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Advanced Imaging to Guide Brain Injury Care

8/27/2019

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Contributed by Center for Diagnostic Imaging 

Brain injuries are complex and can impair a person's physical and emotional functioning. They can be traumatic, resulting from accidents, falls or contact sports; or non-traumatic, resulting from strokes or aneurysms. Severe brain injuries can be difficult to treat. For all types of brain injuries, advanced imaging tools and expertise aids in accurate diagnosis and guiding a care plan.

Diagnosis and Treatment Planning
The treatment of head injuries depends on the type of injury and the severity. To assess the severity of a head injury, a physician may perform a physical and neurologic exam and imaging tests such as: 

COMPUTED TOMOGRAPHY (CT)
A CT of the head and brain is often used as a first imaging test when a concussion is suspected. It is useful for detecting bleeding, swelling, brain injury and skull fractures.

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MAGNETIC RESONANCE IMAGING (MRI) 
An MRI is helpful in detecting small hemorrhages or bruises, and monitoring changes in brain structure and function. It is especially useful in treatment planning.

  • Can provide a benchmark brain scan for athletes or other patients who may be at higher risk for brain injuries
  • Should be considered to evaluate a patient with concussion symptoms lasting more than seven days
  • Should be considered to evaluate changing neurological symptoms 

VOLUMETRIC BRAIN IMAGING
This is performed with MRI post-processing software that provides objective, quantitative volume measurements of two conditions that can result from a brain injury: hydrocephalus and atrophy of the hippocampus.

SUSCEPTIBILITY-WEIGHTED IMAGING (SWI)
SWI is an MRI protocol run at a high resolution, increasing the ability to detect subtler injuries in patients with concussions/traumatic brain injuries, hemorrhages, neurodegenerative diseases and a variety of lesions.

​Learn about CDI’s outpatient medical imaging centers throughout Puget Sound and their specialized clinical teams and services at myCDI.com. ​
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3 THINGS YOU CAN DO TO SPEED UP YOUR RECOVERY

8/22/2019

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Article Provided by Holly Pennington, Outpatient Physical Therapy
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 With each step, you grunt, remember yesterday’s run and ask yourself some version of “why now?” Why do your legs feel like they weigh 200 pounds each? Your mind scrolls through the usual suspects – hills, speed, a new class at the gym, coming back from vacation. None of them fit. You have done this same exact run hundreds of times and your legs have never felt like this the next day.
     Post-exercise recovery science tells us that much more goes into the creation of muscle fatigue than meets the eye. Complicated biological systems co-mingle to birth “Maybe I’m too old for this” trains of thought and make pinpointing the cause of our sore muscles impossible. But, thankfully, scientists can point us to a few action steps to make the morning surprise of tight, tired things much less common.
  1. 1.     Increase your VO2 Max. Wait. What? How do you just do that? When I think of VO2 max, images of Lance Armstrong turning in freakishly high numbers while spinning in a laboratory chamber come to mind. Not exactly helpful. However, the reality is that we all have a VO2 max – an amount of oxygen we take in during exercise – and it can increase with specific types of training. Research has shown that athletes with a higher VO2 max recover more quickly between bouts of vigorous exercise. So, how do you improve your VO2 max? High-intensity interval training. (I know, I know, if you had a dollar for every time this was the answer to your training woes…) Recent studies have shown that 6-12 interval bouts of 2 minutes each is enough to increase VO2 max. So, the real action step for improved recovery is simply this: add at least one interval workout to your weekly training schedule.
  2. Remember that rest and recovery are not the same. When we are moving, blood flows to the muscles and promotes the resynthesis of substances, such as C-reactive proteins and glycogen stores, to help tissues return to their normal state. Blood flow also facilitates the removal of protons. This is why there is ample research to support active recovery. Light intensity exercise (less than 50% of maximal heart rate) between interval bouts, following workouts or the day(s) after races can speed the rate of muscle healing. Most athletes overdo active recovery, so monitor your heart rate and make your recovery sessions uncomfortably easy!
  3. Find a good massage therapist. Delayed Onset Muscle Soreness (DOMS) is the technical name for those 200 pound legs, and one of the best prevention strategies for DOMS is traditional massage therapy. A 20-30 minute massage immediately following or up to 2 hours after a workout has been shown to decrease DOMS for up to 3 days after exercise. It also provides many other post-exercise benefits, such as a reduction in perceived fatigue, cortisol levels and creatine kinase concentrations. Many athletes utilize massage as a tool for recovery from injury, but science tells us it is one of the most effective ways to recover from exercise. Find a massage therapist who is willing to listen to you, adjust pressure based on your feedback, and work with your training schedule.
      These three post-exercise recovery tips will help keep you training without leg setbacks or mind games about why your body feels tired. Set yourself up for success by being intentional about your recovery, not just your training!
 
