Twenty years ago, there was limited knowledge of brain trauma and concussion treatment.
At what point do we know too much?
Dr. Kristian Goulet, medical director at the Children’s Hospital of Eastern Ontario concussion clinic, says that one of his greatest fears is fear itself, when it comes to concussions and public perception.
“It’s almost as though we’ve gone too far with awareness,” Goulet said in an interview. “Now kids are living in fear of head injuries. They saw that movie with Will Smith (Concussion) and they have one concussion and think they’re not going to get better.”
Goulet used the term “stereotype trait” to describe the mentality around concussions and brain health.
“Let’s not terrify kids,” said Goulet, who played junior hockey in the Ottawa area and is the son of longtime hockey coach and scout Mickey Goulet.
Dr. Goulet was a panelist at a recent brain health awareness discussion about concussions and treatment. The event was presented by the University of Ottawa, where Goulet is an assistant professor, and by the Concussion Legacy Foundation.
Goulet has treated thousands of young patients at CHEO. Myriad concussion research papers have helped identify who is most at risk for brain injury. But how best to help those at risk?
“It’s education,” Goulet said. “You educate them on the day they go into the emergency room, give them some good, sound treatment early on, and they will be less likely to get post-concussion syndrome (the lingering symptoms from a concussion).
“Secondarily, you treat the post-concussion syndrome, and there is some good literature coming out on post-concussion syndrome, including studies at CHEO.”
Concern over concussions is one part of the brain trauma discussion. Chronic Traumatic Encephalopathy (CTE) is another. Caused by repeated blows to the head over a long period of time, CTE is a degenerative disease that has shown up in the brains of deceased former pro athletes and in some military veterans exposed to bomb blasts. But the media headlines have caused a level of hysteria among young athletes.
Dr. Lili-Naz Hazrati, a neuropathologist at Toronto’s Hospital for Sick Children, has examined dozens of brains of deceased trauma victims. Hazrati is troubled by the hype over CTE.
“Athletes are thinking all their problems are CTE,” Hazrati told Yahoo Sports earlier this year. “This disease is relentlessly haunting them. I get a lot of phone calls, people saying, ‘I’m sure I have CTE and I’m suffering from it.’ It has made people desperate.”
Hazrati shared the story of a young athlete who was so convinced he had CTE, he took his own life. His brain was examined by Hazrati, who found the young man was suffering from vasculitis, not CTE. His vasculitis could have been treated.
“That is tragic to me,” Hazrati told Yahoo Sports. “It shows what is going on out there.”
During their panel discussion at Algonquin College, Goulet and Dr. Shawn Marshall, medical director of the acquired brain injury rehabilitation program at the Ottawa Hospital Rehabilitation Centre, outlined the symptoms and treatment for concussions.
Goulet said any head injury that changes the way the brain works, often associated with dizziness, an inability to focus, or an emotional change “is a concussion until proven otherwise.”
The brain trauma doesn’t have to involve a blow to the head, but any sudden action causing the brain to move.
As is the case with physical rehabilitation, the latest trend in concussion care leans toward the active, rather than the passive. Refraining from contact after a concussion remains imperative, but the idea of retreating to a dark room for days on end has been updated.
“Cocoon therapy doesn’t work,” Goulet told the Algonquin audience. “To put somebody in a dark room, say, ‘Don’t do anything, don’t go to school, don’t go outside, lock the doors’ … that doesn’t work. Because when you feel sick, you stay sick.”
Goulet and Marshall both advocate moderate activity after a concussion, along with the basics — try to eat well, sleep well and take in fluids. Slowly, build up tolerance in a holistic, full-body approach to recovery. Dial things back if symptoms re-occur.
“Things have changed and evolved,” Marshall said. “We used to believe bed rest was good for back pain, now we know it’s about the worst thing we can do.”
The ultimate message: the brain is resilient. Concussion sufferers will get better. The healing brain prefers calm to anxiety.
“I always say concussions are like the ocean,” Goulet said. “You have to respect the ocean, but you can’t be terrified of the ocean. You have to respect head injury, but you can’t be terrified of it.
“Sometimes that fear can be almost as bad as the head trauma itself.”
This article originally appeared in the Ottawa Citizen on October 24th, 2017. Reprinted with permission of the author Wayne Scanlan.
Reprinted with permission of the author Wayne Scanlan www.ottawacitizen.com