I endured a traumatic brain injury in a car accident and for 35 years I was unable to cry. Then I heard about cranial manipulation treatment. It was presented to me as a cure for what ailed me. To see what it would do, I tried it. It did make me cry, but for no reason and no cause. Was my choice a good one or not? We all live with the intense desire to make right decisions regarding our health, but when we learn we made the wrong decision, it upsets us and leave us with an unpleasant feeling.
Whether to listen to our bodies or the advice we get from “those who know” is not a simple decision to make. We hear, “Listen to your doctor,” or “Ask your health care provider,” but when should we listen to our daily symptoms instead of asking those who think they know what’s best for us?
Another example of following the advice of health care providers instead of listening to symptoms was when I was being treated for my adrenal gland damage. The physician knew this is the one gland of the body that cannot be repaired or cured since the adrenal gland cannot regenerate itself, but this negative fact was not conveyed when this treatment was applied. I didn’t know what was harder to deal with, my hope of getting better being dashed or having a damaged adrenal gland.
During the years of “mending,” I have learned to listen to my body and choose the best medical decision I can.
Friday, February 26, 2010
Longevity
At 93, I feel I have lived long enough to have a personal opinion on longevity. I read an article that says your personality may be the key to a very long life. They examined the personality traits of 246 children of people who lived to be at least 100. The study showed that those who live the longest are more outgoing, more active and less neurotic than other people.
(Time/CNN – The Year in Health 2009)
If this is true, they didn’t interview the offspring of the people who live in my building. I was under the opinion that the crabby, nit picking and somewhat neurotic lived the longest, or maybe that’s just how it feels. But then again, I have been active, outgoing and interested in everything around me –so I guess the study is true.
(Time/CNN – The Year in Health 2009)
If this is true, they didn’t interview the offspring of the people who live in my building. I was under the opinion that the crabby, nit picking and somewhat neurotic lived the longest, or maybe that’s just how it feels. But then again, I have been active, outgoing and interested in everything around me –so I guess the study is true.
Doctors -vs- Patients
I had a disagreement against a physician and I wrote to the State Board of Registration for the Healing Arts. My complaint was rejected by them, without ever giving me a reason for doing so.
A routine visit to my doctor was the start to a long drawn out misunderstanding. He prescribe Amox-Clav, and gave me exercises for my round shoulders, which I explained to him I had lived with my round shoulders since I was six years old. I refused to believe that any pharmaceutical could correct this at my age, which at the time I was 80 years of age.
I took the medication as prescribe, only after one dose I experience bleeding, so I stopped taking the drug and called my doctor. He suggested I go to the emergency room because of the bleeding. I was leery about going myself so I called a friend who came immediately to take me to the hospital. I wasn’t hemorrhaging, but having your doctor tell you to go to the emergency room makes you wonder if he knows something you don’t and doesn’t want to scare you by telling you.
I was admitted for observation, and I ended up spending three days in the hospital before this doctor even showed up to see what might be wrong with me. In the end, the medical staff didn’t find any reason for me to be there. On the third day, he arrived too late to issue a discharge order that would have permitted the hospital to discharge me. If I stayed another day, I would have had to pay for it myself as my insurance would not cover it. Because of this I insisted on leaving without his discharge authorization and did.
Now back to my complaint. Not only did I feel neglected by my doctor, but there was no one that seemed to care about my plight. I doubt if this is an only experience of this type. We need a patient listening ear for patients not just for doctors.
A routine visit to my doctor was the start to a long drawn out misunderstanding. He prescribe Amox-Clav, and gave me exercises for my round shoulders, which I explained to him I had lived with my round shoulders since I was six years old. I refused to believe that any pharmaceutical could correct this at my age, which at the time I was 80 years of age.
I took the medication as prescribe, only after one dose I experience bleeding, so I stopped taking the drug and called my doctor. He suggested I go to the emergency room because of the bleeding. I was leery about going myself so I called a friend who came immediately to take me to the hospital. I wasn’t hemorrhaging, but having your doctor tell you to go to the emergency room makes you wonder if he knows something you don’t and doesn’t want to scare you by telling you.
