good evening.

Thank you so much for watching HealthLine here on PBS Fort Wayne, I'm Mark Evans, your host very important topic tonight and we are going to invite your calls on it.

A lot of sports going on.

A lot of injuries can be happening especially with concussions.

So we're going to be talking about those tonight with Dr. Kyle Leidel and he is a physical medicine and rehabilitation brain injury medicine physician.

>> Nice to have you.

I think you're well qualified for this subject tonight.

Well, thank you.

Glad to be here.

And first time on the show.

Yes.

All right.

Well, very glad to have you and Doctor, what we do is we invite people to give us calls to ask questions whether it's for themselves or a loved one or a friend.

Telephone number is of course on the screen right there.

It's 866- (969) 27 to zero.

Please call at any time during the show.

>> It is a half hour show.

We don't stop down for commercials because we are public television and very proud of that.

>> All right.

Well Doctor, let's just go ahead and build the platform for the show.

What is a concussion?

>> Great.

Yeah, I think that's a great question.

Let's start on what is what are we talking about right.

You know, there's lots of defintions out there and so it's kind of hard to pick one all the time.

But recently the American Congress of Rehab Mosin came out with a definition of concussion and I'm going to kind of summarize it because it's a multiple page document.

But really you need a few things.

One, you need a blow or a jolt to your head, something that kind of shakes your head and then the other thing is that there's something after that blow there could be some confusion, feeling dazed or confused as a common thing that people feel getting their bell rung is a common term.

>> That's boxing.

Yeah, boxing.

And then also you can you maybe have memory loss maybe you can't remember what happened before the event or shortly after the event.

It's hard to remember things.

People sometimes repeat questions saying you what's today and then three minutes later what's today?

>> You know they can't remember the information and then also loss of consciousness.

>> So technically you do not have to have loss of consciousness to have a concussion which is a common misconception.

But you don't want to have loss of consciousness beyond 30 minutes.

>> So that's kind of a cut off for that.

I think that'll be a long time.

It is a long time.

However, if you go beyond thirty minutes you get into more moderate and severe categories of brain injury which is also something important to realize is that concussion is interchangeable in the medical world as a mild traumatic brain injury which is where my specialty brain injury medicine comes along is that we've studied this very in depth.

OK, so as you mentioned, you don't have to be knocked out to have a concussion but sometimes from the shows I've done on this particular topic before I've learned that sometimes you don't even know you have a concussion until maybe a day or two later.

There's some people that maybe they were in a car accident and maybe a few days after that event or even the next day they wake up and they have these really bad symptoms like a headache or vision changes and there's a variety of other ones that can come about.

But it is something that you may not be aware of it and it's important to realize what those symptoms are and then seek the treatment that you need in your particular practice when it comes to adults.

We'll talk about children here in just a second.

But why are these adults getting concussions?

>> Yeah, there's many different reasons as to why people get concussions.

>> Mostly what I see is people unfortunately that are in motor vehicle crashes or car accidents being a huge portion of concussions happen.

I've seen a number of like police officers there in their cars almost all day and unfortunately they're sincere.

That's their job.

They end up having accidents that happen and also falls especially in the elderly population that maybe have a little bit balance issues or diabetes or they can't feel their feet as well and then they end up tripping or falling .

So some basic things like that.

But anything can cause it.

I mean you could trip and fall.

You could be your head a box could fall on your head.

>> There's a number of things also like sports that are you know, definitely bigger in the media and social media about concussion and preventing concussion.

So we we definitely know that sports is a is a thing that we want to consider.

And I think two other important things that I always like to mention is sources of concussion is our military veterans.

They also suffer concussion from blast injuries.

They're over in the Middle East and unfortunately there's these explosions that happen and maybe they're far enough away from the explosion that they're protected but they also get that hit or that shockwave.

And the VA is an excellent job of studying concussions over the last couple of years and then the other group of people is actually people that suffer from domestic violence and I always like to let people know somebody that is struggling and you're wondering you complain of a lot of different symptoms and just being cognizant to ask those questions and even in health care, I encourage my colleagues to ask those questions.

You know, do you feel safe at home?

