Heads Up: What You Need to Know About Brain Injuries

Hello and welcome to the Ask Dr. V Show, brought to you by Channel of Health, where you can be informed and empowered about healthcare issues that are important to you. Today, our topic is heads up, what you need to know about brain injuries. I'm the host, Dr. Valda Crowder, also known as Dr. V. I'm a board certified emergency medicine physician, and we talk about absolutely everything on this show on Mondays, on medical Mondays. So today we're talking about head trauma, which can be really any sort of trauma to your scalp, your skull, or your brain that's really caused by some sort of uh external force. Um and, you know, it can cause brain dysfunction, uh called traumatic brain injury. Um it can also be something just a mild concussion, or it can be something that is a much more severe injury, um, and it can lead to permanent disability and even death. So, you know, when we hear about head trauma, we often hear about it related to sports. Um, most likely, you know, the most common sport that we hear about it is related to football, but you can see head injuries in boxing, um, in soccer, uh, you can also see it in volleyball. So there's a lot of different basketball, there's a lot of different sports that uh it can be related to. But you can just always also have a plain old fall. And that's usually what I actually see in the emergency department. Um, it's people who are actually falling down steps, or they may just be falling from a standing position. So to try to give you an idea of the scope of this, there are about one and a half million emergency department visits a year related to head injuries. And as I said, some of these are mild, and someone may just have bumped their head, others may have a concussion, but you can also have some that actually have what we call intercranial bleeding, which is bleeding inside of their skull in the area where their brain is. Um that's usually like a subdural hematoma or a subarachnoid uh hematoma or uh an intracerebral hemorrhage. So those things are much, much more life-threatening. Um, you'll also people see where people just have a scalp injury and it really, really bleeds a lot. So here's the thing that that's important to know. We have a lot of people these days that are on blood thinners. So falling is a much bigger deal when you're on a blood thinner. Some of the blood thinners are like eloquists, plavox, even a daily aspirin, right? Anybody who is on a blood thinner and falls and hits their head or falls and has a significant injury should actually come to the emergency department. The other group of people that you will find that um are more likely to have significant head injuries are those that are very young or very old, or folks that are like uh an alcoholic where you know their brain size may not be the normal brain size, and there's a little bit more vasculature that's you know covering empty spaces in their brain. And I tell people all the time the way to sort of think about this is when you have a baby, uh the consistency of a baby's brain is like almost jello, right? And then as you get a little bit older, it be your brain firms up a little bit. So by the time you're like maybe 12, 13, 14, it's like a nerf ball, right? And then as you get older, your brain is fully developed when you're about 25 years old. So I know all of those people who think they're grown before 25, your brain is not fully developed until you're about 25, 26 years old. And then that's when it's really firm, like let's say a basketball. So that kind of gives you some idea, and that's why often we're also very concerned about um brain injuries in the very young. Then as you age and you get older, your brain shrinks a little bit. So it shrinks, and by the time you get older, like let's say you're 80 or 90 years old, then there's more empty spaces in your brain. And and vasculature is traversing these empty spaces, and so that coupled with being on a blood thinner, um, can then make it more likely for you to have um a bleed, an intracranial bleed in your head. So we're gonna talk about what you need to do, how to prevent uh head injuries, and and everything you need to know about it today. But ultimately, these sorts of injuries can really lead to sort of long-term cognitive problems. People can have problems with their attention or memory or sort of how to execute more executive functioning. They can be slower, sort of thinking about something or coming up with an answer to something. Um, they sometimes can have behavioral issues, they can be irritable, um, they can be depressed, um, it can cause anxiety or impulse control uh problems. Um, and for some people, head injuries can actually really cause a personality change. Um, other folks have more physical-like symptoms like a persistent headache, or they'll get vertigo, or they'll have difficulty sleeping, or they may even have seizures. Um, and so these are what we call and kind of call like post-concussive syndromes where people have headaches and cognitive complaints and mood problems or sleep problems, and these are all associated with uh head head injuries. So as you can see, any sort of trauma to your head can be serious and really should not be taken uh lightly. All right, so if you're listening to this topic, you can also email me questions or topics that you'd like to talk about, and that's info at asdrv.us. That's info at askdrv.us. What the health is happening, that's a real question. It's also the name of my new podcast where you can literally get life-changing advice. We go over not only this information that we actually talk about in this show, but there's other information that's actually on what the health is happening podcast. So it is where you get the inside scoop on all types of health matters that can empower you with information for when you interface with the healthcare system. Um, it's really, really important to get educated and get the medical updates so you actually know what you should be asking. What the health is happening is your dose of medical reality with me and my friends from the front lines of healthcare, and it is on all podcast streaming platforms. Um so all you have to do is download and subscribe. All right, we're gonna get into news you can use. There has been a lot that has been going on uh this particular week. Um the first thing uh news you could use is um, you know, our our our prayers uh go out to Marshawn Nealan's family. He died of a self-inflicted gunshot wound uh in Texas. He was a Dallas Cowboy defensive end. And apparently he had been sending some very disturbing um text messages to to his family and friends. Um and after the crash, he abandoned uh crashed his car and abandoned his car and then was found uh dead from a self-inflicted gunshot wound. And our um our prayers are with his family. Number two story is that we there are half a million bottles of blood pressure medication that have been recalled by the FDA. And this medication is called prososin, P-R-A-Z-O-SIN hydrochloride. Uh, it comes in one, two, and five milligram doses. Basically, what they have found is there's some cancer-causing chemicals in the blood pressure medication. So if you take prososin, you want to actually go back to the pharmacy and check and make sure to see if your bottle has been recalled. Um, you really want to take a look at other options, uh, get a broker, see what is actually actually available to you. All right, we've got a caller on line one. Linda? Hi, how are you?