I was admitted for observation, and I ended up spending three days in the hospital before this doctor even showed up to see what might be wrong with me. In the end, the medical staff didn’t find any reason for me to be there. On the third day, he arrived too late to issue a discharge order that would have permitted the hospital to discharge me. If I stayed another day, I would have had to pay for it myself as my insurance would not cover it. Because of this I insisted on leaving without his discharge authorization and did.
Now back to my complaint. Not only did I feel neglected by my doctor, but there was no one that seemed to care about my plight. I doubt if this is an only experience of this type. We need a patient listening ear for patients not just for doctors.
Friday, February 19, 2010
The Concussion Puzzle
ALTERNATIVE METHODS OF CONCUSSION ASSESSMENT
Piecing Together the Concussion Puzzle
By: Kevin M. Guskiewicz, Ph.D.
Condensed suggestions for article to be included in
THE HIDDEN INJURY
By Ethel Dimont
Reports of the cumulative effects of multiple head injuries, as well as multiple head impacts, on long-term cognitive functioning are causing clinicians to rethink their approach to managing concussions. The literature has revealed deficiencies in neurocognitive functions such as attention span, memory, concentration and information processing as a result of cerebral concussions. Alternative testing as well as historical perspective of postural stability and neurocognitive testing are essential.
A variety of assessment tools are available for detecting a mild traumatic brain injury following a concussion or blow to the head. However, their practicality is often questions, especially in sport settings. Assessment of mild traumatic brain injury can be likened to piecing together a very complex puzzle. There are several pieces to this concussion puzzle, and it is the clinician’s job to place as many pieces together as possible before making a diagnosis. Some of these pieces may include, but are not limited to:
1. Assessing cognitive abilities
2. Motor functioning (including balance and reaction time)
3. Symptoms such as headaches, dizziness, blurred vision, memory deficits, etc.
4. History of prior MTBI
Though this chapter is geared primarily to head injuries sustained in sport activities, the same problems and difficulties apply to most head injuries, especially where injuries are invisible.
It is essential for physicians to keep clear records of the patient’s symptoms for future decisions pertaining to severity of injury and possible future need for rehabilitation. Many methods of assessing the severity of head and brain injury have already been developed. Computer Tomography (CT) and Magnetic Resonance Imaging (MRI) have enhanced the capability of diagnosticians to identify certain types of brain injuries and their severity. Two widely accepted methods to assess the severity of brain injury are the Glasgow Coma Scale (GSC) and the Abbreviated Injury Scale (AIS). However, their usefulness is questioned in many instances, especially in managing sport-related head injury. [Because these injuries are often hidden, or considered a closed head injury, which often are not even confirmed by the CT or MRI.]
The (GCS) requires observation of the patient while their eyes are open, verbal performance, and motor response, but several problems limit its applicability in certain cases. For example, having the patient’s eyes open may be impossible with facial swelling, and verbal response may be compromised by endotracheal tube.
The AIS is designed to assess overall bodily injury along with severity of injury to specific body parts. The AIS avoids some of the problems of the GCS administration, but according to Sorenson and Kraus, in the book Physical Management in Neurological Rehabilitation, by Maria Stokes, AIS has some of its own limitation. The scale depends on a valid physician diagnosis, and a clear enumeration of symptoms in the medical record to allow assignment of an injury score.
If we view the body as a computer, sending signals from the brain to tell the body what is required of it, or if there is a problem, it becomes a bit easier to understand some of the complicated systems the human body uses to enable it to function on the level it does.
POSTURAL CONTROL SYSTEM:
The postural control system is responsible for the maintenance of upright posture and balance. This system operates as a feedback control circuit between the brain and the musculoskeletal system.
VESTIBULAR AND VISUAL SYSTEM
The vestibular and visual systems work very closely in attempting to retain upright balance. The vestibular apparatus is the organ responsible for detecting sensations concerned with equilibrium. It mainly contributes to posture by maintaining reflexes associated with keeping the head and neck in a vertical position and allowing the vestibular apparatus to control eye movement.
PROPRIOCEPTIVE SYSTEM:
The proprioceptive system is best described through the tactile senses, and the sense of position, which determines the relative actions and rate of movements of the different part of the body.
