A concussion is like shaking a snow globe in your brain. What do you do to cure your brain from a concussive blizzard?
Hear from a concussion expert about the care and cures you need to clear the concussion from your mind.It seems like we hear a lot about concussions in the news and in our communities, compared to years ago.
Today’s guest, Dr. Budd Renier, is a family medicine physician and credentialed concussion expert at the Allina Health Cambridge Clinic. He’s here to speak with us about the importance of medical care for people who have gotten a concussion.
Selected Podcast
The Changing Landscape of Concussions
Featured Speaker:
Budd Renier, MD - Family Medicine
Dr. Renier is a board-certified family medicine physician with professional interests in concussion management, sports medicine and non-surgical orthopedics. He is also a credentialed ImPACT consultant for concussion management. Transcription:
The Changing Landscape of Concussions
Melanie Cole (Host): A concussion is like shaking a snow globe in your brain. What do you do to cure your brain from a concussive blizzard? Today, my guest is Dr. Bud Renier. He’s a family medicine physician and credentialed concussion expert at the Allina Health Cambridge Clinic. Welcome to the show, Dr. Renier. What happens in the brain when someone suffers from a concussion?
Dr. Bud Renier (Guest): Well, as you mentioned, Melanie, a lot of times, what happens is, with the shaking of the brain, it is like a chemical blizzard that occurs and it actually temporarily changes the way that our brain is trying to process the information that comes in. And I think one of the misconceptions is that people think you have to have a loss of consciousness for a concussion, and it turns out that’s not true. Only about 10 percent of concussions have any loss of consciousness with them. But the symptoms that people will often have include anything from fact process issues to physical issues to emotional and even sleep problems.
Melanie: Are concussion more serious in children or in adults? Because we hear in the media today about concussion with our athletes in high school and college, and even younger. Is it more serious in children or adults?
Dr. Renier: Well, it’s a great question. The seriousness of a concussion is actually based on several factors that really are age-independent, if we take it case by case. However, definitely, in younger people, recovery often takes longer, because children still have a developing brain. And then the other issue is that, people under age 25 are at risk for something called second impact syndrome, which is where the brain can get hit a second time while you’re recovering from the first concussion. And unfortunately, that can actually be fatal.
Melanie: When someone suffers a concussion, how do we know? If they’re out on the field, or they come back after we see an impact, what symptoms might we really spot? People always say, “I’m going to look in your eyes and see.” Is that really the best way?
Dr. Renier: Well, if you know the individual, sometimes, looking into their eyes is helpful because you know they’re looking different to you than what you’re accustomed to. But really, there’s a number of things that we’re watching for. Are they mentally foggy? Do they feel like there’s a slowdown in their fact process? Are they having trouble with memory? Sometimes, it’s that their balance is off, they’re extremely dizzy or suddenly they’re light sensitive and they weren’t before. So it can be very subtle sometimes, and sometimes we actually have to watch those patients for a while to see if their symptoms are going to develop over time.
Melanie: And then, what’s the treatment for a concussion, Dr. Renier?
Dr. Renier: Treatment for a concussion. Every concussion is just a little bit different. We need to treat them based on that individual patient’s circumstances. And we always say that there really aren’t any shortcuts. There’s no cookie-cutter approach to managing a concussion. But you do need to be free of any symptoms at rest for several days before starting to go into an exercise mode. And so, we say that only when your symptoms have reduced significantly, after you’ve consulted with a professional who’s trained in a concussion management, should you then return to those activities.
Melanie: Are there any tests that would show whether someone is predisposed to a concussion?
Dr. Renier: Predisposed is difficult. I think that at this point, we don’t have any specific tests that would say they’re predisposed to it. However, there are several tests out there that can help us to manage it after it has happened, and there is a baseline impact test which we will often use, which is a computer-based test, to help us establish what that individual athlete’s baseline function is in their brain. But if they do get an injury, we can then repeat that computerized test and compare them to their own baseline, and that can be quite helpful.
