Participants: Phil Mils, Don Mackintosh
Series Code: HFAL
Program Code: HFAL000035
|
00:52 Hello and welcome to Health for a Lifetime.
00:55 I'm Don Mackintosh, your host. 00:57 Today we're joined with Dr. Phillip Mills 00:59 from Wichita, Kansas. 01:01 Welcome, Doctor. 01:02 I understand that you are a physiatrist. 01:05 What exactly does that mean? 01:07 A physiatrist is someone who is a specialist in 01:10 physical medicine and rehabilitation. 01:12 We take care of such problems as head injuries, which we'll be 01:16 talking about today, strokes, spinal cord problems, as well 01:21 as muscular skeletal problems, and pain problems. 01:24 You take care of a lot of things but probably the most important 01:28 thing is our head. 01:29 We entitled this one, Protecting Your Most Valuable Asset, 01:33 this segment. 01:35 Why is the head so valuable? 01:38 If you look at physiology, everything in the body 01:43 is designed around the head. 01:45 For example; the skull gives it protection. 01:48 The legs give it mobility. 01:51 The stomach gives it nutrition. 01:55 Everything is designed to give information or some help 02:05 to the brain. 02:06 My eyes give it information. 02:08 My ears give it information. 02:10 The mouth gives it communication to the outside world. 02:15 We're just walking brains. 02:16 Well... you might say that and the neurophysiologists certainly 02:22 believe that. 02:23 But if you look at humans through the centuries 02:28 you find that the society of the time always use the highest 02:34 technology to illustrate the brain. 02:36 For example; the Roman era, the highest technology 02:41 of the time was the aqueducts and so they compared the brain 02:45 to an aqueduct. 02:47 The brain has aqueducts. 02:50 We call them various names - aqueduct of Sylvius - so that 02:54 comparisons still comes down to this day. 02:57 In the early 1900's the highest technology of the time was the 03:02 telephone relay stations. 03:04 So they compared the brain to a very 03:06 super telephone switchboard. 03:12 Then if you have today the highest technology appears 03:18 to be the computer. 03:19 Often times people compare the brain to a computer 03:22 I think a Mackintosh computer, I mean my name is Mackintosh! 03:25 That would be a good comparison. 03:27 Actually, the brain isn't a telephone switchboard 03:31 but it does have some switchboard functions. 03:34 It's not a computer, although it does have some 03:37 computer functions. 03:38 Most people have no idea but just to move the arm like this 03:44 requires not only the biceps, for example, to bring my arm 03:50 and flex my elbow, as I'm doing here, but it also requires 03:56 not only the biceps tightening but also the triceps, 04:00 the opposite muscle and some other muscles to tighten as well 04:04 so that you have this very smooth function because the 04:09 cerebellum and the computer portion of the brain 04:13 is figuring out where everything is, how tight it needs to be, 04:17 and the movements that can be made in a 04:21 fluid, coordinated fashion. 04:24 It must be fascinating to study about the brain 04:27 and figure out what's going on with someone as they come in 04:31 when they're injured. 04:32 It's probably not always easy but... 04:35 What are the types of things that we do 04:37 to damage the brain? 04:38 How is it that people are injured? 04:40 The brain is quite well protected but even with the 04:45 protection that God gave it with the skull it can be damaged 04:48 in several ways. 04:50 For example, in ancient times people would fall from horses. 04:55 Today with our high speed society, with motorcycles, 05:00 automobiles, all terrain vehicles, all these give us 05:05 many, many ways to injure the brain as well as the warfare 05:12 that he's done. 05:14 That also exposes the brain to great risks. 05:17 Anything else in every day experience that 05:20 damages the brain? 05:21 The thing that comes to my mind is football. 05:25 The sports that people engage in... when I was growing up 05:30 we played sports. 05:31 I had no idea of the danger that sports could have. 05:36 Football is one, boxing is another that can cause 05:41 brain injury. 05:42 The biggest activity that threatens the brain 05:45 that people do, of course, is the use of alcohol. 05:48 Any other injuries that you see to the brain that you treat? 05:53 You've talked about blunt trauma injuries, anything else? 05:57 Let me just divide up the ways that the brain is injured. 06:01 We have blunt trauma and that is generally where the head 06:05 hits something. 06:06 Where in an automobile accident and the head might hit the 06:11 windshield at high speed. 06:13 Or if you're on a motorcycle and your head hits the concrete 06:16 at high speed. 