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| Q&A: Dr David Hartman on Head Injuries (824 Posts)
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snoball's silly brain
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On 9/9/2005 snoball
wrote in from
United States
(65.35.nnn.nnn)
hi dr.dave...thanks for the reeeply ;)
I don't know anything about neuroscience so won't dare to argue
with you about it. I can only repeat what the neurosurgeon told
me and he's one of the top ten in the country. I had quite a team,
and feel if it weren't for him..um...something something. He's
tops.
He's the one that told me the brain 'remembers' its injuries. I have
scar tissue in my right temporal lobe and diffiuse damage over the
left hemisphere. But, she walks, she talks, she feeds herself ladies
and gentlemen, so in my book I'm quite alright. Anyway, that
remembering part of the med sci is also why he told me to 'keep
my films just in case' lol. Skateboarder, general rucuss pursuer etc
He's also humble enough to admit that when it comes to
understanding the brain and what it can take and can't or overcome
and can't is not easily predictable. He and the team called me
their miracle patient. It was a miracle they didn't kick me out ;-)
I don't think my wrist will ever be right like it was and I don't
expect it to be anymore. X-ray indicate a complete heal of the
bones but to me, well, pain and restricted movement are what
they are. I haven't done those tests you recommended because
there are other things I'd rather be doing than hanging around
doctors. I only want to see you guys if I'm broken, bleeding,
projectile vomiting...you get the picture ;-)
As for the psychoneurocognitive test ( sorry ), no, I never did that.
In fact, as soon as they let me out of ICU I checked myself out of
the hospital and went home. I did my obligatory followups and then
also released myself. No offense to the doctoring profession or anything.
I wear my helmet in bad conditions, and never fail to wear my wrist
guards at the very least. I totally and completely recommend these
two things as minimum restraints and preventitive measures against
self-inflicted injuries and the boredom of waiting rooms that ensue LOL
You're OK Dr.Dave. Don't let anyone tell you any different :-)
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Civ Lives
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On 7/6/2005
Dr. Dave
wrote in from
United States
(68.251.nnn.nnn)
People, take a look at Civ's helmet. Got cracked like an egg instead of Civ's head, so he has a picture and a story to tell us, instead of an obituary.
Very cool, Civ. Thanks.
Dr. Dave
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Lenny's Toe Jam
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On 7/4/2005
Dr. Dave
wrote in from
United States
(24.13.nnn.nnn)
Hey Lenny,
Turf toe can occur after a very vigorous upward bending of the big toe. It happens a lot when your shoe grips hard on the surface and sticks causing bodyweight to go forward, which bends the toe up. Turf toe is common in martial arts too, but I haven't seen anything about turf toe and boarders. You are more at risk if you have increased range of motion in the ankle and/or wear soft flexible shoes.
According to Jonathan Cluett, M.D., turf toe is a condition of pain at the base of the big toe, located at the ball of the foot. The condition is usually caused from either jamming the toe, or pushing off repeatedly when running or jumping. The most common complaint is pain at the base of the toe, but you may also have symptoms of stiffness and swelling.
A turf toe injury is a tear of the capsule that surrounds the joint at the base of the toe. Tearing this joint capsule can be extremely painful. Furthermore, tear of the joint capsule can lead to instability and even dislocation of the joint at the base of the toe. This may lead to accelerated cartilage wear and arthritis of the big toe (hallux rigidus).
Treatment of turf toe consists of resting the sore toe, icing the area, and elevating the foot; anti-inflammatory medications may be recommended by your doctor. Athletes diagnosed with turf toe should avoid their sport for about three weeks to allow the joint capsule to heal. Once returning to activities, special inserts can be used to limit the motion of the big toe and prevent further damage to the joint capsule. Unfortunately, turf toe can return, and rehabilitation may be slow. Surgery is rarely needed for treatment of turf toe, but in certain cases it may be helpful. If a bone spur forms, and severely limits motion of the toe joint, surgery to remove the spur may be helpful.
For boarding, you have to take a look at the shoes you are wearing. If the show is soft, it will allow your big toe to bend too far, so wear a stiff-soled shoe. Make sure your big toe isn't jamming against the top of the shoe during push-offs.
This kind of thing can take several months to heal, with the usual Rest, Ice Compression, Elevation (RICE) and anti-inflammatories. See if a podiatrist can give you a shoe insert that prevents your toe from getting the bends. If it doesn't heal or you re-injure it, see your ortho doc.
