Hyponatremia and Central Pontine Myelinolysis

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Archive for the tag “Centers for Disease Control and Prevention”

Pertussis: antibiotic resistance and additional testing information:

If you’ve read my recent blog posts, you are more in the know than most of the doctors currently are in regards to Pertussis. However, there are a few points that I want to clarify.

I think one of the most important things you can do is get tested. Again, my local doctors did not see the necessity in doing this, and I have a feeling that they aren’t the only doctors that hold this belief. This means that you need to be able to voice your reasoning for having it done and have enough confidence to possibly argue for it with them. You also need to be able to demand the right kind of testing, and here is why:

When my daughter had a positive test, I went to my doctor. I had an appointment scheduled at that time anyway, so I decided that I needed to have myself tested and treated. I was not very sick at that time. I was just starting to get a slight cough. I had already had the cold like symptoms 12 to 14 days prior, so I was a bit surprised that I hadn’t developed the severe coughing like everyone else had. I had only started coughing the night before my appointment.

I had not started researching Pertussis at that point, so I was pretty uninformed. My doctor did feel that it was necessary to be tested. He ordered a blood test because our local lab did not perform the nasopharyngeal swabs. They treated the nasopharyngeal tests as a “procedure”, and their phlebotomists were not skilled in performing “procedures”. Because of this, my GP ordered the blood testing.

If you’ve read my previous posts, then you would realize that having blood testing during the first few days of developing the “whooping” cough, would not be accurate. Having a blood test during this period can lead to false negatives because your antibodies do not have the time to build in response to the infection.

I also had to take my son to get tested. We took him to the Children’s Hospital urgent care department last Saturday. Now, my son by this time had his “whooping” cough for more than 4 weeks. The nurse that was in charge of his care was very reluctant in getting him tested. She did not see the need. I explained that it wasn’t for his care but so that health department could record his case. When I finally convinced them to do it, they were going to do the nasopharyngeal testing. This was the incorrect procedure. At this point I had researched it and I knew it, so I voiced my concerns and stated that he needed to have the blood test performed.

I’m sure you can understand that my correcting the nurse was not met with the best attitude. Actually, she did not come back, but they did both the nasopharyngeal and blood testing, and I was satisfied.

I got the call back today. My son’s nasopharyngeal test was negative (which is what I was expecting because it was beyond the time frame for that test to work), but his lab work showed he had recently had the infection.

So, I was right. If I hadn’t stood my ground, he wouldn’t have had the confirmation that he had it. The hospital has now contacted the community health department and his high school, which was the whole point of having him tested.

What does this mean for you?

You need to know about Pertussis. You need to know about testing, treatment, symptoms, etc because your doctor may or may not know about it. They make mistakes, and because Pertussis is rare and is making a comeback, in order to get the best care you and your family deserves, you might need to stand your ground against them. It’s hard to do even when you know you are correct, so you have to be absolute and persistent. The most important reason for getting a test is to proactively prevent it from spreading. It can kill babies and toddlers, and right now there is a country wide misbelief that if you have your vaccinations that you won’t get it.

The following is the chart used by the CDC to describe when the tests should be done:

Optimal timing for diagnostic testing (weeks).

Culture is best done from nasopharyngeal (NP) specimens collected during the first 2 weeks of cough when viable bacteria are still present in the nasopharynx.  After the first 2 weeks, sensitivity is decreased and the risk of false-negatives increases rapidly.

PCR should be tested from nasopharyngeal specimens taken at 0-3 weeks following cough onset, but may provide accurate results for up to 4 weeks of cough in infants or unvaccinated persons. After the fourth week of cough, the amount of bacterial DNA rapidly diminishes, which increases the risk of obtaining falsely-negative results.

For the CDC single point serology, the optimal timing for specimen collection is 2 to 8 weeks following cough onset, when the antibody titters are at their highest; however, serology may be performed on specimens collected up to 12 weeks following cough onset.

(So again, from the above information, the reason my son had a negative nasopharyngeal test was because he had his cough for more than 4 weeks, but he had a positive blood test. If I hadn’t demanded the blood testing, they would not have diagnosed him properly as having it. In my case, because I had only started coughing within a 24 hour period before my blood test was done, I got a false negative. I has not researched Pertussis when I had my blood test done, or I would have requested the nasopharyngeal swab.)

