We've Been Treating Concussions All Wrong
slate.com
slate.com
* Measuring the economy
* Thinking about the long tail theory
* Giving kids allowance
* Understanding teen happiness
* Making risotto
* Talking about the movie Tár
* Making movies about Malthusian population explosions
* Thinking about herd immunity
* Legalizing marijuana
* Estimating the age of menopause
https://slate.com/search?q=all+wrong#gsc.tab=0&gsc.q=all%20w...
That's from the first two pages, there are at least ten.
The article takes a surprised tone that doctors haven’t updated their practices in line with the latest studies, but that’s not usually how doctors work. Doctors aren’t intrinsically academics, and aren’t necessarily hooked into the scientific literature. Doctors don’t get their orders direct from science, they follow the practices of their peers and network. New knowledge percolates slowly and conservatively through that network.
This isn't "new research" or the "latest study", this is now established scientific consensus.
> Doctors don’t get their orders direct from science, they follow the practices of their peers and network. New knowledge percolates slowly and conservatively through that network.
This is indeed part of the problem.
Doctors should get knowledge of new practices from medical school or CME, not haphazardly through gossip. As noted in the article, medical scools don't teach very much about concussions and clearly our new understanding of concussion treatments are not being dispersed with sufficient speed by CME.
We need to hold our medical system to higher standards, not give them a pass because the broken parts have been broken for a while.
I don't necessarily know if such consensus has been reached for return to normal with concussions, psychology and exercise researchers are trying to make Cognitive behavioural therapy and exercise and a general appeal to nature as the solution to everything in medicine at the moment and there is a lot of bad studies with low or very low quality results on that basis. I haven't followed concussion research so I don't know if that is what is happening here but I suspect its likely. I would just be aware that a lot of the replication crisis with medical research is due to this effect so you have to look at the studies and be aware of the alternatives.
You definitely shouldn't have medics who are relying on long obsolete practices and just incrementally learning via the grapevine, get some regulations. It's bad enough that so many countries don't require CPD for software engineering. I don't care that you've been copying the source code into a dated folder every day since 1987, it's 2024 and you need an actual Revision Control System.
Avoid activities that have a high risk of head contact. That meant no ice hockey until he was cleared, but he was encouraged to do off ice drills.
Overall it didn't seem too bad. He felt better and was cleared in about 2 weeks, with some lingering behavioral changes for about a month after that. And he didn't feel great with some roller coasters we did at 4 months after.
But obviously, every concussion (or mild traumatic brain injury) is different.
If there is one thing developers can be relied upon to do, it’s this: if there is a Fallacy of the Excluded Middle, they will find it, fall into it, and then set up a household there. Just like the author did.
It’s one thing to avoid immediately going back onto a football field, where you might get hit again before you’ve recovered, or to work, which might be cognitively straining. But instead of *nuanced* advice that included downtime or a scaling back of activities, the recommendation became total rest.
A 2022 study published in the journal Pediatrics found that children who spent less than two hours a day on screens in the first week after a concussion had worse concussion symptoms after one month than did those who engaged in “moderate” screen time of two to seven hours a day.
“Not doing energetic things” includes many more options than hiding in your bed sleeping.
That accident happened on a Saturday, and I didn’t sleep at all the next day for fear of going into a coma. I went to school and work on Monday, and managed to finish the semester without any issues.
I know I’m extremely lucky, but I think the fact that I went back to life as if nothing happened was what helped me recover so quickly. I still can recite 299,792,458 m/s as the speed of light and 5.788e-5 eV/T as if it’s the most hard wired connection in my brain.
Apparently he is a little off. 299,792,458 m/s according to Wikipedia
I only had a couple finals remaining, and my profs gave me deferrals as soon as they saw the state of my face when I showed up at their offices. Wrote them a week or two later without issue.
Didn't notice any lingering mental issues, though it's now been nearly two decades and a nerve in my face still feels a bit funny, and my current dentist pointed out that it seems like I've done some damage to some of my jaw tendons at some point. (But as it doesn't cause me problems, didn't recommend treatment.)
