How many concussions are safe?

What exactly is a concussion?  It is the mildest form of brain injury and does not always involve loss of consciousness although it often does.  It usually occurs following a traumatic blow to the head, face, or neck although any impact that transfers to the forces to the head can cause a concussion.  A concussion can occur without any symptoms although the most common signs are headache, dizziness, and lack of awareness of surroundings.  A study also reports the following signs associated with concussion.

• Vacant stare (befuddled facial expression)
• Delayed verbal expression (slower to answer questions or follow instructions)
• Inability to focus attention (easily distracted and unable to follow through with normal activities)
• Disorientation (walking in the wrong direction, unaware of time, date, place)
• Slurred or incoherent speech (making disjointed or incomprehensible statements)
• Gross observable incoordination (stumbling, inability to walk tandem/straight line)
• Emotionality out of proportion to circumstances (appearing distraught, crying for no apparent reason)
• Memory deficits (exhibited by patient repeatedly asking the same question that has already been answered or inability to memorize and return three of three words and three of three objects for five minutes)
• Any period of loss of consciousness (coma, unresponsiveness to stimuli)

How many concussions are safe?  The short answer is the fewer the better with none being optimal  The importance of the brain cannot be overstated and should be protected from injury.  The long answer is well... long.  The lack of data and research makes clinicians hesitant to state a number.  Some sport teams have set limits but mostly out of fear of a lawsuit than from research.  It is difficult to compare concussions because no two are alike.  Complete recovery from a concussion is important to avoid cumulative injury from repeated concussions.  Current guidelines focus of symptom resolution before allowing athletes to return to play

Upstate New York: Aging Adults and Migration of the Young

As we grow older lots of things change.  Our hair falls out or turns gray as our bodies age.  Small everyday tasks leave us sore and aching.  More and more health problems surface and soon our list of medications is longer than a grocery list.  As communities age the need for healthcare, assisted living, and infrastructure increases.  This in turn places a burden on the tax base.  This is a normal turn of events; however, when the tax base begins to shrink questions and concerns are raised.
 
Upstate New York saw an enormous migration of young adults leaving New York in search of greener pastures.  According to "Flight of the Young Adults is Causing Alarm Upstate" an article published in the New York Times there was a 25% reduction statewide in adults age 24-35 between 1990 and 2004.  In the more rural counties the migration was even more pronounced.  The graph below shows census data comparing the median age of New York compared to the US.  Notice the median age of Upstate New York in particular.

For more information see the Graying of the Empire State

What does the future hold?  The smaller tax base has already strained local communities and school districts, but the news isn't all bad.  A little financial stress always helps to bring about creative ways to save money.  Communities are forced to cut out wasteful spending and to reprioritize to focus on the necessities.

Otsego County has been part of this drama with the pending sale of the Otsego Manor, and adult home operated since 1827.  Due to escalating costs and budget cuts the County is selling the home to the highest bidder.   For the latest news on the bidding see this recent article from The Daily Star.

Fatal Hunting Accident In Otsego County: A Reminder to Hunt Safe

Unfortunately there was a fatal accident yesterday, November 16th, near Westford, NY.  It appears that a downstate man was shot in the chest on the opening day of regular deer season.  Details can be found here.  This is a sobering opportunity to review how to stay safe when hunting.

According to the 2012 Hunting Statistics, last year was an exceptionally safe year for New York State.  There were only two fatalities occurring in Orange and Warren counties.  Otsego County had only one accident involving an accidental discharge while operating an ATV.  Hunting accidents have been declining over the past fifty years.

While the DEC highly recommends wearing hunter orange there is no law requiring hunters to do so.  The picture below from the DEC shows two hunters and visibility difference between camouflage and hunter orange.

Deer have more rods and fewer cones than people.  This means they have better night vision but poorer vision during the day.  They also see shorter wavelengths than humans reaching into the ultraviolet wavelengths(if curious see this article).  This means that orange appears a much darker shade to their eyes while for humans it stands out against wooded terrain.

