Brain Injury Law Blog : Head Injury : Coma : Personal Injury : Las Vegas Nevada Lawyer & Attorney Tim Titolo

Recall the recent post I made raising the issue of whether antidepressants were properly relied on by patients and physicians.  That post can be accessed here. http://brainandspine.titololawoffice.com/2009/12/articles/psychiartric-psychological-iss/antidepressant-may-change-personality/

 A new study appears in the December issue of The Annals of Pharmacotherapy.  (Published Online, November 24, 2009. www.theannals.com, DOI 10.1345/aph.1M326) Suicidal adolescents who were prescribed an antidepressant medication during inpatient psychiatric hospital treatment were 85 percent less likely than others to be readmitted within a month after discharge.

The results provide additional evidence that antidepressants may play a key role in helping improve the mental health of suicidal youth. Cynthia Fontanella, co-author of the study and assistant professor of social work at Ohio State University, points out that the the findings are especially important now, because antidepressant use dropped in 2003 after the Food and Drug Administration issued a black box warning that some antidepressants may increase the risk of suicidal behavior for pediatric patients. A black-box warning is the most serious type of warning in prescription drug labeling.

Despite considerable recent attention and wide-scale interventionsby regulatory authorities that have changed drug usage patterns,the possible relationship between psychotropic pharmacotherapy and suicidal behavior among children and adolescents remainsunclear. Confounding by diagnosis adds to confusion in the interpretationof the relationship between antidepressant use and suicidal behavior among young people. Cynthia Fontanella's recent research suggests that antidepressants may be protective against early readmission after hospitalization for suicide attempts or ideation, but that psychotropic polypharmacy (although common) may be associated with increased risk of rehospitalization.There remains an urgent need for high-quality, ongoing research into these clinical dilemmas.

Once again, I invite your input and thoughts on this issue by posting a comment.
 

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Whiplash, or WAD (whiplash-associated disorders) refers to a series of neck injuries caused by or related to a sudden distortion of the neck - hyperextension (over-extension) injury to the neck. In many cases whiplash is the result of being struck from behind, for example, by a fast moving vehicle in an automobile accident.
 

Most people associate whiplash with one vehicle being hit in the rear by another vehicle - the driver in front sustains the whiplash. However, the impact can come from any direction and the head may move backwards or sideways, not only forwards initially. Whiplash injury may also be sustained in various ways, such as from falling off a bicycle or a horse.

 What are the symptoms of a whiplash injury?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

A whiplash injury typically takes from 12 to 24 hours after the accident or blow to develop. At the time of the incident any swelling or bruising to the neck muscles will not be apparent straight away. In most cases the discomfort, pain and stiffness is much worse on the following day, and may continue to worsen as each day goes by. A person with a whiplash injury may experience:

• A loss (or reduction) of movement in the neck
• Headaches
• Neck pain
• Neck stiffness
• The back of the neck feels tender
   
• The following signs and symptoms are also possible: 
   
• Lower back pain
• Pain in the arms and hands
• Numbness or pins and needles in the arms and hands
• Muscle spasms
• Dizziness
• Fatigue
• Swallowing difficulties
• Vision problems (vision may be blurred)
• A feeling that you are moving or spinning (vertigo)
• Ringing in the ears (tinnitus)
• Sleep disturbances
   
• The following less common signs and symptoms are also possible: 
   
• Irritability
• Memory loss
• Poor concentration

Headaches, dizziness, problems swallowing and vision problems should not last long. If they do, tell your doctor.  These could be signs, symtoms and consequences of other injury.

Be aware that certain symptoms of whiplash are also symptoms of Brain injury. A severe whiplash injury, think of shaken baby syndrome, can result in damage to the brain.  Shaken baby syndrome  is a form of child abuse. It refers to brain injury that happens to the child. It occurs when someone shakes a baby or slams or throws a baby against an object. A child could be shaken by the arms, legs, chest, or shoulders.

A coup-contrecoup injury, for example, is common in the hyperflexion/hyperextension process. 

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The American Medical Association (AMA) reports that PET (postron emission tomography) is able to detect the progression of Alzheimer's in patients with dementia.  Preclinical Alzheimer's disease can be detected by screening an individual's cerebrospinal fluid for biomarkers of the condition. In addition, imaging with positron emission tomography (PET) can detect deposits of the substance linked to dementia in living patients.

159 older adults (average age 71.5) who had undergone PET scans and did not have symptoms of dementia were assessed. These patients were followed for between 0.8 and 5.5 years after having the scan and underwent between two and six assessments for dementia during that timeframe.

