October 6, 2025 • 30 mins
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We unpack myths, the new stepwise approach, and why return to school should come before return to play.
• what a concussion is
• common and delayed symptoms including mood and sleep changes
• immediate sideline steps
• why “cocooning” is outdated and how light activity helps
• individualized recovery timelines and risk of returning too soon
• return-to-learn before return-to-play with simple accommodations
• a staircase model for activity and symptom thresholds
• helmets vs brain movement and the role of honest reporting
• practical tips for coaches, parents, and student athletes
Check out our website, send us an email, share this with a friend or young student athlete who is playing some sports and might get a concussion
References
- Broglio SP, Register-Mihalik JK, Guskiewicz KM, et al. National Athletic Trainers' Association Bridge Statement: Management of Sport-Related Concussion. Journal of Athletic Training. 2024;59(3):225-242. doi:10.4085/1062-6050-0046.22.
- Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children. Lumba-Brown A, Yeates KO, Sarmiento K, et al. JAMA Pediatrics. 2018;172(11):e182853. doi:10.1001/jamapediatrics.2018.2853.
- Feiss R, Lutz M, Reiche E, Moody J, Pangelinan M. A Systematic Review of the Effectiveness of Concussion Education Programs for Coaches and Parents of Youth Athletes. International Journal of Environmental Research and Public Health. 2020;17(8):E2665. doi:10.3390/ijerph17082665.
- Gereige RS, Gross T, Jastaniah E. Individual Medical Emergencies Occurring at School. Pediatrics. 2022;150(1):e2022057987. doi:10.1542/peds.2022-057987.
- Giza CC, Kutcher JS, Ashwal S, et al. Summary of Evidence-Based Guideline Update: Evaluation and Management of Concussion in Sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80(24):2250-2257. doi:10.1212/WNL.0b013e31828d57dd.
- Halstead ME. What's New With Pediatric Sport Concussions? Pediatrics. 2024;153(1):e2023063881. doi:10.1542/peds.2023-063881.
- Halstead ME, Walter KD, Moffatt K. Sport-Related Concussion in Children and Adolescents. Pediatrics. 2018;142(6):e20183074. doi:10.1542/peds.2018-3074.
- Leddy JJ. Sport-Related Concussion. The New England Journal of Medicine. 2025;392(5):483-493. doi:10.1056/NEJMcp2400691.
- McCrea M, Broglio S, McAllister T, et al. Return to Play and Risk of Repeat Concussion in Collegiate Football Players: Comparative Analysis From the NCAA Concussion Study (1999–2001) and CARE Consortium (2014–2017). British Journal of Sports Medicine. 2020;54(2):102-109. doi:10.1136/bjsports-2019-100579.
- Scorza KA, Cole W. Current Concepts in Concussion: Initial Evaluation and Management. American Family Physician. 2019;99(7):426-434.
- Shirley E, Hudspeth LJ, Maynard JR. Managing Sports-Related Concussions From Time of Injury Through Return to Play. The Journal of the American Academy of Orthopaedic Surgeons. 2018;26(13):e279-e286. doi:10.5435/JAAOS-D-16-00684.
- Zhou H, Ledsky R, Sarmiento K, et al. Parent-Child Communication About Concuss
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_02 (00:05):
Hi, welcome to your checkup.
We are the Patient EducationPodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try to bringmedicine closer to its patients.
I'm Ed Delesky, a familymedicine doctor in the
Philadelphia area.
SPEAKER_01 (00:21):
And I'm Nicole Ruffo.
I'm a nurse.
SPEAKER_02 (00:23):
And we are so excited you were able to join us
here again today.
Well, I mean, I've heard lastweek was our like best opener.
And it's hard to recreate thattype of energy from the genuine
anguish that I have from theMets losing, the Giants having
an awful day, and MalikNeighbors going down.
(00:45):
As we record this on Sundaynight, uh keeping us very busy.
The Giants lost again.
The Mets still aren't playingbaseball, but at least the
Phillies are having a tough timewith the Dodgers.
So, you know.
It doesn't hurt that bad.
It hurts a lot, though.
And the Yankees are about to getswept.
So I'm very full.
SPEAKER_01 (01:09):
Me too.
We overeat.
And he made white chicken chiliagain.
And it was so good.
And we just kept going back.
Just can't going back.
SPEAKER_02 (01:20):
Can't stop.
Can't stop, want to keep going.
You love that dish.
SPEAKER_01 (01:24):
I do.
It's so yummy.
SPEAKER_02 (01:26):
It's I it's a fair amount of ingredients, and I
really like making it.
And it's fun, it's easy.
Um kind of simple.
But I yeah, no, it's great.
Let's see.
We worked on our list here, andyou wanted to talk about
something that you didn't, butit was a really funny thing.
The rock.
SPEAKER_01 (01:46):
Oh yeah, the anthropology rock.
SPEAKER_02 (01:49):
What are you seeing?
SPEAKER_01 (01:50):
Oh my gosh.
This is like one of the funniestthings I've ever seen.
So people, mainly girls, aredoing this trick on their like
boyfriends, husbands, dads,whatever, saying that they
ordered a rock from the storeAnthropology.
And if you don't know,Anthropology, they have like
(02:12):
clothes and stuff, and thenother sorts of like house
things, candles, those sorts ofthings.
And they're pretty expensive.
So the whole shtick is that thegirl opens this box of a rock
that she like got from thebackyard.
And then she's like, and usuallylike someone else is in on it,
like a mom or a daughter orsomething, and it's kind of
given as a gift.
(02:33):
So she opens it up and they'relike, Oh my god, no way.
Is this an anthropology rock?
Oh my god.
And like then they're trying totalk to the guy, and they're
like, No, you don't understand.
Like, it's sourced from theearth.
And then like the dad will belike, I'll go source of rock
from the earth in the backyardfor you.
But what was even funnier wasthat this like prank TikTok got
(02:56):
so popular that theanthropology, like marketing
team, I guess, oh no, made thesefake TikToks about the rock
collection and how like it was20% off.
And there were, I think, liketwo or three TikToks of like a
fake anthro setup like in thestore.
Oh my god.
This these like deals that theywere running on the rock
collection.
Stop.
So then girls were like doingthis prank at home, and then
(03:18):
they would get out their TikTokand be like, no, look, like and
they're on the anthropologywebsite, and they're like, Look,
they're 20% off.
I got it for a steal.
SPEAKER_02 (03:26):
That's crazy.
I know that was the thing thatyou were missing, and it was
like so funny.
Talk about this.
And you showed me later thatnight, and I thought it was a
hilarious thing.
The anthropology rock.
SPEAKER_01 (03:38):
Yeah.
SPEAKER_02 (03:40):
All right.
Um, tell us about youradventures with your skin.
SPEAKER_01 (03:45):
Oh my god.
I gotta take a sip of waterfirst.
Adventures with my skin.
Where do we start you were born?
Well, I was born.
Um, so I guess like Monday orTuesday, I started having what I
think is like an eczema flare.
(04:06):
Like that's what it kind oflooked like at first.
Like flat, itchy, like whatever.
Kind of looked like eczema.
And I was like, oh, okay,whatever.
Like this happens, it's like thechange of the season, whatever.
But then like over the next dayor so, it evolved into these
blister-looking bite things,kind of.
Well, sorry, it like looked likea little red, like what would
(04:28):
look like a bite, or so wethought.
Um, and then it was blister, andit was like oozing, and like I
looked like I was diseased, andit was kind of like my so then
they would kind of evolve fromthese like bite-looking things
to blisters, and it was on mythighs, kind of just like above
(04:48):
my knees and behind my legs, andlike I looked diseased, and then
I was like covered in theseblisters and are oozing, and
it's gross.
