‘Science Says’ Sunday – Traumatic Brain Injury

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Traumatic Brain Injury (TBI)

TBI has been in the news a lot lately and since it is Super Bowl Sunday (go Niners!), I thought I’d touch on this subject today!

 So, what is TBI? Basically, it’s a brain injury. Injuries that can be caused by hard blows to the head or body. Serious TBI can cause bruising, bleeding, or tearing. Most TBIs happen as a result of sports injuries, car accidents, or other physical activities (like you’ve heard about happening to our military troops). People often wonder how this happens; the physical injury can lead to a back and forth motion of the brain inside of the skull. The back and forth motion leads to the injury of the brain. That’s known as the primary injury. Secondary injury results when the brain becomes so injured that it leads to swelling. The swelling can lead the brain to become grow larger than the space inside the skull, which can lead to stopping oxygen flow to the brain. This secondary injury leads to more serious and potentially permanent damage.

What are the symptoms of TBI? According to the Mayo Clinic, symptoms can range from mild to severe, including:

  • Mild: person is awake; eyes open. Symptoms can include confusion, disorientation, memory loss, headache, and brief loss of consciousness.
  • Moderate: person is lethargic; eyes open to stimulation. Loss of consciousness lasting 20 minutes to 6 hours. Some brain swelling or bleeding causing sleepiness, but still arousable.
  • Severe: person is unconscious; eyes do not open, even with stimulation. Loss of consciousness lasting more than 6 hours.

So how does TBI differ from concussions and chronic traumatic encephalopathy (CTE)?? Concussions, contusions, and hematomas for example, all fall within the TBI definition. They are different types of traumatic brain injuries. Most recently, you may have heard a lot about CTE, especially if you know about football players like Aaron Hernandez. CTE is very much an area of active research, so we still don’t know a lot about it. According to researchers at Boston University, CTE is a progressive disease where the function of the brain becomes progressively worse over time. This has been identified in individuals, especially boxers, as early as the 1920s, but has gained the interest of the public in the context of football. Most common, CTE is found in people with a history of repetitive TBI (often athletes), including symptomatic concussions as well as concussions from hits to the head that do not cause symptoms. It’s important to note that CTE is not limited to current professional athletes; it has also been found in athletes who did not play sports after high school or college. The changes in the brain can begin months, years, or even decades after the last brain trauma or end of any exposure to sports.

How would you know if you have TBI or CTE? Also, can I get CTE after a single TBI?? After an injury to the head or body (e.g., if involved in an accident or sports injury such as a tackle in football for example), if a person experiences any of the symptoms listed above, the person may have a TBI. CTE usually involves chronic, repetitive injury, and according to scientists, “at this time the number or type of hits to the head needed to trigger degenerative changes of the brain is unknown. In addition, it is likely that other factors, such as genetics, may play a role in the development of CTE, as not everyone with a history of repeated brain trauma develops this disease. However, these other factors are not yet understood.”

For more information, consider the resources provided below:

https://www.bu.edu/cte/about/frequently-asked-questions/

https://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/symptoms-causes/syc-20378557

https://www.cdc.gov/traumaticbraininjury/index.html

'Science Says' Sunday – The 2019-nCoV Virus

5 facts about the infamous 2019 Coronavirus outbreak

1.     Is this a new virus? It is in fact a new virus, but it has already been identified and sequenced (aka the DNA strand or sequence, has been studied). That work suggests that it is a relative of other coronaviruses like SARS. In case you’re wondering, the family of viruses called “coronavirus” is responsible for causing things like the common cold, but each virus within that family can cause illness that varies from not too serious to life threatening. The official name, btw, is 2019-nCoV. This virus, the 2019-nCoV appears to have originated late last year in a seafood market Wuhan, China. That seafood market is believed to have been selling wildlife illegally. This virus is believed to have originated or come from an animal source.

