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Concussions

Concussions & Young Athletes

Daily Dose

Dog Bites

1:30 to read

I am a dog lover and we have always had a dog in our house….even before we had our children.  But, some dogs will bite and unfortunately there are more than 800,000 people every year who receive medical care for a dog bite…more than half of these are children.

 

Children are also more likely to be severely injured from a dog bite…and I was reminded of this today when I saw a very serious dog bite to a child’s face.  The child was brought to my office by his nanny after being bitten on his cheek by the family’s dog.  It was one of the worst bites I have ever seen! He was severely injured and should have actually gone straight to the ER….the good news is that he will ok, but he had to undergo surgery to repair the bite and will probably require another small surgery at some later date. 

 

In this case as in most, the dog bite occurs when a child is interacting with a familiar dog, and in this case it was the family pet. The little boy is a toddler with a twin sister and they were playing when he was bitten.  The dog had been around the children since they were born…and it is unclear what precipitated the bite.  Sometimes a dog becomes aggressive if they are bothered while they are eating or sleeping…and you know toddlers, they can “bother” anyone. 

 

One of my “boys” is also a dog bite statistic.  He was raised with dogs (my sweet lab Maggie is at my feet as I am writing), so I was totally caught off guard one night when the phone rang. My son had been spending the night at a friend’s house (he was about 10 years old) and the voice on the other end of the phone was the father of the friend (he too a doctor), informing me that my child had been bitten by their dog.  It seemed the boys were laying on the floor on blankets watching a movie and eating popcorn and for some “unknown “ reason the dog bit my son on his face.  The bite was not precipitated by anything…they had not been playing or rough housing with the dog and the dog had not been known to be aggressive. The next words out of the father’s mouth…”do you know a good plastic surgeon?” Not words you want to hear from another physician.

 

Thankfully, I did know a good plastic surgeon who I awakened after his long day in the OR….and he got out of bed and met us to suture my son’s face with over 20 stitches. Luckily it only involved his nose, cheek and chin, just barely missing his left eye. I am sure I cried more than my son.  He still has a scar across his nose..which only bothers his mother.  Incredibly, he never “blamed” their dog, went back to play at their house, and still loves his own dogs more than anything.  My brother who is a vet still thinks that any dog that bites without provocation should not stay in the home with children…but that is one vet’s opinion. 

 

It is especially important to teach your children never to approach a dog to pet it without first asking the owner if it is okay.  Children should learn to move slowly and let the dog “sniff” them first and to stay away from their face and tail. Teach your child how to gently pet an animal and to always be gentle.  If they are around a dog who is behaving in a threatening manner by growling or barking, they should slowly back away from the dog and try to avoid eye contact with the dog. If they are ever knocked over by a dog they should curl up in and ball and protect their face with their arms.

If your child is bitten and it is superficial it will probably just require care with soap and water. For bites that break the skin you should check in with your pediatrician.  Make sure you know the rabies vaccination status of the dog that bit.  You also need to make sure that your child is up to date on their tetanus vaccination. In some cases your child may also need an antibiotic.

Daily Dose

Ice Burns!

1.00 to read

Many schools are in spring sports or playoff season which means I'm seeing a few strains and sprains in the office. 

The treatment recommendation for a sprain or strain is usually RICE which stands for rest, ice, compression, elevation.  I just saw an adolescent volleyball player who had started back to her volleyball work outs and “pulled a muscle”. So, she followed her coaches directions to “ice it”.  Unfortunately, she just put the ice pack directly onto her skin and she came in with an ice burn! OUCH!

Yes, ice can burn the skin and cause frostbite as well. When treating an injury with ice you need to make sure that you put a towel or sheeting between the ice and your skin.  In this patient’s case the ice burn looked similar to a sunburn, and did not blister or cause any severe damage. In fact, when she pulled up her pants to show me her leg she “quizzed me” to see if I could guess what had caused the redness.......guess what, knowing that she was an athlete helped me guess correctly!

The picture above shows her injury as well.

The treatment is similar to a thermal burn, apply a lubricant like Aquaphor or aloe vera, and let the skin slowly heal.  If it is blistered or has had severe damage to the skin you may need to see your doctor.

Remember, ice is good for injuries but cannot be applied directly to the skin.  

Daily Dose

Paying Attention to the Road

I am always talking to my own children about paying attention to the road and having no other distractions in the car.As I was driving to work today, I routinely go through a school zone. Today was the day that they had motorcycle police using radar and ticketing those drivers who were not following the school zone speed limit. There were a lot of people pulled over getting tickets and a line waiting for the police officer.

