May 3, 2024 • 39 mins
A Crash Course in Concussions
CME Credit link:
https://cmetracker.net/UTHSCSA/Publisher?page=pubOpen#/getCertificate/10095827
Join us for an enlightening episode featuring Dr. Kenneth Nwosa, a distinguished sports medicine specialist, and head doctor for the University of Texas at San Antonio (UTSA) Athletics. Dr. Nwosa shares his journey into sports medicine and provides rich insights from his diverse experience treating a wide range of patients. This episode comprehensively covers crucial aspects of concussions in contact sports, with Dr. Nwosa presenting data, highlighting common symptoms, and underlining the importance of recognition and adherence to sports-specific protocol.
Dr. Nwosa also shares his diagnosis strategy and the crucial role history-taking plays in accurate diagnosis. He emphasizes the significance of routine baseline screenings for concussion management and offers advice on effective utilization of online resources for cognitive function assessments. This episode especially equips pediatric practitioners with critical knowledge about red flags of head injuries requiring immediate evaluation. The emphasis is also on the need for an on-site athletic trainer in sports institutions for immediate attention to injuries and better communication among parents, coaches, and medical professionals.
The conversation goes beyond concussions, shedding light on the pressures faced by young athletes, the dangers of sports specialization, and the benefits of participating in varied sports. Dr. Nwosa promotes a balanced approach to children's sports experience, focusing on educating about bodily development and injury prevention rather than stressing professional anticipation. As a sports medicine specialist, Dr. Ken highlights the importance of comprehensive neuro exams for monitoring brain health post-concussion and offers practical tips on rest, recovery, and supplement use.
Listen in for Dr. Ken's unique take on balancing a demanding career in sports medicine with fatherhood. As a bonus, Dr. Ken shares his favourite Bible quote that motivates him to embrace discipline and determination, both in his practice and personal life.
To send a patient to Dr. Ken, we'll have referral information coming soon, listed here.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Music.
(00:07):
Cases, updates, and discussions for the busy pediatric practitioner.
Click on the link in this podcast for free credit that may include CME,
MOC, or ethics credit, depending on our topic or podcast.
Joining me today here in the podcast studio is Dr. Kenneth Nwosa.
He is a sports medicine specialist.
(00:27):
He's the head doctor for UTSA, or the University of Texas at San Antonio San
Antonio Athletics here in San Antonio, and he also sees patients with sports
injuries in the community.
Dr. Nuosa, thank you so much for being here today. Yeah, thank you very much.
It's a pleasure to be here.
So you went to med school at UTMB and your residency, and then tell me about what you did from there.
(00:52):
Yeah, so the journey to become a sports medicine doctor is pretty unique in
the sense that you can come from any background, whether it be family medicine.
Pediatrics, internal medicine, emergency medicine, even orthopedic surgery.
So I originally was able to complete my medical school in Galveston at UTMB,
(01:14):
and I had the opportunity to go to family medicine residency there in Galveston for three years.
I was chief resident my last year, and the opportunity presented itself to.
Go to a sports medicine fellowship in Birmingham, Alabama, where I worked at
the Andrew Sports Medicine Clinic and the American Sports Medicine Institute,
(01:35):
where I was able to really get my hands on a really robust sports medicine fellowship
from pro athletes to University of Alabama, West Alabama,
Birmingham Southern, to high school athletes and middle school athletes too.
So it was It was a great, diverse collection of patients that I was able to
(01:57):
really develop a firm foundation for my sports medicine knowledge.
And we're talking about concussions today. Our pediatric practitioner listeners
know all too well about concussions where they happen too often.
You were an athlete in high school in Flower Mound.
Yeah, I wasn't a great athlete. I was actually more on the side of performing
(02:22):
in drumline and doing competitions there, but I was an athlete for high school basketball,
middle school football, and concussions are fairly common, especially in contact sports.
Studies and data has shown that football, of course, has a high rate of concussions,
but you can also see it in sports you don't even think about,
(02:43):
cheerleading and soccer.
Those are the top three sports that we see right now.
Where you see the concussions? Yeah. Really? Yeah, those are the top sports
that we see concussions.
And then it differs when you get into the NCAA level because now you include wrestling and hockey.
But football, cheer, wrestling, hockey, soccer, those are things to keep an
(03:03):
eye on for concerns of a concussion.
I was a cheerleader in high school. And there was one of our classmates who
was on the top of the pyramid who was dropped and had a bad injury.
But it didn't seem to have the recognition like it wasn't thought of as other sports.
We competed and we did a lot of athletic things.
(03:26):
But do you think that these other sports, soccer and cheerleading,
are getting more recognized of the risk of a concussion and like football has
for a number of years now? Yeah, because, you know, the most popular thing is football.
Everybody knows that if you get hit, you get your bell rung,
you may sustain a concussion. But again, it can happen in other sports.
And whether or not there's a protocol to identify and then rehab those athletes,
(03:50):
that has to be discussed and further research to define what is a great protocol
for these different sports outside of football. ball.
Our recognition and our observation and treatment of these athletes are continuing
to get better and better and better.
So it's becoming more apparent. People are becoming more privy to it.
(04:11):
And that's just better all around for our athletes. And with cheerleading,
I mean, you're on top of a pyramid.
You're being thrown up in the air. I mean, it makes a lot of sense.
Yeah, a lot of caution for that. It could be very dangerous. And luckily.
USA Cheer has their own concussion protocol. We have our own concussion protocol at UTSA.
And it's always important to have spotters available when conducting in tosses,
(04:35):
basket tosses, pyramids, and also trying to protect themselves,
protect their head and neck area if something happens where the pyramid does, you know, fall.
So it's important to learn techniques on how to decrease the likelihood of head injuries.
And all the gymnastics that's involved, front flips, back flips.
Exactly. If you're up in the air, you're going to come down and hopefully you come down your two feet.
(04:58):
Well, I'd like to put in there, we did win ninth in the nation my freshman year. Uh-oh. There we go.
Awesome. I've always wanted to be able to say that in a public setting. There you go.
And soccer, those hits that may seem not as serious, but it's so often.
Can you tell us about that? So soccer, the main concern is, of course, is heading the ball.
(05:18):
That can be a very serious force to the skull, causing some brain microtraumas.
But also head-to-head collision is something that we see.
Falling down flat on your face on the pitch is something that we see.
So there are a lot of opportunities to get injured and have a concussion.
(05:43):
And so it's just being aware of the possibility that is a possibility that if
your patient, your student athlete,
your daughter or son is having symptoms of headaches or dizziness after conducting
in a contact sport like soccer, it'll be great for to get proper.
It'll be great for you to get proper evaluation and really understand if this
(06:06):
is a diagnosed as a concussion.
So, Dr. Nwosuk, may I call you Kenneth? Dr. Ken, Kenneth. Ken is fine. Ken is fine.
Ken, let's talk about that differential diagnosis.
What would you want pediatricians to know?
So, of course, getting a great history from the student athlete or their parents
(06:29):
is key and it's essential to formulating a proper differential diagnosis,
understanding if they lost consciousness, if they have any neck pain,
headaches or dizziness, numbness or tingling in their upper extremities.
Because the broad differential can include just a regular headache.
Of course, it can include a concussion. Is this something like a stinger where
(06:52):
you have a unilateral radiation of pain down an extremity?
Or is this any other type of neurotrauma to the the head and neck area.
So it'll be very important to get that proper history so you can formulate your
diagnosis accordingly.
And are there certain forms that you recommend?