Good. I'm good. My question comment is that um I did exactly what the last thing that you um are talking about. I have a broker, an insurance broker, and I have gone to them and said, I want all these doctors covered, and now I'm gonna go back to them this year and say, I want these specialists, and I'm going to try to negotiate with them. Is there any advice that you would give me um about negotiating specialists with them? Um, for example, I need to get a colonoscopy next year, so I have a gastroenterologist, and I want to negotiate that covered visit before you actually get the colonoscopy. So that's one. And then two, I wanted to just mention something about um my nephew had a concussion, and uh there was a change in the concussion protocols when he got his concussion. He's he was on the soccer field, a player hit the ball right in his face, he went flat on the ground, hit his head, and then he was stuttering, and then he stopped talking, which pretty was pretty dramatic. Um I I have a question about whether uh there could be any future, like if there's anything that we need to keep monitoring. So those two questions. Okay, so and then I'll find off.

Okay, so let me but let me ask you something just real quickly. Because a lot of people don't even know how to get an insurance broker. What what did you do to get an insurance broker? Did it cost you any money? Where did you go?

Oh no, it cost me no money. So I went to the um DC Health link and I went on there, and they have a link where you can click and look for a broker. And I uh wrote down a bunch of names, and then I looked up the brokers, and I looked up reviews about the brokers. And given that I'm looking for a lot of black doctors, I went with a black woman broker who had a high rating, and she's been terrific. And she kind of asked me what I'm looking for and what would make me happy, and then she gives me a bunch of options. She doesn't just um she doesn't just say, Yeah, you need to stick to care first, regardless of whether they agree with you know, here are some other options that you have in your area.

So last year, when you actually wanted to get your your primary care doctors were not part of the network, correct?

Yeah, I switched. So what happened was I I I didn't like I didn't the primary care physician just it felt too felt like it was meaningless, like I was wasting my time. So I wanted to get a new primary care physician who um, you know, was a little more data driven. Yes. And so I switched, so that's why.

Okay. So yeah, a lot of people don't realize you can actually tell the insurance companies, particularly if you're with an insurance company, let's say, and I'll use care first because you mentioned care first. Let's say you're with CareFirst now. They want to keep your business, right? And so you can say to CareFirst, well, you know, you guys don't cover such and such, or you guys don't cover this particular physician is not a part of your network. Um, and they do sometimes reach out to those physicians and then make them part of the network so that they don't lose your business. Now, what happens sometimes is sometimes those physicians don't want to be part of their network because they don't pay a lot, right? They may be poor reimbursement insurers, right? So there may be then some physicians that say, Well, I'm not gonna be a part of your network unless you start paying me X for a colonoscopy. So there's a whole negotiation that is occurring behind the scenes that a lot of people don't realize. And you can be a part of that negotiation if you advocate for the physician that you actually really uh want to work with. Does that answer your question? Yeah.

Okay, now now you're even if it's a specialist.

Yes, even if it's a specialist, it doesn't yeah, even if it's a specialist, it doesn't even, it could even be a nutritionist or a um physical therapy location that you like to go to. Um if there are places that you like to go, you need to let your insurance company, and this is the time to do it, because they're only listening right now, right? Because once they actually once they actually get your business at at the end of the open season, you know, which ends in the middle of January, they have your business for the year. Then they're not then then they're like, We've got you for the year, right? So now your nephew, how how old your nephew who got hit in the um in the head, yes. How old was he? Gosh, it was now two years ago, so he was 14. So he was 14, yeah. Okay, so yeah, so so you can see where people will black out. They may have problems with um talking, like he was saying he was stuttering. Um some folks will even go as far as having seizures. So did he go to the emergency department?

