TCB Mail Bag

26 Dec

I trust everyone has had a wonderful Christmas experience (or Hanukkah or Kwanzaa or going to have a good Boxing Day), with that I would like to wish everyone continued successes in whatever endeavor they choose.  Over the Holiday I have received many an email regarding concussions; apparently the down time has given people opportunity to share frustrations or good news.

Today I am bringing you a specific case in which we all can learn from.  At the least we can read this and prepare for similar situations that may arise – whether as a parent, doctor, coach or athletic trainer.  

As always you can write in and with your permission I will re-post anything you would like (and it may suit the audience).  It can be attributed to you or anonymously.  Keep it between 500-2000 words and omit any personal identifying factors if it involves patient care or sensitive information.

Here is our post today – by Anonymous:

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Obviously today is Christmas Eve and in most regions of the country kids are not in school for at least the next two weeks. Maybe less, maybe more. All in all it is a great time to rest up that brain and recharge your body. As athletic trainers we also know that sports do not stop for the holidays. For the most part at least. If you remember last year I read an op-ed article that you put on your blog titled “Parental Decisions Can Undercut Good Concussion Laws” or something of that nature. Well, it’s happened again (as it has many times between that time and now but this one is a little more ridiculous than the last) and I’m nauseous!

To be as brief as I can on this without boring you this is the case of a female soccer player who sustained a nasal fracture as well as a concussion when fighting for a header in the air with an opposing player almost a month ago. To be clear, she actually suffered a deviated septum. Anyway, after our AT did a beautiful job of getting this athlete “entered” into our concussion protocol (which Mom still couldn’t get over the fact that she indeed had a concussion; whoda’ thunk it, right?) we all sat in our physician’s office (Mom, AT, myself, physician, athlete) and witnessed the concussion as well as the nasal issue being addressed. The athlete was clearly concussed (clinical exam, balance assessment, and symptom reporting were all abnormal but ImPACT scores remained at baseline) and the athlete was sent for an MRI and referred to an ENT for further evaluation of the nasal issue. Pretty simple. These folks were given the “red carpet” treatment as all of our athletes/parents are and everyone left happy. The consensus was to see the ENT and address that issue then to follow back up with our physician for the resumption of the concussion issue. The athlete ended up having surgery about a week later. She was out for about a week after that. The ENT cleared her to resume play and actually said that there was no concussion. Wow! OK!

Fast forward to last week during exams and the athlete did not follow-up with the AT during exams like she was instructed to do. She THEN shows up to a game on Saturday with a face shield and tries to plead her case to enter the game. The AT did her job and did not allow the athlete to play. Mom was irate. Athlete conceded. Coach was with the AT. So athlete did not go through the GRTP process and as of today the mother refuses to follow-up with our physician for final clearance after all of the objective information is noted. She is choosing to go to her “family” physician (who happens to be the mother of another student at that school) who has no knowledge of the case throughout the process. This physician will clear this athlete to play this coming weekend with little to no experience in concussion management. The mothers rational was that there are college coaches there this weekend and her daughter was wearing a face shield.  I guess she is still in denial that there was ever a concussion and she stated that she spoke with other parents that did not have to go through such a rigorous protocol as her daughter has. She clearly does not get that each injury is unique not to mention her daughter had a surgery that the others did not which set her back a bit.

Oh…and I left one important piece of info out. This is the athlete’s third concussion in about 2 years. The first two were managed improperly (in my opinion) outside of our program. But the most interesting thing was that the athlete self-reported (with the above witnesses in the room) that every time she heads the ball since her first concussion she “see’s black”. Really?

At this point Dustin our hands really get tied and all you can do is wish these folks the best of luck. The AD, coach, and all other relevant parties were notified of the situation and that the mother will have it no other way.

How is this still allowed to happen in today’s culture? Am I overreacting? It just seems that as I tried to make my point that this is some instances and to some degree should almost be considered criminal behavior. We legislate away everything else in this country, how do these actions go overlooked and are rationalized by other parents, the community, the school, and lastly…ourselves as AT’s. For Christ sakes…Phil Robertson is under fire for expressing his god given opinion and we can’t scrutinize and lash out more at such a thing as blatant neglect and disregard for a physical human life possibly at stake right before our eyes! It ludicrous that parents are sometimes allowed to get away with this and others are chastised for worse things.

I understand that we cannot control this sort of thing nor do I seek full control of anything in this life. And for every one situation like this there are substantially more that do not go this way. But I just have to wonder why people are still so dead set on rolling the dice with their children’s future.

Again, I hope you and your family have a great holiday season!

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TCB Commentary:

I do not feel you are overreacting at this situation, merely frustrated with all the hard work you and others have done to make get people on the same page in regards to concussions.  Sometimes we will find “cancers” in the system that seem to take out some “umph” and initiative of many, however we cannot let them win.

I see it this way: “either you are a contributor or a contaminator”*.  Meaning you are here to help or you serve little purpose and must not be allowed to impart your influence on others.

Often time in this concussion issue our focus is beamed upon certain stakeholders that really are not the problem.  Currently, the overriding theme is to blame medical care givers (which we all have some part) or the teams/coaches (really small fish here) or the leagues (which are so insulated its tough to manufacture change).  However, if we were to really look at the issues we see and face it’s the primary stakeholders that should shoulder a lot of the blame and therefore deserve a ton of energy to fix.  In the case of professional sports, more blame and spotlight should be shed on the players themselves; they are the only ones who really know what is going on with their brain.

In this case above, the parent is the obvious “contaminator” and should be dealt with, if possible.  Often times I have found that biggest issue is not the student-athlete it is his/her parent(s) that put up the biggest resistance.  Some can be educated and at least seem to understand the overall goal, but others – like mom above – only have their self-interests in mind.  And this self-interest overrides the advice to keep her daughter “safe”.  Here is where we can make a dent in the issue.

Find the “problem” (college recruiting in this case) and attack it from that angle.  In this case I would suggest/tell the mom that if the daughter has difficulty coming back from any injury (let alone a concussion) colleges will pass on their courting of her services.  Sure, there may be some missed opportunities to be “seen” but with good coaching and proactive “marketing” when fully healthy things, good things, can still occur.

That’s my two cents on this email, and thanks for sending it in.

*quote adapted from a fine HS coach!

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One Response to “TCB Mail Bag”

  1. Lead Soldier (@DocPencil) December 26, 2013 at 12:22 #

    Apparently, in the Spartan culture, where children were raised to be soldiers and unpromising newborns were hurled from high ridges, the cadets were taught: “If you return from battle without your shield in hand, there is only one excuse; your shield is being used to bear home your cold, dead body”.

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