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Brain Injury

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SARA LOMAX-REESE:           Good afternoon. You are listening to the Tuesday edition of the midday café -Health Quest Live on 900 AM WURD. Today we are going to explore the mysteries of the brain. Starting things off we are going to talk with the Einstein docs, Dr. Donee Patterson, a family medicine physician and Dr. Thomas Watanabe, Clinical Director of the Drucker Brain Injury Center at Moss Rehab. In the second half of the show, we will talk with Dr. Barry Rovner, a geriatric psychiatrist at Jefferson Hospital for Neuroscience. He is conducting a $3.5 million project for The National Institute on Aging that targets older African Americans with mild memory loss.Before we welcome our Einstein docs to the program, I read this really interesting little blurb about the brain in a Time magazine cover story. It says, "Trying to map the brain has always been cartography for fools. Most of the other parts of the body reveal their workings with little more then a glance. The heart is self evidently a pump, the lungs are clearly bellows, but the brain,which does more then any other organ, reveals least of all. The three pound lump of wrinkled tissue with no moving parts, no joints or valves, not only serves as the motherboard for all the other body's systems, but also is the seat of your mind, your thoughts,your sense that you exist at all. You have a liver. You have limbs.You are your brain." So I want to welcome Dr. Donee.

DONEE PATTERSON, MD:         Thank you.

LOMAX-REESE:                      …and Dr. Watanabe.

THOMAS WATANABE, MD:      Thank you very much.

LOMAX-REESE:          …and we are going to talk about traumatic brain injury. Let's start things off, Dr. Watanabe, with you, in just giving us an explanation of what exactly is traumatic brain injury?

WATANABE:      A traumatic brain injury is an injury to brain tissue that's caused by a blow to the head ormovement to the head, a traumatic event.

LOMAX-REESE:          And Dr. Donee why did you - you have been kind of guiding us on this path, this journey, with Einstein. Why did you want to focus on traumatic brain injury at this point in time?

PATTERSON:         I wanted to talk about this because it is actually very common. About 1.7 million people are affected each year by a traumatic brain injury and I know that a lot of people may tune us out a little bit right now and they say, well, my kids aren't in sports and my grand kids have nothing to do with sports, but traumatic brain injuries have to affect all of us from zero to 100, they affect everyone. So for actually a large percentage of people that have traumatic brain injuries, they're from zero to 14. We see them often in the emergency room and then another large percentage will be people over 70. So anyone can be affected by this, a motor vehicle accident, someone falling down their stairs or being hit by a car,we can't control those things. So this is a very important topic and we want to bring some awareness to prevention and then if it does happen to you we need you to know what to look for because the earlier that you can take care of it the better your outcome.

LOMAX-REESE:          Absolutely. Absolutely. One of the things when I think of - I mean,obviously there are traumatic events that happen, like car accidents and things like that, but I also think about sports. That to me seems like one of the primary ways, particularly when you have children, who are still having developing brains playing contact sports, like football, probably even things like soccer,where you are hitting the ball and things like that, and there seems to be growing awareness in the NFL, in other places, that there has to be much more attention paid to these concussions and things like that. So Dr. Watanabe, I wanted to see if you could speak to how to detect a concussion and is that considered a traumatic brain injury?

WATANABE:      Yes and that's a very important point. A concussion is an injury to the brain, so people need to be alert and not just say, well, it's just a concussion,because the brain is not working as it should because of that injury. There are a lot of different symptoms and signs that you can see with concussion. Somebody may complain that they're not thinking quite right, they feel like they're foggy, they may have headaches, vision problems, balance problems. These are some of the less obvious things that we might see. Some of the things are actually emergency, so I want to spend a second or two talking about that. So if you notice that somebody has slurred speech,weakness on the side of their body, or numbness or something like that, if they are throwing up, those are emergencies and they have to be assessed in the emergency room right away, but the other symptoms can creep up a little bit later, but people should also be aware of them as well.