Melanie: Give your best advice, Dr. Renier, to patients who have suffered a concussion to their parents. What do you do once you get someone home? If a child has suffered a concussion out on the field and then they go home, what should parents look for that would signal getting them back to the doctor?
Dr. Renier: Right. I think, initially, if there was a loss of consciousness with the injuries at the beginning, that’s a sign that they should go in and be seen right away. If their mental status, their though process is deteriorating at home, that definitely would make me want that patient to be into the hospital to be seen. But really, what the parents would want to do is to put your child into a shutdown mode, where they really aren’t doing any sort of physical or mental exertion. So we say stay away from video games and things like that.” But definitely, no physical exertion, and absolutely no activity where they could get hit in the head a second time. So we really encourage any concussion patient to be seen within 72 hours for the symptoms of a concussion.
Melanie: And you mentioned video games. It’s not easy for a parent to tell their kids they can’t do that when they’re sitting around at home. They’re not going back to school right away. But it’s really important that mental concentration and that they don’t do things that would stimulate their brain. True?
Dr. Renier: That’s absolutely true. And I think what you’re getting at there is that traditionally, people had just monitored concussions. And now we’ve stepped into the realm of actually managing concussion. And that may mean different accommodations for different people, and for school-age patients that definitely comes into play, and we’re seeing more energy now being directed toward making those accommodations in the school world and the workplace so that we’re not prolonging this patient’s illness.
Melanie: When is it okay for them to return either to play or to go back to school or work?
Dr. Renier: Right. So again, that’s very individualized, and we like to see those patients in order to help determine that. But it is okay to get back into a school setting when they are symptom-free to the point where they would actually be able to function well at school. That may mean half-days. It may mean that they’re only able to certain classes; not able to go to, say, a band class, where there is problem with noise. So we do really take it on a case-by-case basis, and so, we have very close contact with all of our concussion patients in order to determine what’s right for that particular patient.
Melanie: Dr. Renier, is it okay to take ibuprofen or Tylenol if you have a headache from a concussion?
Dr. Renier: Yeah, great question. We typically will initially go with Tylenol for the headache. After you’re out of the initial phases of the concussion, like in the first 24 to 48 hours, where you’re more certain that there’s not any sort of a bleed going on in the brain, then I’m okay with people taking ibuprofen. It comes in the blood, so to speak, prior to that, and we don’t want aggravate any bleeding condition that might be there. A concussion itself is not about a bleed. That would be that we were worried about a more serious injury. One of the drawbacks of medicines like Tylenol and ibuprofen, however, can be that many individuals will get something called a rebound headache. And so, you may be treated for a short time, but when the medicine wears off, you may actually have a worse headache than before you took the medicine.
Melanie: Dr. Renier, I think we’re lulled into a false sense of security with some of the equipment that our children wear out there today—helmets and things. Do we put our faith in those pieces of equipment to protect our children from concussion?
Dr. Renier: Yeah. Protective equipment is an excellent way to help prevent more serious injuries, such as skull fractures and perhaps even bleeds to the brain and lacerations. However, it’s definitely been shown that a helmet is not necessarily going to prevent a concussion. We still, of course, think it’s a great idea to try to continue to improve the technology for those, but I agree with you. There is a certain sense of false security with the protective equipment that is out there, and we need to be vigilant about how we’re training people to tackle and how we’re training people to have better neck strength to protect themselves and not just count on a helmet to do so.
Melanie: That’s great information. Dr. Renier, in just the last minute and a half or so, please give your best advice about concussion and tell people why they would come to Allina Health for their concussion care.
Dr. Renier: Yeah. I think that’s what people need to be aware of is that there are plenty of individuals out there who will say that they can work with a patient who has a concussion. I think as long as they are monitoring those patients and making sure that they’re safe to return, I think that’s great. I think that Allina Health has taken the next step toward providing concussion management and really patterning it after the work that’s being done out at the Central Impact Center out in Pittsburg. I think that if you can just see an individual who knows and manages a lot of concussions, it will be safer for the child.
