The Concussion Update
Speaker 1: 01:03 Uh, and we have a very special guest to talk to us about concussions and concussion awareness and concussion treatments and a little bit of concussion prevention. So Dr. Heath Thorton is joining us today. Doctor how you doing? I'm doing well. Thanks for having me. Hey, no problem. Thank you for joining us. We're very excited. Um, so Dr. Thorton, as part of our orthopedic sports medicine family medicine, um, faculty here at wake forest Baptist health. And um, before we dive into too many details about concussions, I just wanted him to give, uh, give them a chance to tell us a little bit about himself and, and what led you down the path to get into medicine and then the further down the path into family and sports medicine. Yeah. So I grew up in Raleigh, North Carolina, so I'm a North Carolinian not too far from here. No, not too far at all.
Speaker 1: 01:52 And I love being back in my home state. Um, only took a short stint out in Virginia. OK. for medical school. Uh, but I got interested in medicine in the, in middle school, um, as we studied the muscle skeletal system, the bones and joints. And I decided that I wanted to be a doctor of that. I had no idea what it was, but I just thought it was really cool. Yeah. Um, and then as I got into medicine, I began learning about the different, uh, pathways, uh, to learn about, um, medicine and found that my personality fit very well, uh, with family medicine, especially when I learned from a mentor about the pathway of sports medicine in primary care or family medicine in my case. Um, and so that's where I, I followed that pathway, uh, which led me back here to North Carolina to wake forest, um, Baptist health and, um, did my training in sports medicine fellowship and have stayed and loved it ever since.
Speaker 1: 02:45 That's awesome. So, um, if you wouldn't mind, I guess just take us real briefly through a typical week, what that might look like for you. Um, I know you're involved in many things here at wake forest Baptist health and some of the partnerships that we have. Um, so I guess just talk a little bit about which, what you would do, uh, during, during the typical week and, um, what schools or organizations you might visit. Sure, sure. Um, so yeah, I carry a few different hats. I'm a Jack of all trades, so to speak. Uh, I, I spent some time with our residency program, our family medicine residency program and our sports medicine fellowship. Um, and I'm the fellowship director for the sports medicine fellowship. Uh, so I do a lot of teaching, uh, of, of folks that, um, uh, residents and fellows that are developing their skills in their trade.
Speaker 1: 03:34 Um, I spend time taking care of patients, uh, both family medicine. So the diabetes, well child checks, hypertension, um, uh, asthma. Uh, and then I also have, uh, some clinics in which I'm taking care of sports related injuries. So that can vary. And we'd like to say that we think all of our patients are athletes. Um, and so we take care of, uh, five-year-olds who aren't walking properly, um, and their, their sport is running around, jumping off of beds. Uh, we take care of our athletes that are coming from the high schools and from community leagues. Uh, I take care of, um, middle-age individuals who are, uh, just working out in the gym or they're, um, uh, marathon runners. Um, a cyclists and then, uh, take care of our, our older patients who are trying to stay active. Um, and so we see it all in our sports medicine clinics.
Speaker 1: 04:27 Sure. Yeah. Then at the same time, also I'm the medical director for a community wellness program over at wake forest, um, a university health and exercise science department. Um, it's called the helps program, healthy exercise and lifestyle programs. Um, and so I spend a morning over there, um, supervising, uh, the, the wellness program that they have there. It's a really incredible program. It's been going on for over 40 years. Um, and then, uh, I will go on Friday nights, um, most every Friday night to a football game. Um, I haven't gotten a couple of schools that, that I work with residents and covering and also the medical director of or the Winston Salem, uh, Forsyth County school system athletic training program that we provide athletic trainers for. That is so cool. So, yeah, that's, I love that you were able to give us an overview. I think that just helps, um, um, give our listeners kind of a view of, of how plugged in wake forest Baptist health is into the community and the different avenues by which we're providing, um, health care.
Speaker 1: 05:27 So, uh, that's, that's great information. Um, so, um, with all those things going on, you occasionally have to talk to people about concussions and, and examine patients for concussions and, and go through that. And I, um, I know we have listeners listening that maybe have kind of varied, um, understanding or are, um, cause some background knowledge of what concussion is and what it can do to your body. Um, so I just want to start off at a very basic level and if want to just give us the, the medical definition of a concussion and how one might, um, get a concussion. Sure. So there's a couple of different key a concussion definitions, but I think the one that most of us talk about is that it's a traumatic event that triggers a, a metabolic, um, a cascade of events in the brain and the cells in the brain, um, that lead to the brain not functioning normally.