Best,
Dr. Dave
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Snoball all over the sidewalk
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On 7/4/2005
Dr. Dave
wrote in from
United States
(24.13.nnn.nnn)
Hey Snoball,
I'm sorry you are my new Poster Child for sk8 protection. If you are breaking bones and they're not healing, have you looked into electical stimulation? Have you had a dexa bone scan to see if bone density is a problem?
The scientific literature on concussion or mild traumatic brain injury says there is no good evidence that getting hit another time is worse than getting hit the other times, and there is no increased risk of early dementia. That being said, if you have or had an aneurysm or a prone to bleeds (hemophilia, taking blood thinners), etc., it is truly not a good idea to shake up the brain. Remember, the brain is kind of like a hemisphere of jello encased in a Hefty Trash Bag (the dura). You shake, it shimmies. Bad shimmy means torn neurons, blood vessels, etc...Kind of like your own personal Shaken Baby Syndrome. Your helmet-wearing now may not prevent another brain bleed, but its ALWAYS better than not wearing one at all.
Also, you are not going to be as quick on your feet, or good at correcting for unexpected problems, with the kind of brain damage you've described. I have to tell you, if I were you, I'd be thinking about passing down the boards to a kid who can't afford them, and taking up a sk8 coaching and/or a sport that doesn't play pituitary ping pong.
Your wrist thing is the other side of Wray's wrist guard injury. It's really tricky to fix wrist injuries because of all the tiny bones, muscles and nerves in that region.
Your "Last Run of the Day" injury is when most of these kind of injuries take place. It seems that when we're tired, but just want to do 'one more' - that's when it's Clobberin' Time.
Anyway, Snoball, take it easy. Another thing to think about is, that if you haven't had a neuropsychological exam, (which takes all your brain functions 'out for a drive' on behavioral tests) it might be a good idea, because then you could get a sense of what parts of your brain are working well, and which areas have hung up their spikes, as it were. . .
Best,
Dr. Dave
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broken bones and brains
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On 7/4/2005 snoball
wrote in from
United States
(65.35.nnn.nnn)
I shattered the end of my ulna and had a clean, horizontal break at the
end of my radius. This was a wrist fracture from two years ago and it is
STILL not quite 'right'. Breaking bones at 12 is one thing, breaking them
after 21 is another. I deserved this break in the sense I'd taken my guards
off and thought,"Eh, just one more run.". So of course that's when it always
happens. And the ortho said what you said. A wrist break is problematic because
of all those bones insert other medical stuff I don't understand.
I had a brain bleed in 2003 and was in ICU, not related to skating. Damaged the temporal lobe and diffuse damage over the left hemisphere. My neuro
shudders when I speak of skating and flat out told me the brain does NOT forget
injuries and another good smack to the head has increased my potential mortality
rate by 80%. IOW, a helmet will not be of that much use but I wear one
anyway. The point is, if a helmet can prevent your sustaining a brain bleed,
which will put you into all sorts of nasty new 'potential' categories and is
NOT fun to go through, then wear the fribbin' helmet! Healing a broken bone
is a heckuva lot easier than healing a broken brain.
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Turf Toe
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On 7/4/2005 Lenny- DHB
wrote in from
United States
(68.252.nnn.nnn)
This past winter, I attended a Sports Medicine Clinic in order to get licensed to coach in public schools. While there, they discussed turf toe. Hearing the symptoms, I realized that I've had that in the past. It struck me odd that I've not heard too much about it in skateboarding since it's primary cause is pushing off on hard surfaces and that's what we as skaters do.
After a weekend of hard skating, guess what, I think I have it again! I'm following the directions (ice, rest, OTC pain killers) to treat it, but when I was reseaching it last night, I read conflictung reports about turf toe prevention. One article said there were braces you could purchase which would support the toe, while another said there was no prevention, but a stiff-soled shoe may lessen the risk. What's your take on this? If there is a brace, what are the pros and cons of it and what does it look like? If it's just wearing stiffer soled shoes, what skate-shoes (or other shoes good for skating) would you recommend? For that matter, any insight on this matter would be a great! It's a bit painful.
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WRay's Wrist - Inside Edition
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On 7/1/2005
Dr. Dave
wrote in from
United States
(24.13.nnn.nnn)
Way cool, WRay. I think that's a first for NCDSA. . .putting your insides on display. Nice pins, by the way. You may want to carry those pics with you the next time you go through airport metal detectors. I'm serious.
Hey readers, got any pad recs for WRay?
