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Myth 9: Mild TBI is not permanent.

Over and over again defense doctors testify that everyone who sustains a mild traumatic brain injury gets better; that mild traumatic brain injury is not a permanent condition. This simply is untrue.

Dr. Alexander has pointed out that at one year after injury, 10 percent to 15 percent of mild TBI patients have not recovered. Many are more symptomatic than even immediately after the injury. Some have had persistence of one particularly troubling symptom –usually headache, neck pain or dizziness. Most have persistence and even worsening of the entire symptom complex. Both groups are at high risk of permanent symptomatic persistent post-concussive syndrome.

Work to date shows that mild brain injury results in measurable deficits in speed of information, processing, attention and memory in the immediate post-injury period. Recovery from these deficits is the rule occurring over a variable period ranging from four to 12 weeks. For small group, recovery may occur much more slowly or remain incomplete.

As Silver and McAlister explain, a good recovery is not universal. They note that although the long-term prognosis is favorable for the majority of patients with a mild TBI, it is well recognized that there can be significant short-term behavioral, somatic and cognitive sequelae. Furthermore, a significant minority of patients develops a chronic, often-debilitating constellation of signs and symptoms known as the chronic post-concussive syndrome.

You can read my other posts on the 10 myths of traumatic brain injuries here.

As a follow up to my previous post at the National Academy of Neuropsychology’s (NAN) 27th Annual Conference in Scottsdale, AZ, below is a link to an MP3 of my presentation.  The topic of the presentation was “Neuropsychology in the Courtroom.”

My presentation was designed to give neuropsychologists an understanding of the admissibility of neuropsychological testimony at trial through a retrospective look at neuropsychological testimony and admissibility in the past and my observations of where neuropsychology was headed in the future.

You can listen to the presentation in its entirety here. (42 MB)

On November 15, the House of Representatives failed to override President Bush's veto of the Fiscal Year 2008 Labor-HHS-Education appropriations bill, which contains important funding for TBI programs.

Despite a great deal of advocacy by many individuals and organizations, the House came up two votes short (277-141) of the necessary two-thirds majority needed to override the president’s veto.

The bill provides $9.455 million for the Health Resources and Services Administration [HRSA] Federal TBI program, over the total $8.910 million allocated last year.  Likewise, the bill includes $5.960 million in funding for Centers for Disease Control and Prevention [CDC] TBI programs, an increase from approximately $5.3 million last year.  Also of key importance, the bill includes $900,000 in additional funding for the TBI Model Systems of Care program in order to prevent this important research program from being downsized.

When Congress reconvenes in December after a two-week Thanksgiving Recess, it is expected that Democratic leaders will pursue a compromise multi-bill “omnibus” appropriations package that would split the difference between the White House and Congressional budget proposals.

Such an omnibus bill is expected to include a cut of $3.5 billion in funding from the recently passed Labor-HHS-Education appropriations bill.

There is a way for you to help. You can contact your Representative and Senators and urge them to retain the current funding levels for your TBI programs. These programs include the CDC and HRSA TBI programs, as well as the important stopgap funding for the TBI Model Systems of Care Program.  For the greatest impact, please call your Representative and Senators, in addition to sending an email.  The Capitol switchboard number is 202-224-3121 -- just ask to be connected to your Representative and Senators.

ScienceDaily (Nov. 27, 2007) — When people with diabetes are asked about the most difficult part of daily diabetes management, the answer is usually the same. People can check their blood sugar and give multiple insulin shots each day, but the greatest challenge is following a meal plan.

A person with diabetes must make food decisions quickly and accurately to maintain blood sugar control. Research has shown that those who follow a meal plan more than half the time have fewer blood sugars above the target range.

So what can people with diabetes do? Begin by setting up a daily meal plan as a guide for meals on typical days. This is beneficial in a number of ways. First, it will assure that the more than 40 different necessary nutrients your body needs are included. Have you ever gone on a vacation and made a list of things to pack? Most times, the items forgotten are always those items that were not on the list. The same is true with a meal plan. Without a meal plan, many nutrients can easily be overlooked. A balanced meal plan should include high fiber grains, lean meats, fruit and vegetables, and low-fat dairy products.

A good meal plan will provide a strategy to prevent heart disease. The risk of heart disease is a concern for all Americans because it is the leading cause of death in the United States, but it is particularly important for people with diabetes. They are two to four times more likely to develop heart disease than people without diabetes.

The foods you eat can prevent or promote the development of atherosclerosis -- a build-up of plaque, a fatty-like substance that narrows the inner walls of heart arteries. Foods to prevent heart disease are those rich in fiber, especially soluble fiber, found in legumes and soybeans, oats, brown rice, barley, fruit and vegetables. Research consistently supports the health benefits of consuming more soluble fiber. Mounting evidence has influenced the marketplace as we find many new foods manufactured with added fiber, like pastas.

