Why Doctors Shouldn’t Be Too Quick To Diagnose a Child With a Concussion Rather than Mild Traumatic Brain Injury


Posted on 22nd January 2010 by Gordon Johnson in Uncategorized

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I have been fighting the labels and the distinctions about what you call the subtle damage to the mind as long as I have been an advocate. See my essay “Mind Damage” at http://tbilaw.com/essays.aaname.php Yet, according to new research, the labels make a huge difference in the perception of the severity of the injury.

According to this research, doctors apparently have to choose their words carefully when they’re talking to parents about their children’s head injuries. The study was published online this week by Pediatrics, the journal for the American Academy of Pediatrics. The study received a lot of play in the consumer press, with outlets such as The Los Angeles Times and UPI writing about it. See http://latimesblogs.latimes.com/booster_shots/2010/01/you-say-concussion-i-say-brain-injury-lets-call-the-whole-thing-serious.html

The bottom line of the research was that when a physician uses the term “concussion” rather than “mild traumatic brain injury,” parents don’t seem to believe that their child’s brain has really been damaged.

The Pediatrics article was headlined “My Child Doesn’t Have a Brain Injury, He Only Has a Concussion.” http://pediatrics.aappublications.org/cgi/content/abstract/peds.2008-2720v1

The research, conducted at McMaster Children’s Hospital in Canada by McMaster University, noted that doctors may choose to use “the concussion label” because it’s less alarming than the term mild brain injury. But the word “concussion” seems to imply to the parents that the injury is not serious and will have no long-term consequences for their child, the study found. Yet it’s known that’s not the case.

“Our study suggests that if a child is given a diagnosis of a concussion, the family is less likely to consider it an actual injury to the brain,” the study’s lead author, Carol DeMatteo, said in a press release on the research. “These children may be sent back to school or allowed to return to activity sooner, and maybe sooner than they should. This just puts them at greater risk for a second injury, poor school performance, and wondering what is wrong with them.”

Children diagnosed with a concussion were released earlier from the hospital, and returned to school quicker, according to the study. Yet it’s known that concussions can have serious after effects, including depression, memory issues and headaches. And returning to former activities, such as sports, before the brain damage of a concussion has healed can lead to dire health problems.

The concussion diagnosis was “significantly more likely” when the computed-tomography results were normal and the child had lost consciousness, according to the study.

The takeaway has to be that physicians should not be too quick to label a child as having a concussion, even if it is a less worrisome term than mile TBI.

Brain Damage Can Kill Too – Car Pedestrian Collision Kills 104 NY Legend


Posted on 11th January 2010 by Gordon Johnson in Uncategorized

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I know it is a continuing oversight by me, but the reality is that brain damage does not only disable, it can kill. In fact statistically, about the same number of people die each year from brain damage as those who have severe brain injury. Now I could be wrong about that, because that is a statistic I have kept in my mind for over 15 years, and perhaps. we are doing a little better with keeping people alive.

Today, one of the world’s most interesting people died. He survived boxing, acting and old age, to be struck down in the prime of his life, at 104 years old, by a minivan. The New York Times told the story exquisitely well. Reading the story I felt like I reading the first chapter of a great novel. Carnivals, Coney Island and all of that lost colorful history of New York and America when we still believed what is says about welcoming immigrants on the Statue of Liberty.

Anyone who was a fledgling reporter on any newspaper, knows about writing obituaries. Yet when it came time to tell the story of Joe Rollino’s life, Manny Fernandez and Michael S. Schmidt of the NY Times did all Pulitzer Prize hopefuls, proud. The story is and the character they portray such a delight, I don’t even want to quote it hear. I am thankful that there are those like Joe Rollino who make it to 104. I am saddened that a life lived so well, could end so quickly because of brain damage. I am proud of the profession of which I was first trained that the NY Times reporter saw that this was not just a story about who survived Joe, but about the life he lived.

The story is so good I don’t want to even quote from it or sum it up. Read it. It is a great story. http://www.nytimes.com/2010/01/12/nyregion/12ironman.html?hp

Mike Leach Firing Clearly Justified by Evidence of Abuse of Brain Injured Athlete

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Posted on 3rd January 2010 by Gordon Johnson in Uncategorized

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Texas Tech has won its bowl game without the Concussion abuser Mike Leach as its head coach. Leach was fired on Thursday, just before his hearing to force reinstatement. The court case was odd, especially since Leach chose to try his case in the media with out of context claims of support from the team doctor and trainer. As reported by the New York Times, neither the trainer nor the team doctor are supporting his treatment of Adam James. See http://www.nytimes.com/2010/01/03/sports/ncaafootball/03leach.html?hp

A Texas Tech athletic trainer said he was told by the fired coach Mike Leach to lock wide receiver Adam James in the dark after doctors determined that he had a concussion, according to an affidavit released Saturday by the university.

According to the NY Times story:

In a Dec. 21 interview with a university investigative attorney looking into James’s treatment, Steve Pincock, Texas Tech’s head football trainer, said he told James he was sorry about placing him inside an equipment shed on Dec. 17 near the practice field. According to the affidavit, Pincock also said he was not aware that any other player had ever been treated in such a manner.

