Head Games #53

Dr. James Glazer:

A young person may become very erratic in terms of their mood, and that's all as a result of a concussion. I think it's really imperative that my colleagues get the word out that this may be a result of concussion and that it really should be handled as such.

Robert Macdonald:

You are in a dark room for as long throughout the day as you can. I was doing up to 10 hours at one point during June and July, and you starve yourself of any sort of brain stimulation or activity. Doctors want you to sort of just rest as much as possible.

Deb Arthur:

I've had several women clients who've told me that when they were young they were told they were clumsy. A lot of what I'm doing with them is getting them confident with their body so they realize they actually aren't clumsy. That that was, you know, they tripped one time somebody called them clumsy and now that became their label. It's sort of a shifting to feeling confident in how you can move and confident in yourself.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle and you are listening to the Dr. Lisa Radio Hour and podcast show number 53, Head Games, airing for the first time on September 16, 2012 on WLOB and WPEI Radio, Portland, Maine. Today's guests include Dr. James Glaser of Coastal Orthopedics and Sports Medicine Rob McDonald, graduate of Cape Elizabeth High School and current Harvard University student and also Deb Arthur, who has her doctorate in physical education and a master's in Science, who currently works at the Body Architect. Each of our guests will help us explore the theme of the head and how it intersects with the body as in mind, body and spirit. Dr. James Glaser will give us more of a clinical eye and some history on concussions and what it means to have a traumatic brain injury while playing sports or in other parts of one's life. Rob McDonald's going to give us a more personal view of this as he describes an episode that took place during his first year of college while playing rugby, a head injury which certainly had an impact on his own life. And Deb Arthur will really bring the idea of mind and body back around again for us. We hope that you enjoy our show today. Please let us know what you think the Dr. Lisa Radio Hour and Podcast is pleased to be sponsored by the University of New England. As part of our collaboration, we feature a segment we call Wellness Innovations. This week's Wellness Innovation focuses on head injuries as interesting concussion rates and prevention strategies at all levels continues to grow. One population that appears to have increasing head injury rates is collegiate football players. Research presented recently at the American Orthopedic Society for Sports Medicine's annual meeting in Baltimore highlights that the concussion rate in three college football programs has doubled in recent years. The increase comes after a 2010 NCAA concussion management initiative that requires athletic programs to report concussion signs and symptoms and then remove players from play. For more information on this Wellness Innovation, visit DoctorLisa.org for more information on the University of New England, visit une.edu.

Dr. Lisa Belisle:

in my medical practice, I've seen recently a rise in head injuries from younger patients which I found somewhat disturbing. And this was one of the reasons we thought it was important to bring in a sports medicine specialist and have a conversation about head injuries as part of our Head Game show. So Today we welcome Dr. James Glaser of Coastal Orthopaedics who is a sports medicine specialist and actually someone that I've had a long standing relationship with as a fellow family practice trained physician. So thank you for coming in and joining us today.

Dr. James Glazer:

Thanks Lisa. Happy to be here.

Dr. Lisa Belisle:

James, tell me a little bit about your background. First of all, I think people are interested in the fact that you are a sports medicine specialist and yet you are trained in family medicine.

Dr. James Glazer:

That's right. There are a number of different paths to become specialized in sports medicine. Right now in general, we have people who do primary care sports medicine or non operative sports medicine, and that's what I do. You can get a residency in any of a number of different medical specialties. Family medicine is a big one, but we have sports medicine specialists who are pediatricians or Emergency room doctors as well, some internal medicine specialists. After your residency program, you go on to do specialized training in sports medicine. And some of my colleagues continue to do primary care. Others of us just specialize in sports medicine and really focus on teaching and training and treating athletes.

Dr. Lisa Belisle:

And at the Maine Medical center, there is a sports medicine fellowship.

Dr. James Glazer:

Now there is. We're very fortunate in Maine to have a fellowship training program. It's been around for a number of years. They train two fellows a year. And I was a faculty member there for six years before going into private practice.

Dr. Lisa Belisle:

As the mother of three children who play sports, I've noticed on the sidelines over the last maybe 10 years an increasing number of professionals supporting the teams. I've noticed that we now have physical therapists and trainers and even physicians on our high school fields working with our athletes. How do you feel about that?

Dr. James Glazer:

I think that's a great thing for Maine. And as a matter of fact, there was just a law passed in May by the Maine legislature about concussions. And one of the things that that law mandates is that people be a little bit more active in evaluating kids and pulling them out of games immediately if they think that they have a concussion. I think that one of the things that has motivated that law is recognition of the fact that concussions are very prevalent. But another thing is that here in Maine, we've had really great community support for having trained medical professionals with our kids, protecting them on the sidelines and making sure that if there are any injuries, they're assessed and treated pretty quickly.

Dr. Lisa Belisle:

Why are concussions or head injuries on the rise in kids sports?