But when we first startednoticing that they kind of just
looked more like bites or likered little dots, the first like
thing, I was like, Oh my god, wehave bed bugs.
Like, pop out.
I was like, I have more.
It's like spreading, I have morebites.
(05:09):
We have bed bugs.
So it's six in the morning, andI'm stripping the whole bed, and
I'm like going around everysingle inch of it with my
flashlight, like lifting up themattress, looking in the box,
right?
Like doing all the things.
There was not a bed bug to befound or like a dead carcass bug
of any sort.
Our bed was totally clean.
I did vacuum it though, but bedwas clean.
So I wash the sheets.
(05:30):
I'm like, okay, we don't havebed bugs.
I feel I feel better.
So then these like bite blisterthings start popping up more and
kind of in like the same area,questionably in a line.
And then we're like, oh my god,I have scabies.
SPEAKER_02 (05:46):
Yeah.
That was the part where it andlike it hurt.
SPEAKER_01 (05:50):
Eddie like was at an Airbnb.
So we're like, oh my god, thisstarted happening around like
Monday.
You got home on a Sunday.
I was like, you brought homescabies from there.
SPEAKER_02 (05:59):
Like, yeah, it's my fault.
SPEAKER_01 (06:01):
And to where like I like got prescribed like a
scabies medicine because I waslike so convinced that like this
is what it was, even though likewe really would have like no
reason to have that.
SPEAKER_02 (06:12):
Right.
SPEAKER_01 (06:13):
Um wouldn't have been a good reason.
Ended up the pharmacy didn'thave it, so didn't need it
because I don't have scabies.
So then on Sunday morning, weget back these beautiful
pictures that we took after Ihad my like hair makeup trial.
We decided to get some photosdone from this photographer that
I really have liked and likehave wanted pictures from her.
(06:33):
Wanted her to do her wedding,but she couldn't, blah, blah,
blah.
So in the photos, I'm wearinglike a sweater dress like that
kind of comes above my knee, andthen I'm wearing knee-high
boots.
So the part of my leg that isexposed is that area on my thigh
right above my knee.
SPEAKER_02 (06:51):
Wait, you don't have anything on your calves either?
SPEAKER_01 (06:54):
No.
SPEAKER_02 (06:54):
Oh my god.
Even more.
SPEAKER_01 (06:57):
And oh, and then like there, there was like spots
on the back of my leg that gotinfected.
So we thought that was somehowlike Oh yeah, don't forget that.
It was like a cellulitis, likethen we thought that was like, I
don't know, whatever.
We're like, what the heck ishappening?
SPEAKER_02 (07:08):
So we get these photos back and we know too
much, but to see it every singleday.
SPEAKER_01 (07:13):
And we noticed that the part of my legs that are
like blistering off are exposed.
And the pictures were taken atthis preserve, but we were like
walking through like high grass,we were sitting in the grass,
like she had us doing all likethese crazy things that got
beautiful photos.
Like I would do it again, andthen we're like, oh my god,
(07:34):
because then you had this wasone spot on your wrist where
your sleeves are rolled upduring the pictures, and then
like a little spot on yourankle, and your ankles were kind
of exposed.
So we're like, oh my god, thisis like poison ivy, or and it
was like following the same likeprogression, like a poison ivy
or sumac or you know, whatever,pick a poison leaf, and like
(07:55):
that's what it was.
And so got some steroids.
I've been putting calamine on itto like dry it out and like do
all the things, and it'sworking, it's working now, so of
course, like all this beingreally critical.
We're yeah, because like I weregetting married in a week, so I
was like, this needs to bewrapped up within a week.
(08:18):
We really gotta make a move onthis fast, but yeah, that was so
crazy, and it's so funny becauseI feel like if I like lived
still in Westchester and we werelike outside a lot and we would
like take Ollie to that onepreserve and like walk him and
stuff, I feel like, or even likeat like my parents or anything
where there's like woods in thebackyard and stuff, like I feel
(08:41):
like my first instinct would belike, oh, this is some sort of
like plant thing.
Right.
But because like we live in thecity, it didn't come and now
like for like a couple yearsnow, the outside like wildlife
and grass, like hasn't been apart of our daily or like weekly
life, and it like wasn't even athought on the radar.
SPEAKER_02 (09:02):
No, it wasn't at all.
SPEAKER_01 (09:03):
But don't you feel like if you if we were like in
Westchester or like in thesuburbs and like going to those
kinds of places more, we wouldthink I would be like, Oh yeah,
this is like I think it wouldhave been a little bit more
obvious.
SPEAKER_02 (09:15):
I well, on top of it, like we were just confused
about what this was, yeah.
And then the timeline didn'tshake out because then I was
like, Oh, is it triggers?
And oh yeah, that was anotherone.
SPEAKER_01 (09:27):
Is it that I thought it was like a bug of some sort,
right?
SPEAKER_02 (09:32):
But then once we started, then I was like, why do
I have it?
Because it can't just be a youthing, yeah.
And then like we weren't therenothing to get bit, so then we
were doing that, and like thatlocked it in for me.
I was like, wow, that's and nowit's getting better, which is
which is even better.
I mean, like huge.
SPEAKER_01 (09:49):
Which I I don't also don't know why, like Eric has
had poison ivy so many times,like he always had like an awful
reaction.
I think he was on steroids everysummer for like eight summers in
a row.
Like he's a skinny legend, andmom's like, oh my god, this is
literally exactly what wouldhappen.
unknown (10:07):
Wow.
SPEAKER_01 (10:08):
So dumb.
SPEAKER_02 (10:09):
That was a big adventure.
SPEAKER_01 (10:10):
Anyway, hopefully we'll be cleared up and not
itchy.
SPEAKER_02 (10:18):
Yeah, I hope you don't have to wake up in the
middle of the night now.
SPEAKER_01 (10:21):
Yeah.
SPEAKER_02 (10:22):
Itchy.
SPEAKER_01 (10:23):
I don't have to go to Bali like this.
Well, I'm like, what is this?
Like, are we gonna have tocancel our trip?
Like, this is only gettingworse.
I'm covered in blisters.
SPEAKER_02 (10:34):
No, I know.
No, that's it didn't look goodthere for a second, but I think
we got it under control.
SPEAKER_01 (10:40):
Yeah.
SPEAKER_02 (10:41):
Thank you for the terribly interesting story.
Um, the only things I have toadd this week, um, because
you've been carrying the show sofar, are our show, watching our
show, The Midnight Mass.
SPEAKER_01 (10:55):
Oh, yeah.
Which like I love some Catholictrauma.
SPEAKER_02 (10:59):
Yeah, there's like some definitely like Catholic
themes in there.
SPEAKER_01 (11:03):
And um it's my god, it's so funny because Eddie was
an altar boy growing up, and Iwas also raised Catholic, but
did not attend church nearly asyou did, nearly as often as you
did.
And it's so funny becausethere's always like the same
like songs and the whole liketo-do and the things that they
say in mass.
So, like anyone who's bit likewas like raised Catholic or has
(11:24):
been to a Catholic mass likethree times would like know all
the words, but because Eddie wasa little altar boy, so he thinks
he's like this goody two shoeslittle Catholic boy.
SPEAKER_00 (11:33):
I am like, oh yeah, yeah, yeah.
This is exactly what happens.
Did you know this is exactlywhat happens in Catholic Church?
Like, it's just like this.
They have it spot on.
I'm like, oh my god.
SPEAKER_02 (11:44):
I was like, oh yeah, those bells are complaining
about everything.
SPEAKER_00 (11:46):
Those bells, I used to ring those bells.
SPEAKER_02 (11:51):
Or like repeating the lines before they'd happen
remote.