(07:15):
Is there something that make sure you use this form for that recognition?
The recommended course of action in terms of identifying a concussion is to
actually get baseline screening.
So if you do have the opportunity to get baseline screenings with your local
high school and athletic trainer, go ahead and do that, whether that's with
the impact or even sway testing. Oh, this is before.
(07:36):
So getting a baseline test before, and there's plenty of apps,
plenty of products that you're able to get mass baseline testing at a given school.
Do you recommend that pediatric practitioners suggest that to families?
Yeah, it can be suggested, but the likelihood of it happening without backing
(07:58):
of the actual school is very very tough so.
It's understandable if it can't happen, but after the concussion is where you
want to conduct a SCAT-6.
The international conference determined that we update from a SCAT-5 to a SCAT-6,
which is a questionnaire that the student athlete,
(08:19):
parent, and yourself as a practitioner can fill out and evaluate through a clinical visit.
And you're looking at cognitive function, you're looking at memory,
coordination and balance, and also identifying certain symptoms and creating a scale.
(08:39):
Practitioners, it's a fairly easy internet search.
Child SCAT 6, as well defined by their age, or even a regular SCAT 6 if they
surpass that age limit. it, found in the British Journal of Sports Medicine,
also on the internet if you look up a PDF.
But it's a great assessment tool to determine memory, cognitive function,
(09:04):
balance, and also scaling their symptoms.
What are the symptoms really where it could be something even more serious than a concussion?
So one of the things you got to look out for is whether or not their Their brain
and their skull is truly traumatized, leading to significant deficiencies in
their neurocognitive function.
(09:26):
So having a long-lasting bout of unconsciousness is an alarming sign.
So longer than, say, how long? 30 seconds?
It determines. So if it's more than 30 seconds or a minute, you just want to
have the proper evaluation. evaluation, but you're going to have to use more
of a clinical subjective sense on the duration of period.
(09:50):
So if they have a long duration loss of consciousness, if there's any nausea
or vomiting, if they have difficulty with vision or they can't see,
those are things to watch out for. And those are the alarming red flags.
Numbness and tingling in the upper extremities that,
that is not coming back, that they don't, they lost that sensation and that
(10:12):
sensation isn't returning.
That's also an alarming sign and significant neck pain in which they cannot
move their neck or they have extreme difficulty with just the basic rotation of their neck.
That's again, a red flag to look out for.
That means we need to go to the emergency room.
We need, this is based off of evaluation on the field.
(10:34):
All right. Because it could be a brain bleed. It could be a spinal cord injury.
Exactly. It could be a spinal cord injury, number one. It could be a fracture of the cervical spine.
It could be a traumatic brain injury that is most severe, leading to possible
bleeding or contusion of the area.
So that means do not pass go. Go straight to the emergency room for proper evaluation.
(10:58):
And you say that every athletic program should have a trainer on site.
Yes. So if your child or if your patients are participating in contact sports,
it's always great to verify if there's an athletic trainer available during
practices or during games because their level of training,
(11:18):
they're able to identify injuries, including concussions, and be able to provide
prompt evaluation and possibly even treatment to help them be seen by a physician afterwards.
So it's always good to ask the school board, ask principal, ask coaches,
do you guys have an athletic trainer on site?
(11:40):
And then also promote the hiring and the position of athletic trainers within
school districts and stadiums and soccer fields, baseball stadiums, everything like that.
And to be on site at the games, at the practices even, would be ideal.
If they can be on site at the practices, even better. We're also realistic that.
(12:00):
You know, this requires a certain amount of funds, but it's an investment that can help save lives.
And can you recommend that the pediatric practitioner, if he or she has time,
to also communicate back to the coach?
Exactly. So I always recommend communicating with the athletic trainer.
(12:21):
I mean, if athletic trainer is not available, communicating with the coach,
making sure that everybody's on page, Not only the student athlete,
but the parents, the athletic trainer and the coaches to understand that,
you know, especially if a concussion is sustained, that there is a return to
play and return to full activity protocol.
(12:42):
And it's five phases and you every phase you're adding a level of activity,
adding a level of strenuous testing to see how their brain is able to tolerate that level of activity.
And hopefully they're able to complete that five-phase protocol and go back
to full contact, go back to full level of activity as normal.
(13:05):
And the five phases you're talking about, is that something that could be handled
in the community pediatric setting?
Or would you recommend, is that a time to refer out to a sports medicine specialist?
So I always, I'm a sports I'm a workforce medicine specialist,
so I always recommend referring out, but it can be handled in the community
with proper understanding of the protocol,
(13:29):
proper identification of red flags, proper identification of signs and symptoms
when the protocol is not going correctly.
How it's written out. So if they're going through the five-phase protocol and
they have symptoms, you want to make sure that they stay at that phase or even go back a phase.
Because if you keep progressing them through that protocol, they're not going to feel any better.
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It's going to cause more harm. It's going to delay their return to play.
So if you have the opportunity to refer out to a sports medicine specialist,
this is something that we are trained in how to communicate properly,
how to monitor properly, and have discussions with parents, athletic trainers,
and coaches so that the student athlete can play to the best of their abilities when they feel.
(14:17):
Right again.
We recommend having a sports medicine specialist you can send to urgently.
Like I know I help connect you to community pediatricians when they call me
and they have a patient with a concussion.
Exactly. Or multiple concussions.
And you, I'm sure, often give your cell phone out to doctors so they can call you.
(14:40):
Yeah, 100%. And it's always a great, you know, having that communication.
It's always great because I can discuss, hey, these are my thoughts.
This is how we should move forward.
And actually, I think we should increase the level of care and maybe consider
referring out to a neurologist or getting proper So having that communication
(15:02):
physician to physician,
practitioner to practitioner is very, very crucial for the management and care of a student athlete.
And it can be really tough with a lot of these sports we're talking about because
the athlete doesn't want to be put out of the game. And...
And the coach doesn't want the athlete to be put out of the game. Yeah, sometimes.
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Sometimes. And then to be put back in after a concussion.
In fact, we had one patient where a community pediatrician called me and the
patient had been put back in five times.
Concussion, concussion, each time getting a concussion. And that can be very serious. Yeah.
And that's why identification, education of parents, of understanding and being
(15:48):
an advocate for their student athlete will always be prime and key.
Education for the student athlete themselves to understand the signs and symptoms.
Hey, when you're not feeling right, make sure you speak up.
Make sure that everybody around you understands how you're feeling in that moment.
So the CDC has a great program called Heads Up that is a concussion educational
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tool for parents and coaches, athletic trainers, physicians.
It's pretty much a basic, it's a basic program to identify the risks,
especially with football, of a concussion, how to identify those symptoms and
what are the next best steps.
So when an athlete is concussed and is put back out there in play,
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the worst possible thing is to get what's called second impact syndrome,
which can cause devastating long-term effects.
So being hyper aware and having proper education of everybody around that athlete
is going to be crucial to decrease the likelihood of long-term effects.
And if you have, if there's an athlete who was put in, say, five times,
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got five concussions, what are some of those long-term effects?
It's still debatable what exactly they are. So I can't really define this is
what's going to happen because every patient varies.
But the worst is going to be long-term.
Permanent neurocognitive decline. And having significant headaches,
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having just neurodefects and neurodeficits that can just hamper their activity.
The concern was that there's going to be neurocognitive decline and defects
just down the line and stuff that can hamper their progression as a student,
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as they finish out high school, as they go into college,
as they become a working adult.