“I do not agree with this form of treatment for anyone,” Pincock said in the affidavit.

In describing what Leach told him to do, Pincock quoted the coach as using graphic and profane language about locking James in a dark place, according to the affidavit. Pincock also told the investigator that Leach “wanted James to be uncomfortable,” the affidavit said. Pincock did not return a message left on his cellphone or reply to a text message Saturday.

Despite Leach’s media claims, the team doctor did not support the treatment of James, either. According to the NY Times:

In another affidavit released Saturday by the university, the team physician Michael Phy told the investigator on Dec. 22 that James “may not have been harmed,” but that Phy considered “this practice inappropriate.” In the statement announcing Leach’s firing, Texas Tech said Leach’s actions put James “at risk for additional injury.”
As I said on one of my other blogs last week, while isolation does not necessarily expose the injured brain to any new physical forces, it can expose the brain to additional stress, which can result in further Post Concussion Syndrome problems. See http://blog.subtlebraininjury.com/2009/12/texas-tech-isolation-for-concussed.html

Last year was a remarkable year for concussion awareness, but we are only scratching the surface of treating the secondary effects of concussion, especially those that involve emotional stressors. I hope the Leach chapter stays in the media focus long enough to get some of the leading thinkers on concussion to educate on this issue further.

Health Care Reform Now Awaits Reconciliation


Posted on 27th December 2009 by Gordon Johnson in Uncategorized

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The New York Times is the world’s best newspaper. I learned that in Journalism school almost 40 years ago. It is still true today. Like all newspapers, it is at risk of failure because of the revolutionary shift in advertising revenues caused by the rise in the internet. I never subscribed to the New York Times, because I was a Midwesterner and it just didn’t seem practical. Well the NY Times is now part of my daily reading, because they have perhaps the best online newspaper: http://nytimes.com. I sure hopes the webpage helps the newspaper survive.

I was newly impressed with the NY Times this morning when I read their analysis of the two health care proposals in our Congress, the House version and the Senate version. I think it is a must read for anyone concerned about the health care debate, or about the health of brain injured people. That article is here: http://www.nytimes.com/2009/12/22/health/policy/22health.html?hp If you are required to register to get to this page, by all means, register. In fact, make the http://nytimes.com your home page, I did.

This article has the most comprehensive explanation of the two bills in Congress and a simple and reasoned explanation of which aspects of each bill should be retained. We hope that our Senators are capable of seeing the big picture and allowing small compromises to get this historic legislation passed. We hope our progressive colleagues in the House don’t blow up the coalition on Health Care Reform over a liberal agenda that can wait for another day.

Read the details. This comes under the category of things you need to know as a citizen.

Health Care Reform Gets Over its Biggest Hurdle


Posted on 24th December 2009 by Gordon Johnson in Uncategorized

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Congratulations to Harry Reid for getting a health care reform bill thru the Senate. After 50 years of effort, the Democrats have almost done it. The next step is reconciliation with the House version and even though the outcome isn’t perfect, it is a huge step. While President Barack Obama has gotten criticism from every direction in the process, he must get high grades for this achievement. When he signs a Health Care Reform bill into law, it will be a moment in history as historic as his election.

I admit that there have been times in the last few weeks when I wondered if the special interest control of our legislatures might ultimately mean that the American system of making laws was broken. But Obama, Reid and Pelosi have found a way to get this done. The found a way to get it done despite the most intensive lobbying effort in history and a complete blockade of legislative cooperation by the Republicans.

Is this the bill that would have best for me? Of course not. I would have preferred the Medicare buy in at 55 because of course, I am 56. Is it the bill that would have been best for all Americans? Probably not. But is it a tremendous step towards coverage for all? Yes it is. After 50 years of nothing, after the collapse of the last major attempt led by two of the great politicians of the last 50 years, Bill and Hillary Clinton, to get this bill out of the Senate is remarkable.

There is some sausage making left over, but when it is done, millions will have health coverage that didn’t, and even though it isn’t everyone, it is still millions whose will have access to medical care.

Bush versus the Trial Lawyers


Posted on 11th September 2009 by Gordon Johnson in Uncategorized

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It is 9/11 today and a good time to reflect on the direction our country has taken this decade and the role trial lawyers can play in our safety and future. In his address on health care reform to the Joint Session of Congress on September 9, 2009, President Barack Obama gave a game changing speech about the overwhelming need for health care reform in the U.S. Yet two incidents from that speech standout in the media and public perception of what he said. Those two incidents were the “you lie” comment from Congressman Joe Who and the Republican enthusiasm for Barack’s discussion of medical malpractice reform. In coming blogs, we will address the high points of what he said about health care reform, but on 9/11, I think it is important to defend the role of American Civil Justice lawyers, in contrast to the havoc that the Republican’s have left us over the last decade.