Yeah, and they were like, oh no,because they were talking about
like the the old, the old likeuh translation, and then they
like switched in like the 2010sand they were like, oh yeah,
like the new translation'scloser to the original Latin,
but they like did this this bit,and uh and they were like, Oh,
(12:12):
well, thank you, Father.
Thank you for doing the oldversion.
Oh and you're like, yep, wait,this now makes sense.
SPEAKER_01 (12:20):
Yeah, because he's the coach.
SPEAKER_02 (12:22):
Well, all right, so spoiler alert.
SPEAKER_01 (12:24):
The show's been out for a couple years, so I feel
like people.
SPEAKER_02 (12:27):
Spoiler alert for if you didn't want to watch it,
three, two, one.
That makes so much sense why hewas saying the old one because
he was old and that's when hewas practicing.
Wow.
That just wasn't like uh Easteregg, bro.
SPEAKER_01 (12:44):
This is exactly how they do it.
I'm like, yeah, bro, I know I'vebeen to church.
SPEAKER_02 (12:49):
No, it's funny.
Anic is getting spooky.
Um, I normally I don't knowwhether it just like you know
hits hits in the old quarterzone.
Um, but it is it is spooky.
And uh I'm in.
I'm into it.
Um this one for some reason ishitting different.
We're saving love is blind forour flight.
And so excited.
(13:09):
This is to let you know thatwe're going to um our next
couple episodes are gonna be upin the air a little bit.
We're gonna have something foryou to listen to, whether it's
an old episode or something new.
But we are, you know, gettingmarried and then honeymoon, and
we want to respect that.
SPEAKER_01 (13:25):
See you never.
So that's what I'm tellingeveryone at work when I leave on
Tuesday.
See you never.
SPEAKER_02 (13:30):
We gotta go back.
SPEAKER_01 (13:32):
Never know.
SPEAKER_02 (13:33):
Not for a little while, but never know what'll
happen.
Let's see.
And then um, it's kind of alittle out of place, but I was
cooking dinner tonight and justnoticed that like the recipes
are so hard to like on a phone,are so hard to follow along
because I feel like there's alandmine of me like scrolling
and then the screen flashesbecause an ad popped up on the
(13:55):
screen.
SPEAKER_01 (13:55):
Oh my god, that drives me crazy.
SPEAKER_02 (13:57):
Or like the there's the life story of the person who
wrote the recipe, and then atthe very end is like the tiniest
little print of the ingredients.
SPEAKER_01 (14:06):
Well, usually there's like a print button at
the top, and then it'll kind ofopen into like a document.
SPEAKER_02 (14:11):
Oh, well, nope, nope.
I've been scrolling.
I get you get the like, youknow, it's a phone, but it's
like one eighth the width of thephone of text down the middle.
It's it's too much.
It's too much.
But that, yeah, I just wanted toshare that to if anyone thought
that was relatable.
All right.
So why don't we why don't wejump in?
(14:32):
I mean, we've given the goodpeople 15 minutes of crisp
banter.
SPEAKER_01 (14:35):
Let's jump in.
SPEAKER_02 (14:36):
When we get to work, uh, what are we gonna talk about
today, Nick?
SPEAKER_01 (14:40):
Today we're talking about concussions.
SPEAKER_02 (14:43):
Yeah, so it's turns out that I've seen this.
I mean, I think a lot of peoplesee this when they are talking
about sports, we're in footballseason, but that doesn't mean
just for professionals, thatmeans for student athletes at
well as well.
And I have seen a few, I havehad a few experiences.
One was covering a game andtalking to the athletic trainer,
and he said, Yeah, you know,like some kids aren't aware of
(15:06):
what a concussion looks like, sothey don't know.
So they like feel that headacheafter they get a hit, and they
just keep going.
And I was like, wow, that seemslike a huge opportunity for like
education and engagement likeoutside of like their health
class if they aren't learning itthere.
And then on the other side, Iget like them back in the
office, and they're coming inand they're like, Oh, like I got
(15:29):
hit in the head.
Either A, do I have aconcussion, or B, I know I have
a concussion.
Can I go back?
So it prompted me to think likewe should do an episode about
this because I think it would bea useful tool to have, and why
not raise a little bit ofawareness about like concussions
and where we're at?
So that's what we're up to.
Um, we'll include all of ourresources, um, references that
(15:51):
we use.
We have a boatload today.
Um, you can find them in theshow notes.
But why don't we just dive in?
So you've probably heard theword concussion tossed around
after um, like we talked abouton a football field or maybe
like a fail in gym class.
I definitely had that.
I was on the on the copes courseand I fell from a wire.
(16:11):
And it's a miracle that it waslike a foot off the ground, but
um, I'm tall, and it's a miraclethe amount of times on a
basketball court or in thatsituation that I haven't had a
concussion that I could tell.
So I guess what I really want totalk about is what happens to
the brain when we have aconcussion.
So a concussion is a type ofmild brain injury that happens
(16:32):
when a bump, a blow, or a joltto the head, or the body causes
the brain to kind of quicklymove around in the skull, which
is like almost like a sloshingaround in water.
One of the most important thingsto know when it comes to a
concussion is that you don'tnecessarily have to lose
consciousness.
And the vast majority of them,um, in fact, about 80, like 90%
(16:54):
of them, happen without anyonebeing knocked out.
So that kind of invites a lot ofopportunity for not securing the
diagnosis early on.
And that's a big reason aboutwhy they can be missed, because
they aren't always reallydramatic.
Sometimes people can just look alittle dazed, they feel a little
(17:14):
off after a fall.
So it's something important tothink about in that way.
Nikki, um can you take usthrough a little bit?
We talked about like what aconcussion is.
Um can you take us through whatsome of the what to think about
some of the signs and symptoms?
SPEAKER_01 (17:36):
I can.
Um first sign is most commonly aheadache, but then other clues
can include um being like dizzyor kind of like feeling like
hazy or foggy, um, blurryvision, confusion, and nausea.
SPEAKER_02 (17:56):
Yeah, lots of different vague symptoms there.
SPEAKER_01 (17:58):
Yeah, and with like younger kids and like teenager,
you might notice that they'rekind of like irritable or having
like a mood change.
SPEAKER_02 (18:07):
And another thing to think about is that the
concussion symptoms either canshow up right away or sometimes
not until hours later, which issomething to keep in mind.
So in the literature that wewere reviewing for you today, we
found that there's some evidencethat about one in five high
school athletes that playcontact sports like football or
(18:28):
soccer will experience aconcussion at some point during
their season or their career,which is really common.
I mean, you look out on thefield, there are more than five
kids out there, so one of themwill probably get it.
Those are the signs.
Um, the next thing we wanted totalk about is what immediately
to do in the moment.
Um, say you are listening tothis and you play a contact
(18:51):
sport, or maybe you're a coachor you're a parent who's
watching their kid participatein a sport.
These are the things that youcan immediately do.
Take them out of the game, leavethe game.
And now I'm speaking directly tothe student athlete.
Like, this is so much more aboutthe greater arc of your life
than it is being in thatcompetitive moment.
(19:14):
So I think it's a tough thingwhen you like are in there and
you're with your your teammatesout on the field in that
competitive spirit.
But the most important thing todo, if you took a hit to the
head and you feel thosesymptoms, or you feel a
headache, this isn't about thegame anymore.
This is about health.
And anyone listening to that,the first thing, easy, don't go
(19:39):
back in the game.
In fact, they shouldn't returnto the game in the same day,
even if they feel fine.
It's actually a law in 50states, all 50 of them, that a
healthcare professional mustclear an athlete before
returning to play after aconcussion.
And yet, despite all of this,which is something we're trying
(19:59):
to improve on today, there issome evidence that up to half of
all concussions go unreported byathletes, often because they
don't recognize the symptoms orthey don't want to lose their
playing time.