I found the following website is also a good reference on what tests should be ordered and why: http://labtestsonline.org/understanding/analytes/pertussis/tab/test

The other very important topic I wanted to discuss, is antibiotic resistant Pertussis.

Ok, Pertussis in and of itself isn’t a significant health issue compared to other communicable diseases, but the number of reports of people who have pertussis has been increasing every year. Again, this is for several factors mentioned in my previous posts. That said, there are also numerous reports of antibiotic resistant pertussis strains.

The general treatment for pertussis is the erythromycin family of drugs. However, since the 1940’s there have been cases of antibiotic resistant forms of pertussis. There have been additional cases reported from Arizona, California, Utah and Wyoming in the past 4 years. This year, there was a report in France.

In these cases, those treated with the erythromycin family of drugs did not recover as expected from pertussis. It seems that in these cases, the person continued to get worse even after receiving treatment. Now, as I reported previously, antibiotics do not stop the symptoms (generally) unless the treatment is started in the first few weeks of infection (before the cough begins or shortly after it begins). The symptoms from Pertussis are caused by the toxins that are  caused from the infection as well as the immune response our body has to the toxins. The reason a person is prescribed antibiotics is to kill the bacteria so that it does not continue to spread. So, I do not fully understand why having an antibiotic resistant form is significant. Unless, it is more contagious than its non mutated form. It also seems that with the antibiotic resistant form, the infection lasts longer and is more symptomatic.

The following provides the cases that were researched in France, as well as in the United States:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358168/

http://jmm.sgmjournals.org/content/57/12/1577.full

http://jac.oxfordjournals.org/content/early/2007/09/06/jac.dkm343.full.pdf

After further review of the above articles and others, I found that the importance of antibiotic resistant pertussis is that a person generally experiences an improvement with initial antibiotic treatment, but after a week or more, there is a sudden worsening of symptoms. This seems to be the alarm that indicates a person has an antibiotic resistant form of Pertussis.

I also find that it is important for medical evaluation and treatment if your symptoms do become worse. This is because Pertussis can cause pneumonia and other secondary infections to occur. So, if you are feeling better, but then start to run a fever or have trouble breathing, etc it is important to be re-evaluated.

I do not know with certainty if antibiotic resistant pertussis is contagious beyond the five days of antibiotic treatment. I would assume that it is. However, you would want to contact a specialist (I would suggest speaking with an infectious disease specialist).

I will try to update posts as I can with the most up to date information.

Pertussis the Basics:

So, I think this is some of the basic information that you should know regarding Pertussis.

1.) ~80% of reported cases for pertussis have happened in those who have been FULLY vaccinated. ~11% happened in those who were partially vaccinated. ~ 8% were in those not vaccinated at all. (That was from a study done in 2011 regarding all of the cases reported to the CDC.)
2.) 2012 is on course to have the most recorded (verified cases) since 1959. There is an expectation that more than 40,000 cases will be verified nation wide. So, far approximately 29,000 cases were reported to the CDC as of September 20, 2012. Please see the previous posts as to the possible reasons why.3.) This figure does not include the number of cases that go misdiagnosed or un-diagnosed. It is estimated that there are 2- 3 cases unreported for every case that is.

4.) Children under the age of 1 have the highest risk of death and serious complications. They usually have to be hospitalized. Their symptoms tend to be apnea. They may not have any indications that they are sick at all, except they tend to gasp for breath. They usually do not have the gasping or whooping cough that is present in children and adults.

5.) There are 3 phases to the illness:


Stage 1: Symptoms mimic the common cold and is contagious via sneezing. (In our case, we had nasal congestion, headache, fatigue, and all over body aches.) It generally lasts 7 to 10 days but can last from 4 to 21 days.

Stage 2: Severe coughing that can lead to vomiting (may or may not develop a “whooping” sound with the coughing). Generally, the coughing will go in “spells” and then resolve. These coughing fits will be worse at night. This stage lasts from 1-6 weeks but can last up to 10 weeks.

Stage 3: Recovery: coughing is less severe and finally resolves

6.) A person can develop the severe coughing spells with subsequent upper respiratory infections (ie, colds) after they are over the Pertussis bacterial infection.

7.) Teenagers and Adults are at a high risk for developing pertussis, but it is generally not life threatening, unless they have a compromised immune system or are over the age of 65.
8.) The coughing is not caused by the bacteria directly but by the body’s response to toxins that the bacteria and your immune system produce. These toxins cause inflammation of the respiratory tract and paralysis of the cilia in the respiratory tract. The infection has recently been discovered in deeper tissues of the lungs as well.9.) YOU MAY NOT HAVE A FEVER or might only have a low grade fever with the infection.