This is the same school zone that my children walked through on their way to school, and therefore I am always aware of the speed limit as it is closest to my home. I am always amazed at the number of cars that go speeding by oblivious to the flashing yellow lights. But, I am also sure that I am not as aware of other areas of the city and those school zones. We all get preoccupied while driving and it seems to be related to other things going on in the car. Whether it is children fighting in the back seat, or the noise from a movie on the car DVD player, or the cell phone or blackberry, there are too many opportunities to have our attention diverted. I am always talking to my own children about paying attention to the road and having no other distractions in the car. I even went as far to have the radio disconnected when our oldest started driving (that didn't go over well!) Well, I think "us" parents need to heed the same advice. Stay off the phone in school zones, no texting while driving, and let's not have kids watching TV on their way to school. Instead, how about talking to the children in the back seat. Whether it is weather, sports, spelling words or quizzing math facts, talking to our kids is far better than any thing else we can find to do on the way to school. And if you find yourself in a school zone, and don't have kids in the car, just pay attention to the rules and enjoy the quiet. That's your daily dose, we'll chat tomorrow! Send your question to Dr. Sue!

Your Child

Kids Who Specialize In One Sport Have More Injuries

Kids who came to the clinic with injuries played organized sports an average of 11 hours a week, compared with fewer than nine hours in the uninjured group. Although the researchers did not specifically look at this, Jayanthi said he has noticed that more highly specialized sports such as tennis, gymnastics and dance tend to be linked to more severe overuse injuries.Because a child’s body is still growing, children who specialize in only one sport suffer repetitive injuries more often, a new study says.

In fact, kids are twice as likely to get hurt –playing just one sport- as those who play multiple sports said Dr. Neeru Jayanthi, medical director of primary care sports medicine at Loyola University Chicago Stritch School of Medicine. "We saw a pretty significant difference with this intensity of training, along with specialization," said Jayanthi. The findings are slated to be presented Monday at the American Medical Society for Sports Medicine annual meeting in Salt Lake City. Research presented at medical meetings should be viewed as preliminary. "It's been accepted for the last five years or so that kids who are not super-specific do better. They're cross-trained, so they're conditioned for other movements," said Dr. Kory Gill, an assistant professor at Texas A&;M Health Science Center College of Medicine. Jayanith’s research team had done earlier studies on 519 junior tennis players and found that the kids who only played tennis were more likely to get hurt. Jayanthi wanted to see if the same findings extended to other sports. "As a physician, you get frustrated seeing kids come in with injuries that keep them out for two to three months. It's devastating," said Jayanthi, who recently saw a young gymnast with a knee injury that will keep her off the mat for at least three months. Here, the researchers looked at 154 young athletes, average age 13, who played a variety of sports. Eighty-five of the participants came to the clinic for treatment for a sports injury, while 69 were just getting sports physicals. The investigation ranked each athlete on how specialized they were, basing the score on factors like how often they trained in one sport, whether they had given up other sports to practice just one, and if they trained 8 months a year or more to compete more than 6 months a year on one sport. What they discovered was that 60.4 percent of the athletes who had been injured were specialized in one sport, compared with only 31.3 percent who came in for physicals. Kids who came to the clinic with injuries played organized sports an average of 11 hours a week, compared with fewer than nine hours in the uninjured group. Although the researchers did not specifically look at this, Jayanthi said he has noticed that more highly specialized sports such as tennis, gymnastics and dance tend to be linked to more severe overuse injuries. Why did these injuries occur? "One reason is repetitive use of the same muscle group and stressors to growing areas, for example, the spine," explained Jayanthi, who stressed that the findings were preliminary. His team, in collaboration with Children's Memorial Hospital in Chicago, plans to enroll more athletes in follow-up research, and those athletes will be evaluated every six months for three years, to look more closely at how intense training can affect a young athlete's body during growth spurts. "Second is exposure risk," he added. "If you're getting really good at one sport, the intensity increases because you are getting better. People are developing adult-type sports skills in a child's body. The growing body probably doesn't tolerate this." Younger children -- those who have not entered high school -- tend to be especially vulnerable as their bodies are still growing, said Gill, who recommended that kids cross-train and condition for other movements, or just play another sport. "I tell parents to let kids be kids and play multiple sports," he said. "See what they're good at and what they enjoy." By high school, when bodies are more mature, specializing is safer, he added. When children play different sports in different seasons, they are using a wide range of motions and muscles. But when they begin playing one sport year-round, the risk of overuse injuries increases.