So that is very significant tothink about.
Did you ever have a concussionfrom jumping in the water too
(20:20):
hard?
SPEAKER_01 (20:21):
No.
unknown (20:25):
No.
SPEAKER_02 (20:26):
Your brothers?
SPEAKER_01 (20:28):
Yeah, Eric had one.
And he's playing football.
And my dad called me.
He's like, Yeah, I think I don'tknow if he was out of game or
practice, but they like had togo pick him up because he like
fell or whatever, or they liketook him home because he like
went down or like hit his head.
And my dad called me and I wasat work.
(20:50):
And he's like, Oh yeah, theythink Eric has a concussion.
I don't know.
He says he like might throw up,and I was like, You need to
bring him here.
Oh my god.
Oh my god.
Yeah, he was like out of it.
My mom even said the like EDattending was like worried about
him, and I was like, Oh man.
Okay, he was fine though.
SPEAKER_02 (21:09):
Yeah, well, that's good.
He's fine now, which is usuallyhow it goes.
People usually have symptoms formaybe about a week, two weeks,
and it goes away.
We can get into the little bitof that later.
So this next section I think isimportant because the management
or thought processes aboutconcussions have changed over
time.
And that's something we wantedto bring a magnifying glass to
(21:31):
today.
So let's talk about what'schanged because it's very
different.
So do you want to go back andforth or go one at a time?
Old thinking, new evidence.
SPEAKER_01 (21:44):
Sure.
SPEAKER_02 (21:44):
All right.
Nick, what was the old thinking?
SPEAKER_01 (21:47):
The old thinking is that you need complete rest in a
dark room until every symptomdisappears.
So the uh And isn't there Idon't think this is down here
lower.
Wasn't it a concussion thatpeople used to say, like, don't
let the person fall asleep?
SPEAKER_02 (22:06):
Yes.
SPEAKER_01 (22:06):
Yeah.
SPEAKER_02 (22:07):
That used to be a thing too.
SPEAKER_01 (22:09):
But new evidence, um, so regarding the complete
rest is that too much rest canactually slow your recovery.
Um and that gentle movement,even going for like a short walk
outside, can help the brain healfaster.
Which makes sense.
Because any sort of like and Ilike currently work on a brain
(22:30):
injury floor, like sleep iscritical for your brain to heal.
SPEAKER_02 (22:35):
Totally.
SPEAKER_01 (22:36):
If you have had any sort of like injury to your
brain.
And yeah, you don't need to bein a dark room.
I mean, we have like a likespecial therapy dedicated to
like cognitive therapy so likestimulate your brain still.
SPEAKER_02 (22:57):
Right.
Um, that's so the moving, likeputting everyone in a like dark
room and on strict rest strictrest was called cocooning, and
that was the predominant idea.
But now things have changed alittle bit, um where they are
recommending a short period ofrest, one to two days, followed
(23:20):
by what you mentioned, the lightactivity that doesn't make
symptoms worse.
So the old way of thinking wasif you feel okay, you can play
again.
And there's now a lot of newevidence that's saying there's
now a lot of new evidence thatsays that feeling fine doesn't
always mean that the brain isready.
And so returning too soon candouble or even quadruple the
(23:43):
risk of another concussion orprolonged symptoms of that
concussion thereafter.
So even if a player feels readyand back to normal, reiterating
that gradual step-by-step returnto play is what keeps them safe.
So, what's the fourth myth?
SPEAKER_01 (24:01):
The fourth one is that all concussions are the
same and they are treated thesame way.
SPEAKER_02 (24:06):
Is that true?
SPEAKER_01 (24:08):
That is not true.
Um, every concussion isdifferent.
Recovery times and even thesymptoms can vary from person to
person, and your treatmentshould be individualized.
Um athletes should be monitoredclosely.
And you know, if two kids get aconcussion in the same football
game, like one might be clearedsooner than the other.
(24:29):
It just depends on how they'rerecovering.
SPEAKER_02 (24:33):
So, in summary, the the old way of thinking seemed
to be like really lock peopleup, don't let them sleep, keep
them in a dark room away fromeverything for a long time, and
then after maybe X amount oftime, toss them back out there
and see how things go, which isvery different than how things
are going these days.
(24:55):
All right, so the next segmentthat we have is talking about
returning to school and sports.
So what we have here is thatmost students recover in about
one to two weeks.
But there is the chance that wehave estimations of about one in
four may have symptoms lastinglonger than a month.
And while that's not great,obviously that stinks to feel
(25:18):
that it ends up being okay.
And if it's longer than a monthor it gets around there, we get
into a different definition ofsomething called post-concussion
syndrome, which we won't talk somuch about right now.
But to stay in line withreturning to school, a return to
school should come before areturn to sport.
Arguably education is moreimportant, but some kids, while
(25:41):
they're doing that, may needshorter days or more breaks for
a while, which should be okay.
Should be okay.
I don't know what this accentwas.
Should be okay.
Um, so you could think of itlike a staircase.
Each step adds a little bit moreactivity when you're going up
the staircase, and if thesymptoms come back, you step
down and then you rest and tryagain.
(26:03):
It's called the rule of two.
Another thing would be thinkingon a scale of one to ten.
If you're doing an activity andyour symptoms go from a two to a
four, maybe you kind of takethat as the upper limit and then
dial it back if you need to.
Um needing accommodations atschool is something that is
pretty regular.
(26:23):
About one in three studentsrecovering from a concussion
needs temporary academicaccommodations.
So teachers and school nursescan really make a difference in
supporting students as they getback to what they were doing
before.
Nikki, um, our next segment istalking about emotional and
cognitive recovery.
And I mentioned this because youmentioned that a teenager who
(26:44):
may get a headache may find tobe a little irritable.
Um, what sorts of things can wethink about here?
SPEAKER_01 (26:51):
So we know that concussions don't just affect
coordination and balance, butthey can change your mood,
sleep, concentration.
So it's normal for like ateenager student to feel
frustrated or down, if you know,they're frustrated, if they are
having trouble concentrating,they're not sleeping well.
Um so they can get kind ofirritable if they can't kind of
(27:15):
keep up with the rest of theirclass or like you know, yeah,
it's kind of stink what theywere doing before.
SPEAKER_02 (27:22):
Like this thing that you weren't planning on having
to get, and then all of a suddenit's impacting so many parts of
your life.
I think in that way support canbe really helpful.
Um, family, coaches, teachers,everyone's kind of staying
positive while the brain getsback to what it was doing
before.
Yeah, that's a big one.
(27:42):
Um, so moving on to our nextsegment, we're talking about
prevention and kind of justcreating awareness.
So obviously, like, you know,there are a lot of high-impact
sports.
I think of boxing, I think ofrugby, I think of soccer, I
think of football.
Football, especially.
I feel like people probably lookat that and they say, Oh, why
wouldn't the helmet totallyprevent the concussion?
(28:04):
And football, like they have thehelmets because they're great
for skull fractures, butsometimes they can't like they
don't fully prevent concussions.
And so that's why like thingslike proper tackling form,
awareness are super importantbecause you can't always see the
symptom, like someone needs todeclare it.
And that's why when me and thislike athletic trainer were
(28:25):
talking, he was like, Oh yeah,like some of the young guys,
there's like a it's like abimodal distribution where some
of the young guys may getsymptoms and they don't
recognize it because they justhaven't been taught it.
But then he said, Some of thehyper competitive older ones
recognize the symptom, and thenthey say, Oh, I want to keep
playing, so I'm just gonna kindof not mention anything because
(28:46):
I know they're gonna take me outif I need to.
SPEAKER_01 (28:49):
Yikes.
Yeah, don't do that.
SPEAKER_02 (28:52):
So I'm not gonna get back up on the soap, the soapbox
again, but that's what hementioned, and I was like, wow,
that's not great.
