Recently there have been some news articles about the deaths of high school football players, especially in the past month. One was titled: “Is Football Safe for Kids? At least seven kids have died while playing football so far this year.” Another read: “Recent deaths of young football players rekindle questions about safety of game.
Eight school children died from injuries in the last month.” It felt at least medically appropriate to review the process and results of concussions. A simple definition of concussion from a CDC article is “a type of traumatic brain injury caused by a bump, blow or jolt to the head or by a hit to the body that causes the head to move rapidly back and forth.
” That translates into your brain gets banged around inside your skull on the hard, jagged bone. From the American Association of Neurological Surgeons’ article, “A concussion is an injury to the brain that results in a temporary loss of normal brain function, including alteration of mental status or level of consciousness that results from mechanical force or trauma.” But not always.
The diagnosis is made by questioning and observation after the trauma, be it from a fall, contact sports injury as in football, car accident or bomb blasts as in a war zone. It does not have to include loss of consciousness, which, until recently, has been part of the concept for eons. The main concussion symptoms reported include headache or pressure in the head, nausea and/or vomiting, balance problems or dizziness, and double or blurred vision.
Others are being bothered by light or noise, feeling sluggish, foggy or groggy, having confusion or concentration problems, just not feeling right or feeling "down." The signs observed might include you not being able to recall events prior to or after a hit or fall, appearing dazed or stunned, forgetting an instruction, moving clumsily, answering questions slowly, losing consciousness even briefly, showing mood or behavior or personality changes (not for the better), trouble sleeping, ringing in the ears or blood coming out of ears. The signs and symptoms might show soon after the injury, or, for some, not for days or a couple weeks.
That makes it very difficult to gauge how serious the concussion is. Several articles labeled them as minimal traumatic brain injury, but they all agree that every concussion is serious. There is no one test or group of tests or X-rays to measure the degree of injury or severity.
There is an ongoing discussion about whether the injury is functional or structural. Likely it is partly both. The tests available just can’t measure cell function or disorder inside your skull.
There is much indirect evidence that the damage is related to swelling and microscopic physical injury. Complications of the trauma can be many. One can be persisting symptoms such as memory and personality changes, headache for weeks, drowsiness and so on.
They are lumped into the category post-concussive syndrome. A second impact syndrome results from acute and sometimes fatal brain swelling when another concussion happens before complete recovery from an initial one. Other complications can include bleeding into brain tissue, skull and/or neck fractures, whiplash, other muscle and bone injuries in the area, etc.
This complicates the entire discussion. Repeated concussions foster permanent damage called chronic traumatic encephalopathy, or CTE, that is found only at death by autopsy. This is a huge point of contention in professional football players with massive litigation ongoing the past few years.
Too much for here. Initial treatments are primarily rest (oversimplified) and not stressing the injured tissues. Other measures are used for the other facets of the trauma.
Pain medicine for the headaches is mostly acetaminophen/Tylenol. Initially it’s not advised to give ibuprofen, aspirin,or other NSAIDS because of the possibility of encouraging bleeding. Opioids can cloud thinking and confuse the picture.
The second article has a sentence that is the crux of the argument: “Considering the risks, should parents consider not allowing their children to play tackle football at all? The recent deaths (of eight schoolchildren) have rekindled questions about the safety of tackle football.” That discussion is far beyond the space and scope of the Hint. But, as a doctor, parent and grandparent, it certainly makes me question it.
The options range from no football to flag football to limiting it until certain ages, etc. There was a wonderful doctor in Winona when we arrived 46 years ago who said that he felt any parent who lost a child never completely got over it, regardless of cause. When I was on the high school golf team, we never lost any teammate, except maybe in the woods looking for a misguided ball.
Dr. Frank Bures Dr. Frank Bures, a semi-retired dermatologist, has worked in Winona, La Crosse, Viroqua and Red Wing since 1978.
He also plays clarinet in the Winona Municipal Band and a couple Dixieland groups. A note from the doctor’s wife: Do you have an amusing or interesting memory of a visit to Dr. Bures’ office? Was there a column he wrote that helped or amused you? We are gathering some recollections for a memoir.
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