LOMAX-REESE:           So what are some of the symptoms? You said slurred speech and you gave us a number of those, but when should you take your child or someone to the hospital, to the emergency room because like you said a lot of times, especially with boys, you know, it's like, oh,just brush it off. You are okay. Get back in there and keep going.

WATANABE:     Right. First of all, if it happens and people are around and they can identify that there has been a loss of consciousness that's a lack of responsiveness at all, they should go to the emergency room. If they are throwing up,if there is any evidence of significant confusion, any problems with weakness, stumbling around, those are all reasons to go right to the emergency room.

LOMAX-REESE:        Now Dr. Donee I wanted to ask you, are there any, because we often talk about racial disparities when we talk about health, at least on my show, and I am wondering are there any kind of racial dynamics to this topic of traumatic brain injury?

PATTERSON:         Well, culturally we often tell our boys, you know, shake it off and I have heard coaches say, "Throw dirt on it. You are okay. Just walk it off." That's something that happens culturally. Our boys aren't allowed to cry. Our boys aren't allowed to express themselves, as far as emotion. So we do see that in sports and so what happens is it gets ignored or the child is afraid to say I still have a headache or I feel confused and they're pushed to keep going and so we do see that translate into sports as well. So for anyone who is a coach or a parent, I implore you to call other coaches and call other parents because you need to know some of these symptoms and please don't ignore those symptoms when a child, or even another adult, is telling you I feel confused. You want to look for some slurred speech. You want to look for them feeling dazed and not ignore those symptoms. Make sure you get them some help immediately.

LOMAX-REESE:           Dr. Watanabe I was looking at some of the research and it says that traumatic brain injury rates are higher for males then for females.Is that related to sports or are there other things that are gender specific?

WATANABE:      Sports and other factors,but in general, boys tend to engage in higher risk activities. That includes sports, but also includes driving habits. Violence tends to be more common in males then females. Those are all different reasons why it is more common in males.

LOMAX-REESE:           For some reason, across all age groups, zero to 100, males tend to have more traumatic brain injuries so when they are younger they often fall more and then they become in more high risk behavior.Actually the number one cause of death in males between 15 and 24 are accidents, accidents of all kinds. So that's about 46 percent and 33 percent of those are car accidents, so we want to encourage people, make sure your teens are prepared. Make sure that they went to driving classes and talk to them about being safe on the road and wearing their seat belts and wearing your helmet on your motorcycle. Those things are very important.

PATTERSON:         And a bicycle.

LOMAX-REESE:                    And a bicycle. Yes.

PATTERSON:         And a bicycle.

PATTERSON:        Absolutely. Well, let me reintroduce our guests. We are talking with Dr. Donee Patterson and Dr. Thomas Watanabe. They are both from Einstein and Dr. Watanabe is the Clinical Director of the Drucker Brain Injury Center at Moss Rehab. So are you very busy Dr. Watanabe? Is there a lot of this going on?

WATANABE:      Yes, there is quite a bit and you had mentioned earlier about sports concussions and how more awareness there is of that so we have always been very busy,especially treating the more severe traumatic brain injury patients, but now with increased awareness of concussions, that's really an area that we've become quite busy.

LOMAX-REESE:          One of the things that they've also recognized particularly in professional football players is that there is a connection between, I guess, traumatic brain injury or concussions and Alzheimer's. They said that there was a disproportionate, there was a higher percentage of football players who had gotten repeated concussions, who were more predisposed to Alzheimer's. Can you talk a little about that?

WATANABE:     Yes, there are a couple things. There's Alzheimer's itself and there is some evidence that prior brain injury may lead to an increased instance in Alzheimer'sand there is a related phenomenon called chronic traumatic encephalopathy, which there has been a lot more awareness recently.Many of the younger retired football players have committed suicide for instance. There has been concern whether they have this newer,or lesser known, entity.

LOMAX-REESE:           I am wondering about, when I think of traumatic brain injury I think of something violent, like shaken baby syndrome, or a car accident or something like that, but I am wondering if stroke is considered, if you do damage to your brain, would that be considered a traumatic brain injury?