Have an ache or pain that’s keeping you from training the way you want? Outpatient PT offers free consults with Board Certified Physical Therapists at every location: Covington, Maple Valley Kent, Renton, Auburn and Puyallup. Need a good massage therapist? Schedule one for right after a long workout at any Outpatient PT clinic! www.outpatientpt.com.
 
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932411/
https://acewebcontent.azureedge.net/SAP-Reports/Post-Exercise_Recovery_SAP_Reports.pdf
            

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Casco Bay Swim/Run -  FUN!

8/14/2019

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PictureThis isn't us - but were dressed a lot like this and also smiled a lot!

Cheryl Iseberg and I did the Casco Bay Swim/Run in Portland, Maine last Saturday. SO FUN!!!!!  Cheryl and wrote this report on the plane home passing my laptop across the aisle.  My words look like This - her words look like This. It's wordy...we were amp'd up!

Patty: My personal finish line drought ended  Saturday when I crossed one with buddy and race report co-author, Cheryl Iseberg at the Odyssey SwimRun Casco Bay in Portland, Maine this weekend. I agreed to do this race with Cheryl when I saw her request for a partner quite a few months ago. I’d heard about these races.  You swim. You run. Over and over. You get tied up to your partner, dress funny...sounded great to me!


Cheryl: This ain’t no triathlon.  Retired from Ironman means I am free to try new things but put all those endurance miles to good use.   Swim/Run is a new sport in its infancy that is crazy fun to do plus new and different equipment! Who doesn’t love new gadgets?  Having done 2 Swim/Runs last year Georgeta Gruescu I was anxious to sign up again this year and was looking for my next victim.  Scratch that. Recruit. Scratch that. Partner. We registered as team “What time is happy hour’. 

It turns out most partners train together for these things - at least a few times. Cheryl and I did one Lake Sawyer Swim/Run about a week before. With my mostly-borrowed gear (thanks Matt Morrisson!) we got our paddles, tethers, shoes, carabiners, cups, flasks, belts, etc all sorted out and met at the airport Friday morning.

Next stop?  Boston via plane. Next stop find the bus going to Portland.  Next stop engage Uber to hotel. Next stop ferry ride on race day to Long Island.   The only thing we didn’t take to get to this race was a train...wonder if that will come in this race report later?   
Race day morning greeted us with good weather and lots of other athletes ready to do this.  We gather and pull on our gear and wait for the start. Think about if you had to strap on your food and water, a pull buoy, paddles, and run in your running shoes during a triathlon.  Then picture running in your wetsuit while wondering where your goggles and swim cap were (they’re on your head).  
OK ready set go.   Now think about during that first 1.5m run to your first swim - you look at your  vicitim/recruit/partner and think “dang this could be a long day”.

If the whole race  felt as awful as the first run, we probably wouldn’t have the strength today to type this race report.   But after we got (way too) warmed up and jumped into the water, everything felt better. There were 6 swims - all different. We used a stretchy tether attaching us at the waist. Great for me - rough for poor Cheryl who had to figure out how to keep the tether out of her way. 

PictureThis actually is us. Look! Still Smiling!
Wait WHAT?  I have to tether to someone to swim as well?   Well how the heck does that work? Trust me sometimes it doesn’t.   Caribiners are sliding around and wait, what is also on this dumb caribiner?  A plastic cup to drink out of at the aid stations? LIttle did we know that dragging those cups of water through almost 3 miles of swimming would impact our swim times so much…. like by hours...hah.  Maybe not. I think it was the unpracticed transtions into the swims. Swim exits were much smoother. Swim entries went something like this.   
Patty - “ready?”  
Me - “no where are my goggles”
Patty - “ready?”\
Me - “ no where are my paddles”
Patty - “ready?”
Me - “no where are we? And where are we going?”


Eventually Cheryl would give me a ‘go’  (or was that a ‘no’ that sounded more like a ‘go’...whatever) and off we went.  We swam through kelp, cold water, warmish water, and currents. The volunteer and pre-race briefing made a big deal about paying attention regarding the swim - knowing the tides & currents (huh?) and not getting swept out to the ocean and picked up by a rescue boat..  We listened, we took notes, we wrote on ourselves with sharpies…. It turns out we are good swim buddies! Unless we clotheslined a lobster buoy (ohps) or needed to get peanut butter and jelly spit off the inside of our goggles, we swam steady and straight - and we passed people!!! 

