H E A D     I N J U R Y

Concussion and Brain Injury

(Excerpted from Surviving Martial Arts)
by C. M. Shifflett

What to Do When You Have a Concussion

Rest. Repair.

Here’s how, with symptoms that MUST NOT be ignored.

Brain injury is like hitting the motherboard of your computer with a hammer. The human computer is a truly wonderful computer as it is self-healing, but it does not heal in the ways that people often think it should. For example, you get no points for getting back on the mat, the mound, or the football field after a head injury.

Trying to “work through” the pain, nausea, or dizziness just doesn’t work. Strangely, the problem is not repaired by hitting the motherboard again with more hammers or by additional jarring and shaking. Doing so is extremely dangerous — to the point of equipment dysfunction, or to the point of fatal error.

Concussions are traditionally classified as follows with sample recommended time lapse between return to play or activity. There is no general agreement on the waiting period before return to activity — nor can there be, for return to activity must not depend on calendar dates, schedules, tests or playoff dates. It depends on healing.

  • Concussion Grade 1: Confusion without amnesia, no loss of consciousness. Drug-free rest. Observe for at least 20 minutes. Be sure patient is completely symptom-free before returning to activity.

  • Concussion Grade 2: Confusion with amnesia, but no loss of consciousness. Medical attention required! Drug-free rest; observe for 24 hours. Return to activity after one week symptom-free depending upon medical evaluation and advice.

  • Concussion Grade 3: Loss of consciousness. Immediate medical attention required! Drug-free rest; observe for 24 hours. Return to activity only after 2-4 weeks symptom-free depending upon medical evaluation and advice.

Again, these are traditional guidelines for concussion. However, computerized systems for evaluating cognitive function in injured athletes are becoming increasingly common. What these systems reveal is that healing generally takes longer than was previously believed.

The athlete who returns to play too soon risks second-impact syndrome. This is a rapid, fatal swelling of the brain that may occur if there is another head injury (even a minor one) before the symptoms of the previous concussion have fully resolved.

Notice that basic treatment for concussion is drug-free rest with time for observation.
What, exactly, does this mean?

  1. Drug-Free Rest. This means:

    • NO NSAIDs.
      No aspirin, no ibuprofen, no Motrin, no Tylenol, no Advil. These destroy blood platelets required for clotting and can cause additional capillary breakage by destroying Vitamin C and encouraging even more bleeding. If surgery is required, neither you nor the surgeon will benefit from poor clotting time and increased bleeding in the brain.

      Once blood platelets are destroyed, it takes 2 weeks for the body to regenerate a complete new set. (You’ll be up to about half the normal level in one week). This is why patients scheduled for surgery are restricted from aspirin for 2 weeks. Advil and Tylenol reduce platelets to a level replaceable in 6-8 hours but even this is too much to risk with a head injury.

      Alcohol alone reduces clotting and promotes bleeding. And, if surgery is required, it may also have toxic interactions with the anaesthesia.

      Alcohol may also cause upchucking, extremely dangerous during unconsciousness. You may choke to death on your own vomit. Or you may breath (aspirate) the vomit into your lungs resulting in the worst and most painful case of pneumonia you’ve ever had. This involves burning of lung tissue by stomach acid (pH 2) plus introduction of enzymes and bacteria that are great in the stomach, very bad in the lungs. For all these reasons, never attempt practice (or any other physical activity!) while drunk.

      Glutamates occur naturally in the brain and normally are carefully controlled. When controls are overwhelmed by accident or design, free glutamates actively destroy brain cells for hours or days after the initial trauma.

      In patients with severe head injuries, levels high enough to destroy neurons were detected in cerebrospinal fluid within 24 hours of the injury. Levels continued to rise up to 72 hours later*. Once levels of brain-destroying glutamates have risen, it takes more time for them to come back down to safe levels.
      *Baker and others, Journal of Neurosurgery, Vol. 79, pp. 369-372, 1993.

      The food industry provides the same free glutamates in processed foods. MSG is manufactured by breakdown of protein into its component amino acids, one of which is glutamic acid. If you don't see MSG on the label it may still be present but disguised as "hydrolyzed" (i.e., "broken") protein from various sources. Glutamates are especially high in broth, bouillon, and soups -- the very foods fed to the sick and injured. Read labels with an eagle eye. It makes no sense to add injury to injury.

      If surgery is required, an empty stomach is safest under anaesthesia.

      Inflammation will subside and minor bleeding will be reabsorbed over time. But if there has been any serious bleeding, a clot can form which takes more time to be reabsorbed. A clot jarred loose before it can be reabsorbed travels through the vascular system as an embolism. It may lodge in an artery of the brain as a thrombus and the victim suffers cerebral thrombosis or "stroke." Or, there may be hemorrhage of damaged or incompletely healed blood vessels.

      Take a break from practice and rest. Really rest. Please don't decide that because you're skipping the breakfall class, that you'll go to the gymn and lift weights or do aerobics instead. If you're injured, you may not feel up to it anyway. Problems arise when people think they need to "work through" the pain, nausea, fatigue.

      Please rest. Just rest.

  2. OBSERVATION. What exactly are you observing?

    • PERL (Pupils Equal & Reactive to Light). Pupils of unequal sizes or pupils pupils that do not change in response to light at all after a head injury can indicate a dangerous rise of pressure in the brain due to pressure due to internal bleeding / swelling. Emergency surgery may be necessary to relieve the elevated pressure.
    • Confusion, disorientation, and sleep patterns.

      Do not allow a person with a head injury to spend the night alone, nor to sleep through the night. The patient should be awakened every couple hours to verify that he can be awakened and has not slipped into a coma. Use a flashlight to verify that pupils are reactive and normal. Marked disorientation or inability to awaken is a signal for immediate emergency medical attention including X-ray to check for bleeding.

      Victims may feel queasy and dizzy, a heart may be racing, mouth may be dry. There may be physical discomfort, emotional instability, and depression for several weeks or months following. If sleepiness, headaches, or vision changes occur (whether weeks to months later) head to the ER.

      Another interesting and annoying symptom: you may find that when blowing your nose, fluid squirts out of a tear duct and onto your glasses. If so, you have also broken some of the delicate internal nasal bones that normally separate tears and nasal secretions. And if you hit hard enough to damage those, there is almost certainly damage to the soft tissues of the brain possibly including the delicate olfactory nerves (sense of smell).

      There may be much much more . . . Next

Copyright(c) 2006 Round Earth Publishing. All rights reserved.
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