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A Crash Course in Concussions 🤕 · Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner

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Music.
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Cases, updates, and discussions for the busy pediatric practitioner.
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Click on the link in this podcast for free credit that may include CME,
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MOC, or ethics credit, depending on our topic or podcast.
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Joining me today here in the podcast studio is Dr. Kenneth Nwosa.
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He is a sports medicine specialist.
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He's the head doctor for UTSA, or the University of Texas at San Antonio San
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Antonio Athletics here in San Antonio, and he also sees patients with sports
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injuries in the community.
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Dr. Nuosa, thank you so much for being here today. Yeah, thank you very much.
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It's a pleasure to be here.
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So you went to med school at UTMB and your residency, and then tell me about what you did from there.
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Yeah, so the journey to become a sports medicine doctor is pretty unique in
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the sense that you can come from any background, whether it be family medicine.
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Pediatrics, internal medicine, emergency medicine, even orthopedic surgery.
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So I originally was able to complete my medical school in Galveston at UTMB,
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and I had the opportunity to go to family medicine residency there in Galveston for three years.
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I was chief resident my last year, and the opportunity presented itself to.
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Go to a sports medicine fellowship in Birmingham, Alabama, where I worked at
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the Andrew Sports Medicine Clinic and the American Sports Medicine Institute,
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where I was able to really get my hands on a really robust sports medicine fellowship
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from pro athletes to University of Alabama, West Alabama,
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Birmingham Southern, to high school athletes and middle school athletes too.
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So it was It was a great, diverse collection of patients that I was able to
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really develop a firm foundation for my sports medicine knowledge.
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And we're talking about concussions today. Our pediatric practitioner listeners
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know all too well about concussions where they happen too often.
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You were an athlete in high school in Flower Mound.
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Yeah, I wasn't a great athlete. I was actually more on the side of performing
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in drumline and doing competitions there, but I was an athlete for high school basketball,
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middle school football, and concussions are fairly common, especially in contact sports.
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Studies and data has shown that football, of course, has a high rate of concussions,
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but you can also see it in sports you don't even think about,
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cheerleading and soccer.
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Those are the top three sports that we see right now.
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Where you see the concussions? Yeah. Really? Yeah, those are the top sports
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that we see concussions.
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And then it differs when you get into the NCAA level because now you include wrestling and hockey.
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But football, cheer, wrestling, hockey, soccer, those are things to keep an
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eye on for concerns of a concussion.
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I was a cheerleader in high school. And there was one of our classmates who
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was on the top of the pyramid who was dropped and had a bad injury.
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But it didn't seem to have the recognition like it wasn't thought of as other sports.
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We competed and we did a lot of athletic things.
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But do you think that these other sports, soccer and cheerleading,
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are getting more recognized of the risk of a concussion and like football has
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for a number of years now? Yeah, because, you know, the most popular thing is football.
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Everybody knows that if you get hit, you get your bell rung,
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you may sustain a concussion. But again, it can happen in other sports.
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And whether or not there's a protocol to identify and then rehab those athletes,
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that has to be discussed and further research to define what is a great protocol
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for these different sports outside of football. ball.
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Our recognition and our observation and treatment of these athletes are continuing
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to get better and better and better.
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So it's becoming more apparent. People are becoming more privy to it.
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And that's just better all around for our athletes. And with cheerleading,
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I mean, you're on top of a pyramid.
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You're being thrown up in the air. I mean, it makes a lot of sense.
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Yeah, a lot of caution for that. It could be very dangerous. And luckily.
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USA Cheer has their own concussion protocol. We have our own concussion protocol at UTSA.
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And it's always important to have spotters available when conducting in tosses,
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basket tosses, pyramids, and also trying to protect themselves,
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protect their head and neck area if something happens where the pyramid does, you know, fall.
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So it's important to learn techniques on how to decrease the likelihood of head injuries.
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And all the gymnastics that's involved, front flips, back flips.
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Exactly. If you're up in the air, you're going to come down and hopefully you come down your two feet.
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Well, I'd like to put in there, we did win ninth in the nation my freshman year. Uh-oh. There we go.
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Awesome. I've always wanted to be able to say that in a public setting. There you go.
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And soccer, those hits that may seem not as serious, but it's so often.
