What should happen when a concussion diagnosis is suspected or has been established? Imagine, the best player on the team hits her head and the coaching staff has to decide when she can return to the competition. It is not always a clear cut decision because “winning is, you know, better than losing.” (I can’t offer money, but I do offer the utmost respect to anyone who can name the movie and the actor.) While not simple, it is a critical decision. Making the wrong choice can increase the risk of post-concussion syndrome, increase the risk of other injury, and has the potential for resulting in long-term neurologic damage or, worse, second-impact syndrome. That being said, more than 90% of concussions are mild and will have no traumatic sequelae.
1. First thing is first. If there is any suspicion that a child has suffered a concussion, he should be sidelined. If he did not lose consciousness and is not vomiting or exhibiting any odd behaviors, medical attention can wait. As stated yesterday, he should be reassessed frequently to make sure that symptoms are not developing. There are sources that suggest taking a piece of equipment, such as a cleat, away from a player whose head has been injured. The possibility of short-term amnesia and confusion puts him at risk for running onto the field and re-injuring himself. This seems a little extreme to me -especially in this weather – but it’s an option in a situation where an athlete seems determined to continue playing.
2. There is disagreement about when return to play is safe, but all sources agree that while symptoms of a concussion, such as dizziness, blurred vision and headache, are present, the athlete should be sidelined. It is not enough that she is symptom-free at rest. She needs to be tested with physical exertion to ensure that the symptoms will not return with activity.
3. After a first concussion, the following guidelines are generally accepted. If symptoms of the concussion clear completely within 15 minutes, and the athlete remains asymptomatic for 15-20 minutes, he or she can return to play. If symptoms last longer than 15 minutes, a good guideline is that the athlete should be symptom free for one week before returning to the field.
4. As I wrote the other day, concussions have a cumulative effect. Not only does one concussion significantly increase your risk of another, each subsequent concussion puts you at greater risk for long-term side effects such as cognitive delays, difficulty focusing and neurologic and psychiatric disorders. There is no consensus on what should be done with a player who has suffered multiple concussions, but common sense and education must prevail. If it is my child, the piano is looking like a really exciting hobby. It is important for coaches to know the concussion history of each of their players so that they can make informed decisions.
5. Even with loss of consciousness, there is no consensus. While it is generally accepted that prolonged unconsciousness warrants an ER visit with head imaging, there are different opinions about brief loss of consciousness. Again, if it is my child, I am headed to the hospital to rule out brain hemorrhage or bleeding. That’s just me. My kids are little anyway – I doubt anyone is going to miss them.
Speaking of needing to get your head examined, I got a spray tan yesterday. Try as I might, I am not one of those women who is good at self-maintenance. It feels like a full time job. My nails are always a mess because I am too impatient to wait for them to dry. My hair is too long and the color is boring because I forget to make an appointment. I never have anything to wear and my collection of bags and shoes is a little embarrassing. Every year, I swear that I am going to become more glamorous before it is too late. In this vein, I took off all my clothes and let a stranger spray paint me like an old car in need of some serious upkeep. Not only was it cold and slightly humiliating, I failed to adhere to any of the post-op instructions. My palms are now orange, my sheets are probably ruined and my golden glow was dripping all over my yoga mat this morning. All this because I am going on vacation and never lost the extra 5 pounds from sweater season. If you are a woman, the tan in lieu of weight loss will make sense to you. If you are a man, just go plop your low-maintenance, handsome self in front of a basketball game. Have a beer and a piece of cake while your at it. You can burn those calories climbing into bed.