WATANABE:      Well, it wouldn't be considered traumatic because trauma is an accident or something that happens, a blow to the head, but it is a brain injury and some of the things that we would do to treat that would be similar.

LOMAX-REESE:          Okay, great. I am curious about the long-term and short-term effects of traumatic brain injury and also when we talk about stroke, we talked about this the last time you were here, Dr.Donee, that timing is everything.

PATTERSON:        Absolutely.

LOMAX-REESE:           You know, how fast you get to an emergency room and get treated iseverything. Is there a really critical time element in traumatic brain injury as well?

WATANABE:     Yes there is and this is especially true for the more severe injuries because there are some interventions that can be done right away, especially neuro surgically, for a very severe injury that can really improve outcome. For a mild injury, like a concussion, timing is very important too, but it is different. It is timing to identify that you've had a concussion and then the primary treatment is rest. So you need to know that you've had a concussion and start resting right away.

LOMAX-REESE:           Now that's interesting because I've heard anecdotally that if you have some type of concussion or something you don't want to go to sleep because you know I have heard horror stories of you go to sleep and you don't wake up.

WATANABE:      Yes. If there is concern about a brain injury you do want to be monitored closely because sometimes complications can come up in the first few hours that are identified by a decreased level of alertness, which you wouldn't see if you were asleep, so there would be a recommendation to make sure that the person is arousable, but for the milder concussions,what I mean by rest is, don't get back on the playing field. Don't get back to school. Don't get back to work. Don't do your daily workout routine. Really just start quieting things down and give your brain a chance to heal.

PATTERSON:        It's real important for parents to tell their teen, to let them know if they have had something happen, because we don't go to all of their practices and we are not with them every second on the playground.So let them know that they should tell us if they fall and hit their head so that we can watch them and check on them and make sure that they are okay and keep a closer eye and also it is very important for us to emphasize that there are very short-term things that happen, so loss of consciousness, confusion, etcetera, like we've described, but then there are things that may happen in hours later. There are things that may happen days later and there are things that may happen weeks later. So if you still have a headache weeks later, or some confusion weeks later, those things are important to us as well, and then there's further things out, like depression and insomnia, lack of sleep, or even too much sleep further out, change in behavior, the person becomes very moody or very grumpy, doing some high-risk behavior that is new to that person. All of those things are very important after a brain injury.

LOMAX-REESE:           I want to invite callers. If you have a question for our guest, Dr. Donee Patterson and Dr. Thomas Watanabe from Einstein, we are talking about traumatic brain injury today. The number is (215)634-8065. Toll free (866) 361-0900. There's a lot of new technology, I guess it's not that new, but there's a lot of technology that can look inside the brain, like CT scans and MRIs and things like that. How much has that changed your ability, Dr. Watanabe, to understand how the brain functions and the impact and severity of these injuries?

WATANABE:      That's a great question.It goes back to your first statement of what you had read about how interesting the brain is and how difficult it is to evaluate. The imaging has definitely helped our ability to detect what part of the brain is injured, if things are getting worse or if things are getting better. There are some newer imaging techniques where we can actually see the function of the brain, what area of the brain is active or not active, as opposed to just seeing where their damage is or where there is bleeding. At the same time, because everybody's brain is so different, imaging helps to some degree,but we really have to evaluate each individual patient to understand exactly what their deficits are. Imaging isn't the end-all be-all. Imaging really doesn't help much in terms of identifying a concussion, at least right now, there is very limited technology for that, but it does have an important role in treatment.

LOMAX-REESE:           I just think the brain is so fascinating. As you reference the little blurb that I read earlier, I mean it really is kind of the seat of your consciousness. So this whole notion of being unconscious, I actually watched a little clip of this woman who was in a, I guess, she was like in a coma for about 17 years. So I don't know if you can speak at all to this question of if you are,I mean, I would imagine you deal with people who go into comas?