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Can you tell us about that? So soccer, the main concern is, of course, is heading the ball.
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That can be a very serious force to the skull, causing some brain microtraumas.
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But also head-to-head collision is something that we see.
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Falling down flat on your face on the pitch is something that we see.
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So there are a lot of opportunities to get injured and have a concussion.
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And so it's just being aware of the possibility that is a possibility that if
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your patient, your student athlete,
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your daughter or son is having symptoms of headaches or dizziness after conducting
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in a contact sport like soccer, it'll be great for to get proper.
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It'll be great for you to get proper evaluation and really understand if this
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is a diagnosed as a concussion.
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So, Dr. Nwosuk, may I call you Kenneth? Dr. Ken, Kenneth. Ken is fine. Ken is fine.
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Ken, let's talk about that differential diagnosis.
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What would you want pediatricians to know?
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So, of course, getting a great history from the student athlete or their parents
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is key and it's essential to formulating a proper differential diagnosis,
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understanding if they lost consciousness, if they have any neck pain,
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headaches or dizziness, numbness or tingling in their upper extremities.
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Because the broad differential can include just a regular headache.
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Of course, it can include a concussion. Is this something like a stinger where
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you have a unilateral radiation of pain down an extremity?
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Or is this any other type of neurotrauma to the the head and neck area.
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So it'll be very important to get that proper history so you can formulate your
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diagnosis accordingly.
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And are there certain forms that you recommend?
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Is there something that make sure you use this form for that recognition?
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The recommended course of action in terms of identifying a concussion is to
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actually get baseline screening.
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So if you do have the opportunity to get baseline screenings with your local
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high school and athletic trainer, go ahead and do that, whether that's with
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the impact or even sway testing. Oh, this is before.
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So getting a baseline test before, and there's plenty of apps,
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plenty of products that you're able to get mass baseline testing at a given school.
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Do you recommend that pediatric practitioners suggest that to families?
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Yeah, it can be suggested, but the likelihood of it happening without backing
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of the actual school is very very tough so.
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It's understandable if it can't happen, but after the concussion is where you
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want to conduct a SCAT-6.
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The international conference determined that we update from a SCAT-5 to a SCAT-6,
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which is a questionnaire that the student athlete,
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parent, and yourself as a practitioner can fill out and evaluate through a clinical visit.
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And you're looking at cognitive function, you're looking at memory,
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coordination and balance, and also identifying certain symptoms and creating a scale.
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Practitioners, it's a fairly easy internet search.
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Child SCAT 6, as well defined by their age, or even a regular SCAT 6 if they
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surpass that age limit. it, found in the British Journal of Sports Medicine,
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also on the internet if you look up a PDF.
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But it's a great assessment tool to determine memory, cognitive function,
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balance, and also scaling their symptoms.
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What are the symptoms really where it could be something even more serious than a concussion?
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So one of the things you got to look out for is whether or not their Their brain
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and their skull is truly traumatized, leading to significant deficiencies in
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their neurocognitive function.
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So having a long-lasting bout of unconsciousness is an alarming sign.
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So longer than, say, how long? 30 seconds?
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It determines. So if it's more than 30 seconds or a minute, you just want to
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have the proper evaluation. evaluation, but you're going to have to use more
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of a clinical subjective sense on the duration of period.
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So if they have a long duration loss of consciousness, if there's any nausea
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or vomiting, if they have difficulty with vision or they can't see,
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those are things to watch out for. And those are the alarming red flags.
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Numbness and tingling in the upper extremities that,
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that is not coming back, that they don't, they lost that sensation and that
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sensation isn't returning.
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That's also an alarming sign and significant neck pain in which they cannot
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move their neck or they have extreme difficulty with just the basic rotation of their neck.
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That's again, a red flag to look out for.
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That means we need to go to the emergency room.
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We need, this is based off of evaluation on the field.
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All right. Because it could be a brain bleed. It could be a spinal cord injury.
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Exactly. It could be a spinal cord injury, number one. It could be a fracture of the cervical spine.
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It could be a traumatic brain injury that is most severe, leading to possible
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bleeding or contusion of the area.
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So that means do not pass go. Go straight to the emergency room for proper evaluation.
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And you say that every athletic program should have a trainer on site.
