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| Q&A: Dr David Hartman on Head Injuries (824 Posts)
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Helmets that work
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On 7/11/2003
Dan Hughes
wrote in from
(207.254.nnn.nnn)
I just got back from riding the full pipe at Hailey, Idaho. Great fun, by the way. Well, on one run through the pipe, I was thinking more about trying to stick a sticker as high as possible in the pipe, than just riding. So, I wasn't concentrating, and I was about 10 O'clock in the pipe, and I decompressed, which shot me out into the air, which caused me to land at the bottom. I hit my head/face pretty hard. As hard as when I blasted my teeth in. But, this time, I was wearing a Giro Switchblade (full face helmet), and it protected me better than I anticipated it would. I thought for sure I'd have a headache or something. But, nothing. I felt ratteled, but that was it. My helment took the impact, and was cracked in a few places, which means I have to replace it. But, I was impressed. Full face for me, all the time!
dan
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As Hip As Bill
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On 7/9/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Bill,
Your sense of things being "out of alignment" would suggest a visit to a chiropractor. They're good when you need to see whether the whole skeleton is lining up right. If that doesn't work, a sports medicine orthopedist is my next choice for you. Don't forget to replace running shoes every 2-3 months. The cushions become much less effective after that.
drdh
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Hip injury that's recurring/slow to heal
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On 7/9/2003
Bill Evans
wrote in from
(63.99.nnn.nnn)
Doc -
I took a bad hipper 6months+ ago in which my whole pelvic cage seemed to get "wacked" or twisted, in addition to the impact to the hip/leg joint itself. It healed up ok, and I'm now wearing a big pad on that hip which has saved me several times.
However, I've taken a couple of other falls that haven't hit the hip, yet now I'm feeling that the connective tissue is "slightly off" after a recent fall - that is, it just doesn't quite feel right. Not necessarily painful, but stiff, throughout the pelvis and on both hips (which is why I indicated that the whole cage felt the impact). It just hasn't returned to 100%.
I'm also a runner (2x a week) and hit the gym, so perhaps I'm overexerting. I'm very religious about stretching too.
For a while it seemed to improve, but I've gone backwards a bit lately. Is this just an issue for rest, or should I see a specialist? I'd still like to keep running.
Thanks,
Bill
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giro
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On 7/5/2003 steve
wrote in from
(64.220.nnn.nnn)
I just wear a Bell bike helmet with that adjustable plastic headband inside. It's got a lot more air holes than that one you linked, and it fits my head! (I have an oval head that doesn't fit well in shell helmets like that.)
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Yup...
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On 7/3/2003 Chuck
wrote in from
(192.249.nnn.nnn)
...they still got 'em, less than $15, any color you want as long as it's yellow.
http://www.rei.com/online/store/ProductDisplay?productId=47665080&storeId=8001&catalogId=40000008001&langId=-1
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Best Skate Helmet...
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On 7/3/2003
Chuck
wrote in from
(192.249.nnn.nnn)
..I ever used is my current one...a bike helmet! The Giro Semi is lightwight, comfortable, offers excellent coveraage, and I believe it is CPSC rated. It has the hard foam that all good bike helmets have for impact protection.
I got mine for a great price a couple of months back at REI.com, in their outlet section. Dunno if they still have 'em cheap or not...but they're worth the full price if you gotta pay it.
Plus you'll get to support a company that (a) sponsors Lance Armstrong, who will begin the process of winning his 5th Tour de France in 2 days, and (b) supports slalom racing (the Roe team is sponsored, and Judi from Giro races herself, as well as facilitates donation of helmets for prizes at many races). Good helmets from good people.
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Zack's Quest
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On 7/3/2003
Dr. Dave
wrote in from
(12.207.nnn.nnn)
Zack,
A trip across the USA on a longboard? Whoa. . .As you suggest, that's a pretty big trip, and one that would require a lot of aerobic endurance. I would suggest training on an elliptical trainer alternating with actual board runs. Ellipticals have the advantage of being shock-free and will nicely stretch your calves and tendons.
And I wouldn't sweat it if you can't get the endurance by August. You might want to set that goal for a year or two in the future, since what you're suggesting is really a series of longboard "ultramarathons" - a pretty extreme endeavor.
Now, on to what you've got, which is probably some mild achilles tendinitis. The cord at the back of your foot is probably a little irritated or inflamed. Treatment is usually with anti-inflammatories like Aleve or something from your doctor (but don't take anything new without checking with doc), good supportive shock absorbing sk8 shoes, and if the pain continues, a visit to your local sports podiatrist. Do mild stretching before your go out on a training run. Your achilles tendon ain't broke, but if you ignore it, the swelling and/or damage could increase and that would be really really not fun at all.
Good luck and let us know what happens. Tell us more about this cross country longboard event.
drdh
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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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