Speaker 1: 06:25 Um, so a simple way of, of kind of putting it in terms that I, I tell my, my kids, I tell my patients, um, is that, uh, it basically has some sort of trauma to the body. It doesn't have to be directly to the head, uh, that leads to the brain not working properly. Um, that the, um, whether it's a, uh, physical effect or a, um, uh, emotional effect or a, um, cognitive or thinking process, um, these get disrupted. And so the individual is unable to, um, function the way they normally function. [inaudible] all right. So, um, you know, thinking about this, I think you, just by virtue of, of TV and, and what we see in, in mass media, um, maybe the first thing that comes to mind when we, when someone hears the word concussion or someone got a concussion is they think of on the football field.
Speaker 1: 07:18 Um, especially, you know, on the national professional level, there's been a lot of attention, um, brought up and pay to that over the last few years with, with NFL and, and what they're doing with concussion protocols. Um, but someone can experience a concussion, um, in a lot of different ways, not just on a football field. Isn't that correct? That's absolutely correct. Yeah. I mean, every sport can, um, can run into, uh, situations when someone might receive that sort of trauma to the body that leads to concussion. And then you have kids that are playing on playgrounds and there are people that are riding their bikes on the road. Yep. Um, car accidents, of course, that can happen also where they get head trauma. Sure. So, um, if someone, um, if an occurrence happens, uh, either on, on a playing field or out in the community with someone just experiences a trauma and they come in and see their doctor or, um, one of our sports medicine clinics, what do you all initially do?
Speaker 1: 08:18 What's kind of the initial evaluation of, of looking at does this person have a concussion? Don't they? They just have a headache? Walk us through that a little bit. Sure. Um, I think there's some important components of that evaluation. The first one is usually we try to get all the symptoms. There's certain types of symptoms we typically look for. Um, so we tend to dive into that and finding out from, uh, the individual, uh, the athlete or the individual that has received a concussion. And then also it's very helpful to get information from parent associate level when someone that, that knows the person. Well. Um, one of the great that we have at our schools is athletic trainers who get to know the athletes well and they know when some kid is just not acting quite right. Sure. And so in the clinic we try to do the same thing, uh, with the people that are around the individual that has a concussion.
Speaker 1: 09:09 So after we gather the information as far as specific symptoms, um, problems that they're having, uh, then we want to kind of dive into a little bit more of the, what we call objective or the tests. Um, and there are certain different types of tests that we do. We, we test the memory test, reaction time. Uh, we'll test, um, uh, whether they can concentrate their balance and then we'll also do some testing of more advanced neurologic, um, functions. So we'll look at eyes and balance and tracking and things such as that, that, and we use all of it together. There's no one test that allows us to say, yes, this person has the concussion. We try to use as many as we can, different tools to gather the information that we need so that we can make that final decision. Whether if someone has a concussion and then try to figure out, okay, how, how long do we think it may take?
Speaker 1: 10:01 Or what sort of interventions do we need to do based on those findings? That's really interesting. So, um, after those tests and gathering the information from their parents or other ones, other people in their life that maybe have a, a, a semblance of, of what their normal day to day, uh, twos and froze are like, and you evaluate all the data based on that examination. Um, so let's say someone has a concussion. So now what, so, and you know, it could be, like you said earlier, it could be I'm a 15 year old on a, on a playing field. It could be someone, um, who fell off their bike at the park and um, or someone, uh, in, in a car accident. I hear that brought up a fair amount. So what plane do you all do when someone has a concussion to get them back to return to work or return to play, um, or return to their normal life, quote unquote, um, what does that look like?
Speaker 1: 10:56 And, you know, for people listening and I just wanna you know, for maybe some of the information they see on TV or online, it can be really scary. You know, this something happened to my brain, you know, so I want to help, um, give them a good context of information of, of what y'all do to help get people back to I'm recovering from a concussion. And I think that's one of the most important questions that patients have because they recognize that they're not acting properly. The brain isn't giving them the help, they need a functioning in the correct way. And so they really looking for that relief so they can get back to normal life. Yeah. Um, our approach tends to be a period of rest. Yeah. Uh, you know, the brain does everything. Um, and just as if you broke a bone, we would immobilize the bone, cast it, split it, so that can heal.
Speaker 1: 11:48 We need to do something to allow the brain to heal, but you can't shut it down. Yeah. So we have to some way of reducing the stress. And so there's a period of rest. And that can vary depending on symptom, a amount of symptoms that individual has and other circumstances related to the, the demands of their life. Um, we eliminate physical stress, um, especially in our athletes because that's something that is a variable we can control typically. Um, but the biggest thing is just that initial risks. Uh, most of the literature these days, we talk about 24 to 48 hours of just really shutting everything down. Uh, that early rest allows for some initial, uh, healing, uh, which will then permit us to start easing them back into things. So after that, we'll start to do some, a gradual return to some sort of activity, usually modifying that activity.