A total of 23 participants progressed to clinically detectable dementia during follow-up, and nine were diagnosed with dementia of the Alzheimer type. These diagnoses were made by specialist clinicians who diagnosed the condition at an earlier stage than typically occurs and corroborated the diagnosis by declines in multiple cognitive domains as well as a loss of volume in certain areas of the brain.
 

If this new discovery can assist clinicians in detecting dementia and Alzheimer's symptoms earlier, treatment can be more effective.

This study provides support for the premise that preclinical Alzheimer's disease, detected by the cerebrospinal fluid signature for Alzheimer's disease predicts symptomatic Alzheimer's disease.  The study is published at Arch Neurol. 2009;66[12]:1469-1475.
 

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The American Psychiatric Association revised the timeline for publishing the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, moving the anticipated release date to May 2013.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States. It is intended to be applicable in a wide array of contexts and used by clinicians and researchers of many different orientations (e.g., biological, psychodynamic, cognitive, behavioral, interpersonal, family/systems).

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) has been designed for use across clinical settings (inpatient, outpatient, partial hospital, consultation-liaison, clinic, private practice, and primary care), with community populations. It can be used by a wide range of health and mental health professionals, including psychiatrists and other physicians, psychologists, social workers, nurses, occupational and rehabilitation therapists, and counselors. It is also a necessary tool for collecting and communicating accurate public health statistics.

Diagnostic criteria provide a common language for clinical communication and their use has been shown to increase diagnostic agreement between clinicians.   It is important to understand that the appropriate use of the diagnostic criteria requires clinical training and that they cannot be simply applied in a cookbook fashion.

Another important aspect of the DSM diagnostic system is that the diagnoses are described strictly in terms of patterns of symptoms that tend to cluster together.  These symptoms can be observed by the clinician or reported by the patient or family members.  Because it focuses on manifest symptoms clinicians from widely differing theoretical orientations can therefore use the DSM.  Since the causes of most mental disorders are subject to ongoing scientific inquiry, the DSM avoids incorporating competing theories in its diagnostic definitions.  This feature has been an important element in the widespread clinical acceptance of the DSM, and has allowed a wide scope of research investigation.  

This is also an important limitation of the DSM system.   Patients sharing the same diagnostic label do not necessarily have disturbances that share the same etiology nor would they necessarily respond to the same treatment.   It is therefore critical to understand that the diagnostic terms and categories in the DSM represent only current knowledge about how symptoms cluster together.   

I find that the DSM has been too general in situations involving my clients and too specific and exclusionary in other situations.  I, and experts I consuted, fully expect that, over the coming decades, the DSM system will be radically reorganized as the etiologies of mental disorders become better understood.

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So is your boss paying you enough?  Do you want a raise or better working conditions?  What motivates employees to perform?

People paid by the hour exhibit a stronger relationship between income and happiness, according to a study published in the current issue of Personality and Social Psychology Bulletin (PSPB), the official journal of the Society for Personality and Social Psychology. 

The Society for Personality and Social Psychology (SPSP) is an academic society for personality and social psychologists with over 4500 members worldwide. SPSP serves as Division 8 of the American Psychological Association and publishes the journals Personality and Social Psychology Bulletin and Personality and Social Psychology Review and the biannual newsletter, Dialogue. It also co-publishes the journal Social and Personality and Psychology Science.

Researchers explored the relationship between income and happiness by focusing on the organizational arrangements that make the connection between time and money. They found that the way in which an employee is paid is tied to their feeling of happiness.

The researchers theorize that hourly wage-earners focus more attention on their pay than those who earn a salary.

A UK survey of managers across health and social care found that nearly two thirds (62 per cent) of them believe that Christmas parties are important in helping improve employee engagement. The survey comes in the wake of a government report that blames UK business leaders for low levels of staff engagement.
 

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People often confuse coma as being necessary for brain injury to occur.  This is far from the facts or truth.  However coma usually confirms that brain injury has, in all probability, robbed the individual of cognition or motor function.  Only rarely does one recover completely from coma.

I thought a refresher on what Coma and Glasgow Coma Scale are would be helpful.

A coma, or being comatose, is a deep state of unconsciousness - longer-term comatose patients may be reclassified as being in a permanent vegetative state. Recall Terry Schiavo. The patient cannot be awakened and does not respond to pain, light or sound in a normal way - the person in coma cannot react with the surrounding environment. A person in a coma does not take voluntary actions and does not have sleep-wake cycles.

The inability to waken differentiates coma from sleep. Levels of unconsciousness and unresponsiveness vary, depending on how much of the brain is functioning.  Neurological Experts and family often argue about whether the comatose patient can hear voices or perceive events or the presence of people. 

Coma may occur for various reasons, such as intoxication, CNS (central nervous system) diseases, a traumatic injury, and hypoxia (oxygen deprivation). Coma can be induced deliberately with pharmaceutical agents - perhaps in order to protect the patient from intense pain during a healing process, or to preserve higher brain function following another form of brain trauma.

