As I was reading the sports page this morning, after working my way past yesterday’s Preakness news, I was motivated to write this post by the report of Jeff Zrebieck in the Baltimore Sun’s Notebook section. Earlier this week, Brian Roberts of the Orioles was removed from the lineup due to headaches. At the time, I thought back over the games that preceded this news report but couldn’t remember any incident when Roberts could have sustained an injury that led to his headaches. For a guy like Brian Roberts, whose recent career has been marred by injuries, it was hard to believe that as tough and gritty as he is, that something like a sinus problem, allergies or the like had felled this guy. Then within a day or so, following examination and testing, we learned that Brian had sustained a concussion.
Once again, I thought through the games leading up to his line-up departure and still couldn’t remember any play or at-bat that would, in my mind, cause a concussion. There was no high and tight, back-him-off-the-plate pitch, no knee to the head by a middle infielder when he was sliding into second on an attempted steal, not even a take-out at second base while he was turning a double play. As we learned later, he sustained his current injury while sliding into first base headfirst trying to beat out a single. He never struck his head on anyone or anything. So how in the world did Brian Roberts wind-up on the disabled list with a concussion?
Last year’s injury set the stage for a recurrence
While no one knows for sure, the speculation during the 2010 season, which was also marred for Roberts by a back injury, was that Roberts had caused the concussion when, out of sheer frustration from a bad plate appearance, he struck himself in the helmet with his bat on the return to the dugout. We’re not talking a violent collision between a defensive back and an unprotected wide receiver, a car crash or a vicious criminal assault. Nevertheless, Roberts’ head injury lingered on well past the end of the season, which ended for him six games early due to dizziness and headache following this incident.
When he reported to spring training, the Orioles faithful were hoping that the past season’s injuries (back, strained abdominal muscle, concussion), which caused him to miss a total of 103 games in 2010, were a thing of the past. Then on Wednesday, February 23, 2011, the report came out that Brian had left spring training that morning due to a stiff neck. What was this all about? Then came the news last week – a slide felled this mighty warrior.
Concussions: a mild traumatic brain injury
Just what is a concussion? Brainline.org, a great resource for those seeking more information about traumatic brain injuries, gives this description:
In a nutshell, a concussion is a blow or jolt to the head that can change the way your brain normally works. Also called amild traumatic brain injury, a concussion can result from a car crash, a sports injury, or from a seemingly innocuous fall.Concussion recovery times can vary greatly.
Most people who sustain a concussion or mild TBI are back to normal by three months or sooner. But others . . . have long-term problems remembering things and concentrating. Accidents can be so minor that neither doctor nor patient makes the connection.
The Days of Yore – “Gut It Out” – are thankfully coming to an end
Anyone who follows sports is well aware that finally the old school mentality of “gut it out and get back in there” following blows to the head are coming (not too soon) to an end. Committees have been formed, articles written and the national spotlight of the media have finally focused on this issue. Those recommendations, debates and guidelines are beyond the scope of this post. Nevertheless, those involved in sports, particularly at the scholastic levels, should constantly be aware of this ever-expanding information, which is available through multiple resources and media channels.
What are the signs and symptoms of a concussion?
While there is apparently no universally accepted definition of concussion despite hundreds of studies and years of research, according to one source, there is some unanimity in what are the worrisome signs and symptoms, which can include:
- Decreased coordination or balance
- Slurred speech
If you or someone in your family has sustained any type of head injury, no matter how minor and they show these signs or symptoms, get to the doctor or an emergency room immediately.
CT Scans, MRI’s and other diagnostic test after head injuries
TBI’s or traumatic brain injuries are reported to be “a major cause of death and disability worldwide, especially in children and young adults.” In cases of obvious severe head trauma, it’s a “no-brainer” that diagnostic testing should be done. But what about cases of mild to moderate head trauma? Who defines what is “minor” and “moderate” when it comes to TBI’s? What testing is necessary; when is it unnecessary?
While these judgments are made by the medical professionals, you need to be your own advocate at times in making this decision-making process. Brian Roberts was tested and submitted to radiographic tests for a host of reasons – probably not the least of which is the fact that he is a very valuable member of a professional sports team. What about the ordinary guy in the street?
Well, the short answer is – the recommendations vary when it comes to mild and moderate head injuries. In fact, the very definition of what constitutes a moderate TBI can also vary depending on whom you read. Nevertheless, certain signs, symptoms and history are not disputed indications for a radiographic study to rule in or rule out a potential brain injury. For example, one need only read the indications for the use of radiographic studies published by MedicineWorld.org or a host of other organizations on this topic.
In a recent case, I personally came across someone whom I believe to be a leader in the field of traumatic brain injuries (TBI), Dr. Andy Jagoda, an emergency medicine specialist in New York. He has done extensive research, writing and lecturing on this topic. I’ll save you the effort, here are the search results for his body of work.
A Lesson – Hopefully – Learned
I started this piece with the story of Brian Roberts. I didn’t simply do this because I am a long-suffering fan of the Orioles (which I am) and an admirer of Brian Roberts (which I also am) but because of the message his story tells us. A self-inflicted bat to the helmet because of a strikeout? A slide into first base with no blow to the head? A concussion none the less – apparently!
Brian Roberts may have a team of medical specialists watching and monitoring his every grimace, complaint and move; you probably won’t have that luxury. If you have a head injury – minor or otherwise – and have any of the known signs, symptoms or risk factors for a traumatic brain injury, be vigilant and pro-active for your own health and well-being.
If you are in an emergency room and the discussion of whether or not you should undergo radiographic testing takes place, get involved – ask questions. If you are discharged from the emergency room, whether you had a CT or an MRI or not, pay very careful attention to the head injury discharge instructions you are given. It is a well known phenomenon that there can be a delay in symptoms and signs of a TBI days if not weeks later. If you are suffering any ill-effects during this post-discharge period, get to a healthcare provider immediately.
The stories of how lives are altered forever more as a result of TBI are legion. Don’t become yet another statistic.
Your time to share
Have you ever had a TBI? Know someone who has? What happened in that situation? Was a test done? Do you think CT scans are overused, particularly in children? Are they underused? How did your “experience” turn out? Any advice for others? Share, Good People, share!
Good luck, Brian – and speed recovery!