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Yes. So if your child or if your patients are participating in contact sports,
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it's always great to verify if there's an athletic trainer available during
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practices or during games because their level of training,
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they're able to identify injuries, including concussions, and be able to provide
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prompt evaluation and possibly even treatment to help them be seen by a physician afterwards.
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So it's always good to ask the school board, ask principal, ask coaches,
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do you guys have an athletic trainer on site?
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And then also promote the hiring and the position of athletic trainers within
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school districts and stadiums and soccer fields, baseball stadiums, everything like that.
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And to be on site at the games, at the practices even, would be ideal.
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If they can be on site at the practices, even better. We're also realistic that.
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You know, this requires a certain amount of funds, but it's an investment that can help save lives.
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And can you recommend that the pediatric practitioner, if he or she has time,
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to also communicate back to the coach?
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Exactly. So I always recommend communicating with the athletic trainer.
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I mean, if athletic trainer is not available, communicating with the coach,
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making sure that everybody's on page, Not only the student athlete,
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but the parents, the athletic trainer and the coaches to understand that,
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you know, especially if a concussion is sustained, that there is a return to
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play and return to full activity protocol.
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And it's five phases and you every phase you're adding a level of activity,
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adding a level of strenuous testing to see how their brain is able to tolerate that level of activity.
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And hopefully they're able to complete that five-phase protocol and go back
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to full contact, go back to full level of activity as normal.
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And the five phases you're talking about, is that something that could be handled
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in the community pediatric setting?
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Or would you recommend, is that a time to refer out to a sports medicine specialist?
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So I always, I'm a sports I'm a workforce medicine specialist,
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so I always recommend referring out, but it can be handled in the community
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with proper understanding of the protocol,
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proper identification of red flags, proper identification of signs and symptoms
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when the protocol is not going correctly.
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How it's written out. So if they're going through the five-phase protocol and
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they have symptoms, you want to make sure that they stay at that phase or even go back a phase.
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Because if you keep progressing them through that protocol, they're not going to feel any better.
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It's going to cause more harm. It's going to delay their return to play.
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So if you have the opportunity to refer out to a sports medicine specialist,
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this is something that we are trained in how to communicate properly,
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how to monitor properly, and have discussions with parents, athletic trainers,
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and coaches so that the student athlete can play to the best of their abilities when they feel.
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Right again.
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We recommend having a sports medicine specialist you can send to urgently.
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Like I know I help connect you to community pediatricians when they call me
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and they have a patient with a concussion.
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Exactly. Or multiple concussions.
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And you, I'm sure, often give your cell phone out to doctors so they can call you.
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Yeah, 100%. And it's always a great, you know, having that communication.
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It's always great because I can discuss, hey, these are my thoughts.
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This is how we should move forward.
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And actually, I think we should increase the level of care and maybe consider
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referring out to a neurologist or getting proper So having that communication
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physician to physician,
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practitioner to practitioner is very, very crucial for the management and care of a student athlete.
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And it can be really tough with a lot of these sports we're talking about because
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the athlete doesn't want to be put out of the game. And...
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And the coach doesn't want the athlete to be put out of the game. Yeah, sometimes.
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Sometimes. And then to be put back in after a concussion.
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In fact, we had one patient where a community pediatrician called me and the
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patient had been put back in five times.
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Concussion, concussion, each time getting a concussion. And that can be very serious. Yeah.
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And that's why identification, education of parents, of understanding and being
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an advocate for their student athlete will always be prime and key.
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Education for the student athlete themselves to understand the signs and symptoms.
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Hey, when you're not feeling right, make sure you speak up.
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Make sure that everybody around you understands how you're feeling in that moment.
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So the CDC has a great program called Heads Up that is a concussion educational
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tool for parents and coaches, athletic trainers, physicians.
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It's pretty much a basic, it's a basic program to identify the risks,
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especially with football, of a concussion, how to identify those symptoms and
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what are the next best steps.
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So when an athlete is concussed and is put back out there in play,
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the worst possible thing is to get what's called second impact syndrome,
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which can cause devastating long-term effects.
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So being hyper aware and having proper education of everybody around that athlete
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is going to be crucial to decrease the likelihood of long-term effects.
