Transcription of Dr. James Glazer for the show Head Games #53
Dr. Lisa: This is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour and Podcast show number 53, “Head games” airing for the first time on September 16th 2012 on WLOB and WPEI Radio, Portland, Maine. Today’s guest include Dr. James Glazer of Coastal Orthopedics and Sport Medicine, Rob McDonald graduate of Cape Elizabeth high school and current Harvard University student, and also Deb Arthur, who has a doctorate in physical education and a masters in science who currently works at The Body Architect.
Each of our guests will help us explore the theme of the head and how it intersects with the body as in mind, body, and spirit. Dr. James Glazer will give us more of a clinical eye and some history on concussions and what it means to have a traumatic brain injury while playing sports or in other parts of one’s life. Rob McDonald is going to give us a more personal view of this as he describes an episode that took place during his first year of college while playing rugby, a head injury which certainly had an impact on his own life. And Deb Arthur will really bring the idea of mind and body back around again for us. We hope that you enjoy our show today. Please let us know what you think.
The Dr. Lisa Radio Hour and Podcast is pleased to be sponsored by the University of New England. As part of our collaboration we feature a segment we call Wellness Innovations. This week’s Wellness Innovation focuses on head injuries.
It’s interesting concussion rates and prevention strategies at all levels continue to grow, one population that appears to have increasing head injury rates is collegiate football players. Research presented recently at the American Orthopedics Society for Sports Medicine annual meeting in Baltimore highlights that concussion rate in three college football programs has doubled in recent years. The increase comes after a 2010 NCAA concussion management initiative that requires athletic programs to report concussion signs and symptoms and then remove players from play. For more information on this Wellness Innovation visit d-o-c-t-o-rlisa.org. For more information on the University of New England visit une.edu.
Speaker 1: This portion of the Doctor Lisa Radio Hour and Podcast has been brought to you by the University of New England, UNE, an innovative Health Sciences University grounded in the liberal arts. UNE is the number one educator of health professionals in Maine. Learn more about the University of New England at une.edu.
Dr. Lisa: In my medical practice I have seen recently a rise in head injuries from younger patients which I found somewhat disturbing, and this was one of the reasons we thought it was important to bring in a sports medicine specialist and have a conversation about head injuries as part of our “Head Games” show. So today we welcome Dr. James Glazer of Coastal Orthopedics who is a sports medicine specialist and actually someone that I’ve had a long standing relationship with as a fellow family practice trained physician. So thank you for coming in and joining us today.
Dr. James: Thanks Lisa, happy to be here.
Dr. Lisa: James, tell me a little bit about your background first of all. I think people are interested in the fact that you are a sports medicine specialist and yet you are trained in family medicine.
Dr. James: That’s right. There are a number of different paths to become specialized in sports medicine right now. In general we have people who do primary care sports medicine or non operative sports medicine, and that’s what I do. You can get a residency in any of a number of different medical specialties. Family medicine is a big one, but we have sports medicine specialists who are pediatricians or emergency room doctors as well, some internal medicine specialists. After your residency program you go on to do specialized training in sports medicine. And some of my colleagues continue to do primary care, others of us just specialize in sports medicine and really focus on teaching and training and treating athletes.
Dr. Lisa: At the Maine medical center there is a sports medicine fellowship now.
Dr. James: There is. We’re very fortunate in Maine to have a fellowship training program. It’s been around for a number of years. They train two fellows a year, and I was a faculty member there for six years before going into private practice.
Dr. Lisa: As a mother of three children who play sports I’ve noticed on the sidelines over the last maybe 10 years an increasing number of professionals supporting the teams. I’ve noticed that we now have physical therapists and trainers and even physicians on our high school fields working with our athletes. How do you feel about that?
Dr. James: I think that’s a great thing for Maine and as a matter of fact there was just a law passed in May by the Maine legislature about concussions. One of the things that that law mandates is that people be a little bit more active in evaluating kids and pulling them out of games immediately if they think that they have a concussion. I think that one of the things that has motivated that law is recognition of the fact that concussions are very prevalent. But another thing is that here in Maine we’ve had really great community support for having trained medical professionals with our kids, protecting them on the sidelines, and making sure that if there are any injuries they’re assessed and treated pretty quickly.