Dr. James Glazer:

I think that's a great question, and that's something that researchers are doing a lot of investigation into right now. One of the main things that I think we're seeing now is increased awareness. So whereas 10 years ago a kid might have had something that his coach termed a bell ringer and just shrugged it off, now we recognize that that actually is a concussion and that it's very important to take advantage of an opportunity to educate the athlete, to educate the coach, and to treat it appropriately so that we don't see long term problems as a result of repeated small concussions.

Dr. Lisa Belisle:

Does this have anything to do with, say, Muhammad Ali or some of the other boxers that are out there who have had this sort of repeated traumas and are now showing up with Parkinson like symptoms?

Dr. James Glazer:

Absolutely. There's a range of medical conditions that are more long term and neurologic in nature that we're now recognizing may have to have to do with long term effects of repeated concussions. And we've seen football players in the news recently, A rash of suicides that there's investigation going on right now to find out if those were related to the long term effects of concussion.

Dr. Lisa Belisle:

What sports put athletes at highest risk for concussions?

Dr. James Glazer:

You know, that's a really interesting question because I think if you asked most doctors 10 years ago, they would have said that the male sports dominate. And there are some predominantly male sports, like football, that have very high rates of concussion. But interestingly, if you look at the statistics, female sports are on the rise and not far behind their male counterparts in terms of the frequency of concussions. So soccer is a big dangerous area. Both men and women's hockey players are at risk for concussions. And we see concussions in sports like lacrosse as well, both for girls and boys who are playing it.

Dr. Lisa Belisle:

Now you described the risk of suicide. What other things do you see as a result of a child getting a concussion?

Dr. James Glazer:

One of the really devastating effects of concussions has to do with the effect that it can have on a kid's progression through school. So I often see athletes who have had a lot of trouble catching up in school, have had trouble with concentration Sometimes there are some pretty profound mood changes Where a young person may become very erratic in terms of their mood. And that's all as a result of a concussion. Oftentimes these symptoms aren't recognized early. And so you can you see kids out there who are really depressed, who are really having trouble in school, sometimes three, six, or nine months after a concussion. And I think it's really imperative that my colleagues and other people who are interested in this subject get the word out that this may be a result of concussion and that it really should be handled as such.

Dr. Lisa Belisle:

Is there a way to test for cognitive function?

Dr. James Glazer:

There are a number of different tests that are used. One of the widest used tests right now in Maine is called the impact test, which is a little bit of an unfortunate name, but it's a computerized concussion test. It's used primarily by sports medicine specialists like me to determine when an athlete is ready to get back to playing. So not so much as a way to diagnose a concussion, but as a way to make sure that once the symptoms are all clear, that the athlete's brain is really functioning the way it was before the concussion.

Dr. Lisa Belisle:

All three of my kids play soccer, and I've seen people wearing these bands around their heads. What do you think about these bands that theoretically are supposed to be preventive as far as heading the ball and preventing concussions.

Dr. James Glazer:

I get questions about those bands and other kinds of protective gear. Often we all want to find something that is going to protect our kids from concussions. And so there's a lot of interest in mouth guards or helmets or bands or other kinds of things. The very frustrating thing from my point of view is that there really isn't any research that supported that. As we look at large numbers of athletes who are using this protective equipment over a number of athletic contact hours, they don't seem to protect against concussions. So generally what I say to parents is that there's no evidence that it's going to help, but there's also no evidence that it hurts. And so in some situations with some kinds of impact, it may confer a little bit of protection. And for many parents that's worth it and they go ahead and use them.

Dr. Lisa Belisle:

As you know, the Dr. Lisa Radio Hour and podcast is focused on the mind, body and soul. Sometimes our bodies are giving us a little indication that maybe things aren't quite right. Here to talk to us about some particular things that we can listen to when our bodies are acting up is Dr. John Herzogen of Orthopedic Specialists in Falmouth, Maine. Today's diagnosis is medial epicondylitis.

Dr. James Glazer:

Dr. John Medial epicondylitis commonly goes by golfer's elbow. That means where you're really sore right on the inside part of your elbow. We treat that again with ultrasound to diagnose it. Sometimes cortisone, sometimes PRP or conservative measures. But we have a high healing index utilizing the simplest treatment possible and you can have more information on that by calling 781-9077 or type on to orthocareme.com.

Dr. Lisa Belisle:

If you have a child that has suffered a concussion, what types of treatment options are there available?

Dr. James Glazer:

Well, it's important that we now have been able to break out of the main paradigm, which I think has been present in the medical field for years and years in terms of treating concussions. And that's just relying on rest. Concussion research is a Rapidly advancing field. And for the people who do a lot of concussion work, there's new recommendations coming out all the time. So I usually talk to parents and athletes about two cornerstones of rest, one of which is athletic rest. And that's something that we're all pretty familiar with. You can't go to practice, you can't play sports. But what I think you'll find over the next five years is that we really are discovering that cognitive rest is much more important in some ways than athletic rest. So protecting your child from cognitive exertion, protecting your child from going to school all day and coming home with a headache. Every kid is different, and every concussion is different. So some of them are able to go right back to school and to study and do fine. But the important thing is not to ignore symptoms as they appear. There also is an emerging area of research around using medications for concussions. Medications aren't the rule. They're not necessary in every case. But in some athletes who have had pretty severe symptoms that have been persistent for three or four weeks, medications can really be important in helping them get over that hump and get better.