10.) An antibiotic kills the bacteria and makes it non-contagious, but it does not get rid of the coughing or other symptoms once the severe coughing begins (because that’s the body’s reaction to the toxins the bacteria produced).

11.) The general incubation period (period from when you were exposed till the time you develop your first symptom) is 7-10 days (BUT IT CAN TAKE UP TO 6 WEEKS!!!!). This means that if you have lunch with a friend who is sick with pertussis during the contagious period, you may not develop the first symptoms until 6 weeks later.

12.) If you have been exposed, at the first onset of sneezing, runny nose, headache, sore throat or mild cough, you need to be treated with an antibiotic, ESPECIALLY IF YOU HAVE CONTACT WITH INFANTS or Toddlers. Early treatment with antibiotics can prevent further symptoms from developing. (If you are treated in the first two weeks (before the coughing attacks begin, then you may not get as sick.)

13.) If you are not treated with antibiotics, you are contagious for approximately three weeks!!! After three weeks of illness, the bacteria is generally gone and your symptoms are being caused by the toxins.

14.) Once you begin taking antibiotics, you are contagious for FIVE days after you take it.

15.) Nasopharyngeal testing is most accurate within two weeks after the coughing fits develop. After that it is less accurate, and there is a higher chance of false NEGATIVES. Blood tests can be used from the 2 to 8 week point(after onset of severe coughing) but is not as accurate as the nasopharyngeal swab test. To indicate recent infections via blood testing, it is important to have your IGA antibodies tested. If those are above normal, it is because you have recently had the illness.

 16.) Unlike other bacterial infections, this infection produces generous amounts of CLEAR, stringy mucous. (This is another reason that it is commonly misdiagnosed as allergies, cold, etc).
So, what does all this mean?
It means, you have to be proactive. It’s important that if you’ve had it (especially in confirmed cases) that you let people you’ve been in close contact with (up to six weeks prior!) know that you were diagnosed. I also believe it is fundamentally important to get a confirmation of the illness. Because if your doctor just proactively treats you with an antibiotic, you may not have it, and you don’t want to panic people if you don’t. Also, you may have an antibiotic resistant form or a form different from pertussis that is causing the same symptoms, in which it is important to confirm and report any mutations so that these issues can be addressed through the CDC.
The testing for pertussis is not instantaneous, so I would highly recommend that if it is suspected that you have it, quarantine yourself and those you live with until you have a definitive answer.
Finally, there is no treatment for the symptoms, though early antibiotic might lessen the severity in your symptoms (because you kill the bacteria before it causes a maximal amount of toxins). So why take an antibiotic at all?  Because it kills the bacteria and prevents it from being spread. (and again early use of antibiotics will lessen the amount of toxins that build in your system.)
I’ve talked with many health professionals over the past week, as well as representatives from the CDC. There isn’t any medication that can be prescribed that will remove the toxins. You body just has to clear them naturally and this is why it can take up to 6 weeks for you to recover from the cough.
However, it is suggested that there are OTC remedies that might help relieve the coughing spells. I will provide both basic OTC remedies, as well as non traditional remedies that might help. None of these suggestions are proven, but when you are miserable or your children are miserable, you will find you are willing to do anything that might help.
Basic OTC remedies:
Delsym cough syrup (or other OTC cough syrup- didn’t work well for us)
Vicks vapor rub (applied generously at night)
Cold air vaporizer with Eucalyptus
Baking soda and salt baths
anti-inflammatory drugs: ibuprofen
Sleeping upright or as much as possible
Non-traditional:
Antibacterial or antimicrobial:
Silver Colloidal
garlic
Vitamin C
Vitamin A
Vitamin E
Echinacea
Golden Seal
Olive Leaf
Wellness Formula
Honey
To help eliminating the mucous:
Total Cleanse: respiratory
muellin
Oregano
Cell Food
Charcoal
Sonnie’s 7
There is no scientific proof that any of those remedies both natural and basic OTC medications work at all in relieving the symptoms, killing the bacteria, or preventing the spread of whooping cough or any other illness or infection. However, you will find that when you’re child is coughing so hard that they are vomiting that you will try anything.
If you do try the natural based products, in order for any relief at all, they need to be used on a consistent basis. Natural products do not have the potency that prescription medicines have, so they do not provide immediate relief.
Please feel free to ask questions or leave advice for what has worked for you.
Most of the information provided in this post has come from the CDC: http://www.cdc.gov/pertussis/index.html

Pertussis- Is there an increase and why?:

We are in the midst of an outbreak of Pertussis, and there is a lot of information pointing blame at those who have not been immunized or fully immunized. At first, that was what was widely believed to be the cause.