But I guess you see it after somany years.
So, concussion management isfocused on safe, gradual return
to activity, and it's notisolation or extreme rest.
(29:13):
And be patient.
I think it takes a long time forthings to happen once they do
happen, and do the best we canto avoid getting concussions the
best you can.
Um, but if it does happen, knowthat there's something to do
about it.
So, thank you for coming back toanother episode of your checked
up.
Hopefully, you were able tolearn something for yourself, a
loved one, or a neighbor.
(29:35):
Check out check us out, send usan email, find us on our
website, share this with afriend or young student athlete
who is playing some sports andmight get a concussion.
Uh, but most importantly, stayhealthy, my friends.
Until next time, I'm Ed Delesky.
SPEAKER_01 (29:49):
I'm Nicola Rufo.
SPEAKER_02 (29:50):
Thank you, goodbye.
SPEAKER_01 (29:51):
Bye.
SPEAKER_02 (29:57):
This information may provide a brief overview of.
Diagnosis, Treatment, andMedications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments, or
medications for a specificperson.
This is not medical advice or anattempt to substitute medical
advice.
You should contact a healthcareprovider for personalized
guidance based on your uniquecircumstances.
(30:19):
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorse anytreatments or medications for a
specific patient.
Always talk to your healthcareprovider for a complete
information tailored to you.
In short, I'm not your doctor.
SPEAKER_01 (30:34):
I am not your nurse.
SPEAKER_02 (30:35):
And make sure you go get your own checkup with your
own personal doctor.
Hi, welcome to your checkup.
We are the Patient EducationPodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try to bringmedicine closer to its patients.
I'm Ed Delesky, a familymedicine doctor in the
Philadelphia area.
SPEAKER_01 (00:21):
And I'm Nicole Ruffo.
I'm a nurse.
SPEAKER_02 (00:23):
And we are so excited you were able to join us
here again today.
Well, I mean, I've heard lastweek was our like best opener.
And it's hard to recreate thattype of energy from the genuine
anguish that I have from theMets losing, the Giants having
an awful day, and MalikNeighbors going down.
(00:45):
As we record this on Sundaynight, uh keeping us very busy.
The Giants lost again.
The Mets still aren't playingbaseball, but at least the
Phillies are having a tough timewith the Dodgers.
So, you know.
It doesn't hurt that bad.
It hurts a lot, though.
And the Yankees are about to getswept.
So I'm very full.
SPEAKER_01 (01:09):
Me too.
We overeat.
And he made white chicken chiliagain.
And it was so good.
And we just kept going back.
Just can't going back.
SPEAKER_02 (01:20):
Can't stop.
Can't stop, want to keep going.
You love that dish.
SPEAKER_01 (01:24):
I do.
It's so yummy.
SPEAKER_02 (01:26):
It's I it's a fair amount of ingredients, and I
really like making it.
And it's fun, it's easy.
Um kind of simple.
But I yeah, no, it's great.
Let's see.
We worked on our list here, andyou wanted to talk about
something that you didn't, butit was a really funny thing.
The rock.
SPEAKER_01 (01:46):
Oh yeah, the anthropology rock.
SPEAKER_02 (01:49):
What are you seeing?
SPEAKER_01 (01:50):
Oh my gosh.
This is like one of the funniestthings I've ever seen.
So people, mainly girls, aredoing this trick on their like
boyfriends, husbands, dads,whatever, saying that they
ordered a rock from the storeAnthropology.
And if you don't know,Anthropology, they have like
(02:12):
clothes and stuff, and thenother sorts of like house
things, candles, those sorts ofthings.
And they're pretty expensive.
So the whole shtick is that thegirl opens this box of a rock
that she like got from thebackyard.
And then she's like, and usuallylike someone else is in on it,
like a mom or a daughter orsomething, and it's kind of
given as a gift.
(02:33):
So she opens it up and they'relike, Oh my god, no way.
Is this an anthropology rock?
Oh my god.
And like then they're trying totalk to the guy, and they're
like, No, you don't understand.
Like, it's sourced from theearth.
And then like the dad will belike, I'll go source of rock
from the earth in the backyardfor you.
But what was even funnier wasthat this like prank TikTok got
(02:56):
so popular that theanthropology, like marketing
team, I guess, oh no, made thesefake TikToks about the rock
collection and how like it was20% off.
And there were, I think, liketwo or three TikToks of like a
fake anthro setup like in thestore.
Oh my god.
This these like deals that theywere running on the rock
collection.
Stop.
So then girls were like doingthis prank at home, and then
(03:18):
they would get out their TikTokand be like, no, look, like and
they're on the anthropologywebsite, and they're like, Look,
they're 20% off.
I got it for a steal.
SPEAKER_02 (03:26):
That's crazy.
I know that was the thing thatyou were missing, and it was
like so funny.
Talk about this.
And you showed me later thatnight, and I thought it was a
hilarious thing.
The anthropology rock.
SPEAKER_01 (03:38):
Yeah.
SPEAKER_02 (03:40):
All right.
Um, tell us about youradventures with your skin.
SPEAKER_01 (03:45):
Oh my god.
I gotta take a sip of waterfirst.
Adventures with my skin.
Where do we start you were born?
Well, I was born.
Um, so I guess like Monday orTuesday, I started having what I
think is like an eczema flare.
(04:06):
Like that's what it kind oflooked like at first.
Like flat, itchy, like whatever.
Kind of looked like eczema.
And I was like, oh, okay,whatever.
Like this happens, it's like thechange of the season, whatever.
But then like over the next dayor so, it evolved into these
blister-looking bite things,kind of.
Well, sorry, it like looked likea little red, like what would
(04:28):
look like a bite, or so wethought.
Um, and then it was blister, andit was like oozing, and like I
looked like I was diseased, andit was kind of like my so then
they would kind of evolve fromthese like bite-looking things
to blisters, and it was on mythighs, kind of just like above
(04:48):
my knees and behind my legs, andlike I looked diseased, and then
I was like covered in theseblisters and are oozing, and
it's gross.
But when we first startednoticing that they kind of just
looked more like bites or likered little dots, the first like
thing, I was like, Oh my god, wehave bed bugs.
Like, pop out.
I was like, I have more.
It's like spreading, I have morebites.
(05:09):
We have bed bugs.
So it's six in the morning, andI'm stripping the whole bed, and
I'm like going around everysingle inch of it with my
flashlight, like lifting up themattress, looking in the box,
right?
Like doing all the things.
There was not a bed bug to befound or like a dead carcass bug
of any sort.
Our bed was totally clean.
I did vacuum it though, but bedwas clean.
So I wash the sheets.
(05:30):
I'm like, okay, we don't havebed bugs.
I feel I feel better.
So then these like bite blisterthings start popping up more and
kind of in like the same area,questionably in a line.
And then we're like, oh my god,I have scabies.
SPEAKER_02 (05:46):
Yeah.
That was the part where it andlike it hurt.
SPEAKER_01 (05:50):
Eddie like was at an Airbnb.
So we're like, oh my god, thisstarted happening around like
Monday.
You got home on a Sunday.
I was like, you brought homescabies from there.
SPEAKER_02 (05:59):
Like, yeah, it's my fault.
SPEAKER_01 (06:01):
And to where like I like got prescribed like a
scabies medicine because I waslike so convinced that like this
is what it was, even though likewe really would have like no
reason to have that.
SPEAKER_02 (06:12):
Right.
SPEAKER_01 (06:13):
Um wouldn't have been a good reason.
Ended up the pharmacy didn'thave it, so didn't need it
because I don't have scabies.
So then on Sunday morning, weget back these beautiful
pictures that we took after Ihad my like hair makeup trial.