Dr. Dave
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Wray's Wrist
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On 7/1/2005
Ray
wrote in from
United States
(24.50.nnn.nnn)
Hi Dr. Dave,
Yup, that's exacty what he said. You might think you guys all went to the same schools or something..:)
Update: I had surgery wednesday because the radius wasn't aligning properly.
Isn't this cool?
"We can rebuild him. We can make him better."
The surgeon said it would have been much worse if that force at that angle had been applied to the wrist itself.
So, I'll be looking for some longer more padded wrist guards to maintain my skateboarder's sense of invulnerability..:) Sometimes a 42 y/o body with a 17 y/o brain needs to learn a lesson the hard way.
Thanks for this valuable resource Dr. Dave,
Wray
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WRay's Wristguards
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On 6/26/2005
Dr. Dave
wrote in from
United States
(24.13.nnn.nnn)
Hey Ray,
Next time ask your ortho doc what would have happened to your wrist/hand bones if you hadn't been wearing the guard. If you have to break something, your forearm is much simpler to heal. There are 27 bones in your hand, eight of these in your wrist. They're little, and if they get messed up they interfere with anything you'd use your hand for. Use your imagination.
But you've discovered the Dirty Little Secret of Wrist Guards. In a very high impact fall (like an 8 foot drop), they will protect your wrist but transfer the shock upward, hence your broken forearm. So you're absolutely right about what happened.
The solution is to get the biggest, fattest wristguard you can find, to absorb as much of the shock as possible. Ditto for the rest of your pads too. Try not to fall with your hands at a 90 degree angle to your body since that means all the shock is hitting your wrists and arms.
So, I wouldn't take the stiffening out of the wrist guard. I personally like wrist guards that go a few inches up the forearm, but I don't have any data for you on how they work. I don't think a Coleman Slide is going to help you in pool and vert (readers, correct me if I'm wrong). Your best bet is a wrist guard with a big spring to absorb the maximum shock. Take a look at the Pro-Design guards for example.
If anybody has wrist guards they swear by, tell Ray about it on this list. He'll have plenty of time to look for them while he heals. . .
Dr. Dave
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Broken Wrist added
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On 6/26/2005 Ray
wrote in from
United States
(24.50.nnn.nnn)
I am a 42 y/o experienced vert/pool skateboarder. I didn't want to leave the impression I was a fruitbooter or a nebie..
Sorry
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Broken Wrist
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On 6/26/2005
Ray
wrote in from
United States
(24.50.nnn.nnn)
Hi Doc,
My father's day present to myself was a broken right arm. I broke both bones in the forearm about 2 inches up from the wrist, right about where my pro-tec wrist guards end. I'm not blaming the wrist guards, but I have to assume they were either worn wrong or improperly fitted. I was mainly wearing them to protect my palm. The way I fell I'm pretty sure something would have broken regardless of wrist protection, about an 8 foot drop from a vert ramp landing hand, head, back.
I'm going back to my ortho doc tomorrow to see if pins are needed. He said he sees a lot of these with first time inline skaters who are surprised that they have a break since the wearing wrist guards. He also the back splint on most wrist guards is too short and that is most likely why mine broken the way it did.
Now to my question, right now I'm leaning toward wrist guards with the back splint removed. comments? thoughts? I've also seen some wrist guards that extend higher up the arm. Thoughts? Commens?
Thanks,
Ray
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A Stent in Time. . . or Smitty Outskates the Reaper
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On 6/25/2005
Dr. Dave
wrote in from
United States
(24.13.nnn.nnn)
Smitty,
Sounds like you're going to skate anyway, but several suggestions:
1. If you are on blood thinners (e.g., coumadin, Warfarin) check with your doc, because falling with thinned blood makes bleeding, internally and externally more likely. You don't want to trade a heart attack for a stroke. People on blood thinners are at risk for internal bleeding with impact accidents.
2. You're going to groan at the second suggestion, but think about it. Does BC have any of those radio receiver "I've fallen and I can't get up" companies out there? Wearing a lanyard with a button like that might not be a bad idea if there is a service in your area. It summons ambulances fast. Otherwise skate with a cell phone. Get a Rhinoskin aluminum cover for the phone.
3. And get your heart exams regularly. Stents can close up. Gotta watch 'em. Monitor your cholesterol. Keep your blood pressure in the normal range. Ask your doc about whether it's useful in your case to carry a couple of regular (not enteric) aspirin with you as an emergency de-clotter (And DON'T do it without asking your heart doc)
4. Stay away from Mad Cow Burgers. High fat diets make things harder on your heart and can increase plaque.
5. Don't smoke. Smoking and high fat diet together are much worse together than either is separately.
So check all this stuff out, Smitty. And since you're in B.C. think about Whistler in the Winter. . . Best of luck, hope you are always one hill ahead of the Guy with the Scythe. . . Let us know more about how it all goes.
