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Vail Daily column: Take concussions seriously

Dr. Drew Werner
Dear Doc
Vail, CO Colorado

The inspiration of my article this week is The Clash on the Gridiron and the fast break down the court. Another time or another day, however, it might be Birds of Prey, Super G, the X-Games, Ride the Rockies or a hundred other recreational or competitive activities that encourage us to try a little harder, go a little faster and push the envelope further. Our lives are all about challenge, each of us pursuing it in our own way. It is impossible to stop, but we can be smart, and not use our heads.

Dear Doc,

My son had a head injury playing a high school sport. He is still dizzy, but he never got knocked out. Should we be concerned?



Dizzy in Vail

Dear Dizzy,



The simple answer is YES. In fact until medically determined otherwise any head injury should be considered a concussion. As the significance of the symptoms increases so does the risk of serious underlying brain injury. It may be easy to recognize the dramatic symptoms of amnesia and loss of consciousness, but even a mild head injury with any symptoms is concerning. Repeated head injuries set off alarms as they make the risk of brain damage exponentially worse.

A concussion is any head injury with any symptoms ranging from headache or dizziness to coma. To put it simply, if someone hits their head and says “ouch,” if the fans gasp or say “that must have hurt,” a player should be suspected to have suffered a concussion. Perhaps most importantly our players need to be aware of the risks of concussion and be ready to recognize and acknowledge any symptoms they have after any head injury. With competitive sports often comes a shake-it-off-and-get-back-out-there attitude. While that may be true at times, it never holds true for concussions. At the recent winter sports meeting, Eagle Valley Devils Head Basketball Coach Brent McConaghy said it best: “We take any concussion very seriously.”

Once an athlete has suffered even a mild concussion, prematurely returning to the game can lead to far more serious brain damage and even death. This is referred to as second impact syndrome. While many authors have devised recommendations regarding the safe return to sports, there is surprisingly no well-established gold standard. The most difficult decisions then revolve around both the minor helmet ding or bell ringer, and the second or third concussion.



With respect to any concussion, no athlete should return to play if they remain symptomatic. Early concussion symptoms include headache, dizziness, tinnitus (ringing in the ears), confusion, nausea, vomiting and visual changes. Later, concussion symptoms include memory and sleep disturbances, poor concentration, irritability, personality and mood changes, fatigue and lingering headaches. It is also important to remember that symptomatic means symptomatic. That is, a concussion has not resolved if symptoms return with activity, even if they were gone at rest. If an athlete develops any return of concussive symptoms while on the field or under exertion, it is time to stop – immediately. Generally, if an athlete had a mild head injury without LOC (loss of consciousness), and, any mild symptoms rapidly disappear, they may return to play 20 minutes after all their symptoms have resolved. Any LOC requires medical attention and you should consider undergoing a brain image with CT scan.

ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) is a computer-based neurological and cognitive test that can help predict recovery and the full resolution of a concussion. It has been around for more than a decade and is generously provided to all our high school athletes by the Steadman Clinic. A concussion is a brain injury and ImPACT testing may be one of the best tools we have to determine when it is safe for any athlete to return to their sport. For those athletes who have suffered a second concussion, or even worse a third, only your physician can determine when you may be ready to return to play.

Play hard, but play safe. If there is a helmet for your sport, wear it! We can fix broken bones, but not broken heads.

Have a wonderful Thanksgiving!

Dr. Drew Werner is the vice chief of staff at Valley View Hospital in Glenwood Springs and the Eagle County Health Officer. He lives in Eagle with his family. E-mail comments about this column to cschnell@vaildaily.com.


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