Healthy holiday eating; how aging occurs; treating concussions: Upstate Medical University's HealthLink on Air for Sunday, Nov. 17, 2024

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a dietitian shares some healthy eating advice for the holidays.

Heather Dorsey, RD: ... The best thing to do is kind of envision what we call the plate method, where half of your plate you really want to focus on good, healthy vegetables. ...

Host Amber Smith: An exercise physiologist discusses the aging process.

Carol Sames, PhD: ... They found that there were some patterns that suggested that these molecules were changing at different rates, specifically around two times, around 44 years of age and 60 years of chronological age. ...

Host Amber Smith: And a doctor of physical medicine goes over the concussion protocol.

Matthew Grier, DO: ... Things that we watch for are the angle of the injury itself. So typically you're more likely to see concussive injuries when there's a torsional moment, or the body's twisted in space, or if the player was not prepared for impact. ...

Host Amber Smith: All that, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, an exercise physiologist discusses the aging process, which isn't necessarily gradual. Then we'll go over the concussion protocol. But first, some healthy eating advice to get through the holidays.

From Upstate Medical University in Syracuse, New York. I'm Amber Smith. This is "HealthLink on Air."

As we get into the holiday season, making healthy food choices may become more of a challenge for help navigating menus and buffet tables, I'm talking with registered dietitian Heather Dorsey from Upstate.

Welcome to "HealthLink on Air," Ms. Dorsey.

Heather Dorsey, RD: Hi.

Host Amber Smith: Let's start by talking about eating out during the holidays. A lot of people enjoy a break from cooking. What do we need to know about restaurant dining?

Heather Dorsey, RD: Well, I think the most important thing to know about restaurant dining is just to be mindful. Be aware of what you've had for the day to eat, what you're planning on wanting to have. And I think the best thing to do is kind of envision what we call the plate method, where half of your plate you really want to focus on good, healthy vegetables; a quarter of your plate, some healthy lean protein; and the last quarter of your plate, your starches, which include if you're going to get potatoes, corn, peas, when you're out at a restaurant. It's really important to kind of envision that and be mindful.

Host Amber Smith: So what are the best things on the menu typically? I think a lot of people think a salad is the safest bet. Is that always the case?

Heather Dorsey, RD: Not always the case. Some salads are pretty heavy with cheese, and depending on the salad dressing, and depending on the type of meat choice, especially if you get something that's fried versus grilled, that can be challenging. But salads are a good option if you're mindful of maybe asking for extra vegetables. "I would like double tomatoes, double onions. Go light on the cheese." Those are some options.

I think other good options are vegetable-based entrees or sometimes they're like the vegetarian entrees. And another option that's always available at most restaurants is they'll have a light fare menu, which typically aims for meals less than 600 calories. And that's really the optimal number of calories, or the high end of calories that you should shoot for in a meal. And you can use that for the whole menu, but what's nice about the lite fare menu is it usually keeps it under that number. And you don't have to, you can enjoy the whole entree versus halving. What I also recommend is taking half of your entree home. That is always a good option, too.

Host Amber Smith: So you have lunch the next day.

Heather Dorsey, RD: Yeah, it's nice. You have lunch or a dinner for the next day, and you didn't overspend on your calories, and you still feel good, and you're staying in a healthy frame of mind.

Host Amber Smith: In general, what are the things to try to steer clear of on the menus?

Heather Dorsey, RD: Well, the things to just really watch out for is anything that's fried. Anytime you get into the fried realm, you're going to increase your calories a lot. And, just for obvious reasons, fats have the most calories. So when they're adding fat to your food, it's going to increase those calories.

Another thing to be really aware of is things that are smothered in, like, gravies or have glazes on them, or extra sauces or cheeses. The cheese can really add a lot of calories, and a lot of meals tend to put that on to make it taste more rich. And so, watching out for cheeses and cheese sauces, those would be some of the worst options that you'd have to be mindful of.

Host Amber Smith: And I thought you were going to say dessert. Are there desserts that are OK to have?

Heather Dorsey, RD: You know, I don't think that dessert is the worst thing to have. I think if you're mindful during your meal that sharing a dessert, or like I said, having half the dessert just like you would the entree and taking the other half home for a nice little special surprise the next day is always fun.

I don't like to omit food from people because I think especially during the holidays and going out, this is about family and friends and gathering and being social, and food is pleasurable, and it's social, so you want to enjoy yourself, but you just want to be, like I said, the big word that I use is just being mindful of what you're doing. Because if you overdo it, obviously the next day you're going to feel not so happy with what you chose to do.

Host Amber Smith: Now, what are the best drinks for when you're dining out?

Heather Dorsey, RD: Well, the best drinks are water or unsweetened tea. Or you could have a nice cup of coffee with some non-dairy creamer and Splenda or Truvia if they have those on the table. Those are best options. You can always go for a diet beverage. Especially if you have if you have diabetes, you do want to pick the diet or unsweetened options. But I think the best bet is water. And I always say ask for lemon or lime, because then it tastes a little bit better. And it's free, and it's healthy.