Dr. Dave
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As a Matter of Fact...
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On 6/18/2005
Smitty
wrote in from
Canada
(154.20.nnn.nnn)
Heh...funny you should mention the family doctor. About eight years ago I had a series of heart attacks, and ended up with a stent placement as a delay tactic...the docs want to wait for laproscopic bypass to get more mainstream) Seems I have a heart defect nobody found for thirty years. Lost my dad early, and a brother in infancy to similar problems.
When they found it, they told me they were surprised I wasn't one of those perfectly healthy kids that just keels over on the soccer field. I was EXTREMELY active as a kid...high school soccer, marching band, waterskiing, fishing, hunting.
The transition to heart patient has been an emotional kick in the pants. Two years ago, shortly after arriving in the land of the big gnarly hill (British Columbia), I decided that if I am going, I am going while having fun. This is not a death wish...More of a life wish.
So, I may pitch over carrying my Drop Carve back up the street (we try and use a chase/safety car as much as we can), but by GOD I'll be smiling when I go!
Geronimo!
Smitty
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Face Time for Smitty
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On 6/17/2005
Dr. Dave
wrote in from
United States
(24.13.nnn.nnn)
Hey Smitty,
Over 40 and longboarding is just fine. If you don't have osteoporosis,arthritis, balance problems or Alzheimer's, go for it. Well, get a clean bill of health from your family doc, just to be sure. And consider one of those new lightweight "body armor" jackets which have all the pads, and also protect the hips.
It's funny, no-one questions skiers in their 50's and over, but somehow longboarding is eyebrow raising. O.K., you probably won't hang out and make friends at the local skate park, but maybe you can set an example and gather a following of extreme adults. . .
If you do any kind of speedboarding, I would recommend a motorcycle helmet. I would specifically NOT recommend a BMX helmet, with the chin protrusions. You fall face forward on one of those and it could snap your neck or twist it into paralysis or worse.
People, if anyone is using a full face helmet, what would you recommend for Smitty? drdh
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Time to buy a full face helmet
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On 6/17/2005
Greg 'Smitty' Smithwick, CLBC
wrote in from
Canada
(154.20.nnn.nnn)
Hi Doc!
Hey, I just graduated from a transition long(ish) park board to a Landyachtz Drop Carve...and the easy speed difference has me thinking it is time for a full face. In reading some of the other columns, the debate for 'best helmet' seems to revolve around what is within the rules for different races.
Since I don't intend to race, what are my best SAFETY choices. I'd be fine with wearing goggles or safety glasses, in fact I like that better than a shield. What do you think?
Between you and Coleman, I am getting used to the idea that being over 40 and on a board is NOT bad!
Smitty
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Skateboard Army
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On 6/14/2005
Dr. Dave
wrote in from
United States
(24.13.nnn.nnn)
Sammy,
Well, you would think that a kevlar helmet would be protective, but my guess it may be more protective for getting shot at, than falling from a skateboard. You might want to email the company and see if they have stats on shock absorbing properties of the helmet. It probably looks cool, but I would still go for a Snell or CPSC certified skate, snowboard or motorcycle (NOT BMX) helmet, because these are rated for falling, rather than being shot. You want a nice round helmet, no dangerous protrusions or points or wings anywhere.
Dr. Dave
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Helmet
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On 6/14/2005
Sammy
wrote in from
United States
(207.200.nnn.nnn)
Whats up Doc?
I recently got a really good condition kevlar british military helmet with lods of padding, and a helmet liner. I was just wondering if this would protect my noggon from a nice fall off the longboard.
Thankyou,
Sammy
P.S. It fits my head nicly:)
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It's all in the wrist
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On 6/13/2005
Dr. Dave
wrote in from
United States
(68.251.nnn.nnn)
Justin,
Look up the following website: http://www.kinesis-ergo.com/ at the contoured keyboard. It has two wells that let your fingers fall just where they should with no wrist twist like conventional keyboards. They work on PC or MAC's. I have no financial relationship with the company but I type all the time and I own several of them. They absolutely do work to stop wrist pain and prevent further pain.