And that's something that we really hope that doesn't happen.
And the worst thing would just be causing an actual traumatic event to the brain
where it leads to actual brain injury, structural injury and damage,
(18:02):
such as significant contusion or even a bleed?
My cousin, Alex Smith, he was quarterback for the Kansas City Chiefs,
and he got a concussion. Oh, that's your cousin? Oh, nice.
He got a concussion as quarterback. He had the best record.
Like the most consecutive starts or something like that? Was that it?
(18:24):
I don't remember exactly, but something like that. Yeah, I remember it was something like that.
Yeah, and so everything was going great. He got a concussion and talked about
his symptoms and got pulled out of the game, had to take some time off to rest,
followed the protocol, did the right thing.
But then the coach hired someone else and he lost his job basically as quarterback
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for the Kansas City Chiefs.
Do you think we've gotten better since then in terms of understanding how serious this is?
Yeah. I think as years go on, we're always going to get better and better of
understanding the impact of a concussion and also having empathy for athletes
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that have to sit out in order to recover.
Unfortunately, when you get to the professional ranks, it's very much a business.
So it's a little bit more difficult in terms of when you're sitting on the sideline
recovering in terms of job protection.
But luckily for high school and for For college, these student-athletes are
protected, and they are very much so watched over as they recover through the
(19:29):
return-to-play protocol.
And essentially, every year, we're just getting better and better at advocating
for these athletes and providing accommodations academically for them,
too, so they can be a successful student also.
One of the last games, my son played JV basketball for his high school.
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And one of his fellow teammates got, I mean, it looks like a really...
Tough head injury and he was lying there on the
court and his mom got up
and yelled get up get up now and she kept yelling at him just to get up when
he's lying there and i was just shocked that that's what she was yelling it
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just seemed and he eventually did and he was taken out of the game but the when
they feel the pressure even from parents to get up right after you've been injured Yeah.
And that's, you know, that's kind of the world that we live in now with AAU with seven on seven.
I was there this weekend for AAU. Exactly. And an ambulance came,
a crew, there was, it was actually a knee injury, one of the kids,
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but taken out on a stretcher.
So it's getting, it's getting more tough where you're having the professionalization
of amateur athletes in high school and college.
So the stakes are getting even much more higher. so
it's really just again boils down to having a foundation of education of what
to watch out for and having the necessary staff at these competitions so if
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you have a tournament you know if you have a major tournament who's who who
is actually watching for injuries are.
Are these organizations hiring a and a prn athletic trainer and paying them
to be on the sidelines to look at all the treat and determine the severity of injuries,
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if the EMS should be called, should you use their services.
So it's going to be about education, providing necessary staff and support for
athletic trainers in these areas.
And hopefully this can kind of mend off the pressure from the professionalization
of amateur sports. Yeah, it seems like there's a lot of pressure.
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And I could see these boys just playing their hearts out, but hopefully they're having fun still.
Yeah, I had fun. So I'm not sure what they're having right now.
Hopefully, I don't think they can just get like a shoe deal from their AAU tournaments.
Hopefully, they're just they're creating connections with their teammates and
actually having fun playing basketball.
Yes it's like this who's watching it
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like adidas is here i'm like what do you mean adidas is here
yeah why why does that matter yeah the odds are
you know the odds back in the 80s versus the odds and
now they're the same it's one in a million that adidas is gonna pay you to play
basketball yeah they're still gonna you know the the greats that were there
in the 80s probably play the same played less and had less pressure on them
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guess what they're still gonna to be great. And that's kind of what it is now.
So it's hopefully, you know, there's just less pressure on, on student athletes
are just meant to be student athletes,
you know, not, you know, they're not going to go to the pros and that they can
just enjoy their time with their teammates and with their coaches and with their families too. So.
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Is that what you recommend as parents that we say to our kids when we can?
Yeah. You know, realization is always important and how you present it.
That's going to, you know, that's your own, that's going to be your own thing, but.
Honey, you might not make it pro. It's actually a pretty high chance you won't.
Exactly. It's like, let's focus more on enjoying the sport.
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Let's focus more on, you know, if you do have the opportunity to play in college,
focus on getting that degree. When you look at the stats, an average pro career
is around two to three years, right?
Even if you're great, even if you have the opportunity to get a college scholarship
and get drafted, undrafted, and play in a professional league,
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your lifespan averages at two to three years.
So if you're pressuring yourself
to now just work for two to three years
and not focus on all the outside stuff and a big thing right now is sports specialization
so focusing on just one sport can actually hinder the development of just your
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body and of your the biomechanics of your body because you're not participating
in other like track and field like soccer and you're just
focusing on just football or just focusing on basketball or especially baseball,
you want to be able to try different things to work on your coordination.
So have fun, be a kid. Parents promote that. Have fun, be a kid.
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And also just educate yourself on identifying injuries, educate yourself on
the resources around you.
And hopefully that can just, you know, just Just let them be a kid and have fun at playing sports.
And why with baseball? Is that because of certain injuries that happen?
Yeah. As you can see now in the news, the biggest thing right now is Tommy John,
(24:38):
Tommy John injuries, which involves the ulnar collateral ligament.
And they're determining that the human body pretty much cannot sustain a level of.
95 to a hundred mile per hour fastballs over and over again.
And you can see things in, you can see several diagnoses in little league that
(24:59):
involves like little league shoulder, elbow, avulsion fractures,
because they keep throwing and there needs to be a period of rest.
There needs to be a change in the environment, change in the sport because the
intensity and And the repetition and overuse of pitchers'
elbows and shoulders are just leading to an ultimate decline that if they do
(25:24):
have the opportunity to play in college or in pro,
they already worn out their arm that they're most likely going to tear their
ulnar collateral ligament.
So it's okay to play baseball, but also try to play another sport or just play during the season?
Exactly. Play other sports, take a break, monitor the intensity and the amount
(25:46):
of pitching, even outside of the games.
What are you doing in terms of training?
Is your athlete now pitching with the coach outside and then has their fall
ball team and then their spring ball team that they practice with?
It. So you have to monitor all this.
And I also hope that you're plugging in your child into other environments to
(26:11):
work on other body parts so they can be a well-rounded athlete.
That's great advice. Let's take a case. So Samantha is a 15-year-old soccer
player. She got a concussion.
She was put back in the game and then she got a second concussion.
What should the pediatric practitioner do? So again, getting a good history.
(26:36):
So that's the baseline, getting a good HPI. You want to implement the SCAT-6.
Go through that worksheet with the parent and the athlete.
Go through the memory tests, the coordination and balance testing.
And also go through just every page to make sure that they fill it out properly.
(27:00):
With that SCAT-6, you're able to now do your own neuro exam,
looking at all cranial nerves, looking at their coordination,
their balance, their vestibular function,
their specific tests, and develop a plan from that.
And you're able to determine the extent of their concussion injury.
(27:20):
So the first thing is always send them out, allow their brain to rest.
Supplements like fish oil can help just with the rest and recovery after a concussion,
making sure that they decrease stimuli.
Of bright lights, loud noises, especially looking at their cell phone at night
can cause a little bit more strain and photophobia.
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So try to stay away from that. If they can, you know, there used to be hard
restrictions of going to a dark room and not sleeping.
We have matured from that and understanding what we can do for the brain.
So I think that if you just decrease stimuli that could exacerbate the pain, really focus on that.
And then you have the option of continuing to follow the athlete until their
(28:07):
symptoms return to zero to start the return of play protocol.