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And if you have, if there's an athlete who was put in, say, five times,
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got five concussions, what are some of those long-term effects?
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It's still debatable what exactly they are. So I can't really define this is
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what's going to happen because every patient varies.
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But the worst is going to be long-term.
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Permanent neurocognitive decline. And having significant headaches,
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having just neurodefects and neurodeficits that can just hamper their activity.
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The concern was that there's going to be neurocognitive decline and defects
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just down the line and stuff that can hamper their progression as a student,
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as they finish out high school, as they go into college,
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as they become a working adult.
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And that's something that we really hope that doesn't happen.
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And the worst thing would just be causing an actual traumatic event to the brain
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where it leads to actual brain injury, structural injury and damage,
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such as significant contusion or even a bleed?
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My cousin, Alex Smith, he was quarterback for the Kansas City Chiefs,
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and he got a concussion. Oh, that's your cousin? Oh, nice.
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He got a concussion as quarterback. He had the best record.
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Like the most consecutive starts or something like that? Was that it?
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I don't remember exactly, but something like that. Yeah, I remember it was something like that.
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Yeah, and so everything was going great. He got a concussion and talked about
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his symptoms and got pulled out of the game, had to take some time off to rest,
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followed the protocol, did the right thing.
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But then the coach hired someone else and he lost his job basically as quarterback
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for the Kansas City Chiefs.
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Do you think we've gotten better since then in terms of understanding how serious this is?
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Yeah. I think as years go on, we're always going to get better and better of
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understanding the impact of a concussion and also having empathy for athletes
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that have to sit out in order to recover.
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Unfortunately, when you get to the professional ranks, it's very much a business.
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So it's a little bit more difficult in terms of when you're sitting on the sideline
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recovering in terms of job protection.
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But luckily for high school and for For college, these student-athletes are
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protected, and they are very much so watched over as they recover through the
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return-to-play protocol.
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And essentially, every year, we're just getting better and better at advocating
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for these athletes and providing accommodations academically for them,
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too, so they can be a successful student also.
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One of the last games, my son played JV basketball for his high school.
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And one of his fellow teammates got, I mean, it looks like a really...
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Tough head injury and he was lying there on the
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court and his mom got up
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and yelled get up get up now and she kept yelling at him just to get up when
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he's lying there and i was just shocked that that's what she was yelling it
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just seemed and he eventually did and he was taken out of the game but the when
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they feel the pressure even from parents to get up right after you've been injured Yeah.
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And that's, you know, that's kind of the world that we live in now with AAU with seven on seven.
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I was there this weekend for AAU. Exactly. And an ambulance came,
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a crew, there was, it was actually a knee injury, one of the kids,
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but taken out on a stretcher.
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So it's getting, it's getting more tough where you're having the professionalization
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of amateur athletes in high school and college.
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So the stakes are getting even much more higher. so
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it's really just again boils down to having a foundation of education of what
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to watch out for and having the necessary staff at these competitions so if
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you have a tournament you know if you have a major tournament who's who who
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is actually watching for injuries are.
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Are these organizations hiring a and a prn athletic trainer and paying them
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to be on the sidelines to look at all the treat and determine the severity of injuries,
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if the EMS should be called, should you use their services.
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So it's going to be about education, providing necessary staff and support for
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athletic trainers in these areas.
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And hopefully this can kind of mend off the pressure from the professionalization
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of amateur sports. Yeah, it seems like there's a lot of pressure.
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And I could see these boys just playing their hearts out, but hopefully they're having fun still.
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Yeah, I had fun. So I'm not sure what they're having right now.
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Hopefully, I don't think they can just get like a shoe deal from their AAU tournaments.
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Hopefully, they're just they're creating connections with their teammates and
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actually having fun playing basketball.
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Yes it's like this who's watching it
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like adidas is here i'm like what do you mean adidas is here
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yeah why why does that matter yeah the odds are
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you know the odds back in the 80s versus the odds and
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now they're the same it's one in a million that adidas is gonna pay you to play
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basketball yeah they're still gonna you know the the greats that were there
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in the 80s probably play the same played less and had less pressure on them
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guess what they're still gonna to be great. And that's kind of what it is now.
