Posted tagged ‘head trauma’

Head Injury

November 3, 2012

Hello All.  It has been quite a while.  Lots of things developing lately…i will announce when ready.  Recently something happened, and how I reacted, reflects on how differently we osteopathic physicians assess and look at a situation.  Hopefully by sharing this episode, the broader public can assess their current health situation in context and compare between MDs and DOs.  Four days ago, I received a call from my chidren’s daycare.  You need to come.  Something happend to Kathleen.  What happened? You just need to come and pick her up.  Another kid ran into her on his bike.  Her head whacked the handle bar and she had this gigantic blue lump on her forehead the size of an egg…really it was quite a chickenegg.  The skin was scraped so thank goodness I did not have to sew her up.   My best friend, who is also a pediatrician with her kids in the same school prods me.   Did K hit the kid or did the kid hit K?  Her little one “saw the whole thing,” told her mommy that he did it and that K was the innocent bystander.  My best friend was really concerned and freaked out, more so than I.  The next day when i went in to drop her off, the staff was very nervous.  Her teacher who was present and watching the kids, felt so bad, she was crying and very apologetic.  I said to her, “Ahh, its okay. I’ve seen worse.  Accidents happen.” Really…I’ve seen worse…concussions, gigantic gaping cuts that lead to thick scars, etc…besides, the worst brain injuries happen when the force is transmitted deeper and absorbed by the skull or neurons; if her skin and scalp is bruised than, logically, it took most of the force and some minor residue is absorbed internally…better that than a “brain bruise,” i.e., concussion with brain swelling risks…  I let it pass.  I think everybody thought that I would flip out, threaten them and expect some head rolling.  Even my best friend was suprised at how lightly I was taking this.  She called me the next day and said that she was amazed at how Kathleen was healing.  Overnight, the lump and swelling practically went away.  It could have been the 2 doses of arnica that we gave her that night…but I suspect that she drained well simply because her head had been treated in the past.  Today, 4 days post injury, she is already starting to get the raccoon eyes when blood in the injured tissue starts to break down and ooze underneath the skin and bruising appears around the eyes (usually takes about a week).  My friend, who is an MD, whose two kids have great big giant melons, and traumatized ones at that, have really hard heads consequently, had never seen such quick resolution.  (I should have taken pictures…next time…told her to do the same for her kids and we will compare).  She was suprised that I was unfazed by this event.  She stated that if it was her kid she would be completely freaked out, paranoid and upset and try to get to the bottom of the cause of this accident.  I said accidents happen all the time…we see it…it will not be her only one…besides…she going to be smart-er for it…???????what?????how did you arrive at this conclusion???? you want her to have head trauma??? no…of course not…if it happens, if its minor, i’m not going to fuss over it.  Kathleen is already smart, primarily because of good genes and secondarily because she has an intact family with social support and involvement; everyone who comes in contact with her comments on how bright she is.  I proceed to explain that she took a blow to her forehead, frontal lobe, location of executive function.  The pressure and force of the trauma shocked her system, the brain and all those lovely neurons, 6 layers of gray matter (in humans, 3 in monkeys).  The pressure will force the neurons to cope and adapt and form new connections.   I plan on waiting for 2-3 weeks to let the pressure build up before i decompress her head…once new connections are made, releasing the pressure will not make them ‘unconnect,’ i.e., they will be permanent…it is not the size of the brain that counts, or necessarily the number of neurons, but the complexity and number of connections between the neurons that count…Some of you may be agast at how I plan on caring for her…allowing “pressure to build up”…mind you i can wait because she is subclinical, meaning it has not (yet) affected her sleep, behavior, personality…believe me, if she showed any signs, i would certainly throw my plans out the window and intervene sooner…Read my prior post on how Genius is Made and you will hopefully get a clearer understanding…Just today I treated a teenager who slipped and fell and severely whacked his head that he immediately and for hours afterwards got a headache, very likely a mild concussion…I treated him immediately because I did not want him to suffer.  The traumatic force alone was probably enough to cause connection formation, so that it would continue even if i decompressed him enough to eradicate the pain of the pressure.  I told his mom this, and she commented that this was the most unusual of perspectives that she has heard about head injury…she commented that he always seemed to be a bit brighter than his peers, but that she had attributed this to his being a 7 month preemie…i agreed with her, that the gravitational forces upon a premature infant head causes it to be heavy and dense, sometimes misshapen, but that they do end up smart, the only problem is that they also have focus, attention and impulse control issues…now on the other hand, what happens to fully mature and formed brains that undergo a traumatic injury…less plastic, less pliable tissue, less likely to form new connections, but with the same or even worse tendency to vascular congestion? is it reasonable to postulate that the protein build up in the brains of alzheimer’s patients is not so much the result of a genetic tendency to excess production and deposition but rather, poor clearance and drainage of normal protein production?  how about those ex-football players now who have early dementia, or Mohammed Ali’s neurologic issues, how can these diseases not be linked to trauma? or that during a critical developmental period in autistic children, when they are still neurologically plastic, from past traumatic injuries, instead of forming connections of those few neurons, the are developing “garbage collecting” white matter cells whose sole function is to try and dispose of those proteins because the drainage can range from mildly affected or severly compromised (hence the ‘spectrum’).  Osteopathy is very common sense medicine.  The nerds in their ivory towers would rather attribute genes and genetics to a biochemical process of deranged excessive metabolism and engineer (pharmaceutically, genetically) a product that will interfere or disrupt those processes.  Ahhh…how about we undo the trauma, let the tissue drain itself, clear and heal itself…i like this way better because it is profound and far more beautiful in its precision as to…causation…and the patient can be whole again and not have to be forever dependent on any medical system or drugs or machines.  i think that most patients suffering and lost in the vast CMS (conventional medical system) would consider this perspective refreshing and appreciate its beauty and simplicity.   ADDENDUM:  today is 11/3/2012, 5 days after her head injury…Kathleen has been difficult, whiny, clingy and just plain unpleasant this whole day.  As in a prior post, emotional lability is a sign of traumatic head injury.  I checked her head tonight and it is completely whacked out.  She slammed her head pretty hard and the force was still fully impressed in her forehead and the front part of her skull and brain.  I treated her and she said that she felt better.  Poor thing! ADDENDUM: Kathleen is now 8 years old and we just had her parent-teacher conference.  Her teacher says that she likes math! Who knew?? Well, I kinda did…Maybe she likes math because I show her my shortcuts…Next real post, I will update you on her lisp and that tongue…still driving me crazy.