In New York State there have been no fatal accidents involving a wearer of hunter orange in the past ten years.

Non hunters should be aware of hunting season and plan accordingly.  This means wearing bright colors or avoiding walking in the woods during deer season.  I have heard of more than one close call of a walker and jogger being shot at.

The dates for the 2013 NY deer season are early bow (Oct 1-Nov 15), regular (Nov 16- Dec 8), late bow (Dec 9- 17).

Promoting Agricultural and Rural Health

Upstate New York is home to a good deal of farming and the unique health conditions associated with farming.  In the early 1980's David Pratt MD and John May MD started the Farm Safety and Health project out of Bassett Hospital.  The program was successful enough to become the New York Center for Agricultural Medicine and Health or NYCAMH for short.

NYCAMH educators have written a host of articles covering every aspect of farm safety.  Did you know that the sap from  wild parsnip can cause phyto-photo-dermatits?

Giant Hogweed

The sap from Giant hogweed also causes a similar reaction with photosensitivity as well.

Logging is another high risk occupation that also is commonly done on farms.  Being safe about logging has very little to do with how many trees one cuts down.  It only takes one accident to cause irreversible consequences.  Chainsaws with inertia brakes work best for kickbacks because they are independent of hand positioning.

What I Have Learned

Otsego County has a wide range of health services available.  The entire county is almost completely served by the Bassett Healthcare Network.  This integrated model helps to provide a better continuity of care. There are multiple school based health centers as well.

Bassett Medical Center in Cooperstown, NY



The greatest challenge facing healthcare delivery is access to care and providers.  Access to care is more frequently not a question of insurance but of distance and convenience.  A visit to a clinic or hospital can be very inconvenient and time consuming.  Not to mention their might be a long wait at the office.  Secondly, recruitment of providers to upstate New York can be very difficult.  Young physicians tend to stay in more urban areas.

It should be noted that hospitals are facing large reimbursement cuts that will make financial viability difficult.  Saving health care dollars starts with the individual, and it begins with choosing a healthy lifestyle today.

Kick Butts Day

Is tobacco dangerous? The answer is an overwhelming yes!  Smoking damages just about every organ in the human body.  Why then are children smoking?  The answer is a bit more complicated.  Peer pressure, advertising, education, and family environment all play a role.  Ninety percent of smokers start using tobacco before the age of 18.  In high school, 18.1% of students report smoking in the past month.  One thousand kids under the age of 18 become new smokers every day.  The tobacco industry spends 23 millions dollars a day on advertising.  Coincidence? I think not.  If you want more statistics with references please click here.

March 20th was Kick Butts Day.  This is an national event organized by the Campaign for Tobacco-Free Kids that focuses on protecting children from the dangers of tobacco.  This article talks about Kick Butts Day activities in Otsego County schools.  

Kick Butts Day has been held for the last eighteen years.  It is exciting to see investment in the health of children, however their parents should not be forgotten.  Second hand smoke is often left out of the conversation.  Smoking cessation for parents is an important and difficult undertaking.

At Home Care Inc

For many patients leaving the hospital and returning home is an important part of the healing process.  However, discharge from a hospital can be delayed by lack of access to treatment and care at home. 

At Home Care Inc., is a not-for-profit agency that provides healthcare at home.  It was founded in 1987 and recently received an award for the business of the year by the Otsego County Chamber of Commerce.   At Home Care provides nursing care, physical therapy, occupational therapy, respiratory therapy, and more to over 800 patients.  The agency works out of Oneonta, Norwhich, and Herkimer.  

At home care also operates Telehealth, a phone based technology that improves access by allowing providers to make a virtual visit.

Patients can also use Lifeline in their home.  Lifeline is an emergency response system that allows patients to call for help in their home even when they cannot reach a nearby phone.