However, recently, it has become accepted that the pertussis vaccine is not as effective as an earlier version. There are a few theories as to why, but the medically accepted reason right now is the new formula that was introduced in the late 1990’s is not as effective as the original vaccine. The original vaccine contained whole cells of the bacteria. The new vaccine contains acellular components of the bacteria.

They changed the formula because there were serious side effects ranging from fever and malaise to meningitis. Frankly, there have been significantly more claims of reactions to the original (whole cell) vaccine, but those are the widely accepted reasons behind changing it.

Unfortunately, about 20% of the children that receive the whole cell vaccine experience mild side effects. About 0.1% of infants experience convulsions soon after receiving the vaccine and in a very small number of cases (1 in 150,000?) severe or irreversible brain damage may occur. In the absence of the disease in an immune population, parents have begun to wonder if the risk of vaccinating children outweighs the risk of the disease, and the value of the whole cell vaccine has been questioned. (http://textbookofbacteriology.net/themicrobialworld/pertussis.html)

From ABCnews.com: http://abcnews.go.com/Health/Wellness/whooping-cough-vaccine-effective-early-form-study-finds/story?id=16898211#.UHsvmMXA-8A

The original vaccine, which contained a small amount of inactivated whole bacteria, was a crude form that brought with it side effects like fever and swelling at the injection site, but it was considered lifelong lasting at preventing the disease. In the late 1990s, it was substituted for a so-called cleaner vaccine that only used small particles of the bacteria and was considered safer but might not be as effective long term.

According to an article published in JAMA– (http://jama.jamanetwork.com/article.aspx?articleid=1362036), the vaccination for pertussis is not effective:

To assess clinical, epidemiologic, and laboratory factors associated with this increase, all pertussis cases reported during January 1–June 16, 2012, were reviewed. Consistent with national trends, high rates of pertussis were observed among infants aged <1 year and children aged 10 years. However, the incidence in adolescents aged 13–14 years also was increased, despite high rates of vaccination with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine, suggesting early waning of immunity.

The following article is in accordance to the belief of the vaccine not being as effective, according to an article in the Oxford Journals, Clinical Infectious Disease: (http://cid.oxfordjournals.org/content/early/2012/03/13/cid.cis287.short).

We identified 171 cases of clinical pertussis; 132 in pediatric patients. There was a notable increase in cases in patients aged 8-12. The rate of testing peaked in infants, but remained relatively constant until age 12. The rate of positive tests was low for ages zero to six, and increased in preadolescents, peaking at age 12. Vaccination rates of PCR positive preadolescents were approximately equal to that of controls. Vaccine Effectiveness was 41%, 24%, 79%, for ages 2-7, 8-12, 13-18, respectively.

Conclusions: Our data suggests that the current schedule of acellular pertussis vaccine doses is insufficient to prevent outbreaks of pertussis. We noted a markedly increased rate of disease from age 8 through 12, proportionate to the interval since the last scheduled vaccine. Stable rates of testing ruled out selection bias. The possibility of earlier or more numerous booster doses of acellular pertussis vaccine either as part of routine immunization or for outbreak control should be entertained.

So the question starts with, does the vaccine really work? And it is not certain if it does. If we use the data from above Oxford Journal article, the effectiveness of the vaccine in ages 2-7 was 41%, ages 8-12 only 24%, and ages 13-18 it was 79%.

Frankly, I don’t think any of those statistics are promising considering the severity of the infection.