Melanie: Thank you so much, Dr. Bud Renier, family medicine physician and credentialed concussion expert at the Allina Health Cambridge Clinic. You’re listening to The Wellcast by Allina Health. For more information, you can go to allinahealth.org. This is Melanie Cole. Thanks so much for listening.
The Changing Landscape of Concussions
Melanie Cole (Host): A concussion is like shaking a snow globe in your brain. What do you do to cure your brain from a concussive blizzard? Today, my guest is Dr. Bud Renier. He’s a family medicine physician and credentialed concussion expert at the Allina Health Cambridge Clinic. Welcome to the show, Dr. Renier. What happens in the brain when someone suffers from a concussion?
Dr. Bud Renier (Guest): Well, as you mentioned, Melanie, a lot of times, what happens is, with the shaking of the brain, it is like a chemical blizzard that occurs and it actually temporarily changes the way that our brain is trying to process the information that comes in. And I think one of the misconceptions is that people think you have to have a loss of consciousness for a concussion, and it turns out that’s not true. Only about 10 percent of concussions have any loss of consciousness with them. But the symptoms that people will often have include anything from fact process issues to physical issues to emotional and even sleep problems.
Melanie: Are concussion more serious in children or in adults? Because we hear in the media today about concussion with our athletes in high school and college, and even younger. Is it more serious in children or adults?
Dr. Renier: Well, it’s a great question. The seriousness of a concussion is actually based on several factors that really are age-independent, if we take it case by case. However, definitely, in younger people, recovery often takes longer, because children still have a developing brain. And then the other issue is that, people under age 25 are at risk for something called second impact syndrome, which is where the brain can get hit a second time while you’re recovering from the first concussion. And unfortunately, that can actually be fatal.
Melanie: When someone suffers a concussion, how do we know? If they’re out on the field, or they come back after we see an impact, what symptoms might we really spot? People always say, “I’m going to look in your eyes and see.” Is that really the best way?
Dr. Renier: Well, if you know the individual, sometimes, looking into their eyes is helpful because you know they’re looking different to you than what you’re accustomed to. But really, there’s a number of things that we’re watching for. Are they mentally foggy? Do they feel like there’s a slowdown in their fact process? Are they having trouble with memory? Sometimes, it’s that their balance is off, they’re extremely dizzy or suddenly they’re light sensitive and they weren’t before. So it can be very subtle sometimes, and sometimes we actually have to watch those patients for a while to see if their symptoms are going to develop over time.
Melanie: And then, what’s the treatment for a concussion, Dr. Renier?
Dr. Renier: Treatment for a concussion. Every concussion is just a little bit different. We need to treat them based on that individual patient’s circumstances. And we always say that there really aren’t any shortcuts. There’s no cookie-cutter approach to managing a concussion. But you do need to be free of any symptoms at rest for several days before starting to go into an exercise mode. And so, we say that only when your symptoms have reduced significantly, after you’ve consulted with a professional who’s trained in a concussion management, should you then return to those activities.
Melanie: Are there any tests that would show whether someone is predisposed to a concussion?
Dr. Renier: Predisposed is difficult. I think that at this point, we don’t have any specific tests that would say they’re predisposed to it. However, there are several tests out there that can help us to manage it after it has happened, and there is a baseline impact test which we will often use, which is a computer-based test, to help us establish what that individual athlete’s baseline function is in their brain. But if they do get an injury, we can then repeat that computerized test and compare them to their own baseline, and that can be quite helpful.
Melanie: Give your best advice, Dr. Renier, to patients who have suffered a concussion to their parents. What do you do once you get someone home? If a child has suffered a concussion out on the field and then they go home, what should parents look for that would signal getting them back to the doctor?
