Posted: November 3, 1999
This week's questions:
Browse the Ask the Doctor Archive for more:
Alternative Medicine | Common Ailments | Drug & Alcohol-Related | Fitness/Sports Injuries | General Medical | Men's Health | Food/Nutrition | Sexuality/Sexual Health | Stress/Mental Health | Women's Health
Or, search Ask the Doctor by entering keywords below:
I'm a 13-year-old girl. While playing
football recently, I received a few hits to my unprotected head from tackles and
thrown footballs. I wound up feeling dizzy and lightheaded. My vision was also a
bit distorted, experiencing a bit of a "shake" or "skip." I didn't go to the
doctor, but I'm worried. Could I have gotten a concussion or some other brain
injury?
—DU
For some time, athletes, coaches,
parents, and doctors have fretted about head injuries incurred while playing
sports. I remember once being knocked cold during a football game. I hit the ground
and remained motionless for two minutes. I have some vague recollection of smelling
salts — a noxious ammonia smell intended to rouse the stunned victim. My next
memory is sitting in the locker room, being unable to answer the doctor when he
asked me my name. The doctor wouldn't let me resume play, for fear a more serious
concussion (and possibly brain damage) would follow.
At the time, I was not terribly bothered by my concussion; I thought it was all
in the line of duty. In many sports, risking injury is a part of the game. Now, as
a parent with three boys playing soccer, I worry about the effects of injuries;
about permanent joint instability after ligament tears, or more serious head and
neck trauma. Recently, the newspapers have featured articles on the potential for
long-term learning deficiencies among soccer players because of the repeated trauma
of heading the ball.
The symptoms you've described are very possibly the result of being struck in
the head. It doesn't sound like a concussion, something we generally think of as a
trauma sufficient to cause loss of consciousness and some degree of amnesia. But
any symptoms experienced after an injury to the head should prompt a telephone call
to your physician. My guess is that your symptoms will quickly disappear —
hopefully, by the time you read this. You're right to wonder about the potential
for long-term effects. We don't know how much trauma is required to cause
intellectual or emotional problems after a head injury, or how much repetitive
minor head trauma is needed to cause long-term problems. Common sense would tell us
that the worse the initial injury, the more concerned we should be. More
information is needed so that we do not unnecessarily risk the health of
competitive athletes like yourself.
— R.
Jandl,11/3/99, Category: Fitness/Sports Injuries
Back to Ask the Doctor
home | Ask the Doctor a
question
After a urinary-tract infection test, my
doctor told me that there was more bile in my urine than he'd ever seen. A
short physical exam determined that I was having pretty severe abdominal pain.
Could he have seen the bile with his naked eye, or did the dipstick that he
used to test my urine have a color-coded spot that told him of the bile?
—CC
In these days of high-tech scanners,
laparoscopic surgery, and powerful medications, much of the day-to-day practice of
medicine is rather elemental. Basic observations of body fluids, their color,
quantity, and composition, are used to make important assessments about how well
the body is performing. Examination of urine and other secretions — while
unpleasant to the uninitiated — are one of the responsibilities of doctors
and nurses.
The color of bile, a fluid produced in the liver and stored in the gall bladder,
comes from a substance called "bilirubin." If the bile duct is obstructed, or if the
liver is not functioning properly, bilirubin accumulates in the body. Bilirubin
causes the golden-orange skin color of jaundice. Some babies develop jaundice after
birth, causing them to appear suntanned. They are placed under ultraviolet light to
help break the bilirubin down into harmless substances, thereby avoiding damage to
the brain. Young adults who develop jaundice commonly have viral hepatitis, which
causes temporary liver malfunction. The symptoms might include nausea, fever, aches
and pains, a tender abdomen (over the liver), and bilirubin in the urine. Older
people with jaundice and unexplained weight loss are always a worry, for cancer is
a common cause of an obstructed bile duct.
If the blood level of bilirubin increases slightly, it begins to spill over into
the urine. Small amounts can be detected chemically on the urine dipsticks, such as
the one you mentioned, that are used in everyday practice. Larger amounts will make
the urine very dark brown in color and can be recognized with the naked eye.
Your doctor may be onto something and will undoubtedly perform additional tests.
Hopefully, it will be nothing too serious.
— R.
Jandl,11/3/99, Category: General Medical
Back to Ask the Doctor
home | Ask the Doctor a
question
As a tall ballerina, I find it demanding
to keep up with the smaller dancers. I'm interested in developing more
fast-muscle fibers to help me move and react more quickly. I would be willing
to cross train in any sport, but I don't know where to begin. What would you
recommend?
—JM
Skeletal muscles are those that move
the skeleton (as opposed to muscles that move internal organs, or cardiac muscle
cells, all of which are different). They are made of three types of fibers,
conveniently named slow, intermediate, and fast, according to how quickly they
contract. They may also be distinguished by their biochemical makeup, their
primary fuel for energy (fatty acids versus carbohydrates), and by their
dependence on oxygen.
All skeletal muscles have all three fiber types. The proportions differ
according to the muscle, and are genetically determined. Lower-back muscles have
large numbers of slow fibers. They depend upon the presence of oxygen and provide
sustained force over time. Leg muscles have more fast fibers. These move quickly,
giving you the agility and quickness to keep up with the shorter ballerinas, but
they also fatigue quickly when stored intracellular energy runs out.
You cannot increase the number of fast-muscle fibers in a muscle. You have a
fixed number. What you can do is increase their strength, through training, and
that may also improve quickness. Rather than suggest an exercise program or have
you work from a generic text, I would suggest you hire a personal trainer. At
your level of performance, you will need personal advice on which muscle groups to
work and how best to work them. The trainer may need to learn a bit about ballet
in order to understand the demands and needs of your occupation. Ask around for recommendations.
— R.
Jandl,11/3/99, Category: Fitness/Sports Injuries
Back to Ask the Doctor
home | Ask the Doctor a
question