Looked at the concussion alliance website - it seems to be quite reasonable. https://www.concussionalliance.org/treatments
>“It’s a huge myth,” Gormally told me. In 2018, after his experience, he and his mom founded Concussion Alliance, a nonprofit that is dedicated to patient and provider education. “It’s so pervasive; it’s actively damaging people’s recovery.” The idea that cocooning may be harmful is completely new information to most patients Gormally meets.
Such is the state of healthcare, though. Physicians are not wizards. You can't expect one person to know everything. The PCP probably should have referred him to a specialist, but barring that, you need to insist on seeing one yourself. Unfortunately, a kid isn't going to know that, so parents, please do the same for your kids.
As for the actual protocol I went through, it was retest weekly, continue going to work and running and what not, but don't play any sports, avoid the motorpool, light duty in the office instead, and I was barred from driving until I could pass all the tests, which took four weeks.
The discussion about who to blame is a little naive IMO. Doctors do not learn everything they need to know to be doctors in medical school. Largely, they learn the foundations of medicine that they need to be successful in a residency. In residency is where they will learn the things they need to know about how to treat patients in their specialty. The authors primary care physician was very likely taught about concussions in residency, before these new guidelines came out, and simply has not updated their practice to be in line with the new guidelines... Science changes and I'm sure it is hard to stay on top of each new thing that comes out but at the end of the day, that is the job of the physician to stay on top of new developments.
Granted, they obviously get more mild than that, but the milder they are, the less they matter as long as it isn't happening repeatedly.
I think this is a gross oversimplification.
If memory serves, the rate of ethanol metabolism is something around 0.015 (units?) per hour.
In my ED, an average BAL for a patient that we realize is intoxicated (and choose to get a level) is probably 0.3 or so. 0.4 - 0.5 is common, and we see nearly 0.8 (in ambulatory patients!) from time to time.
So for 0.3, if you are maximally generous and consider "sober" 0.08 (the level for an automatic DUI in my state), you're looking at 15 hours of observation. Not exactly "a few."
Further, your own anecdote highlights exactly my point. How you you *know* you had a TBI? Because it felt like one? Because a doctor told you it was one? Because a physician's (subjective) assessment of your exam suggested it was one? Because your insurance would cover an inpatient stay for one if they listed that as the diagnosis?
Don't misunderstand, I do a relatively thorough neurological exam compared to my colleagues, but I have no pretenses as to the level of subjectivity in my assessment, or to the external biases that could potentially sway my judgment. A more objective measure would be greatly appreciated, both to help ensure that I was acting in patients' best interest, and frankly to help me compel others to act in appropriate cases.
The old man wasn't too far off the mark after all.
no, the better question is why do we putting ourselves or encouraging our children to put themselves in situations where they get concussions? Does not seem worth it.
Youth sports are something else - the risks and the potential damage have been amplified mightily by attempting to emulate professional sports practices. So if that's what you're getting at, absolutely.
Two things it feels like we've started to forget as a society: doctors aren't gods, they are fallible, they don't have the answer to everything; and you aren't immortal, you are also fallible, vulnerable.
Synthesizing those two things, and the quote: you need to take responsibility for your own health. There's people who do that; and then there's people who take months to recover from a concussion, and upon barely recovering immediately go back to playing hard contact sports, twice, and then get interviewed for a magazine piece about how wrong doctors are.
I've seen Olympic hopefuls being KNOCKED out and given the okay to compete by doctors. The macho attitude doesn't help. One personal anecdote I've seen, time and time again, that has helped is oxygen post-knockout.
every person I've spoken to who has gotten oxygen after a knockout or a hard match told me that they felt much much better vs the times they haven't. Not sure why or how.
It can take very little whiplash of the skull to cause a concussion.
I would add to this: If you’re a clumsy person who trips on treadmills, maybe walking on a treadmill should not be in the cards for you.