California Seeks To Prevent Radiation Overdoses During CT Scans With New Bill

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Posted on 29th May 2010 by Gordon Johnson in Brain Injury

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California is looking to enact a law to protect patients from radiation overdoses from CT scans, which are one of the key tools to detect brain injury.

The state Senate last Friday passed a bill, 24 to 5, which mandates that the dose of radiation released during each scan be recorded on the image from the scan, as well as in the patient’s records.  http://www.latimes.com/news/local/la-me-ctscans-20100529,0,3030576.story

  The proposed law aims to prevent recent errors that led to patients at three hospitals, including Cedars-Sinai Medical Center, to receive radiation overdoses.

Now that the bill has been approved by the Senate, it has to be passed by the state Assembly and signed by the governor before it is law.   

Cedars-Sinai patient Michael Heuser had radiation overdoses during three different scans last year, according to the Los Angeles Times. I expect he’s looking for a good medical malpractice attorney now. 

But Heuser was just one of many who received an overdose.  As it turned out, there were more than 260 cases of radiation overdoses during scans at Cedars-Sinai. During one 18-month period, the hospital accidently delivered eight times the proper radiation to people who were getting CT brain perfusion scans, which detect stroke, the  Times reported.

The Cedars-Sinai overdoses prompted the Food and Drug Administration to issue a warning that hospitals should check their scanning machines. It turned out that two more hospitals in the Los Angeles area, Glendale Adventist and Providence St. Joseph Medical Center in Burbank, did have problems with their machines, as did an Alabama medical center.    

It’s believed the higher levels of radiation were being administered because the machines had been reprogrammed to use new instructions to contol the scans, the Times said. 

 Republican California lawmakers oppose the new bill, maintaining that regulating the scans and machines should be undertaken by the federal, not state, government.

Texas Tech Regent Asks Judge To Dismiss Ex-Coach Leach’s Lawsuit Against Him

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Posted on 26th May 2010 by Gordon Johnson in Brain Injury

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Yet another member of the Texas Tech Board of Regents has asked a judge to dismiss former coach Mike Leach’s lawsuit against him as an individual. http://lubbockonline.com/node/10928/print

This time, on Monday, lawyers for Board of Regents chairman Larry Anders filed documents that rebutted Leach’s attempt to hold individual college officials responsible for the school’s decision to fire him Dec. 30 last year.

The coach was let go two days after being suspended for allegations that he mistreated player Adam James, who Leach believed was faking a concussion. To punish the receiver, Leach had him stand in a dark shed during practice for several hours.

 http://espn.go.com/blog/big12/post/_/id/12784/leach-suit-defendant-former-coachs-story-inconsistent

Leach’s lawsuit not only names several Regents and other university officials, but also Craig James, an ESPN football analyst who is also Adam’s father.

Brain Injuries Keep TBI Patients Up At Night, Study Finds

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Posted on 25th May 2010 by Gordon Johnson in Brain Injury

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Adding insomnia to injury, those who suffer from traumatic brain damage may have issues sleeping because they are producing less melatonin, according to a new study.  http://www.webmd.com/brain/news/20100524/brain-injuries-may-lead-to-sleeping-problems

Australian reseachers conducted a sleep experiment where they compared patients who had suffered traumatic brain injury on average 14 months prior to the test with 23 healthy people. 

The research found that the healthy test participants produced more melatonin at night than those with brain injuries. 

Melatonin is a hormone that affects the body’s circadian rhythm. Normally, melatonin levels spike right before bedtime, to help bring on sleep. 

The study also found that brain injury patients: spent less time in bed actually sleeping; spent more time awake after first falling asleep; spent more time in non-REM sleep; and had more anxiety and depression.

 For example, brain injury patients spent an average of 62 minutes a night awake, after initially falling asleep, versus 27 minutes for the healthy group.

One explanation for the sleeping problems is that cerebral damage may interfere with the brain structures that regulate sleep, including the synthesis of melatonin by the pineal gland.

Insomnia is a common problem of those with TBI, the study said. 

And the research’s authors suggested that perhaps sleep problems lead to depression, instead of depression leading to sleep problems.

The study was published in the journal Neurology.