Daily Dose

Parents Need To Take Concussions Seriously

Dr. Sue explains why parents need to take concussion seriously. They are a brain injury.I have blogged previously about the latest recommendations concerning concussions and restrictions on activity after sustaining a  concussion. This subject has been in the news a great deal lately, not only within the medical community, but also within the NFL and other major sports groups.

There is more and more data to show that concussions in and of themselves are dangerous, but that repetitive concussions may cause even greater damage to the brain, especially to the still developing brain of young athletes. I just saw an eleven year old boy who is a soccer play, actually, he is the goalie. He was at school, just playing around in the gym, when he sustained a concussion after running into another child head on and falling backwards.  The boy remembered falling, but shortly thereafter he became disoriented, could not take a test due to the fact that his memory was impaired, and subsequently vomited. His concerned parents brought him to my office to be evaluated.  By the time I saw him he was feeling better, and he had a normal neurological exam. Based upon the history of his injury he was diagnosed with a concussion.  Because of this he and his parents were advised that he not participate in sports for a minimum of a week.  Of course, as it would turn out,  his school soccer team was supposed to be in the State championship game in 48 hours.  Their team was 92 -0.  After much discussion and a conversation with his coach the parents we all agreed that he would not play. The following day, I received an email from his father who felt that his son was doing well and was “back to normal”.   He had been re-thinking the issue of his son not playing and wanted me to reconsider my instructions for his son not to play. He even noted that he himself had played college soccer and had often played after suffering a concussion.  He felt that if his son played (if he was absolutely needed to secure a win) and did not do “headers” that he would be okay. What was he thinking?  I don’t really think he was thinking about anything other than his son’s team winning a State championship. He seemed to have tunnel vision, and could not see that there would be many more soccer games in his son’s future, but another concussion could cause long term problems for his son.  So, I stood by my recommendation, for which his mother “thanked me”.  His team played the game and of course they lost. I felt terribly for their loss, but at the same time, knew that medically this was the appropriate decision. So many times, we as parents get so “wrapped up” in our children’s lives, whether it be in sports, academics or even having the “best” birthday party, that we lose sight of the “big picture”.  I see the” big picture” as trying to make the best decisions for our children, given the best information that we have to help make that decision. Many of those decisions may not be easy, but we as parents know they are right.  Whether that is keeping your child from playing a soccer game after suffering a concussion, or taking away a teen’s cell phone and computer privileges after they have been drinking under age.  There are so many of these difficult decisions and we all hope to make them correctly. This patients family did, and I am proud of them! That's your daily dose for today.  We'll chat again tomorrow! Send your question or comment to Dr. Sue!

Daily Dose

Young Athletes and Overuse Injuries

I see more and more kids who come in with complaints of back pain, knee pain, ankle and elbow pain often secondary to repetitive motion from sports.We had a pediatric orthopedic surgeon on the show recently and we discussed overuse injuries in adolescent athletes. I see more and more kids who come in with complaints of back pain, knee pain, ankle and elbow pain often secondary to repetitive motion from sports.

They usually don't have a lot of swelling, and they complain of pain with their activity, but otherwise are fine. When taking a history their biggest complaints occur during the sport or immediately after, and they usually feel better after resting overnight.The pain re-occurs once they resume their work out the next day. The cycle is continuous. The best treatment for overuse injuries is to follow the pneumonic RICE: Rest, Ice, Compression and Elevation. For further relief of pain add an anti-inflammatory medication such as Aleve, Motrin or Advil. If the athlete can play through the pain, it does not awaken them throughout the night and they are fine attending school and other activities, they are probably fine to continue in the sport. If the pain becomes persistent during the day, disrupts their sleep etc, then they will need to have further evaluation. For persistent stress-related injuries rest may be the next step. Many times it is just necessary to let the body have some "time off" and may also involve stretching exercises to strengthen their core muscles, or yoga and Pilates to improve flexibility and strength. This is usually a four to six week period away from their sport. One caveat that was discussed was the importance of watching for depressive symptoms in an athlete who has had to take time off from their activity. Parents need to recognize not only the physical pain their child is experiencing, but also the child's emotional pain related to stopping their sport. Many of these kids have such passion for their sport and also gain a great deal of self worth from their participation. To take that away from them is emotionally devastating, and their young minds are not cognitively developed enough to deal with the loss of their athletic endeavors, even for a short time. Watch closely and be supportive and acknowledge their feelings. It is just as important to seek help for their mental health if that seems necessary. That's your daily dose, we'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Common Thumb Injury

1.00 to read

Have you ever slammed your finger in the door or has your child hit their thumb with the head of a hammer?  If this has happened to anyone in your family you may recognize the bruised and bloodied nail bed, which is called a subungual hematoma.  Essentially this is a collection of blood, like a bruise, beneath the nail. 

