Protecting Young Brains: Inside Concussion Care with the Spurs’ Team Surgeon

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Welcome to Pediatrics Now. I'm Holly Wayment.
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We're talking about an important topic today, concussions and early identification
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of traumatic brain injury.
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With recent attention on the San Antonio Spurs star Victor Wembenyama,
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or Wembe, as many San Antonio fans and fans worldwide know him,
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and his recent concussion, it's a good moment to look at what happens medically
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when a head injury is suspected.
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I'm thrilled today because I'm joined by Leah Brown, Head Team Orthopedic Surgeon
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for the San Antonio Spurs and Associate Professor at UT Health San Antonio.
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Dr. Brown, thank you so much for joining us, and we really appreciate you joining
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us with your busy travel schedule, traveling to Portland with the team.
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Yes, well, thank you. Thank you so much, Holly, for the invite.
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This is something I'm passionate about.
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I am passionate about youth sports and how we best take care of our participants in youth athletics.
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Well, and first of all, how's Wimby doing? So he traveled there with the team?
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Yes. So when a concussion is suspected during a game, what are the first steps
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from a medical standpoint?
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So anytime there's a concern for concussion, the first thing is recognizing
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it and doing an appropriate initial assessment. As we have seen,
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the recognition of concussion in sports has exploded, and that's really important.
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We know that there are approximately a million to almost two million concussions
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sustained by our youth athletes annually, just in the United States.
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So this is really about recognition and appropriate diagnosis.
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Wow. So what are the most important early signs of a concussion that,
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of course, no one would ever want to miss?
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Certainly, we understand that mechanism is huge.
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And so if these are sport-related concussions, usually there is a mechanism
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and you can see where something may happen. But usually these symptoms involve
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cognitive cloudiness or mental fog.
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You can have headache, noise sensitivity, nausea, light sensitivity.
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Then you can have even more progressive or more extreme symptoms like neurologic
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symptoms or other kinds of manifestations that way.
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So recognizing them early is important. When it becomes a little more difficult
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is when these types of injuries happened in regular activities like bicycling or on the playground.
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Can you tell me more about that? So we oftentimes consider concussion with athletics,
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and that's great because that is a lot of times where they're happening.
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But children play, people get injured, you know, accidents happen.
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And so, you know, people ride a bike and, you know, as much as we say,
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you know, use your helmets, they may or may not.
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Scooter use and motorized other vehicles use has increased significantly as
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our technology has increased.
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And so recognizing when there can be evidence of a traumatic brain injury from
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an accident, and it doesn't even have to be a big collision.
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It can be a whiplash type mechanism. It can be a lot of different things.
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Falling off the swings, you know, falling down or off the playground or the
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monkey bars. You know, we see injuries like that all the time.
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And just for an example, my 14-year-old daughter, she was talking to her friend
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the other day who does barrel racing.
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And she was saying, she said that when she had a concussion after barrel racing,
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she was back on a horse the next day.
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So to use her friend's words, it's dumb to wait to sit out if you feel like going back in.
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So, yes, it is up to us as the medical experts to educate parents,
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athletes, and all of our patients that this is a significant injury.
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We think of a broken arm or a torn ACL.
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We recognize that. We want to get the diagnosis, and we're going to go through
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the treatment protocols so we can return to play.
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Brain injury is no different and should be respected tremendously.
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Obviously, brain injury, and we know, especially in our younger population,
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actually affects adolescents more so than even the adult brain. It is still forming.
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There are a lot of changes happening. And what is most important is preventing
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that second hit encounter.
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So the initial concussion, a lot of times we can recognize and people will shake it off.
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It's avoiding the second hit while you're still symptomatic.
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So returning to play while you're still symptomatic is just inviting danger
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and actually prolonging the potential for an appropriate recovery.
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Because the brain is more susceptible to that next injury situation.
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Absolutely. We call it the second hit syndrome. So, you know,
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we've seen all of the coup, contra coup type mechanisms.
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You know, this is not a bone. The brain is like a bowl of jelly in a skull.
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And you can get a second hit that really has a negative impact and people can die.
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You know, we saw recently this year, unfortunately, there was a college basketball
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player in Oklahoma that died after a concussion.
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And so these are things that we really have to take seriously.
