Guest: Dr. David Reiss
Presenter: Neal Howard
Guest Bio: Dr. Reiss began training in Sports Medicine while in medical school, working with and studying the Northwestern University football team and authoring a paper, “The Psychological Anatomy of a Losing Season.”
Segment overview: Dr. David Reiss discusses a current project that would specifically address psychiatric issues that occur related to head trauma, both Sports Related Head Injuries and domestic violence-related.
Health Professional Radio – Sports Related Head Injuries
Neal Howard: Hello and welcome to Health Professional Radio. Thank you so much
for joining us today, I am your host Neal Howard. Our guest in studio today is Dr. David Reiss, practicing
psychiatrist and he is here today to discuss mental health consequences of concussions and other head
injuries and how these injuries relate to both our self-esteem, cognitive skills, and sometimes maybe
symptoms related to Alzheimer’s are not Alzheimer’s at all. How are you doing today Dr. Reiss?
Dr. David Reiss: Very good, glad to be with you.
N: We’re talking about some of the needs that we have to address concussion
especially in light of this movie that just came out, that specifically talk about concussion as it relates to
football at particular NFL, colleges and high school. When it comes to dealing with head injuries, when
people are talking about being in denial, well we have helmets, we have procedures and all of these
safety measures yet these injuries occur how do you plant to get the word out to get people aware and
start taking a closer look at the consequences of some of these head injuries?
R: Well a lot of it is now that athletes themselves are being more open about it and
athletes are donating their brains to science and unfortunately after they pass away studies are done,
we have more facts so it’s not just ‘I heard this or I think that.’ But also being more aware of the topic
many of us are just taking a better history, I may have someone come in with a primary substance abuse
problem but of a sudden I’m goanna ask did you play ball in high school? And whether it be football or
soccer, even baseball especially for catchers you often get a history of head injury. Women also, we
have women who play soccer who we’re seeing significant problems with, as well as a lot of times
people would asked about issues of domestic abuse, child abuse, but not the way ask ‘Were you beaten
around the head?’ ‘Were you choked?’ And we’re finding more and more that there is some correlations
that doesn’t close the whole problem, but these are factors in people with these problems.
N: Are there certain activities that I guess if you engage in this activity you are
guaranteed to get some type of head injury? Even if it’s a minor head injury, say if you’re playing
football you don’t necessarily have to get a concussion or is that pretty much a guarantee?
R: Well you may not get a concussion, but what causes the damage is the brain
moving around within the skull. Now helmets basically protect the skull, there is a research on new
helmets that do more to protect the brain, but they reduce skull fractures but the brain is still gonna
bounce around. So anyone who’s alignment playing football is going to have that but whether you’re
playing soccer, hockey, and the thing we know now particularly we have a lot of good evidence coming
up is that under age 16, 17 the brain is much more vulnerable. So even like in terms of playing soccer the
damage that maybe done by just an innocent header, that no one even considers an injury to a 14 year
old it could be much more significant than the same situation with a 22 year old.
N: The 14 year old executes this header, he’s still developing, growing.
N: The small injury, is there nothing that can happen during his normal development
to repair this injury? I could understand someone being older but when you’re young the body doesn’t
heal itself even to that extent.
R: I’m not a neurologist so I can’t give you very detail specifics, but it appears from
the evidence coming up that the kids who are exposed to repetitive traumas it just interferes with
development. It may not even be damaging the brain as much as causing whether it be inflammation or
something that just sets development often a slightly different way, and I sure don’t know the details
but we are seeing the results of it.
N: Now you authored a paper “The Psychological Anatomy of a Losing Season,”
you’ve been involved with professional sports throughout your career, and you’ve consulted with
professional athletes regarding wellness.
N: How much of a part that just practicing overall wellness contribute to the
prevention of head injuries, even if you are involved in some of these questionable sports?
R: Right, to a very large extent just being aware having the assertiveness and
basically the courage to say if you’re hurt. Being aware that I may not deal with any numbers of the kids
who will say, and they maybe adults now or they may still be, ‘Oh yeah I was dinged but I just felt fuzzy
for 5 mins.’ Well just to be to have the self-awareness that means ‘I’ve been hurt and I probably
shouldn’t play for a few days.’ Also to avoid the drugs, the alcohol, the things that make it worst as well
as just the emotional stability to realize that if had an injury like that and for a few days let’s take a high
school kid on just not functioning in school quite as well as I usually do to talk to someone about it
rather than to give up or to turn to some other roles or something or some other drug or to just try to
hide it, because people loses their sense of confidence when they’re not functioning well, and that can
settle for a depressive path or a dysfunctional path.
N: You experience very minor head injury but it does cause a bit of neurological
damage, are there things, certain types of damage that workers compensation or insurance, deems well
not as I guess payable as others or are there more investigation involved? I guess for lack of a better
term is it a pain in the butt, sometimes like pain diagnosis, pain being very hard to determine whether
it’s real or imagined or how severe it is, you have to trust with the patient is telling you. When it comes
to some of these minor injuries, if you don’t have a CAT scan that’s saying this guy’s having seizures
because of this or because of that, how do you navigate the claims ocean?
R: That is a huge problem. I was just at a meeting yesterday about that we we’re
talking about ‘Okay we can identify people at risk, but how do we get insurance companies to cover it
when we can’t necessarily get a real clear or definite diagnosis or the treatment isn’t what like just given
this antibiotic or this medication?’ It’s a very big problem. And if someone comes in and says ‘My
memory isn’t good, I’m not concentrating.’ Yes, you can do neuropsychological testing and really get an
objective sense of that but even that can cost $1,500 but then insurance company isn’t gonna want to
pay for. So I’ve seen many number of people where we know the trauma is there and we can’t get
assistance even pay for an evaluation let alone treatment.
N: And is there any I guess grass roots efforts among psychiatrists or healthcare
professional in general in an attempt to get the word out and get more support for what is needed when
it comes to diagnosing and treating head injury?
R: I would say more of the effort right now on the diagnosing because that we have
more control over. Like now even in the hospital where I’m working on the admission form, one of the
question is have you ever had any type of head injury? That wasn’t there 5 years ago, unless you’re on a
neurological unit. On the other hand in terms of coverage the whole mental health system is in such bad
shape right now, I mean we’re fighting just to get basic coverage for basic issues. So unfortunately these
more difficult issues probably aren’t getting much attention at all. We’re trying to, we’re trying to make
it known and get it out there, but I’d be dishonest if I’d say I was optimistic.
N: You’re currently working with a psychiatric hospital as you say in New England to
develop a specific intensive outpatient program for athletes both High School age through the retired
professional. What is the progress or the status of that program?
R: Actually it’s preliminary right now. We’ve seen the number of people we have
coming through who could make use of it. The mechanisms of actually setting up the program, figuring
out how to get it as you say through insurance and exactly how to integrate psychiatry, neurology,
nutrition, exercise. We have a way to go but we’re all working on it.
N: Great, thank you. You’ve been listening to Health Professional Radio, I’m your
host Neal Howard. We’ve been in studio today talking with Dr. David Reiss, practicing psychiatrist about
head injuries both sports related and as well as domestic violence. And we’ve been here talking about
the need for more attention to be paid to the treatment and diagnosis of head injuries both severe head
injuries as well as minor head injuries. Dr. Reiss is internationally recognized as an expert in workers
compensation claims dealing with head injuries both first responders as well as professional athletes. It’s
been great having you here with us today Doctor.
R: Thank you very much, my pleasure.
N: Thank you. Transcript and audio of this program are available at
healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to our podcast on iTunes.