Sunday, December 9, 2012

Madeline Uretsky

I have begun to join the interesting community on social networking sites that follows concussions and brain injury. Shortly after launching my twitter account (@concussionguide) I heard from ConcussionMom who is Jamie Stelman Uretsky from Massachusetts. She told me about her daughter, Madeline and wrote this:

“In October, she was the speaker at the 10th annual Brian Injury Association Walk in Boston, and last week, she was a speaker at the Pediatric Brain Injury Conference in Marlborough, MA. She will also be featured in an article for Bay State Parenting Magazine in January. This injury has certainly changed her life, and she intends to have some good come of it for others, so she's become an activist for students with concussions. She truly wants to make a difference.”

Here is Madeline’s story in her own words written for, the website for my book:

"My name is Madeline Uretsky, and I am a high school student/athlete; I play soccer, ice hockey, and track, am an active member in my school/class, an honor roll student, and a very positive person. In a matter of seconds, all of this changed for me. You never think it’s going to happen to you. 
I sustained a mild concussion in May 2011 when I hit my head on a car door. It was my second concussion on October 13, 2011, that has changed my life. While playing in my high school soccer game, I was tripped from behind, fell on my forehead, snapped my neck back, and hit my forehead again. I knew something was wrong immediately, but I had no idea how serious it would be.
I spent the first 3 months of my concussion lying in bed at home, in a dark room, and on complete brain rest. This brain rest meant that I could not watch TV, use a computer, phone, draw, text, read anything, do any sort of homework or exercise. In other words, I could just sleep and lie in bed.
At this time, my symptoms were numerous and very high on the symptoms scale at the doctor. I had excruciating headaches as well as very sharp pains all over my head, severe whiplash, disorientation, memory loss, extreme fatigue, dizziness, balance problems, trouble following a conversation, ringing in my ears, and I could not tolerate any bright colors, light, or noise of any kind. My sleep at night was erratic and filled with nightmares.
For the first 3 months I went to my pediatrician weekly, and my neurosurgeon monthly, for a symptom evaluation. On a scale of 0-6, I had almost all 5’s and 6’s during those three months of brain rest; I could not believe how awful I felt. I started going weekly to a massage therapist who practices a type of acupressure that helps brain injured patients. I liked going because it was a way to relax myself, even though it was painful. I continue to go on an as needed basis, and also do many other kinds of alternative therapies that have been helpful.
As these weeks turned into months, it became apparent that there was no end in sight for me. I was isolated from my friends and my school, yet I felt so awful that I accepted that there was just nothing I could do about it, except rest, and wait it out. I had visitors, on a limited basis, but I did not even feel well enough to enjoy myself. I was unable to engage in any kind of conversation, and I would randomly fall asleep. There were times that I could not even remember that I had visitors.
I missed almost my entire sophomore year and I am still not cleared for physical activity other than walking. I did catch up with my schoolwork and now I am on a full schedule at school but with accommodations such as extended time on tests. I still have many of my symptoms, but they are less severe. Focusing, processing new information, multi tasking, and comprehending orally are some of the issues I currently have. I am doing much better than I was a year ago, but brain injuries are a work in progress.
I have been lucky to have a great support system of family, friends, and my medical team. Brain injuries can be very isolating and lonely, and I want to use my experience to help others, and let them know they are not alone. Things do get better over time."

Image attached from via Google Images.

Friday, November 30, 2012

Lack of ZZZs May Increase Injury in Teen Athletes

Teens always seem tired, except maybe on Saturday night. As parents of adolescents, we’ve all been there. We encourage them to get sleep to be at their best: to get good grades, be sharp in school and at work, to stay awake and alert playing in goal and even to act polite at the dinner table.

But there may be something more important that comes from enough sleep. That’s an immunization against injury.  A recent study from Connecticut shows that athletes who slept “at least 8 hours per night were 68% less likely to be injured, compared with athletes who slept less. Interestingly, the level of sports participation, commitment in terms of hours of training and practice, number of sports, private coaching or an attitude of “having fun in sports” did NOT correlate with increased injuries. The study was reported in the November 2012 issue of Infectious Diseases in Children. (

No mention was made of types of injuries but we can be sure that head injury and concussion figure in this data. It’s startling to me when I review ImPACT tests on athletes at school, whether baseline tests or post-injury tests, how often students report 4-5 hours of sleep the night before. So in addition to making them prone to bad moods, inattention and trouble learning, we now can point out that lack of sleep may well have contributed to the injury itself.