Host Amber Smith: Now, there are options when you go to a restaurant, but maybe not so much when you're invited to a friend's home or to a party. What can people do when they're faced with food that they don't know if it's good for them or not?

Heather Dorsey, RD: I think eating at a friend's house can be really challenging. And one of the things that I always recommend, and I do this in my own personal self, is when I have a family gathering or a friend gathering, I always bring something that I know that I'm going to be able to eat plenty of if I need to. So I'll always bring a large salad, a green salad, with tons of vegetables on it, and a nice light dressing, or make my own dressing. Or I'll bring a vegetable base, like a roasted vegetable tray. Or I'll bring a fresh vegetable tray, or a fruit tray. And, actually, I have some recipes to share regarding those types of options.

Host Amber Smith: OK. We'll definitely get to those. Now, what if you're faced with a buffet table? I'm imagining you're going to tell me that plate strategy comes back.

Heather Dorsey, RD: It does come back. It absolutely does. Because when you're faced with a buffet, you're going to have plenty of protein choices, lots of starchy choices, and probably some minimal vegetable choices. Hopefully we want more vegetable choices than not. But we also want to look at some of the protein and the starchy choices to make sure that they have some things that are beneficial. Like, look for things that have nuts in them or brown rice or wild rice or even beans. Those things are going to increase your fiber, and they're going to keep you more satisfied and will make it just more enjoyable and healthy for you.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with registered dietitian Heather Dorsey.

This time of year, the grocery stores are full of seasonal foods that we can prepare in our own homes if we're hosting a gathering or if we just need a meal idea for regular days. What are some of your favorites?

Heather Dorsey, RD: For seasonal stuff, well, the fall is all about pumpkin. So roasting pumpkin seeds or actually mixing pumpkin with other types of squashes like acorn or butternut. One of my favorite seasonal, I love spaghetti squash. It's very low in calories, and you can make some really good ... you can cut the spaghetti squash in half, bake it, and then add some beans and some ground turkey and some vegetables and then rebake it and have a really nice spaghetti casserole, which is delicious and healthy.

One of my favorite fall things is chili. Load it up with every kind of bean that you can think of -- black beans, northern beans, pinto beans.Also, substituting like a ground turkey versus a hamburger, just to, again, lower the fat consumption. And then of course, roasting vegetables, parsnips, asparagus. And then, I love apple crisp, but I think one of the ways we can make apple crisp a little bit more healthy is making it with some almonds or some walnuts.

Host Amber Smith: You've mentioned roasted vegetables a couple times. For people who are not really, they don't consider themselves cooks, how would you describe the process of roasting vegetables?

Heather Dorsey, RD: So to roast a vegetable, you would take a sheet pan. You can line it with some aluminum foil. Pick your roasted vegetables of choice, whether it be parsnips, sweet potatoes, some different types of squashes. And then you would take a little bit a side of olive oil, and you can actually put a little bit of cinnamon in there and then baste the vegetables. And then just roast them in the oven at 350 degrees Fahrenheit till they're a little al dente. And then just enjoy them. I wouldn't have to put anything else on them because you already used a little bit of the extra virgin olive oil as your healthy fat.

Host Amber Smith: All right. Now, when cooking, do you have some ingredient swaps that can make a dish more healthy that you'd like to share?

Heather Dorsey, RD: I do. And actually my recipes have one of the main ones, and that's when recipes call for sour cream, substituting in Greek yogurt. richer in protein, lower in calories. Another really good one, and this especially goes for a lot of the holidays that are coming up, we love mashed potatoes. What's a nice thing to do is either do mashed cauliflower, which some people don't like the flavor of, just the mashed cauliflower alone. So I always say, just try, go 50/50, do half mashed cauliflower, half mashed potatoes. Or even mix it in with mashed sweet potatoes. It lowersthe calorie point. It also lowers the starch, because potatoes are a more starchy vegetable.

Baking is a big thing for the holiday season. Switching out just your flour, using whole wheat flour versus all-purpose flour. And I always like to stress nuts with cooking, really ground-up almonds, walnuts, put them in pie crust or sprinkle them on top for a nice crumbly topping. It adds a lot of nutrition benefits, and it goes a long way. Oil can be substituted for applesauce, preferably unsweetened applesauce. Butters can be substituted with nut butters or almond butters like peanut butter -- but look to make sure that your peanut butter and your almond butters are low in sugar.You can substitute pasta with zucchini noodles. That's a really good swap out, and sometimes it makes the entree a little bit more colorful, which is nice and healthy, lower in calories and richer in fiber. Of course, that swap of white rice, if you're going to be serving white rice, maybe do brown rice or mix in brown rice with the white rice or even some wild rice. More vibrant colors and definitely higher in fiber and more nutritious.