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So it's hopefully, you know, there's just less pressure on, on student athletes
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are just meant to be student athletes,
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you know, not, you know, they're not going to go to the pros and that they can
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just enjoy their time with their teammates and with their coaches and with their families too. So.
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Is that what you recommend as parents that we say to our kids when we can?
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Yeah. You know, realization is always important and how you present it.
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That's going to, you know, that's your own, that's going to be your own thing, but.
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Honey, you might not make it pro. It's actually a pretty high chance you won't.
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Exactly. It's like, let's focus more on enjoying the sport.
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Let's focus more on, you know, if you do have the opportunity to play in college,
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focus on getting that degree. When you look at the stats, an average pro career
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is around two to three years, right?
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Even if you're great, even if you have the opportunity to get a college scholarship
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and get drafted, undrafted, and play in a professional league,
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your lifespan averages at two to three years.
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So if you're pressuring yourself
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to now just work for two to three years
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and not focus on all the outside stuff and a big thing right now is sports specialization
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so focusing on just one sport can actually hinder the development of just your
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body and of your the biomechanics of your body because you're not participating
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in other like track and field like soccer and you're just
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focusing on just football or just focusing on basketball or especially baseball,
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you want to be able to try different things to work on your coordination.
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So have fun, be a kid. Parents promote that. Have fun, be a kid.
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And also just educate yourself on identifying injuries, educate yourself on
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the resources around you.
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And hopefully that can just, you know, just Just let them be a kid and have fun at playing sports.
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And why with baseball? Is that because of certain injuries that happen?
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Yeah. As you can see now in the news, the biggest thing right now is Tommy John,
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Tommy John injuries, which involves the ulnar collateral ligament.
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And they're determining that the human body pretty much cannot sustain a level of.
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95 to a hundred mile per hour fastballs over and over again.
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And you can see things in, you can see several diagnoses in little league that
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involves like little league shoulder, elbow, avulsion fractures,
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because they keep throwing and there needs to be a period of rest.
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There needs to be a change in the environment, change in the sport because the
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intensity and And the repetition and overuse of pitchers'
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elbows and shoulders are just leading to an ultimate decline that if they do
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have the opportunity to play in college or in pro,
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they already worn out their arm that they're most likely going to tear their
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ulnar collateral ligament.
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So it's okay to play baseball, but also try to play another sport or just play during the season?
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Exactly. Play other sports, take a break, monitor the intensity and the amount
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of pitching, even outside of the games.
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What are you doing in terms of training?
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Is your athlete now pitching with the coach outside and then has their fall
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ball team and then their spring ball team that they practice with?
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It. So you have to monitor all this.
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And I also hope that you're plugging in your child into other environments to
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work on other body parts so they can be a well-rounded athlete.
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That's great advice. Let's take a case. So Samantha is a 15-year-old soccer
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player. She got a concussion.
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She was put back in the game and then she got a second concussion.
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What should the pediatric practitioner do? So again, getting a good history.
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So that's the baseline, getting a good HPI. You want to implement the SCAT-6.
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Go through that worksheet with the parent and the athlete.
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Go through the memory tests, the coordination and balance testing.
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And also go through just every page to make sure that they fill it out properly.
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With that SCAT-6, you're able to now do your own neuro exam,
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looking at all cranial nerves, looking at their coordination,
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their balance, their vestibular function,
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their specific tests, and develop a plan from that.
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And you're able to determine the extent of their concussion injury.
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So the first thing is always send them out, allow their brain to rest.
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Supplements like fish oil can help just with the rest and recovery after a concussion,
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making sure that they decrease stimuli.
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Of bright lights, loud noises, especially looking at their cell phone at night
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can cause a little bit more strain and photophobia.
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So try to stay away from that. If they can, you know, there used to be hard
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restrictions of going to a dark room and not sleeping.
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We have matured from that and understanding what we can do for the brain.
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So I think that if you just decrease stimuli that could exacerbate the pain, really focus on that.
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And then you have the option of continuing to follow the athlete until their
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symptoms return to zero to start the return of play protocol.
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Or you can refer out to a sports medicine specialist to assume care,
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have proper communication with the coach, athletic trainer, parents,
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and the athlete to now wait till their symptoms decrease and then start that
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return to play protocol.
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And do you want to reiterate, when would there be a case like this could really
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be handled easily in the community pediatric setting?
