Recently the London Free Press published a series of articles outlining the importance of recognition of concussive injuries.  Normally, I'm not a fan of media pieces as I find they push fear mongering and poorly researched arguments.  Kudos to the LFP - I encourage you to read it, but if you're too busy, here are my take home points:

1. Concussions are SERIOUS, but if managed properly there is usually no need for long term concern. The issues with encephalopathy are real, but rare, and typically because of repeated and poorly managed injuries!

2. No one would send their kid to the rink or field without a helmet...so why are we sending them without having a solid concussion protocol in place? This MUST include baseline testing, honesty on the part of the athlete, and recognition by coaching staff.

3. "We’re missing a huge amount of minor concussions that most of the time will, by luck, resolve without consequences, but a few of those are those kids who will get a second hit that will constitute a very bad episode of concussion that could have been prevented by early detection." - Dr. Pierre Fremont, Canadian Concussion Collaborative

4. These kids need assessment by EXPERIENCED concussion experts, not bench trainers, parents, or even at times their family doctor (not all MDs have experience treating concussions, actually very few do).

5. Don't let emotions make return to play decisions! Even if it's the last game of the tournament, and you're the top goal scorer, if the brain is injured you need to be taken off!!

Those who know me are well aware of my push for baseline testing.  I see dozens of concussion patients every week, and the number of those who came in with baseline tests are unfortunately low.  Very low.  What difference does that make?  Looking back at my last month in the clinic, those who had a baseline test were returned to play approximately twice as fast as those who did not.  Sure there's the severity issue, or length of time it took them to finally get assessed (in some cases 30 years!), but when I know what your "normal" levels should be there's less guess work.  It takes time to fully assess what level of functioning is considered normal - there are many people who struggle with short term memory on a good day!

Let your kids compete!  Let them have fun!  Keep them active (and away from those damn video games)!  We are going to end up with a society of overweight, lazy, whiney teenagers who have no sense of respect, teamwork, sportsmanship or disappointment.  There are risks with everything we do - you can't bubble wrap everything.  But if something does happen, get it looked after!  Find someone who has experience in managing the injury and move on from it!  At the end of the day, our kids are going to need to find jobs and no matter what that job is - "you're going to need a brain for that!"

 I find myself constantly repeating this phrase to friends, family, and patients alike.  It rings true for so many facets of our everyday lives.  Whether we are buying a car, signing up for the newest diet program, or visiting a healthcare practitioner.  If it sounds too good to be true, it is.

This is the age of technology.  The age where we have access to any piece of information we could possibly desire to get our greedy little mitts on.  If I want to find out how to build my own house, change the alternator on my vehicle, or perform minor surgery, the good ol' interweb is at my beck and call.  

I have been inundated on my social media sites with miraculous self-cures for MS, amazingly simple recipes to help me lose 10 pounds overnight, and how to cure my own back pain.  Who'd a thunk it'd be so simple?  Why the heck did I spend a decade in post-secondary education??

In my 8 years in practice, I have had numerous encounters with patients who have come to me with file folders FULL of web pages indicating their self-diagnosis.  Dr. Google has informed them they have about 4 months to live and should get their affairs in order.  At what point did we as a society lose all trust in the healthcare system that we would rather consult a computer program or our hair dresser rather than a highly trained, skilled provider?

I get it.  We are a "right now" society.  I want to eat what I choose, take a pill, and have the weight magically disappear from my stomach to reveal the rippling six-pack I attained from wearing my ab-a-cizer belt.  It's sooooooo much easier. 

The reason I have chosen to write about this particular topic is because over the last two months I have had: three patients who have had their neck adjusted by their massage therapist, two patients who have gone off their medication on a recommendation from their fitness "coach", a patient who had a friend use essential oils to battle cancer, and countless patients express to me that their coach/trainer/reflexologist/dog-walker offered them dangerous medical advice.