06:17 That is called a blunt trauma. 06:23 You not only have the injury right there at the sight of the 06:29 trauma, but interestingly enough, since the brain is 06:33 consistency of Jell-O, the brain will jiggle. 06:39 Let's say you hit your head against the dash board, 06:46 the brain, like this Jell-O, smashes up against the skull 06:52 and then it bounces back and hits the other side 06:57 of the skull. 06:58 This is called a coup contrecoup injury. 07:01 The contrecoup injury can also be quite substantial. 07:05 So the rebound place? 07:07 Yes, and then you have the twisting types of motion, 07:11 the torsion types of motion, that can tear little blood 07:14 vessels and so there is bleeding inside. 07:18 In fact we now understand that the original injury is generally 07:24 not the worst type of injury to the brain. 07:27 It's the injuries that occur after the original injury 07:31 because of swelling and other types of problems. 07:33 The second kind of injury is the penetrating wound injury 07:40 where you're shot in the head. 07:41 We had a patient that had been in a jail and apparently 07:54 he had made some fellow- inmates very angry 07:58 They took an awl and they hammered it through his brain 08:03 and then moved it back and forth. 08:05 We call that pithing - pithing the brain like in some 08:11 experiments in biology. 08:13 They pith the frog in the spinal cord. 08:15 How did that man do? 08:16 That doesn't sound like something you'd want done. 08:18 That is not something you would like to have happen to you. 08:23 He didn't survive. 08:28 Sometimes they do survive those types of injuries. 08:34 If they can survive in a penetrating wound injury, 08:37 if they can survive the original injury, often times those types 08:41 of injuries may be less damaging because they are very specific 08:47 areas that they damage, gunshot wound for example, 08:50 maybe less than a more global kind of injury. 08:57 The worst kind of head injuries that you can get are those 09:01 that involve loss of oxygen because they encompass 09:05 the entire brain, every cell. 09:08 So that can be a real problem with carbon monoxide poisoning 09:12 those sorts of insults to the brain. 09:16 What's the first thing that needs to be done if you've 09:19 had a severe head injury? 09:21 What should happen first? 09:24 Immediately, of course, you need medical attention. 09:27 The types of things that the brain does for the body 09:31 easily, automatically, you don't think about, breathing, and the 09:37 heart rate, all these types of automatic activities 09:42 may be lost. 09:44 The person needs to be immediately in a hospital 09:49 that is skilled in taking care of people with acute 09:53 brain injuries. 09:54 You think about this, what God built into our brains 09:59 takes many, many skilled professionals to do 10:05 for the person. 10:07 He may not be able to breath 10:09 so that you have to have artificial support systems, 10:12 he's not able to empty his bladder and so that has to 10:16 be dealt with. 10:17 So you have this whole team 10:21 that is working to save his life and this our little brain 10:26 that God made is working all automatically doing those 10:31 functions for us and we don't even think about it. 10:36 So when the brain gets hit you talked about that coup and 10:40 contrecoup, what happens? 10:42 Does it swell up inside? 10:43 What goes on? 10:45 The first problem that has to be dealt with by the neurosurgeon 10:48 and the acute trauma team is that swelling. 10:51 Because the brain is solid, there's no give to it, this 10:56 swelling has no place to go except there's a large hole 11:02 at the very bottom of the brain and it's called, interestingly 11:05 enough, large hole: foramen - hole, 11:08 magnum - large. 11:09 The problem is it begins to squish the brain tissue down 11:16 through that hole. 11:17 Now at the very bottom of your brain that is your life 11:21 support system, that's your breathing, that's your 11:26 blood pressure, some of the mechanisms, there's just a lot 11:33 of mechanisms there on these vegetative levels. 11:36 Because of that you're at risk of dying if something 11:46 immediately isn't done. 11:47 This has to be monitored. 11:49 Surgery may need to be done. 11:51 They actually relieve the pressure if possible. 11:54 They give various medications to relieve the pressure. 11:57 That's all on an emergent basis. 11:59 I would like to say something about these vegetative functions 12:03 here at the very base of the brain. 12:05 It's fortunate that's where those vegetative functions are 12:09 because they get the first supply of oxygen, the first 12:13 supply of blood as it comes out of the heart there at 12:17 the base of the brain. 