We decided to get some photosdone from this photographer that
I really have liked and likehave wanted pictures from her.
(06:33):
Wanted her to do her wedding,but she couldn't, blah, blah,
blah.
So in the photos, I'm wearinglike a sweater dress like that
kind of comes above my knee, andthen I'm wearing knee-high
boots.
So the part of my leg that isexposed is that area on my thigh
right above my knee.
SPEAKER_02 (06:51):
Wait, you don't have anything on your calves either?
SPEAKER_01 (06:54):
No.
SPEAKER_02 (06:54):
Oh my god.
Even more.
SPEAKER_01 (06:57):
And oh, and then like there, there was like spots
on the back of my leg that gotinfected.
So we thought that was somehowlike Oh yeah, don't forget that.
It was like a cellulitis, likethen we thought that was like, I
don't know, whatever.
We're like, what the heck ishappening?
SPEAKER_02 (07:08):
So we get these photos back and we know too
much, but to see it every singleday.
SPEAKER_01 (07:13):
And we noticed that the part of my legs that are
like blistering off are exposed.
And the pictures were taken atthis preserve, but we were like
walking through like high grass,we were sitting in the grass,
like she had us doing all likethese crazy things that got
beautiful photos.
Like I would do it again, andthen we're like, oh my god,
(07:34):
because then you had this wasone spot on your wrist where
your sleeves are rolled upduring the pictures, and then
like a little spot on yourankle, and your ankles were kind
of exposed.
So we're like, oh my god, thisis like poison ivy, or and it
was like following the same likeprogression, like a poison ivy
or sumac or you know, whatever,pick a poison leaf, and like
(07:55):
that's what it was.
And so got some steroids.
I've been putting calamine on itto like dry it out and like do
all the things, and it'sworking, it's working now, so of
course, like all this beingreally critical.
We're yeah, because like I weregetting married in a week, so I
was like, this needs to bewrapped up within a week.
(08:18):
We really gotta make a move onthis fast, but yeah, that was so
crazy, and it's so funny becauseI feel like if I like lived
still in Westchester and we werelike outside a lot and we would
like take Ollie to that onepreserve and like walk him and
stuff, I feel like, or even likeat like my parents or anything
where there's like woods in thebackyard and stuff, like I feel
(08:41):
like my first instinct would belike, oh, this is some sort of
like plant thing.
Right.
But because like we live in thecity, it didn't come and now
like for like a couple yearsnow, the outside like wildlife
and grass, like hasn't been apart of our daily or like weekly
life, and it like wasn't even athought on the radar.
SPEAKER_02 (09:02):
No, it wasn't at all.
SPEAKER_01 (09:03):
But don't you feel like if you if we were like in
Westchester or like in thesuburbs and like going to those
kinds of places more, we wouldthink I would be like, Oh yeah,
this is like I think it wouldhave been a little bit more
obvious.
SPEAKER_02 (09:15):
I well, on top of it, like we were just confused
about what this was, yeah.
And then the timeline didn'tshake out because then I was
like, Oh, is it triggers?
And oh yeah, that was anotherone.
SPEAKER_01 (09:27):
Is it that I thought it was like a bug of some sort,
right?
SPEAKER_02 (09:32):
But then once we started, then I was like, why do
I have it?
Because it can't just be a youthing, yeah.
And then like we weren't therenothing to get bit, so then we
were doing that, and like thatlocked it in for me.
I was like, wow, that's and nowit's getting better, which is
which is even better.
I mean, like huge.
SPEAKER_01 (09:49):
Which I I don't also don't know why, like Eric has
had poison ivy so many times,like he always had like an awful
reaction.
I think he was on steroids everysummer for like eight summers in
a row.
Like he's a skinny legend, andmom's like, oh my god, this is
literally exactly what wouldhappen.
unknown (10:07):
Wow.
SPEAKER_01 (10:08):
So dumb.
SPEAKER_02 (10:09):
That was a big adventure.
SPEAKER_01 (10:10):
Anyway, hopefully we'll be cleared up and not
itchy.
SPEAKER_02 (10:18):
Yeah, I hope you don't have to wake up in the
middle of the night now.
SPEAKER_01 (10:21):
Yeah.
SPEAKER_02 (10:22):
Itchy.
SPEAKER_01 (10:23):
I don't have to go to Bali like this.
Well, I'm like, what is this?
Like, are we gonna have tocancel our trip?
Like, this is only gettingworse.
I'm covered in blisters.
SPEAKER_02 (10:34):
No, I know.
No, that's it didn't look goodthere for a second, but I think
we got it under control.
SPEAKER_01 (10:40):
Yeah.
SPEAKER_02 (10:41):
Thank you for the terribly interesting story.
Um, the only things I have toadd this week, um, because
you've been carrying the show sofar, are our show, watching our
show, The Midnight Mass.
SPEAKER_01 (10:55):
Oh, yeah.
Which like I love some Catholictrauma.
SPEAKER_02 (10:59):
Yeah, there's like some definitely like Catholic
themes in there.
SPEAKER_01 (11:03):
And um it's my god, it's so funny because Eddie was
an altar boy growing up, and Iwas also raised Catholic, but
did not attend church nearly asyou did, nearly as often as you
did.
And it's so funny becausethere's always like the same
like songs and the whole liketo-do and the things that they
say in mass.
So, like anyone who's bit likewas like raised Catholic or has
(11:24):
been to a Catholic mass likethree times would like know all
the words, but because Eddie wasa little altar boy, so he thinks
he's like this goody two shoeslittle Catholic boy.
SPEAKER_00 (11:33):
I am like, oh yeah, yeah, yeah.
This is exactly what happens.
Did you know this is exactlywhat happens in Catholic Church?
Like, it's just like this.
They have it spot on.
I'm like, oh my god.
SPEAKER_02 (11:44):
I was like, oh yeah, those bells are complaining
about everything.
SPEAKER_00 (11:46):
Those bells, I used to ring those bells.
SPEAKER_02 (11:51):
Or like repeating the lines before they'd happen
remote.
Yeah, and they were like, oh no,because they were talking about
like the the old, the old likeuh translation, and then they
like switched in like the 2010sand they were like, oh yeah,
like the new translation'scloser to the original Latin,
but they like did this this bit,and uh and they were like, Oh,
(12:12):
well, thank you, Father.
Thank you for doing the oldversion.
Oh and you're like, yep, wait,this now makes sense.
SPEAKER_01 (12:20):
Yeah, because he's the coach.
SPEAKER_02 (12:22):
Well, all right, so spoiler alert.
SPEAKER_01 (12:24):
The show's been out for a couple years, so I feel
like people.
SPEAKER_02 (12:27):
Spoiler alert for if you didn't want to watch it,
three, two, one.
That makes so much sense why hewas saying the old one because
he was old and that's when hewas practicing.
Wow.
That just wasn't like uh Easteregg, bro.
SPEAKER_01 (12:44):
This is exactly how they do it.
I'm like, yeah, bro, I know I'vebeen to church.
SPEAKER_02 (12:49):
No, it's funny.
Anic is getting spooky.
Um, I normally I don't knowwhether it just like you know
hits hits in the old quarterzone.
Um, but it is it is spooky.
And uh I'm in.
I'm into it.
Um this one for some reason ishitting different.
We're saving love is blind forour flight.
And so excited.
(13:09):
This is to let you know thatwe're going to um our next
couple episodes are gonna be upin the air a little bit.
We're gonna have something foryou to listen to, whether it's
an old episode or something new.
But we are, you know, gettingmarried and then honeymoon, and
we want to respect that.
SPEAKER_01 (13:25):
See you never.
So that's what I'm tellingeveryone at work when I leave on
Tuesday.
See you never.