Dr. Dave
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wrist
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On 6/13/2005 Justin
wrote in from
South Africa
(196.25.nnn.nnn)
I work on a Mac doing colour retouching so my hands are pretty intune with the keyboard, so I would say its that. Cant blame skating for everything. Thanks for the insight.
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Good opportunity
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On 6/12/2005
Dr. Dave
wrote in from
United States
(24.13.nnn.nnn)
Hey people, now that the Lords of Dogtown is coming out, it's a great opportunity to do a little helmet education for all the I-saw-the-movie sk8wannabees who think that imitating Jay Adams is a good way to show off.
Search this corner for info, or just ask me but don't be afraid to get on the helmet pulpit. You could save a life.
Dr. Dave
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When your mind makes a promise, your body can't fill. . .
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On 6/12/2005
Dr. Dave
wrote in from
United States
(24.13.nnn.nnn)
Little Feat said it for both you guys. Bodies are the sum of their twists, breaks, aches, etc.
Justin, there there are two main reasons for wrist pain. A sudden event or an acute injury can break a bone or tear a ligament. Or repetitive activities, e.g., typing, can cause strain and pain. Repetitive strain injuries include carpal tunnel syndrome, and DeQuervain's Disease. Other causes of wrist pain can include diabetes, thyroid disease, arthritis, and pregnancy. . .O.K., probably the last isn't much of a risk for most of you.
Finally, there's arthritis, which can be the result of trauma, or just your bad genes. Traumatic arthritis is a byproduct of the healing process when ligaments are injured or bones are broken. Bone surfaces tend to rub and wear out and the tissues and linings around the bone become irritated and swell, causing scarring. The end result is arthritis. Some people also get arthritis because their parents gave them bad genes. Talk to your parents. . .
If none of the above sound like you and the usual anti-inflammatories don't stop the pain, your friendly orthopedist should x-ray the area and see what you've got. Let us know.
And Mikez, I'd get a back x-ray from an orthopedist, just to see what you're dealing with. Remember though, there may not be much of a correlation between back pain and what's going on. Some people with blown discs feel fine, and others with more minor stuff feel like they're being hit with a cattle prod.
Chiropractors are good for stretching out and realigning the back, but see what's in there first. Let us know how it goes.
To keep those tendons and ligaments limber and tender, there's pretty good scientific evidence that taking glucosamine/chrondroitin which is available over the counter e.g., Cosamin, is good stuff. Talk to your doc about it.
Dr. Dave
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lower back pain
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On 6/11/2005 mikez
wrote in from
South Africa
(198.54.nnn.nnn)
hey doc,
I had a a bunch of blows to my lower back about a year ago, fall off a skateboard, tripped over a cats eye in the road while jogging(one of those little reflective things just incase the terminology is different over there) and twisted it surfing - all culminating in full blown back cramps that renedered me unable to move at all-i almost passed out trying to breath deep enough to call someone! a couple visits to the doctor and then physio and I was pretty much on my way, however it has slowly started coming back, especially in my car whilst driving or sitting for a long time. I really don't want to end up with chronic back pain. whats the next step? pyhsio? chiro? doctor? x-ray? lots of bubble baths?
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Sore wrist
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On 6/11/2005 Justin
wrote in from
South Africa
(196.25.nnn.nnn)
Whats up Doc Dave? Ive been skating for many years, more street sk8ing and only now for the past 3 yrs downhilling. Four days ago some odd reason my left wrist has started to pain (irrataiting pain) right where the arm meets the hand in the middle. Ive never broken or sprained it but I know when I was street sk8ing that I've fallen hard on it, but that was quite a few years ago. Winter is here in SA so I dont know if it is the cold that is bringing on the pain. My girlfriend even massaged my wrist but it did not help.
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Return of some stupid aussie
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On 5/9/2005
Dr. Dave
wrote in from
United States
(24.13.nnn.nnn)
SSA,
3 days of dizziness is worth a visit to an ER or a neurologist. Go for it.
By "handle" I meant the label "some stupid aussie" which is kind of asking for a social handicap, if you know what I mean.
Anyway, let us know what's going on with you. Think about cutting back on the alcohol a little for a while, so you don't burst into flames in the emergency room. . . . :)
drdh
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head
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On 5/9/2005 stupid aussie
wrote in from
Australia
(211.30.nnn.nnn)
yeah prolly right getting it checked tomorrow i'm still a little dizzy happened 3 days ago almost now. definitely feeling much better though. and change handle? if thats about wanting to maybe have a few beers and such i dont drink that often (maybe once a week on friday or saturday night) and even then usually only 6-8 beers.
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