Or you can refer out to a sports medicine specialist to assume care,
have proper communication with the coach, athletic trainer, parents,
and the athlete to now wait till their symptoms decrease and then start that
return to play protocol.
And do you want to reiterate, when would there be a case like this could really
(28:29):
be handled easily in the community pediatric setting?
And then when is the edge? I'm going to refer you to a sports medicine specialist.
I think the case right now where there's maybe a multiple hit when there was
a possible concussion that they were pushed back in or they didn't know and
(28:50):
they just went back in and got hit again,
I think that's a great case to send to a sports medicine specialist.
I think a hit and they sat that out.
You can definitely treat that in the community, but it's also about how busy
is your clinic? Do you have time to do the SCAT-6?
Because that does take time to go over the questionnaire and figure out a plan from there.
(29:11):
So it's really practitioner and physician dependent on how they want to go about referring.
But sports medicine specialists can see pretty much anything,
any severity, and then assume care from there.
Can you say that your work at UTSA as the head athletic doctor helps your work
(29:36):
treating kids in the community and vice versa?
Exactly. So I have the opportunity to be the head team physician at UTSA and
all their sports team, including football, soccer, baseball,
men's and women's tennis, softball.
So pretty much 400 to 450 athletes.
Athletes and taking what I learned from their injuries and from their rehabilitation,
(30:02):
working closely with their athletic trainers, I'm able to now transmit that
knowledge to taking care of us in the community, you know, weekend warriors,
people that just jog on the trail on the weekend, people that just like to go out and walk.
You know, outside or play pickleball or play recreational basketball.
So using that, using UTSA as a place to develop and innovate and really use
(30:28):
research-based medicine to
now coordinate that and translate that to the community has shown great,
just great overall results for our patients.
And then not all patients are the same.
So even working with the community, having a clinic just specifically for the
community has helped me to understand certain diagnoses that I'm like,
(30:51):
hey, I actually saw that in my clinic.
Maybe this UTSA athlete has this and it's helped both ways. So it's a very,
very, I'm very, very happy with my practice.
It's very satisfying seeing that translational effect of treating high-level
athletes, treating the community and seeing how each one can help each other.
And do you see adults as well?
(31:12):
Yes. I see, yeah, I see adults.
And kids. Yeah. So you You see patients at the University of Texas Health Science
Center's new location at Kyle Seale Parkway and at the Medical Arts and Research
Center in the Med Center, or also known as the MARC. Yes, yes, yeah.
I see, they call it KSP of 1604 and then also in the Medical Center at the MARC, yeah.
(31:33):
So for our listeners in the South Texas area, San Antonio area,
we'll put that information in the chat. Pat, as an athlete in middle school
and high school, this is a dream come true to be doing what you're doing now?
Yeah, you know, I've always loved being part of a team, and being in sports
medicine allows me to be a part of that team, allows me to share accomplishments, have a common goal.
(31:58):
And the best thing about it is that every athlete wants to get better,
wants to get back on the field pitch, on the court, and it just helps me.
Really revitalize and provide the energy to really get them to where they want to be.
And Ken, what would you say to your middle school football playing self or your
(32:20):
basketball high school self? Keep studying.
That's pretty much it. Yeah. Keep studying. Yeah. Listen to your coaches pretty much. And have fun.
Yeah. Have fun. Have fun. You know, I had a lot of fun playing Well,
I didn't take it too seriously.
I did think I was going to go to the NBA at one point, but then I decided to be a doctor instead.
(32:44):
And it's worked out. Yeah, right.
Here on Pediatrics Now, we love quotes. I love quotes.
Is there a quote that inspires you? I know you mentioned there's a quote from the Bible that you love.
Yeah, 1 Corinthians 9.25. It's one of the verses in the Bible that actually talks about sports.
(33:05):
And it highlights just about training for pretty much a boxing match,
how that discipline and that focus that a boxer can put into their sport and
perfect their craft is the same type of focus and energy that you can put into your life.
And for me, that's also the same type of energy that I put into my sport when
(33:31):
I was younger or put into my practice right now is the same type of energy I
can put into my family, put into my community.
Put into my volunteer working in church.
So there's a lot of passion in sports.
And I believe that the purpose of sport is to develop that discipline and incorporate
(33:52):
that into your life in several different aspects.
And that's the way, that's how I find my joy knowing that if I get this athlete
back to playing sports to the best of their ability, they can use that to now
translate that to their life,
to the relationships that they have, to their spirituality, to different things.
(34:12):
That can inspire others.
Do you want to read it to us? Oh, yeah, sure, sure.
1 Corinthians 9, 24 through 25, and the passage is titled The Need for Self-Discipline.
It states, Do you not know that in a race all the runners run,
but only one gets the prize?
Run in such a way as to get the prize.
(34:33):
Everyone who competes in the games goes into strict training.
They do it to get a crown that will not last, But we do it to get a crown that will last forever.
So using that and just make sure that, hey, like the same energy,
I got to use that to translate it to energy for, you know, things that really
(34:54):
matter and formulate things that really matter in the relationships that I have.
That's wonderful. And we also like to promote, and Pediatrics Now,
doing stuff outside of medicine to help recharge in this high-stress,
high-burnout career. What do you like to do in your spare time?
So I'm still figuring it out because I have a little 11-month-old son.
(35:16):
Congratulations. I appreciate that.
So it's really just hanging out with him and my wife when we can,
watching some Netflix shows, taking a walk in our neighborhood.
We do like trying out different restaurants and places to go for lunch.
Being in the hill country is very beautiful.
So we try to take advantage of that.
(35:39):
Do you feel like being a father has changed you?
I think so. I think, you know, you think about, first of all,
you think about paying for college.
I'm like, what is the price of college going to be like in 2040?
You know, I went to Baylor and And I was like, okay, yeah, I don't know if he can go to Baylor.
You know, they're assuming all this. I saw a calculator the other day.
(35:59):
I was like, okay, this is a lot.
But so, so that, that right there already puts a pressure on your plate.
But I think just, just knowing that you have somebody always looking at you
for, for support, you know, my, my wife said the other day, like,
did you know, like we're his whole world?
Like he, he really doesn't, he has no other friends but us.
(36:22):
I was like, he's looking at us for entertainment, for food, for water, for nurturing.
I was like, yeah, that's true. I say it's the hardest, best job in the world.
Exactly. Exactly. Exactly.
Ken, it's such an honor being here talking to you today in the podcast studio.
Is there anything you want to mention before we wrap?
(36:42):
No, I think this is great. I think, again, just wrapping up,
just education is the main thing. CDC has a heads-up program on their website.
They have just a free program to educate yourself on concussions.
UT Health San Antonio is doing a really good job of developing our sports medicine
(37:02):
program and having a concussion pathway and open for referrals.
And also, just God bless and birds up.
Dr. Ken Nwosa with the University of Texas Health Science Center or UT Health San Antonio.
And the UTSA head doctor for athletics.
(37:22):
Thank you for being here on Pediatrics Now. Thank you very much.
Are we going to have a good football team this next season? Oh yeah, you better be.
Music.
Coming up next week, a Grand Rounds talk about child neglect.
So neglect is usually typified by an ongoing pattern of inadequate care,
(37:46):
and it can actually do as much damage as physical abuse.
I'm Holly Wayment. Thank you so much for listening.
Click on the link for free credit that may include CME, MOC,
or ethics credit, depending on our topic or podcast.
Our website is pediatricsnowpodcast.com. My email address is on there.
(38:10):
Please email me with episode ideas or comments.
