Joey Wahler (Host): They affect many people that play sports at all levels. So, we're discussing concussions and their treatment. Our guest, Dr. Shelley Street Callendar, she's an Internal Medicine, Pediatric and Sports Medicine physician with Summit Sports Medicine and Orthopaedic Surgery.

This is Health Matters from Southeast Georgia Health System. Thanks for joining us. I'm Joey Wahler. Hi there, Doctor. Thanks for being with us.

Shelley S. Callender, MD: Well, thanks for having me, Joey. It's a pleasure to be here today.

Host: Same here. We appreciate the time. So first, it's so interesting your background. You've been a Professor of Medicine, a Director of Sports Medicine, a Pediatric Orthopedic Physician. So, tell us the gist about your versatile background. How did you come to be involved in so many different things?

Shelley S. Callender, MD: Well, like many people, I was involved in sports as a youth and then continued some of that exposure during college. And so, sports medicine has always been an interest for me. But I like taking care of the community. And so, everyone who's active to me is a sports medicine patient. When I went to medical school, I looked into different specialties and I enjoyed the thought process of internal medicine and taking care of adults.

And then, I had the opportunity to do some things that were very special with kids. And I enjoyed working with children as well. And so, my career path took me into doing both of those specialties followed by a sports medicine fellowship, which is where I landed. And I landed in sports medicine, just because I wanted to volunteer in the community. So, I volunteered for an inner city school in Detroit, Michigan at the time. And that path led me to the school asking me to be their team physician and sort of taking off from there.

Host: Yeah, that was at Mercer where you were the team physician, right?

Shelley S. Callender, MD: So, Mercer is after that. Once I was in Detroit and did some work with some of the teams there, I took an opportunity after some life changes to take on a directorship at Mercer University. That's correct.

Host: And that's Division 1. They've had some success in basketball over the years at the mid-major level, right?

Shelley S. Callender, MD: That's correct. And I was there during that success, so it was fun to watch and to be involved with.

Host: I'm sure. And what was your sport or sports of choice as an athlete yourself?

Shelley S. Callender, MD: I, in high school, did track and cross country and basketball; and in college, did basketball.

Host: Okay. And so, what would you say brought you to Southeast Georgia Physician Associates, which I guess was about a year ago, right?

Shelley S. Callender, MD: That is correct. We had a family decision to move towards the coast. And it's beautiful in this area as if you've been or visited from anywhere else in the state are aware of. So, we decided we'd take that plunge to be closer to the ocean and take on some boating and things, activities that weren't as accessible to us in middle Georgia. And that's sort of what brought us to the area.

Host: And so, we're discussing, as mentioned, concussions here, mainly sports-related. First, just how common are they, sports-related concussions? And what are the main signs or symptoms to watch for that would indicate one may have occurred?

Shelley S. Callender, MD: So, head injury or concussion is one of the major injuries experienced in contact collision sports most well known in the sport of football, but not uncommon in the sports of soccer and basketball as well. Of course, when we think about things like hockey, which isn't as popular in the Southeast, they also have a good number of head injuries as well. They are underreported. We estimate that at least one in a thousand people have experienced one, but some don't know it, and some don't report it, and it's still underreported.

One of the signs we recommend that people make sure they are observing, particularly if you're at a field of play, is just someone getting up slow from a tackle hit, hurt, twist, heading, et cetera.

Host: You touched on soccer there. It's always been interesting to me that those that don't follow soccer closely are often surprised to hear that that's one of the leading sports when it comes to concussions, because you might not think from a distance that what you see on the field would add up to head injuries, but they do occur a lot, right?

Shelley S. Callender, MD: Absolutely. Soccer and basketball are two key sports, particularly for girls. As we imagine, not as many girls play contact collision football, where football clearly is the leading sport for concussions for boys.

Host: And hockey as well, right?

Shelley S. Callender, MD: Hockey is another sport where concussion is not uncommon.

Host: So, one thing that you can make a distinction of here for us is when should people seek concussion care with their primary care doctor versus an emergency care visit as opposed to an immediate care facility? How do you know where to go?

Shelley S. Callender, MD: Yeah, those are great questions. And obviously, if you're concerned, there's never a bad time to take them to the emergency room if you absolutely don't know where you should go following a head injury. Because they can be serious and there can be some folks that are nervous about that.