Foods that promote the development of heart disease are those high in saturated fat and trans fatty acids. Most often, the fat contained in food is not obvious because you can’t see it. Some of the foods high in saturated fat include cheese, hot dogs, sausage, bacon, bologna, chicken nuggets, macaroni and cheese, French fries, doughnuts, cookies, snack cakes, potato chips, cheese crackers, mayonnaise, creamy salad dressings, cream sauces, gravy, ice cream and whole milk.

A meal plan will help establish consistency of eating habits and balance the amount of carbohydrates consumed throughout each day. This is essential in determining the amount of insulin required to keep blood glucose levels within range each day.

Studies reveal better metabolic control is directly related to regular meals. Irregular meals are the No. 1 contributor to poor metabolic control resulting in higher glycohemoglobin A1c levels. What, when and how much you eat directly affects blood sugar levels. Learning to balance food, insulin and activity helps keep the blood sugar stable and within target ranges and lowers the risk for long-term complications.

In general, a meal plan will include three meals and a bedtime snack. Some meals are higher in carbohydrates than others. In general, breakfast is the highest carbohydrate meal, and dinner has the least amount of carbohydrates. Carbohydrates consumed at meals provide the energy the body needs each day to be active, to grow (in children and youth) and maintain health.

Most of us need more energy to start our day, and much less energy after dinner. Eating too much at dinner will result in the body storing energy for the future in fat cells, thus causing weight gain. It is especially important for the bedtime snack to be consistent.

Excessive snacking is eating large amounts of food frequently. This practice will directly contribute to a higher glycohemoglobin A1c. A snack should not be the same size as a meal. General guidelines for a snack include keeping the portion under 30 grams of carbohydrates and less than 200 calories. Allow two hours between eating a snack and the next meal.

A meal plan will also serve as a map or guideline to maintain healthy weight. Over time, people with diabetes often narrow their focus of meal planning to only high carbohydrate foods. Although only some protein and very little fat turns into blood glucose following a meal, these can contribute to higher blood sugar levels. If your regular diet includes a considerable amount of protein and fat, this may require insulin doses to be increased. The practice of focusing only on foods' carbohydrate content neglects the fact that total caloric or energy intake is responsible for managing weight. All calories count. It is necessary for everyone to be mindful of all of the foods consumed, not only those that “count” as carbohydrate. A personalized meal plan provides a guideline of how much food is the right amount for each individual so excessive weight gain can be prevented.

A person cannot succeed without a plan. Unfortunately, it is impossible to maintain blood sugars within normal ranges and prevent long-term complications without a meal plan. Meal planning is the main element necessary for success. If you are striving to succeed in any area of life, you know there is a greater likelihood of achieving a goal when you have a written plan. For the person who says, “Well, one day I will...” success will always be “one day” away.

Make today that “one day.” Begin to write out a meal plan and meet with a registered dietitian. Dietitians are nutrition experts and can help develop a personalized meal plan to fit individual needs. After an initial plan is developed, meeting with a dietician two or three times a year is essential to ensure the meal plan is the best plan for success.

I have diabetes. How can eating more fiber help?

What can I do to include more fiber?

Remember:

Adapted from materials provided by Pennsylvania State University.

Ingredients
24 Prawns, small 
125g English Spinach 
1 Tablespoon Sesame oil 
Beef, rump steak  500 g 
1 cup (90g) Bean sprouts 
1 red Onion, small, finely sliced 
1 red Capsicum, small, cut into thin strips 
1 Lebanese Cucumber, small, cut into thin strips
200g Radish, daikon, peeled and cut into thin strips 
1 Tomato, small, halved, seeded, thinly sliced
1/4 cup (5g) Mint leaves 
1/2 cup (15 g) Coriander leaves  
2 cloves Garlic, finely chopped 
2 Chillis, red, small, chopped
2 Chillis, green, small, chopped 

Dressing    
1/4 cup (60ml) Lime juice  
1/4 cup (60ml) Fish sauce 
1 Tablespoon Lemon grass, finely chopped
1 teaspoon Sugar 
 
 
 
 
Description 
1  Chop the prawns up finely. Wash the English spinach and drain well. Trim the thick stalks and coarsely shred the leaves. 
2  Heat the oil in a frying pan, add the steak and cook over high heat until medium rare, for about 1 1/2 - 2 minutes on each side. Remove from the pan and allow to cool slightly. Slice the steak thinly. 
3  To make the dressing, combine the lime juice, fish sauce, lemon grass and sugar in a small jug. Whisk until the ingredients are well combined. 
4  To assemble the salad, combine the prawns, sliced beef, bean sprouts, onion, capsicum, cucumber, radish, tomato, mint, coriander, garlic and chillies in a large bowl. Place the spinach on a serving plate, top with the combined beef and vegetables, 
 
 

Calories          231
Total Fat          6
Saturated Fat   2
Cholesterol     222
Salt              1159
Carb               7
Sugars           5
Protein          36

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