Dr. Lisa: Why are concussions or head injuries on the rise in kid sports?
Dr. James: I think that’s a great question and that’s something that researchers are doing a lot of investigation into right now. One of the main things that I think we’re seeing now is increased awareness. So whereas 10 years ago a kid might have had something that his coach turned a bell ringer and just shrugged it off, now we recognize that that actually is a concussion and that it’s very important to take advantage of an opportunity to educate the athlete, educate the coach, and to treat it appropriately so that we don’t see long term problems as a result of repeated small concussions.
Dr. Lisa: Does this have anything to do with say Muhammad Ali or some of the other boxers that are out there who have had this sort of repeated traumas and are now showing up with Parkinson like symptoms?
Dr. James: Absolutely. There’s a range of medical conditions that are more long term and neurologic in nature that we’re now recognizing may have to do with long term effects of repeated concussions. And we’ve seen football players in the news recently a rash of suicides that there is investigation going on right now to find out if those were related to the long term effects of concussion.
Dr. Lisa: What sports put athletes at highest risk for concussions?
Dr. James: That’s a really interesting question because I think if you asked most doctors 10 years ago they would have said the males sports dominate and there are some predominantly male sports like football that have very high rates of concussion. But interestingly, if you look at the statistics, female sports are on the rise and not far behind their male counterparts in terms of the frequency of concussions. So soccer is a big dangerous area, both men and women’s hockey players are at risk for concussions, and we see concussions in sports like lacrosse as well both for girls and boys who are playing it.
Dr. Lisa: Now you described the risk of suicide. What other things do you see as a result of a child getting a concussion?
Dr. James: One of the really devastating effects of concussions has to do with the effect that it can have on a kid’s progression through school. So I often see athletes who have had a lot of trouble catching up in school, who’ve had trouble with concentration. Sometimes there are some pretty profound mood changes where a young person may become very erratic in terms of their mood. And that’s all as a result of the concussion.
Oftentimes these symptoms aren’t recognized early and so you see kids out there who are really depressed, who are really having trouble in school, sometimes three, six, or nine months after a concussion, and I think it’s really imperative that my colleagues and other people who are interested in this subject get the word out that this may be a result of concussion and that it really should be handled as such.
Dr. Lisa: Is there a way to test for cognitive function?
Dr. James: There are a number of different test that are used. One of the most widely used tests right now in Maine is called the Impact test which is a little bit of an unfortunate name, but it’s a computerized concussion test. It’s used primarily by sports medicine specialists like me to determine when an athlete is ready to get back to playing. So not so much as a way to diagnose a concussion, but as a way to make sure that once the symptoms are all clear that the athlete’s brain is really functioning the way it was before the concussion.
Dr. Lisa: All three of my kids play soccer and I’ve seen people wearing these bands around their heads. What do you think about these bands that theoretically are supposed to be preventive as far as heading the ball and preventing concussions?
Dr. James: I get questions about those bands and other kinds of protective gear often. We all want to find something that is going to protect our kids from concussions, and so there’s a lot of interest in mouth guards, or helmets, or bands, or other kinds of things. The very frustrating thing from my point of view is that there really isn’t any research that supported that. As we look at large numbers of athletes who are using this protective equipment over a number of athletic contact hours, they don’t seem to protect against concussions. So generally what I say to parents is that there’s no evidence that it’s going to help, but there’s also no evidence that it hurts. And so in some situations with some kinds of impact it may confer a little bit of protection and for many parents that’s worth it and they go ahead and use them.
Dr. Lisa: If you have a child that has suffered a concussion what types of treatment options are there available?