2.     How easily is it transmitted from human to human? We don’t yet fully understand how “infectious” or how easily it is transmitted from human to human. As scientists collect data, we will know more. Currently, the scientific data suggest that it is more infectious than the flu, but how infectious will depend on a number of factors and those factors change on a daily basis. As scientists gather more information about it, we will have a better idea about how easy it will be to contain it, create a vaccine for it, prevent others from getting it, how sick it will make people, etc. It’s still, simply, too early to tell.

3.     Do you need to worry if you’re in the US? That’s a tricky question. As I write this, there are a total of 5 cases reported in the US. There are 2062 reported in mainland China. It is most certainly a greater public health emergency in China than it is in the US, or anywhere else in the world for that matter. If you’re in the US, you currently have more reason to worry about the flu and getting sick from that, than getting infected with 2019-nCoV. That said, it is helpful to keep up with information about this new outbreak. I’ve listed a number of great resources at the end of this post. Bottomline: We are not facing a pandemic. Not yet at least.

4.     Is the disease deadly?? When reports first came out, there was concern that the high rates of pneumonia meant that the disease was super harmful, possibly deadly. As days have passed, scientists and physicians have seen milder cases appear, suggesting that the 2019-nCoV virus does not seem to be as deadly as it first seemed, and maybe less deadly than SARS, which killed 11% of the people it infected. It is STILL VERY EARLY to say this with absolute confidence, though, so scientists continue to monitor cases and the virus itself before making more concrete statements about it. Many of the cases of death due to 2019-nCov appear to have occurred in people with other illnesses or conditions which weakened their immune system.

5.     I’m traveling to China soon; should I be worried?? China has put a quarantine in place (sort of like a mandatory isolation of a group or persons or area), meaning that they have encouraged people not to travel, go places, etc., including travel, until they figure out what’s going on. There are questions about how effective the quarantine will be, given that every province in China has had cases of the virus. The timing of the Chinese New Year and all the travel and proximity of groups to one another likely has not helped transmission of the virus in China. We currently know that the virus is transmitted from human-to-human and that a person can be infected with the virus 7-12 days without showing symptoms. If you are traveling to China, you should practice hygiene and self-protection measures like you would against other respiratory infections, like washing your hands and covering your mouth/nose with a mask during travel or when around others.

To keep up with the latest numbers of cases, follow along here: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

Additional sources of evidence-based information:

https://www.nature.com/articles/d41586-020-00166-6?utm_source=fbk_nnc&utm_medium=social&utm_campaign=naturenews

https://foreignpolicy.com/2020/01/25/how-to-tell-whats-really-happening-with-the-wuhan-virus/

https://www.statnews.com/2020/01/26/containing-new-coronavirus-may-not-be-feasible-experts-say/

https://www.washingtonpost.com/world/asia_pacific/coronavirus-china-latest-updates/2020/01/26/4603266c-3fa8-11ea-afe2-090eb37b60b1_story.html

https://www.reuters.com/article/us-china-health/china-scrambles-to-contain-strengthening-virus-idUSKBN1ZP02B

https://www.washingtonpost.com/world/asia_pacific/coronavirus-china-latest-updates/2020/01/26/4603266c-3fa8-11ea-afe2-090eb37b60b1_story.html

https://www.statnews.com/2020/01/26/containing-new-coronavirus-may-not-be-feasible-experts-say/

‘Science Says’ Sunday – Vitamin D Deficiency

Three years ago, I experienced tiredness like never before. There were days where I could barely manage to get off the couch on the weekend, because the fatigue was simply so overwhelming. I finally decided to go to the doctor and requested they run some labs. Because my fatigue was so significant, they also ran a vitamin and hormone panel. The results were astounding. While the Institute of Medicine recommends that Vitamin D levels fall between 20-40 ng/dL, mine was 12 ng/dL. TWELVE! One week of intensive vitamin D supplementation and I was back to feeling like myself again.