The Republicans want to blame it all on the trial lawyers. We liberal Democrats want to blame the Republicans for destroying American legitimacy in the world in their endless pursuit of Corporations first and their politics of being tough on national security. Keith Olberman on his show Countdown before the President’s speech said the major issue in the domestic politics of the last 100 years was whether our government was on the side of the Corporations or the people. The competing interests are clear, but it is not just domestic politics which illustrate the danger of choosing Corporate interests over people. In our so called “War on Terror” we chose Corporate warfare (or was that Welfare) versus lawyers.

Two detours on my career otherwise devoted to brain injury advocacy over the last two decades arose out of the events of September 11, 2001. The first, I became an outspoken critic of our first War on Terror and the invasion of Afghanistan. The second, I became part of the first lawsuit filed against the Airlines for 9/11. Those two footnotes to my career do illustrate why we need a lot more Civil Justice and a lot less Corporate first government.

My first public statement about the War in Afghanistan was spoken before my church congregation the Sunday after 9/11. I stood up, without an invitation, and reminded my fellow parishioners of our church’s commitment to peace during a Vietnam, a commitment that had shaped my thinking as a teen, had a major influence on who I became as an adult. I told them that you do not start a war to catch a criminal. Punishing a criminal is a job for laws and lawyers, not armies of crusaders.

I wrote these words about Afghanistan on October 30, 2001:

As the political consensus which propelled American into war starts to fade, the Republican’s and their talk show hosts, remind us of the promise of Bush and Rumsfeld that this would be a long war, that American’s will have to be patient.

I remember an amused arrogance when the Russians invaded Afghanistan circa 1979, somehow clearly remembering James Michener’s portrayal of the country. I am rereading Caravan’s (a James Michener novel copyright of 1963). It is quite prophetic. A passage worth reading with care:

“In Afghanistan, almost every building bears jagged testimony to some outrage. Scars still remained of Alexander the Great or Genghis Kahn or Tamerlane or Nadir Shah of Persia. Was there ever a a land so overrun by terror and devastation as Afghanistan.”

Then later, his character, the Afghanie engineer with the runaway American wife, tells the narrator, an American diplomat, this story of the ancient oasis where they are spending a night.

“Genghis Kahn destroyed Afghanistan. In one assault on the City he killed nearly a million people. That’s not a poetic figure. It’s fact. In Kandahar the slaughter was enormous. Some refugees fled to this caravanserai… this room. They were sure the Mongols wouldn’t find them here, but they did.

“First Genghis erected a pole right through the roof. Then the Mongols took their prisoners and tied their hands. Laid the first batch on he floor over there and lashed their feet to the pole. All around. That’s why the pillar is twelve feet across.

“They just kept on laying the prisoners down, one layer on top of the other until they reached the roof. They didn’t kill a single person that day, the Mongols, but they kept soldiers stationed with sticks to push back the tongues when they protruded. And while the pillar of people was still living – those that hadn’t been pressed to death – they called in masons to plaster over the whole affair. If you’d scrape away the plaster you’d find skulls. But the government takes a dim view of scraping. Its a kind of national monument. The Caravanserai of the Tongues.”

“I tell you these things only to explain the terrible burdens under which Afghanistan has labored. Our major cities have been destroyed so many times. Do you know what I expect … seriously. When a thousand men like me have rebuilt Kabul and made it as great as The City once was, either the Russians or the Americans will come with their airplanes and bomb it to rubble. “

I wonder, does George W. Bush believe that we American’s can win a war of patience against such a people? Perhaps we can declare victory when we have evened the score by killing 5,001 Afghanies. If not, Osama bin Laden’s goal of an Islamic uprising, deposing all western leaning Arab monarchies, will be built upon a foundation of silenced but never forgotten Afghanie tongue.

What does this story have to do with Medical Malpractice reform and the Republican commitment to Corporate World? I will discuss further my actions as a lawyer in 2001 in my coming blogs, and the reader can decide whether the trial lawyers or the Republicans chart the course our country should follow. Know this though, our mess in Afghanistan is getting deeper and the liberal Democratic president of whom I am so proud is at a crossroads decision point to send another 30,000 troops their to pacify the country. If he listens to the politicians and generals and not the historians, our attempted occupation of the unoccupiable country, may be remembered in infamy as long as Genghis Kahn.

Next. You don’t start a war to catch a criminal. That is what the laws, lawyers and the Courts are for.

White House putting off budget update


Posted on 20th July 2009 by Gordon Johnson in Uncategorized

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Healthcare reform, Wallstreet’s collapse and rebirth, unemployment and huge deficits. A hell of a time to finally get the kind of leader this country has needed for a decade. Money and American politics, money in American politics should be on center stage this summer. But it has been a big news cycle of deaths and so far from any upcoming election that only the wonks really seem to notice.

Here are the facts: our economy is in decline and unless we can find ways in which to generate greater economic activity at home, we are going to continue to fall further and further behind. 10% unemployment isn’t a surprise, unless you really believed what the politicians were saying (even Obama) when things looked the darkest. Wall Street can recover, but that doesn’t mean the American economy will recovery. Most of Wall Street’s numbers are based on trading, not production and what production these American companies are doing is overseas.

Regardless of how deep of a hole it seems to put us in we must have economic stimulus from the Federal Government. The complex issue is how we turn that stimulus not only into short term American jobs, but into making the American economy stronger, more competitive, greener. It seems such a logical thing to combine Obama’s idealism on these green issues with the economic needs of our country. But economic planning is complex and thwarted at every turn by special interests.