Thank you so much for listening.
Our sister podcast is Pediatrics Now for Parents.
Wish your patients heard some of the stuff you just heard?
We'll put that in our Pediatrics Now for Parents podcast, health news in small
(38:33):
bites for the busy parent.
In our sister podcast, Pediatrics Now for the Busy Parent, we include most of
the topics you hear here on Pediatrics Now for the Practitioner,
but in shorter snippets that are meant for the patient or parent.
That's Pediatrics Now for Parents anywhere you get your podcast or the web address
(38:53):
is pediatricsnowforparents.com.
It's meant to be one less thing you have to say in the exam room.
I love this quote by Nelson Mandela, history will judge us by the difference
we make in the everyday lives of children.
Thank you for making a difference.
I'm Holly Wayment, and you're listening to Pediatrics Now.
Music.
(00:07):
Cases, updates, and discussions for the busy pediatric practitioner.
Click on the link in this podcast for free credit that may include CME,
MOC, or ethics credit, depending on our topic or podcast.
Joining me today here in the podcast studio is Dr. Kenneth Nwosa.
He is a sports medicine specialist.
(00:27):
He's the head doctor for UTSA, or the University of Texas at San Antonio San
Antonio Athletics here in San Antonio, and he also sees patients with sports
injuries in the community.
Dr. Nuosa, thank you so much for being here today. Yeah, thank you very much.
It's a pleasure to be here.
So you went to med school at UTMB and your residency, and then tell me about what you did from there.
(00:52):
Yeah, so the journey to become a sports medicine doctor is pretty unique in
the sense that you can come from any background, whether it be family medicine.
Pediatrics, internal medicine, emergency medicine, even orthopedic surgery.
So I originally was able to complete my medical school in Galveston at UTMB,
(01:14):
and I had the opportunity to go to family medicine residency there in Galveston for three years.
I was chief resident my last year, and the opportunity presented itself to.
Go to a sports medicine fellowship in Birmingham, Alabama, where I worked at
the Andrew Sports Medicine Clinic and the American Sports Medicine Institute,
(01:35):
where I was able to really get my hands on a really robust sports medicine fellowship
from pro athletes to University of Alabama, West Alabama,
Birmingham Southern, to high school athletes and middle school athletes too.
So it was It was a great, diverse collection of patients that I was able to
(01:57):
really develop a firm foundation for my sports medicine knowledge.
And we're talking about concussions today. Our pediatric practitioner listeners
know all too well about concussions where they happen too often.
You were an athlete in high school in Flower Mound.
Yeah, I wasn't a great athlete. I was actually more on the side of performing
(02:22):
in drumline and doing competitions there, but I was an athlete for high school basketball,
middle school football, and concussions are fairly common, especially in contact sports.
Studies and data has shown that football, of course, has a high rate of concussions,
but you can also see it in sports you don't even think about,
(02:43):
cheerleading and soccer.
Those are the top three sports that we see right now.
Where you see the concussions? Yeah. Really? Yeah, those are the top sports
that we see concussions.
And then it differs when you get into the NCAA level because now you include wrestling and hockey.
But football, cheer, wrestling, hockey, soccer, those are things to keep an
(03:03):
eye on for concerns of a concussion.
I was a cheerleader in high school. And there was one of our classmates who
was on the top of the pyramid who was dropped and had a bad injury.
But it didn't seem to have the recognition like it wasn't thought of as other sports.
We competed and we did a lot of athletic things.
(03:26):
But do you think that these other sports, soccer and cheerleading,
are getting more recognized of the risk of a concussion and like football has
for a number of years now? Yeah, because, you know, the most popular thing is football.
Everybody knows that if you get hit, you get your bell rung,
you may sustain a concussion. But again, it can happen in other sports.
And whether or not there's a protocol to identify and then rehab those athletes,
(03:50):
that has to be discussed and further research to define what is a great protocol
for these different sports outside of football. ball.
Our recognition and our observation and treatment of these athletes are continuing
to get better and better and better.
So it's becoming more apparent. People are becoming more privy to it.
(04:11):
And that's just better all around for our athletes. And with cheerleading,
I mean, you're on top of a pyramid.
You're being thrown up in the air. I mean, it makes a lot of sense.
Yeah, a lot of caution for that. It could be very dangerous. And luckily.
USA Cheer has their own concussion protocol. We have our own concussion protocol at UTSA.
And it's always important to have spotters available when conducting in tosses,
(04:35):
basket tosses, pyramids, and also trying to protect themselves,
protect their head and neck area if something happens where the pyramid does, you know, fall.
So it's important to learn techniques on how to decrease the likelihood of head injuries.
And all the gymnastics that's involved, front flips, back flips.
Exactly. If you're up in the air, you're going to come down and hopefully you come down your two feet.
(04:58):
Well, I'd like to put in there, we did win ninth in the nation my freshman year. Uh-oh. There we go.
Awesome. I've always wanted to be able to say that in a public setting. There you go.
And soccer, those hits that may seem not as serious, but it's so often.
Can you tell us about that? So soccer, the main concern is, of course, is heading the ball.
(05:18):
That can be a very serious force to the skull, causing some brain microtraumas.
But also head-to-head collision is something that we see.
Falling down flat on your face on the pitch is something that we see.
So there are a lot of opportunities to get injured and have a concussion.
(05:43):
And so it's just being aware of the possibility that is a possibility that if
your patient, your student athlete,
your daughter or son is having symptoms of headaches or dizziness after conducting
in a contact sport like soccer, it'll be great for to get proper.
It'll be great for you to get proper evaluation and really understand if this
(06:06):
is a diagnosed as a concussion.
So, Dr. Nwosuk, may I call you Kenneth? Dr. Ken, Kenneth. Ken is fine. Ken is fine.
Ken, let's talk about that differential diagnosis.
What would you want pediatricians to know?
So, of course, getting a great history from the student athlete or their parents
(06:29):
is key and it's essential to formulating a proper differential diagnosis,
understanding if they lost consciousness, if they have any neck pain,
headaches or dizziness, numbness or tingling in their upper extremities.
Because the broad differential can include just a regular headache.
Of course, it can include a concussion. Is this something like a stinger where
(06:52):
you have a unilateral radiation of pain down an extremity?
Or is this any other type of neurotrauma to the the head and neck area.
So it'll be very important to get that proper history so you can formulate your
diagnosis accordingly.
And are there certain forms that you recommend?
(07:15):
Is there something that make sure you use this form for that recognition?
The recommended course of action in terms of identifying a concussion is to
actually get baseline screening.
So if you do have the opportunity to get baseline screenings with your local
high school and athletic trainer, go ahead and do that, whether that's with
the impact or even sway testing. Oh, this is before.
(07:36):
So getting a baseline test before, and there's plenty of apps,
plenty of products that you're able to get mass baseline testing at a given school.
Do you recommend that pediatric practitioners suggest that to families?
Yeah, it can be suggested, but the likelihood of it happening without backing
(07:58):
of the actual school is very very tough so.
It's understandable if it can't happen, but after the concussion is where you
want to conduct a SCAT-6.
The international conference determined that we update from a SCAT-5 to a SCAT-6,
which is a questionnaire that the student athlete,
(08:19):
parent, and yourself as a practitioner can fill out and evaluate through a clinical visit.
And you're looking at cognitive function, you're looking at memory,
coordination and balance, and also identifying certain symptoms and creating a scale.
(08:39):
Practitioners, it's a fairly easy internet search.