Neck Exercises May Prove To Be The Ounce Of Prevention For Football Concussions

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Posted on 24th May 2010 by Gordon Johnson in Brain Injury

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Here’s a pro-active approach to dealing with potential brain injuries in sports: Prevent them by doing neck-strengthening exercises. http://www.foxnews.com/sports/2010/05/24/concussions-fought-neck/

 Mike Gittleson, who was the University of Michigan’s football strength and conditioning coach for 30 years, believes young athletes should be doing neck-strengthening exercises to protect themselves from brain injuries. In fact, I agree with him that such exercise should be mandatory, in both high school, college and even the NFL. 

Gittleson retired from Michigan in 2008, but his work for a sports-clothing company since then has taken him to more than 250 colleges. From what he’s witnessed, few schools are promoting neck exercise. Essentially, we are training all parts of the body except the one that can help steady and protect one of our most valuable organs, the brain.

 Gittleson wants to change that. He recently addressed the Collegiate Strength and Conditioning Coaches annual Convention in Orlando, Fla., about the issue. He is asking that the group make knowledge of neck anatomy a part of  its certification and argues that neck-strengthening exercises must be taught to athletes.

Physicians who study concussions agree that stronger necks can lessen, or diffuse, the impact of blows that cause concussions. So says Dr. Robert Cantu, who is a co-director of Boston University’s Center for the Study of Traumatic Encephalopathy.

Cantu and Dr. Dawn Comstock are almost done with research on how neck length, diameter and strength factor into head trauma.    

 Another researcher, Ralph Cornwell, is conducting a study of 24 college-aged women and men who haven’t done neck exercises.  He will do tests where these people will be moving, as if a car, but then suddenly be stopped. Cornwell will measure how much their heads jerked by watching film of the test participants and digital mapping. 

He will then have the 24 participants do neck exercises for a period of time, and retest them to see if there is any change in their range of motion when their movement is suddenly stopped.

At least one former Michigan player, Steelers linebacker LaMarr Woodley, credits Gittleson’s neck training with  helping  him play college and pro football without suffering any concussions.  That’s pretty good proof in favor of neck-strengthening.

U.S. Troops Experiencing More Stress Than British In Iraq, Afghanistan Combat

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Posted on 17th May 2010 by Gordon Johnson in Brain Injury

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Nobody knows the reason why yet, but American troops who have seen combat in Iraq and Afghanistan are suffering far higher rates of post-traumatic stress than their British counterparts, according to a new study.  http://www.nytimes.com/2010/05/17/world/17trauma.html?ref=world

U.S. troops returning to the United States are seeing rates of PTS in the 10 to 15 percent range, while for the British the rate is only 4 percent, notwithstanding the fact that both groups of solidiers have experienced the same amount of combat duty, according to The New York Times Monday.

The newspaper called the new study, whose findings are being reported in the current issue of  the journal The Lancet, http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60672-1/abstract, “the most rigorous psychiatric study of Britian’s military so far.”

The next question, of course, is why is there such a difference between the level of post-traumatic stress between the American and British soldiers. As a Harvard psychologist, Richard McNally, is quoted in The Times as saying, “The big mystery is why we find these cross-national differences.”

In the study, U.S. Navy, Air Force and Royal Army members were given mental-health questionnaires to fill out from 2007 to 2009. The results were that one in five soldiers had mental health problems, typically depression or anxiety, and 13 percent drank a lot. But not many cited symptoms for post-traumatic stress syndrome, such as flashbacks.     

However, the study did find that reservists reported symptoms of post-traumatic stress more frequently than regular troops.

According to The Times, the researcher who led the study, Dr. Simon Wessely, said that may be why the rate of stress is higher for American soldiers than the British: Reservists account for about 30 percent of the U.S. forces but only 10 percent of the British forces.

Another possible explanation for the higher stress rates for U.S. soldiers is the different ways deployment works in America and Great Britain, according to The Times. American soldiers have tours that last 12 to 15 months, with a year off between tours. The British deploy their troops for six-month tours, with no more than 12 months in every 36 months, The Times reported.   

College Football Player In Oregon Dies Of Brain Injuries From Scrimmage

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Posted on 10th May 2010 by Gordon Johnson in Brain Injury

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Another tragedy has struck a young football player on the field.