Comas generally do not last for more than a few weeks. A patient whose state does not change after an extended period is often reclassified as being in a persistent vegetative state. Unfortunately, those in a persistent vegetative state for over twelve months rarely wake up.

Another condition is known as "Locked-In Syndrome."  Locked-in syndrome is a rare neurological disorder characterized by complete paralysis of voluntary muscles in all parts of the body except for those that control eye movement. It may result from traumatic brain injury, diseases of the circulatory system, diseases that destroy the myelin sheath surrounding nerve cells, or medication overdose. Individuals with locked-in syndrome are conscious and can think and reason, but are unable to speak or move. The disorder leaves individuals completely mute and paralyzed. Communication may be possible with blinking eye movements

A book and movie called "The Butterfly and Diving Bell" was written by Jean-Dominique Bauby who could only move his eyelid.  Through the help of an interpreter, he wrote the entire book, letter by letter, by moving his eyelid when the letter was identified.
 

What are the possible causes of a coma?

A coma can have several possible causes, including:

• Diabetes - if the blood sugar levels of the diabetes patient rise too much they will have hyperglycemia, the opposite is hypoglycemia (blood sugar levels are too low). Sustained periods of hyperglycemia or hypoglycemia can result in coma.
   
• Hypoxia (lack of oxygen) - a person who nearly drowned may not awaken because of a shortage of blood (which carries oxygen) to the brain. The same may occur to somebody who is resuscitated after a heart attack.
   
• Infections - those which cause inflammation of the brain, spinal cord or tissues surrounded the brain can result in coma if symptoms are severe enough. Examples include encephalitis or meningitis.
   
• Stroke - a condition where a blood clot or ruptured artery or blood vessel interrupts blood flow to an area of the brain. A lack of oxygen and glucose (sugar) flowing to the brain leads to the death of brain cells and brain damage, often resulting in impairment in speech, movement, and memory - and sometimes coma.
   
• Toxins and drug overdoses - exposure to carbon monoxide can result in brain damage and coma, as can some drug overdoses.
   
• Traumatic brain injuries - these include injuries from vehicle accidents and violent attacks. They are the most common cause of comas.

Diagnostic Tools

Lumbar puncture (spinal tap) - this can determine whether there is an infection. The doctor inserts a needle into the patient's spinal canal, measures pressure and extracts fluid.   Ruling out meningitis usually utilizes spinal tap.

Imaging scans of the brain - these will help determine whether there is any brain injury/damage, and where. Examples include:

• CT (computed tomography) scan - also known as a CAT (Computer Axial Tomography) scan. It is a medical imaging method that employs tomography. Tomography is the process of generating a two-dimensional image of a slice or section through a 3-dimensional object (a tomogram). The medical device is called a CTG scanner; it is a large machine and uses X-rays. It used to be called an EMI scan, because it was developed by the company EMI.
   
• MRI (magnetic resonance imaging) scan - an MRI machine uses a magnetic field and radio waves to create detailed images of the body, which in this case would be the brain. Most MRI machines look like a long tube, with a large magnet present in the circular area. When beginning the process of taking an MRI, the patient is laid down on a table. Then depending on where the MRI needs to be taken, the technician slides a coil to the specific area being imaged. The coil is the part of the machine that receives the MR signal. MRI scans are good for examining the brainstem and deep brain structures. The doctor may inject a special dye which shows up on the scans and distinguishes healthy tissue from damaged tissue. 
   
• EEG (electroencephalography) - the device measures the electrical activity within the brain. Electrodes are placed on the patient's scalp; they pick up electrical impulses that occur in the brain. These impulses are recorded on the EEG device. An EEG can tell whether the patient is having non-convulsive seizures. 
•  
• PET (Positron Emission Tomography) - a nuclear medicine imaging technique which produces a three-dimensional image or picture of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide (tracer), which is introduced into the body on a biologically active molecule. Images of tracer concentration in 3-dimensional space within the body are then reconstructed by computer analysis.

 Glasgow Coma Scale (GCS)

This scale is very useful for determining conciousness in severe cases.  Unfortunately it is fequently misused in cases of mild and moderate traumatic brain.  For instance, Mild Traumatic Brain Injury, which many times has devasting consequences, is defined by the same value on GCS as for a completely normal individual.  Hence those with incentive to discredit the reality of brain injury point to the "normal" GCS.

The GCS scores patients according to verbal responses, motor responses (physical reflexes), and how easily they can open their eyes.

• Eyes - Glasgow Coma Scale
  
  Score of 1 - does not open eyes.
  Score of 2 - opens eyes in response to painful stimuli (when given pain).
  Score of 3 - opens eyes in response to voice.
  Score of 4 - opens eyes spontaneously.
  