Child SCAT 6, as well defined by their age, or even a regular SCAT 6 if they
surpass that age limit. it, found in the British Journal of Sports Medicine,
also on the internet if you look up a PDF.
But it's a great assessment tool to determine memory, cognitive function,
(09:04):
balance, and also scaling their symptoms.
What are the symptoms really where it could be something even more serious than a concussion?
So one of the things you got to look out for is whether or not their Their brain
and their skull is truly traumatized, leading to significant deficiencies in
their neurocognitive function.
(09:26):
So having a long-lasting bout of unconsciousness is an alarming sign.
So longer than, say, how long? 30 seconds?
It determines. So if it's more than 30 seconds or a minute, you just want to
have the proper evaluation. evaluation, but you're going to have to use more
of a clinical subjective sense on the duration of period.
(09:50):
So if they have a long duration loss of consciousness, if there's any nausea
or vomiting, if they have difficulty with vision or they can't see,
those are things to watch out for. And those are the alarming red flags.
Numbness and tingling in the upper extremities that,
that is not coming back, that they don't, they lost that sensation and that
(10:12):
sensation isn't returning.
That's also an alarming sign and significant neck pain in which they cannot
move their neck or they have extreme difficulty with just the basic rotation of their neck.
That's again, a red flag to look out for.
That means we need to go to the emergency room.
We need, this is based off of evaluation on the field.
(10:34):
All right. Because it could be a brain bleed. It could be a spinal cord injury.
Exactly. It could be a spinal cord injury, number one. It could be a fracture of the cervical spine.
It could be a traumatic brain injury that is most severe, leading to possible
bleeding or contusion of the area.
So that means do not pass go. Go straight to the emergency room for proper evaluation.
(10:58):
And you say that every athletic program should have a trainer on site.
Yes. So if your child or if your patients are participating in contact sports,
it's always great to verify if there's an athletic trainer available during
practices or during games because their level of training,
(11:18):
they're able to identify injuries, including concussions, and be able to provide
prompt evaluation and possibly even treatment to help them be seen by a physician afterwards.
So it's always good to ask the school board, ask principal, ask coaches,
do you guys have an athletic trainer on site?
(11:40):
And then also promote the hiring and the position of athletic trainers within
school districts and stadiums and soccer fields, baseball stadiums, everything like that.
And to be on site at the games, at the practices even, would be ideal.
If they can be on site at the practices, even better. We're also realistic that.
(12:00):
You know, this requires a certain amount of funds, but it's an investment that can help save lives.
And can you recommend that the pediatric practitioner, if he or she has time,
to also communicate back to the coach?
Exactly. So I always recommend communicating with the athletic trainer.
(12:21):
I mean, if athletic trainer is not available, communicating with the coach,
making sure that everybody's on page, Not only the student athlete,
but the parents, the athletic trainer and the coaches to understand that,
you know, especially if a concussion is sustained, that there is a return to
play and return to full activity protocol.
(12:42):
And it's five phases and you every phase you're adding a level of activity,
adding a level of strenuous testing to see how their brain is able to tolerate that level of activity.
And hopefully they're able to complete that five-phase protocol and go back
to full contact, go back to full level of activity as normal.
(13:05):
And the five phases you're talking about, is that something that could be handled
in the community pediatric setting?
Or would you recommend, is that a time to refer out to a sports medicine specialist?
So I always, I'm a sports I'm a workforce medicine specialist,
so I always recommend referring out, but it can be handled in the community
with proper understanding of the protocol,
(13:29):
proper identification of red flags, proper identification of signs and symptoms
when the protocol is not going correctly.
How it's written out. So if they're going through the five-phase protocol and
they have symptoms, you want to make sure that they stay at that phase or even go back a phase.
Because if you keep progressing them through that protocol, they're not going to feel any better.
(13:54):
It's going to cause more harm. It's going to delay their return to play.
So if you have the opportunity to refer out to a sports medicine specialist,
this is something that we are trained in how to communicate properly,
how to monitor properly, and have discussions with parents, athletic trainers,
and coaches so that the student athlete can play to the best of their abilities when they feel.
(14:17):
Right again.
We recommend having a sports medicine specialist you can send to urgently.
Like I know I help connect you to community pediatricians when they call me
and they have a patient with a concussion.
Exactly. Or multiple concussions.
And you, I'm sure, often give your cell phone out to doctors so they can call you.
(14:40):
Yeah, 100%. And it's always a great, you know, having that communication.
It's always great because I can discuss, hey, these are my thoughts.
This is how we should move forward.
And actually, I think we should increase the level of care and maybe consider
referring out to a neurologist or getting proper So having that communication
(15:02):
physician to physician,
practitioner to practitioner is very, very crucial for the management and care of a student athlete.
And it can be really tough with a lot of these sports we're talking about because
the athlete doesn't want to be put out of the game. And...
And the coach doesn't want the athlete to be put out of the game. Yeah, sometimes.
(15:23):
Sometimes. And then to be put back in after a concussion.
In fact, we had one patient where a community pediatrician called me and the
patient had been put back in five times.
Concussion, concussion, each time getting a concussion. And that can be very serious. Yeah.
And that's why identification, education of parents, of understanding and being
(15:48):
an advocate for their student athlete will always be prime and key.
Education for the student athlete themselves to understand the signs and symptoms.
Hey, when you're not feeling right, make sure you speak up.
Make sure that everybody around you understands how you're feeling in that moment.
So the CDC has a great program called Heads Up that is a concussion educational
(16:10):
tool for parents and coaches, athletic trainers, physicians.
It's pretty much a basic, it's a basic program to identify the risks,
especially with football, of a concussion, how to identify those symptoms and
what are the next best steps.
So when an athlete is concussed and is put back out there in play,
(16:36):
the worst possible thing is to get what's called second impact syndrome,
which can cause devastating long-term effects.
So being hyper aware and having proper education of everybody around that athlete
is going to be crucial to decrease the likelihood of long-term effects.
And if you have, if there's an athlete who was put in, say, five times,
(16:58):
got five concussions, what are some of those long-term effects?
It's still debatable what exactly they are. So I can't really define this is
what's going to happen because every patient varies.
But the worst is going to be long-term.
Permanent neurocognitive decline. And having significant headaches,
(17:20):
having just neurodefects and neurodeficits that can just hamper their activity.
The concern was that there's going to be neurocognitive decline and defects
just down the line and stuff that can hamper their progression as a student,
(17:41):
as they finish out high school, as they go into college,
as they become a working adult.
And that's something that we really hope that doesn't happen.
And the worst thing would just be causing an actual traumatic event to the brain
where it leads to actual brain injury, structural injury and damage,
(18:02):
such as significant contusion or even a bleed?
My cousin, Alex Smith, he was quarterback for the Kansas City Chiefs,
and he got a concussion. Oh, that's your cousin? Oh, nice.
He got a concussion as quarterback. He had the best record.
Like the most consecutive starts or something like that? Was that it?
(18:24):
I don't remember exactly, but something like that. Yeah, I remember it was something like that.
Yeah, and so everything was going great. He got a concussion and talked about
his symptoms and got pulled out of the game, had to take some time off to rest,
followed the protocol, did the right thing.
But then the coach hired someone else and he lost his job basically as quarterback
(18:45):
for the Kansas City Chiefs.
Do you think we've gotten better since then in terms of understanding how serious this is?
Yeah. I think as years go on, we're always going to get better and better of
understanding the impact of a concussion and also having empathy for athletes
(19:05):
that have to sit out in order to recover.