According to the National Vaccine Information Center, there is also evidence that the vaccine has caused pertussis to mutate so that the vaccine does not work effectively:

There is also some evidence that B. pertussis bacteria may have evolved to become vaccine resistant. (http://www.nvic.org/vaccines-and-diseases/Whooping-Cough.aspx)

The idea that there was a mutation in reaction to the vaccine was published in a research article by Dr. Fritz Mooi. Dr. Mooi has studied Bordetella Pertussis for over 15 years and is world renowned as an expert on Pertussis: (http://www.ncbi.nlm.nih.gov/pubmed/19879977):

The etiologic agent of pertussis, Bordetella pertussis, is extremely monomorphic and its ability to persist in the face of intensive vaccination is intriguing. Numerous studies have shown that B. pertussis populations changed after the introduction of vaccination suggesting adaptation. These adaptations did not involve the acquisition of novel genes but small genetic changes, mainly SNPs, and occurred in successive steps in a period of 40 years. The earliest adaptations resulted in antigenic divergence with vaccine strains. More recently, strains emerged with increased pertussis toxin (Ptx) production. Here I argue that the resurgence of pertussis is the compound effect of pathogen adaptation and waning immunity.

The other consideration is that there are different types of pertussis, and the vaccine is only targeting one type of Bordetella bacteria, Bordetella pertussis.  According to an article published in JAMA: (http://jama.jamanetwork.com/article.aspx?articleid=1150090)

An unusual 2010 outbreak of whooping cough in Ohio that disproportionately affected adolescents led disease hunters from the US Centers for Disease Control and Prevention (CDC) to the surprising discovery that about a third of the cases were caused by infection with Bordetella holmesii and not Bordetella pertussis, the usual isolate among individuals with the characteristic symptoms of whooping cough.

There are other forms of Bordetella that cause whooping cough beside Bordetella holmesii. According to the National Vaccine Information Center (http://www.nvic.org/vaccines-and-diseases/Whooping-Cough.aspx):

There is another Bordetella pertussis whooping cough disease called B. parapertussis. Symptoms of B. parapertussis whooping cough can look identical to B, pertussis whooping cough but they are usually milder. B, parapertussis is increasing in the U.S. and other countries, which have had high pertussis vaccination rates for few decades. There are estimates that perhaps up to 30 percent of whooping cough disease in highly vaccinated populations may be  caused by B. parapertussis organisms.

It is possible to have both B. pertussis and B. parapertussis infections at the same time. Parapertussis is often milder than B. pertussis but can also involve serious complications which lead to pneumonia and death.

Pertussis vaccines widely used around the world do not protect against parapertussis. There is no vaccine for parapertussis.

Finally, is there an actual increase at all?

Right now, there is a LOT of publicity decreeing an outbreak, and you have people taking sides of who is to blame. You have people saying that it is being caused by the vaccine itself. You have people stating it’s from vaccinations not working or that it’s because some people aren’t getting vaccinations. Some people believe that the vaccines have caused mutations in the bacteria, and others believe that the vaccinations aren’t working because of the mutations in the bacteria. The most intriguing idea that I found is a belief that there hasn’t been any increase at ALL.

This final group that I’m researching believes that the number of people getting pertussis hasn’t increased, but the methods and standards for “classifying” a person as having pertussis has changed.

Previously, in order to be diagnosed with pertussis, a person had to have a persistent cough for more than 3 weeks AND a positive test for pertussis in order to have a “confirmed” case of pertussis. The CDC changed their definition and now states that a person only has to have the cough for 2 weeks AND a positive test for pertussis.

There have also been more defined symptoms for having pertussis. This makes it more likely for a physician who might not have considered it as being pertussis to now consider and test for it.

Regardless of these changes, it is also firmly accepted that for every reported and confirmed case of pertussis there are two or three cases that still go unreported.

I found this to be true in the case of my family.

When the test was positive, I thought, boy they’re going to want to notify EVERYONE (my son was sick first, and he went to school the entire time), but when the community health department called, I was told that even though my daughter had the positive test, they would not consider her as to having it because she has only had the cough for 10 days. Further, they were not going to “confirm” my son as having it even though he’s had his cough for 4 weeks because he did not have the positive test.

I was shocked! There weren’t going to be any notifications at all. I found this to be incredulous. The community health representative told me that if I took my son back to get tested, and he had a positive test than they would submit the confirmation, and if I called them back to report that my daughter still had her cough after 14 days, they would confirm her case too.

Why should this matter?

My children exposed a significant number of people while they were unknowingly contagious, so I approached their doctor to get the lab work done, but found out that she did not feel that it was necessary. AND it is not necessary for them. They don’t need the confirmation. They are being treated, but it is going unreported and therefore no one else will get the notice. The people that they exposed will not know to watch out for the illness.

