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Concussions in Sports

Thu, 27 Aug 2009 10:30:00 -0700

A concussion is an injury to the brain, usually caused by a blow to the head. Symptoms of a concussion include confusion, headache, nausea, balance problems, amnesia, and loss of consciousness. Most concussions do not result in a loss of consciousness.

There are an estimated 300,000 concussions per year from sports. High-risk sports include contact and collision sports such as football, ice hockey, rugby, wrestling, lacrosse, and, to a lesser extent, soccer and basketball. Younger players are more prone to concussions and to more serious concussions because of their immature nervous systems. Also, females are more likely to sustain a concussion than are males and tend to take longer to recover.

Any athlete sustaining a suspected concussion should be evaluated on the field or sidelines for severity of the injury using one of the validated sideline tools, such as the Sport Concussion Assessment Tool (SCAT).

When to return to play decisions following a concussion are based on attempting to prevent serious complications such as second-impact syndrome or permanent brain damage. Second-impact syndrome occurs when a player returns to play before the symptoms of a concussion clear. A second, often minor, blow to the head can then lead sudden brain swelling and rapid death.

Because of their immature brains, athletes less than age 18 are particularly vulnerable to this problem. For this reason, no one under age 18 should ever return to play on the same day as a concussion occurs and no athlete should return to play until all symptoms have cleared, which may take several days. The treatment for a concussion is rest - that means no exertion, physical or mental. No video games, text messaging, cramming for tests, or, in some cases, school. Symptoms will usually clear over a period of several days. After symptoms clear, the athlete should follow a stepwise and graded exercise program as recommended by the AAN (American Academy of Neurology) to ensure full recovery before return to play. This program will usually take several days to a week to complete. If the concussion was severe or if it was not a first concussion, the time to return to play may be a month or longer.

It is important that you not allow your child to return to play too early. Returning to participation before complete recovery will greatly increase the risk of developing long-term or even deadly complications.

The Two-Headed Influenza Season

Tue, 25 Aug 2009 22:33:00 -0700

The Two-Headed Influenza Season

This year's influenza ("the flu") season will be a trial for families and physicians alike. In late August or September, pharmaceutical companies will release the influenza vaccine (both nasal and injectable) against "seasonal" influenza, which was prepared last spring based on recommendations from the World Health Organization (W.H.O.). It will be comprised of three strains of influenza anticipated to circulate this winter. Children under nine years of age who have not been previously vaccinated against influenza will need two injections four weeks apart; everyone else should receive one vaccination. Don't underestimate the value of vaccination against seasonal influenza! Last year over 30,000 Americans died from complications of seasonal influenza.

The United States government, in cooperation with the C.D.C. and pharmaceutical companies, is already working on a vaccine against the novel H1N1 (Swine flu) that started circulating in the spring of 2009 after the W.H.O. had made the recommendations for the winter of 2009-10. Hopefully a vaccine will be available for distribution by late October/November/December 2009. If so, everyone will need to receive two vaccinations approximately four weeks apart to have full protection against all flu strains likely to circulate this winter. However, as of this time all dates and specifics about the novel influenza vaccine are not fixed and are subject to change.

What's a parent to do? First, contact your physician in early September and have your entire family vaccinated with the seasonal influenza vaccine originally recommended by the W.H.O. Whenever the novel (Swine) influenza vaccine becomes available, have your family revaccinated against this strain of flu. There will be shortages of both vaccines, so don't delay.

Russell McDonald, M.D.

Medical Director, Pediatrics After Hours 2

Swimmers Ear (External Otitis)

Fri, 17 Jul 2009 09:52:00 -0700

Swimmer's Ear is a common problem in the summer when our children are in and out of the pool on a regular basis. The outer ear is designed to be dry and the recurrent wetness from swimming causes local irritation and promotes the growth of both fungi and bacteria. Once it starts the outer ear becomes swollen, tender and full of drainage. Almost always the ear lobe hurts when pulled and your child is miserable.

What can you do? In the short run, ibuprofen works best for pain, but acetaminophen is fine if available. However, your child will need to be seen promptly and started on antibiotic drops. Generally five to seven days should be sufficient. Some physicians also like to use antibiotic drops combined with steroids to decrease inflammation and help pain. If the ear is so swollen that the drops can't move down into the deeper ear canal, the physician may place a small piece of gauze called an ear wick into the ear canal to help pull ear drops deeper to promote faster healing. In severe cases of pain a few days of acetaminophen with codeine may be indicated for pain relief. I don't recommend any swimming until the child is substantially better which takes three to five days depending on the severity of the initial infection.

How to prevent a recurrence. After your child is well I recommend putting ear drops in both ears after your child is done swimming. Several options include alcohol mixed with hydrogen peroxide (this will burn if used before your child is well), alcohol plus vinegar or one of several brands of preventative drops which can be purchased at your local pharmacy.