Playing around with herbs, that's a big one that I think a lot of peoplereally need to try to incorporate into their diets because instead of using salt for flavor, really sampling, more cinnamon, more cumin, more tarragon, more even cayenne pepper, just putting some things into their items that are herb related versus adding salt for flavor.

And then, a good thing to put out for a sweet treat is definitely dark chocolate versus milk chocolate because it's definitely healthier for you as far as antioxidants are concerned.

Host Amber Smith: Well, that's some good advice. You also mentioned that you have some recipes to share. What can you tell us?

Heather Dorsey, RD: I do, I do. I wanted to really focus on when you're thinking about having to go over to a friend's or a family member's house or just going to a gathering, and you want to make sure that there are things that you can eat, like I was saying, a great veggie tray or a great fruit tray, and utilizing that Greek yogurt for a base for a dip.

So a really quick veggie dip based with Greek yogurt is a cup of Greek yogurt, a tablespoon of olive oil, a tablespoon of lemon, a little clove of garlic, a teaspoon of dried dill, and a little bit of parsley. And then if you want to add a little heat to that dip, you can put a pinch of pepper flakes in it.

And likewise with the fruit tray. You can pair it with a delicious Greek yogurt-based dip. Again, start with a cup of Greek yogurt, two tablespoons of honey, a teaspoon of vanilla and a half a teaspoon of cinnamon. And those additives actually really have some deep health benefits with antioxidants and helping with blood sugar control. So that makes it a really healthy dip.

Two of my other favorites to bring that has a little bit more substance to it, is something called cowboy caviar. This is basically a black bean-based dip that you can use with tortilla chips, which are whole grain corn. You get a can of no salt black beans, a can of no salt corn, a nice red pepper, one onion, one tomato, one avocado and a little bit of cilantro. Mix it all together, and you've got this really nice, almost like a high-fiber, vegetable-based dip that's going to keep you satisfied, but very low in calories and healthy for you. You can add some heat with a jalapeño if you want.

And then my go-to is always bringing some guacamole. Avocados are a really good, rich source of omega 3's and a healthy fat. They definitely fill you up. So it would be just a couple avocados, a red onion, a couple cloves of garlic, a little bit of tomato, squeeze a lime, some cilantro. And again, if you want to add some heat, you can throw a jalapeño in there.

But just some quick and easy things that you can take to a gathering that you can have and take the pressure off of having maybe some of the more decadent things that the host might be serving. So it's just you're kind of putting yourself in the control seat of, OK, if I bring something that's healthy, I know that that's my go-to that I can go and have, andI won't feel guilty later on for overindulging.

Host Amber Smith: Well, Ms. Dorsey, thank you so much for taking time to tell us about this and help us eat healthy during the holidays.

Heather Dorsey, RD: You're welcome. It was my pleasure.

Host Amber Smith: My guest has been Heather Dorsey, a registered dietitian from Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Aging isn't always gradual -- next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

As we age, our bodies change, but are those changes gradual or more abrupt? I'm talking about this with an exercise physiologist from Upstate. Dr. Carol Sames is also an associate professor of physical therapy education at Upstate.

Welcome back to "HealthLink on Air," Dr. Sames.

Carol Sames, PhD: Thanks so much, Amber. It's great to be here.

Host Amber Smith: The journal Nature Aging published a study recently from a team of Stanford scientists that described waves of biomolecular shifts in the body that happen around ages 44 and 60. I wanted to ask you about this because I think a lot of us feel that aging is gradual.

This study suggests otherwise, though, right?

Carol Sames, PhD: Yeah, it was really an interesting study. So what they did was, they followed 108 individuals over a couple of years. They were a fairly diverse ethnic population, different ages, 25- to 75-year-olds, and they collected blood and stool and skin and oral and nose samples.

And they just wanted to look at a bunch of different molecules and see, do these molecules appear to age at the same rate?

And what they found: that there were some patterns that suggested that these molecules were changing at different rates, specifically around two times, around 44 years of age and 60 years of chronological age.

Host Amber Smith: So why 44 and 60? Why are these key points?

Carol Sames, PhD: So they're not exactly sure why. The authors even state that future research is clearly needed. They need a larger sample size. They didn't control for physical activity, and we certainly know that physical activity has a lot of positive benefits on changing the slope of the line of aging.

And, they mentioned that future research could potentially lead to the development of early diagnoses and/or prevention strategies. So I think what they were trying to do is maybe tie the concept that aging is impacted by genetics and lifestyle choices, and we already have evidence that is suggestive of that.

Host Amber Smith: Can you define what aging is?

Carol Sames, PhD: Well, I can tell you what the World Health Organization defines aging as, and it's a biological process. It results in progressive and irreversible decline in physical function. It impacts most organ systems, and it puts individuals at risk for various age-related diagnoses and diseases.

That's the technical definition, but what we have found in the last 10 years are these two concepts. One is this idea of resilience, that when we get older, we tend to lose our physical resilience. And resilience is just the ability to resist or recover from a stress or a challenge. It could be an infection, surgery, medication, exposure.