Dr. Lisa Belisle:

And what type of medications are you talking about?

Dr. James Glazer:

The medications that have been most widely researched at this point and are most widely used are types of antidepressant medications. Selective serotonin uptake inhibitors are one of the kinds of medications that most people are familiar with and have been used and are safe in kids. Tricyclic antidepressants are also used often in concussion situations, and they work really well to help kids get better from some of the cognitive and headache symptoms that they'll often feel. There's a growing body of research looking into stimulant medications as well. Many kids have trouble concentrating and. And they have symptoms that are very similar to ADD after a concussion. And so some people are using those kinds of medications. I think it's very important, though, before any parent sees their child go on medication, to be sensitive and thoughtful about this and really be sure that you ask your physician all the questions. Make sure that you're working with a physician who's pretty comfortable, not just with concussions, but in the use of these kinds of medications. I always recommend that in any kind of medication that we use, that's changing the neurochemistry of our brains.

Dr. Lisa Belisle:

What is it about a head injury or a concussion that leads to depression or leads to a change in emotional response or behavior? I mean, I saw this all the time when I worked in the county jail, and people would come in after a head injury, they would have a complete personality change. I mean, it's very clear that this happens. But tell me a little bit about the sort of physiology behind that if you can.

Dr. James Glazer:

Well, I'd like to be able to, but this is something that's a very hot area of study right now. And so we don't really understand all that goes into it. One thing that has become clearer over the last few years is that if you look at the neurotransmitters that are present in the brain and the, and the relative levels of each neurotransmitter, a concussed brain tends to look very similar to the brain of somebody who has clinical depression. And so there's something in the physiology of the brain that's mimicking that depressed state. And so some of the symptoms obviously are also congruent. It's probably one of the reasons why some of these medications are so helpful and helping athletes get through these tough periods.

Dr. Lisa Belisle:

Do you have any favorite resources for parents or coaches about concussions, concussion prevention treatment?

Dr. James Glazer:

There's a website through the CDC that shows has a lot of information about concussions. It's very helpful for parents. But like many complicated issues in medicine, this is one of those things where every case is so unique and every case is so individual. I really, I encourage parents to read as much as they can and as much as they want to, but I also encourage them to go and talk with their physician because what you read on the Internet so often is very helpful, but may not line up exactly with your own individual situation. And one of the things that I think it's important for all of us to recognize is that concussions, a concussion in a 10 year old is really different from a concussion in an 18 year old. And a lot of the stuff that we're reading on the Internet these days is not necessarily tailored for those younger kids. So we have to recognize that it's a very different situation depending on how old your child is and how severe the concussion is. And sometimes I see some unique aspects as well related to family history or the individual athlete's concussion history. So it's a complex topic. It's good to educate yourself, but don't forget to ask questions and bring a list of inquiries to your doctor as well.

Dr. Lisa Belisle:

If people are interested in finding you, where would they find you?

Dr. James Glazer:

You can find me at Coastal Orthopedics. If you Google for Coastal Orthopedics in Maine, you'll come up with our website. We have directions to my office and a little bit of information about me and my partners as well.

Dr. Lisa Belisle:

Well, we've been speaking with Dr. James Glaser from Coastal Orthopaedics on our Head Game show. I really appreciate your coming in and talking to us about this very important topic.

Dr. James Glazer:

It's been a pleasure. Thank

Deb Arthur:

you.

Dr. Lisa Belisle:

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Dr. James Glazer:

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Dr. Lisa Belisle:

Earlier in our show, which we've titled Head Games, we spoke with Dr. James Glaser about the impact of concussions on children. Now I have in front of me a person who, well, at one point was a child. He clearly a very big person now, but he has experience with concussions. This is. And I thought it'd be really important to bring on Rob McDonald, graduate of Cape Elizabeth High School and also student at Harvard University, to talk about the impact of concussions on his life, because it's more significant than I think many parents would think. And it's definitely something that I think maybe coaches need to be paying attention to. So thanks for coming here in and talking to us today, Rob.

Robert Macdonald:

Thanks for having me. Yeah, concussions are like my baby right now. I'm really passionate about them.

Dr. Lisa Belisle:

Well, let's tell people who are listening. What has your experience been with concussions? Tell us, where did this whole story begin?