All this seems logical to parents who are perennially concerned about teens’ lack of sleep. But this might not be so evident to coaches, certified athletic trainers and athletic directors. Of course, “policing” or encouraging good sleep habits starts at home. But sometimes a student will hear the advice with a more open mind from a mentor on the team.

Image from

Thursday, November 15, 2012

Cheerleading Hurts!

The days of innocent pompoms, splits and clapping are long gone.  And with the increasingly athletic and fast-paced routines and stunts that we see cheerleaders doing from elementary school on through professional sports, it is not surprising that the number and severity of injuries has increased.  In fact between 1980 and 2007, the number of hospital emergency room visits for cheerleading injuries increased by over 400%.

Responding to this data, the American Academy of Pediatrics just issued a policy statement about cheerleading injuries.  One of the problems they point out is that cheerleading is not widely recognized as a sport.  Even competitive cheerleading is not included on the NCAA roster.  This leads to the following consequences according to the AAP:

  • ·      Data collection about injuries is not uniform or monitored
  • ·      Valuable safety resources and regulations are not available to teams
  • ·      Coaches may not be qualified
  • ·      Access to certified athletic trainers and physicians is not certain
  • ·      Pre-participation sports physicals are not mandatory, so many participants are not well conditioned.

Stunting which involves “maneuvers in which 1 or more bases supports 1 or more flyers off the ground” accounts for nearly 2/3 of all cheerleading injuries and 96% of all concussions.  Although the overall injury rates for girls in cheerleading are lower than many other sports,  almost 70% of “catastrophic” injuries--resulting in permanent brain injury, paralysis, or death--among high school and college female athletes were among cheerleaders. 

The Academy issued a twelve point set of recommendations which ranges from instructions on safer surfaces to improved training for coaches and the presence of certified athletic trainers to asking for the NCAA to designate cheerleading a sport. These recommendations and the entire article can be seen here.

image from the via google images

Thursday, November 8, 2012

Pediatricians Should be Checking for STDs in Teens

Did you know?

Nearly 50% of all STDs occur in 15-24 year olds?

Four out of five US 18 year olds have "engaged in vaginal intercourse, oral-genital sexual activity, and/or anal intercourse."


The proportion of office visits made by 11-17 year olds to pediatricians (as opposed to other health care providers) has climbed to beyond 50%.  

These data do not overlap exactly due to age differences in the three different studies.  However, experts are inferring from this mix of data that more than ever pediatricians are in a position to be responsible for the sexual health of their teenage patients.  I would also bet that with more young adults under 26 being covered by their parents' insurance through the Affordable Care Act, these folks are also returning to their pediatricians at least up to age 21 or whenever they "graduate" and move on to internists, gynecologists, emergency rooms, free standing clinics or more often, no one.

What many parents and young people should recognize from this data is that a whole lot of sex is happening before intercourse these days.  No problem.  We told them to wait, didn't we?  We told them that they could get pregnant or HIV or other STd's, didn't we?  But what we didn't count on, maybe, or want to deny is that teenagers are crafty, inventive and sexy.  They have found new ways of being sexual and STD's are definitely transmitted this way.

What many parents and young people do not realize is that NO PELVIC EXAM is necessary to check for chlamydia and gonorrhea, the two most common STD's that we check for. The most widely used test is  a simple urine test that gets sent off to a lab.  Often providers and teens are reluctant to risk insurance companies or billers revealing that such a test was done.  Time to face reality.  Be glad if your pediatrician is screening for STDs. It probably also means that your teen has had a chat with the doctor about sex and sexuality.  And that's a good thing, for sure.

This new recommendation was published in the October issue of Pediatric News.

image from via Google images

Sunday, October 21, 2012

Role model?

"He’s a kid, still, in a lot of ways. He wants to show that he can take a licking and keep on ticking. But that’s a head in his helmet, not a Timex " Tracee Hamilton, Washington Post, October 8, 2012

This refers of course to Robert Griffin III just a day after his aggressive play which ended in a concussion and a short rest from game play--a length of time which itself has since stirred controversy.

