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2010-11 Trauma Room (Malhotra out for the year)

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Old
02-19-2011, 12:43 PM
  #276
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Originally Posted by raygunpk View Post
Anybody else worried about Hamhuis returning so fast?
Yup. There is the dreaded second impact syndrome to consider. Look at Sidney Crosby and Marc Savard.
Second Impact Syndrome – The first concussion is bad enough. But one often overlooked aspect of concussions is second impact syndrome. According to the Centers for Disease Control (CDC), “A repeat concussion that occurs before the brain recovers from the first—usually within a short period of time (hours, days, or weeks)—can slow recovery or increase the likelihood of having long-term problems. In rare cases, repeat concussions can result in brain swelling, permanent brain damage, and even death. This more serious condition is called second impact syndrome.”

Second impact syndrome is a special concern for highly committed athletes who want to play very soon after sustaining a concussion. This is where the coach has to step up and do the right thing. The CDC advises, “Keep athletes with known or suspected concussions from play until they have been evaluated and given permission to return to play by a health care professional with experience in evaluating concussions. Remind your athletes: ‘It’s better to miss one game than the whole season.’”
http://www.tampabaylightningcare.com...m-concussions/

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02-19-2011, 12:47 PM
  #277
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Quote:
Originally Posted by raygunpk View Post
Anybody else worried about Hamhuis returning so fast?
Yeah. When'd he get the first one? last Thursday? I know the usual recovery time is 1 week, but I tend to err on the side of caution. 1.5-2 weeks is what I'd like to see.

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02-19-2011, 12:50 PM
  #278
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Oh my god let's lock him in a box and keep him there forever.

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02-19-2011, 12:54 PM
  #279
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Quote:
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Oh my god let's lock him in a box and keep him there forever.
2 weeks is not forever, but nice straw man.

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02-19-2011, 12:59 PM
  #280
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2 weeks is not forever, but nice straw man.
If he feels healthy, says he's healthy, and the doctors agree, let the man play.

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02-19-2011, 01:01 PM
  #281
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I don't know, Samuelsson had a concussion earlier in the year and only missed 1 game. If it's a mild concussion and the player is symptom free for period of time, then why not let him play? Second Impact Syndrome happens when the player hasn't recovered from his first concussion. I assume Hamhuis has passed the baseline tests and has been heavily scrutinized by doctors, so it's definitely not a Mitchell or Crosby situation where they missed zero time.

Just because he was knocked out doesn't mean it's any more serious than any other concussion. Seabrook was knocked unconscious by a hit that landed Wisniewski an 8 game suspension and he was back within a few days and missed only 2 games.

I too would be inclined to sit him out another game just to be safe, but really, he's already missed 10 days of action, so it's not like they're just throwing him back in there the next day like what happened with Crosby and Mitchell.

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02-19-2011, 01:01 PM
  #282
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Quote:
Originally Posted by VanEric View Post
If he feels healthy, says he's healthy, and the doctors agree, let the man play.
True, but considering what happened to Mitchell last year, I am cautious. The last thing we need is Hamhuis to take another hit in a bad spot.

It's not like we need to rush him either, last time I checked we did have top spot in the NHL. What would be the harm in sitting him an extra day or two?

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02-19-2011, 01:07 PM
  #283
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Originally Posted by VanEric View Post
If he feels healthy, says he's healthy, and the doctors agree, let the man play.
Exactly. I didn't realize we had a team of doctors that congregated here.

Quick, go to Rogers Arena and tell the team doctors not to let Hamhuis play, before it's too late!!

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02-19-2011, 01:11 PM
  #284
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Quote:
Originally Posted by pitseleh View Post
http://www.canada.com/topics/sports/...e4bfbd&k=20953

This is all it requires:

"If at that time the player is determined to have had a concussion than that triggers the concussion protocol, which means the player must be kept out of play until they are symptom-free both at rest and on exertion," he said

http://www.nhl.com/ice/news.htm?id=545327
Thanks - that's really interesting. We keep hearing about 7 days symptom free.

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02-19-2011, 01:15 PM
  #285
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Looks like its Tuesday for Hamhuis:

benkuzma Ben Kuzma
Hamhuis stays out for post game-day skate #Canucks drills. Could be back Tuesday from concussion.

»

Jason Botchford
BotchonCanucks Jason Botchford
Looks like Tuesday for hamhuis's return.

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02-19-2011, 01:18 PM
  #286
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If Hamhuis has no symptoms for a week, can't see any reason that he's not good to go.
Edit: oops
By the way, the hit Hamhuis took was similar to somebody else's last year - I'm wondering if the glass not being flush with the boards causes the head to hit the glass before the shoulder (as there would be some sort of tilt effect)? Also, I wonder if neck strength training could somewhat alleviate these kinds of concussions as the head would snap less after a hit?