Unfortunately, when you get to the professional ranks, it's very much a business.
So it's a little bit more difficult in terms of when you're sitting on the sideline
recovering in terms of job protection.
But luckily for high school and for For college, these student-athletes are
protected, and they are very much so watched over as they recover through the
(19:29):
return-to-play protocol.
And essentially, every year, we're just getting better and better at advocating
for these athletes and providing accommodations academically for them,
too, so they can be a successful student also.
One of the last games, my son played JV basketball for his high school.
(19:50):
And one of his fellow teammates got, I mean, it looks like a really...
Tough head injury and he was lying there on the
court and his mom got up
and yelled get up get up now and she kept yelling at him just to get up when
he's lying there and i was just shocked that that's what she was yelling it
(20:10):
just seemed and he eventually did and he was taken out of the game but the when
they feel the pressure even from parents to get up right after you've been injured Yeah.
And that's, you know, that's kind of the world that we live in now with AAU with seven on seven.
I was there this weekend for AAU. Exactly. And an ambulance came,
a crew, there was, it was actually a knee injury, one of the kids,
(20:33):
but taken out on a stretcher.
So it's getting, it's getting more tough where you're having the professionalization
of amateur athletes in high school and college.
So the stakes are getting even much more higher. so
it's really just again boils down to having a foundation of education of what
to watch out for and having the necessary staff at these competitions so if
(20:58):
you have a tournament you know if you have a major tournament who's who who
is actually watching for injuries are.
Are these organizations hiring a and a prn athletic trainer and paying them
to be on the sidelines to look at all the treat and determine the severity of injuries,
(21:20):
if the EMS should be called, should you use their services.
So it's going to be about education, providing necessary staff and support for
athletic trainers in these areas.
And hopefully this can kind of mend off the pressure from the professionalization
of amateur sports. Yeah, it seems like there's a lot of pressure.
(21:42):
And I could see these boys just playing their hearts out, but hopefully they're having fun still.
Yeah, I had fun. So I'm not sure what they're having right now.
Hopefully, I don't think they can just get like a shoe deal from their AAU tournaments.
Hopefully, they're just they're creating connections with their teammates and
actually having fun playing basketball.
Yes it's like this who's watching it
(22:05):
like adidas is here i'm like what do you mean adidas is here
yeah why why does that matter yeah the odds are
you know the odds back in the 80s versus the odds and
now they're the same it's one in a million that adidas is gonna pay you to play
basketball yeah they're still gonna you know the the greats that were there
in the 80s probably play the same played less and had less pressure on them
(22:28):
guess what they're still gonna to be great. And that's kind of what it is now.
So it's hopefully, you know, there's just less pressure on, on student athletes
are just meant to be student athletes,
you know, not, you know, they're not going to go to the pros and that they can
just enjoy their time with their teammates and with their coaches and with their families too. So.
(22:50):
Is that what you recommend as parents that we say to our kids when we can?
Yeah. You know, realization is always important and how you present it.
That's going to, you know, that's your own, that's going to be your own thing, but.
Honey, you might not make it pro. It's actually a pretty high chance you won't.
Exactly. It's like, let's focus more on enjoying the sport.
(23:11):
Let's focus more on, you know, if you do have the opportunity to play in college,
focus on getting that degree. When you look at the stats, an average pro career
is around two to three years, right?
Even if you're great, even if you have the opportunity to get a college scholarship
and get drafted, undrafted, and play in a professional league,
(23:32):
your lifespan averages at two to three years.
So if you're pressuring yourself
to now just work for two to three years
and not focus on all the outside stuff and a big thing right now is sports specialization
so focusing on just one sport can actually hinder the development of just your
(23:52):
body and of your the biomechanics of your body because you're not participating
in other like track and field like soccer and you're just
focusing on just football or just focusing on basketball or especially baseball,
you want to be able to try different things to work on your coordination.
So have fun, be a kid. Parents promote that. Have fun, be a kid.
(24:14):
And also just educate yourself on identifying injuries, educate yourself on
the resources around you.
And hopefully that can just, you know, just Just let them be a kid and have fun at playing sports.
And why with baseball? Is that because of certain injuries that happen?
Yeah. As you can see now in the news, the biggest thing right now is Tommy John,
(24:38):
Tommy John injuries, which involves the ulnar collateral ligament.
And they're determining that the human body pretty much cannot sustain a level of.
95 to a hundred mile per hour fastballs over and over again.
And you can see things in, you can see several diagnoses in little league that
(24:59):
involves like little league shoulder, elbow, avulsion fractures,
because they keep throwing and there needs to be a period of rest.
There needs to be a change in the environment, change in the sport because the
intensity and And the repetition and overuse of pitchers'
elbows and shoulders are just leading to an ultimate decline that if they do
(25:24):
have the opportunity to play in college or in pro,
they already worn out their arm that they're most likely going to tear their
ulnar collateral ligament.
So it's okay to play baseball, but also try to play another sport or just play during the season?
Exactly. Play other sports, take a break, monitor the intensity and the amount
(25:46):
of pitching, even outside of the games.
What are you doing in terms of training?
Is your athlete now pitching with the coach outside and then has their fall
ball team and then their spring ball team that they practice with?
It. So you have to monitor all this.
And I also hope that you're plugging in your child into other environments to
(26:11):
work on other body parts so they can be a well-rounded athlete.
That's great advice. Let's take a case. So Samantha is a 15-year-old soccer
player. She got a concussion.
She was put back in the game and then she got a second concussion.
What should the pediatric practitioner do? So again, getting a good history.
(26:36):
So that's the baseline, getting a good HPI. You want to implement the SCAT-6.
Go through that worksheet with the parent and the athlete.
Go through the memory tests, the coordination and balance testing.
And also go through just every page to make sure that they fill it out properly.
(27:00):
With that SCAT-6, you're able to now do your own neuro exam,
looking at all cranial nerves, looking at their coordination,
their balance, their vestibular function,
their specific tests, and develop a plan from that.
And you're able to determine the extent of their concussion injury.
(27:20):
So the first thing is always send them out, allow their brain to rest.
Supplements like fish oil can help just with the rest and recovery after a concussion,
making sure that they decrease stimuli.
Of bright lights, loud noises, especially looking at their cell phone at night
can cause a little bit more strain and photophobia.
(27:43):
So try to stay away from that. If they can, you know, there used to be hard
restrictions of going to a dark room and not sleeping.
We have matured from that and understanding what we can do for the brain.
So I think that if you just decrease stimuli that could exacerbate the pain, really focus on that.
And then you have the option of continuing to follow the athlete until their
(28:07):
symptoms return to zero to start the return of play protocol.
Or you can refer out to a sports medicine specialist to assume care,
have proper communication with the coach, athletic trainer, parents,
and the athlete to now wait till their symptoms decrease and then start that
return to play protocol.
And do you want to reiterate, when would there be a case like this could really
(28:29):
be handled easily in the community pediatric setting?
And then when is the edge? I'm going to refer you to a sports medicine specialist.
I think the case right now where there's maybe a multiple hit when there was
a possible concussion that they were pushed back in or they didn't know and
(28:50):
they just went back in and got hit again,
I think that's a great case to send to a sports medicine specialist.
I think a hit and they sat that out.
You can definitely treat that in the community, but it's also about how busy
is your clinic? Do you have time to do the SCAT-6?
Because that does take time to go over the questionnaire and figure out a plan from there.
(29:11):
So it's really practitioner and physician dependent on how they want to go about referring.