I tried to address those concerns with their doctor, and she said it didn’t matter because as long as the people that they’ve had contact with have had their vaccinations, they won’t get it. I tried to express that I had found information to the contrary and even representatives from the CDC were stating that the vaccination is not as effective as it had been previously.  She felt I was wrong.

Frankly, it doesn’t matter to me what she thinks of me, it’s the fact that she is treating other people and if she doesn’t understand the importance of having the illness reported, then I’m at a loss. She  felt that we should just contact everyone that we’ve been in contact with over the past few weeks, but it simply isn’t as simple as that. My son plays for both JV and Varsity football. He is in contact with 100’s of people each week. We went to a MAJOR amusement park for two weekends while they were sick. There is no way to contact everyone that they’ve exposed, especially without the help of the community health department.

Again, she also believes that other people won’t need to worry about it because they’ve been vaccinated (I shared this belief prior to a week ago), but now I know that might not be 100% true.

She wasn’t the only local doctor who feels this way. I took my children back to the local children’s hospital yesterday, and the nurse that was taking care of them didn’t understand the need for testing and agreed with my doctor. As long as they were being treated, what’s it matter?

Our babysitter has been exposed over the past few weeks, and she started getting sick this week. Her father wasn’t going to do anything about it. Since she is 18 (and fully vaccinated), we took her to her doctor, and he treated her but did not run the testing to see if she had it. The doctor felt that she probably did have it, but he felt that testing or reporting of it was unnecessary.

Granted, the information in this post is new. It just gained major media attention in September that there are more reported cases since the 1950’s AND that those who have been vaccinated are getting ill too, but it is mind BLOWING to think that the local medical community does not understand why testing and reporting it is necessary.

That is the reason, I am writing about it now. I feel it fundamentally important that if you believe you have pertussis, than you need to get treated ASAP. You need to quarantine yourself until you’ve been on antibiotics for at least 5 days. You need to push for getting the testing done and have it reported to your local health department, and PLEASE do not think that just because you’ve been vaccinated (even fully vaccinated) that you don’t have it. Especially get tested if you find out that someone you know has been diagnosed with it and then you start to develop symptoms.

Dying to play Football:

This post is a bit of a stretch from my norm, but I really think it deserves a look.

I encouraged my son to start playing football in 2nd grade. I thought it would be a great way to build character, endurance, and I really thought it would help me as a single mom teach Zachary more about respect and discipline. Ok, and let’s face it, everyone wants their child to become an athletic super star.

I’ve always encouraged Zachary to dream big, and now that he’s finishing his freshman year of high school, he is dreaming big. He does want to play college level football for Ohio State University. It’s been his dream since he was in the fourth grade, and following that he dreams of playing for the NFL. I have never discouraged him. I believe he can do anything he wants to do, but after I sustained my brain injury, I’m looking at his “career” in football in a whole new light.

Tonight, I read another account of a retired NFL player committing suicide. My heart goes out to his friends and family, and I really believe that his physical trials after playing football need to be addressed.

Here’s the reality folks, a brain injury is a brain injury, and though there are MANY ways to have trauma to the brain, it really is all the same.

Let me clarify, I’m not saying that EVERYONE who has a brain injury has the same symptoms, but an injury to the brain is an intense injury, and it is an invisible injury to the rest of the world.

If you saw someone in a wheelchair, you have an immediate awareness that this person has a disability, but there are no external indicators that tell you a person has a brain injury. You really have no way of telling.

Trust me, before my injury, I would speak to people through my job, and I would immediately assume that they were really, really stupid. Some people, I talked with, I knew they had an injury because their speech was impacted, but for those where it wasn’t apparent as soon as they started speaking, I seriously judged their intellect.

I know better now.

Whether you were in a car accident, you fell down and hit your head, you were in sports like boxing or the NFL, or you just got into one too many fights, it’s important to realize that you may have life long issues related to these occurrences. AND please be aware, even just one event can cause these life long issues.

Okay before you start walking around with a helmet strapped to your head, in most cases, one bump to the head won’t cause permanent damage, but it is anticipated that more than 1.2 million people or more experience mild traumatic brain injury.