28:33
And then when is the edge? I'm going to refer you to a sports medicine specialist.
28:39
I think the case right now where there's maybe a multiple hit when there was
28:45
a possible concussion that they were pushed back in or they didn't know and
28:50
they just went back in and got hit again,
28:52
I think that's a great case to send to a sports medicine specialist.
28:55
I think a hit and they sat that out.
29:00
You can definitely treat that in the community, but it's also about how busy
29:04
is your clinic? Do you have time to do the SCAT-6?
29:06
Because that does take time to go over the questionnaire and figure out a plan from there.
29:11
So it's really practitioner and physician dependent on how they want to go about referring.
29:21
But sports medicine specialists can see pretty much anything,
29:25
any severity, and then assume care from there.
29:28
Can you say that your work at UTSA as the head athletic doctor helps your work
29:36
treating kids in the community and vice versa?
29:40
Exactly. So I have the opportunity to be the head team physician at UTSA and
29:44
all their sports team, including football, soccer, baseball,
29:49
men's and women's tennis, softball.
29:52
So pretty much 400 to 450 athletes.
29:56
Athletes and taking what I learned from their injuries and from their rehabilitation,
30:02
working closely with their athletic trainers, I'm able to now transmit that
30:07
knowledge to taking care of us in the community, you know, weekend warriors,
30:11
people that just jog on the trail on the weekend, people that just like to go out and walk.
30:16
You know, outside or play pickleball or play recreational basketball.
30:20
So using that, using UTSA as a place to develop and innovate and really use
30:28
research-based medicine to
30:30
now coordinate that and translate that to the community has shown great,
30:34
just great overall results for our patients.
30:38
And then not all patients are the same.
30:41
So even working with the community, having a clinic just specifically for the
30:47
community has helped me to understand certain diagnoses that I'm like,
30:51
hey, I actually saw that in my clinic.
30:53
Maybe this UTSA athlete has this and it's helped both ways. So it's a very,
30:58
very, I'm very, very happy with my practice.
31:01
It's very satisfying seeing that translational effect of treating high-level
31:06
athletes, treating the community and seeing how each one can help each other.
31:10
And do you see adults as well?
31:12
Yes. I see, yeah, I see adults.
31:14
And kids. Yeah. So you You see patients at the University of Texas Health Science
31:18
Center's new location at Kyle Seale Parkway and at the Medical Arts and Research
31:24
Center in the Med Center, or also known as the MARC. Yes, yes, yeah.
31:27
I see, they call it KSP of 1604 and then also in the Medical Center at the MARC, yeah.
31:33
So for our listeners in the South Texas area, San Antonio area,
31:37
we'll put that information in the chat. Pat, as an athlete in middle school
31:42
and high school, this is a dream come true to be doing what you're doing now?
31:47
Yeah, you know, I've always loved being part of a team, and being in sports
31:52
medicine allows me to be a part of that team, allows me to share accomplishments, have a common goal.
31:58
And the best thing about it is that every athlete wants to get better,
32:02
wants to get back on the field pitch, on the court, and it just helps me.
32:08
Really revitalize and provide the energy to really get them to where they want to be.
32:15
And Ken, what would you say to your middle school football playing self or your
32:20
basketball high school self? Keep studying.
32:25
That's pretty much it. Yeah. Keep studying. Yeah. Listen to your coaches pretty much. And have fun.
32:31
Yeah. Have fun. Have fun. You know, I had a lot of fun playing Well,
32:35
I didn't take it too seriously.
32:37
I did think I was going to go to the NBA at one point, but then I decided to be a doctor instead.
32:44
And it's worked out. Yeah, right.
32:46
Here on Pediatrics Now, we love quotes. I love quotes.
32:50
Is there a quote that inspires you? I know you mentioned there's a quote from the Bible that you love.
32:56
Yeah, 1 Corinthians 9.25. It's one of the verses in the Bible that actually talks about sports.
33:05
And it highlights just about training for pretty much a boxing match,
33:11
how that discipline and that focus that a boxer can put into their sport and
33:19
perfect their craft is the same type of focus and energy that you can put into your life.
33:25
And for me, that's also the same type of energy that I put into my sport when
33:31
I was younger or put into my practice right now is the same type of energy I
33:35
can put into my family, put into my community.