Is there anything I can do to help you as you learn those kind of things and is it the same for children or do they have a different set of circumstances especially when they're young to get concussions?

>> Great question.

So children I would say obviously are a lot more active than adults.

A lot of them don't have sedentary jobs even though they're at school they have recess.

They AP especially intramural sports and professional or in my professional sports depending on the age.

So sports is a big part of concusion in the youth and unfortunately as well abuse is a part of concussion and especially the little guys.

And so we do want to be cognizant of when somebody comes in, especially if they're not able to walk or you they're not actively you know, you say that the scenario doesn't mesh with what the story says and we want to be really cognizant.

Is there some form of abuse going on as well?

I'm glad you brought those up and especially about the veterans.

Honestly, I didn't think about that but I'm so glad you did.

So let's talk about you get a concussion so if you don't get it treated, what can happen with long term effects of a concussion?

Yeah, and we'll talk about treatment here in a minute but right.

>> Yeah.

I think the big thing about this is knowing the signs and symptoms of concussion because those are kind of the long term effects.

You know, it's not like something where you know you have high blood pressure and then the numbers are high and that's what we're treating.

Concussion comes along with a variety of symptoms and those could be from headaches and dizziness, balance issues, nausea, sensitivity to light even can be something that people just complain of or maybe it's something as simple as like a more irritable some people say I have a shorter Fuze like maybe I could deal with some nagging that I could before but now I can't or even being more sensitive to alcohol is something that can happen after concussion and a common thing though is that like we talked about earlier that you know, you may not be aware of it.

Some people actually maybe have an injury and then they go back to work or to school and they find themselves not being able to concentrate on maybe their math homework or they're not able to sit at the computer as long because the screens are really in their face and it's bothering them.

So really being cognizant about those kind of return to work return activity or even play you know, sometimes people don't know they have a concussion and go back to their sport the next day and then they realize aren't just running down on the sidelines making my head hurt.

So being really aware of those scenarios too.

OK, we do have a call coming in and it's from Josh who prefers to be off the air which is fine.

>> But we're going to read this question why are helmets designed to shatter?

Oh, yeah, that's a really interesting question.

So there's actually a variety of different helmets out there and shattering is actually so a good example would be a bike helmet.

>> So bike helmets are made of a material that when they get hit they do destroy in a way and they're actually one time use .

So if you end up hitting your head on a bike helmet and the reason is because it wants to take the blunt of the injury or the you know, the force that's coming towards your head and so when it breaks up like that it helps to spread the force out more rather than like some helmets that are very hard actually just transmit the force through that.

So this is actually kind of is like a cushion in protecting your head.

Yeah, I've seen those in fact I have a bicycle helmet.

Luckily I haven't had to use it but I haven't had to use it, you know what I mean?

>> But it has the foam insulation inside and and I can tell well if I did hit my head really hard it would probably shatter or at least break.

>> Well I guess that's not such a bad thing as you just know.

Yeah, it's a one time use in the sense of if you fall in and it breaks or cracks it's time to get a new helmet.

>> OK, that's a that's a good word of warning there.

Thank you.

All right.

And Josh, thank you for that phone call.

The number on the screen is six six (969) 27 two zero.

>> And just as I say that another call is coming in from Bart.

>> Bart, what is your question for Dr. Leidel?

Yeah, my name is Bart.

I was just wondering my grandpa growing up he served that boxing wasn't really good for those guys out there just slamming each other's hands around, beating them up and stuff.

So the prime example not making fun of them but look how far Muhammad Ali at the end of his career he could barely talk and stuff.

And then another thing he brought something up by a helmet and is it really safe for those football players to be out there crashing each other like that?

>> I'm a I'm a turn my back up so I can hear you but thanks Doctor.

OK, thank you for calling Bart.

>> Yeah, thank you Bart.

So first the question of boxing and concussions.

Yeah that is a sport that has a brain injury medicine doctor I wouldn't necessarily recommend but I'm not going to say that it's a bad sport.

I think that you know, just like any other sport there there's rules in this game and we have to be very cognizant of those rules and but yeah, I think we do need to be careful and watch you know, those athletes those are some very elite athletes and they go through rigorous training and they learn how to also protect themselves.

