TALL PEOPLE, SHORT DOORWAYS (standard:Editorials, 1231 words)
Author: GXD	Added: Jul 05 2009	Views/Reads: 3968/2095	Story vote: 0.00 (0 votes)
Are you tall enough to hit your head on a low doorway now and then?? Head injuries are among the most costly health care issues. Let's put a few million carpenters to work raising every doorway in the nation, so people 7 feet tall won't have to always du

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''For now, it's only a hypothesis,'' he said. ''But your symptoms and
your results show the distinct neurobehavorial fingerprint of brain 
damage, the kind that stems from a series of mild traumatic brain 
injuries.'' 

''That's impossible,'' I said. ''I've never even been knocked
unconscious.'' 

''And that,'' Dr. Canick said, ''reflects a very common misperception.''
Concussions do not always result in a loss of consciousness, he 
explained; one can have a mild concussion, experienced as ''seeing 
stars,'' and remain conscious. In fact, a person doesn't even have to 
experience direct impact to her/his head. Rapid acceleration or 
deceleration of the head, which is often accompanied by a rotation of 
the brain, can result in concussion. In some cases the brain bounces 
off the interior of the skull, causing dendrites and axons to be 
stretched and sheared, damaging the myelin sheath and disrupting 
communication in a way that could cause a person eventually to slow 
cognitively and physically. Mild traumatic brain injuries often are 
undiagnosed, Dr. Canick said. With successive concussions, the effect 
is more logarithmic than linear. Even if the first injury did little 
harm, the second can have exponential impact, as does every injury that 
follows. 

A few weeks later, I broached the subject of brain injury with my
brother Peter, expecting him to agree that Dr. Canick's hypothesis was 
ridiculous. He did not. ''Don't you remember,'' Peter asked, ''when we 
were children, and I hit you with. . . . '' I never heard the end of 
the sentence. I hadn't given it a thought in 30 years, but in less than 
a second, I was 9 years old, back in the basement of our house in 
Scarsdale. My brother, a whirling towheaded kid drunk on centrifugal 
force, spun in circles, an old broomstick extended horizontally from 
his hands. I was in the wrong place. The impact knocked me flat. For 
the next three weeks, as my eye sockets and forehead turned every color 
in the rainbow, my fourth-grade teacher referred to me as Miss 
Technicolor. 

There were other head injuries as well: horseback-riding wrack-ups and,
because I am tall, forehead-smashing collisions with low-hanging 
doorways and tree branches. One by one, these recollections emerged. 
According to the National Center for Injury Prevention and Control, at 
least 1.1 million people each year sustain mild traumatic brain 
injuries that result in confusion, disorientation or impaired 
consciousness for fewer than 30 minutes. The number is probably 
underestimated, given that many people with mild injuries don't go to a 
doctor's office or an emergency room at all. 

How could I know that Dr. Canick was right -- that my mild traumatic
head injuries could actually produce long-lasting neurocognitive 
deficits? I was reluctant to credit his diagnosis, suspecting that he 
might want to be the guy with the answer, whether or not that answer 
was correct. I understood the concept of logarithmic damage, but why 
had I failed to notice any impairment until I reached my mid-30's? 

'You must take into account the concept of neuronal reserve,'' said Dr.
Ronald Ruff, a clinical neuropsychologist in San Francisco, who 
concurred with Dr. Canick's findings. ''By age 25, you have all the 
neurons you're going to get,'' he said. ''For most of us, the fact that 
we experience continuous slow cell death over the years doesn't become 
evident until we reach our 80's. If, on the other hand, you've had 
concussions, or abused substances or alcohol, you'll have diminished 
your share of neurons, and the slope of decline will be sharper. In 
your 20's, this is usually no big deal, but by the time you reach your 
mid-30's or 40's, the net availability has declined so much that, when 
you're called to rise to the height of your capacity, you start to 
notice.'' 


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