  
   
• Verbal - Glasgow Coma Scale
  
  Score of 1 - makes no sound.
  Score of 2 - incomprehensible sounds (mumbles).
  Score of 3 - utters inappropriate words.
  Score of 4 - confused, disorientated.
  Score of 5 - oriented, chats normally.
  
   
• Motor (physical reflexes) - Glasgow Coma Scale
  
  Score of 1 - makes no movements.
  Score of 2 - extension to painful stimuli (straightens limb when given pain).
  Score of 3 - abnormal flexion to painful stimuli (moves in a strange way when given pain).
  Score of 4 - flexion/withdrawal to painful stimuli (moves away when given pain).
  Score of 5 - localizes painful stimuli (can pinpoint where pain is).
  Score of 6 - obeys commands.
  
  
   
• Brain injury will be classified in the Glasgow Coma Scale as:
  
  Coma = a score of 8 or less.
  Moderate = a score of 9 to 12.
  Minor = a score of 13 or more.

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Researchers working with NASA have developed a non-synthetic substance made of bone cells that replicates actual bone.  They intend to study how growth occurs in living bone.

We all have, or know someone who has, broken a bone.  Interestingly, there are numerous types of broken bones.  Not only is the probability of developing arthritis increased in the area of fracture, but additional complications result near joints.

The best way to prevent a fracture is to stop bones from reaching the point where they are prone to breaking, but understanding the process of how bones form and mature has been challenging.  A fracture, also referred to as a bone fracture, is a medical condition where the continuity of the bone is broke. A significant percentage of bone fractures occur because of high force impact or stress; however, a fracture may also be the result of some medical conditions which weaken the bones, for example osteoporosis. A fracture caused by a medical condition is known as a pathological fracture.

The word break is commonly used by lay (non-professional) people. Among health care professionals, especially bone specialists, such as orthopedic surgeons, break is a much less common term when talking about bones.

A crack (not only a break) in the bone is also known as a fracture. Fractures can occur in any bone in the body. There are several different ways in which a bone can fracture; for example a clean break to the bone that does not damage surrounding tissue or tear through the skin is known as a closed fracture or a simple fracture. On the other hand, one that damages surrounding skin or tissue is known as a compound fracture or an open fracture. Compound or open fractures are generally more serious than simple fractures, with a much higher risk of infection.

Most human bones are surprisingly strong and can generally stand up to fairly strong impacts or forces. However, if that force is too powerful, or there is something wrong with the bone, it can fracture.  With travel speeds and related sudden stop velocity (crash) in cars, trains and planes far exceeding the old fashioned modes of walking, horseback riding (or elephant riding if you are from India), forces have greatly varied in modern times.

The older we get the less force our bones can withstand. Approximately 50% of women and about 20% of men have a fracture after they are 50 years old (Source: National Health Service, UK).

Because children's bones are more elastic, when they do have fractures they tend to be different. Children also have growth plates at the end of their bones - areas of growing bone - which may sometimes be damaged.

Some different types of fracture:

• Avulsion fracture - a muscle or ligament pulls on the bone, fracturing it.
   
• Comminuted fracture - the bone is shattered into many pieces.
   
• Compression (crush) fracture - generally occurs in the spongy bone in the spine. For example, the front portion of a vertebra in the spine may collapse due to osteoporosis.
   
• Fracture dislocation - a joint becomes dislocated, and one of the bones of the joint has a fracture.
    
• Hairline fracture - a partial fracture of the bone. Often this type of fracture is harder to detect. 
   
• Impacted fracture - when the bone is fractured, one fragment of bone goes into another.
   
• Longitudinal fracture - the break is along the length of the bone.
   
• Oblique fracture - A fracture that is diagonal to a bone's long axis.
   
• Pathological fracture - when an underlying disease or condition has already weakened the bone, resulting in a fracture (bone fracture caused by an underlying disease/condition that weakened the bone).
   
• Spiral fracture - A fracture where at least one part of the bone has been twisted.
   
• Stress fracture - more common among athletes. A bone breaks because of repeated stresses and strains.
   
• Torus (buckle) fracture - bone deforms but does not crack. More common in children. It is painful but stable.
   
• Transverse fracture - a straight break right across a bone.

 Now researchers at the University of Houston department of health and human performance have created a process that grows real human bone in tissue culture, which can be used to investigate how bones form and grow. 

The research is ready to market and hopefully will help in the prevention of broken bones and advance our ability to heal them.

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Have you ever seen a 65 year old man with graying head driving with the top down in his brand new red Corvette?  Or how about the 80 year old great grandmother who thinks her jet black hair is fooling anybody?  Well these otherwise refusing-to-act-their age folks might just be on to something.