12:18 This area of the brain, the forebrain, gets the very last 12:24 part of this blood as it goes through the head. 12:27 If these vegetative functions were here in the forebrain 12:33 then if a person smoked, or used alcohol at all, it would kill 12:42 them immediately. 12:43 But they still get enough oxygen and supplies because they're 12:47 located here at the base and a person can still function. 12:51 So God created it in a way that protects us if we did 12:55 happen to get injured. 12:57 Yes. 12:58 When a person then that brain is swollen I'm sure it takes 13:05 quite a bit of time for that swelling to go down. 13:08 How long does it take for it to go down? 13:09 Well, it depends, it may take even several weeks or it may, 13:14 depending on how severe it is, it may go down more rapidly. 13:18 But really, at that point, as a person becomes stabilized, 13:23 then a whole different type of treatment 13:26 needs to be instituted. 13:28 And that's really my area of specialty. 13:30 This is fascinating. 13:32 When we come back we want to talk more 13:34 about this area of specialty. 13:36 If your watching or just joining us, we're talking about 13:39 head injuries. 13:40 We're talking about what happens when someone has a head injury, 13:42 what needs to be done, how to relate to those who have had 13:45 head injuries. 13:47 When we come back we hope that you join us. 14:03 Have you found yourself wishing that you could 14:04 shed a few pounds? 14:05 Have you been on a diet for most of your life, 14:08 but not found anything that will really keep the weight off? 14:11 If you've answered yes to any of these questions, then we 14:14 have a solution for you that works. 14:17 Dr. Hans Diehl and Dr. Aileen Ludington 14:19 have written a marvelous booklet called, 14:22 Reversing Obesity Naturally, and we'd like to send it to you 14:25 free of charge. 14:26 Here's a medically sound approach successfully used 14:30 by thousands who are able to eat more 14:32 and loose weight permanently 14:33 without feeling guilty or hungry through lifestyle medicine. 14:37 Dr. Diehl and Dr. Ludington have been featured on 3ABN 14:41 and in this booklet they present a sensible approach to eating, 14:44 nutrition, and lifestyle changes that can help you prevent 14:47 heart disease, diabetes, and even cancer. 14:50 Call or write today for your free copy: 15:14 Welcome back. 15:16 We've been talking with Dr. Phillip Mills from 15:19 Wichita, Kansas. 15:20 He is a specialist in rehab medicine or physical medicine, 15:24 dealing with those that have had strokes 15:26 and brain injuries of any kind. 15:29 Today we're talking about head injuries. 15:32 Is there any hope for those that have had head injuries? 15:36 What happens when they start to recover from a head injury? 15:39 The head injury has a certain way of healing. 15:43 At least typically a way of healing. 15:46 After you've stabilized them in the intensive care and they 15:49 are able to breath again and are able to have 15:53 automatic functions return, then you transfer them 16:00 at an appropriate time to a rehabilitation center. 16:04 We give them intensive rehabilitation. 16:07 Now there are certain steps in the recovery that we look for. 16:11 The first step is the agitation phase. 16:15 The person begins to thrash around and they are rolling 16:18 and moving their arms. 16:20 We look very closely at this stage because a person can't 16:24 maybe talk to us but we see that every aspect of their body is 16:29 moving. 16:30 Their arms are moving. 16:31 Each leg is moving and that's a good sign. 16:34 If you get the agitation phase the earlier you get it 16:37 the better it is. 16:39 Sometimes we'll watch and they'll be agitated but they'll 16:42 only move one side. 16:43 Bad sign? 16:44 Well, it's not a bad sign, but it means that they may have 16:47 a problem on one side, a hemi paresis. 16:51 We may find that they move their arms but not their legs 16:55 and then we have to look and see if they've also sustained 16:57 a spinal cord injury. 16:58 So we look at that. 16:59 But if they're moving all extremities 17:02 we're relatively happy. 17:04 Now they may not at this point have any memory of what's 17:09 going on, usually would not, but early recovery is 17:13 beginning to occur. 17:14 Then as we have further healing, the swelling is decreasing, and 17:22 brain function is beginning to be restored, they may have 17:26 windows of memory. 17:28 Let's go back to that thrashing thing for a minute. 17:30 What do you do? 17:31 I suppose if I had a family member and someone was going 17:34 through that right now in my family, I would be very 17:37 worried if they were thrashing around. 17:38 What do you do, tie them up? 17:40 Do you talk to the family? 17:42 What happens there? 