It’s funny, but I’d been feeling like writing about concussion (or MTBI, mild traumatic brain injury) for a few days now. Mr. Keselowski’s comments have given me a reason to.

As an emergency physician I see lots of concussions. This is a pathology that interests me personally, because it has long been underdiagnosed, undertreated, and, well, minimised. So from now on, I want you to promise me that when you read “mIld traumatic brain injury“, you’ll see it like this:

xxxx traumatic FREAKIN’ BRAIN INJURY!!!!

(and i want you to see it with the exclamation points)

There’s nothing mild about interacting with someone who’s concussed. Thought power reduced dramatically, asking the same question over and over again. The blank stare. The nausea. The vomiting. The total inability to string together a rational train of thought. Not sure that one needs to be a doctor (even a race-ignorant one!) to want to know, despite SUBJECTIVE denials (yes you racers SURE do want to get back into your cars), if this brain is still capable of information processing at over 200 mph. If I was sitting in the stands, I’d like to figure SOMEONE would take you out of your car if you couldn’t remember anything that happened a few minutes ago.

It doesn’t stop there actually. Yeah, this is regularly followed by days, or more typically weeks, of altered sleep-wake cycles. Not ideal for students, or pretty much anyone intent on any kind of productive life. Emotional lability. Head splitting headaches. Inappropriate laughter, or crying. Atypical morosity, or euphoria. Difficulty concentrating on anything, and in retaining information for any period of time.

I suppose it’s not surprising. With 100 TRILLION synapses, the brain is functioning at a rather sophisticated level of integration. Go ahead and kick a coke machine, Mr. Keselowski, and then see if it works. Not surprising it doesn’t, at least not how it did before, right? How about your brains inside your helmet after hitting the wall? Get the picture?

Funny thing is, until that brain, that kicked-100-trillion-synapse-coke-machine inside your helmet gets better (and remember how easy it is to deny symptoms), it’s exquisitely sensitive to a second concussion. Do you REALLY think Dale Jr.’s second concussion was a coincidence? And it’s even scarier. We know from other sports that when that still-recovering brain gets a mild hit, it can sometimes, and unpredictably, swell. This causes a coma, and is often, all too often, associated with a persistent vegetative state, or even death. We call it the second impact syndrome. Ever hear about it? It’s why we like to diagnose concussions, and then make sure they’re GONE before letting you guys back in the cockpit. Better for everybody.

I don’t resent being told, generically, that “doctors don’t understand our sport”. But let me tell you something. Very very clearly. READ THE ABOVE MR. KESELOWSKI. That’s medicine, and it’s sport, and it’s people getting their heads knocked. Do people in YOUR sport get their heads knocked Mr. Keselowski? See? We’re starting to understand each other.

We really do understand concussion, or at least how to do the best we can with concussed patients in 2013.

I’ll suppose, Mr. Keselowski, that you’re too . . . busy . . . to be following all the stories in the lay press about the epidemic of chronic traumatic encephalopathy (CTE). Anyway, I’m sure I’ve no need to remind you Brad (can I call you Brad?, you can call me Gary), CTE is caused by numerous episodes of, yes you guessed it (you’re a SHARPIE!) concussion. And with CTE, the terrible, treatment-resistant depression. The almost constant descent into alcohol and/or drug dependency. The dementia. The death in the late 40s or early 50s. The ruined families that started with such promise.

You say you racers are risk takers. That’s certainly true. I’ve known my share. They, however, would appear not to be willing to risk CTE. I’m pretty sure no one would blame them.

ImPACT, the test NASCAR is going to use, uses OBJECTIVE criteria. That’s what makes it beautiful. Compared to baseline, it allows the clinician to judge the severity of cognitive dysfunction . . . OBJECTIVELY. Beyond a well described, objective threshold, a concussion is present. Until those scores are back to baseline, the concussion isn’t healed. This is one more, objective, tool (and not the only tool) in the arsenal of the physician taking care of you guys.

Just when we’re making into inroads on getting concussion taken seriously, in high schools, in colleges, and pretty much everywhere people are getting them, you come along and discredit what is virtually a major public health initiative. Dude, you’re a risk taker? Go bungee jumping. But when you’re behind the wheel of that car, you’re a sportsman, and you’re doing it in front of thousands of people sitting there. And for millions sitting in front of their TV sets. You can hurt the ones at the track. Kill them even. Getting behind the wheel when you’re concussed puts them at risk. Do you REALLY want to criticise a tool that can prevent that from happening?

Read a bit, DM me, we’ll talk. I want you to understand why we do this. It’s really not to bother you guys, just to make it all safer.