But we know that with increasing age, people tend to lose that resilience, and that kind of ties into this new concept, or newer concept, of senescence, which is that as we get older, our body starts to accumulate damage. When you're young, you also can have damage, but it gets repaired, fairly quickly.

But with increasing age, that damage remains, and so we get what's called cellular senescence, and it's occurring throughout the body, and it certainly impacts body systems. One, for instance, is the musculoskeletal system, so we start to see issues with joints and cartilage and ligaments and tendons.

So I think those two concepts really do play into this World Health Organization definition of aging.

Host Amber Smith: So when we're born, we start growing. When do we start aging, or the cellular senescence? When does that start?

Carol Sames, PhD: Well, if we talk about when we age, we basically start aging on day two of life, because we have to get older, or we'd stay as infants. So there are changes that are going to occur. We generally identify, like, puberty as a big time-inflection point. But in terms of senescence, there's not a definite age because we know that aging is impacted by genetics and lifestyle changes.

And so some individuals, we could say, "Wow, they're aging well." And other individuals, we might say, "aging not as well."

There's not a defined date. There's a difference between chronological age, which is your specific age, and biological age. And biological age is more of an observable process that we can describe or define.

Host Amber Smith: Does aging differ based on gender or race or nationality?

Carol Sames, PhD: So if we look at, like, life expectancy as a way of kind of describing this, we know that in the U.S., Caucasian women live about two years longer than the total population and also live a few years longer than men.

If we look at African Americans, especially African American males, they have a life expectancy about 10 years less than Caucasian women.

If we look at the world, we see that Asian populations have the highest life expectancy, and the lowest life expectancy comes from American Indian and Alaskan native populations, and their life expectancy is 65 years.

Host Amber Smith: And do we know, does sedentary lifestyle versus active lifestyle, that has something to do with life expectancy, too, right?

Carol Sames, PhD: Absolutely, a very huge impact on life expectancy. If you just go through body systems and what being active can do to all major systems, we see that individuals that tend to be more active, they tend to have a longer life expectancy. It's certainly not a guarantee, because part of the equation is genetics, and we can't choose our parents, so we're always going to have that part. But lifestyle is considered about 65% of the equation, and genetics about 35% of the equation.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith.

I'm talking about aging with exercise physiologist and physical therapy associate professor Carol Sames.

I'd like to ask you what naturally we can expect as we age from, let's start with metabolism. Is it different for men versus women?

Carol Sames, PhD: The only difference would be that men usually have more muscle mass than women.

So as we age, we lose muscle mass. It's a natural occurrence. It happens in everyone, even individuals who are active. It's called sarcopenia. However, being active and engaging in resistance training can help change the slope of the line so that we lose less muscle mass.

And muscle mass is tissue that's very metabolically active. It needs energy. Muscle needs energy to contract and so that we can move. Fat mass sits there and takes up space, but it's not an active tissue. So when we lose muscle mass, we lose, essentially, calories that are burned off during the day, and so metabolism slows.

We also note that as individuals get older, if we look at activity levels, it starts to drop off. Like from 65- to 75-year-olds, only about 16 and a half percent of the population engage in regular activity.

When you get to 75- to 85-year-olds, they're down to about 10%.

And when you get over the age of 85 years old, we're down to less than 5% of the population, so we're moving less as we get older, and that certainly is going to impact metabolism.

Host Amber Smith: What about our skeletal system?

Carol Sames, PhD: So, as I mentioned, we lose muscle mass, even if we're participating in resistance training. However, as I mentioned, you can slow the slope of the loss, of that line. And we also know, with aging, we lose power. And power is really important to older adults. Power is how strong I am divided by time.

So we need power to get out of a chair. We need power to go upstairs. We need power to walk. And those fibers that are associated with power are fast-twitch fibers, and we start to lose those with age. Again, I can't change that, but I can maintain as much strength as possible. So that's really important.

We know that individuals who are inactive tend to have worsening effects of that sarcopenia. They also tend to have more falls, they tend to become frail, and they start to have more mobility concerns. You also get increases in hospitalizations, and you also have an increased risk of developing osteopenia and osteoporosis (weakened and brittle bones).

If you're not loading bone, we're going to lose bone.

Host Amber Smith: What about our stamina, just our ability to get through a workout?

Carol Sames, PhD: So that really ties into muscle, as we just mentioned. If I start to lose muscle mass, what happens is the muscle that's remaining is going to get used, but there's not enough of it. So it will require more oxygen so that when I start to move, I'm going to noticeably be short of breath, and I'm going to feel fatigued.

We also know that (regarding) the cardiovascular system, our arteries become stiffer. That's just a natural progression that occurs with age. That impacts blood flow to muscle, and muscle needs blood flow because it needs oxygen.