Robert Macdonald:

At Harvard. I was playing rugby and I joined the team earlier. I joined the team in the fall and I knew concussions were almost part of the sport because I. A lot of guys come in having played American football, and so they're used to like, you know, really getting in there with the tackle, getting their head in there, which is, you know, not so much how a rugby tackle is usually supposed to go, but so I knew concussions were part of the sport. And then in April, I got my first concussion and did, you know, the dark room rest, which is what doctors prescribe afterwards that you're supposed to do? And then sort of felt like I was okay, and then, you know, it was sort of feeling normal for a few weeks. And then my cognitive function ended up being a little lacking, so I ended up not being able to take finals in the spring. And so I didn't finish out the semester. And I have to take. I'm actually taking those finals as medical makeup exams this coming October. And so, yeah, my concussion has totally just been a really weird experience for me and also really hard, too, because, you know, when you get a concussion, it's not just that you can't play sports for two weeks, which a lot of guys have, but a lot of times it's like your ability to think, your ability to make connections between thoughts, your ability to, you know, your short term and long term memory even can be really affected. So that's so. I mean, even since April, I'm still recovering from my concussion and it's now early September. And doctors have said, you know, I could be recovering for a couple more weeks or I could be recovering for a couple more months. So they don't really know exactly how long things will be. And so, yeah, that's been my experience up till now, and it's been pretty tough, but also something that's, you know, it sort of showed me a lot about like myself even in a lot of ways, so.

Dr. Lisa Belisle:

Well, tell me. So you were a high school athlete, you played golf and soccer and baseball at Cape Elizabeth. And did you combinations of those throughout yet? And you played them pretty aggressively. I mean, I remember because you played against my son Campbell, who was at Yarmouth at the time. He played soccer and baseball against him. And I remember, you know, you were out there just like Campbell, full force like most kids your age. But you didn't have this experience with concussions before, is that correct?

Robert Macdonald:

Right? That's correct. I never had an experience with a concussion. My only experience with concussions was, you know, I had friends who are similarly athletes and they had gotten concussions and it was usually like a two week thing. You're sort of, for two weeks, your impact test scores, which is the baseline concussion test that I think every athlete in the state of Maine takes now. And if you have like a ding, if you get hit in the head or you're feeling woozy after a play, then a lot of times the athletic trainer or one of your coaches will sit you out for the rest of the game and then you'll take the impact test again. And if there's any sign of a concussion, the impact test, I think almost always picks it up. So a lot of times what happens is concussed athletes will have few weeks where they'll, their impact scores will be lower and then as soon as the impact scores are back, coach will put them back in and like, that's fine. That's how most concussions work. So that was my experience with concussions in high school, and until I had mine, I didn't really understand it. It can be a lot more than just those two weeks of, you know, resting and recovering. It can be totally different.

Dr. Lisa Belisle:

Well, tell me about what it was like in the, the weeks. Well, tell me what it was like when you first got your concussion. What did that feel like? How was that? How were you doing as you were coming off the field?

Robert Macdonald:

Yeah, so when I first got my concussion, I just, I pretty much knew right away. I got, I was going in for a tackle and a guy was kicking his knees up really high. It was a much bigger guy than me. So I'm, you know, five' eleven, so pretty stocky. But, you know, there are a lot of really tall guys and big dudes. I was playing against a big Canadian team, so they were tough. But I got hit in the side of the head with his knee when I was Going in to tackle him. And I pretty much knew right after I got up off the ground, I was like, okay, I feel really woozy. It's almost like your eyes go out of focus and you can't. So there's like a lot of. There's definitely a lot of physical symptoms you can immediately feel. So I went off the field.

Dr. Lisa Belisle:

And so when they talk about having your bell rung, it really felt like you had your bell ring was wrong.

Robert Macdonald:

Yeah, you don't see stars or anything. It's not like you go into a new universe, but like, you definitely feel that something's going on. And like they talk about it on the, on the rugby, on the sidelines, as someone's got a concussed look, like you can. They look a little. They just look dazed.

Dr. Lisa Belisle:

Okay, so you came off the field and tell me what happened right then and what happened subsequent to that.

Robert Macdonald:

So right then they checked me out a little bit. One of the trainers who was there, and they just want. Essentially what they wanted to make sure is that I remembered, you know, having woke up that morning and gotten breakfast and having come to the field and warm up, warmed up. That's the big concern, I think, for a lot of people is if they forget the portions of the day up until their concussion, then they can have some serious damage. I also didn't lose consciousness, which a lot of people do during the concussion, But I think that they found out that whether or not you lose consciousness doesn't necessarily affect how severe your concussion's gonna be. That there are other factors. It's tough to say what those factors are, of course, but there are other factors that will play into the length of recovery time.

Dr. Lisa Belisle:

And did the trainer pull you out of the game for the rest of it or give you. You any recommendations at that point?

Robert Macdonald:

Yeah, it was pretty much understood that I wasn't going back into the game. I mean, I wouldn't have put myself back in or allowed the coach to do that. And so, yeah, it was basically just rest up here on the sidelines. And then that was on a Thursday. And then after that weekend, I went to the university health services there and they said, he's definitely showing some symptoms consistent with a post concussion. And of course, all the nomenclature and all the different terminologies that go into a concussion are so different. So they didn't know exactly how to call it. Because post concussive syndrome is this other thing which I learned about later, which is, you know, so with concussions, 90% of people have that two week concussion period. I think that's the statistic. So they have it for about two weeks or up until a month, and they recovered within a month. And the other 10% of people, it's either a month to three months in which they diagnose post concussive syndrome, which, you know, there's this whole tension, there's this whole controversy in the medical community, like, can you even call it a syndrome? Because the nature of post concussive syndrome is that almost everyone has a unique, different recovery time and they don't exactly know how long it's going to be or how exactly they can treat it. This is my experience with it. So it might not be everyone's, but so, yeah. So people who have those really long concussions have post concussive syndrome.