WATANABE:      Yes.

LOMAX-REESE:           …as a part of your - so how do you counsel people to understand what the likelihood of them being able to reemerge out of that or that this might be an actual death sentence?

WATANABE:      It all depends on a few factors. First of all, if it is very early after the injury, say in the first few days, even with a very severe injury, we have fairly limited ability to predict outcome because people really recover at different rates. So early on, if it is a very severe injury, I will let people know that it is a very severe injury and there is a high likelihood of long-term problems, but that's certainly not the time to say this person is never going to wake up, never going to walk again, but as time goes on, and you see that everything else is healing up, and you realize that the brain really isn't healing up as well as we would hope, then you are a little bit more accurate in your prediction of how somebody is going to do six months from now or a year from now.

LOMAX-REESE:           We are going to go to the phones in just a second. I have one other question, Dr. Watanabe, because there is so much that we don't know about the brain. How much of these traumatic brain injuries and the changes in the healing process can be attributed to things that we just don't know like spirituality, like faith, like prayer, like,you know, the intangible.

WATANABE:      I would say that there is a lot that we don't know and those are some of the factors that we think may be important, but so we certainly encourage families to be supportive. If clergy are around, we encourage that, because we don't know what impact that has. We know that we are not very good at predicting outcome. We suspect that some of the reason is there are these intangibles, as you speak of, that may be a factor, as well as other things that we do have a better understanding of.

LOMAX-REESE:           We are talking with the Einstein docs today. We are talking with Dr. Thomas Watanabe, Clinical Director of the Drucker Brain Injury Center at Moss Rehab, and Dr. Donee Patterson from Einstein Internal Medicine. Can we take Reverend Joe? Okay, we are going to go to the phones. We've got Reverend Joe. Welcome to the show.

REVEREND: Good afternoon.

WATANABE:      Good afternoon.

PATTERSON:        Good afternoon.

REVEREND: I am just wondering if anything can be passed on or hereditary part of brain damage? I was talking to the curator of the slave museum and he was said someone shipped him a real big ball, a wooden ball with a handle on it and that was used to knock the Africans out before they were capturing them for slavery and I am wondering how many people, how many of the slaves might have had brain concussions for life and never got any treatment that could pass on to their grandkids or hereditary? Is that making sense? I don't know. I am thinking if they knock a person out somebody has to have a brain concussion or something.

LOMAX-REESE:                      Thanks for your question Reverend Joe. Dr. Donee?

PATTERSON:         This particular topic is about traumatic brain injury so it is something that happens to you as an individual. Having something like that be passed down is not, it doesn't quite happen exactly that way, but it is not to lessen the fact that those are horrible things that happened to people, but those aren't necessarily genetic things. It is individual things that happen to each individual's brain.

LOMAX-REESE:           We are going to take a quick break. When we come back we will continue our conversation with Dr. Thomas Watanabe and Dr. Donee Patterson. Don't go away. We are back. You are listening to HealthQuest Live on 900 AM WURD. Today we are talking about traumatic brain injury with our Einstein docs and one of the things that we were talking about was how people can heal after having some type of traumatic brain injury and I wanted to see if you guys could talk a little bit about the whole kind of rehab process. What is the regimen and I am sure it differs and it varies based on what has transpired, but what are some of the things that people mayexperience if they had to go through rehab?

PATTERSON:        Well,some of the basic things, Dr. Watanabe can talk about what they actually do in the center, but I do want to emphasize that this is a really confusing time for a lot of people so you want to check with people that you trust and have them help you sometime with your finances or your bills because it is your brain. Your brain is affected. You also want to, this is a time to avoid alcohol. You don't want to use excess alcohol, that can make you confused,affect your brain any way, make you have more falls. You also want to make sure that throughout this you are getting rest because that's a rehabilitation state for your brain to get rest and repair and you also want to try to eat healthy and stay positive and that's what we were talking about before, having other family members around that can encourage you because depression is a very common part of traumatic brain injuries.