Speaker 1: 12:38 So if it's school, we tend to put a lot of accommodations in school, uh, such as not looking at screens, uh, or, um, allowing them to, uh, have extra time on tests, things such as that, that allows, uh, the, the individual not to have to overburden their brain because the brain is not working at full capacity. Yeah, sure. And so we need to have, um, some accommodations to, uh, to mitigate the fact that they just can't do things as quickly or as efficiently or as well as they once did. Yeah, I'm really glad you brought up the, um, the school aspect, um, because, and I think we've spoken earlier in, um, so because of our relationship with the school systems in this area and have an athletic trainers in there, um, you all are able to provide support, um, to the school administrators. Um, you know, because maybe our first thought might be okay, when, when can you hear she get back on the court or the playing field?
Speaker 1: 13:32 Um, but they're in school for learning, uh, first and foremost. So, um, I think it's great that you all are able to coordinate with the schools and provide assistance when, when you need it, when they need it on. Um, some accommodations for on the academic side too, right? Yeah. No, and I, and I think that's an excellent point because if you have a broken bone, everybody sees it, right? Yeah. If you've cut something, everybody sees it with a concussion, no one can really tell. Yeah. And so it creates an area of uncertainty, but also it's the brain. And so people tend to worry as you pointed out earlier. Um, and so having some, some experts in that area, the trainers at the school, um, ourselves, uh, and others that are sports medicine and concussion trained, uh, allows for a resource to give them support. Um, so yes, we do presentations at the schools about concussions.
Speaker 1: 14:23 The trainers are there, they're communicating with the administrators, with the teachers, with the coaches, so that they have that resource to ask questions, to guide the, the return to learning and the return to play for those athletes. So a is is one of the, just, I guess main questions you get from patients, young or old is how long, how long time is it? Two days, two weeks, two months, doc gimme that give me the magic number every single visit. Yeah, always. And I tell them all the same. I can't predict it. Yes. There's just no way of knowing. Every concussion is different. They say that once you've seen a concussion, you've seen one concussion. And it's true. Yeah. Um, and we've also found that on our all our efforts to try to predict how long it takes someone to recover, it fails almost every time we can say that about, uh, 80% of all concussions are going to get better and within four weeks, which is very encouraging.
Speaker 1: 15:19 It is. Um, but it does leave for that 20% that can last longer and that can be six weeks or it can be six months. Um, and so we just have to, um, keep that in mind. Um, and you have to be patient. And I tell my athletes and my patients, um, non athletes that come in for concussions, I explained to them as, as, as much as anxiety provoking, not knowing. Yes. Um, that anxiety just makes things take longer. And so you just have to kind of take it one day at a time. And if you do that, it will get better. And sometimes they just wake up and they're like, Oh, I feel so much better. And other days it's like a slow, steady improvement. So I guess you all are just touching base with them and doing followups to, to monitor the progress.
Speaker 1: 16:02 Yes. I tend to bring them back, um, at initially weekly hoping that they'll get better quickly so we can get rid of some of those accommodations, get them back to full school, get them back to normal activity, getting back to their sport. Um, but sometimes we spread it out depending on how they're doing. Okay. So, um, once a I have a concussion, um, if I continue in that activity, if it's rock climbing or riding my bike or playing basketball or soccer or football is, can, I bet I'm, I'm probably gonna get another concussion at some point. Does it make me much more prone to get another concussion once I've had one? Can you talk to us a little bit about that and, and maybe ways that, um, when people do return to school or work or play, what are some steps that we can do to maybe prevent that from happening again?
Speaker 1: 16:53 Sure. So, so one of the things that, um, we talk a lot about as they start getting back on doing normal things. Has to do with what their risk is in the future. And then also how do we prevent future ones? How do we prevent worsening? Um, so there's two things that are a couple things I want to make sure we point out. One, first and foremost, if someone ever is suspicious that someone around them has a concussion or if they're suspicious, they might have a concussion themselves. One of the worst things we can do is throw ourselves back into the situation where we might get a further head injury or further body injury that leads to worsening symptoms. The ones, the individuals that tend to take the longest to get better are those that have had, um, a, uh, a multiple concussions or multiple stress on the brain after they've received a concussion.