A complex network of neural connections and centers are related by peripheral and central feedback mechanisms. A hierarchy integrating the cerebral cortex, cerebellum, basal ganglia, brainstem, and spinal cord is primarily responsible for controlling voluntary movements.
PATHOLOGICAL BALANCE ASSESSMENT:
Disorders of orientation and balance can be very debilitating, especially in an athletic environment. The complexity of the balance system makes localization of the problem difficult, since the abnormality may occur in one or more of the sensory modalities (vision, vestibular, somatosensory) or in the motor system involved in carrying out a particular movement.
Contrary to clinical belief, studies have demonstrated that motor deficits are present in mild head injury patients one year after injury, suggesting that motor skills should be routinely assessed after a concussion.
Symptoms in persons with cerebella damage generally include the following:
1. Cannot perform movements smoothly
2. Walk awkwardly, with the feet well apart. Difficulty in maintaining balancing causes unsteadiness of gait.
3. Cannot start or stop movements quickly or easily. Motions are slow and irregular.
4. Cannot easily combine the movements of several joints into a smooth, coordinated motion. i.e.: To move the arm, they must first move the shoulder, then the elbow, and finally the wrist.
PATHOLOGICAL NEUROCOGNITIVE ASSESSMENT
Neuropsychological techniques have been developed to reliably assess the extent of neurocognitive deficits following cerebral concussion in athletes. Due to the variability of neurocognitive abilities of athletes, acquisition of baseline (pre-injury) measurements for comparison with post-injury measurements is a necessity when instituting a neuropsychological testing program for athletes. This model is not realistic for use in a clinic or hospital setting, but has endless potential when used in the sports medicine where baseline testing is possible for athletes who have a higher risk for injury.
Neuropsychological testing has revealed cognitive declines in as little as 24 hours post injury from the pre-season levels in areas of attention, concentration, and rapid-complex problem solving. These mild deficits were directly correlated with reported symptoms of increased headaches, dizziness, and memory problems. Most test include 5-8 sub tests which assess the various domains of cognitive functioning (re: working memory, mental processing speed, and attention: concentration, procedural reaction time, and visual scanning abilities.)
RECOMMENDED PROTOCOLS FOR ASSESSMENT OF CONCUSSION
This can best be accomplished through the use of a symptom checklist. An on-line check list can be obtained from The Brain Injury Resource Center, http://www.headinjury.com/checktbi.htm. Using the total symptom score and the total number of symptoms reported takes some of the guesswork out of determining an athletes readiness to return to activity. The additional use of objective measures such as postural stability assessment and neuropsychological evaluation can be invaluable to the sport medicine clinician.
These three measure (symptom checklist, postural stability assessment, and neuropsychological evaluation), combined with a thorough clinical examination provide the best resources for making a sound clinical diagnosis and a safe return to participation. The certified athletic trainer and team physician can therefore more easily detect lingering symptoms such as irritability, sadness, concentration deficits, etc.
The athlete should always be referred to a neurosurgeon if post-concussion symptoms worsen within the first few hours post-injury. Neuropsychologists can also play an important role if the symptoms persist during the first several days post-injury. They have advanced training in the administration and interpretation of neuropsychological tests. It is recommended that all sports medicine teams include a neurosurgeon and neuropsychologist, at the very least, for referral purposes.
Understanding that no two head injuries are created equal will help one to realize that this is a complex problem. Some injuries will resolve quickly, and never present any recurrent complications. Others, even those that may appear to be very mild, can result in persistent symptoms that lasts for weeks, months, or even years.
Future research will inevitably develop additional concepts that will aid those with head injuries. Until then, with present knowledge, everyone should be able to agree that no athlete should be permitted to return to competition while still symptomatic, nor should any person suffering from post-concussion syndrome attempt a quick entry back into activities that may predispose them to complicate or interrupt the healing process. Admittedly, though these signs and symptoms are often difficult to assess objectively, erring on the side of caution is the most logical way to deal with piecing together the concussion puzzle.
Piecing Together the Concussion Puzzle
By: Kevin M. Guskiewicz, Ph.D.