Dr. Renier: Right. I think, initially, if there was a loss of consciousness with the injuries at the beginning, that’s a sign that they should go in and be seen right away. If their mental status, their though process is deteriorating at home, that definitely would make me want that patient to be into the hospital to be seen. But really, what the parents would want to do is to put your child into a shutdown mode, where they really aren’t doing any sort of physical or mental exertion. So we say stay away from video games and things like that.” But definitely, no physical exertion, and absolutely no activity where they could get hit in the head a second time. So we really encourage any concussion patient to be seen within 72 hours for the symptoms of a concussion.
Melanie: And you mentioned video games. It’s not easy for a parent to tell their kids they can’t do that when they’re sitting around at home. They’re not going back to school right away. But it’s really important that mental concentration and that they don’t do things that would stimulate their brain. True?
Dr. Renier: That’s absolutely true. And I think what you’re getting at there is that traditionally, people had just monitored concussions. And now we’ve stepped into the realm of actually managing concussion. And that may mean different accommodations for different people, and for school-age patients that definitely comes into play, and we’re seeing more energy now being directed toward making those accommodations in the school world and the workplace so that we’re not prolonging this patient’s illness.
Melanie: When is it okay for them to return either to play or to go back to school or work?
Dr. Renier: Right. So again, that’s very individualized, and we like to see those patients in order to help determine that. But it is okay to get back into a school setting when they are symptom-free to the point where they would actually be able to function well at school. That may mean half-days. It may mean that they’re only able to certain classes; not able to go to, say, a band class, where there is problem with noise. So we do really take it on a case-by-case basis, and so, we have very close contact with all of our concussion patients in order to determine what’s right for that particular patient.
Melanie: Dr. Renier, is it okay to take ibuprofen or Tylenol if you have a headache from a concussion?
Dr. Renier: Yeah, great question. We typically will initially go with Tylenol for the headache. After you’re out of the initial phases of the concussion, like in the first 24 to 48 hours, where you’re more certain that there’s not any sort of a bleed going on in the brain, then I’m okay with people taking ibuprofen. It comes in the blood, so to speak, prior to that, and we don’t want aggravate any bleeding condition that might be there. A concussion itself is not about a bleed. That would be that we were worried about a more serious injury. One of the drawbacks of medicines like Tylenol and ibuprofen, however, can be that many individuals will get something called a rebound headache. And so, you may be treated for a short time, but when the medicine wears off, you may actually have a worse headache than before you took the medicine.
Melanie: Dr. Renier, I think we’re lulled into a false sense of security with some of the equipment that our children wear out there today—helmets and things. Do we put our faith in those pieces of equipment to protect our children from concussion?
Dr. Renier: Yeah. Protective equipment is an excellent way to help prevent more serious injuries, such as skull fractures and perhaps even bleeds to the brain and lacerations. However, it’s definitely been shown that a helmet is not necessarily going to prevent a concussion. We still, of course, think it’s a great idea to try to continue to improve the technology for those, but I agree with you. There is a certain sense of false security with the protective equipment that is out there, and we need to be vigilant about how we’re training people to tackle and how we’re training people to have better neck strength to protect themselves and not just count on a helmet to do so.
Melanie: That’s great information. Dr. Renier, in just the last minute and a half or so, please give your best advice about concussion and tell people why they would come to Allina Health for their concussion care.
Dr. Renier: Yeah. I think that’s what people need to be aware of is that there are plenty of individuals out there who will say that they can work with a patient who has a concussion. I think as long as they are monitoring those patients and making sure that they’re safe to return, I think that’s great. I think that Allina Health has taken the next step toward providing concussion management and really patterning it after the work that’s being done out at the Central Impact Center out in Pittsburg. I think that if you can just see an individual who knows and manages a lot of concussions, it will be safer for the child.
Melanie: Thank you so much, Dr. Bud Renier, family medicine physician and credentialed concussion expert at the Allina Health Cambridge Clinic. You’re listening to The Wellcast by Allina Health. For more information, you can go to allinahealth.org. This is Melanie Cole. Thanks so much for listening.