So they're not only just getting hit but they're learning how to protect themselves.

>> And I would say that we do want to have a medical team and have athletic trainers that are closely monitoring them and there are protocols in place especially for boxing athletes and you mentioned like football is another thing I would say that you know, is it safe for them to be out there again?

We're learning a lot more about repeated concussion as time goes on.

But at the same time, you know, football players and the leagues that they're in are really learning how to protect their athletes more and more every day.

And I think that that's one of the neat things in our research is we're learning more about concussion and brain injury is that a lot of these leagues are actually the center of our our our research and they're funding a lot of things to protect people.

So I think that we do have to be careful in boxing or football or soccer or any sport.

But we we also want to lean towards safety for all of our athletes.

Absolutely.

And Bart was mentioning about boxers and just as a little story about my my grandfather my my mom's father he was a carnival boxer back in the early 19th hundreds and he would travel with the carnival if he could beat his name.

Nickname was Slim.

He was six foot six and if you could beat him he won the prize.

>> Well, Slim won a lot but unfortunately Granddad Slim was as they would call a little punch drunk in his later years.

>> So so being hit in the head that often and what would is the medical term for being punch drunk?

>> What is yeah.

So there's a term CTE or chronic traumatic encephalopathy.

OK and so we are learning a lot about this.

This has been something in the media and social media over the last several years and it is something that we do because we do want to be very careful about the positive things.

It's very rare and we don't really understand the full mechanism as to how it happens but we do know that it can be from either multiple concussions or it could be from even sub concussive blows.

So just being hit in the head over and over example would be like a soccer player who heads the ball over and over and so having those injuries continue on for many, many times can lead to something called chronic traumatic encephalopathy which is basically a form of dementia.

>> Yeah, yeah.

I had trouble sometimes with memory and also keeping his balance.

>> Yes.

And you know, he's a towering man but yeah, that's so you have to excuse me your granddad's a little punch drunk.

>> Yeah.

So you don't drink Granddad right.

The positive thing I always like to say about that though is it hasn't been associated with one or two concussions.

So some people that have had a concussion they asked me like well am I going to get this disorder or I'm going to get dementia?

The answer that we know so far is no or very unlikely it's been shown to be with people that have had repeated injury after injury after you know OK, well that explains that I'm sure another call just came in.

In fact, Margarita's asking to stay off the air but her question is is it safe to wear a helmet force seizure or can that lead to concussions?

>> Do you understand that pquestion?

Oh, she's getting I think there are some people that have seizures and they wear helmets to try to protect themselves.

OK, and I think that's what she's asking there.

I would say if somebody does have a seizure disorder I think it would be OK to wear a helmet for protection because some people that have uncontrolled epilepsy or frequent seizures can have these kind of drop attacks where they're where they may be walking and then fall suddenly to the ground.

And so having a helmet to protect them I think would be reasonable.

But you know, the thing also is that Helman's helmets help decrease the risk of concussion in a way but they're not perfect.

So even if you're wearing a helmet you can still unfortunately get a concussion.

Yeah, it's not a 100 percent fail safe.

You know it's not you're going to have some some problems especially in the higher impact type things.

The we'll talk more about some of the signs and so forth a little later in the show.

You've already gone over that a little bit how if you think you've got a concussion or you know, for instance somebody gets hurt the playing field, you're going to take them into the E.R.

perhaps or maybe a couple of days later take them into the family physician.

>> How are concussions diagnosed?

Yeah, I think that's a great question.

So the majority of the time concussions are a diagnosis is made clinically so we talk to them about their symptoms.

The timing of the injury to their symptoms.

You know, there's a lot of people that think well if I have a concussion they need to get an MRI or a CT scan of my head, you know, some type of advanced imaging we don't really have the capability of doing that at most centers there's a few like research centers that have been shown that there's certain types of really advanced imaging that can suggest that you may have had a concussion but the vast majority of our diagnosis is is clinical.