LOMAX-REESE:                     And Dr. Watanabe, yes?

WATANABE:      Yes, those are really important points. I think the most important thing about treat ment is identifying the problems and with traumatic brain injuries there can be so many different problems that you really want to have some expert evaluation first before you do any sort of treatment. So there could be problems with dizziness and balance, vision problems, memory problems, insight and judgement problems, problems walking, strength or weakness, I guess. Evaluating all those is very important because the treatment will be based on what problems you are having. If it is problems with vision or vision therapies and things that can be done, if it is problems with balance,specific therapy addressing balance or understanding why the person is having problems with balance, same thing with memory or any other cognitive ability of the brain, the more precise the diagnosis, the better the treatment.

LOMAX-REESE:          One of the things I was reading was that as there is more and more research about the brain they're realizing how, there's a lot of plasticity to the brain, that there's a lot of things that you can do that are recoverable and that can be, you know, the brain has a lot more flexibility, I guess, then maybe originally thought. One of the things, you said that one of the growing groups for traumatic brain injury are adults 75 years old and older. I would imagine that's because of falls and they're experiencing traumatic brain injury from falling and hitting their head.

PATTERSON:       Exactly.

WATANABE:     Yes, that's the most common reason and the other reason is that with the aging demographics are just more older people who are living, living with a lot of different disabilities, whether it's vision problems,balance problems, problems with their blood pressure medications,all contributing to more falls and more injuries.

LOMAX-REESE:           Are there any recommendations for, I mean, Dr. Donee mentioned seat belts and safety measures and things like that, but are there any other recommendations for preventing traumatic brain injury?

PATTERSON:         We just want people just to be smart. We can't keep our kids from playing.I was just saying how I have four kids and they just do all kinds of things. You can't keep your kids from playing, but you can encourage them to be in safer situations and talk to them about hurting their brain and protecting their brain and also when we are driving, try not to drive distracted, and try not to run that light. We are all in a rush, but that could just totally change your life. Try to just be very thoughtful that an accident could happen. I don't want people to live in fear and be anxious, but just be cautious about the things that we do every day.

LOMAX-REESE:          I would imagine having children modeling for them, so wearing your helmet and not talking on the phone while you are driving and all of those things that kids can pick up on, not just because you say it, but that you actually do it.

PATTERSON:        Absolutely.

LOMAX-REESE:           I am going to give you the last word, Dr. Watanabe. Is there anything that you want to leave our listening audience with on this topic?

WATANABE:      Well, I think I want to emphasize that last point that there is no cure for traumatic brain injuries so prevention is by far the most important thing, but ifit does happen, make sure you see an expert because the injuries are so complex and so different that you want to make sure that you are being treated by somebody that has a lot of awareness of these problems.

LOMAX-REESE:          I would imagine you want to err on the side of caution. You don't want to just shake it off or brush it off. You want to go in and see someone sooner rather then later.

WATANABE:      That's true.

PATTERSON:        Absolutely.

WATANABE:      Especially when you are dealing with youths.

LOMAX-REESE:                     Absolutely. So Dr. Donee, anything you want to say as we closeout?

PATTERSON:         I just want us to remember think about how much we have to lose and just really try to protect yourself and protect your family and be safe in the car and be safe when you are riding a bike and be safe whenyou are crossing the street. There are a lot of pedestrian accidents in Philadelphia. Just think about how much we have tolose and let's just be smart about it. If you have any questions or any further questions, you can always contact us at 1-800-EINSTEIN,or you can put comments onEinstein's Facebook page about this particular topic.

LOMAX-REESE:           Excellent. Well, I want to thank you both for being with me and being with us today to share information about this very important topic and hopefully not very many people will experience it firsthand, but if you do at least you will be a little bit more knowledgeable, a little bit more prepared. So thank you, Dr. Watanabe, and thank you, Dr. Donee Patterson.

WATANABE:      Thank you very much.

PATTERSON:         Thank you very much.


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