Dr. Lisa Belisle:

And did they give you that diagnosis after you had spent a few weeks and weren't really getting quite back to your normal self?

Robert Macdonald:

This is actually, I got this diagnosis when I came home to Maine. So I got the concussion in April, didn't get the diagnosis until around June, July, because they don't really, they can't really call it until then because you could always get better. And some people wake up one morning and just immediately feel better. And for me, the sense is it's just gonna fade out. And so Dr. Bill Hines, who is a, he's an orthopedic surgeon at Orthopedic Associates, who I've seen a bunch of times, said that, yeah, we're probably looking at post concussive syndrome here.

Dr. Lisa Belisle:

So tell me about what was happening between April and June. I mean, it sounds like it was significant enough so that you couldn't concentrate on your studies so that it wasn't possible for you to finish your classes

Robert Macdonald:

immediately after the concussion. I was, I did, I couldn't go to classes because I just immediately after I was so fatigued, sleeping about you know, 14 to 16 hours a day. And then ended up, as I said, not taking my final exams. And then once I got home, I thought, you know, like, I'll get home, I'll be out of the school environment. Like, I'll be at my house, my parents will be able to like, you know, make me meals instead of having to go to a dining hall and whatnot. But then I sort of thought that the concussion was fading out. And then I ended up like a month later after, you know, I was working. I worked at a company here in Portland and was doing sort of low intensity work, but still work. So getting up early in the morning and just had a relapse one night and ended up having these horrible migraine symptoms. And I started to get a lot of pressure throughout my face. And I was pretty upset actually, because I thought I'd been getting better. And then I know a lot of people who have concussions feel this way. They'll sort of be counting down the days until they're getting better or will think they'd be super optimistic, like, I'm almost there, I'm almost there. Which after a long multiple month period of being injured, especially in your brain, can be really difficult once there's a setback that you have no setback for reasons you don't understand or that you can't pinpoint. So yeah, after that relapse, I essentially did dark room rest, which is a prescription a lot of doctors will give people with concussions, especially long term concussions.

Dr. Lisa Belisle:

So what does that actually look like? What is dark room rest?

Robert Macdonald:

Dark room rest is. I mean it's actually sort of similar to sensory deprivation torture, but. And what you do is you are in a dark room for as long throughout the day as you can. I was doing up to 10 hours at one point during June and July. And you starve yourself of any sort of brain stimulation or activity. So no, obviously no screens, no phones, no reading, no music. I would play a little soft music once in a while just to sort of create some new space. I guess it's like a book on cd, anything. Because I was concerned and that I would be, that I was stimulating my brain too much. And they just sort of, you know, doctors want you to sort of just rest as much as possible. Of course though, then when you're like thinking about stuff and it's a very stressful environment, even though you're doing nothing essentially, and it can be tough. And so I ended up, after about a few months of doing that, of going on to. I went down to Master Normal Hospital to their concussion clinic that they have down there, one of the best in the country. And they put me on a more aerobic based plan. So the idea was to get the blood flowing to my brain, doing a lot of like cardiovascular work to get my body back in shape. Of course, I've been essentially vegetating for the last two months. So I was definitely out of shape. And with that I started to do a lot better. Even if, you know, I'd go in with a headache and I'd come out with a headache. They said if the headache is about the same intensity, then that's, that's okay, that's good. If it Gets worse. You know, be careful. If it gets too much, way, much, way too much worse, you want to stop. And so essentially, I did a gradually increasing aerobic routine, doing a lot of running on the elliptical machines, which are good because they minimize impact to the head, and ended up just making a pretty good recovery after that.

Dr. Lisa Belisle:

So what was it like to spend to go from being a college student? Well, first of all, let's just back up. So you obviously did well enough at Cape Elizabeth that you got into Harvard and you went on and you were a college student and your life was sort of progressing along a path. You just kept working hard, nose to the grindstone. All of a sudden, you kind of get smacked upside the head and you go. Your life gets completely turned around and you're laying in a dark room and you're not working and you can't study and you can't exercise. What was that like?

Robert Macdonald:

It was pretty crazy, actually. So throughout high school and into my freshman year of college, I always had sort of progressed in a straight line, step by step, you know, doing this and that, building up a strong resume. You know, I never really had. I was always just very studious and very focused in a lot of ways. And so with the concussion, I was just. It was like a total maybe step back for a second, and everything was different around me. My whole life seemed to be different. And it was like this for me. It felt like it wasn't part of the sort of vague plan that I had for myself. And so now I'm taking a year off from school, gonna do some work, hopefully in Maine, and then hopefully travel and study abroad, which is something I would have. I'd always sort of figured I'd like to do, but might not have actually gotten in the process of planning if it hadn't been for such an event as this.