Time for true leadership in Washington and lets start by telling the truth.

Attorney Gordon Johnson

Date: 7/20/2009 10:08 AM

TOM RAUM,Associated Press Writer

WASHINGTON (AP) — The White House is being forced to acknowledge the wide gap between its once-upbeat predictions about the economy and today’s bleak landscape.

The administration’s annual midsummer budget update is sure to show higher deficits and unemployment and slower growth than projected in President Barack Obama’s budget in February and update in May, and that could complicate his efforts to get his signature health care and global-warming proposals through Congress.

The release of the update — usually scheduled for mid-July — has been put off until the middle of next month, giving rise to speculation the White House is delaying the bad news at least until Congress leaves town on its August 7 summer recess.

The administration is pressing for votes before then on its $1 trillion health care initiative, which lawmakers are arguing over how to finance.

The White House budget director, Peter Orszag, said on Sunday that the administration believes the “chances are high” of getting a health care bill by then. But new analyses showing runaway costs are jeopardizing Senate passage.

“Instead of a dream, this routine report could be a nightmare,” Tony Fratto, a former Treasury Department official and White House spokesman under President George W. Bush, said of the delayed budget update. “There are some things that can’t be escaped.”

The administration earlier this year predicted that unemployment would peak at about 9 percent without a big stimulus package and 8 percent with one. Congress did pass a $787 billion two-year stimulus measure, yet unemployment soared to 9.5 percent in June and appears headed for double digits.

Obama’s current forecast anticipates 3.2 percent growth next year, then 4 percent or higher growth from 2011 to 2013. Private forecasts are less optimistic, especially for next year.

Any downward revision in growth or revenue projections would mean that budget deficits would be far higher than the administration is now suggesting.

Setting the stage for bleaker projections, Vice President Joe Biden recently conceded, “We misread how bad the economy was” in January. Obama modified that by suggesting the White House had “incomplete” information.

The new budget update comes as the public and members of Congress are becoming increasingly anxious over Obama’s economic policies.

A Washington Post-ABC News survey released Monday shows approval of Obama’s handling of health-care reform slipping below 50 percent for the first time. The poll also found support eroding on how Obama is dealing with other issues that are important to Americans right now — the economy, unemployment and the swelling budget deficit.

The Democratic-controlled Congress is reeling from last week’s testimony by the head of the nonpartisan Congressional Budget Office, Douglas Elmendorf, that the main health care proposals Congress is considering would not reduce costs — as Obama has insisted — but “significantly expand” the federal financial responsibility for health care.

That gave ammunition to Republican critics of the bill.

Citing the CBO testimony, House Minority Leader John Boehner, R-Ohio, on Monday accused Democrats of “burying this budget update until after Congress leaves town next month.” He called the budget-update postponment “an attempt to hide a record-breaking deficit as Democratic leaders break arms to rush through a government takeover of health care.”

Late last week, Obama vowed anew that “health insurance reform cannot add to our deficit over the next decade and I mean it.”

The nation’s debt — the total of accumulated annual budget deficits — now stands at $11.6 trillion. In the scheme of things, that’s more important than talking about the “deficit,” which only looks at a one-year slice of bookkeeping and totally ignores previous indebtedness that is still outstanding.

Even so, the administration has projected that the annual deficit for the current budget year will hit $1.84 trillion, four times the size of last year’s deficit of $455 billion. Private forecasters suggest that shortfall may actually top $2 trillion.

The administration has projected that the annual deficit for the current budget year will hit $1.84 trillion, four times the size of last year’s deficit of $455 billion. Private forecasters suggest that shortfall may top $2 trillion.

If a higher deficit and lower growth numbers are not part of the administration’s budget update, that will lead to charges that the White House is manipulating its figures to offer too rosy an outlook — the same criticism leveled at previous administrations.

The midsession review by the White House’s Office of Management and Budget will likely reflect weaker numbers. But where is it?

White House officials say it is now expected in mid-August. They blame the delay on the fact that this is a transition year between presidencies and note that Obama didn’t release his full budget until early May — instead of the first week in February, when he put out just an outline.

Still, the update mainly involves plugging in changes in economic indicators, not revising program-by-program details. And indicators such as unemployment and gross domestic product changes have been public knowledge for some time.

Standard & Poor’s chief economist David Wyss said part of the problem with the administration’s earlier numbers is that “they were just stale,” essentially put together by budget number-crunchers at the end of last year, before the sharp drop in the economy.

Wyss, like many other economists, says he expects the recession to last at least until September or October. “We’re looking for basically a zero second half (of 2009). And then sluggish recovery,” he said.

Orszag, making the rounds of Sunday talk shows, insisted the economy at the end of last year, which the White House used for its optimistic budget forecasts, “was weaker at that time than anyone anticipated.” He cited a “sense of free fall” not fully recognized at the time.

“It’s going to take time to work our way out of it,” the White House budget director told “Fox News Sunday.”