To differentiate, a person with a Traumatic Brain Injury usually needs to be hospitalized for their injury, and in regards to a Mild Traumatic Brain Injury, a person sustains ongoing issues after receiving a hit to the head, but did not require hospitalization. However, it is believed that there could be a significantly higher number of people with MTBI. The following quotes come from the CDC. In 2003, they were approaching congress to obtain more funding to study MTBI:

First, no standard definitions exist for MTBI and MTBI-related impair­
ments and disabilities. The existing Centers for Disease Control and Prevention (CDC)
definition for TBI surveillance is designed to identify cases of TBI that result in hospital­
ization, which tend to be more severe. MTBI is most often treated in emergency depart­
ments or in non-hospital medical settings, or it is not treated at all. Few states conduct
emergency department-based surveillance, and current efforts do not capture data about
persons with MTBI who receive no medical treatment. Additionally, neither hospital- nor
emergency department-based data can provide estimates of the long-term consequences
of MTBI.

In 2003, the Center for Disease Control defined Mild Traumatic Brain Injury as this:

The Definitions Subgroup developed a conceptual definition of
MTBI based on clinical signs, symptoms, and neuroimaging; and an operational defini­
tion to be used in identifying cases of MTBI in administrative databases, medical
records, and survey and interview results. The Methods Subgroup evaluated surveillance
databases and identified those that would best capture the types of data needed to determine the full magnitude of MTBI and related impairments and disabilities.

The conceptual definition of MTBI is an injury to the head as a result of blunt trauma or
acceleration or deceleration forces that result in one or more of the following conditions:
● Any period of observed or self-reported:
◆ Transient confusion, disorientation, or impaired consciousness;

◆ Dysfunction of memory around the time of injury;

Loss of consciousness lasting less than 30 minutes.

● Observed signs of neurological or neuropsychological dysfunction, such as:
◆ Seizures acutely following injury to the head;
◆ Among infants and very young children: irritability, lethargy,
or vomiting following head injury;
◆ Symptoms among older children and adults such as headache,
dizziness, irritability, fatigue or poor concentration, when
identified soon after injury, can be used to support the diagnosis
of mild TBI, but cannot be used to make the diagnosis in the
absence of loss of consciousness or altered consciousness.
Research may provide additional guidance in this area.
Based on this conceptual definition, separate operational definitions of MTBI are
recommended for cases identified from interviews and surveys, administrative health
care data sets, and patient medical records.

The conceptual definition of a prevalent case of MTBI is any degree of neurological or
neuropsychological impairment, functional limitation, disability, or persistent symptom
attributable to an MTBI.
The operational definition of a prevalent case of MTBI-related impairment, functional
limitation, disability, or persistent symptoms is any case in which current symptoms are 3
reported consequent to MTBI or made worse in severity or frequency by the MTBI,
or in which current limitations in functional status are reported consequent to MTBI.
Symptoms and limitations are described on pages 19-21. (http://www.cdc.gov/ncipc/pub-res/mtbi/mtbireport.pdf)

Ok folks, so what does all of that MEAN?

The CDC realized that in regards to mild trauma to the head, those hits that don’t require hospitalization, are being ignored in the medical community as causing a problem. They understand that these is a serious lack of understanding regarding the brain trauma that occurs after something as simple as whiplash in a car accident or a hit in the head during a boxing match. In order to try to obtain information for those that are being injured, but aren’t being hospitalized, the CDC created the above definitions for hospitals and doctors to use to try to document these cases. So, the above information is a guideline set up by CDC, so that they could start researching this issue further.

They set up the definitions in two parts. The first part is more of the physical symptoms that present and establish that a person might have experienced a MTBI, and the second part is the cognitive effects a person might experience after having a MTBI.

They are stating that doctors should pay attention to both definitions, the conceptual and operational.

This means, YOU should pay attention to both as well because if you fall down and are disoriented, you might experience ongoing issues. However, that does not mean that you WILL experience ongoing issues.

It is anticipated that approximately 30% of those who experience a hit to the head will experience temporary issues, but only 5 to 7 percent of that 30% will have permanent ongoing neurological or cognitive issues.

It is also believed that MTBI’s tend to build, and this brings us back to our NFL football players. If you had just one hit to the head or maybe two or three, the chances of your having a permanent brain injury are pretty remote, but if you started playing football in 2nd grade, and continued to sustain hits through high school, college, and then into the NFL, well by the time you’re in your early 40’s, your brain is going to start turning to jelly. Ok, not literally jelly, but figuratively.

So that brings us back to, you can’t see the injury, and most people don’t understand what’s happening to them. You fell off your bike, and you weren’t wearing a helmet, and you haven’t been quite the same since. You might go to your doctor. They might order a few tests, but brain injuries do not always show on a MRI or CT scan, or by the time a doctor orders it, the inflammation that the images detect has subsided, and you probably start to feel just a little bit crazy.