This is not meant to be an attack piece on any particular profession.  Yet, if you feel like I may be centering in on you, maybe it would be pertinent to review your scope of practice (and if you don't have a mandated scope, that does not give you carte blanche).  This is meant to be a wake-up call to the consumers of healthcare.

As a responsible person, you should always digest what some people are recommending to you and look at their background and training before taking them at their word.  There is no substitute for registered health professionals.  They have spent years training in their craft, and for the most part, will be your best source.  Fitness and health magazines do not always contain the most up-to-date or validated information.  Google cannot diagnose your specific type of back pain to tell you what interventions are most appropriate for you.  Just the other day I saw someone on Facebook post that 'everyone with sciatica should do the following exercises'.  Firstly, who diagnosed you with sciatica; is it actually sciatica?  Secondly, what's causing the sciatic irritation?  Without a validated and experienced consultation you may end up doing more damage than good (and in this example the exercises suggested were horrendous).  The unfortunate reality is that some people can "talk the talk" and have consumers eating out of their hands.  

Conveying a diagnosis is a protected act, just like filling a cavity, that only certain highly-trained doctorate-level professionals are legally allowed to do.  Before you accept the diagnosis of a 'rotator cuff tear' from your personal trainer, who then gives you a variety of exercises to fix it, maybe you should get a second opinion from someone who is actually trained to ensure you don't have cervical radiculopathy, subacromial pain syndrome, or an acromioclavicular sprain.  These all require completely different therapy, and can be made tremendously worse with the wrong intervention.  I fully admit that a trained monkey could "do" the therapy that I do.  It's a matter of knowing why, how, and what to do if it goes wrong.  For example, why do you think those patients came to me after having an adjustment of their neck from their massage therapist?  It's because they are not trained in, or permitted to utilize, spinal manipulation and he created a severe sprain of the joints and nerve irritation!

I don't claim to have the answers to everything, nor do I intend to use my educational background to allow me the right to give recommendations on every topic within healthcare.  What I do claim, though, is that over the years I have developed a solid understanding of everyone's roll within the healthcare system.  We have as many diverse professionals as we do for a reason.  If you struggle with headaches, we have chiropractors and neurologists that can help immensely (and have the validated research to prove it).  If you destroyed your ACL playing soccer, we have surgeons who can fix that.  If you have a nagging cough or ear ache that just won't go away, you're best to consult your family physician.  

Do you ever notice that these self-labelled "coaches" and "lifestyle advocates" have a cure for everything, that just happens to be the product they were trained to sell?

It's difficult as a consumer of healthcare to weed through all the noise.  You can't open your Facebook account without seeing ads, or friends posting about how their plan can help you lose weight, cure your headaches, or battle Parkinsons without medication.  And often they even claim to have 'research' to support their claims (look at this research though, very often it's bankrolled by the company or someone who has a vested interest in the results). 

I attempt to run my day-to-day practice with integrity and utilize the best available validated evidence to direct my therapy, and if my techniques are not right for you, I will do my best to find someone who can help you.  Trust me, it's hard to tell someone "I'm not the right doctor for you"; those of us in healthcare do have a bit of an ego!  But at the end of the day, I would like to think the patient respects me more for bowing out to someone better equipped.

A well-respected research reviewer I know, Dr. Shawn Thistle, begins his seminars and presentations with a disclaimer, which I have subsequently adopted (ie. stolen): "I don't claim to know every piece of research.  This is just my take."  Again, I don't know everything about everything, but I know what I know and am confident in what I do (and cannot do).  If you feel like this article has hit home and feel slapped by my words, I would suggest if you're that passionate about helping people with their health and fitness needs, go back to school!  Go get that education, write those exams, prove your worth!  And subsequently, practice (within your scope)!!  Otherwise, be cautious with your advice.  

Check back often!  Dr. Coghlin will be adding content to the blog as time permits.

If you have a topic of interest, please contact Dr. Coghlin here!