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Doctor, Why is My Child So Clumsy?

November 16, 2010

I occasionally hear this question in various forms.  Parents bring up this subject  for discussion in several ways.  Did s/he inherit this clumsiness?  Or, s/he was ‘born’ clumsy! The answer is…sort of.  As a conventional pediatrician, this was never taught to us in medical school, in our books, or in our training programs.  I came upon this conclusion several years ago but did not put it together until a couple of weeks ago watching my babyrepeatedly knock her head.  Short answer: Head trauma.  Below is the long winded explanation…

We are creatures of bilateral symmetry.  This means that the right side is a mirror image of the left and vice versa.  Usually, in our Most Natural State, unimpeded and untraumatized, we develop with a balanced form.  The next question to ask is, well, which and what types of unnatural states would cause our symmetry to be disrupted?  Let’s take the legs.  If you break a leg, the growth in th broken leg is disrupted while it repairs in the cast for 6 weeks.  I must also mention the possibility of your ortho casting the underside too thick, which would add inches to ‘length’ on that side for the period of casting.  Other orthos may use a boot.  If you have ever seen people hobbling around on the fancy-schmancy boots, take a close look at their hips.  The pelvis is off balance and the side of the broken leg is higher.  When the pelvis tilts, it causes…hello…a compensatory scoliosis…hello.  So, one little trauma and the subsequent attempt to treat it causes major structural shifts that neither the patient nor the doctor are aware of…hmmm…makes one think, huh?  Let’s talk about the arms.  You say, Doctor H., “In what case would you ever see one arm longer than the other?”  Well, again a fracture would do it; especially at the elbow.   The elbow is notoriously difficult to repair.  It almost always heals angulated and that will cause a shortened length.  Serious tennis athletes who slam out serves of close to a hundred miles an hour…all that repetitive force will stimulate a lengthing of that arm.  So what does this all have to do with clumsiness?

Our balance, equilibrium, our perception of our self in space, all these mechanisms are housed within our ear canals.  The temporal bones to us Traditional Osteopathic Physicians move in synchrony and there is balance.  The first trauma that can disrupt this balance is called..birth.  In the birthing process, after the head is engaged, it is then compressed.  As the baby’s compressed head traverses the birth canal, it has to spiral (followed by the full length of the body).  Somewhere along this path, one side gets more compressed than the other, see my prior post Plagiocephaly and Other Malformed Infant Heads.  As nursing commences, engaging all the muscles of the face and mouth, the infant head, over time decompresses.  Some babies continue to be molded, i.e., stuck.  If one ear is more stuck than the other, you get an imbalance.  Self and our perception is distorted in these patients.  In some ways clumsiness can be ‘inherited’ because the child’s head is prone to compression in the back if a parent has that tendency.