Dylan Steigers, a 21-year-old Eastern Oregon University football player, died a day after he sustained brain injuries after being struck in the head during a scrimmage Saturday. 

Steigers, who had been a football star at Sentinel High School in Missoula,, Mont., walked off the field after being hit, but then threw up while on the sidelines. Vomiting after taking such a blow is considered a sign of concussion, according to a press release put out by Eastern Oregon.  http://chinook.eou.edu/ua_story/index.cfm?ID_num=979

Following protocol, an EOU certified trainer called 911, the university said. Steigers was transported to Grand Ronde Hospital, and then sent via LifeFlight to Saint Alphonsus Regional Medical Center in Boise. Medical staff told university officials that he suffered an acute subdural hematoma as a result of contact to the head.

The youth, who was found to be brain dead, was on life support until Sunday afternoon, when he died. His family took  him off the apparatus.   

“It’s hard to describe the emotions we all feel about losing Dylan,” EOU President Bob Davies said. “I sat with Dylan’s family during the scrimmage, and had the chance to connect with them. Dylan was an exceptional young man who loved to play football, and he had a bright future ahead of him. This is a loss we will feel for a very long time. We are reaching out to Dylan’s family in this time of loss.”

EOU Head Coach Tim Camp has been in continual communication with the family, and was in Boise until early Sunday morning.

“One of the most difficult situations I think that you could ever be in is when you lose a member of your family,” Camp said. “It is very difficult time for our coaches and our players. We will provide these fine young men with the mentoring and help they need to get through this very difficult situation.”

Davies said that the university and its community have been deeply affected by the loss.

“I have received many e-mails, phone calls and messages from members of the local community and beyond — university presidents, alumni, Foundation trustees and others — with offerings of support, prayers and asking what they can do to help,” Davies said. “The outpouring of support has been amazing.”

Steigers had joined the Mountaineer football program this spring after transferring from the University of Montana. He was working out with the team and building his eligibility to play on the team during the fall 2010 season. He graduated from Missoula Sentinel High School in 2006.

He is survived by his parents, Tom and Cindy of Missoula, a sister, Libby, his 2-year-old daughter, London, and partner, Liz Apostol.

 

Why We Think Helicopters, not MRIs, Mark The Greatest Advance In Brain Injury Care

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Posted on 10th May 2010 by Gordon Johnson in Brain Injury

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It would seem quite logical to believe that using helicopters to transport the injured to hospitals would make a dramatic difference in their prognosis and survival. After all, what land vehicle has the mobility and speed of a whirlybird?

But at a recent conference in Las Vegas, Dr. Bryan Bledsoe, a professor of emergency medicine at the University of Nevada School of Medicine, took a contrarian view on the issue. He cited several studies that found that there was no improvement in outcome when injured patients were transported to hospitals by helicopter. http://www.ems1.com/print.asp?act=print&vid=815233

One study, for example, entitled “Helicopter Evacuation of Trauma Victims in Los Angeles: Does It Improve Survival?,” concluded that emergency helicopter transport only helps the worse off.

 ”EMS helicopter transportation of injured patients does not appear to improve overall adjusted survival after injury,” the study said.  ”There is, however, a potential benefit (of  helicopter evacuation) for severely injured subgroups of patients due to the shorter prehospital times.”  http://www.springerlink.com/content/u0g518567x348173/

 Bledsoe, saying that the helicopter industy is unregulated and spinning out of control, noted that the number of medical helicopters has more than doubled in the past decade. And since there is this glut of helicopters, there is pressure to turn to them even in situations where their use, which is quite costly, is unwarranted, according to Bledsoe.

I, and others, couldn’t disagree more with Bledsoe and the studies he cited in his presentation. Based on my many years of  experience with traumatic brain injury victims, I have long believed that the helicopter was one of the greatest breakthroughs in coma care. 

Last year when actress Natasha Richardson tragically died of a brain injury sustained while skiing in Canada, I wrote that she would be alive if she had been airlifted by helicopter to get the proper medical attention — and necessary surgery. http://www.tbilaw.com/blog/tag/intracranial-pressure-monitoring

In that blog, I recalled how I had once asked a nurse  what she believed to be the most important advance in medical science to help brain injured, expecting her to say the CT or MRI. But her answer was “the helicopter.”

