Thursday, April 29, 2010
Only Yellow Easter Eggs for the Cain house next year
What does this have to do with concussion or obesity.....absolutely nothing. It really has nothing to do with Easter either. What happened is I used all my wife's bottles of food coloring, except yellow, in an effort to find the leak in my ski boat. My skiing partner and I got the boat going about a couple weeks ago and noticed that after each outing we seemingly had more water in the bilge than would be expected. This really came to confront us last weekend when my daughter and her boyfriend joined us at the lake and we started out accelerating away from the dock and you could see water welling out of the stern back panel of my 19ft inboard tournament ski boat. Not good. Fortunately I turned on the bilge pump and the water was pumped out in short order. We kept an eye on the water intrusion and it was slow enough not to get in the way of a fun day of skiing for all of us. After one run through the slalom course a piece we took on only 4" of water in the bilge. But this is about 3.5" more than we should. After the day of skiing was done we unscrewed the back floor panel to look at the drive train and fittings from the inside to try and find the leak. From what we could tell the drive shaft coupling was well sealed and that the leak was coming from somewhere on the stern left of the centerline behind the fuel tank where it was not visible without moving the tank.........not a quick job to do. This left two possibilities looking at the outside of the boat. Either it was a leak around the left inboard exhaust seal or it was related to the left speedometer cable or pickup mount. This is where the food coloring come in. We went home and came back two days later with my wife's box of multiple food coloring bottles and pulled the boat up on the trailer. We drained all the water in the bilge and then tilted it so any residual bilge water would run to the back. We looked for a leak with our eyes and none could be readily seen. Next we made up a bucket of water with a dark brew of blue, red and green food coloring and dumped it in the bilge. After a few minutes a slow drop by drop trickle began to show up around where the left speedometer cable exits the hull; leak identified. We didn't have the proper sealant with us at the time to fix it on the spot but that will be today's job. Hopefully we will again be seaworthy soon. Why yellow Easter eggs? Well yellow was the only color in the box we didn't use. I quietly but the almost empty box, save the yellow dye, back on the kitchen cupboard shelf. Unless my wife reads this, she'll never know..... at least until next Easter.
Saturday, April 17, 2010
Concussion and Cognitive Exertion
I was recently evaluating a young athlete following a concussion in a sporting event. He was three days out from his injury which involved less than a minute of loss of consciousness. He only had slight symptoms at the time of this evaluation including a very mild headache and slight fatigue. Specifically he said he did not have any light sensitivity. He had a normal physical exam with particular attention to his neurologic exam. His balance testing was not the best but not abnormal. I performed an ImPACT neurocognitive assesment and he was normal across the board based on percentiles. However, what was very interesting is that by the end of the ImPACT test he said he had a terrible headache and his eyes were very light sensitive. He had to turn the lights down in the exam room part way through just to finish the test. This is the second time in recent months where I have had a patient develop a severe headache and photophobia (light sensitivity) when performing the ImPACT test. This phenomenon seems to be a rather interesting marker of the impairment of concussion brought on by cognitive exertion of neuropsychological testing in the recovery phase. This was quite telling as he wanted to know if he could go back to school the following week. I noted that we would have to be careful to craft a list of restrictions and accommodations to meet his temporary diminished "cognitive stamina." Over the last several months I have started asking how the post-injury athlete how they feels after taking the ImPACT test. I have had several who have said they felt a little worse in addition to these two who had a marked increase in symptoms, including photophobia, with testing. This is just one more thing to think about asking in the evaluation of a patient with a concussion. Here is a youtube of a typical concussion patient
Friday, April 16, 2010
Gary Small's Town Hall Lecture - Digital gains changing our brains, especially young ones

http://seattletimes.nwsource.com/html/localnews/2011608655_ibrain15m.html
My son and a colleague and I went to the Town Hall talk by Dr. Small last night. Dr. Small brought out some interesting points: 1) our youth are losing interpersonal and social interaction skills, 2) we sometimes feel anxious when we lose control or access to our technology, 3) we often make more mistakes when multitasking, 4) fMRI studies of brains while websearching show increased activation that decreases with time as we become more efficient at it.
On the other hand Dr. Small did not allude to one very beneficial effect of our technology which was brought out by a questioner in the audience at the end of his talk. Specifically, that modern technology stimulates human creativity by the coming together of ideas to create totally new ideas; that without modern "iTech" these new creations would never have had the chance to come to fruition (at least they would be statistically improbable to do so). Overall the talk was not all that inspiring but I might give his book a try.....when it comes out on Kindle :)
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