Speaking of injuries ...

So I finally landed a new job, and of all the ones I applied for, I actually got the one I wanted the most. Suffice to say that a small part of my job involves reading or at least perusing the alumni and development literature from the nation’s top medical centers. I was given a copy of the Winter 2006 issue of Johns Hopkin’s “Hopkins Medicine” magazine the other day, and found this interesting story on page 51 (this article is not available on their web site):

Thinking on their Feet
Alums who serve as sports team physicians need to make quick assessments, they say.
By Mike Field

PROFESSIONAL ATHLETES LEARN to think fast to determine their next play. Oftentimes, their team physicians must think just as quickly to determine whether there will be a next play.

Leslie Bisson ('91), head physician of the National Hockey League's Buffalo Sabres, remembers hurrying into the rink in one such situation. A player was down and apparently unconscious after a nasty collision. The lights were glaring and the fans unusually quiet as Bisson reached the prone figure at center ice. It was a Sabres player with a well-established tough-guy reputation. As Bisson bent over, the player opened his eyes. "Do you know where you are?" Bisson asked.

"Go #%&$!, doc!" barked the player, demonstrating a fluent use of ice hockey vernacular. "I'm fine!"

Fine or not, Bisson sidelined the player for the remainder of the game, as he has also done for National Football League Buffalo Bills players, where he also serves as a team physician.

Such tough calls, according to other Hopkins alums who serve as profes¬sional sports docs, make the job both challenging and gratifying.

"An important part is not to treat the athletes like celebrities," savs Allen Sills ('90), who works with the National Basketball Association's Memphis Grizzlies. "You can't let it interfere with your diagnosis and skills. When you begin to treat athletes differently, you cloud your own judgment."

Sills is a practicing neurosurgeon, one of a growing number brought in as assistant team physicians in professional sports. "Most sports team medicine is orthopedics and internal medicine," says Sills. "But the incidence of neuro¬logical injury in sports is quite high."

Like many other team physicians, Sills is a lifelong sports fan who was, he says, "a better student than athlete" in his high school and college days. His front-and-center involvement with a professional basketball team since then has been something of a revelation. "You can't appreciate how unbelievably physical the game is. You just don't get that sense of it watching it on TV There are these incredibly strong, fast and agile athletes playing a very, very physical game."

It is soccer-with its exposed heads and high-speed collisions-that records the highest incidence of head injuries, says Sills. But it is boxing and football where the most problematic of those injuries occur. "That's where you tend to see second-impact syndrome," he says. "A player has a previous injury that has not fully healed and then is reinjured, leading to rapid, uncontrollable swelling of the brain. This is where most sports-related head-injury death comes from. It's what we all fear."

Sills uses a new computer-based diagnosis system to assess player injury and recovery. Every player takes a 15-minute test that establishes a baseline measurement. If injured, the player takes the test again, and the results are measured against the baseline to help identify any cognitive deficits. "It's a tremendous advance in terms of diagnostics because it enables us to recognize when the brain is fully recovered," says Sills. Because athletes have often learned to play through pain, they are often poor judges of their own readiness to play the game. This tool provides an objective way to justify these decisions.

"Return-to-play decisions are a challenge," agrees Michael Brunt ('80), team surgeon with the National Hockey League's St. Louis Blues. "The question we always have to ask is if it's safe to go back to play. Usually these decisions are made with input from the training staff. We can give the medical OK, but the coach always has the final say."

Working with professional athletes, Brunt says, is a very particular kind of high-stakes medicine. "Sometimes it's just a split second that makes a difference, so as a surgeon, my outcome has to be perfect or near to perfect. Otherwise the player won't achieve the highest level of physical performance." The stakes are high in another way as well, as any medical decision can have a possible downside that could impair or end an athlete's career.