Also the amount of blood that is ejected from the heart, because the heart muscle gets stiffer, less blood comes out, and we naturally have an increase in blood pressure. And so that kind of prevents blood flow also. Maximum heart rate decreases with age, so that all contributes to that: "My muscle is weak. I'm not getting enough blood flow to muscle. I feel tired when I'm doing activity."

Host Amber Smith: Chronic conditions become more prevalent among older people. Are we able to predict or influence which ones are going to affect us?

Carol Sames, PhD: Again, what we can influence is not the genetic side, but we can really influence the lifestyle side. And so that's why it's so important that people remain active, that we engage in some kind of continuous, repetitive activity. Walking is fantastic or swimming or biking, just repetitive activity and also strength training.

And I think strength training really hasn't gotten out into the media. Most people kind of think, "I need to walk every day," and that is wonderful, but we also need to do some kind of strengthening. It doesn't require equipment. We have a body. A body weighs something. We can do body-weight exercises. Most of us have a chair, we have a wall. If you've been to physical therapy, you might have a couple of TheraBands (stretchy bands for exercise) lying around. So you can do strengthening activities and not require going to a facility or purchasing of equipment.

Host Amber Smith: Well, the million-dollar question: What can we do to slow the aging process?

Carol Sames, PhD: So back to activity, back to strength training.

And the other thing that's big that people don't realize is reducing sedentary behavior. So I can be active, I could have gotten up this morning and done a walk, and then I can sit in my chair for the next eight hours. And that sedentary behavior in some ways negates some of the benefits that I got from getting up and walking this morning.

So it's really important to monitor how many hours we are sitting, and this is awake time, it's not sleep time. The exact number is not known. We're thinking it's around 10 hours a day. And you'd be surprised how easily you could accumulate 10 hours, especially, like, if after dinner people sit down and maybe watch television for a couple of hours. You can get to 10 hours pretty quickly.

Making sure that you seek regular medical care, again, because maybe things can get diagnosed as they're starting, as opposed to when they become more of a chronic condition.

Making sure that people get a healthy amount of sleep.

Staying cognitively challenged. Engaging in activities, engaging in social activities, monitoring chronic stress because chronic stress leads to chronic inflammation, and we're learning a lot more that inflammation affects everybody's system.

Moderate alcohol, not too much alcohol.

If you're smoking, really try to quit smoking.

Controlling cholesterol, managing blood sugars, not gaining too much weight.

All really important things that can help with those lifestyle impacts on aging.

Host Amber Smith: So I know that sedentary behavior is not healthy for us, but does that accelerate aging? If you lie around on the couch all day, are you aging faster?

Carol Sames, PhD: So what we know from the research is there seems to be a relationship, not a cause and effect, but a relationship, with cognitive decline and hours of sedentary behavior. More and more research keeps getting published, and so, that certainly is an aging process because we know that there are brain changes with age. We do lose gray matter. Our brains actually get a little smaller, and neurotransmitters don't work as well as they had previously.

But when we think of what exercise can do as a beneficial thing, when we exercise, we have an increase in blood flow to the brain. When we're sedentary, we're not using muscle. Blood flow's still occurring, but not at a greater rate.

So just the idea of just getting up every hour and moving for a couple of minutes, it kind of breaks that lengthy sedentary behavior. And I think probably within the next one or two years, we will see that added as a risk factor for cardiovascular disease. It isn't there yet, but with the amount of research that's being published, population-wide research following people for years, I think that will be an addition to a risk factor, along with chronic inflammation. That's probably the next one also to join the "risk factor parade," I guess you could say.

Host Amber Smith: So it sounds like we have really no control over this, but there are some things that we can do that might make it slow a little bit.

Carol Sames, PhD: Yeah, absolutely. I mean, there is no reason why we cannot, besides the genetic component, why we cannot age and be active. I think in the past we did a disservice to older adults. We were like, "Let me do that for you." "Oh no, you shouldn't be doing this." In some ways we probably forced older adults to be inactive.

As I was saying in class today, I don't want to be older and just be concerned with performing activities of daily living. I want to be older and doing fun activities. And being active to me is my defense, of trying to be as strong as I can, trying to get sleep, trying to eat a balanced diet, because certainly that's a lifestyle indication.

I want to make sure that I'm not eating a whole lot of ultra-processed foods, Once in a while, fine, but not on a daily basis. So I think there are a lot of lifestyle changes that we can make, and they don't have to all be made at once, but just being active, you're just going to feel better.

I mean, that's physiology. So just trying to get people to move a little bit more and not sit as much and try to engage in some aerobic, continuous activity and some strength training can do a world of wonders for our bodies.

Host Amber Smith: Well, Dr. Sames, thank you so much for making time for this interview.

Carol Sames, PhD: My pleasure. Thank you so much for inviting me.

Host Amber Smith: My guest has been Dr. Carol Sames. She's an exercise physiologist and associate professor of physical therapy education at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air" -- symptoms and treatment of concussion.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Today, we're talking about concussions with Dr. Matthew Grier. He's an assistant professor of physical medicine and rehabilitation and co-director of the Concussion Clinic at Upstate.