I’m not certain that the Vitamin D supplementation alone was responsible for my fatigue. I was a mom of two under 7, it was a very busy/stressful time for me on the faculty, etc etc. It could have very well been a placebo effect (ie, “a beneficial effect produced by a placebo drug or treatment, which cannot be attributed to the properties of the placebo itself, and must therefore be due to the patient’s belief in that treatment”), given that a big study in the New England Journal of Medicine (one of the premier journals in academic medicine) published a study indicating that a more appropriate cutoff might be closer to 12.5 mg/DL, based on the analysis of blood samples from hundreds of thousands of individuals. 

So why is it possible that my potential vitamin D deficiency may have led to such extreme tiredness??

Well, Vitamin D is not frequently found many of the foods humans consume. Furthermore, we typically get Vitamin D from the SUN! So, if you don’t consume many of the foods that contain vitamin D, or consume them in quantities large enough to provide the Vitamin D levels your body needs, AND/OR you don’t get a lot of sun exposure, then it possible you could be vitamin D deficient. Since I wasn’t getting Vitamin in my food and getting very little sun exposure, it’s likely that the combination of those two things led to my deficiency.

So, what are some of the foods that contain Vitamin D naturally??

  • Fatty fish, like tuna, mackerel, and salmon
  • Foods fortified with vitamin D, like some dairy products, orange juice, soy milk, and cereals
  • Beef liver
  • Cheese
  • Egg yolks

At that time in my life, I didn’t eat eggs, I didn’t drink milk at all, I rarely ate salmon or tuna, definitely did NOT eat beef liver (although no judgement of those who do!!), and didn’t consume orange juice fortified with Vitamin D. Furthermore, this time of year three years ago also meant that I had been wearing lots of layers, and likely hadn’t spent much time outside because it’s winter. Also, it’s flu season and hello! Best to stay indoors. 😀 All that to say, I now consume a lot more salmon, and definitely take the Vitamin D dosage my physician prescribed.

Studies suggest that people most at risk for Vitamin D include:

  • people with anorexia nervosa
  • people who have had gastric bypass surgeries
  • people who suffer from other malabsorption syndromes like celiac sprue
  • people who have dark skin
  • people who wear total skin covering (and therefore absorb less sunlight even when they are outdoors for extended periods of time) 

 What are some of the symptoms of Vitamin D deficiency??

Some people have no symptoms at all. Others experience tiredness or fatique (like I did), others experience muscle aches. Extreme and prolonged (that lasts a long time) vitamin D deficiency can lead to brittle or misshapen bones.

If you have vitamin D deficiency, and have questions about what to do or what to take, definitely consult with your healthcare provider about an appropriate dosage if you’re not already getting it in your diet or you’re not in the sun a lot. Oh, but don’t forget, if you’re in the sun, WEAR SUNSCREEN because, hello, skin cancer. 😦

For more information, visit the following sites which include significant information about this topic!

https://www.health.harvard.edu/blog/vitamin-d-whats-right-level-2016121910893

https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

https://ods.od.nih.gov/factsheets/VitaminD-Consumer/

JoAnn E. Manson, M.D., Dr.P.H., Patsy M. Brannon, Ph.D., R.D., Clifford J. Rosen, M.D., and Christine L. Taylor, Ph.D. Vitamin D Deficiency — Is There Really a Pandemic? New England Journal of Medicine

Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism 2011

Heaney RP, Holick MF. Why the IOM recommendations for vitamin D are deficient. Journal of Bone and Mineral Research

Bouillon R, Van Schoor NM, Gielen E, et al. Optimal vitamin D status: A critical analysis on the basis of evidence-based medicine. Journal of Clinical Endocrinology & Metabolism.

Cauley JA, Greendale GA, Ruppert K, Lian Y, Randolph JF Jr, Lo JC, Burnett-Bowie SA, Finkelstein JS. Serum 25 hydroxyvitamin D, bone mineral density and fracture risk across the menopause. Journal of Clinical Endocrinology & Metabolism, May 2015.