There is an epidemic in our midst that most of us are unaware of. Untold numbers of young people are suffering at an alarming rate. Many cases of the epidemic go unreported. The public, as well as the medical profession, have failed to appreciate the consequences of this problem and have been unaware of its significance and its long-term complications.
One could be forgiven for thinking these words apply to some disease in a far-off country. In fact they are words written by an eminent physician—Dr. Michael Lee, about a condition we see right here in our community.
And to what does it refer? An issue we here in Whistler are all too familiar with— concussion.
Lee has been evaluating patients with concussions for several years, has lectured at conferences and has had articles published in SportsMed — in short he knows what he is talking about when it comes to brain injuries, especially in adolescents. So to read that he is describing it as an epidemic is alarming. In the past year or so I have had direct experience with concussions. Just over a year ago my then 10-year-old son got a concussion skiing (not serious, thank goodness), then a friend suffered a very serious concussion, which to this day she is bravely battling, trying to get her life back, and just recently a Pique staff member became concussed.
There is no doubt that in the past few years there has been a paradigm shift in the way medical professionals have started to treat this condition. Some of this improvement must be laid at the feet of sports heroes such as NHL player Sidney Crosby, who suffered a serious concussion in the 2010-11 season that is still affecting his play. By raising the profile of the injury everyone sat up and took notice. A number of high-profile snow sport athletes have also had devastating concussions including 2010 Olympic snowboard cross medalist Mike Robertson, Canadian alpine skier Robbie Dixon and alpine U.S. superstar Lindsey Vonn.
Just this week scores of lawsuits involving thousands of former football players touched by concussions and brain injuries have been consolidated into one master complaint, setting up a massive and potentially costly case for the NFL.
It is now clear that post concussive care is absolutely crucial to recovery. But there are still big gaps in the diagnosis of the condition and its long-term treatment, especially when it comes to fitting all the pieces together for a patient to have time off work to recover and so on. Not everyone is an NHL millionaire, not every child has a stay at home parent.
According to an article in Maclean's at the end of last year, there were approximately 37,600 concussions in Canada per annum with 7,500 of those lasting more than two weeks.
In children and adolescents the incidence is even higher — up to 200 per 100,000 — and it is harder to detect, the symptoms tend to be more severe and take longer to subside.
"Until about 19 or 20 you're still gaining neural connections, so any effect before that has the potential for changing the final course of that person's cognitive ability," Dr. Jeffrey Kutcher, a neurologist and professor at the University of Michigan told Macleans.
When my son was concussed we followed all the rules — no TV, no gaming, no reading, no school for a few days and so on. It all looked fine from the outside. After a few weeks it was back to normal, or so we thought. But strangely he kept getting nauseous when he went to his tramp class. Not realizing there could be any link he kept going and I kept sending him. After the third time I picked him up throwing up outside class we called it quits. It was months later that I put two and two together and realized it was likely the concussion.
That is why I was excited to read recently that a Canadian doctor has found a way to detect concussions with a simple blood test, and it could tell us within the first hour how severe the injury may be.
Dr. Linda Papa, a Montreal native now leading a U.S. National Institutes of Health-funded research project at American trauma centres, has shown certain proteins released by the brain after a head injury can be detected in blood, according to a recent Postmedia story.
After a head trauma, the barrier around the brain also gets damaged, and the proteins leach out into the blood. Concussions can be very difficult to diagnose and many people when they bang their heads just shrug it off. Even medical diagnosis such as CT scans can miss a subtle injury, and if people get a second blow to the head before recovering from the first it can have fatal consequences.
Papa found that the proteins were highest in those who needed urgent surgery.
"The key is, could these proteins tell us in advance how severe the head injury is, and is this patient going to require some kind of neurosurgery?" she pondered.
"There's really no approved blood test for the brain as we know it right now."
Part of keeping athletic kids and athletes safe is doing baseline testing. For many months there has been a push to have this done widely. The Whistler Mountain Ski Club recommends that all their athletes do it (more info at email@example.com). Whistler Minor Hockey is also anxious to do it, but is struggling with cost and logistical problems associated with the testing.
Baseline testing is already in place for professional athletes in a wide range of sports.
Concussions can have life-long effects, so whatever can be done to test or lessen their impact should be embraced.
And please, wear a helmet, especially if you are cycling along the highway.
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