We're saying did you get hit in the head or did you have some jolt to your head like maybe a whiplash injury that maybe didn't actually hit your head but you shook your head violently and then did you have any of these symptoms after that injury?

Like we talked about earlier, the headache and the nausea and the vision changes I think.

Yeah, and I happen to come across something earlier when I was doing a little research for the show and the Glasgow coma scale.

>> Yes.

With that can you explain that?

Yeah.

So the Glasgow coma scale is a scale that we use especially in trauma and when patients come into the hospital we'll we'll use that utilize this scale and it looks at a variety of things.

So it looks at, you know, your cognitive ability.

It looks at your motor function and how you can move it looks at your eyes, you know, so there's there's a variety of components to that scale and it's on a fifteen point scale.

And so if you have anywhere from 13, 14 or 15 so that's the higher end of the scale where you want to be if you're in that higher range then you will most likely have a concussion if you're in that lower range so 12 or below then you're going to have a change in classification of your head injury.

So it could be that mild or moderate severe brain injury like we you know, maybe you're familiar with like like a person who's in a vegetative state that has a really severe brain injury.

Yeah.

And so those numbers tend to drop lower and lower.

OK, so the lower the number the word is OK all right call just came in from bass bars.

Thank you for the question.

She's here she is asking if you get a concussion can you suffer from short or long term memory loss?

>> Yes, that's a great question.

Thank you for asking that the the short or long term memory loss.

So the answer is can you yes.

You can.

So unfortunately most people that have had a concussion will not remember the event and it may be sometimes fortunately some people that are in a car accident it's fairly traumatic and maybe you hit your head and you don't remember, you know, driving the car and you actually forget that an event or even you don't remember things a few minutes after the event.

So sometimes I talk to patients and that have had a concussion in a car accident and they say well I remember leaving work and then the next thing I knew the ambulance was there at the scene of the accident.

>> That whole gap is gone.

It doesn't come back long term memory I would say is less common.

So it's not like in the movies where you get this amnesia that you can't remember anything from twenty years ago but you can't struggle with memory.

So a common thing that I hear as well is that, you know, maybe your wife told you to take the trash out and then normally you would remember every single time and then now after the concussion you're having a harder time remembering things like that or maybe it's just some of those memories kind of drift away like you can't remember somebody's name or somebody's birthday like you used to.

You just it's a little bit harder to grasp those things but it's not like you're you're forgetting your entire past.

Yeah.

And that you're giving me memories about my granddad Slim how about that some of those symptoms OK, another call just came in.

It looks like Len asking a question offline I was hit in the head by a soccer ball and saw stars that happened to me once.

Was that a concussion?

You know, I think it's hard to say.

>> You know, he probably needed some more information, probably some further assessments to say yes or no.

You know, depending on how long those stars lasted.

You know, some people if you just get hit briefly, you do kind of see a little jolt of light just because it's actually when your head gets struck your eyes also shake and that can change some of your visual input.

Just briefly.

But if that kind of story feeling in your eyes takes a while to go away like several minutes or even hours then yeah, I think concussion would be reasonable as a diagnosis.

OK, also we were talking about some of these old myths.

I mean certainly if somebody got hit in the head and lost their memory you don't want to go back and hit them and again to reset you know that does not work.

Have you seen come on cartoons?

Yes.

Yes.

That's the wrong thing to do.

Definitely do not do that at home.

That's for sure.

You touched on this earlier but I want to delve into this a little deeper.

>> What are the potential risks or long term complications of a concussion?

Yeah, so you know, a few of the risks that we really want to be cognizant about are things like unfortunately brain bleeds.

So whenever you hit your head, you know, luckily concussion most of the time your symptoms go away within just a few hours or even days.

But we do want to be aware of what's going on and so when you have a head injury you want to be monitored closely and like you can have a brain bleed which would be like subdural hematoma or things that people have heard about in the news from different you know, even actors and actresses that have had these incidents that have happened.

>> So that's why if you're older than 65 or if you've lost consciousness or if you have any neurologic change like if you feel like you're weak on one side you have new numbness or tingling.

You've lost vision or hard to speak or anything like that, I would say go to the emergency room right away and get that evaluated because that can actually that automatically bumps you from a concussion to that more moderate category of head injury.