I vote to go back to the Chicken cage.

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02-19-2011, 01:28 PM
  #287
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Remember to keep those elbows high Hammer. Don't mind killing a few elbowing minors in the regular season if it keeps him healthy for the playoffs.

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02-19-2011, 01:29 PM
  #288
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Quote:
Originally Posted by LeftCoast View Post
Thanks - that's really interesting. We keep hearing about 7 days symptom free.
Its probably just an unofficial rule used by the training staffs.

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02-19-2011, 01:29 PM
  #289
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Quote:
Originally Posted by VanEric View Post
Oh my god let's lock him in a box and keep him there forever.
Yes, Why air on the side of caution? It is not like we've ever had troubles with defensemen injuries or concussions...

And its not like we have a commanding lead...

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Old
02-19-2011, 01:30 PM
  #290
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Originally Posted by raygunpk View Post
Anybody else worried about Hamhuis returning so fast?
Yes.

Here's hoping the length he's been out was already a drastic "over precaution". 'Cause he's gonna get head-hunted now for sure.

 
Old
02-19-2011, 01:31 PM
  #291
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Remember to keep those elbows high Hammer. Don't mind killing a few elbowing minors in the regular season if it keeps him healthy for the playoffs.
The team would glady kill off a few forearm shivers to keep this team together.

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02-19-2011, 01:32 PM
  #292
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no symptom in 8-9 days. no sensitivity to light, ever. If anything, team has been overly cautious
Hamhuis has passed all base line tests/concussion protocol. Told team he could go tonight. But Canucks will hold him out until Tuesday

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02-19-2011, 01:39 PM
  #293
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Quote:
Originally Posted by spixel View Post
BotchonCanucks
no symptom in 8-9 days. no sensitivity to light, ever. If anything, team has been overly cautious
Hamhuis has passed all base line tests/concussion protocol. Told team he could go tonight. But Canucks will hold him out until Tuesday
All the things I wanted to hear. Great news.

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02-19-2011, 01:43 PM
  #294
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Good on them not to rush him back imo.

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02-19-2011, 01:45 PM
  #295
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Originally Posted by LeftCoast View Post
Thanks - that's really interesting. We keep hearing about 7 days symptom free.
That was part of the concussion protocol that was developed by Dr. Karen Johnson. She was the first to take functional approach to concussions as a brain injury requiring stepped return to physical activity.
A concussion is defined as any trauma that induces an alteration in one's mental state, whether or not there was loss of consciousness. Confusion and amnesia, occurring either immediately or shortly after he impact, are considered hallmarks of the syndrome.

Recent research has pointed to the serious nature of all brain injuries even in cases where loss of consciousness did not occur. In the past, many concussions went unrecognized because the symptoms weren't all that dramatic initially.

Recognizing when a concussion has taken place is essential because one such injury leaves the brain more vulnerable to subsequent blows. Second Impact SynDrome usually occurs when a second concussion is sustained while a person has not fully recovered from the first. "We really don't understand the exact mechanism of it, but one of the theories is that it does lead to a rise in pressure inside the head which can be fatal," said Tator.

It is the cumulative effects of several concussions that doctors especially worried. Some long term, and even permanent, effects include memory loss, frequent headaches, ringing in the ears, poor concentration, increased irritability and other personality changes. Concussion in Sport, a group chaired by Dr Karen Johnson, director of neurotrauma at the McGill University Health Centre, recently published guidelines in the British Journal of Sport Medicine, the Clinical Journal of Sport Medicine, and Physician and Sport Medicine, outlining a highly structured rehabilitation plan for athletes who have suffered concussions.
http://www.mcgill.ca/reporter/34/13/tator/

The NHL seems to have modified her protocol. I went through this in an earlier post in November 2007:

Quote:
PCS can be a very difficult thing and it is very individual how a person reacts and recovers. Some people never recover from what may appear to have been a very mild concussion while others make a complete recovery from a very serious concussion.

Remember Jason Allison. He took a fairly routine crosscheck that caused mild whiplash and he was out of action with PCS for a long time and likely never did fully recover. He tried to play through the injury initially. "Concussion is a functional injury rather than a structural one," concussion specialist Dr. Karen Johnston says. "If athletes aren't knocked out, they might not even realize the symptoms they're having are related to a concussion."

As Dr. Karen Johnson, the NHL concussion guru and Director of the Concussion Program at the McGill Sport Medicine Clinic has said on numerous ocassions - a concussion is a brain injury and every concussion has to be viewed as potententially serious. She points to the debilitating headaches, nausea, cognitive problems and clinical depression that afflict athletes for months—even years—after a complex concussion.