Dr. James: It’s important that we now have been able to break out of the main paradigm, which I think has been present in the medical field for years and years in terms of treating concussions, and that’s just relying on rest. Concussion research is a rapidly advancing field, and for the people who do a lot of concussion work there’s new recommendations coming out all the time. So I usually talk to parents and athletes about two cornerstones of rest, one of which is athletic rest and that’s something that we’re all pretty familiar with, that you can’t go to practice, you can’t play sports.
But what I think you’ll find over the next five years is that we really are discovering that cognitive rest is much more important in some ways than athletic rest. So protecting your child from cognitive exertion, protecting your child from going to school all day and coming home with a headache. Every kid is different and every concussion is different, so some of them are able to go right back to school and to study and do fine, but the important thing is not to ignore symptoms as they appear.
There also is an emerging area of research around using medications for concussions. That’s medications aren’t the rule, they’re not necessary in every case, but in some athletes who have had pretty severe symptoms that have been persistent for three or four weeks medications can really be important in helping them get over that hump and get better.
Dr. Lisa: And what type of medications are you talking about?
Dr. James: The medications that have been most widely researched at this point and are most widely used are types of antidepressant medications, so active serotonin uptake inhibitors are one of the kinds of the medications that most people are familiar with and have been used and are safe in kids. Tricyclic antidepressants are also used often in concussion situations and they work really well to help kids get better from some of the cognitive and headache symptoms that they’ll often feel.
There’s a growing body of research looking into stimulant medication as well as. Many kids have trouble concentrating and they have symptoms that are very similar to ADD after a concussion, and so some people are using those kinds of medications. I think it’s very important though before any parents sees their child go on medication to be sensitive and thoughtful about this and really be sure that you ask your physician all the questions, make sure that you’re working with a physician who’s pretty comfortable not just with concussions but in the use of these kinds of medications. I always recommend that in any kind of medication that we use that’s changing the neurochemistry of our brains.
Dr. Lisa: What is it about a head injury or a concussion that leads to depression or leads to a change in emotional response or behavior? I mean I saw this all the time when I worked in the county jail and people would come in after a head injury and they would have a complete personality change. I mean it’s very clear that this happens, but can you tell me a little bit about the physiology behind that if you can.
Dr. James: I’d like to be able to, but this is something that’s a very hot area of study right now. So we don’t really understand all that goes into it. One thing that has become clear over the last few years is that if you look at the neurotransmitters that are present in the brain and the relative levels of each neurotransmitter, a concussed brain tends to look very similar to the brain of somebody who has clinical depression. So there’s something in the physiology of the brain that’s mimicking that depressed state and so some of the symptoms obviously are also congruent. It’s probably one of the reasons why some of these medications are so helpful in helping athletes get through these tough periods.
Dr. Lisa: Do you have any favorite resources for parents or coaches about concussions, a concussion prevention treatment?
Dr. James: There is a website through the CDC that shows, has a lot of information about concussions. It’s very helpful for parents. But like many complicated issues in medicine this is one of those things where every case is so unique and every case is so individual. I really I encourage parents to read as much as they can and as much as they want to, but I also encourage them to go and talk with their physician. Because what you read on the Internet so often is very helpful, but may not line up exactly with your own individual situation.
And one of the things that I think it’s important for all of us to recognize is that a concussion in a 10 year old is really different from a concussion in an 18 year old, and a lot of the stuff that we’re reading on the Internet these days is not necessarily tailored for those younger kids. So we have to recognize that it’s a very different situation depending on how old your child is and how severe the concussion is. And sometimes I see some unique aspects as well related to family history or the individual’s athlete concussion history.
So it’s a complex topic. It’s good to educate yourself, but don’t forget to ask questions and bring a list of inquiries to your doctor as well.
Dr. Lisa: If people are interested in finding you where would they find you?
Dr. James: You can find me at Coastal Orthopedics. If you Google for Coastal Orthopedics in Maine you’ll come up with our website. We have directions to my office and a little bit of information about me and my partners as well.
Dr. Lisa: We’ve been speaking with Dr. James Glazer from Coastal Orthopedics on our “Head Games” show. I really appreciate you coming in and talking to us about this very important topic.
Dr. James: It’s been a pleasure. Thank you.