Welcome to "HealthLink on Air," Dr. Grier.

Matthew Grier, DO: Thank you. I appreciate you having me.

Host Amber Smith: Now, to start off with, are all head injuries that occur during sports necessarily concussions?

Matthew Grier, DO: Thankfully, no. So a cascade of events have to follow that event occurring, in order for it to qualify as a concussion.

Host Amber Smith: So how do you define concussion, or what are those cascade of events that have to occur?

Matthew Grier, DO: Concussion's considered a mild traumatic brain injury. And so, essentially, it results from a transfer of mechanical energy to the brain from external forces, resulting from either the head being struck directly with an object, the head striking a hard object or surface, or the brain undergoing an acceleration or deceleration moment without direct contact between the head and an object on the surface.

And also, it's important to look at the forces that were generated there. A good example of that are concussive injuries classically are from explosions, and just that trauma itself could be enough to create the atmosphere where concussion would occur.

Host Amber Smith: Now, those of us that watch NFL games see potential concussions every game, it seems like.

Can you watch a tackle and determine whether it's a concussion or not, or how do you diagnose that it was a concussion?

Matthew Grier, DO: Well, you're exactly right. There's so much force being applied. The difference is with the protective equipment, say, in football, which is designed to mitigate some of that force. So rather than the trauma or the direct force being transmitted directly to the skull, it's carried through the helmet or down to the shoulders through the padding that they wear.

But things that we watch for are the angle of the injury itself. So typically you're more likely to see concussive injuries when there's a torsional moment, or the body's twisted in space, or if the player was not prepared for impact.

Host Amber Smith: I see. Now, if you're in the hospital, and someone comes in with a suspected concussion, you won't have the benefit of having seen that collision, so how do you go about determining?

Matthew Grier, DO: We try to, as best we can, ascertain what occurred and how, and what forces were applied. Here at our clinic we see a host of different mechanisms causing concussions. Motor vehicle accidents, for example, are very common here. So we try to get the story as best we can from the patient if they're able to relay it. But what we're looking for really are some clinical signs that would indicate that there's been some structural damage.

One is, is there a reported loss of consciousness or not immediately following the injury? And if so, how long did that loss of consciousness occur for? That's a big one.

The second is, is there an alteration of the patient's mental status immediately following the injury or upon regaining consciousness? What we're looking for there is, there'd be evidence by reduced responsiveness or inappropriate responses to external stimuli. So essentially, like a flash of light, and a patient jumps across the room to try to get away from it.

We also look for, is there a general slowness to their response? Are they sluggish? Do they appear agitated? Are they able to follow simple commands and two-step commands accurately? And of course, their orientation. Do they know where they're at, why they're there, what day of the week it is, those types of things?

Host Amber Smith: So if there was a loss of consciousness, does that mean it was a concussion?

Matthew Grier, DO: It is more likely; it doesn't necessarily mean that. It doesn't give you a grade of the concussion. It just says that there was a significant force applied about the head if there's a loss of consciousness, unless there's other factors at play. Some things like we see here, people will get syncopal, or basically, their blood pressure drops quickly for a host of reasons, be it a cardiac reason, or be it their blood sugar is low.

And then they have a fall. And so it gets a little bit cloudier there, so it's always trying to put it into context of what's presented.

Host Amber Smith: And could a person have a concussion if they didn't lose consciousness?

Matthew Grier, DO: Yes. Yeah, and that's pretty common. You will see, typically, it's something I've taken to call "God's erase button," where the person won't remember the exact event, or they won't remember five minutes leading to it or maybe five minutes after, so that amnesia. And I call it God's erase button because reliving that can bring out other things down the road, like post-traumatic stress disorder or anxiety with driving, et cetera.

But the amnesia part's important, in terms of how long that persists for. People who are significantly injured and have a more severe concussion by our estimation, typically have longer amnesic periods. They may not remember the entire day prior, they may not remember the day going forward or two days after the injury, and they start remembering day-to-day events.

Host Amber Smith: We mentioned football. What other sports do you see concussions in, typically?

Matthew Grier, DO: If you look internationally, the No. 1 sport for concussions has remained rugby for some time. And I think if you've ever watched rugby, it's easy to understand why. But here, more regionally, we're looking at the contact sports.

Ice hockey would be pretty high up on the list there, too. I believe it's No. 2 in most of the scales I looked at.

Then we have lacrosse; that would be third.

Soccer actually is pretty common. We see probably more soccer players over here than football players in our clinic, and I think that's due to some variables and that it's not considered a contact sport, but yet people are moving at high speeds, and they're going for headers, or they're trying to pass looking right, and someone slide-tackles them from the left, and they're not prepared for it as much, and they really have no protection.

After that, wrestling. You would think it would be higher, but they do use different techniques of wrestling, and they're heavily trained how to keep their head midline. And they also wear protective gear as well. As the winter comes on, we'll see more basketball players as well. That usually occurs when they're going for rebounds or coming down from grabbing a board, for example.

