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?
- 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.
- NO ALCOHOLIC BEVERAGES.
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.
- NO DIET SODAS, NO ASPARTAME (NutraSweet), NO MSG
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.
- NO HEAVY MEALS.
If surgery is required, an empty stomach is safest under anaesthesia.
- NO INTENSE ACTIVITY.
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.
- 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 . . .
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