17:43 We used to tie them up but today we have many better ways 17:50 to treat them. 17:51 Sometimes we used to give them medications to sedate them. 17:56 But we've found better ways. 17:58 In a good rehab center what you do is place them in a safe 18:02 place so they can move around and not be injured. 18:05 There are special beds. 18:06 In fact before we had some of the beds we have now, we would 18:11 simply put a big mattress that would cover the entire room 18:16 floor and then they could move around and it was safe. 18:20 They would not be harming themselves or someone else. 18:23 So you want them to be able to move. 18:27 They don't know exactly what's going on, they're confused, 18:31 they're not sure what the lights mean, who these people are 18:36 around them, and so we can understand their confusion. 18:39 But then they will have windows of recognition. 18:42 It's very important for family members to understand some 18:46 of the stages of head injury. 18:48 So you talk with them and you explain it all to them? 18:50 Well, let me give you a sample. 18:53 The wife may be present and you ask the patient what his name is 18:59 and the patient will give you their name. 19:02 And then you'll say, "Who is that, is their anybody 19:04 next to you?" 19:05 They will look and they will see maybe there is somebody. 19:09 Then you say, "Who is that?" 19:10 They may be alert enough to know they should know 19:13 but they're not certain who it is or 19:16 they can't get the name out. 19:18 And they may have a problem we call perseveration. 19:21 That is once a thought has gone through their brain it just 19:24 keeps going over and over in their brain. 19:27 They just said their name so they say their name 19:31 for their wife's name. 19:32 That just keeps coming out for two or three times. 19:35 Often times a wife or mother can't understand why the husband 19:43 is not able to say who she is. 19:45 And she may think he is just joking, he may not realize this 19:51 is an important question, or they may be just quite offended. 19:57 It's very important for the family members to understand 20:01 these are just part of the healing process. 20:04 The patient isn't trying not to say the name but at that point 20:08 may not be capable of it. 20:09 With the rehabilitation program you begin to show them pictures 20:14 of the family members and try to bring the memory of past 20:18 events, important people, and important dates back into 20:22 their focus. 20:23 Try to repeat today's date until finally they know where 20:28 they are, who they are, and what the date is. 20:32 There is various techniques that we gently try to move the 20:37 patient through these various stages of brain recovery. 20:40 Can you do too much for someone who's coming out 20:44 of a head injury? 20:45 Yes. 20:46 Once again the family members need to work closely with the 20:49 team and the team will let the family members know what 20:53 should or should not be done to assist the patient. 20:56 I noticed when you gave the example you said that the 20:59 wife is there and the husband had the head injury. 21:03 Who has the most head injuries, males or females? 21:06 It's a sexist type disease, actually virtually 90% of males 21:14 will have a head injury some time in their life. 21:16 It may be a minor injury but any time a person looses 21:20 consciousness they've had a head injury. 21:23 I don't know if you've had a head injury, have you ever 21:26 lost consciousness? 21:27 I don't know if I want to admit to that! - laughter - 21:29 Do you mean just loosing consciousness, 21:32 being knocked out? 21:33 Being knocked out is having a head injury? 21:35 Yes. 21:36 Well, I believe I've had one then. 21:38 You would be with the vast majority of males. 21:42 Have you had one? 21:43 Yes, I've had actually quite a severe head injury. 21:47 I was amnesic for three hours and that was the result of a 21:51 bicycle accident. 21:53 That was when I was about 10 years old. 21:55 But if you ask this question to a group of females 21:59 there will just be a few that have had head injuries. 22:05 It is not because males have softer skulls, it is because 22:11 they take greater risks. 22:12 What other behaviors are fairly typical of someone that's had 22:16 a head injury? 22:17 I guess a part of that question is are there some things we 22:23 should give people that have had a head injury a break? 22:25 In other words, they act a certain way 22:27 because this happened? 22:28 I'm not talking about just getting knocked out once 22:30 or having a bicycle injury, I'm talking about 22:32 significant head injury. 22:33 I think you ought to give me a break, if I have 22:35 problems remembering, it's not my fault, it's just this 22:38 head injury! - laughter - 22:39 That's what I mean. 22:40 I'm trying to get to that point. 