Dr. Lisa Belisle:

So there's a silver lining is what you're trying to say.

Robert Macdonald:

Yeah, absolutely. Definitely a silver lining. But, you know, going from super active, you know, always very social, hanging out with My friends and all that stuff in my life at college to essentially over the. To essentially losing my summer, to the concussion and the recovery. And, you know, it wasn't just like if you had torn your ACL or something. I know friends who have done that and had to get surgery over the summer, and they're essentially, you know, couch potatoes over the summer is what they have to be. But, you know, at least they get to watch every season of Breaking Bad. I wasn't able to do that. I was sitting in my room just hanging out with my thoughts, essentially. And so that was really hard in a lot of ways for me. But it also. I went from doing a thousand things at once to doing zero. So I think in a lot, those two extremes, hopefully I can find sort of a medium between those. And I think so in a lot of ways, the silver lining. You were right, there was a silver lining. And it was probably a good thing for me to do just sort of decompress for a long time, since I never really decompress or rested, give myself, my brain, any sort of rest in my life. So, yeah, it was really hard. But probably now will be probably later on, 10 years down the road, I'll look back and be like, that was something I needed at that sort of time.

Dr. Lisa Belisle:

It sounds like you've worked through a lot of things. You're still, I know, going down to New England rehab and doing work with them. I know you have upcoming exams and you're thinking, thinking about the next year. Are things feeling brighter for you now?

Robert Macdonald:

Absolutely. Since my concussion, it sort of. I did a lot of reflecting and a lot of thinking about what's next, especially after experiencing, you know, this sort of this very intense, difficult situation that I. That I experienced this past summer. And it actually made me appreciate everything about just life in general a lot more and about where I'm at and some of the opportunities that I have, Even just this year, hopefully looking into studying abroad and having experiences there. And yeah, it's been. I mean, I feel a lot better about that, and I feel a lot better about the situation. So it definitely. I had a really difficult summer, but I actually used to joke about, you know, got my. One of my buddies who is doing, like, the, like, a Knowles India course, which is supposed to be the most difficult. Knowles is the National Outdoor Learning Service, one of the most difficult hiking course, like, trips that, like, people can do. And I was joking with him. I was like, I probably had a similarly difficult summer, just as you. You know, yours was more physical, mine was Mental. And I just sort of come to terms with this, with the fact that, like, my. I felt like my whole life had been almost thrown off course. And I was. I didn't, like, I didn't know how I was going to overcome this injury. And it's really. It's gonna be a really scary feeling, especially if, you know, I've always been very into school and very studious and into debating people. And I felt like I couldn't do that at all. And it's a really scary feeling. You're like, well, that's like what I do, you know, I, like, process information and I talk to different people and, you know, it was just. It was really scary. So it's. But now, you know, I sort of learned to really appreciate that because especially I was talking to that football player, the Harvard football player who's currently going through a concussion. He says that when he's in the locker room, he can sort of feel that pre game intensity that everyone has in a locker room before a game. He's like, man, you guys should really cherish this. This is really a pretty special thing. And just every. He said the way he thinks of it is every single snap, like, is. It's a gift like that you get to go out and play football with your buddies and, you know, fight with your team. It's an important thing. And like, I think about it in a very similar way. I think so. Definitely the concussion is, though, difficult, giving me, like a new perspective. So it's been. It's been okay, actually.

Dr. Lisa Belisle:

Well, I appreciate your coming in and talking to us. I know that it's not always easy to sit in front of a microphone and kind of share your story. And especially a story that's as intensely personal as this. It sounds like you've learned and experienced a lot through this really interesting and strange twist of fate. So you're 19 now?

Robert Macdonald:

Yeah.

Dr. Lisa Belisle:

Yeah. As a 19 year old, there aren't as many people who could do this and come in and speak with us with the type of mindfulness and thoughtfulness that you have. So we really appreciate talking to you about all this. We've been Talking with Rob McDonald, Cape Elizabeth High School graduate and Harvard student who recently has undergone this concussion. Thank you so much for coming in.

Robert Macdonald:

Thank you so much for having me. It was definitely a good experience even being here. Hopefully I can reach some people who have gone through a concussion or are currently going through one or maybe if they will in the future. So thanks a lot.

Dr. Lisa Belisle:

As part of our Head Game show, we are spending time with Deb Arthur, who happens to have a lot of experience, both in her head and in her life, with sports and sports medicine and personal training. She actually has a doctorate in physical education and a master's in science. So she's well versed. She knows all about the academics behind sports. We thought we'd bring her in and talk a little bit about what she knows, her mind, body connection experience, her own personal experience with all of this and just see where this conversation goes. Thanks for coming in, Deb.

Deb Arthur:

Thank you for having me.