33:39
Put into my volunteer working in church.
33:42
So there's a lot of passion in sports.
33:45
And I believe that the purpose of sport is to develop that discipline and incorporate
33:52
that into your life in several different aspects.
33:55
And that's the way, that's how I find my joy knowing that if I get this athlete
34:00
back to playing sports to the best of their ability, they can use that to now
34:04
translate that to their life,
34:06
to the relationships that they have, to their spirituality, to different things.
34:12
That can inspire others.
34:13
Do you want to read it to us? Oh, yeah, sure, sure.
34:17
1 Corinthians 9, 24 through 25, and the passage is titled The Need for Self-Discipline.
34:24
It states, Do you not know that in a race all the runners run,
34:28
but only one gets the prize?
34:30
Run in such a way as to get the prize.
34:33
Everyone who competes in the games goes into strict training.
34:37
They do it to get a crown that will not last, But we do it to get a crown that will last forever.
34:44
So using that and just make sure that, hey, like the same energy,
34:49
I got to use that to translate it to energy for, you know, things that really
34:54
matter and formulate things that really matter in the relationships that I have.
35:00
That's wonderful. And we also like to promote, and Pediatrics Now,
35:03
doing stuff outside of medicine to help recharge in this high-stress,
35:09
high-burnout career. What do you like to do in your spare time?
35:12
So I'm still figuring it out because I have a little 11-month-old son.
35:16
Congratulations. I appreciate that.
35:18
So it's really just hanging out with him and my wife when we can,
35:23
watching some Netflix shows, taking a walk in our neighborhood.
35:27
We do like trying out different restaurants and places to go for lunch.
35:34
Being in the hill country is very beautiful.
35:36
So we try to take advantage of that.
35:39
Do you feel like being a father has changed you?
35:41
I think so. I think, you know, you think about, first of all,
35:45
you think about paying for college.
35:46
I'm like, what is the price of college going to be like in 2040?
35:50
You know, I went to Baylor and And I was like, okay, yeah, I don't know if he can go to Baylor.
35:56
You know, they're assuming all this. I saw a calculator the other day.
35:59
I was like, okay, this is a lot.
36:01
But so, so that, that right there already puts a pressure on your plate.
36:05
But I think just, just knowing that you have somebody always looking at you
36:11
for, for support, you know, my, my wife said the other day, like,
36:16
did you know, like we're his whole world?
36:18
Like he, he really doesn't, he has no other friends but us.
36:22
I was like, he's looking at us for entertainment, for food, for water, for nurturing.
36:28
I was like, yeah, that's true. I say it's the hardest, best job in the world.
36:32
Exactly. Exactly. Exactly.
36:35
Ken, it's such an honor being here talking to you today in the podcast studio.
36:39
Is there anything you want to mention before we wrap?
36:42
No, I think this is great. I think, again, just wrapping up,
36:47
just education is the main thing. CDC has a heads-up program on their website.
36:52
They have just a free program to educate yourself on concussions.
36:57
UT Health San Antonio is doing a really good job of developing our sports medicine
37:02
program and having a concussion pathway and open for referrals.
37:08
And also, just God bless and birds up.
37:13
Dr. Ken Nwosa with the University of Texas Health Science Center or UT Health San Antonio.
37:18
And the UTSA head doctor for athletics.
37:22
Thank you for being here on Pediatrics Now. Thank you very much.
37:26
Are we going to have a good football team this next season? Oh yeah, you better be.
37:30
Music.
37:36
Coming up next week, a Grand Rounds talk about child neglect.
37:41
So neglect is usually typified by an ongoing pattern of inadequate care,
37:46
and it can actually do as much damage as physical abuse.
37:53
I'm Holly Wayment. Thank you so much for listening.
37:57
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38:01
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38:05
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38:10
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38:15
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38:20
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In our sister podcast, Pediatrics Now for the Busy Parent, we include most of
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38:43
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38:56
It's meant to be one less thing you have to say in the exam room.
39:01
I love this quote by Nelson Mandela, history will judge us by the difference
39:06
we make in the everyday lives of children.
39:09
Thank you for making a difference.
39:11
I'm Holly Wayment, and you're listening to Pediatrics Now.