God bless my grandmother, Mary, 86 years young.  She lives with me and my family and we just got back from a Christmas Holiday cruise.  And that was her second cruise in 6 months!  We call her the energizer bunny for obvious reasons.

Therapies that can keep us younger longer might also push back the clock on Alzheimer's disease, suggests a new study of mice in the December 11th issue of the journal Cell, a Cell Press publication.

Reduction of insulin signaling is known to extend life span, but now Dillin and colleagues report that this strategy can also work to mitigate and forestall the affects of Alzheimer's disease in a mouse model.

Most cases of Alzheimer's disease (AD) exhibit sporadic onset during the seventh decade of life or later, whereas the fewer mutation-linked, familial cases typically manifest during the fifth decade. These temporal features, common to numerous neurodegenerative diseases, define aging as the major risk factor for the development of these maladies (Amaducci and Tesco, 1994).

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Prompted by the rape case of former KBR employee Jamie Leigh Jones, defense contractors will no longer be able force claimants into mandatory arbitration.  Typically defendant's like arbitration to keep cases away from juries that may award higher amounts.

The arbitrations applied to discrimination and sexual assault on contracts greater than $1,000,000.

The no-arbitration clause will have some minor exceptions, such as allowing arbitration if “it is necessary to avoid harm to national security interests of the United States.”  

Read more here.

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The N.Y. Times reported a bobsleding accident has stopped Todd Hays from participating in the sport at the Winter Olympics.

Many sports, while entertaining, can have devasting impacts on participants.  Nevada, for example, recently ran stories on how its tax base is forced to pay for fighters who have injuries that cost more than $50,000.  That amount is what is required of promoters to post as health related insurance for fighters.  Fighting is a big Las Vegas draw. 

The Las Vegas Review Journal reported recently that fighter Zeta Gorres is admitted at University Medical Center, Clark County's only public hospital. He has piled up about $500,000 in bills since he suffered a traumatic brain injury, and he won't be able to cover all the costs. Taxpayers are on the hook for most of the tab.

The 27-year-old is a bantamweight professional boxer who suffered injuries in a Nov. 13 fight against Luis Melendez on the Strip.

After nearly two months of constant nursing care and physical therapy, and after requiring some of the most advanced medical procedures available, Mr. Gorres is making progress.

The taxpayers of Southern Nevada are, unfortunately, accustomed to covering tens of millions of dollars worth of uncompensated care at UMC every year for all types of indigent patients, including illegal immigrants. But why now, when UMC is facing an $82 million deficit, is the public being asked to provide welfare to a professional fighter whose injuries were sustained during a state-sanctioned bout?

The reason is a horribly outdated state law that requires promoters to provide only $50,000 worth of health insurance for each fighter in the ring. That amount might cover a single trauma surgery. Fighters are not required to carry their own health insurance or supplementary coverage, and as a result, they usually don't. Mr. Gorres didn't.

 The Nevada Athletic Commission can't expect the public, especially in this economy, to cover the costs of caring for injured fighters. The state must raise the minimum insurance requirement for professional bouts to $1 million per fighter or require promoters to pay into a pool that covers boxers' medical bills for catastrophic injuries suffered in the ring.

Hays, who won a silver medal in the 2002 Salt Lake Games, was having a strong season that included a second-place finish in a World Cup race in Park City Utah, and hoped he would race in his fourth Olympics. But the devastating accident happened during training for the four-man bobsled Dec. 9 in Winterberg, Germany. His resulting head injury has prompted him to retire.

Hays, 40, was initially diagnosed with a concussion, but a magnetic resonance imaging test revealed he had intraparenchymal hematoma, a serious and  life-threatening injury where the brain bleeds.

Intracranial hemorrhage  is a common cause of acute neurologic emergency. Pathologic accumulation of blood in the cranial vault may occur in the brain parenchyma or the surrounding meningeal spaces. Such accumulations can be epidural hematomas , subdural hematomas , subarachnoid hemorrhages , or intraventricular hemorrhages .

The etiology of  Intracranial hemorrhage is multifactorial and varies with a person's age and predisposing factors.

I often represent clients who have sufferred from Intercranial hemorrhage and had it surgically removed.  Many times they are able to leave the hospital and resume some semblance of normalcy.  But I too frequently encounter lawyers, inurance adjusters, and jurors that have a predisposition to assume that if a person "looks ok" then they must "be ok."

Read more here.

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The Sarah Jane Project concerns pediatric traumatic brain injury from shaken baby syndrome. 