Dr. Lisa Belisle:

Deb, first of all, what does it mean to have a doctorate in physical education? What type of education is required? What's the coursework and the background?

Deb Arthur:

At Springfield College, it's considered a generalist degree. So we actually get a taste of a lot of different things from exercise physiology to psychology to management. And I chose to focus in the area of sports psychology and measurement and have found it actually to be incredibly useful. Kind of wish I knew that stuff when I was a competitive athlete myself. Very actually kind of basic stuff, but really useful in life in general and especially particularly in athletics.

Dr. Lisa Belisle:

Well, I want to ask you about the sports psychology and measurement, but tell me about your experience as a professional athlete.

Deb Arthur:

Okay. Well, not professional, though. That would have been nice. I trained in Boston when I was at UMass Amherst. As an undergraduate. I played soccer and then I got into rowing crew and was invited to development camps, national team development camps. So I decided that it was something I loved and I continued it even after college. I went to Boston, rode on the Charles river and trained for national team. And for me and for all of us that were training, it was our life, it was everything. We worked so we could row. And the mindset as an athlete was to push as hard as you can and basically shift your mind away from your body when you row. Crew in particular, incredibly uncomfortable and painful when you're racing, your legs are burning, your chest is burning, and so you learn to separate from yourself so that you can keep going and not that it's all bad. Making it sound all bad. I mean there's a rhythm in the body that, I mean in the body and in the boat that you get into and you just try to flow with that and that's pretty amazing. But initially you really have to kind of separate. So there was times I would get out of the boat and I'd have cuts all up my leg from the boat. Didn't even notice it while I was rowing. And so it's over time, as I've gotten older that I've kind of shifted away from that separating from what's going on in my body and coming back into my body and realizing how important it is. Don't know. It's sort of be an interesting concept to know if we could teach that to athletes, but that's probably another topic. So that's that experience of being really separate from my body in order to achieve excellence. And now coming back into body so I can be tuned into what's right for my body and what's safe and what's comfortable is a really different kind of experience.

Dr. Lisa Belisle:

So sports psychology and measurement.

Deb Arthur:

Sure.

Dr. Lisa Belisle:

What are you measuring?

Deb Arthur:

Measurement, it's measuring psychological variables. So what our focus is, was in my program was to create psychological tools not for diagnosis of any kind of mental illness, but for measuring motivation. Persistence was a new topic at the time. My focus was on perceived physical self competence. Thank you. And so what I did, I was focusing on kids at the time. My theory was that girls, girls tend to have really low sense of self confidence in their physical selves. And so I created a measuring tool where I looked at boys and girls and compared how they perceived themselves physically. And so that was where my focus was at the time.

Dr. Lisa Belisle:

Why did you become interested in that?

Deb Arthur:

I was always interested in body image and athletes and particularly interested in how things females feel about themselves physically because we live in a culture that does not, that really promotes physical appearance is how women value themselves. And so I was curious to look at the factors that influenced girls in particular. It tends to be self appearance. But I was interested to see if we could somehow change their perception of their physical self through physical activity. Now I didn't go far, far, far with this research. I just really did the basic doctoral work. So it wasn't, I didn't take it with me and try to make a change in young girls, but that was my interest at the time, was to create that tool so we could create a tool to measure perception.

Dr. Lisa Belisle:

Did you become interested in that in part because you have your own daughters?

Deb Arthur:

I didn't have my daughters Then I think just, just being an athlete and knowing how that benefited me and knowing how when I was a young girl, this is kind of going into a different direction a teeny bit. But physical education was boys and girls and we were separate. And then Title IX came and everything became united. And so it was really hard as an elementary school kid to start, start playing with the boys because they were stronger and faster. And I just remember I was always the superstar and then when I had to play with the boys, I was no longer the superstar. So my sense of self and my sense of physical ability kind of was shot down a bit just because. In comparison to the boys.

Dr. Lisa Belisle:

Yeah, no, that's really helpful. So you saw a shift before and after this was this.

Deb Arthur:

I did, I was very aware of it as a child to. I was very aware that I did not feel as good about my physical ability when I was playing with the boys as well because they were stronger, faster.

Dr. Lisa Belisle:

Well, this brings me to something that we had talked with Dr. Glaser about from Coastal Orthopedics and he was talking with us earlier about concussions and athletes who get a concussion and have to rest and then have to slowly come back into being athletes again. I mean, you've been talking about one side of it which is people who maybe haven't had as much experience with their bodies or they're older or they're older and it's just something that they need to get back into. What about the athletes who have been consistently athletic and then all of a sudden they have to stop?