If this professional quarterback still plays and behaves like a kid, then imagine what goes on in the minds of the middle schoolers with ADHD who are out there playing their hearts out, using their heads in one way or another.

My book, It's All in Your Head: Everyone's Guide to Managing Concussions will introduce players, trainers and providers at all levels to ways in which everyone in the community must begin to take responsibility for those heads. Not every bobble-headed 10 year old has the NFL police watching out for his welfare; this is where parents, friends, coaches, teachers and health care providers may need to step in.

Get it now at

Tuesday, October 16, 2012

Trickle Down or Touch Down

The country is having a conversation about football. As a culture and a nation we are asking questions like where, when and how the game should be played, in addition to whether it should be played at all. It seems the lower age limit on this discussion is trickling downward all the time.

Peewee league players with their helmeted bobbleheads are now on the covers of several books that review the history of head injury and its revelation in the NFL. Likewise, an excellent documentary film, Head Games, chronicles the same history in graphic detail.

Now, serious investigators and clinicians are asking whether the sport should be played by pre-teens at all. Schools, teams, leagues and others are trying to make sense of where football is or should be going.

But the sport isn’t going to slink into the history books so fast. Not as long as programs like Steve Clarkson’s in California continue to exist and thrive. This quarterback training camp, profiled in The New Yorker, shows us the lengths to which families will go to give their kid a “leg up” or a “head start “ on a football career, sometimes enrolling promising peewees as young as 8. Not surprisingly, this article also profiles the parents of these youngsters “who may be inclined to see an overreaction to the concussion controversy that has left youth football in a seemingly precarious position.”

NPR also just produced a show called “Head injuries rattle even devout football parents,”

It is troubling to read about such denial in the face of mounting data. It feels reminiscent of the deniers of global warming or the deniers of the effects of second hand smoke. That cultural mores and stubborn traditions may actually stand in the way of childrens’ mental and physical well-being is what is so disturbing. Every parent, coach, teacher, clinician and adult has the ability to prevent injury and long term consequences if they are educated. 

And it starts with the players themselves. “This is a very important part of teaching concussion awareness, letting players know it's their responsibility to acknowledge a problem,” writes Tom Goldman in his NPR story. “Historically that hasn't often happened in football, where playing with pain and injury is a sign of toughness, a badge of honor.” What we need to teach everyone is the Four Rs: Learning to Recognize, Respond, Rest, and Reassess after a head injury is everyone’s responsibility, from the injured athlete (of any age) on up.

Thursday, September 27, 2012

You Need My New Book!

Dad fell off the ladder and struck his head.
You tripped and banged your head earlier and now it hurts.
Your son took a hard hit in the soccer game and probably has a concussion.
What do you do now?

It’s All in Your Head: Everyone’s Guide to Managing Concussions will walk you through the steps of evaluating a head injury and will assist in diagnosing, managing, and recovering from a concussion. Based on the simple principle of The Four Rs: Recognize, Respond, Rest, and Reassess, It’s All in Your Head will empower you to support the injured and advocate for the best possible treatment and outcome, whether the injured person is you or someone you care about.

Following the Four Rs will guide the injured through what they need in order to recover successfully and return to work, school, play, and other everyday activities as quickly and safely as possible.

If you've followed my blogs at all over the last few years, or even if you haven't, you know that concussions have become a hot issue. Hardly a day goes by without a news story about an athlete who is sidelined--or worse-- by a head injury. And that's just in the news.

You should see what schools and colleges are managing on a daily basis as we begin to recognize and manage head injury in a more comprehensive and safer way. As of June 2012 New York State, and over 30 other states, have mandated policies about head injury in the public schools. In the schools I work in we are busy doing the right thing and catching up.

You can find the book, available now as an e-Book and in paperback through Amazon and Barnes & Noble at

It’s All in Your Head: Everyone’s Guide to Managing Concussions, is a valuable and unique resource for parents, coaches, trainers, physicians, therapists, and school personnel who need to understand concussions and collaborate to manage them safely and effectively.

The first step for everyone is to be educated and prepared. This book will help get you there.

Tuesday, September 18, 2012

Criticism of our Kids

Ever go to bed mad at yourself for being too critical of your kid? Ever worry that your kid doesn't respect your advice anymore now that she's sixteen?

