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Message: [QUOTE="Cuseregular, post: 1960654, member: 185"] First I've been worried about DB and his position here almost from day one so I get what you're saying: [URL='http://syracusefan.com/threads/the-offense-to-me-still-looks-like-a-shafer-team.108004/#post-1876692']The offense to me still looks like a Shafer team[/URL] [URL="http://syracusefan.com/threads/the-offense-to-me-still-looks-like-a-shafer-team.108004/page-3#post-1877260"]The offense to me still looks like a Shafer team[/URL] With respect to ED's circumstance the fact that there's so many shades of grey here with the whole concussive issue in general makes this situation less concrete as to what to advise and recommend and is a frustrating thing for player, doctor and coach alike. I've been all of these at one point at another so I can tell you how I handle it in my private practice with the patients I see with these concerns. Been in health care 25 years now treating a variety of orthopedic/spinal disorders, concussions, sports injuries, etc. and as mentioned in another post teaching on it all as well for even longer. The amount of nuance in this issue is, as mentioned, frustrating for all involved. Its unlike most other conditions I treat in that with neck, back injuries, shoulder, knee, ankle disorders where these are all more concrete both with respect to how they're treated as well as with respect to what recommendations are made to best address them both now and down the road. For example, those non currently active with competitive sport patients who still like to run/do high impact activities, for them with knee problems, back problems, etc. I flat out tell them that they need to change from these activities to more smooth, rhythmical, lower impact activities as it's not a matter of if but when they're going to need joint replacements and/or back surgeries if they continue down the same path that ultimately got them into my office. Pretty straight and simple. With concussions on the other hand where I'm often not the primary provider but more ancillary and co treating offering advice/opinion along with Rx, these break the mold of simplicity with both treatment and prospective advice, this given that every circumstance is different dependent on how many they've had, what grade or type was it/how well did they do in follow up neurological testing, what sport are they trying to return to, what position do they play, etc. The last one as the thought is that the recurrent and repetitive smaller hits (over time) may be as bad if not more of a concern as the bigger concussions. Having been a player who played right through such issues in contrast with some emerging evidence of the later effects of such injuries, knowing that not everybody who gets one (or more) is effected the same way, both short and long term, if they are effected at all, treating such injuries semi regularly leaves me in a position where I need to try and present all sides of the issue do to it's more complicated nature of the condition(s) itself. I tell them that since they're in the office I have to wear my dr hat and give advice accordingly and that advice in this case here with what seems to be going on both now in the present and with what is the past history, would be to shut it down (for the year at least) knowing he's had two previous bad ones in combination with this milder appearing one, and very possibly likely for a career if there's any indication on post concussive testing that's there's been any detioration in cognitive function on post injury neurological testing. That the potential cons seem to outweigh the pros potentially in that there is a litany of examples now of long term concerns in these circumstances with past players who now are having problems. I then follow up and say that listen I myself played with these issues, and so did thousands of others whose cognitive facilities have and continue to be just fine. That there really is no way to know with certainty what the future holds. If I was a young man in his shoes I would understand the desire to play and may have done so myself and that ultimately this is a decision for him and his parents to make knowing all the potentialities of the cirumcumstances. If it were my child I'd advise against it but that after age 18 the final decision if cleared by an institution is his decision to make as there is exactly zero consistency from school to school on what the protocols and procedures are to follow with respect to recommendations of allowing continued play or not. And the crazy thing of it all is that since my gut is that he's doing well after this latest one, what appeared to this trained eye to be the mildest one of the 3 with him likely (hopefully) passing the neurologic testing, but since it's number 3 the school must have some type of self declared protocol on it to hold kids out after three regardless of grade/severity, the crazy thing is if he gets that second opinion, does well with it, has passed all testing, knowing there's no hard and fast criteria to rigidly follow, there's actually a chance he could be out there again this season. I personally hope that is not the case given where I sit now and what I do and what I know, but the crazy thing is if it were me I think I'd want to be out there too. I get all sides of this. [/QUOTE]

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