This kind of trauma, albeit not life threatening, can cause a lot of pain and discomfort. Because the blood has no where to go due to the overlying protective coating of the nail, the injured finger or thumb just pounds and throbs as the blood pools under the nail.  

If the hematoma is fairly small and the injury minor, the nail just looks dark and the pain goes away fairly quickly and the nail may not even fall off. But with a bigger crush injury and more damage, the hematoma involves the entire nail bed and it is pretty painful and won’t stop pounding.  

The treatment is really fairly simple and I can remember keeping a large paper clip at home for just this reason. With my own children and friends and neighbors, I often was the “hero” Mom for a second or two as I would clean the injured finger and then heat the tip of the paper clip and just “magically” poke a hole through the fingernail to let the oozing blood out!!! Voila, no more pressure or pounding and really no pain with the procedure. Kids loved to watch his trick! 

Modern medicine has advanced and we have now moved to an electric cautery in the office. It does the exact same thing, puts a hole in the nail and relieves the pressure of the blood beneath the nail. It is just a little “slicker” than that handy dandy paper clip. 

So.....here you go, my last patient was happy to oblige with this picture of the procedure and I promise you there were no tears. Maybe a few tears of joy when the nail quit throbbing! 

 

 

 

Daily Dose

Concussions Are on the Rise

As our children become more and more involved in competitive athletics the incidence of concussions is also on the rise.

Not surprisingly, football still has one of the highest rates of concussions, with one in five high school or college players experiencing a concussion each year. Cheerleading has also seen a rise in number of concussions reported, as cheerleading stunts become more about athleticism and tumbling, putting cheerleaders at risk for a head injury from a fall. A concussion is defined as a trauma induced alteration in mental status that may or may not cause loss of consciousness. A concussion is a functional rather than a structural brain injury. The injury, typically arising from a direct or indirect blow to the head sets off a cascade of neuro-pathological events leading to a confusional state or memory dysfunction. Because a concussion is more of a metabolic crisis of the brain, neuroimaging studies with CT scans and MRI are rarely helpful. Concussions are typically diagnosed based upon symptoms including amnesia, confusion, impaired level of consciousness, poor concentration, headache, dizziness, fatigue, nausea or vomiting. Many symptoms may be non-specific in nature, but impaired mental status of any degree is the hallmark of a concussion. Because young athletes want to continue playing, even after a concussion is suspected, it is important to assess the athlete’s mental status immediately after the injury. There are several tests that may be performed even while the athlete is on the field, including orientation to person, place and time; attention; memory and higher cognitive functions. It is also important to assess the athlete’s judgment, and mood. Both coaches and parents should be aware of the hazards of returning a student to play after even a mild “ringing of the athlete’s bell”. Recent studies have shown that the still developing brains of adolescents and children are slower to heal from concussions. The younger you are the longer it takes to recover from a concussion; the brain is just more vulnerable. Allowing a teen to re-enter a soccer or football game, or cheerleading stunt immediately after a head injury puts them at risk of second – impact syndrome, a rapidly progressive brain injury that can lead to brain swelling and death. Concussions may lead to one fatality for every 300,000 children participating in sports. Current guidelines regarding return to activity and athletics are tending to be more conservative as studies have shown that the likelihood of long term and permanent impairment in cognitive function increases with each concussion. While a simple concussion typically resolves in seven to 10 days and requires no further intervention than rest, a more significant injury may take more than two to four weeks to reach full recovery. Once the athlete has rested, meaning no exercise or exertion for at least a week and all symptoms of headache, “feeling foggy” and fatigue have resolved, they may begin light exercise, such as walking or riding a stationary bicycle. If there are no recurrence of symptoms with light exercise then running, and resistance training may begin. With each increase in activity level the athlete should remain asymptomatic and may gradually move toward full activity and return to competitive play. Parents and coaches must remind student athletes that while missed games may feel like an unnecessary restriction, it is really only a minor inconvenience, which will help maintain long-term brain health. That’s your daily dose, we’ll chat again tomorrow.

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