Deb Arthur:

It's incredibly challenging. I never had a concussion. I don't think, knock on wood, I don't think I did. But I injured my back very badly and rowing and it is the hardest thing to do to be this like sort of powerhouse and able bodied and then to suddenly be on your in your bed for a couple of weeks because you can't do anything. It would be great for coaches to be able to. I'm sure coaches, I don't know, I'm sure they all each have their way of helping the athlete through it. But it's about, it's going to have to be about baby steps for them and that's the hardest thing. But such a great learning for them if they can do it. And then as they take the baby steps into being back into being full force as an athlete, they can then look over past their past experience and they can see how it got them back to where they wanted to be. But athletes aren't taught to do that. They're taught to just go as hard as they can every time. So that's a challenging one. Wouldn't it be wonderful if we could allow athletes to be so tuned into themselves that they didn't do anything to hurt themselves? It's so counter to the athletic culture, though. The athletic culture is all about push, push, push, go faster, go faster, go faster, hit harder, hit harder. And so that would be a whole cultural change to have athletes coming from what feels right in their body first. A concussion's not a concussion is different in that they got there was an impact to their head. But the needing to slow down to come back is definitely a challenge. I think that the answer to that is it's just a challenge. And sometimes we humans have to say, I don't want it to be this way, but what can I learn from this and how can I grow from this and how can I become a better athlete from this progression I have to go through in order to get myself back to competitive status?

Dr. Lisa Belisle:

Well, I know that my daughter had an ACL injury last summer, and then she wasn't actually. She had it last playing lacrosse. And then all summer long after her surgery, she wasn't able to do anything except physical therapy. And this was a three season sport, swimming, soccer. And she had to sit out the entire sophomore season of soccer. And it really impacted her in a big way. I saw her go through some significant, I would say it's an adjustment reaction, but other people might know it as almost a minor depression.

Deb Arthur:

Right. And the thing with a knee injury, you know, head injury, you can't do anything that is impactful anymore, right. Until it's healed. And I don't, I'll be honest with you, I don't know if they could do other activities that aren't impactful. I mean, for an ACL injury, she could be doing upper body, she could be doing core, so that she feels like she's doing something and she's keeping part of her body strong. Do you know what I mean? So that sort of gives them a sense that they're still accomplishing something physical, even though she can't use her legs.

Dr. Lisa Belisle:

And I think she did do that, I think for her. And now she's back and she's playing and I give her just. I'm so proud of her for all the work that she did to get to this place because she had to deal with the psychology of it, the emotions of it. I'm probably more proud of that than any of her quote unquote accomplishments as an athlete. But I think one of the things that she missed the most was the sense of playing on a team, was a sense of camaraderie. And it's something that you can sit on the sidelines and watch your team, but you're not really a part of it unless you're actually out there. And it's a very interesting thing that happens when you're sort of extracting from something you've known for a long time, this sort of crowd mentality.

Deb Arthur:

Now I sort of go to this philosophical place with this, which I know is easier for us to have a chat about than for your daughter to perhaps feel. But everything that happens in our lives provides us with an opportunity for learning. So what she was able to experience was that contrast. And now when she goes back to soccer, wow, does she appreciate it and is she grateful for it more so than she was beforehand? Probably. And I don't know what her process is with it, but, you know, you could talk to her about it, but just that, you know, wow, you know, we just take things for granted. We all do. We take things for granted. And then when something is changed in our life, like a concussion and injury, now we feel kind of lost and bummed out and oh, poor me, and this stinks. But if we can step back and go, okay, I don't want this to happen. But you know what? When I'm better and I get back into this, I am going to really be grateful for this and I am going to love every minute of my athletic experience. What's interesting is that as we get older, people have a sort of a similar kind of experience. Because I've had clients, men and women who have been athletic when they were younger, now they're getting older and their body doesn't do the same thing. So it's not as abrupt as an injury. It's more long term and incremental. But that sort of sense, like, wow, I can't do what I used to do. And that's when I always tell people, well, let's honor this. Let's listen to your body and let's find what you can do with where you are right now and progress you to another place. But we can't live with what was. I mean, just can't.

Dr. Lisa Belisle:

Well, I think that that is a perfect way to conclude a conversation about head games, which has been far reaching, but has had really some wonderful nuggets from somebody who has herself been an athlete at a pretty high level, but now lends wisdom to people at various levels of athleticism. So thank you for coming in. We've been talking to thank you Deb Arthur from who's now at the Body Architect.

Deb Arthur:

Thank you so much. I appreciate it.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle and you have been listening to the Dr. Lisa Radio Hour and podcast show number 53, Head Games, airing for the first time on September 16, 2012. Today's guests have included Dr. James Glaser from Coastal Orthopedics and Sports Medicine, Cape Elizabeth High School graduate and Harvard student Rob McDonald and Deb Arthur of the Body Architect. For more information on our show's guests, visit drlisabelisle.com Please take a moment to like our Dr. Lisa Facebook page and let us know what you think. Also, let our sponsors know that you appreciate the work and the time and the effort that they're putting into our program. Without our sponsors, this program wouldn't exist. All past episodes of the Dr. Lisa Radio Hour and Podcast may be downloaded for free from itunes. Please let us know what you think about our past shows and forward along any show ideas you might have for the Future. This is Dr. Lisa Belisle. Thank you for being part of our world. May you have a bountiful life.