But oftentimes, there's someone on the sideline that can help navigate that for you. Sometimes, in the state of Georgia, we have a number of schools that have certified athletic trainers and physicians on the sidelines. There are other schools that do not have that access. Clearly, if someone has lost consciousness or they stay down on the ground for more than 10 to 30 seconds, then that's someone you most likely want to transport or have seen it in an emergency room. If you get right back up or you just feel lightheaded or dizzy and you otherwise are normal, then you can actually wait and see, go to an urgent care, immediate care, or your primary care physician. What should be done is you should not reenter that activity. So, whatever it is that you are doing, you should not resume doing it including—and not excluding—driving. So if you're an adolescent or an adult that experiences something, and they feel dizzy, lightheaded, nauseous, unbalanced, in a fog, any of those components, don't get in a car and then drive, just like you wouldn't get back on the field and play football.

Host: And of course, if an athlete is playing at a level where they're under the care of a team physician, as you were, as we talked about, or a professional trainer, et cetera, then these questions are typically answered ahead of time. We're talking more if an athlete, especially a younger athlete, is in a situation, or maybe even an older weekend warrior is in a situation, right, where they don't quite know where to go because they're more on their own.

Shelley S. Callender, MD: Correct.

Host: How about what would you say you're most proud of about the approach to patient care on the part of you and yours?

Shelley S. Callender, MD: Well, I think it's been wonderful to see. Back when I played sports through high school and college, you didn't have concussion care recognized at all. And it was just go back in there. You feel a little dazed, shake it off, and run back in. And the amount of advances, I think, we've made from then to now are just astronomical. And I think we've made some great headway in taking care of people who have concussions, and helping them navigate the way back to full activity.

And so, now, I have adolescents and adults who will tell me I have a concussion or I have these symptoms of concussion, whereas before they would not even recognize that the symptoms they were having were concussion or what a concussion even was.

Host: And indeed, even well before your time playing sports, back in the day, I mean, we've all seen these videos from NFL films from back in the '60s or '70s when a guy would get his bell rung and clearly had a concussion, didn't know what round he was in. And he'd say to the coach, "I'm fine." And the coach would go, "Okay, get back in there then." and that was it, right? It sounds crazy now, doesn't it?

Shelley S. Callender, MD: It does sound crazy. And we went through stages of knowing what was the results of some of those decisions we made long ago. And some people did just fine and other people not so well. And so, it's nice to see the movement towards understanding that this is really an injury that we need to take care of and do the right thing for so that everyone who plays a sport can be safer in what they're playing and anyone who sustains a head injury or a concussion knows where to go and what to do about it, so that they don't subject themselves to further delay and return to their work, play, sport or school and it doesn't delay their lifelong goals or aspirations.

Host: Absolutely. And speaking of which, after a concussion, that all begs the question, simply put—and of course, everyone's different, they respond differently, they take different amounts of time to recover from a concussion—but how would you sum up best for people to understand how a professional like yourself knows when it's time for a given patient to return to sports? And what legal requirements are there that professionals have to follow?

Shelley S. Callender, MD: That's a lot of questions in that one. If you're in an organized sport environment, then they are legally bound that they should not allow anyone to return to the playing field or court until they've been evaluated, treated, and cleared to return to that sport.

Host: And so, I'm sure you must often deal with athletes that are chomping at the bit to get back into action. How do you balance their eagerness with making sure that they're fully recovered? I guess, what I'm asking is during that recovery period, what's the support you're offering them for their own good, whether they like it or not?

Shelley S. Callender, MD: Yeah, you can imagine that everyone's eager to get back. And I will tell you, I'm eager to get them back because it makes my life easier too. If they are back to doing the things they enjoy and love doing. And so, I share that with them and say, "You know, I want you back quickly too, because we all are happier if you're playing what you want to play." That, coupled with, "We are going to do it in a safe manner."

And I will tell you the more experienced athletes get it. And they are sometimes the ones that are holding back and saying, "I want to wait one more day." My younger athletes, the younger they are, the more they don't—you know, I guess, their brain functions just aren't quite there all the time to make those synapses that say, you know, "Waiting one more day, isn't going to hurt you. Waiting one more day might be better for you." And so, that's when you get a team approach to it. And that team includes their parents, sometimes their teachers, sometimes their aunts and uncles. It's a family sort of affair. And when you get everyone on board, then it helps that athlete move as well or the patient who's interested in getting back to their even recreational play. And so, I try not to hold people out any longer than what they have to. And that's one of the, I guess, nuances of taking care of concussion.