Speaker 1: 17:41 Gotcha. And so identification early is the key to that. Then it's the question of once you have one, are you at risk for the future? Um, we do know that multiple concussions put people at risk for future concussions, but after one concussion, does that mean you're at higher risk? Not necessarily. Okay. Um, and so the most, the important thing to prevent that increased risk is making sure that someone fully recovers as best that we can tell fully recovers from a concussion before they're back in the situation where they might get another injury that can lead to further symptoms or another concussion. Yeah, I think you brought up a great point and maybe we should reiterate it and you know, um, we have a, a bonafide medical professional here. We're talking with Dr. Thorton and you know, he may be the idea or stigma of concussions or not.
Speaker 1: 18:35 Uh, he, he says his head hurts, so he wants to sit out and kind of the, the old school tough, tough guy mentality. That's, that's not, that's not the way to go. And I think, you know, just from seeing information, um, we've made progress in that, but you might still run into that in your clinics and you know, you, you deal with these patients on a regular basis of, of this, this kind of old school mentality of, Oh, just walk it off, shake it off, get back in there, you'll be fine. Um, that's, that's not maybe good longterm for, for the patient, right? It is. You're right. And, and, and there is the athlete, um, is trained to push through pain, right? Sure. That's the way they become successful is pushing themselves beyond what they normally, um, would tolerate. You know, and that includes minor injuries.
Speaker 1: 19:23 Um, but, uh, the question is you can't really see the broken bone. You can see the broken bone, but you can't see the broken brain, so to speak. Uh, and so that's where we really have to be vigilant. A lot of, uh, of the problem that you pointed out is dealing with lack of education. Um, there had been in the past, uh, an acceptance of you have a concussion when you get knocked out. That used to be years and years ago, the way that we diagnose concussion in addition, that, um, kind of grading system or that way of diagnosing, they also used if you had more than three concussions, you were done for the rest of your life. Um, and we don't use that anymore. And that's been one of the, that and many other misconceptions about concussion had been part of the problem. Getting people to, to recognize that it's, it's a big deal when someone has a concussion, we need to address it quickly and appropriately and we can get them back quickly.
Speaker 1: 20:20 Um, but we have to really be careful and right off the bat. Yeah. Um, and so I think, I think it is important to keep that in mind. It's an important to make sure we educate as many people as can about this. Yeah, sure. Well, um, you know, we're going to be wrapping up in an in a minute and we're talking once again with Dr. Heath Thorton. Um, and he's given us a lot of great information about concussions and concussion protocol and recovering from concussions. Um, and speaking I guess a little bit if you want to, um, the future of prevented preventing concussions. Some of that research is being done here at wake forest Baptist health. Um, I don't know if you just want to take a second and talk about in broad terms, um, you know, some of the things that we're doing here, um, being an academic medical center of doing research to, to help mitigate this, this condition.
Speaker 1: 21:10 Sure. It's, it's really exciting to see some of the possibilities. There's things, uh, such as, um, uh, forced monitoring. So putting these monitors in helmets and mouthpieces that can identify when a force maybe reaches a level that will make us concern. There's blood work that, uh, is being looked into that can help us determine whether someone has had a concussion or maybe even when someone has fully recovered from a concussion. Um, and then there's other things that we do such as, you know, is there a way that we can strengthen the neck or is there training? You can do a head of time, uh, for the brain that might help prevent it from, um, being as susceptible to concussion. Uh, and then of course out there, there's also genetic markers they're looking at to try to identify people that may be at higher risk. Um, so there's a lot of interest in those areas.
Speaker 1: 21:59 It's all, I'm still very early, but we're getting a lot of good data and information that might help us find that, that, uh, golden bullet in the future. Yeah, that's, that's really encouraging. So I applaud you and your colleagues efforts and, and keep pushing, keep pushing forward. Um, Dr. Thorton, thanks so much for joining me today. I appreciate it. It's been my pleasure. Yeah. And um, you know, if anyone listening has any questions, um, about concussion or any other sort of, um, uh, orthopedic sports medicine injury, um, you can definitely find out more information about concussions and other types of conditions on our website at wakehealth.edu slash sports medicine. Um, you can also call seven one six week three, three, six, seven one six week. Um, if you think that you or someone you might know might need to be evaluated or needed an appointment and we'll get you taken care of that way as well. So everyone, um, this has been a great, great episode and, uh, thanks for listening.
Speaker 2: 22:58 Until next time, be well, thanks for listening to this episode of the best health podcast brought to you by wake forest Baptist health. For more wellness info, check out wakehealth.edu and follow us on social media. Wake forest Baptist health, the gold standard of healthcare.