury site. · Swelling around the elbow. · Bruising that appears soon after injury. CAUSESSharp force that bends the elbow sideways or backward, causing stress on a ligament and temporarily forcing or prying the elbow joint out of its normal location.RISK INCREASES WITH--------------------· Contact sports such as football, basketball, hockey and soccer. · Previous elbow injury. · Obesity. · Poor muscle conditioning. HOW TO PREVENT--------------------· Long-term strengthening and conditioning appropriate for sport. · Warm up before practice or competition. · Tape vulnerable joints before practice or competition. WHAT TO EXPECT========================================APPROPRIATE HEALTH CARE· Doctor's diagnosis. · Application of a cast, tape, elastic bandage or sling. · Self-care during rehabilitation. · Physical therapy (moderate or severe sprain). · Surgery (severe sprain). DIAGNOSTIC MEASURES--------------------· Your own observation of symptoms. · Medical history and exam by a doctor. · X-rays of the the elbow, wrist and shoulder to rule out fractures. POSSIBLE COMPLICATIONS--------------------· Prolonged healing time if usual activities are resumed too soon. · Proneness to repeated injury. · Inflammation at the ligament attachment to bone (periostitis). · Prolonged disability (sometimes). · Unstable or arthritic elbow following repeated injury. PROBABLE OUTCOMEIf this is a first-time injury, proper care and sufficient healing time before resuming activity should prevent permanent disability. Ligaments have a poor blood supply, and torn ligaments require as much healing time as fractures. Average healing times are:· Mild sprains--2 to 6 weeks. · Moderate sprains--6 to 8 weeks. · Severe sprains--8 to 10 weeks. HOW TO TREAT========================================NOTE -- Follow your doctor's instructions. These instructions are supplemental.FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.CONTINUING CAREIf the doctor does not apply a cast, tape or elastic bandage:· Continue using an ice pack 3 or 4 times a day. Place ice chips or cubes in a plastic bag. Wrap the bag in a moist towel, and place it over the injured area. Use for 20 minutes at a time. · Wrap the elbow with an elasticized bandage between ice treatments. · After 72 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments or ointments. · Take whirlpool treatments, if available. · Massage gently and often to provide comfort and decrease swelling. MEDICATION--------------------· For minor discomfort, you may use: Aspirin, acetaminophen or ibuprofen. Topical liniments and ointments. · Your doctor may prescribe: Stronger pain relievers. Injection of a long-acting local anesthetic to reduce pain. Injection of a corticosteroid, such as triamcinolone, to reduce inflammation. Other oral non-steroidal anti-inflammatory medications. ACTIVITYResume your normal activities gradually after clearance from your doctor.DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.REHABILITATION--------------------· Begin daily rehabilitation exercises when the cast or supportive wrapping is no longer necessary. · Use ice massage for 10 minutes before and after exercise. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball. · See section on rehabilitation exercises. CALL YOUR DOCTOR IF========================================· You have symptoms of a moderate or severe elbow sprain, or a mild sprain persists longer than 2 weeks. · Pain, swelling or bruising worsens despite treatment. · Any of the following occur after casting or splinting: Pain, numbness or coldness below the elbow. Blue, gray or dusky fingernails. · Any of the following occur after surgery: Increased pain, swelling, redness, drainage or bleeding in the surgical area. Signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever). · New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
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Flat spots
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On 5/3/2003 Alex Richard
wrote in from
(142.177.nnn.nnn)
How do you get rid of flatspots
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