Headbanger’s ball

Buffalo QB Edwards has been a Headache for Bills opponentsEd Zieralski (Contact) Friday, October 17, 2008 ORCHARD PARK, N.Y. – Shortly into his Wednesday briefing with the media here, second-year Buffalo Bills quarterback Trent Edwards called an audible to avoid a blitzing paparazzi.

Just three days back from a bye week and 10 days removed from being knocked out cold on the third play in the Bills' loss at Arizona, Edwards was tired of answering questions about his noggin. Edwards underwent tests here to see if the resulting concussion from the hit caused any aftershocks. He was cleared Tuesday to play after he passed his final neurological tests at a Buffalo hospital.

"I talked a lot about (the concussion) Monday, so let's move on and talk about this game (against the Chargers) Sunday," said Edwards, a Stanford alum who shows a lot more poise, cockiness and leadership than your average second-year NFL quarterback. "Let's talk about the team and not my concussion."

Life is full of headaches. Just ask Brandon Stokley. A smaller guy for an NFL player, Stokes just recorded a new personal record.

Broncos receiver Brandon Stokley suffered a concussion Sunday after he took three sets of blows to the head. The first was after he made his first catch for 4 yards on the Broncos' opening series. On the next play, Stokley caught an 11-yard touchdown pass from Jay Cutler and took some more cranial abuse.

"On the touchdown, I got head-butted a few times from teammates," Stokley said. "So that didn't help." Stokley left for good early in the second quarter. He had just made a 14-yard reception and was touched down by Jacksonville safety Brian Williams. Stokley got up, started walking to the sideline — and collapsed to his knees.

"I kind of lost my equilibrium," he said. Stokley got up and returned to the sideline but didn't return to play and still was foggy Monday. If it was his first concussion, Stokley would have a good chance of playing in the Broncos' next game Monday night at New England. But as far as Stokley can recall, it was concussion No. 8 or 10. His playing status for the Patriots will be, at best, questionable.

Denver Post

Professionally, I had some experience in this area so I thought that, with your permission, I'd share it. As part of my work, I wrote articles that were published on what is called 'mild to moderate traumatic brain injury' as well as post-concussive syndrome. I wrote a treatment protocol for these problems that was distributed for years by a major neurological hospital and I got to see a lot of cases first-hand.

One of the issues in medicine is the constant concern with having tools that work. No surgeon operates with a dull scalpel. Medications work or they're ulled from the marketplace (if they get there at all). But, we don't have tools that necessarily work when diagnosing this problem. Our ability to test in all areas of medicine is growing rapidly, but sometimes it isn't there yet. This is a field in which that is currently true.

Often, the symptoms either don't show up for a long time or, as part of the patient's cognitive 'landscape' due to the nature of the problem, the patients don't recognize what is going on. What we do know is that beyond three concussions, there is normally a permanent loss of cognitive function in some degree. It may be mild. More often, it's not.

Isolated cases don't carry any weight in medicine, and I fully support research based outcomes. But, this area is a tough one, becuase I saw so many cases that didn't show up on the current tests but clearly experienced problems with emotion and cognition following 1 or more concussions. I saw a patient who had experienced over a dozen concussions. When he had a mild exacerbation (such as bad turbulence while travelling), he would lose between 1 and 4 days of his life. He lost the ability to think during these episodes. He would try to hide this when it happpened, just because the injury involvled a loss of logical function. It created a lot of pain for those who loved him. And, nothing showed up in the tests, which frustrated all of his docs, me included. That happened a lot - I commmonly dealt with post-trauma cases that had not responded to other forms of treatment, and found a lot of post-concussive problems by doing extensive histories and by interviewing family, since the patient's memory was often substantially faulty.

What we know for a fact is that the longer you rest in between occurences, the less severe the repercussions. Ben Hamilton rested for a season after his, and he is apparently fine. As a fan, that pleases me greatly, since he's a force at guard. As a person, I want him to be a healthy guy, just like we all do. That approach - resting for a full year - is the safest approach, and offers the highest chance of preventing or reducing future problems.

As fans we want two things for our players. We want them to be healthy, for selfish reasons like performance and for altruistic reasons such as human kindness. Sometimes those two are at odds, and I don't have a perfect answer for that any more than anyone else does.

A lot of the folks on this site play, or coach, this game that we all love. Others support children, perhaps their own, who are learning a great sport that can and should be a lifelong enjoyment. Some of us just watch, and love it just as much. If you see a player (at any level) who has/had a concussion, be aware. Sometimes we don't have a test that shows a condition accurately. So, let's talk about young players.

In this situation, the player will have the rest of their life to deal with the outcome of concussions, or of post-concussive syndrome should it arise. If you're ony a fan who watches, this is why players need more time off. We're just beginning to understand the nature, progresion and outcome of concussions.

If you have any other interaction, would you consider following two simple rules? If a person experiences a post-concussive syndrome, they may have inappropriate emotions, usually anger, commonly depression. We sometimes see that anger as 'spirit', so, if need be, err on the side of caution. If a younger player shows any external signs - brief loss of consciousness, dazed appearance, unfocused eyes, reduced ability to listen or to respond to questions, sleepiness, confusion or excessive fatigue, take charge and get them to a doctor immediately. This is true for any contact sport, or for any car accident or other trauma that may involve acceleration/deceleration trauma, what we commonly cal whiplash, or any blow to the head.

If you are told that despite any of these conditions that the player/person is Ok, but you still see any of these problems, take charge. If they are a younger person, they need to be out of contact sports for one full year. Sometimes that's a tough row to hoe, but we're talking about a person's life and ability to think, to have normal emotions, to not experience depression and to have good relationships, so caution is a reasonable outcome. The brain, especially a young brain, needs time to heal. Since we don't have all the accurate tests that we need to right now, let's look at the longer picture. Make sure that they are safe.

Ok, the soapbox can go back to the far corner of the closet in my den, and I'm going back to today's games. If one player avoids a long term problem, this was worth writing, and, I hope, worth reading. Thanks. Let's keep our children safe on this one.

Dr. Emmett Smith, OMD

Originally posted at MHR

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