What follows is the first of two guest posts about Criticizing our children by Ken Barish, PhD, a Clinical Associate Professor of Psychology, at my alma mater, Cornell's Weill Medical College; a practicing psychologist in Westchester County, and the author of his recently published Pride and Joy: A Guide to Understanding Your Child’s Emotions and Solving Family Problems.

The Harmfulness of Criticism

If I were asked to identify the most common problem presented to me in three decades of therapeutic work with children, adolescents, and families, my answer would be unequivocal: “As parents, we are, unwittingly, too critical of our children.”

This statement has surprised some of my colleagues and is at odds with much of the conventional wisdom about contemporary parents - that we are overprotective or overly indulgent; or that we fail to provide children with needed guidance and limits; or that we are too ready to be our child’s friend, rather than an authority.

Research findings from many studies, however, now provide ample scientific evidence to support my personal experience and this, admittedly, anecdotal claim.

We all know, from our own lives, how criticism feels. We may have experienced the demoralizing effect of frequent criticism in the workplace or in our love relationships. It is surprising, then, how often we fail to consider this in relation to our children.

In many families, parents and children have become locked in vicious cycles of unhealthy family interactions. Criticism and punishment lead to anger and defiance, or secretiveness and withdrawal; and then to more criticism; and then more defiance, and more withdrawal.

As these cycles escalate, parents feel increasingly justified in their criticism and disapproval, and kids, for their part, feel increasingly justified in their resentment and defiance. Parents tell me, “He never listens.” Teenagers tell me, “All I hear is criticism” or “They are always yelling at me.”

Much of our criticism, of course, is well intentioned. We criticize because we are anxious about our child’s future. We want her to improve, and eventually succeed in a competitive world. We think of our criticism as constructive, or not as criticism at all, but rather as instruction and advice, and we regard our child’s defiance or his unwillingness to communicate (especially in adolescence) as an unavoidable consequence of responsible parenting. I disagree.

When frequent criticism persists, all other efforts to improve our family relationships are likely to fail.

The Solution

The solution to the problem of frequent criticism begins with this fundamental fact: Children and adolescents, when they are not angry and discouraged, want to do well. Your children want to earn your praise and approval, and they want you to be proud of them.

There is no better antidote for frequent criticism and argument - and no better way to help children bounce back from the common frustrations and disappointments of childhood - than patient and respectful listening. Listening, of course, does not mean agreement or giving in to unreasonable demands. When we listen, we make a genuine effort to understand and appreciate our child’s point of view and to acknowledge what is right about what he is saying before we point out what is wrong.

I recommend that parents create moments, on a regular basis, that are conducive to this kind of patient listening. It is especially important, in these brief daily conversations, to acknowledge a child’s grievance – what he feels is unfair in his life. We should also acknowledge our own errors and, when appropriate, apologize to our children. We should say, for example, “I feel bad that you were so upset earlier today. I know I was very angry at you. Maybe I got too angry.”

Some parents express concern that, in apologizing to their children, they may implicitly condone their child’s disrespectful or defiant behavior and diminish their authority as parents. This fear is understandable, but unfounded. Your apology does not excuse your child’s bad behavior. To understand your child’s mood is not to indulge his mood; the needs of others always have to be considered.
In my opinion, when a parent offers an apology, he has modeled an important lesson in interpersonal relationships and gains authority with his child, because our children’s acceptance of adult authority is, ultimately, based on respect.

In my next post, I will continue this discussion, and offer additional solutions to the problem of frequent criticism.

Ken Barish, PhD

Friday, August 24, 2012

Adolescent Online Porn Addiction

Some of the many emails that enter my inbox daily--and some I actually look forward to are from the professional Listserve I belong to through the Society for Adolescent Health and Medicine or SAHM.

Today there is a lively and provocative discussion about adolescent pornography access and even addiction to pornography.  It was generated by a first email sent by a professional colleague who wrote of a young man in his early 20's who recently told her "on-line porn is the scourge of my generation of young men."

He described his addiction with online porn and the ensuing isolation and loneliness he felt and the impact it has on his "expectations of relationships."