But sports medicine specialists can see pretty much anything,
any severity, and then assume care from there.
Can you say that your work at UTSA as the head athletic doctor helps your work
(29:36):
treating kids in the community and vice versa?
Exactly. So I have the opportunity to be the head team physician at UTSA and
all their sports team, including football, soccer, baseball,
men's and women's tennis, softball.
So pretty much 400 to 450 athletes.
Athletes and taking what I learned from their injuries and from their rehabilitation,
(30:02):
working closely with their athletic trainers, I'm able to now transmit that
knowledge to taking care of us in the community, you know, weekend warriors,
people that just jog on the trail on the weekend, people that just like to go out and walk.
You know, outside or play pickleball or play recreational basketball.
So using that, using UTSA as a place to develop and innovate and really use
(30:28):
research-based medicine to
now coordinate that and translate that to the community has shown great,
just great overall results for our patients.
And then not all patients are the same.
So even working with the community, having a clinic just specifically for the
community has helped me to understand certain diagnoses that I'm like,
(30:51):
hey, I actually saw that in my clinic.
Maybe this UTSA athlete has this and it's helped both ways. So it's a very,
very, I'm very, very happy with my practice.
It's very satisfying seeing that translational effect of treating high-level
athletes, treating the community and seeing how each one can help each other.
And do you see adults as well?
(31:12):
Yes. I see, yeah, I see adults.
And kids. Yeah. So you You see patients at the University of Texas Health Science
Center's new location at Kyle Seale Parkway and at the Medical Arts and Research
Center in the Med Center, or also known as the MARC. Yes, yes, yeah.
I see, they call it KSP of 1604 and then also in the Medical Center at the MARC, yeah.
(31:33):
So for our listeners in the South Texas area, San Antonio area,
we'll put that information in the chat. Pat, as an athlete in middle school
and high school, this is a dream come true to be doing what you're doing now?
Yeah, you know, I've always loved being part of a team, and being in sports
medicine allows me to be a part of that team, allows me to share accomplishments, have a common goal.
(31:58):
And the best thing about it is that every athlete wants to get better,
wants to get back on the field pitch, on the court, and it just helps me.
Really revitalize and provide the energy to really get them to where they want to be.
And Ken, what would you say to your middle school football playing self or your
(32:20):
basketball high school self? Keep studying.
That's pretty much it. Yeah. Keep studying. Yeah. Listen to your coaches pretty much. And have fun.
Yeah. Have fun. Have fun. You know, I had a lot of fun playing Well,
I didn't take it too seriously.
I did think I was going to go to the NBA at one point, but then I decided to be a doctor instead.
(32:44):
And it's worked out. Yeah, right.
Here on Pediatrics Now, we love quotes. I love quotes.
Is there a quote that inspires you? I know you mentioned there's a quote from the Bible that you love.
Yeah, 1 Corinthians 9.25. It's one of the verses in the Bible that actually talks about sports.
(33:05):
And it highlights just about training for pretty much a boxing match,
how that discipline and that focus that a boxer can put into their sport and
perfect their craft is the same type of focus and energy that you can put into your life.
And for me, that's also the same type of energy that I put into my sport when
(33:31):
I was younger or put into my practice right now is the same type of energy I
can put into my family, put into my community.
Put into my volunteer working in church.
So there's a lot of passion in sports.
And I believe that the purpose of sport is to develop that discipline and incorporate
(33:52):
that into your life in several different aspects.
And that's the way, that's how I find my joy knowing that if I get this athlete
back to playing sports to the best of their ability, they can use that to now
translate that to their life,
to the relationships that they have, to their spirituality, to different things.
(34:12):
That can inspire others.
Do you want to read it to us? Oh, yeah, sure, sure.
1 Corinthians 9, 24 through 25, and the passage is titled The Need for Self-Discipline.
It states, Do you not know that in a race all the runners run,
but only one gets the prize?
Run in such a way as to get the prize.
(34:33):
Everyone who competes in the games goes into strict training.
They do it to get a crown that will not last, But we do it to get a crown that will last forever.
So using that and just make sure that, hey, like the same energy,
I got to use that to translate it to energy for, you know, things that really
(34:54):
matter and formulate things that really matter in the relationships that I have.
That's wonderful. And we also like to promote, and Pediatrics Now,
doing stuff outside of medicine to help recharge in this high-stress,
high-burnout career. What do you like to do in your spare time?
So I'm still figuring it out because I have a little 11-month-old son.
(35:16):
Congratulations. I appreciate that.
So it's really just hanging out with him and my wife when we can,
watching some Netflix shows, taking a walk in our neighborhood.
We do like trying out different restaurants and places to go for lunch.
Being in the hill country is very beautiful.
So we try to take advantage of that.
(35:39):
Do you feel like being a father has changed you?
I think so. I think, you know, you think about, first of all,
you think about paying for college.
I'm like, what is the price of college going to be like in 2040?
You know, I went to Baylor and And I was like, okay, yeah, I don't know if he can go to Baylor.
You know, they're assuming all this. I saw a calculator the other day.
(35:59):
I was like, okay, this is a lot.
But so, so that, that right there already puts a pressure on your plate.
But I think just, just knowing that you have somebody always looking at you
for, for support, you know, my, my wife said the other day, like,
did you know, like we're his whole world?
Like he, he really doesn't, he has no other friends but us.
(36:22):
I was like, he's looking at us for entertainment, for food, for water, for nurturing.
I was like, yeah, that's true. I say it's the hardest, best job in the world.
Exactly. Exactly. Exactly.
Ken, it's such an honor being here talking to you today in the podcast studio.
Is there anything you want to mention before we wrap?
(36:42):
No, I think this is great. I think, again, just wrapping up,
just education is the main thing. CDC has a heads-up program on their website.
They have just a free program to educate yourself on concussions.
UT Health San Antonio is doing a really good job of developing our sports medicine
(37:02):
program and having a concussion pathway and open for referrals.
And also, just God bless and birds up.
Dr. Ken Nwosa with the University of Texas Health Science Center or UT Health San Antonio.
And the UTSA head doctor for athletics.
(37:22):
Thank you for being here on Pediatrics Now. Thank you very much.
Are we going to have a good football team this next season? Oh yeah, you better be.
Music.
Coming up next week, a Grand Rounds talk about child neglect.
So neglect is usually typified by an ongoing pattern of inadequate care,
(37:46):
and it can actually do as much damage as physical abuse.
I'm Holly Wayment. Thank you so much for listening.
Click on the link for free credit that may include CME, MOC,
or ethics credit, depending on our topic or podcast.
Our website is pediatricsnowpodcast.com. My email address is on there.
(38:10):
Please email me with episode ideas or comments.
Thank you so much for listening.
Our sister podcast is Pediatrics Now for Parents.
Wish your patients heard some of the stuff you just heard?
We'll put that in our Pediatrics Now for Parents podcast, health news in small
(38:33):
bites for the busy parent.
In our sister podcast, Pediatrics Now for the Busy Parent, we include most of
the topics you hear here on Pediatrics Now for the Practitioner,
but in shorter snippets that are meant for the patient or parent.
That's Pediatrics Now for Parents anywhere you get your podcast or the web address
(38:53):
is pediatricsnowforparents.com.
It's meant to be one less thing you have to say in the exam room.
I love this quote by Nelson Mandela, history will judge us by the difference
we make in the everyday lives of children.
Thank you for making a difference.
I'm Holly Wayment, and you're listening to Pediatrics Now.
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