SPEAKER_02 (13:30):
We gotta go back.
SPEAKER_01 (13:32):
Never know.
SPEAKER_02 (13:33):
Not for a little while, but never know what'll
happen.
Let's see.
And then um, it's kind of alittle out of place, but I was
cooking dinner tonight and justnoticed that like the recipes
are so hard to like on a phone,are so hard to follow along
because I feel like there's alandmine of me like scrolling
and then the screen flashesbecause an ad popped up on the
(13:55):
screen.
SPEAKER_01 (13:55):
Oh my god, that drives me crazy.
SPEAKER_02 (13:57):
Or like the there's the life story of the person who
wrote the recipe, and then atthe very end is like the tiniest
little print of the ingredients.
SPEAKER_01 (14:06):
Well, usually there's like a print button at
the top, and then it'll kind ofopen into like a document.
SPEAKER_02 (14:11):
Oh, well, nope, nope.
I've been scrolling.
I get you get the like, youknow, it's a phone, but it's
like one eighth the width of thephone of text down the middle.
It's it's too much.
It's too much.
But that, yeah, I just wanted toshare that to if anyone thought
that was relatable.
All right.
So why don't we why don't wejump in?
(14:32):
I mean, we've given the goodpeople 15 minutes of crisp
banter.
SPEAKER_01 (14:35):
Let's jump in.
SPEAKER_02 (14:36):
When we get to work, uh, what are we gonna talk about
today, Nick?
SPEAKER_01 (14:40):
Today we're talking about concussions.
SPEAKER_02 (14:43):
Yeah, so it's turns out that I've seen this.
I mean, I think a lot of peoplesee this when they are talking
about sports, we're in footballseason, but that doesn't mean
just for professionals, thatmeans for student athletes at
well as well.
And I have seen a few, I havehad a few experiences.
One was covering a game andtalking to the athletic trainer,
and he said, Yeah, you know,like some kids aren't aware of
(15:06):
what a concussion looks like, sothey don't know.
So they like feel that headacheafter they get a hit, and they
just keep going.
And I was like, wow, that seemslike a huge opportunity for like
education and engagement likeoutside of like their health
class if they aren't learning itthere.
And then on the other side, Iget like them back in the
office, and they're coming inand they're like, Oh, like I got
(15:29):
hit in the head.
Either A, do I have aconcussion, or B, I know I have
a concussion.
Can I go back?
So it prompted me to think likewe should do an episode about
this because I think it would bea useful tool to have, and why
not raise a little bit ofawareness about like concussions
and where we're at?
So that's what we're up to.
Um, we'll include all of ourresources, um, references that
(15:51):
we use.
We have a boatload today.
Um, you can find them in theshow notes.
But why don't we just dive in?
So you've probably heard theword concussion tossed around
after um, like we talked abouton a football field or maybe
like a fail in gym class.
I definitely had that.
I was on the on the copes courseand I fell from a wire.
(16:11):
And it's a miracle that it waslike a foot off the ground, but
um, I'm tall, and it's a miraclethe amount of times on a
basketball court or in thatsituation that I haven't had a
concussion that I could tell.
So I guess what I really want totalk about is what happens to
the brain when we have aconcussion.
So a concussion is a type ofmild brain injury that happens
(16:32):
when a bump, a blow, or a joltto the head, or the body causes
the brain to kind of quicklymove around in the skull, which
is like almost like a sloshingaround in water.
One of the most important thingsto know when it comes to a
concussion is that you don'tnecessarily have to lose
consciousness.
And the vast majority of them,um, in fact, about 80, like 90%
(16:54):
of them, happen without anyonebeing knocked out.
So that kind of invites a lot ofopportunity for not securing the
diagnosis early on.
And that's a big reason aboutwhy they can be missed, because
they aren't always reallydramatic.
Sometimes people can just look alittle dazed, they feel a little
(17:14):
off after a fall.
So it's something important tothink about in that way.
Nikki, um can you take usthrough a little bit?
We talked about like what aconcussion is.
Um can you take us through whatsome of the what to think about
some of the signs and symptoms?
SPEAKER_01 (17:36):
I can.
Um first sign is most commonly aheadache, but then other clues
can include um being like dizzyor kind of like feeling like
hazy or foggy, um, blurryvision, confusion, and nausea.
SPEAKER_02 (17:56):
Yeah, lots of different vague symptoms there.
SPEAKER_01 (17:58):
Yeah, and with like younger kids and like teenager,
you might notice that they'rekind of like irritable or having
like a mood change.
SPEAKER_02 (18:07):
And another thing to think about is that the
concussion symptoms either canshow up right away or sometimes
not until hours later, which issomething to keep in mind.
So in the literature that wewere reviewing for you today, we
found that there's some evidencethat about one in five high
school athletes that playcontact sports like football or
(18:28):
soccer will experience aconcussion at some point during
their season or their career,which is really common.
I mean, you look out on thefield, there are more than five
kids out there, so one of themwill probably get it.
Those are the signs.
Um, the next thing we wanted totalk about is what immediately
to do in the moment.
Um, say you are listening tothis and you play a contact
(18:51):
sport, or maybe you're a coachor you're a parent who's
watching their kid participatein a sport.
These are the things that youcan immediately do.
Take them out of the game, leavethe game.
And now I'm speaking directly tothe student athlete.
Like, this is so much more aboutthe greater arc of your life
than it is being in thatcompetitive moment.
(19:14):
So I think it's a tough thingwhen you like are in there and
you're with your your teammatesout on the field in that
competitive spirit.
But the most important thing todo, if you took a hit to the
head and you feel thosesymptoms, or you feel a
headache, this isn't about thegame anymore.
This is about health.
And anyone listening to that,the first thing, easy, don't go
(19:39):
back in the game.
In fact, they shouldn't returnto the game in the same day,
even if they feel fine.
It's actually a law in 50states, all 50 of them, that a
healthcare professional mustclear an athlete before
returning to play after aconcussion.
And yet, despite all of this,which is something we're trying
(19:59):
to improve on today, there issome evidence that up to half of
all concussions go unreported byathletes, often because they
don't recognize the symptoms orthey don't want to lose their
playing time.
So that is very significant tothink about.
Did you ever have a concussionfrom jumping in the water too
(20:20):
hard?
SPEAKER_01 (20:21):
No.
unknown (20:25):
No.
SPEAKER_02 (20:26):
Your brothers?
SPEAKER_01 (20:28):
Yeah, Eric had one.
And he's playing football.
And my dad called me.
He's like, Yeah, I think I don'tknow if he was out of game or
practice, but they like had togo pick him up because he like
fell or whatever, or they liketook him home because he like
went down or like hit his head.
And my dad called me and I wasat work.
(20:50):
And he's like, Oh yeah, theythink Eric has a concussion.
I don't know.
He says he like might throw up,and I was like, You need to
bring him here.
Oh my god.
Oh my god.
Yeah, he was like out of it.
My mom even said the like EDattending was like worried about
him, and I was like, Oh man.
Okay, he was fine though.
SPEAKER_02 (21:09):
Yeah, well, that's good.
He's fine now, which is usuallyhow it goes.
People usually have symptoms formaybe about a week, two weeks,
and it goes away.
We can get into the little bitof that later.
So this next section I think isimportant because the management
or thought processes aboutconcussions have changed over
time.
And that's something we wantedto bring a magnifying glass to
(21:31):
today.
So let's talk about what'schanged because it's very
different.
So do you want to go back andforth or go one at a time?
Old thinking, new evidence.
SPEAKER_01 (21:44):
Sure.
SPEAKER_02 (21:44):
All right.
Nick, what was the old thinking?
SPEAKER_01 (21:47):
The old thinking is that you need complete rest in a
dark room until every symptomdisappears.