The professional feedback bemoans the fact that there is really no good research into this growing phenomenon much less sound or tested advice on how to advise parents or patients on this and many of the other issues that arise from "growing up online."  How do we even ask the questions in the right way in order to get at the answers?  What constitutes addiction anyway?  How do we measure that?  What can we do if we uncover it?

There were some answers from the world of research into gaming addiction which is already being considered for the Diagnostic and Statistical Manual (the bible of psychiatric diagnosis).  Some warning signs might be:

  • Preoccupation with Internet gaming/porn
  • Withdrawal symptoms when Internet is taken away
  • Development of tolerance. This means the need to spend increasing amounts of time engaged in gaming/porn to get the same effect/pleasure
  • Unable to control gaming/porn habits
  • Continued use despite knowledge of negative impact
  • Loss of previous interest in hobbies, entertainment, sports
  • Use of gaming/sports to escape unpleasant moods
  • Deception toward family, therapists and others regarding amount of time spent gaming/on porn sites
  • Loss of job, relationship, career opportunity because of gaming/porn use
The exchange between professionals called for more research among institutions to begin to understand this problem.  The Center on Media and Child Health at the Harvard School of Public Health has begun to collect data and explore positive and negative effects of media on child health.  In addition they maintain a website, AskTheMediatrician which may be helpful if parents are concerned about their child's activities.  It's a place to start taking suspicious behavior seriously and stop looking the other way.
image from via Google

Wednesday, August 1, 2012

Is there a biker in your family?

This image was taken from the Internet;it's not true that I watched from "there"

This weekend my four boys will be riding bikes together in the Pan Mass Challenge or PMC, an event that has happened every summer for the last 32 years across Massachusetts and has raised over $330 million for the Dana Farber Cancer Institute.  This year over 5000 cyclists will ride over 200 miles over two days.  It's a joyful occasion for people of all ages, many of them cancer survivors, most of them friends and family of survivors.

As I had breakfast today with my son, Justin, I noticed a new wrist band on his arm.  It's called RoadID and it's ingenious.  Everyone who is a biker, triathlete or otherwise risky athlete should get one.  The band looks like this (and comes in many colors and designs):

and can be purchased in a simple or an interactive version.  For an initial $20 investment and then an annual fee of about $10 the band provides important identifying data but it also gives access to a website or an operator that can retrieve important coded contact information, medical data, medications, allergies, and insurance information that you provide and can update or change online at any time.  

Because I am always worried about head injury in my hard charging children, I am glad that they are using their heads to think ahead.  Should one of them not be able to speak for himself, emergency responders would know whom to contact and have all the information they might need to help give them optimal care.  I think that's technology at it's best.

Monday, July 30, 2012

It's been a while!

The George Washington Bridge from Riverbank State Park
 There has been a long lag in my blog posts! Summer you know!

I've been busy with moving from a house to an apartment and all that entails--downsizing and peeling away, getting rid of, parting with, selling, giving away, triaging, storing, sorting, pleading with grown children to make decisions, packing, repacking and unpacking and finally settling in to new space, a new neighborhood and new neighbors.  All an adventure in growing up and out,  in many ways, in going back.  For me, going back to New York City, even to a neighborhood, Washington Heights, where I trained to be a doctor, a neighborhood rich in memories, some more bitter than sweet, but now one that is new with wonderful and surprising places and cultures to explore.

In the mean time, I am also hard at work on a book, that with a bit of luck and some blessings from all those powers we rely on for our good fortune, will emerge in the next weeks to months.  It is a book that will help anyone who has had a concussion.  It will also be a useful guide for parents and professionals who know someone who has experienced a head injury or is likely to see one because of the sports they coach or play. 

In late June of this year, just moments before public schools let out, New York State released its new Guidelines for Concussion Management in the School Setting.  This document is based on the Concussion Management and Awareness Act  (Chapter 496 of Laws of 2011) which requires all districts to have rules and regulations to address students who may have had  a concussion whether in school or not.

The new rules are robust and comprehensive although not terribly specific.  Each district will be faced now with the task of creating committees, protocols and education plans for the entire community (from students to families, coaches, certified athletic trainers to nurses, guidance counselors, teachers and administrative staff) in order to manage head injury responsibly and effectively.