Condensed suggestions for article to be included in
THE HIDDEN INJURY
By Ethel Dimont
Reports of the cumulative effects of multiple head injuries, as well as multiple head impacts, on long-term cognitive functioning are causing clinicians to rethink their approach to managing concussions. The literature has revealed deficiencies in neurocognitive functions such as attention span, memory, concentration and information processing as a result of cerebral concussions. Alternative testing as well as historical perspective of postural stability and neurocognitive testing are essential.
A variety of assessment tools are available for detecting a mild traumatic brain injury following a concussion or blow to the head. However, their practicality is often questions, especially in sport settings. Assessment of mild traumatic brain injury can be likened to piecing together a very complex puzzle. There are several pieces to this concussion puzzle, and it is the clinician’s job to place as many pieces together as possible before making a diagnosis. Some of these pieces may include, but are not limited to:
1. Assessing cognitive abilities
2. Motor functioning (including balance and reaction time)
3. Symptoms such as headaches, dizziness, blurred vision, memory deficits, etc.
4. History of prior MTBI
Though this chapter is geared primarily to head injuries sustained in sport activities, the same problems and difficulties apply to most head injuries, especially where injuries are invisible.
It is essential for physicians to keep clear records of the patient’s symptoms for future decisions pertaining to severity of injury and possible future need for rehabilitation. Many methods of assessing the severity of head and brain injury have already been developed. Computer Tomography (CT) and Magnetic Resonance Imaging (MRI) have enhanced the capability of diagnosticians to identify certain types of brain injuries and their severity. Two widely accepted methods to assess the severity of brain injury are the Glasgow Coma Scale (GSC) and the Abbreviated Injury Scale (AIS). However, their usefulness is questioned in many instances, especially in managing sport-related head injury. [Because these injuries are often hidden, or considered a closed head injury, which often are not even confirmed by the CT or MRI.]
The (GCS) requires observation of the patient while their eyes are open, verbal performance, and motor response, but several problems limit its applicability in certain cases. For example, having the patient’s eyes open may be impossible with facial swelling, and verbal response may be compromised by endotracheal tube.
The AIS is designed to assess overall bodily injury along with severity of injury to specific body parts. The AIS avoids some of the problems of the GCS administration, but according to Sorenson and Kraus, in the book Physical Management in Neurological Rehabilitation, by Maria Stokes, AIS has some of its own limitation. The scale depends on a valid physician diagnosis, and a clear enumeration of symptoms in the medical record to allow assignment of an injury score.
If we view the body as a computer, sending signals from the brain to tell the body what is required of it, or if there is a problem, it becomes a bit easier to understand some of the complicated systems the human body uses to enable it to function on the level it does.
POSTURAL CONTROL SYSTEM:
The postural control system is responsible for the maintenance of upright posture and balance. This system operates as a feedback control circuit between the brain and the musculoskeletal system.
VESTIBULAR AND VISUAL SYSTEM
The vestibular and visual systems work very closely in attempting to retain upright balance. The vestibular apparatus is the organ responsible for detecting sensations concerned with equilibrium. It mainly contributes to posture by maintaining reflexes associated with keeping the head and neck in a vertical position and allowing the vestibular apparatus to control eye movement.
PROPRIOCEPTIVE SYSTEM:
The proprioceptive system is best described through the tactile senses, and the sense of position, which determines the relative actions and rate of movements of the different part of the body.
A complex network of neural connections and centers are related by peripheral and central feedback mechanisms. A hierarchy integrating the cerebral cortex, cerebellum, basal ganglia, brainstem, and spinal cord is primarily responsible for controlling voluntary movements.
PATHOLOGICAL BALANCE ASSESSMENT:
Disorders of orientation and balance can be very debilitating, especially in an athletic environment. The complexity of the balance system makes localization of the problem difficult, since the abnormality may occur in one or more of the sensory modalities (vision, vestibular, somatosensory) or in the motor system involved in carrying out a particular movement.
Contrary to clinical belief, studies have demonstrated that motor deficits are present in mild head injury patients one year after injury, suggesting that motor skills should be routinely assessed after a concussion.
Symptoms in persons with cerebella damage generally include the following:
1. Cannot perform movements smoothly
2. Walk awkwardly, with the feet well apart. Difficulty in maintaining balancing causes unsteadiness of gait.
3. Cannot start or stop movements quickly or easily. Motions are slow and irregular.
4. Cannot easily combine the movements of several joints into a smooth, coordinated motion. i.e.: To move the arm, they must first move the shoulder, then the elbow, and finally the wrist.