Even as it prepares to put larger deficit and smaller growth figures into its official forecast, the administration is looking for signs of improvement.

“If we were at the brink of catastrophe at the beginning of the year, we have walked some substantial distance back from the abyss,” said Lawrence Summers, Obama’s chief economic adviser.

Copyright 2009 The Associated Press.

Focal Dystonia? Ailing Guitarist Gets Second Chance with Left Hand


Posted on 29th June 2009 by Gordon Johnson in Uncategorized

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Date: 6/29/2009 1:32 PM

Ailing guitarist gets second chance with left hand
JEFF BAENEN,Associated Press Writer

MINNEAPOLIS (AP) — Guitarist Billy McLaughlin was at the top of his game a decade ago, a fingerstyle player noted for his technique of tapping on strings, when he began having problems controlling his right hand, missing notes with no clue why. Audiences thought he was drunk.

After a maddening couple of years in which his playing grew so bad he couldn’t perform his own songs, McLaughlin finally received a diagnosis: an incurable neuromuscular disease.

“When this first started happening, I thought I had done something wrong, I had committed some sort of musician’s sin or something,” McLaughlin said. “I didn’t sleep enough, maybe I was out too many nights after the concerts carousing around.”

McLaughlin has focal dystonia, a mysterious ailment that affects about 10,000 musicians around the world. For horn players, it can mean clenched jaws or immobile lips. For pianists, violinists or guitarists, the result can be frozen fingers that spell the end of a career. In McLaughlin’s case, the pinkie and ring finger on his left hand — the hand a right-handed guitarist uses to form chords or run scales on the fretboard — curled inward.

Instead of giving up, McLaughlin decided to relearn how to play the guitar left-handed — something another Twin Cities acoustic guitar virtuoso, Leo Kottke, likens to “trying to breathe through your feet. It’s exactly that hard.”

Now McLaughlin is back on the road and the subject of a recent documentary, “Changing Keys: Billy McLaughlin and the Mysteries of Dystonia.”

On a late spring day, McLaughlin — in jeans and boots — shows off his skills at his friend Jeff Arundel’s studio in downtown Minneapolis. His eyes closed and his shoulder-length blond hair waving, McLaughlin runs through his composition “Church Bells,” and the familiar Pachelbel’s Canon. His right hand runs across the fretboard while the index and middle fingers of his left hand hold, then release bass strings. The pinkie and ring finger of his left hand remain bent behind the neck of his guitar, which is emblazoned with “BILLY” on the head. The sound is smooth, calming, flawless.

Arundel, 51, a producer and fellow guitarist, knew McLaughlin in his heyday and watched his return.

“Imagine a guy learning to pitch with the other hand — the idea that a guy would get back to the major leagues doing that,” Arundel said.

McLaughlin, 47, grew up in Minneapolis and started playing guitar around 13 after “failing” on piano and trumpet. He studied guitar performance at the University of Southern California, switching to steel-string acoustic when his electric hollow-body Gretsch was stolen after graduation in 1984.

While performing with an ensemble, McLaughlin developed his signature percussive style, a hammering technique that demands strong fingers. He would step out on stage while the band took a break and wow the crowd with his tapping style. Eventually McLaughlin developed a solo act and became a big draw on college campuses, performing 200 days out of the year and logging 400,000 miles on his van.

After self-releasing seven CDs, McLaughlin signed a contract with Narada, an instrumental and world music label, in 1995. His first Narada release, “fingerdance,” reached No. 7 on Billboard’s New Age chart. It was around the time of his second Narada release, “Out of Hand,” in 1998 that McLaughlin’s finger problems began.

McLaughlin slipped on ice on the way to a photo shoot for the album and dislocated two fingers on his left hand. He underwent therapy and had gotten past the injury, but he said “something never felt quite right in that hand.” He ended his contract with Narada, completing his deal by releasing a best-of CD in 2000, and his marriage fell apart.

McLaughlin found his pinkie wouldn’t reach notes and that he had to refinger even easy pieces. He tried acupuncture, deep tissue massage and a chiropractor, spending “a small fortune trying to get this hand to work.”

Finally McLaughlin visited the performing arts clinic at the Sister Kenny Rehabilitation Institute at Abbott Northwestern Hospital in Minneapolis, where he was told he had focal dystonia. He didn’t believe it and continued trying to practice through the problem until Mayo Clinic confirmed the diagnosis in 2001.

Focal dystonia is a localized movement disorder that’s part of a family of neurological disorders. In one form, it can cause a person’s eyelids to involuntarily close, effectively resulting in blindness. Writer’s cramp is another form. A generalized dystonia can contort a person’s entire body. The origins of dystonia — which affects about 300,000 people in North America — may be genetic. Treatments can involve anticonvulsants or surgery, but there’s no cure.

Normally muscles work together to raise or lower a joint, but in focal dystonia the muscles don’t act together and instead are in a “tug of war,” explained Dr. Mahlon DeLong, a neurology professor at Emory University in Atlanta.