22:42 You know some people would blame everything on this 22:43 but what really is the problem? 22:46 Can we hold them accountable for certain things 22:51 with a head injury? 22:52 We have to see the flow of the improvement. 22:57 They go through these various stages and now you're asking 23:00 long term. 23:02 Most people with head injuries have very little sequela. 23:07 I used to hate to take care of... 23:09 What's sequela? 23:10 Sequela - long term, real substantial deficits. 23:15 It's a very small percentage of head injuries that have 23:20 large deficits. 23:24 I used to be very depressed taking care of head injured 23:27 patients until I had a chance to see these patients 23:30 one, two, three, four years out and see how well 23:34 they did returning to their occupations many times. 23:39 Now some of these patients are the most rewarding 23:43 patients that you have. 23:45 But typically, the long term effects of a head injury 23:51 are a magnification of the underlying personality. 23:58 If they were quiet, they would be more quiet. 24:01 If they were boisterous, maybe they're more boisterous. 24:05 It tends to magnify the problem. 24:09 But one area that is very, very common, they tend to be 24:14 irritable. 24:16 We can understand this. 24:18 It's easy to explain. 24:21 If I'm over-tired, if I am trying to do too many things, 24:26 it's not difficult for me to be irritable. 24:31 I have to fight irritability. 24:32 Well, that's not because of the mild injury that I had. 24:36 That's just the way human nature is. 24:38 But in a head injury, if it takes everything they can 24:45 just to do their day-to-day tasks, now you have loud sounds 24:51 and many other things, it is as if they're handling a little 24:56 extra stress like we would handle a great deal of stress. 25:01 We have to understand there's a certain measure of patience 25:04 that we should give a person like this. 25:07 This is fascinating! 25:10 Is there any other behaviors that we would look for in 25:13 someone that has had a head injury? 25:15 There is something very interesting. 25:17 If you watch a patient, particularly the males, as they 25:21 begin to become aware of their surroundings, very low level of 25:26 function, they may be quite sexually inappropriate. 25:29 What that has taught me, it doesn't take much brain function 25:33 to be sexually inappropriate. 25:36 So it's a low brain function? 25:37 Yes. 25:39 The highest activity of the brain is not at that level. 25:44 As they get more brain function that area begins to diminish. 25:52 Hopefully they get over that fairly soon. 25:55 Well, let's move from the low brain function and talk more 25:57 about high brain function. 25:58 How can we avoid having a head injury? 26:01 What types of things do you see, what kind of things 26:03 should we avoid? 26:05 Well, our lifestyle, particularly recreationally 26:08 is a problem - motorcycles, boxing, and football - these 26:14 are dangerous. 26:15 Bicycles are particularly dangerous for young people, 26:19 children I'm talking about. 26:21 A person should not do any of these activities without 26:25 wearing helmets. 26:26 If I would have had a helmet on when I was riding my 26:29 bicycle I would not have sustained a head injury. 26:33 So I am very much in favor of helmets and helmet laws 26:37 for motorcycles. 26:39 Anything other underlying those or behaviors? 26:42 Yes, the single most important risk in head injury is alcohol. 26:49 Sometimes I'll be talking to a patient and I'll ask them how 26:53 much they drink. 26:54 And they will say, "Well, I drink socially. " 26:56 There is no such thing as social drinking. 26:59 Drinking is an anti-social behavior. 27:02 If you want to avoid head injury don't drink and drive. 27:09 Some of the more recent studies have shown that you shouldn't 27:12 drink and ride a boat. 27:14 There are other studies that show that you shouldn't drink 27:18 and walk. 27:19 In other words, don't drink and drink. 27:21 What's the percentage of head injuries that are 27:25 related to alcohol? 27:26 80 percent of the injuries to the head are caused by alcohol. 27:31 80 percent, so that's a very significant that 27:34 underlies everything it looks like. 27:36 Thank you so much for joining us, Dr. Mills, for taking time 27:39 out of your very busy practice and away from your family. 27:42 We're thankful that you've joined us today on 27:45 Health for a Lifetime. 27:46 We hope that as a result of today's program you'll be 27:50 involved in behaviors that protect your most 27:53 valuable asset. 27:54 And thanks again for joining us for Health for a Lifetime. |
Revised 2014-12-17