And then our softball and baseball players would come in next.

And we've had a fair number of cheerleaders, especially the flyers, who are on top of the pyramid, so to speak, who get missed or dropped.

And then even volleyball would make the list of the more common ones.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith.

I'm talking with Dr. Matthew Grier. He's an assistant professor of physical medicine and rehabilitation at Upstate, and we're talking about concussion.

So let's talk about how concussion is treated, starting from when the head injury happens. What is the concussion protocol for schools in New York state?

Matthew Grier, DO: So in New York state, and this is based on the Concussion Management and Awareness Act, which is from 2011, but also includes non-public schools effective in July, I believe, of 2023. Essentially, if any student, an athlete or not, is suspected of sustaining a concussion, either at home for the non-athletes or even the athletes, or witnessed, the first thing that is done is they are removed from play or academic participation for a period of at least 24 hours.

Now, depending on the environment where they're injured, there's a big discrepancy. So if this happens during a sporting event, there is going to be an evaluation done, typically at the field or at the court, by the athletic trainer, and by the medical personnel if they're available to do so.

The problem is the non-athletes, because a lot of these things happen, and so then we really have to rely on observation of school staff. is this person acting differently when they come to school, are they struggling to keep their eyes open? Are they putting their head down because of bright lights? Do they seem agitated?

And so then, they become the reporter and have to do the investigation. But if there's suspicion of concussion with them, the rules are the same. They're removed completely for at least 24 hours, until they're symptom-free, essentially. And then there's protocols for both your non-student athletes and your student athletes for returning to participation, both academically and athletically.

Host Amber Smith: At what point would they need or consider the Concussion Clinic?

Matthew Grier, DO: We kind of serve a unique role over here. We have a couple clinics where we're trying to get people in more readily, for these student athletes who were just injured or your non-student athlete who was just injured. So we have some specialty clinics to get them over here, and typically we're involved when symptoms are not improving or if they're actually going the other direction, and things are getting worse for them.

But we don't typically see people within a day or two of the initial injury. Most concussions, if you look at them kind of across the board, they improved within usually two months, about 82% of them, regardless of intervention. So we tend to get the people who did not improve, and that kind of falls into the world of post-concussion syndrome, where people have persistent symptomatology that was brought on by the event, that's not improving, and they need some further diagnostics and medical intervention, as well as our skilled therapists, to get back to their baseline and functioning.

Host Amber Smith: Well, it sounds like the majority do get better and are able to return to their sport, I assume?

Matthew Grier, DO: Yeah, the vast majority do. And in New York state and in most states, there's criteria for how you return them to sport.

Take a football player, for example. He is injured on say, a Sunday game. He's removed from all play for 24 hours. If he's reporting no ongoing symptoms at that time, and he's cleared by a medical professional, then he starts what's called the "return-to-play protocol," which is a graduated series of advancing exercise and cardiovascular work all the way up until, participating in contact drills again.

But each one of those steps takes 24 hours without recurrence of symptoms, so for someone to go from grade one, which is really light activity, like walking at an increased rate without an increase in symptoms greater than two points on a visual analog scale, meaning if he has a headache, and he reports a two and it doesn't get to a four, then they're OK to move on to the next level, which is again, just gradual increase in work.

And again, each step takes 24 hours without a recurrence of symptoms or worsening of symptoms. If they do not, let's say you're at a stage two, and you're doing a little bit more from a cardio standpoint, but your headache goes from a two to a five, then you're going to be knocked back down to stage one again, until they can be advanced.

Host Amber Smith: Some of this is subjective on the athlete's part, is that right?

Matthew Grier, DO: Yes, it is, and there's the difficulty. And some of the testingthat's available for sideline work is designed or configured really to try to tease that out, because so much of this is subjective reporting. So a lot of schools, in the area and also nationally, use computerized-based testing, which is usually administered to all of the athletes prior to the season and prior to participation, and then repeated at the time of the injury, when it's deemed appropriate by the medical staff, to see if there's a variance in and of themselves objectively on cognitive testing.

Host Amber Smith: Well, we've been talking about children or young adults, but concussions can happen to anyone. Are there differences in how they're diagnosed or treated in an older adult?

Matthew Grier, DO: Well, there is, and so it's interesting. Children typically take longer to recover from concussion than, say, your middle-aged adult, but it's bimodal, meaning that the kids take a little bit longer, then the elderly can take longer as well. And there's different reasons there in terms of why we think that that occurs.

But in children, you have a developing brain, you have connections being formed all the time. And then with concussion, you need to do a little bit of rewiring because with the force, there's a diffuse axonal injury, typically. What that means is the outside of the brain and the inside of the brain are connected by all these little inner neurons, and with the force applied to the brain, those areas travel at the same speed, but they don't stop at the same speed. The midbrain is denser or heavier. And so there's actually a loss of some of those connecting axons.