PATHOLOGICAL NEUROCOGNITIVE ASSESSMENT
Neuropsychological techniques have been developed to reliably assess the extent of neurocognitive deficits following cerebral concussion in athletes. Due to the variability of neurocognitive abilities of athletes, acquisition of baseline (pre-injury) measurements for comparison with post-injury measurements is a necessity when instituting a neuropsychological testing program for athletes. This model is not realistic for use in a clinic or hospital setting, but has endless potential when used in the sports medicine where baseline testing is possible for athletes who have a higher risk for injury.
Neuropsychological testing has revealed cognitive declines in as little as 24 hours post injury from the pre-season levels in areas of attention, concentration, and rapid-complex problem solving. These mild deficits were directly correlated with reported symptoms of increased headaches, dizziness, and memory problems. Most test include 5-8 sub tests which assess the various domains of cognitive functioning (re: working memory, mental processing speed, and attention: concentration, procedural reaction time, and visual scanning abilities.)
RECOMMENDED PROTOCOLS FOR ASSESSMENT OF CONCUSSION
This can best be accomplished through the use of a symptom checklist. An on-line check list can be obtained from The Brain Injury Resource Center, http://www.headinjury.com/checktbi.htm. Using the total symptom score and the total number of symptoms reported takes some of the guesswork out of determining an athletes readiness to return to activity. The additional use of objective measures such as postural stability assessment and neuropsychological evaluation can be invaluable to the sport medicine clinician.
These three measure (symptom checklist, postural stability assessment, and neuropsychological evaluation), combined with a thorough clinical examination provide the best resources for making a sound clinical diagnosis and a safe return to participation. The certified athletic trainer and team physician can therefore more easily detect lingering symptoms such as irritability, sadness, concentration deficits, etc.
The athlete should always be referred to a neurosurgeon if post-concussion symptoms worsen within the first few hours post-injury. Neuropsychologists can also play an important role if the symptoms persist during the first several days post-injury. They have advanced training in the administration and interpretation of neuropsychological tests. It is recommended that all sports medicine teams include a neurosurgeon and neuropsychologist, at the very least, for referral purposes.
Understanding that no two head injuries are created equal will help one to realize that this is a complex problem. Some injuries will resolve quickly, and never present any recurrent complications. Others, even those that may appear to be very mild, can result in persistent symptoms that lasts for weeks, months, or even years.
Future research will inevitably develop additional concepts that will aid those with head injuries. Until then, with present knowledge, everyone should be able to agree that no athlete should be permitted to return to competition while still symptomatic, nor should any person suffering from post-concussion syndrome attempt a quick entry back into activities that may predispose them to complicate or interrupt the healing process. Admittedly, though these signs and symptoms are often difficult to assess objectively, erring on the side of caution is the most logical way to deal with piecing together the concussion puzzle.
Friday, February 12, 2010
Max Dimont's books on Kindle
If you loved Max Dimont's book in paper form - you will love them in e-form too. Here's a link to E-Reads where you can find many of Max's books.
http://www.ereads.com/author.asp?authorid=145
If you like paper books - try this.
http://tinyurl.com/yhlphua
Enjoy!
Friday, February 5, 2010
Washington University in St. Louis to establish religion and politics center | Newsroom | Washington University in St. Louis
Washington University in St. Louis to establish religion and politics center Newsroom Washington University in St. Louis
Religion and politics have been hot topics for thousands of years. The Greeks had taken the idea of discussion to great heights at Mars Hill, and the world has been influenced by their brilliant minds ever since.
How wonderful to think we may again have brilliant minds tossing around the pros and cons of ideas and philosophies here in St. Louis. As we will know, religion and politics have infuenced one another since the beginning of time.
Religion and politics have been hot topics for thousands of years. The Greeks had taken the idea of discussion to great heights at Mars Hill, and the world has been influenced by their brilliant minds ever since.
How wonderful to think we may again have brilliant minds tossing around the pros and cons of ideas and philosophies here in St. Louis. As we will know, religion and politics have infuenced one another since the beginning of time.
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