I don’t think there can be any doubt that helicopters can often mean the difference between life and death for those with TBI

True, there may be situations where helicopters are being overused.  Common sense must dictate when to send a helicopter out to a scene. But with severe head trauma, using helicopters to transport patients is often a necessity, not a luxury.

 

Even the Los Angeles study that Bledsoe cited conceded as much, when it said that those are are badly hurt and need swift care being the exception to the finding that helicopter evacuations do not make a difference for most patients.

Bledsoe’s conference remarks sparked a lively debate on the site,  http://www.ems1.com, from EMS workers who posted comments on the story.

 Many argued the case for medical helicopters. For example, once wrote, “It is true that helicopters by and of themselves don’t necessarily offer the ‘speed’ that we think of…On the other hand, often times the care that is provided during the on-scene and transport leg is equivilent or near-equivalent to what is provided initially at a receiving hospital.”     

 Other trauma workers maintained that the use of medical helicopters is imperative in rural areas — “out here in the boondocks,” as one put it –  where an injured parient is far away from a medical facility. But these posters believed the aircraft should be used only sparingly in urban areas.

 Some noted that “the smoothness of the ride” can be important in some medical emergencies, and a trip over rough terrain could kill the patient. What other choice is there, then, than a helipcopter?

Here’s a side note to this topic.  The Wall Street Journal Monday ran a feature about the New York Police Department’s Aviation Unit. The story talks a log about  Detective Erin Nolan, the first female NYPD pilot qualified to operate a large Bell 412 air-sea rescue helicopter. http://online.wsj.com/article/SB10001424052748703674704575234220104616034.html?KEYWORDS=NYPD+Aviation+unit

The story, “Up in the Air With One of the Finest’s Finest,” is fascinating, as reporter Ralph Gardner Jr. takes to the air with Nolan.

The NYPD unit does more than traditional rescue and medical tranport. It keeps watch over presidential motorcades and parades, looking for trouble in the crowd or on rooftops.

It spotted and rescued a windsurfer far out in the sea. “If it weren’t for Erin he’d be in England,” one of Nolan’s cop colleagues told The Journal.

And the NYPD Aviation Unit not long ago flew Manhattan detectives to Philadelphia and back, a 40-minute trip one-way, as part of the investigation of the recent Times Square bombing.       

So emergency/medical copters do have a role in big cities such as New York, although it may be different than in most locales.

Gardner was accompanied on his helicopter trip by a Pultizer Prize winnning photographer, David Turnley. Turnley has worked for National Geographic, and told the reporter that more photographers at National Geogrpahic had been killed in helicopter crashes than anything else.

 Be that as it may, when a person has suffered  severe brain damage, the need to get swift medical care outweighs any concerns about helicopter safety. 

And I think Professor Bledsoe should rethink his broad statements about helicopter evacuations not actually helping the injured.

 

 

 

 

Study Finds People With Common Heart Defect More Likely To Have Brain Aneurysms

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Posted on 6th May 2010 by Gordon Johnson in Brain Injury

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In what appears to be an unusual link, those who have a common heart defect may also be more likely to have brain aneurysms, according to a new study published this week in the mediocal journal Neurology. http://www.sciencedaily.com/releases/2010/05/100503161227.html

As much as 2 percent of the population is born with bicuspid aortic valve, or BAV,  meaning the valve has just two flaps instead of the normal three, according to Science Daily. That valve permits blood to go from the heart to the aorta.    

The latest research has found that the artery issues that relate to BAV may also take place in the brain,

 Some people with  BAV, especially adults, over time get a narrowing or leaks of the aortic valve, and that the heart defect may in fact be a connective tissue disorder.   

 The research done by Cedars-Sinai Medical Center in Los Angeles sought to find out what brain aneurysms have in common with people with BAV.    

 As part of the study 61 people with BAV were tested for brain aneurysms, as were 291 people who didn’t have BAV but were having tests for suspected stroke or a brain tumor during this period.

According to Science Daily, six of the 61 with BAV had brain aneurysms, or 9.8 percent, versus three of the 291 who didn’t have BAV, or 1.1 percent. Only 0.5 to 2 percent of the adult population has brain aneurysms.

Researchers said that the finding indicate a significantly greater risk of brain aneurysms among those with BAV.  

    

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