So the uh And isn't there Idon't think this is down here
lower.
Wasn't it a concussion thatpeople used to say, like, don't
let the person fall asleep?
SPEAKER_02 (22:06):
Yes.
SPEAKER_01 (22:06):
Yeah.
SPEAKER_02 (22:07):
That used to be a thing too.
SPEAKER_01 (22:09):
But new evidence, um, so regarding the complete
rest is that too much rest canactually slow your recovery.
Um and that gentle movement,even going for like a short walk
outside, can help the brain healfaster.
Which makes sense.
Because any sort of like and Ilike currently work on a brain
(22:30):
injury floor, like sleep iscritical for your brain to heal.
SPEAKER_02 (22:35):
Totally.
SPEAKER_01 (22:36):
If you have had any sort of like injury to your
brain.
And yeah, you don't need to bein a dark room.
I mean, we have like a likespecial therapy dedicated to
like cognitive therapy so likestimulate your brain still.
SPEAKER_02 (22:57):
Right.
Um, that's so the moving, likeputting everyone in a like dark
room and on strict rest strictrest was called cocooning, and
that was the predominant idea.
But now things have changed alittle bit, um where they are
recommending a short period ofrest, one to two days, followed
(23:20):
by what you mentioned, the lightactivity that doesn't make
symptoms worse.
So the old way of thinking wasif you feel okay, you can play
again.
And there's now a lot of newevidence that's saying there's
now a lot of new evidence thatsays that feeling fine doesn't
always mean that the brain isready.
And so returning too soon candouble or even quadruple the
(23:43):
risk of another concussion orprolonged symptoms of that
concussion thereafter.
So even if a player feels readyand back to normal, reiterating
that gradual step-by-step returnto play is what keeps them safe.
So, what's the fourth myth?
SPEAKER_01 (24:01):
The fourth one is that all concussions are the
same and they are treated thesame way.
SPEAKER_02 (24:06):
Is that true?
SPEAKER_01 (24:08):
That is not true.
Um, every concussion isdifferent.
Recovery times and even thesymptoms can vary from person to
person, and your treatmentshould be individualized.
Um athletes should be monitoredclosely.
And you know, if two kids get aconcussion in the same football
game, like one might be clearedsooner than the other.
(24:29):
It just depends on how they'rerecovering.
SPEAKER_02 (24:33):
So, in summary, the the old way of thinking seemed
to be like really lock peopleup, don't let them sleep, keep
them in a dark room away fromeverything for a long time, and
then after maybe X amount oftime, toss them back out there
and see how things go, which isvery different than how things
are going these days.
(24:55):
All right, so the next segmentthat we have is talking about
returning to school and sports.
So what we have here is thatmost students recover in about
one to two weeks.
But there is the chance that wehave estimations of about one in
four may have symptoms lastinglonger than a month.
And while that's not great,obviously that stinks to feel
(25:18):
that it ends up being okay.
And if it's longer than a monthor it gets around there, we get
into a different definition ofsomething called post-concussion
syndrome, which we won't talk somuch about right now.
But to stay in line withreturning to school, a return to
school should come before areturn to sport.
Arguably education is moreimportant, but some kids, while
(25:41):
they're doing that, may needshorter days or more breaks for
a while, which should be okay.
Should be okay.
I don't know what this accentwas.
Should be okay.
Um, so you could think of itlike a staircase.
Each step adds a little bit moreactivity when you're going up
the staircase, and if thesymptoms come back, you step
down and then you rest and tryagain.
(26:03):
It's called the rule of two.
Another thing would be thinkingon a scale of one to ten.
If you're doing an activity andyour symptoms go from a two to a
four, maybe you kind of takethat as the upper limit and then
dial it back if you need to.
Um needing accommodations atschool is something that is
pretty regular.
(26:23):
About one in three studentsrecovering from a concussion
needs temporary academicaccommodations.
So teachers and school nursescan really make a difference in
supporting students as they getback to what they were doing
before.
Nikki, um, our next segment istalking about emotional and
cognitive recovery.
And I mentioned this because youmentioned that a teenager who
(26:44):
may get a headache may find tobe a little irritable.
Um, what sorts of things can wethink about here?
SPEAKER_01 (26:51):
So we know that concussions don't just affect
coordination and balance, butthey can change your mood,
sleep, concentration.
So it's normal for like ateenager student to feel
frustrated or down, if you know,they're frustrated, if they are
having trouble concentrating,they're not sleeping well.
Um so they can get kind ofirritable if they can't kind of
(27:15):
keep up with the rest of theirclass or like you know, yeah,
it's kind of stink what theywere doing before.
SPEAKER_02 (27:22):
Like this thing that you weren't planning on having
to get, and then all of a suddenit's impacting so many parts of
your life.
I think in that way support canbe really helpful.
Um, family, coaches, teachers,everyone's kind of staying
positive while the brain getsback to what it was doing
before.
Yeah, that's a big one.
(27:42):
Um, so moving on to our nextsegment, we're talking about
prevention and kind of justcreating awareness.
So obviously, like, you know,there are a lot of high-impact
sports.
I think of boxing, I think ofrugby, I think of soccer, I
think of football.
Football, especially.
I feel like people probably lookat that and they say, Oh, why
wouldn't the helmet totallyprevent the concussion?
(28:04):
And football, like they have thehelmets because they're great
for skull fractures, butsometimes they can't like they
don't fully prevent concussions.
And so that's why like thingslike proper tackling form,
awareness are super importantbecause you can't always see the
symptom, like someone needs todeclare it.
And that's why when me and thislike athletic trainer were
(28:25):
talking, he was like, Oh yeah,like some of the young guys,
there's like a it's like abimodal distribution where some
of the young guys may getsymptoms and they don't
recognize it because they justhaven't been taught it.
But then he said, Some of thehyper competitive older ones
recognize the symptom, and thenthey say, Oh, I want to keep
playing, so I'm just gonna kindof not mention anything because
(28:46):
I know they're gonna take me outif I need to.
SPEAKER_01 (28:49):
Yikes.
Yeah, don't do that.
SPEAKER_02 (28:52):
So I'm not gonna get back up on the soap, the soapbox
again, but that's what hementioned, and I was like, wow,
that's not great.
But I guess you see it after somany years.
So, concussion management isfocused on safe, gradual return
to activity, and it's notisolation or extreme rest.
(29:13):
And be patient.
I think it takes a long time forthings to happen once they do
happen, and do the best we canto avoid getting concussions the
best you can.
Um, but if it does happen, knowthat there's something to do
about it.
So, thank you for coming back toanother episode of your checked
up.
Hopefully, you were able tolearn something for yourself, a
loved one, or a neighbor.
(29:35):
Check out check us out, send usan email, find us on our
website, share this with afriend or young student athlete
who is playing some sports andmight get a concussion.
Uh, but most importantly, stayhealthy, my friends.
Until next time, I'm Ed Delesky.
SPEAKER_01 (29:49):
I'm Nicola Rufo.
SPEAKER_02 (29:50):
Thank you, goodbye.
SPEAKER_01 (29:51):
Bye.
SPEAKER_02 (29:57):
This information may provide a brief overview of.
Diagnosis, Treatment, andMedications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments, or
medications for a specificperson.
This is not medical advice or anattempt to substitute medical
advice.
You should contact a healthcareprovider for personalized
guidance based on your uniquecircumstances.
(30:19):
We explicitly disclaim anyliability relating to the
information given or its use.
This content doesn't endorse anytreatments or medications for a
specific patient.
Always talk to your healthcareprovider for a complete
information tailored to you.
In short, I'm not your doctor.
SPEAKER_01 (30:34):
I am not your nurse.
SPEAKER_02 (30:35):
And make sure you go get your own checkup with your
own personal doctor.
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