The book I am writing will help all involved to understand the basic Four R's: Recognizing what a concussion is: Responding Responsibly to such an injury: Resting as much as is necessary for a complete Recovery; and Reassessing to be sure Recuperation is at hand. 

Stay tuned.  We all have a lot to learn together.

Thursday, June 14, 2012

Pop Warner Saves Football and Our Kids

On Tuesday night I spoke briefly to a standing room only audience at Mamaroneck High School along with  the athletic director to discuss rules, regulations and policies with parents and student athletes who are planning to play Fall sports.  I talked about head injuries and concussions and the upcoming New York State regulations that mandate among other things that schools educate the community about the importance of correct management of concussions.  The talk ended with the recent fabulous New Yorker cartoon that shows a football team huddled together and the coach saying: "Now promise me you will all be very careful?"  And I posed the question to the audience "Will this new information be a game changer?"  My answer was "Yes, I think it will and I think it already has."

When I returned to my seat a jocular father tapped me on the shoulder and said: "Hey, doc, but really how ya going to change the game. I played hard my whole childhood?  Really now?"

And then yesterday we woke up to the news that Pop Warner, the "only national youth sports organization that requires scholastic aptitude to participate" and supports 425, 000 youth ages 10-16 in football, cheerleading and dance activities, has adjusted the rules regarding contact and head tackles in football.   Hooray.   This is fantastic news.  It means that the information has begun to trickle down from the NFL and that the terrible, tragic stories we have been sharing on this website and in so many other places have finally begun to have an impact on our children's health.  

For more discussion from ESPN, click here.

Meatheads beware!  Times are changing.

Sunday, June 3, 2012

Greetings from Haiti

I am in Haiti this week with an organization founded by a colleague of mine with whom I shared pediatric residency training, Dr Jill Ratner who practices pediatrics in Mount Kisco, New York.

The organization, Hands Up for Haiti, is a not for profit, non-denominational group that is dedicated to treating pediatric patients in northern Haiti as well as teaching staff in the clinic facilities it serves.

I am here with another pediatrician from Westchester, Dr Katherine Hough from Hastings and  two nurses  who also work in Westchester, and we are sharing a house with a group of eight football players from the midwest who  are  here with an evangelical Christian group from Florida. They are here to build additions onto an orphanage they started in this village, sweetly called Limonade, three years ago.

"Non-denominational" one discovers in the developing world always has to be re-defined when it comes to funding and possibly to getting things done. This orphanage is part of a complex which includes our clinic called "Porte Ouverte" or Open Door, a school for 500 students, the orphanage for 26 children, and of course a well-attended evangelical church. 

This is a complex country, we live in complicated times, and I am here to learn how one person can make a dent that might last. 

Tuesday, May 22, 2012

Heads Up: Be the First Responder! Your Turn to Talk

It has become clear to many of us that lots of head injuries and concussions go undiagnosed.  There are a number of reasons for this:
  • Athletes want to stay in the game.  
  • Denial is a powerful tool.  
  • Concussions impair judgment even when our best interests are at stake.  
  • The signs can be subtle.  
  • Players often think a headache after a soccer game is a normal part of the game and "suck it up." 
  •  Or the camp counsellor might think "Of course she needs to take a nap today, she fell out of her bunk last night."

In order to better understand what a concussion actually feels like, I am hoping to tap into the collective intelligence of my readers and their friends in order to "crowd source" this information.  I want to know what it felt like to have a concussion; what people around said and did, including coaches, parents, teachers and medical providers.  I want to hear what part of your head hurt and what else you experienced.  

This Questionnaire has already gone out through friends and family and is coming back to me with some astounding detail.  This will help all of us who work as health care providers and in schools to better understand the first minutes, hours and days of head injuries and how and why we need to respond to our children, athletes, and patients.  Please take a moment to look at the Concussion Query here.  It need only take a few minutes to respond. Or you may find yourself pausing to recollect some very interesting and powerful memories.  I will use all information anonymously.  

If you have never had experience with a head injury but know someone who might have,  please send this on.  For my research I am particularly (but  not exclusively) interested in hearing from more girls and young women, younger children, and non-athletes.  Stupid stuff is fine, too.  One student concussed by "merely" hitting his head on the upper locker door!

Many thanks!  Pass it on!

image from via Googleimages