In 2000, she revolutionized the way the injury is treated when she wrote the McGill Concussion Protocol. This new system effectively did away with the old grading scale that rated any loss of consciousness as a Grade Three concussion, at the time considered the gravest of all types. "A brief loss of consciousness is probably less important than amnesia or post-concussion symptoms, which occur afterward," says Johnston.

So for all you tough guys (and gals) who say be a man and suck it up, play through the pain - it does not work for PCS.
This is covered in detail in this publication:
http://www.thinkfirst.ca/downloads/c...ussionSite.pdf

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02-19-2011, 01:47 PM
  #296
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yeah, definitely wise not to rush him. It seems like in previous years he might not have missed time at all, but the Canucks still owe him $25m on that contract, so it's worth resting him even if the danger is small.

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02-19-2011, 02:03 PM
  #297
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Quote:
Originally Posted by spixel View Post
BotchonCanucks
no symptom in 8-9 days. no sensitivity to light, ever. If anything, team has been overly cautious
Hamhuis has passed all base line tests/concussion protocol. Told team he could go tonight. But Canucks will hold him out until Tuesday
Looks like somebody agrees with Reverend Mayhem for once.

/vindicated

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02-19-2011, 02:07 PM
  #298
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Originally Posted by NuxFan09 View Post
Exactly. I didn't realize we had a team of doctors that congregated here.

Quick, go to Rogers Arena and tell the team doctors not to let Hamhuis play, before it's too late!!
One of the issues that constantly comes up is the problem with team doctors being in a conflict of interest.

There is a real issue with the independence of team medical staff and even so-called "independent opinions" commissioned by the teams often come from doctors that have past relationship with the team.

There are all kinds of problems as academics, medical associations and insurers have pointed out. Team doctors are in an inherent conflict of interest because if they do not get players back asap - the team gets a doctor who will.
"A friend of mine who was a team doctor on one of the other NHL teams said, `Well, we don't have any concussions,'" said Dr. Jamie Kissick, former Ottawa Senators team physician. "He said this facetiously because the coach didn't believe in them, so there were no concussions."
http://www.thestar.com/Sports/article/288194

There have been numerous critical assessments of these relationships between team doctors and the clubs they are associated with.

I have been involved from both perspectives. When I was first practising law, the firm I worked with represented the major medical negligence insurer and this was very much a live issue. In fact for a period of time team doctors could not get medical negligence coverage due to concerns over their independence.

Later when I was player agent I arranged for players to have independent medical assessments and several of them were quite at odds with what the club doctors had said.

We have seen these problems play out before with Dave Babych, Eric Lindros, Owen Nolan, etc.
Dave Babych was awarded $1.37 million US by a jury on Thursday.

Babych, 41, will be compensated $1.02 million US in lost wages and $350,000 US for pain and suffering.

The six-woman, three-man jury ruled that improper treatment of a broken left foot forced the former Philadelphia Flyer defenceman to end his career prematurely.

Babych had long claimed his 18-year NHL career was cut short because the Flyers forced him to play injured.

So he sued Comcast-Spectacor, the corporate owner of the Flyers, and former Flyers physician Dr. Arthur Bartolozzi for $2.3 million US plus damages.

Because a judge earlier dismissed Comcast-Spectacor as a defendant, citing a lack of evidence proving the team committed fraud or misrepresentation, Bartolozzi is liable for the entire $1.37 million US reward.

Babych suffered the injury blocking a slap shot on April 8, 1998, and recalled telling then-Flyers head coach Roger Neilson that he would be unavailable for Philadelphia's playoff series against the Buffalo Sabres two weeks later.

Babych testified Neilson ordered him to play and that he received pain-numbing injections in his fractured foot, which Bartolozzi originally diagnosed as a bone bruise.

Babych not only played the entire series, but another full season before calling it a career.

Though the jury ruled Bartolozzi failed to use accepted standards in treating the injury, it was reluctant to charge him with fraud.
http://www.cbc.ca/sports/story/2002/...ych021031.html

Owen Nolan went through the same sort of problems with the Leafs. Ultimately the Leafs ended up terminating their entire medical staff.

Eric Lindros had a collapsed lung that was missed and was told he could fly and it could well have killed him. During an April 1, 1999, game against the Nashville Predators, Lindros suffered what was diagnosed as a rib injury (bruised ribs). Later that night, the teammate he was sharing a hotel room with, Keith Jones, discovered Lindros lying in a tub, pale and cold and called a trainer who called the club doctor.

The club doctor told the trainer was told to put Lindros on a plane that was returning to Philadelphia with injured team mate Mark Recchi. However Jones refused and insisted that Lindros be taken to a nearby hospital where it was discovered Lindros had a collapsed lung caused by internal bleeding of his chest wall.