And that happens with adults, too. And the variance is how much room the brain has to move. And so in the elderly population, we see more cortical atrophy, or the brain gets smaller, as we age. But what that means is the skull does not, and there's relatively more room for that brain to be shaken around. But you're more likely to see bleeding events in the elderly, versus in children.

Host Amber Smith: If we're talking about the elderly, how does something like dementia complicate a diagnosis?

Matthew Grier, DO: It certainly does. And we've had countless patients who were on that borderline, maybe having some age-related memory changes, but they were kind of living with it or putting it off to just getting older.

And then after a concussive event, it becomes more fulminent. It's kind of the straw that broke the camel's back. And then we work here a lot with our gerontology department once we identify that this looks more like a dementia than a concussion, then we work with them as well for assistance and help with medication management there.

Host Amber Smith: Well, looking ahead, does a history of concussion set someone up for other medical problems in the future?

Matthew Grier, DO: Yeah, and this is a hot-topic issue, and it's in and out of the lay press all the time. To the best of my knowledge and a recent literature search on this, having one concussion, which you recovered from fully, does not seemto bring any long-term effect or risk for things like developing dementia or chronic traumatic encephalopathy.

Having repeated concussions is really the problem and why these return-to-play protocols exist, because we know if a brain is trying to heal, and it's injured again in that period, then likely the second concussion is going to be far worse than the first one.

So that's really what we're trying to avoid, by identifying these people early on and then gradually returning them to play, making sure, as best we can, that they are as safe as they can be and at a normal risk of injury for their sport.

Host Amber Smith: So it's cumulative damage over the years, over the decades, perhaps?

Matthew Grier, DO: Yes, perhaps. I think what we have to bear in mind, these protocols didn't exist, back even when I was in high school or college. They'd play college hockey, they'd brush it off, get you back out there. So I think we're seeing the effects of what happens when people rush back to participate more than anything else, versus what's this going to look like in 20 years if someone's gone through the return-to-play protocol, and they've had multiple concussions, but the brain was fully recovered before the second or third one occurred. I think you're going to see some different outcomes down the road, but the jury, to be fair, is still out on that.

Host Amber Smith: Well, I appreciate you making time for this interview, Dr. Grier.

Matthew Grier, DO: Sure. It was my pleasure. I appreciate your time.

Host Amber Smith: My guest has been Dr. Matthew Grier, an assistant professor of physical medicine and rehabilitation and co-director of the Concussion Center at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Here's some expert advice from Dr. Ioana Medrea, from Upstate Medical University. What can a person do to get rid of a headache?

Ioana Medrea, MD: Aspirin is a great medication for small aches generally and for headache as well. My only concern would be is how often is someone using aspirin? If you're using it infrequently, I think it's great. I have nothing against it. If you're using it every day, it becomes a problem.

There is a risk of bleeding from the gut with aspirin, and that can be dangerous. But, in addition to that, there's problems with kidneys that are possible, problems with blood pressure, so I would not want you to use it unnecessarily.

Of course we use an aspirin every day for prevention of stroke or heart attack, but that isn't someone who already has those risk factors, and the risk-balance trade-off is warranted. But in someone who has no medical conditions, I wouldn't say that that would be my go-to every day.

If you find yourself using aspirin very frequently, perhaps you might need preventive treatments for your pain and headache, which is a medication you get every day to decrease the frequency of your headaches, and that would be an indication that you need to see either your primary care to start that or a neurologist or headache specialist.

Host Amber Smith: You've been listening to neurologist Ioana Medrea, from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Ubong Johnson, a fourth-year medical student from Nigeria, sent us a poem about how his brother's tragic death both inspired his decision to become a doctor and helped him avoid a public humiliation during his training.

"Locked Jaw"

i walk into the pediatric ward today,

blue scrubs, sticking to my black skin like kin,

and i am reminded of that Tuesday my mother lost herself.

that morning, my twin brother,

who was born a bright-eyed flower, died a tree.

stiff necked. jaws locked. limbs like branches.

death had weeks before crawled into his eight-year-old

body through a dirty puncture wound underneath his big toe,

seizing him by the nape like a bully.

he died a faulty machine, jerking and spasming, doctors

racing to keep life from escaping through his nostrils, my mother's

wails slicing into the air; my father's sclerae like wet red clothes.

i silently complete the arc of medical students around a small bed,

and my consultant's eyes regard me as though she considers tossing

me outside for arriving late for rounds yet again.

she withdraws her glare, and the question meant to

humiliate me, my punishment, clambers out of her throat:

you, tell me what you think afflicts this child? everything about it, i mean.

and God save you if you don't know.

i look down, and i smile. another chance to tell

my twin brother's story. to describe clostridium tetani;

the reason i have chosen to become a doctor.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

Next week on "HealthLink on Air," how to care for your tattoos, and a pediatrician who prescribes books.

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel and graphic design by Dan Cameron.

This is your host, Amber Smith, thanking you for listening.