After his diagnosis, McLaughlin called renowned concert pianist Leon Fleisher, whose own career was derailed by focal dystonia that affects the fourth and fifth fingers of his right hand. Fleisher, 80, switched to a left-hand piano repertoire before undergoing Botox injections in 1995. The injections, combined with deep tissue massage, allowed him to resume playing two-handed (he recently released his first two-handed recording of concertos in more than 40 years).

Fleisher told him the skills McLaughlin enjoyed at his height were gone forever. But McLaughlin said he was relieved just to talk to someone who understood what he was going through.

For a musician, according to Fleisher, focal dystonia is “truly, profoundly tragic.”

“Your life is over, and it takes a special kind of courage to do what Billy has done,” he said in a telephone interview from his home in Baltimore.

For McLaughlin, who didn’t want to give up music, the answer was to switch hands. He had his two guitars refitted and restrung for left hand and is about to receive his first custom-made left-handed guitar.

“What allowed me to do what I’m doing now is making a mental break from ‘What’s wrong with me?’ to ‘What do I have that still works?'” McLaughlin said. He took a left-handed guitar with him on vacation and for two weeks worked out his pieces note by note.

“The biggest hurdle initially was me allowing myself to sound like crap,” McLaughlin said. “I’m a beauty addict, and to not be able to create anything that sounded beautiful was difficult to get through.”

Ron Tracy of Hoffman Guitars in Minneapolis was the one who turned McLaughlin’s right-handed guitars into left-handed models.

“He basically had to start like a kid learning to crawl and walk, and did it,” Tracy said. “It’s really starting over. He had the noise in his head, but couldn’t make it come out his hands.”

When he was ready, McLaughlin debuted as a left-handed guitarist at a solo performance in Detroit in late 2005, an event captured by the “Changing Keys” documentary.

“We didn’t know what the story was going to be yet. We didn’t have an ending. It was a leap of faith,” said “Changing Keys” producer and director Suzanne Jurva. The documentary has been shown on Twin Cities public television and is looking for national distribution.

In April 2006, McLaughlin made what he calls his “comeback” performance, rounding up his old bandmates and playing a mix of old and new music with a string orchestra in suburban Maplewood for a self-released CD, “Into the Light.”

“That was me saying, ‘If I never play again, this is how I want to go out,'” McLaughlin said.

McLaughlin tours Texas in July. He’s busy being a single dad to his 16- and 13-year-old sons and believes his best d ays of playing lie ahead. He lives with the possibility that his dystonia will migrate to his healthy hand.

“You know the vase hits the floor and in that moment that it shatters and that sound comes out you realize, ‘Oh, oh, that’s gone forever,'” McLaughlin said. “And in my case, there’s no new hand to put on. But I found another way around it. And that’s a lesson for every area of my life.”


On the Net:

Billy McLaughlin: http://www.billymacmusic.com

Dystonia Medical Research Foundation: http://www.dystonia-foundation.org

Copyright 2009 The Associated Press.

FDA backs drug that treats diabetes via the brain


Posted on 8th May 2009 by Gordon Johnson in Uncategorized

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Date: 5/6/2009 1:08 PM

AP Medical Writer

WASHINGTON (AP) — People with Type 2 diabetes may soon get a very different treatment approach: A drug that helps control blood sugar via the brain — an idea sparked, surprisingly, by the metabolism of migrating birds.

The Food and Drug Administration approved Cycloset, maker VeroScience Inc. announced Wednesday. It’s a new version of an old drug called bromocriptine, used in higher doses to treat Parkinson’s disease and a few other conditions. But unlike its older parent, Cycloset is formulated to require a low, quick-acting dose taken just in the morning — no other time of day.

That timing provides a bump of activity in a brain chemical that seems to reset a body clock that in turn helps control metabolism in Type 2 diabetes, said VeroScience’s Anthony Cincotta, who led the drug’s development.

Company studies suggest that one morning dose helped lower the usual post-meal blood sugar rise at breakfast, lunch and dinner. Over six months, 35 percent of Cycloset users reached recommended average blood sugar levels, compared with 10 percent of diabetics given a dummy drug, Cincotta said.

Cycloset is the first drug to win FDA approval under new guidelines that require better evidence that diabetes treatments are heart-safe. Diabetics are at increased risk of heart disease. In a yearlong safety study involving 3,000 diabetics, those given Cycloset had 42 percent fewer heart attacks and other cardiovascular complications than those given a dummy drug.

Where do the birds come in? Years ago, Louisiana State University researchers were studying how migrating birds arrived at their destinations without being emaciated. They develop seasonal insulin resistance, the very condition that in people leads to Type 2 diabetes.

People don’t have those seasonal variations but the theory is the dopamine plays a role anyway.

The researchers discovered a biological clock — in the brain’s hypothalamus — that controlled when the metabolism change kicked in for the birds, and also in hibernating mammals. Different concentrations of certain brain chemicals, including dopamine, at different times of day dictated whether the bird metabolized like a fall bird or a summer bird, said Cincotta.

People don’t have those seasonal variations but the theory is the dopamine plays a role anyway in sensitivity to insulin, although Cycloset apparently did not affect weight.

Bromocriptine mimics dopamine: “We’re regulating the regulator,” Cincotta said.

