cnighbor1
07-31-2018, 03:30 PM
From a doctor in my GPC Club on Concussions and cycling
From: Martin Goodman MD
To: GPC WED Ride List
Sent: Sunday, July 29, 2018 03:25:54 PM
Subject: Concussion and cycling
It's been a long time since I rode with folks of the Wednesday ride group, or posted to this list. I rather regret this. In any case, I do follow posts of those fortunate enough and wise enough to still be riding.
Hearing of of Krehe's accident reminded me of past experiences when active people have sustained concussions riding bicycles, and while hiking. As a former avid cyclist and hiker, backpacker, and mountaineer, and as a physician, I've a few thoughts I'd like to add.
(1) Recognizing a concussion:
Tho Krehe apparently went flying off the edge of an improperly banked turn on Lucas Valley road in what looked on the face of it to be a significant cycling accident, it's possible to sustain a concussion in the aftermath of what appears to be a trivial and harmless accident. On one night ride years ago a friend riding with us fell over while near stationary, or at less than 4 mph. She immediately picked herself up, and said she felt fine. I was ready to join others in our group in judging she was just fine, when someone in our group noticed her helmet had a crack in it.
Only on hearing of and then seeing the (minor, but definite) crack in her helmet was I motivated to specifically check her for signs of a concussion.. Specifically, I questioned her in a way that would reveal whether or not she was having trouble turning short term memory into long term memory (over a period of about 3 minutes).
This revealed she was entirely unable to remember anything that transpired around her 3 minutes after it happenned. Revealing she had sustained a significant concussion.
The lesson: After all cycling accidents, one should inspect the rider's helmet. If there is a crack, check for concussion in this fashion. If there is any indication of even an ostensibly minor head injury during the accident, also check for concussion.
This rider recovered her memory functions after about 8 hours.
(2) To go a hospital, or not?
In general, if you have identified a concussion, it's best to have it properly evaluated at an emergency room. Best, but not absolutely necessary in all cases. In the case of the rider, above, our group stayed with her for about 2 hours, and I (a physician) was able to establish that she had no "laterlaizing" findings (neuro problems on one side and not on the other), nor was her condition in any way worsening. And we established her sister was knowledgeable about "neuro checks post concussion", and would take her in and check her hourly for the next 8 hours. So we took our friend to her sister, who followed her to make sure nothing serious was developing that might require emergency neuro surgery.
I sustained a concussion when I fell running down hill 3 hours into a hike in rural country (with a group, tho I was alone at the time). I slipped on some muddy ground, went down, and whacked the side of my head on a rock. Someone who saw me from the top of that hill later told me it did not look as if I had passed out at all during the event. I walked out (3 hr hike) assisted by a friend and by an ER physician who was in the hiking group at the time, but was then, from the trail-head, carted off to a hospital. When discharged, I was released in the care of an old friend who is an RN and very familiar with neuro checks on post concussion patients..
Both of us fully recovered our short term to long term memory functions within 6 to 12 hours. We remained in a subjectively somewhat altered state for about a week. Friends told me that they liked my personality better in the week post concussion (they said I was more calm and pleasant). One very good friend even mused it might be desireable for her to whack me on the side of the head every two weeks with a baseball bat.
(3) CAT scan, or not?
There is valid medical debate regarding whether or not one needs a CAT scan if one has had a simple concussion with no other findings, and no history of brain problems that might put one at risk. And no indication worriesome things are beginning to appear in the patient's picture. I was given a CAT scan at the hospital, tho it was suggested it was for "medical-legal reasons" even there. Our friend on the night ride, of course, was not given a CAT scan.
While there are valid medical and economic reasons to question whether a CAT scan is appropriate post simple concussion, it is not wise to decline a CAT scan felt by medical authorities to be appropriate because one fears risk from the radiation one receives during the CAT scan.. The X-ray dose involved is so low that it has zero potential to produce radiation-releated medical disease, either acutely or over the entire rest of your life. Not low risk. Not very low risk. ZERO risk.
Zach Kaplan related to me a tragic tale of a cyclist he knew, who had sustained a concussion while riding. He went to a hospital, but adamently refused to have a CAT scan done. This cyclist's reason for declining a CAT was an irrational fear of radiation out of all proporption to the facts intellectually honest science and medicine have amassed concerning this issue. He appeared to make a recovery from the concussion, but two weeks later sustained a brain bleed which, even when treated with emergency neurosurgery, result in his losing most of his vision, and changed his personality significantly. From the information given I cannot tell for sure whether had a CAT scan been done it would have alerted doctors to the danger of this brain bleed occurring, but it certainly is POSSIBLE that is the case.