Shaken baby syndrome is a type of inflicted traumatic brain injury that happens when a baby is violently shaken.  A baby has weak neck muscles and a large, heavy head.  Shaking makes the fragile brain bounce back and forth inside the skull and causes bruising, swelling, and bleeding, which can lead to permanent, severe brain damage or death.  The characteristic injuries of shaken baby syndrome are subdural hemorrhages (bleeding in the brain), retinal hemorrhages (bleeding in the retina), damage to the spinal cord and neck, and fractures of the ribs and bones.  These injuries may not be immediately noticeable.  Symptoms of shaken baby syndrome include extreme irritability, lethargy, poor feeding, breathing problems, convulsions, vomiting, and pale or bluish skin.  Shaken baby injuries usually occur in children younger than 2 years old, but may be seen in children up to the age of 5.

I was asked to pass this on on behalf of Jessica York and her work with The Brain Project.

This Saturday is Patrick's 39th birthday and we want to do something very special for Sarah Jane's dad. As you know, Patrick named the Sarah Jane Brain Foundation after his adorable 4-year-old daughter who was shaken by her baby nurse when she was only 5 days old, causing a severe brain injury. Since he started it two years ago, the foundation has quickly galvanized the pediatric brain injury community into action across the country and around the world. What you may not know is Patrick is a single dad with sole custody of his little girl. What’s more, he gave up his salary from his consulting firm more than a year ago to devote all his energy, time and personal resources to advancing the foundation's efforts. We are organizing a surprise for him in the same vein as his favorite movie, "It's a Wonderful Life!" where Jimmy Stewart's character receives support from all over recognizing his efforts. We would like you to be part of this wonderful surprise and make a generous donation as a birthday present to this amazing father.

Sarah Jane is a beautiful little girl, but because of her brain injury she still can't do most of the things other children her age are doing. She can't say "I love you, Daddy." She can't finger paint a picture or even scribble on a Birthday card for him. She can't give him a hug or a kiss. But you can help us give Patrick a gift that will help make sure one day Sarah Jane will be able to do all those things. Patrick has moved mountains, reinvented the wheel, and gone the distance for his daughter and he believes with every fiber of his being that Sarah Jane will one day be able to say "I love you, Daddy."

His exhaustive efforts have launched The National Pediatric Acquired Brain Injury (PABI) Plan and the largest-ever medical and educational collaboration on behalf of brain-injured children, but these are only the first steps on a long road that needs continued work and support (below is a summary of this year's accomplishments). In honor of his amazing example of fatherly devotion every single day, we are hoping that together we can honor Patrick by donating to the foundation that means so much to him. From now until Saturday, you can donate directly to the special Happy Birthday PayPal account and include a special note to Patrick. Sarah Jane can't tell Patrick what a good father he is - but you can!

We want to surprise Patrick with this, so on Saturday we're going to print all the notes and put them in a big birthday card for him, along with one big check made out to the Sarah Jane Brain Foundation that's the total of everyone's birthday donations. As Patrick likes to say, "Every dollar makes a difference; every $1,000 makes a thousand differences!" So please be generous. If you would prefer to make your tax-deductible donation with an actual check, please overnight it to: The Sarah Jane Brain Foundation, 339 Fifth Avenue - Suite 405, New York NY 10016, and mark the envelope to my attention (Jessica York).

Here is the special birthday PayPal link (Patrick won't see it until Saturday): https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=10563509.

2009 Accomplishments of the Sarah Jane Brain Foundation (yes, we got all of this done in one year):

· Developed an Advisory Board with over 200 doctors, lawyers and researchers from just about every major medical institution (from MD Anderson and Johns Hopkins to Mayo Clinic and Mount Sinai) and research university (from Harvard and Yale to UCLA and NYU)

· In January, this Advisory Board developed the first-ever National Pediatric Acquired Brain Injury Plan (PABI Plan) which creates a seamless, standardized, evidence-based system of care, universally accessible for all PABI families regardless of where they live in the country

· This spring we completed a 12-city American PABI Heroes Tour in which we traveled across the country (11,000 miles in two weeks) raising awareness about PABI, raising money for local PABI families and bringing together talented and philanthropic musicians to support these PABI families (Boston, New York, D.C., Raleigh, Atlanta, Miami, Birmingham, Columbus, Chicago, Dallas, Denver and Los Angeles)

· On June 5 (Sarah Jane’s 4th birthday) we announced the largest healthcare collaboration in U.S. history dealing with PABI (one institution in every state plus D.C. and Puerto Rico was selected to be our State Lead Center, i.e., Children’s Hospital Boston/Harvard Medical School in MA, Kennedy Krieger/Johns Hopkins in MD, Yale-New Haven Children’s Hospital in CT, Mayo Clinic in MN, University of Virginia in VA, etc.)