Side effects include nausea and dizziness, sometimes because of blood pressure dips upon standing. Nursing women shouldn’t use it. Bromocriptine inhibits lactation, and although no link is proven, there have been reports of strokes in postpartum women using higher doses. The FDA said it also should be used cautiously with people taking blood pressuring-lowering medication.

It’s uncertain how soon sales can begin, or the drug’s cost: VeroScience, of Tiverton, R.I., is in negotiations with larger drug companies to find a distributor.

Copyright 2009 The Associated Press.

Brain Injury Association of America Policy Corner E-Newsletter – October 3, 2008


Posted on 5th October 2008 by Gordon Johnson in Uncategorized

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A weekly update on federal policy activity related to traumatic brain injury

Dear Advocates:

In late breaking news from the United States Capitol, Congress has just approved a $700 billion financial bailout package, which also includes landmark mental health parity legislation (H.R. 1424/S. 558) and dozens of expiring tax breaks for businesses and individuals.

This legislation was sent in an expedited fashion this afternoon to President Bush who signed the measure into law hours after its passage.

As the previous edition of Policy Corner noted, several important legislative developments occurred last week, and this week’s edition of Policy Corner includes additional details about these developments as they pertain to brain injury policy.

It remains unclear whether Congress will return for a lame duck session in November after the elections, although at least a short session appears likely for the Senate the week of November 17. BIAA will provide an update on the remainder of this year’s congressional schedule as soon as this information available.

*Distributed by Laura Schiebelhut, BIAA Director of Government Affairs, on behalf of the Brain Injury Association of America; 703-761-0750 ext. 637; lschiebelhut@biausa.org

BIAA’s Policy Corner and Legislative Action Alerts are made possible by the Centre for Neuro Skills, James F. Humphreys & Associates, and Lakeview Healthcare Systems, Inc. The Brain Injury Association of America gratefully acknowledges their support for legislative action.

To sign up to receive future BIAA Policy Corner E-Newsletters and Legislative Action Alerts, please go to http://capwiz.com/bia/mlm/signup/

Congress Passes Financial Bailout Legislation, Mental Health Parity

In late breaking news from the United States Capitol, Congress has just approved a $700 billion financial bailout package, which also includes landmark mental health parity legislation (H.R. 1424/S. 558) and dozens of expiring tax breaks for businesses and individuals.

This marks a tremendous victory for mental health advocates and others who have supported efforts to enact a parity bill for years. This legislation will require private health insurers to offer mental health and addiction benefits equal in cost and scope to traditional medical benefits.

Earlier this year, BIAA strongly endorsed the House version of this legislation. In a letter officially endorsing the bill in March, BIAA noted, “An intricate and intertwined relationship exists between substance abuse, mental health, and traumatic brain injury (TBI). Substance use and abuse is often both an antecedent to and a consequence of TBI.”

Upon its passage this afternoon, one of the bill’s sponsors and leading champions, Congressman Patrick J. Kennedy (D-RI), stated:

“This legislation is one more step in the long civil rights struggle to ensure that all Americans have the opportunity to reach their potential. For far too long, health insurance companies have used the stigma of mental illness and substance abuse as an excuse to deny coverage for those biological disorders. That ends today when this critical legislation outlaws the discrimination that is embedded in our laws and our policies.”

Other bill sponsors and leading supporters include Rep. Jim Ramstad (R-MN) in the House of Representatives, as well as Sen. Pete Domenici (R-NM) and Sen. Edward Kennedy (D-MA) in the Senate. Late Senator Paul Wellstone (D-Minn.) was also a leading champion of this legislation.

Appropriations Update

Last week, the House passed an omnibus continuing appropriations bill to fund most government programs – including TBI and trauma-related programs – at Fiscal 2008 (last year’s) levels until March 6, 2009.

Over the weekend, the Senate also passed this omnibus legislative package and forwarded it to President Bush, who signed it into law just hours before the beginning of the new fiscal year on October 1.

This massive year-end spending package includes a Continuing Resolution (CR) which funds programs covered by nine unfinished appropriations bills (including the Fiscal 2009 Labor-HHS-Education Appropriations bill, which contains funding for key federal TBI programs) at Fiscal 2008 levels until enactment of the bills or March 6, 2009 – whichever comes first. This essentially leaves final funding decisions on domestic programs to the next Congress and president.

Within this CR, all civilian health programs, including TBI and trauma-related programs, are funded at Fiscal 2008 levels. These Fiscal 2008 levels, and thus continuing funding levels through the beginning of next year, are as follows:

CDC TBI Programs (HHS): $5.709 million

HRSA TBI Programs (HHS) (HRSA TBI State Grant Program and Protection and Advocacy Systems): $8.754 million

TBI Model Systems of Care (NIDRR/Department of Education): $8.155 million

In addition to the CR to provide continuing appropriations for most federal programs, the omnibus bill also includes three Fiscal 2009 appropriations bills in their entirety. These three appropriations bills are those that fund Defense, Homeland Security and Military Construction-VA for all of FY 2009.

The Defense appropriations measure included in this legislative package contains $300 million in funding for Traumatic Brain Injury and Psychological Health initiatives within the Department of Defense.