How do I know this?  I do equilibrium testing before and after treatment.  Adult patients get better.  They walk straighter with their eyes closed.  I’ve done equilibrium testing so many times that I’ve stopped.  Patients feel better, their heads are less congested, they report that they sleep better; this is proof enough for me.  In infants, their heads look more rounded, symmetrical and balanced.

In older children, from repeated trauma to the body, buttocks and head, these kids are definitely out of whack.  Trauma begets trauma.  It is a vicious cycle.  An accident causes trauma.  Thereafter, balance is affected leading to more accidents and injuries.  Athletes know this all too well.  One ankle sprain will lead repeatedly to re-spraining. 

So what can we parents do about this?  Early on, get the child treated with OMT.  Infants and children should only be touched by osteopathic physician and not anyone else.  I had an infant come to me late because mom had taken the child to a ‘craniosacral therapist’ and  a chiropractor.  The baby still had problems nursing and latching.  On the first visit, after I treated, mom could tell right away that the latching and nursing was improved.  When I treat an infant, parents notice within the same visit results.  Do not settle for less.  Keep in mind that you get what you pay for.  For children, it takes longer to see results because their young bodies usually pile up traumatic strain before they clinically present.

Doctor,what is that blue mark on my baby’s face?

January 18, 2010

I hear this question occasionally from mom’s who have already asked this of their regular pediatrician.  Usually the pediatrician doesn’t know or gives them an unsatisfactory answer.

This blue mark was not always apparent at the time of birth. It shows up later, dead center between the eyes right on top of the nasal bridge, usually after 4 months. In some babies as they get older, then it becomes thicker and very prominent. In boys you will see this mark in the active rambunctious ones who run, fall, crash and hit their heads often. This mark is a distended vein underneath the delicate tissues around the eyes and nasal bridge. As they age and continue with head trauma, there is back pressure in the venous system, that vein bulges and starts to thin and “carve out”  the overlying skin. In some babies, that mark is there from birth.

In infants, the head gets compressed during the birth process. Breast feeding immediately helps decompress and expand the cranium. Those bottle fed or very compressed from a long difficult vaginal birth will be more at risk. How do I know this, when other pediatricians don’t? Very easy.  I treat infants for all manner of problems. When I find head compression, I decompress and the vein(s) lighten immediately. In fact, I teach parents to watch it as a sign of increasing back pressure. It will coincide w/a number of issues – the child will start to get fussy, nap poorly, or wake up at night, the soft spot can be tight, hard and small.  This tells them when to bring the child back.  Check out my website for other photos of severely compressed heads.  I have tried to photograph and document the resolution of this vein after treatment but it does not stand up to my amateur camera; believe me, I have certainly tried.

www.doctorhoang.com

Addendum: October 23, 2010.  It seems that since I first wrote this blog, this is the most popular search.  This blue vein is very common.  Please moms if you want to find an osteopathic physician near you google www.cranialacademy.org although I do have to warn you that I am not a member (secondary to politics plus I am good enough to succeed without need of their directory referral service).  I will also say that traditional (old fashioned 10 fingered) osteopathic medicine is very much like martial arts and results and styles of physicians may vary somewhat; one of my patients calls this work our ‘Jedi Arts’.  Whatever you do, do not seek nor allow yourself to believe that MDs, chiropractors, physical therapist and especially craniosacral therapists can get you my results.  It is too difficult. They do not have enough training. My results come about after training to become a pediatrician (4 yrs college, 4 yrs osteopathic medical school, 3 yrs pediatrics training) and 7 yrs of hands on experience.  This  proprietary knowledge of the traditional DOs is not shared with any other types of professionals. They are still unformed, their nervous system too new…

Addendum 2: March 16, 2014. There are infants and children who grow up to have a bluish tinge on the inside bridge of the nose near the inside corner of the eye. This is back pressure building up in an area deep inside the brain called the ‘cavernous sinus’ and usually results from…a face plant, in infancy either onto carpet, or worse, onto wood or tile floor. This area and this fall in early infancy is near impossible to cure. My baby fell (or rather i dropped her,face plant) when she was 2 months old trying to calm her excessive fussiness. My 83 year old physician mentor (50 years hands on experience) was able to treat her in 20 minutes (where other doctors failed) and cured her of her fussiness. She is now 4 years old and when she has sinus issues, the deep dark circles come out.