You don’t feel the same. You can’t think as clearly as you did before, but your doctor does not see anything in your scans. YOU FEEL LIKE YOU’RE GOING NUTS. Then, you get depressed. No one believes you. Your doctors are telling you there’s nothing wrong. Your spouse doesn’t understand what’s happening to you. You get depressed, and you don’t feel like life is worth living.

Folks, it’s time to understand that you aren’t alone, and no matter how you received your injury, you have an injury. It’s an unseen injury, but you aren’t crazy, and you deserve and need to get help, cognitively, psychologically and physically.

Ray Easterling, former Atlanta Falcons defensive back, died from suicide this weekend. He suffered from memory issues, headaches, dementia, and other health issues.

The NFL is being sued because it is believed that the league was aware that continuous concussions were causing these injuries, but they did not make players aware of the risks, and in some cases denied players ongoing health coverage to help with their medical problems (http://msn.foxsports.com/nfl/story/Ray-Easterling-death-ruled-suicide-Atlanta-Falcons-041912).

http://www.youtube.com/watch?v=pJCEbHJ1oBY&feature=fvst

In 2007, there was a fund created by the NFL to cover medical costs of retired NFL players, however this fund does not cover older NFL team players, and they do not choose to cover everyone’s costs. There is a panel that decides whether or not a former NFL players medical costs will or will not be covered. (http://www.nytimes.com/2011/02/21/sports/football/21duerson.html)

For information on the 88plan:     https://www.nflplayercare.com/Default.aspx

Another great website regarding medical assistance for former NFL players:  http://www.gridirongreats.org/

It is important to understand that the name used for the brain injuries that these football players had is Chronic traumatic encephalopathy (CTE), but this is the name of a disease related to chronic brain injury, either TBI or MTBI.

Other NFL players that have committed suicide after brain injury (CTE):

Andre Waters (2006)

Dave Duerson (2011)

Rick Rypien (age 27)

Michael Current

Shane Dronett

Corwin Brown (suffering from brain injury, attempted suicide, but luckily survived)

Owen Thomas (COLLEGE FOOTBALL player with Penn State had the same injury as the NFL players above).

Please note that the above football players lost their lives, but thousands of others are living with TBI and MTBI, and are at risk.

It is also important to note that it is not just football players, but cheerleaders, boxers, martial artists, kick boxers, soccer players, etc that can also receive these injuries. It’s also important to understand that something as simple as being in a car accident that causes whiplash can cause this injury.

It’s really important to spread the word regarding how this unseen injury is impacting people in their every day, and to understand that if you experience things that just aren’t right for you (unexplained headaches, nausea, memory loss, fatigue, visual or hearing disturbances, attention problems, etc…SEEK HELP. You might be wondering what your next step is after you have been told by a doctor that nothing is wrong; call your local hospital and ask about neurocognitive testing with a psychologist or a neuropsychologist. In most cases, your insurance will cover this type of testing, but you might need a doctors referrel.

In the end, DON’T GIVE UP. YOU ARE NOT ALONE!!

PLEASE, if you are experiencing issues that you don’t understand and need help: LEAVE A MESSAGE here or you can also contact the http://www.biausa.org (that’s the brain injury association).

I really recommend online support groups. It’s AMAZING to talk to people who are LIVING with the same types of issues that you are.

If you are experiencing suicidal thoughts, call 1-800-suicide (1-800-784-2433) or you can go online to crisischat.org. OR go to your nearest emergency room.

In the end, you are not alone, and even though your life has changed and it’s not easy, you can get help and you can learn ways to live and adjust to your injury.

GOD BLESS!

Here are a following broadcasts regarding concussions and mild head injury in sports:

Football:

http://www.youtube.com/watch?v=VfO6Yyr4dmw

http://topics.nytimes.com/top/reference/timestopics/subjects/f/football/head_injuries/index.html

Soccer:

http://www.youtube.com/watch?NR=1&feature=endscreen&v=klESLYtbRe8

Sports in General:

http://www.youtube.com/watch?v=T3FLRDxbLXg&feature=related

Head trauma related to the pituitary gland and how head trauma impacts your hormone function:

http://www.youtube.com/watch?v=Q8DXiCr3-jE&feature=related

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