The Military Construction-VA appropriations measure includes $41 billion in funding for the Veterans Health Administration (veterans medical care), representing $1.8 billion above the President’s budget request earlier this year and $4.1 billion above 2008 levels. This funding bill also provides $510 million in funding for Medical and Prosthetic Research, including cutting edge research into areas such as Post Traumatic Stress Disorder (PTSD), Traumatic Brain Injury, suicide prevention, and polytrauma. This funding level for research represents $30 million above 2008 levels, and rejects a $38 million cut proposed by President Bush.

The Military Construction-VA appropriations bill contained in this omnibus legislative package also included important report language (strongly supported by BIAA) urging the Department of Veterans Affairs to increase returning servicemembers’ access to TBI care and expertise in the civilian sector. Specifically, the Explanatory Statement accompanying this bill states:

“The Appropriations Committees strongly urge the Department to establish and expand cooperative agreements with public and private entities with neurobehavioral rehabilitation and recovery experience in the treatment of Traumatic Brain Injury (TBI) as recommended in section 1703 of Public Law 110-181” [FY 2008 National Defense Authorization Act].”

In addition, the bill provides $200 million for fee-based services intended to allow the VA to tap expertise in the public and private sector for health care that may not be readily available within VA medical centers.

Congress Authorizes VA Epilepsy Centers of Excellence

Last week, the House passed an omnibus veterans health care package (S. 2612), including key provisions of The Epilepsy Centers of Excellence Act (H.R. 2818/S. 2004), which BIAA has strongly endorsed.

Over the weekend, the Senate also passed this legislation and it is expected to be signed into law by the President imminently.

The legislation, championed by the American Academy of Neurology and endorsed by BIAA, anticipates an expected increase in the number of TBI-related epilepsy cases among veterans returning from service in Iraq and Afghanistan. The bill will create up to six Epilepsy Centers of Excellence (ECoE) at the Depart ment of Veterans’ Affairs (VA), and is aimed at restoring the VA as a national leader in epilepsy care and research.

The bill was sponsored by Rep. Ed Perlmutter (D-CO) in the House of Representatives and Sen. Patty Murray (D-WA) in the Senate.

Congress Clears FY 2009 Defense Authorization Bill For President’s Signature

Within the past few days, Congress also passed the FY 2009 defense authorization bill (S. 3001). This legislation contains a “Sense of Congress on TBI Research.” Specifically, the bill states in Sec. 725:

“It is the sense of Congress that the requirement under section 1621(c)(7) of the National Defense Authorization Act for Fiscal Year 2008 (Public Law 110–181; 122 Stat. 453; 10 U.S.C. 1071note) to conduct basic science and translational research on traumatic brain injury includes pilot programs designed to test the efficacy of clinical approaches, including the use of pharmacological agents. Congress urges continued studies of the efficacy of pharmacological agents for treatment of traumatic brain injury and supports continued joint research with the National Institutes of Health in this area.”

BIAA Signs on To Coalition Letter Opposing Proposed Medicaid Outpatient Regulation

BIAA recently signed on to a coalition letter urging Congress to enact a moratorium on a regulation proposed by the Centers for Medicare and Medicaid Services (CMS) to restrict Medicaid reimbursement for outpatient services. This regulation is termed the “Medicaid Outpatient Clinic and Hospital Services Rule,” and it would reduce federal Medicaid funding to states for freestanding health clinics and hospital outpatient departments.

This regulation, published on September 28, 2007 – and expected to be finalized in November of this year – would cut Medicaid reimbursement to many types of outpatient services, including services utilized by individuals with brain injury. [72 Federal Regulation 55158 to 55166 (to be codified at 42 C.F.R. 440, 447 and sometimes referred to as CMS 2213-P).]

To prevent finalization of this rule, BIAA has joined the Consortium for Citizens with Disabilities in urging Congress to enact a moratorium delaying implementation of this harmful regulation through April 2009.
In a heartening development, this week Members of Congress introduced legislation aimed at enacting such a moratorium.

Yesterday, Sen. Charles Schumer (D-NY) and Sen. Hillary Rodham Clinton (D-NY) introduced the “Preserving Access to Healthcare” (PATH) Act of 2008, which would, among other provisions, delay the proposed Medicaid outpatient regulation by six months.

In addition, earlier this week, Rep. John McHugh (R-NY) introduced H.R. 7219, the Protecting Hospital Outpatient and Community Clinic Services Act of 2008, which would provide a moratorium on the regulation.

BIAA strongly supports these legislative efforts.

BIAA Representatives Attend Trauma Spectrum Disorders Conference

Multiple BIAA representatives attended this week a scientific conference titled, “Trauma Spectrum Disorders: The Role of Gender, Race & Other Socioeconomic Factors.”

This conference – jointly sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, the Department of Veterans Affairs, and the National Institutes of Health – focused on identifying and sharing knowledge and lessons learned about gender and race as they relate to psychological health and traumatic brain injury.

Presentations made at this conference are expected to soon be made publicly available on the Defense Center of Excellence’s website: http://www.dcoe.health.mil/.