Yes. He had he was actually at that point, he was part of an INOVA program that did baselines of a lot of his, you know, just they kind of scanned his body and did a bunch of baselines. So he actually so they were actually able to quickly diagnose that it was a concussion. And they knew that he had um he had to go through their new concussion protocol. So that was helpful. I guess what I'm wondering is going forward, do we have to keep being vigilant and monitoring what's going on with him?

Is he still playing soccer? Is he still playing soccer? Then absolutely. So so absolutely. So one of the things that is actually most important is when people get repeated concussions, right? So it especially if they are now if you have a concussion and you don't have another concussion for five or six years, that's one thing. But if you have a concussion one week and then you turn around and you have a concussion the next week, this is why they often keep the football players off the field, right? Because rapid succession of concussions is really, really dangerous. Um, but if you want to actually look at like some of the things, I don't know if you got a spec scan, but a spec scan is one of the things that more a more advanced imaging technique that we actually use for people that have that are post-concussion. Um the other thing is it's really important that he has an anti-inflammatory diet and like a diet that's rich in like omega-3 fatty acids like your salmons and your fatty fishes, and antioxidants like vitamin C and E foods, right? Um, and then sleep is really important. The brain really repairs itself while it actually uh goes to sleep. But the main thing is to try not to have another one.

Good luck there. Wait, can you just repeat that? So you were saying in terms of the diet, anti-inflammatory diet.