When not staying out of the ripping current or plucking kelp off our heads we were running (well ok call it whatever you want).   The runs varied from rock scrambles (stay low, poison ivy high), beach runs, forest trail runs, running on the road, and running on a sand bar (ok, walking).  A very unique area between the last few islands had a ripping outgoing tide in only about 2 feet of water so you couldn’t swim all of it. We walked half of it until we had enough water to swim and thankfully it was not in the outgoing tide.  It felt like a river current under your feet and that was no joke across that channel. We had some hard work behind us with a long 3.5 mile run that felt like 103.5. There is nothing like the sun, gear hanging off you, running in a wetsuit, and shoes full of sand to make you feel like you are out of shape, old, and, well, out of shape and old.   
One more long swim in the ripping tide and a good run to close out the race.   What will happen next? Will we make it across that channel and do what the volunteers said “STAY RIGHT”.  Will Patty make the right decisions or lead us into the Casco Bay shipping channel?  
​

Well...we made it without incident to the finish line and that last swim and run were really wonderful.   I remember when I used to race a lot, there was this tension toward the end about wanting to get a great finish time but not wanting it to be over. I really felt that yesterday with Cheryl. At the end it was a fun downhill finish, an energetic finish line, a wonderful announcer, and sights and feelings to soak in and remember.  It was about adventures and sharing the experience with a good friend.  

A beer at the finish?  Well sign me up! She poured most of it out...This is a great experience for two old (old as in we have known each other a long time not because we are actually old) friends, two new friends, or just two people who literally want to “hang” together via a tether for a few hours.   These races are fun, challenging, and a great way to do something with someone else. They tell you that up front to look out for each other and that is what you do. We have done alot of crazy things but this takes the cake. A great weekend of adventure, endurance, swimming, running, and well cocktails cause you know what time is happy hour?

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DOING WHAT YOU SUCK AT

8/6/2019

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Article written by Phil Kriss of Kriss Chiropractic
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k It’s easy and comfortable to do what you are good at. It may be hard, but since it is in your psyche “that’s cool, this is fun”, it may be difficult but enjoyable. Chances are you are pretty good at it. Top Maple Valley Chiropractor Phillip Kriss explains the importance of getting outside your comfort zone.
It’s easy to do what you love! If swimming is your passion, you probably find yourself in the water 3 or more days a week doing very difficult workouts. And, it likely is enjoyable!
There are some who may not have the same passion. When they do make the occasional water appearance, it can be with apathy and sarcasm resulting in lack of effort. (That’s me!). Not only will it hurt that person’s performance via poor mindset, but it can pollute others who think swimming is really cool!
Even if you do something you really love to do and are good at it, finding room for improvement is necessary and beneficial. It is important to make your strong suits stronger.

ADDRESSING YOUR WEAKNESSES
​However, everybody has a weak spot that needs to be addressed. If anybody is going to make progress, they must work harder on the weak spots than they do the strong suit.
Weak spots could be swimming, biking or running. It could be strength training. It could be nutrition. It could be your health. It could be your head space. It could be your lack of time. It could be you hate getting up in the morning (because you stayed up too late eating junk food while drinking excessive amounts of bad for you stuff while on a Netflix or YouTube binge). Ever make that choice? Doesn’t make getting up at 4:30 to work out sound like much fun now, does it?
Making a positive change is not as difficult as we may think it is. Much of it has to do with who we hang around with.
So, find people who successfully do what you need to do and do what they do!
I had a most interesting conversation with a then unknown running buddy of mine many moons ago. I heard he ran the famed 20.5 mile “Orting Death Loop” each Sunday morning at 4:15. I needed to do that since my running long distances sucked. I found him on Facebook. We agreed on the time. Having never met him before, I opened the conversation with “I hope you don’t’ think I am too much of an a#*^($e, because I am going to run with you each Sunday unless I am racing”. We became best of friends. The group grew. They all became my friends and story-telling comrades. I made it to Boston several times. I got sucked into the Ironman thing. I met my wife Heidi when she showed up to run one day! Amazing how that story turned out. After not too long the 20 mile run was a piece of cake.
The marathon became easy, not because of my super great talents, skill or determination, but because of those I hung around those that spurred to think bigger than I had thought. I didn’t want to fail largely because of them, and they encouraged me to suck it up and keep going.
It confirmed the truth anybody can accomplish almost anything they want, provided they are willing to pay the price necessary for success.
Just one word of advice…Don’t be telling the successful thinkers what your stinking thinking brain really thinks. Keep your fat mouth and loose tongue shut and paste a smile on it until it becomes real!

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