· On August 18 we announced the largest grant proposal in U.S. history dealing with PABI (a $930 million multi- department proposal to begin funding the PABI Plan)

· On October 13 the PABI Act of 2009 was introduced into the U.S. House of Representatives which has Congress endorsing the PABI Plan and encouraging federal, state and local governments to begin implementing it (H. Con. Res. 198 currently has close to 90 co-sponsors and is almost ready for passage)

· On November 17-18 we held the first-ever National PABI Legal Conference to develop a National Legal Advocacy Organization to serve as a legal advocate for the millions of PABI families across the country

· This past month The Sarah Jane Brain Foundation "went Global" by adding experts from around the world to its renamed International Advisory Board and launched The International Mind, Brain, Health and Education Initiative with Harvard University

For more details about these accomplishments, please visit our website www.TheBrainProject.org. As we come to the end of 2009, please consider a generous tax-deductible donation. Every 23 seconds in the United States, another person sustains a brain injury - it is the #1 cause of death and disability for children and young adults in the United States! (As a reference point, the total number of cumulative cases of autism is 560,000 - compared to the 3 million NEW cases of brain injury that occur each year!) Have a wonderful and safe holiday season and a Happy and Healthy 2010!

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The Brain Injury Association of America has long been a leading advocate for victims of brain injury.  I have been fortunate over the past few years to serve on the executive planning committee for the annual Brain Injury Conference in Las Vegas.  The BIAA's mission is to educate.  In that context, the BIAA offers plaintiff and defense lawyers education into the realities and truths of brain injury from both sides of the aisle, so to speak.

The conference is but one tool used by the BIAA in Creating a better future through brain injury prevention, research, education and advocacy.

Founded in 1980, the Brain Injury Association of America (BIAA) is the leading national organization serving and representing individuals, families and professionals who are touched by a life-altering, often devastating, traumatic brain injury (TBI).

Together with its network of more than 40 chartered state affiliates, as well as hundreds of local chapters and support groups across the country, the BIAA provides information, education and support to assist the 3.17 million Americans currently living with traumatic brain injury and their families.
 

 www.BIAA.org 

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Have you ever considered the claims by celebrities, like Tom Cruise, or health care professionals that decry the impact of anti-psychotics and anti-depression medicine?  Have we come to rely on Prozac, Paxil and the laundry list of "feel good" medication to overcome what generations of folks have dealt with without them?  Or, is there a benefit reaped by those on the medication?  Do doctors overprescribe?  I am interested to know what you think.  Drop me a comment. 

The December issue of Archives of General Psychiatry, one of the JAMA/Archives journals,  reports Individuals taking a medication to treat depression may experience changes in their personality separate from the alleviation of depressive symptoms.

Two personality traits, neuroticism and extraversion, have been related to depression risk, according to background information in the article. Individuals who are neurotic tend to experience negative emotions and emotional instability, whereas extraversion refers not only to socially outgoing behavior but also to dominance and a tendency to experience positive emotions. Both traits have been linked to the brain's serotonin system, which is also targeted by the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

Read More Arch Gen Psychiatry.2009;66[12]:1322-1330.  Drop me a comment on your take on this issue.

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In this time of withdrawing consumer rights regarding avoidable medical mistakes, would requiring disclosure and public dissemination of physician malpractice data be welcome?  Currently, in Nevada, there is no such disclosure.

How often do we see physicians who our friends say are "good doctors?"  Or when we go to the emergency room we are "referred" to the doctor on rotation?  Would it serve the patient's interest to be able research the doctor they are considering?  Well that is starting to happen in other states.

The Raleigh News & Observer (12/8, Garloch) reports, "For the first time, consumers can easily check whether North Carolina doctors have settled or lost medical malpractice claims or been convicted of crimes. The N.C. Medical Board announced Monday that it has expanded its Web site to include malpractice settlements or judgments and criminal records for its 35,000 licensed physicians and physician assistants. The expansion comes in response to a law passed by the General Assembly in 2007 that requires the board to publish malpractice payments, misdemeanor and felony convictions, hospital suspensions and discipline by medical boards in other states."

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The fact of repeated impacts to the brain causing brain damage made news.  A private university will pay $7.5 million to provide lifetime care to a former football player who suffered a severe brain injury in a 2005 game after an earlier concussion went untreated.

The family of Preston Plevretes, 23, of New Jersey, settled their lawsuit against La Salle University.

The settlement came as the NFL, the NCAA and other governing bodies review rules about when athletes should return to play following concussions, amid research that suggests returning too soon can lead to brain damage.

Read more: http://sportsillustrated.cnn.com/2009/football/ncaa/wires/11/30/2060.ap.fbc.football.concussion.lawsuit.3rd.ld.writethru.0664/#ixzz0Z1OZ8nRV
 

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The American Psychological Association notes that Holiday stress is a leading cause of financial stress for Americans.   National unemployment levels push into double digits for the first time in decades, the American Psychological Association's (APA) newest Stress in America survey finds that Americans continue to cite financial concerns as leading sources of stress.