>> And so you want to be concerned about that.

We talked about the punch drunk .

Yes.

Yeah.

And then the other thing is is prolonged symptoms or there's post concussive syndrome.

>> People give it different names but basically it's when those symptoms last longer than you would expect and so most people have their symptoms again gone within just a few days like over probably 85 90 percent of people within just a few hours, two days their symptoms are gone.

But the if it continues to linger then that's usually when you need to seek some additional treatment and look into is there other things that we could be doing to help you in your recovery .

>> OK, and hinging on that, what are the effects of repeated concussions?

>> Mm hmm.

So for instance, an athlete you're getting knocked out every other game or so.

>> Yeah.

So typically we obviously want to try to prevent that.

Yes, absolutely.

Yeah.

Repeated concussions from it's kind of hard to tell exactly what the repercussions of that is just like we mentioned the boxers earlier like part of their job is to get concussed and if you get knocked out kill you know and that's what you're supposed to do.

Somebody wins a prize.

Yeah, that's right.

But really sometimes I have noted that if you've had multiple concussions sometimes those symptoms tend to linger longer.

So maybe the first concussion lasted for an hour and you felt fine after that and you can go back to whatever you were doing and maybe the second time around it may last a little bit longer.

It's not consistent though.

Some people have multiple concussions and they have no problems and even I've had patients that have had a repeat concussion, you know, a few months later and their symptoms actually recovered faster than their first one.

Oh wow.

So it's very variable for these repeat concussions.

But we do want to be aware of people that are having these concussions.

Is there something going on?

And that's one thing that we've we've also seen in our sports concussions is that sometimes your balance can be affected and for us that are just walking around most of our day, it's not that big of a deal because we just walking.

>> But however in somebody that's an elite athlete where you have to cut and you have to zig zag very quickly then having just a slight difference in your balance can make a big difference in your athleticism which then puts you at risk for higher concussion.

So some of the tests that like the athletes and their athletic trainers are put through help us to determine are you fullypre really want them to get back to sport is when they're fully recovered.

>> We don't want to get them back too soon.

OK, and we've got a couple more minutes left and we've got a couple more questions for you.

>> But you know the kids when they're out there on the fields and they're playing and so forth, they really don't know what to look for or you know what to report to the coach or their parents.

What do the coaches and parents need to be watching for from the sidelines?

>> Yeah, I think, you know, whatever sport there is I think you know, one is just you watching the play happen and seeing was that a hard hit?

>> You know, I think most of us I enjoy watching football and sometimes when somebody gets hit everybody kind of cringes like, you know, when that happens.

And I think in those moments hopefully the parents and the coaches will kind of take a step back themselves if they kind of cringe at the hit you know, pull the kid to the side for the next place, say hey, how are you doing?

Did you feel that you know, what are you feeling?

What are you experiencing?

And nowadays there's a lot of protocols in place for athletes to say, OK, if you even looked like you got hit in a way of concussion, we're going to take you to the sideline.

We're going to take you to the locker room.

Yeah, we're going to do a more in depth examination but I think just really not pushing them too fast to get back on the field whatever sport it is.

Right.

I think that we do want to be careful about that.

There is a disorder you mentioned the kind of concussions that it's called Second Impact Syndrome which we do want to be very aware of .

But it's also incredibly rare.

There's only been a handful of cases reported in literature in the last several decades.

But the biggest concern is that this second impact syndrome is when you've gone back to your activity and you have a second concussion before you fully recovered from the first concussion and it can cause severe cerebral edema, brain swelling and even sometimes it unfortunately leads to death.

And so luckily it is very rare but it is something that we want to be very cognizant about in sports.

OK, well what a fascinating conversation and very we've got being mindful of those concussions adults and children as well.

Yes.

Dr. Kyle Leidel, thank you, sir.

so much.

Physical medicine, rehabilitation and brain injury medicine physician that's a long title but well-deserved I'm sure.

Thank you so much for watching.

We'll see you next Tuesday night for HealthLine here on Fort Wayne .

>> Until then, good night and good