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And that's such great advice.
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But again, if you are in a sport that has a higher risk, like these high collision
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or contact sports, then that just means you have to have a low index of suspicion.
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Anyone that has a headache, anyone that has mental fog, anyone that is displaying
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any types of symptoms, that's an immediate concussion evaluation.
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If they are symptomatic, they are absolutely prevented from returning to sport
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within 24 hours. There is no same-day return to play with any symptoms of concussion.
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And we have moved away from our previous cocooning of patients with concussion.
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So it used to be that we would, you know, tell individuals that were diagnosed
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with a concussion, you know, stay in a dark room, don't do anything,
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sleep, and just minimize exposure.
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We know that that actually prolongs people's return to school and return to sport.
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So it's important that we individualize treatment and we continuously monitor symptoms.
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So early controlled return to activity is important.
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And it is most important, especially as we're talking pediatrics,
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you return to learning before you return to sport. If a patient has not returned
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to full learning, they absolutely are not allowed to return to full sport participation.
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What are your thoughts on halo-style helmets for flag football or non-tackle
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sports? Do they actually help prevent concussions?
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You know, there's a lot of literature, there are a lot of studies going on,
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and we honestly just don't know the answer yet.
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I think if we did have an answer, we would start seeing implementation of such
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types of protective equipment.
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So, you know, it's important that we recognize the goal of protective equipment,
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and that is to prevent or reduce concussion.
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Ideally, yes, it seems like padding would be great. Sometimes that just doesn't work.
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Sometimes it's about changing how contact happens.
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Sometimes it's about, you know, changing the rules of the game.
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They've done this in hockey, in youth hockey, where they're not allowed to do
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body checks like adults can.
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They've changed it in youth soccer, where they're not allowed to head the ball
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until they're a certain age or a certain level.
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So, you know, we have found that those have a better reduction risk factor than
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the equipment, but we're working on it for sure.
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And I saw that ACL injuries are on the rise with teenage girls, especially in soccer.
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That would be another podcast, though. Yeah.
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So, Dr. Brown, what's the one thing you wish every pediatric provider and parent
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understood about concussions?
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That the brain is worth protecting and that no activity is worth the sacrifice of brain health.
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And, you know, as much as we enjoy watching our children succeed and perform,
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whether it's on a field or a court or a gym, it's important that we are having
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our young athletes engage in athletic activity for health reasons, for team enjoyment,
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for self-confidence, you know, for total health and not performance.
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So it's really important that we convey that information as medical experts
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and as parents to our children who are participating in these activities.
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Your brain is, you get one brain.
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So we've got to take care of it. And it's really important.
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We don't get to see the brain like we can see maybe bones or skin or something
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like that, where it's easy to recognize injury.
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So we have to really keep a close eye on it and be respectful of injuries that we can't see.
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And what happens after a concussion? It can affect people down the road.
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Yes. So any, you know, concussion is a type of traumatic brain injury.
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And so what we are trying to prevent is any prolonged effect.
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And we are successful most of the time.
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But there are some times where people are at higher risk of further concussion
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once they've had concussions.
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And multiple concussions, you've seen our best, our highest level athletes have
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to retire from the sport because their susceptibility to concussions now is so low.
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But what we don't want to happen is for it to become a learning impairment or
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have emotional ability or have some kind of lifelong altering consequence from the injury itself.
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And Dr. Brennan, do you want to say anything about that athlete you mentioned
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who passed away from a concussion?
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Any red flags for parents, this is what you need to get the child to the emergency
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room, the worst headache of the athlete's life, anything like that?
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So any red flag symptoms, the worst headache, if they are having further mental
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fog, any question of consciousness and any neurologic deficit, seek immediate care.
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Nobody will ever judge a parent for having a low threshold to seek expert information,
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but those are the red flags where even the medical professionals are starting
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to institute much higher diagnostic imaging or evaluation.
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And I know with my 18-year-old son, he tends to downplay anything.
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He did get a concussion in playing basketball, high school basketball,
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but really he downplayed his symptoms and after the fact then told me how he was really feeling.
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Yes. This again is about coaching our culture, the culture around sports.
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You know, we reward the hero.
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We reward the, you know, the warrior your mentality.