---marty
Martin H. Goodman MD
From: Martin Goodman MD
To: GPC WED Ride List
Sent: Sunday, July 29, 2018 03:25:54 PM
Subject: Concussion and cycling
It's been a long time since I rode with folks of the Wednesday ride group, or posted to this list. I rather regret this. In any case, I do follow posts of those fortunate enough and wise enough to still be riding.
Hearing of of Krehe's accident reminded me of past experiences when active people have sustained concussions riding bicycles, and while hiking. As a former avid cyclist and hiker, backpacker, and mountaineer, and as a physician, I've a few thoughts I'd like to add.
(1) Recognizing a concussion:
Tho Krehe apparently went flying off the edge of an improperly banked turn on Lucas Valley road in what looked on the face of it to be a significant cycling accident, it's possible to sustain a concussion in the aftermath of what appears to be a trivial and harmless accident. On one night ride years ago a friend riding with us fell over while near stationary, or at less than 4 mph. She immediately picked herself up, and said she felt fine. I was ready to join others in our group in judging she was just fine, when someone in our group noticed her helmet had a crack in it.
Only on hearing of and then seeing the (minor, but definite) crack in her helmet was I motivated to specifically check her for signs of a concussion.. Specifically, I questioned her in a way that would reveal whether or not she was having trouble turning short term memory into long term memory (over a period of about 3 minutes).
This revealed she was entirely unable to remember anything that transpired around her 3 minutes after it happenned. Revealing she had sustained a significant concussion.
The lesson: After all cycling accidents, one should inspect the rider's helmet. If there is a crack, check for concussion in this fashion. If there is any indication of even an ostensibly minor head injury during the accident, also check for concussion.
This rider recovered her memory functions after about 8 hours.
(2) To go a hospital, or not?
In general, if you have identified a concussion, it's best to have it properly evaluated at an emergency room. Best, but not absolutely necessary in all cases. In the case of the rider, above, our group stayed with her for about 2 hours, and I (a physician) was able to establish that she had no "laterlaizing" findings (neuro problems on one side and not on the other), nor was her condition in any way worsening. And we established her sister was knowledgeable about "neuro checks post concussion", and would take her in and check her hourly for the next 8 hours. So we took our friend to her sister, who followed her to make sure nothing serious was developing that might require emergency neuro surgery.
I sustained a concussion when I fell running down hill 3 hours into a hike in rural country (with a group, tho I was alone at the time). I slipped on some muddy ground, went down, and whacked the side of my head on a rock. Someone who saw me from the top of that hill later told me it did not look as if I had passed out at all during the event. I walked out (3 hr hike) assisted by a friend and by an ER physician who was in the hiking group at the time, but was then, from the trail-head, carted off to a hospital. When discharged, I was released in the care of an old friend who is an RN and very familiar with neuro checks on post concussion patients..
Both of us fully recovered our short term to long term memory functions within 6 to 12 hours. We remained in a subjectively somewhat altered state for about a week. Friends told me that they liked my personality better in the week post concussion (they said I was more calm and pleasant). One very good friend even mused it might be desireable for her to whack me on the side of the head every two weeks with a baseball bat.
(3) CAT scan, or not?
There is valid medical debate regarding whether or not one needs a CAT scan if one has had a simple concussion with no other findings, and no history of brain problems that might put one at risk. And no indication worriesome things are beginning to appear in the patient's picture. I was given a CAT scan at the hospital, tho it was suggested it was for "medical-legal reasons" even there. Our friend on the night ride, of course, was not given a CAT scan.
While there are valid medical and economic reasons to question whether a CAT scan is appropriate post simple concussion, it is not wise to decline a CAT scan felt by medical authorities to be appropriate because one fears risk from the radiation one receives during the CAT scan.. The X-ray dose involved is so low that it has zero potential to produce radiation-releated medical disease, either acutely or over the entire rest of your life. Not low risk. Not very low risk. ZERO risk.
Zach Kaplan related to me a tragic tale of a cyclist he knew, who had sustained a concussion while riding. He went to a hospital, but adamently refused to have a CAT scan done. This cyclist's reason for declining a CAT was an irrational fear of radiation out of all proporption to the facts intellectually honest science and medicine have amassed concerning this issue. He appeared to make a recovery from the concussion, but two weeks later sustained a brain bleed which, even when treated with emergency neurosurgery, result in his losing most of his vision, and changed his personality significantly. From the information given I cannot tell for sure whether had a CAT scan been done it would have alerted doctors to the danger of this brain bleed occurring, but it certainly is POSSIBLE that is the case.
---marty
Martin H. Goodman MD