Lindros's father wrote the Flyers a letter in which he stated that if the trainer had followed team orders, Eric would be dead, a statement supported by the doctors who treated him in Nashville. The following season, Lindros was stripped of his captaincy after criticizing team doctors.

This problem has gone on for decades. Back in the 1970's Mike Robitaille sued the Canucks successfully for medical negligence. He tried to play through the pain and became addicted to painkillers.
(Robitaille) began to experience back pain. He reported his difficulty to the club's management. They in turn emphasized how important it was that he continue to play. To help him through the pain, he was given an ample supply of valium to which he soon became addicted. To eventually break the addiction, Robitaille sought the help of a psychiatrist. As such, he was labeled a "head case." As he continued to suffer, the club's management assumed he was faking his symptoms.

But finally, one night, while playing a home game against the Pittsburgh Penguins, he jumped out of the penalty box and heard the crowd yelling. He thought they wanted him to get moving on a breakaway. But the fan reaction was to portend a massive blind-sided hit laid on by the Pens' Dennis Owchar. Robitaille fell heavily to the ice and was eventually diagnosed with a bruised spine at the base of his skull. Still he pressed on until he was no longer able to function.

When he didn't show up for training camp at the start of the next season, the Canucks launched a breech-of-contract suit against the rearguard. Robitaille countered with a suit of his own, maintaining that the Canucks were negligent in not ensuring his safety.

Meanwhile, Robitaille's playing career was finished. He left hockey unable to hold a regular job. He stuck to his guns through the litigation process, however, and in 1981, was rewarded with a $355,000 settlement from the Canucks. The money came just in time as the penniless former defenseman was struggling to catch up on mortgage payments.
http://www.legendsofhockey.net/Legen...p?player=14155

Here is the generally accepted view of medical conflicts of interest involving team doctors:
Team physicians for professional sports franchises face a conflict of interest created by the competing loyalties they owe to the team that employs them and to the athlete patient they must treat. Marketing agreements under which physicians pay significant sums of money to be designated as the team's official healthcare provider exacerbate this conflict. These marketing arrangements call into question the independent judgment of team physicians and cause players to question the quality of care they receive. This paper explores several solutions to the growing problem of conflicts between athletes and team doctors in order to enhance players' trust in the medical care they receive. First, to remove the dual loyalty problem that team physicians face, professional sports leagues or players' unions should hire medical providers directly - as opposed to having individual teams employ and provide them. If this fundamental employment alteration proves impossible, physician groups should enter into explicit agreements with sports franchises asserting their independence, and professional sports leagues should mandate that physicians disclose all potential conflicts of interest to the players they treat. Finally, states might consider exceptions to the exclusive remedy provisions of workers compensation laws to ensure that professional athletes have legal recourse when they suffer the deleterious effects of these conflicts.
http://papers.ssrn.com/sol3/papers.c...ract_id=755030

Also:

The relationship between a professional athlete, his or her professional sports team, and a team physician is legally complex and has inherent potential for conflict. Although a physician should always consider an athlete's best interest when determining an athlete's fitness to participate in competitive sport, a physician also has a responsibility to his or her employer to act in the best interest of the team. The dual role of a team physician results in the potential for conflict if a professional sports team and the professional athlete's best interests do not coincide. The workers' compensation co-employee doctrine immunizes a professional sports team from vicarious liability in tort for its team physician's negligence. Recent judicial opinions and legal commentary suggest that the workers' compensation law barring tort suits between a professional athlete and a co-employee team physician for injuries caused within the scope of employment should not ipso facto confer absolute tort immunity for a physician. The argument being made is that if a team physician breaches the ethical and legal duty to provide the standard of care, the co-employee doctrine should not provide a shield from tort liability for harm caused to professional athletes. Physicians must be aware of legal opinions surfacing in the literature so they can understand that their most prudent approach, no matter what the circumstance, is to practice in a manner in which a professional athlete's health interest supersedes all other interests.
http://www.thesportjournal.org/artic...er-tort-immuni

Couple this with the drive for elite athletes to return to the action as soon as possible and you have potentially devastating mix of interests.

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Old
02-19-2011, 02:19 PM
  #299
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Originally Posted by spixel View Post
BotchonCanucks
no symptom in 8-9 days. no sensitivity to light, ever. If anything, team has been overly cautious
Hamhuis has passed all base line tests/concussion protocol. Told team he could go tonight. But Canucks will hold him out until Tuesday
Seems to confirm what was reported soon after the injury. The fact that Hamhuis was at the next game talking to staff and trainers was a good sign and made any comparison to Mitchell (who couldn't attend an Olympic hockey game 6 weeks after his injury because of his symptoms) ridiculous, IMO.

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02-19-2011, 02:21 PM
  #300
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Ehrhoff - Hamhuis
Salo - Ballard
Tanev - Rome

That looks a lot more workable.


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