Host: I'm sure it is. So, changing things up just a bit for a moment, is it safe to say that much of what you're discussing here so far applies not just to sports-related concussions, but people that have been concussed in an auto accident as well?

Shelley S. Callender, MD: We do actually separate out or have started to separate out the literature between head injuries sustained in sport and head injuries sustained in motor vehicle accidents or high collision crashes. We don't really think there's a big difference in how you might manage some of those except that, particularly in the beginning, depending upon the mechanism of action, you may have an increased risk of having a brain bleed. Most of our sports-related concussions do not result in brain bleeds. But some of our motor vehicle accidents and ATV accidents, et cetera, can.

Host: That's great indeed. So when we talk about success, I'm sure a lot goes into it. But simply put, how do you think sports organizations can reduce concussions, including in urban areas and rural communities where cultural experiences can come into play in terms of the way things have always been done?

Shelley S. Callender, MD: Right. I think the first step is recognizing that you have it. And we need to recognize symptoms, both those that are participating and those that are watching participation. And once we recognize it, then we have to move to the next step of removing the person from that activity as soon as we recognize it. And we're getting better, but we're not yet quite there. Once we recognize it and remove them, then we should institute the appropriate care, make sure they're hydrated and then get them to the necessary resources to be able to guide that process back to their activity of choice.

Host: Now, the American Medical Society for Sports Medicine, known as the AMSSM, has a position statement concerning sports concussions. Can you tell us why people should know about that?

Shelley S. Callender, MD: They're one of the big organizations that participates in education, resources, and research in head injuries. And a number of the members of the American Medical Society for Sports Medicine, AMSSM, are on both national and international writing papers and recommendations through the CDC, et cetera, as to requirements for concussion.

So, this document that talks about and is re-evaluated, as to the new research in the area, give some guides for sports-related concussions. And if you're involved in sports, you should at least be aware that there's guidelines—or they aren't specifically guidelines, they're more information that you should know about concussions because they're not written as strict guidelines. They're more written as a guide for you to be aware of and the things that you should think of when you're taking care of people for concussions.

A lot of that literature is written actually for your physicians, physician assistants, and your providers, your certified athletic trainers. I think the general public needs to be aware of it—not necessarily have read the whole document. And that your coaches, trainers—trainers absolutely—should be very aware of it and your coaches should be aware of it. And then, the medical personnel should actually have knowledge about it, particularly if they're taking care of athletes who are involved in sports where head injury is a concern and almost every sport has some risk for head injury.

Host: Absolutely. Now, just a couple other things. Switching gears a bit, when you're away from work and all these work-related duties, how do you spend time away with your family and enjoy yourself?

Shelley S. Callender, MD: Yeah. We like to travel. The family my husband and two kids, we enjoy traveling and we do a fair amount of that. My boys, I think, take sports for granted because they go to a lot and watch a lot and meet some fun people who take care of some great athletes. We enjoy cooking and just even going for walks and rides as well. And we bake cookies together and we enjoy, you know, family time. So, we do a fair amount of fun home things that help us sort of reminisce and think about things together.

Host: That's great. I mean, when you talk about making cookies with your kids, that's about as all American as it gets, right? So, in summary here, finally, what would you say your message is to those tuning into our conversation about what parents and kids playing organized sports should keep in mind so that they can be prepared to have success, but at the same time to be safe?

Shelley S. Callender, MD: Have true conversations, particularly with your young individuals that are participating in organized sports. And have that conversation that says there's nothing wrong with admitting that you have something going on. There's nothing wrong with saying you feel a little dizzy or a little off.

There's nothing wrong with telling someone right away that something doesn't feel quite right, because that might lead to more questions to help you define what is going on with you and keeping you safe. So, I encourage my kids that I want you to enjoy it, I want you to have fun in your sport, and I want you to be comfortable enough to tell me if something doesn't feel right.

Host: Well, folks, we trust you're now more familiar with concussions and their treatment. You just got a chance to meet her. She is a busy woman, including beating her kids at H-O-R-S-E, but then baking them cookies. So, it all evens out in the end. Doctor, thanks so much again.

Shelley S. Callender, MD: Thank you for having me. It's been a pleasure.

Host: Dr. Shelley Street Callendar. Thank you. And for more information, please visit sghs.org/concussion-management. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for being part of Health Matters from Southeast Georgia Health System.