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And so what we're really having to change around sport culture is it's heroic
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to take care of your body.
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It's heroic to recognize limitations and to prevent further injury in the future.
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So being honest with yourself, being honest with your coaches,
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that is what's going to enable you to maximize your performance.
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One small little, you know, minimization like that could have astronomical effects.
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So being honest, because that's the best way people can help you.
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And I remember being in a high school game and one of the players watching it
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and one of the players took a looked like a terrible hit to his head, was knocked out.
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And then his mom was standing up and yelling, get up, get up and play, get up.
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And this pressure, I mean, it just it's it's just it stops you like the pressure
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that you're talking about.
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We it's a societal culture shift. Right. So we want to see that success.
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And like I said, that hero mentality has been ingrained in us,
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but at the same time, it's up to us to change the culture around health in general.
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So being tough is not pushing through injury.
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Being tough is standing up and saying, hey, I am injured. Let me get assessed.
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Let me figure out what is going on so I can be the best contributor.
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Being a 50% contributor isn't always helping the team. And that's the other
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thing that people also need to understand.
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And Dr. Brown, as a champion gymnast, how did that prepare you for your role today?
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I think being an athlete helps other athletes recognize I understand where they're coming from.
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So I'm not sitting up on some, you know, at some higher level telling them what
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to do because what they're going to say is that you don't understand or,
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you know, I have this at stake.
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I've been there, been there every single level. I absolutely know what is at stake.
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I absolutely know what it feels like to have put blood, sweat,
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and tears into something.
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And so being able to identify that and recognize and respect that and say it
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out loud helps me better relate to my patients and their parents.
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And any advice for parents who their child is begging, can I do barrel racing
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or something that could be high risk? It's tough.
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I mean, you want them to be able to do what they want to do.
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Yeah, that is a hard thing and it's different for every family and every goal.
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I always go back to the purpose of participating in a sport or an activity. Do you find joy in it?
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You know, is this something that you are going to get something from?
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Meaning, I'm going to learn how to be, you know, work hard. I'm going to learn
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resilience. I'm going to learn how to be a team player.
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I'm going to stay physically fit. You know, we've got to change our mindset
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from I've got to get this college scholarship or this is my way into to to some
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other thing, because that is not what sport is about.
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It is fantastic that opportunities like that exist, but the foundation of youth
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athletic participation is not about ultimately getting a Division I offer or
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becoming a professional athlete.
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It's really about the joys of participation and what that brings to you both
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physically, emotionally, and mentally when it comes to finding an activity.
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That's so well said. Dr.
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Brown, is there anything else that you want to mention before we go?
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It's such an honor to be able to talk to you, and I so appreciate you taking time to talk to us.
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Oh, no. Well, thank you. It's my absolute pleasure. And what I think is really
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important is that we recognize that we've got to trust our experts.
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We've got to trust that the science is there to help us be better.
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And, you know, if you're not sticking by the science of it, then there is an exposure.
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You're potentially opening up risk for further injury. And what we all want
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is for everybody's health, wellness, and safety.
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It's so true. And don't just, after a head injury, try to sleep it off.
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No, no. Be in tune to your symptoms.
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Recognize what they are. And be communicative. Seek help.
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No one is going to criticize anyone for seeking help and expertise.
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And are you seeing patients at the MARC, or do you want to mention where you see patients?
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I see patients at the UTHealth CalSeal Parkway location, and I operate at the
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Multi-Specialty Research Hospital and at the Outpatient Surgery Center at the
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CalSeal Parkway Clinic.
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Two of our newest locations and beautiful locations. Yes.
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It's such a tremendous honor being a part of the UT system. I'm excited to be here.
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I'm excited to be a factor in the San Antonio medical community,
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and I can't wait to take care of everyone.
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I see patients anywhere from around 12 years old.
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Sometimes we see patients a little bit younger than that up to 80 years old.
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So I see them all, but I do really enjoy taking care of my adolescent athletes.
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That's great to know. And I hope everything goes well in Portland,
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Spurs, Yes, go Spurs, go. Go Spurs, go.
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Dr. Leah Brown, head physician for the Spurs and with UT Health San Antonio,
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thank you so much for being here today on Pediatrics Now. Thank you so much.
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I'm Holly Wayment, and I'll see you next week.