Approximately seven in ten Americans report that money is a significant source of stress (71 percent), according to APA's 2009 Stress in America survey, with similarly high percentages reporting stress resulting from work (69 percent) and the economy (63 percent). More than half of adults (55 percent) also cited family responsibilities as a significant source of stress in their lives.

APA suggests the following strategies to manage holiday stress and enjoy the season:

1. Take time for yourself. Taking care of yourself helps you to take better care of others in your life. Go for a long walk or take time out to read or listen to your favorite music. By slowing down you will actually have more energy to accomplish your goals.

2. Volunteer. Many charitable organizations face new challenges as a result of the ongoing economic downturn. Find a local charity, such as a soup kitchen or a shelter, where you and your family can volunteer together. Helping others who are less fortunate can put hardships in perspective and can build stronger family relationships.

3. Set realistic expectations. No holiday celebration is perfect; view inevitable missteps as opportunities to demonstrate flexibility and resilience. Create a realistic budget and remind your children that the holidays aren't about expensive gifts.

4. Remember what's important. Commercialism can overshadow the true sentiment of the holiday season. When your holiday expense list is running longer than your monthly budget, scale back. Remind yourself that family, friends and the relationships in our lives are what matter most.

5. Seek support. Talk about stress related to the holidays with your friends and family. Getting things out in the open can help you navigate your feelings and work toward a solution. If you continue to feel overwhelmed, consider talking with a professional such as a psychologist to help you develop coping strategies and better manage your stress. A psychologist has the skills and professional training to help people learn to manage stress and cope more effectively with life problems, using techniques based on best available research and their clinical skills and experience, and taking into account an individual's unique values, goals and circumstances. Psychologists have doctoral degrees and are licensed by the state in which they practice. They receive one of the highest levels of education of all health care professionals, spending an average of seven years in education and training after they receive their undergraduate degrees.

Read more here.

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Robert C. Griggs, MD, FAAN, President of the American Academy of Neurology and The American Academy of Neurology, the world's largest professional association of neurologists, is encouraged by news reports that the National Football League will soon implement a new policy requiring an independent neurologist to evaluate players who have suffered a concussion. The Academy would welcome an opportunity to work with the NFL to implement this new policy change as it is imperative that an unbiased neurologist be involved in determining when it is safe for a player to return to play. The Academy has a network of sports neurologists available nationwide who are members of the Academy's Sports Neurology Section. For more information about the American Academy of Neurology, visit http://www.aan.com.
 

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According to Medilexicon's medical dictionary:

Cluster headache is "possibly due to a hypersensitivity to histamine; characterized by recurrent, severe, unilateral orbitotemporal headaches associated with ipsilateral photophobia, lacrimation, and nasal congestion."

Cluster headaches (also used in singular: headache), also nicknamed suicide headaches, occur several times a day, they come on unexpectedly, do not last long, and are generally very painful. The pain is usually intense, and sometimes only on one side of the head. Frequently, the sufferer also feels pain around the eye.

A cluster-headache sufferer can wake up during the night because of the pain. Often, this occurs at the same time each night. The eye on the painful side of the head may be reddened and watery. The individual's nose may be runny or blocked on the side of the nose where the pain is.

Read more here.

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A new study published in the Scientific Journal Neurology reveals that women who store fat on their waist in middle age are more than twice as likely to develop dementia when they get older.

The most common symptoms of dementia are forgetfulness, impaired speech and problems with recognition and orientation. It is a condition that can affect all our mental faculties and which is more common as we get older. Around seven per cent of the population over the age of 65 and just over 20 per cent of the over-80s have severe dementia.

Dementia isn't a specific disease. Instead, it describes a group of symptoms affecting intellectual and social abilities severely enough to interfere with daily functioning. It's caused by conditions or changes in the brain. Different types of dementia exist, depending on the cause. Alzheimer's disease is the most common type.

Memory loss generally occurs in dementia, but memory loss alone doesn't mean you have dementia. Dementia indicates problems with at least two brain functions, such as memory loss along with impaired judgment or language. Dementia can make you confused and unable to remember people and names. You may also experience changes in personality and social behavior. However, some causes of dementia are treatable and even reversible.

Dementia symptoms vary depending on the cause, but common signs and symptoms include:

Memory loss
Difficulty communicating
Inability to learn or remember new information
Difficulty with planning and organizing
Difficulty with coordination and motor functions
Personality changes
Inability to reason
Inappropriate behavior
Paranoia
Agitation
Hallucinations
 

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