Yeah, anti-inflammatory yeah, anti-inflammatory diet, omega-3 fatty acids, which are like your fish, your salmon, your fish, right, and antioxidants, which are foods that are high in vitamin C and E. If you can get it naturally, that's actually really better. And then if he really wants to see, there's a you know, getting a spec scan. One of the best head injury places in the country is uh Dr. Daniel Aman, A-M-E-N, and he's actually in uh Reston, Virginia. Um and that is one of the um a lot of the football players actually go there. I think he also has offices in California and Florida for anybody who's listening who's around the around the around the country. Um but anti-inflammatory diet, uh high in omega-3 fatty acids, and antioxidants, like vitamin foods that are high in vitamin C and E. Thank you. Alrighty, okay. Thanks for calling in. All right. Thank you. If you'd like to share your story, you want to join us today. If you have any questions, you can call in. This show is live. It's 1-800-450-7876. That's 1-800-450-7876. I have some folks that have emailed me in some questions, and I am going to start to answer them. Alrighty, I got a question from Stephanie, and she wants to know what is the difference between a concussion versus traumatic brain injury versus CTE. I hear these words used almost interchangeably. Are they the same thing or are they different things? So, Stephanie, this is a great question because they are very different. So a concussion is usually mild. It's a blow to the head, and you might have symptoms for maybe a couple of days or a week. That's kind of a concussion. And the main thing with a concussion that a lot of people don't realize is if you come to the emergency department, all your testing and CAT scans will be negative, right? So people will say, Did you see the a concussion on my CAT scan? You never see a concussion on a CAT scan, right? So a concussion is a constellation of symptoms. So it's either that you blacked out, or like the previous caller said, there was stuttering, sometimes there's seizures, sometimes there's posturing, right? And it's related to a blow to your head, and it usually goes away within days to weeks. Traumatic brain injury is um usually a more severe form of a concussion. It can be short term or long term, but usually traumatic brain injury, that term is used when you have lasting effects, and you have effects that actually last um months to years. Um you may have people who have uh difficulty answering questions or figuring out uh problems or speaking, and so the traumatic it it's traumatic brain injury is when you have longer uh longer symptoms. CTE is completely different. Okay, so CTE, we hear about that in the setting of football, and it's chronic, traumatic, encephalopathy. That's what the C, the T and the E stand for. And so, and it is that is a chronic disease. And it is a disease that gets progressively worse over time. So think of like an Alzheimer's or a Parkinson's disease or something like that, where it gets progressively worse. And basically, what it is a degenerative disease of the neurologic system. So the neurologic system actually degenerates, um, and it is caused by repeated head injury. We do not diagnose CTE while you were living. CTE is diagnosed by autopsy, right? And what happens is there's a lot of centers in the United States where they actually uh do those autopsies. They take the brain. Um, one of the largest centers is in uh Boston where a lot of the football players uh will send their brains to. It's one of the largest c collections of uh postmortem brains um where they have actually diagnosed. So CTE is diagnosed post-mortem after you die. That is not a diagnosis that you actually have while you're living. All right, so I hope that actually helps you in uh making the difference between concussion, traumatic brain injury, um, and CTE. Alrighty, uh next question from Taylor says, uh we often hear never fall asleep after a head injury. Is this true or is this just a myth? So this is something that we used to tell people, and I remember at the beginning of my career where we would have people wake them up every three or four hours. So we we don't we no longer have that recommendation. So now the recommendation is more to look out for any sort of unusual symptoms. So if someone's exhibiting some unusual symptoms, um like a severe headache or vomiting or confusion or they have a seizure or they've got weakness or numbness of their arms or legs, or they have problems with their speech, or they seem to be unusually agitated, these are all signs and things kind of to look for. But we kind of have stopped the whole like wake people up every three to four hours because one of the things that they found out is that they're um that sleep is really, really important for the brain to act to act to actually repair. So it is it is really, really important it for people in the reparative process. So we don't have people um wake each other, wake each other up every um uh three to four hours anymore, but very good question. Uh Fonea, I think that's how she pronounces her name. Uh, she said, please share the symptoms that a person with brain injuries or concussion might have. I found my 83-year-old mother on the bathroom floor recently. She has vertigo, lost her balance and fell. However, I have no idea if she hit her head or what symptoms to look for. She begged me not to go to the hospital again since she just came home from there two to three weeks ago. Um, I've got my good eye on her, but need to know what to actually look for. So this uh so a lot of the things that I just said are the things to look for, which are the headache, the seizures, the vomiting, loss of consciousness, confusion. But here, I but I want to actually, this question is really important for a couple of reasons. I want to really talk about how to prevent falls. And I'm telling you, I don't know what's going on, but everybody falls in the bathroom. Everybody's like, I fell in the bathroom. Okay. So this is really important. As fall prevention, how do you actually prevent falls? What the bathroom has is a lot of rugs. Okay. Get the rugs up off the bathroom floor, get any clutter up off the bathroom floor. It's really important for older people to have non slip shoes on and not. Non-slip socks. They've got the socks, the non-slip socks with the rubber things on the bottom. That's really, really important because people get up and they actually have on regular socks and away they go. Right? The other thing that's important is sometimes as you get older, flip-flops and house shoes are very difficult to navigate, right? If you have a shoe without a heel, I see a lot of people trip on things like that. Um, the other thing is improved lighting and have a night light. Grab bars are very, very important. Installing a grab bar in a shower or by a toilet. Um, the other thing is that, you know, they're uh canes and walkers. So a couple of things. One is, you know, we have some elderly folks that don't want to use their cane and walker. So there's a there's a stubbornness component that's going on here as well, right? And so you want to really have a conversation with your family member that you really want them to be safe and you would really want need them to use their cane and walker so that they don't fall. The other thing that's important is to have multiple canes and multiple walkers around the house. Because sometimes people get to a certain point in the house and then they can't actually navigate to the next point, right? And they're holding on to things, they're holding on to dressers, they're holding on to refrigerators, they're holding on, I've seen people they tip over, they fall, the dresser falls on top of them. So you want to make sure to have uh multiple canes and walkers um around the house. Um, and then the last thing, which I think is something that has been really studied a lot, and a lot of people don't know about it, but Tai Chi is very, very effective in decreasing falls in elderly. And they do Tai Chi in the chair. If you can't do Tai Chi standing, um, you'll see now in a lot of senior centers there'll be Tai Chi classes. Tai Chi has been shown to decrease the likelihood of a fall by almost 50%. So it is really, really important. If you can get an elderly family member into a Tai Chi class, uh you really, really want to do it. So it is it is super, super important because in addition to head injuries, when older people fall, they get hip fractures, um, they get rib fractures. There's a lot of things that happen. Uh there's a lot of things that happen with falls. Um alrighty. So, all right, Trey asked me, uh, Dr. V, CTE is a big issue in football and contact sports. With Marshawn Nealon, how will they be able to tell if the C if the suicide was CTE related? So, so so interesting. I've actually been so I've been following the story a little bit. Um, I think certainly in Marshawn Nealon's case, you know, I I don't know him. I never examined him. I can't really talk about specifically uh and and I have no information on how many head injuries he had during his career or anything like that. But I will say this a couple of things is one that I heard that he had uh a death, uh, a death in his family, that his mother died um shortly or around the time he got drafted. Um and um and and I think that um if they were to diagnose CTE, that would be done post-mortem. Um what you will find is that a lot of the football players, and this is really unfortunate, when they commit suicide, they will shoot themselves in the chest so that way it preserves their brain. And a lot of them have actually told their family members that they want their brain to go to Boston. Um so I don't know whether or not that's something that his family is doing. But if they do decide to do that, we will uh we will hear about it later. Um we've tackled a big topic today, which is head injuries, and I want to really thank you guys for joining me. If there are other topics that you actually want me to actually go over, please make sure to send it to me at infotasdrv.us. That's info at askdrv.us. We'll be back next week to talk about another topic that is important to you so that you can stay informed and empowered about your health.