Archive for the ‘NEUROLOGY WRITING (NOT TECHNICAL!)’ Category


May 16, 2010

In early March, a young woman was thrown from her dressage horse during a routine schooling ride.  She was rendered comatose and two months later in a rehab facility with a mild hemiparesis but finally able to swallow.

The woman was a member of the US Equestrian Olympic Team, one of only two sports where men and women compete equally.  I say “was,” because we both know it is unlikely that she will ever be able to compete again at a high level in dressage, one of the most demanding partnerships between man and animal.  She has recovered remarkably well and hopes to teach riding; unfortunately, even her young age was not young enough for better recovery.  She is at higher risk for epilepsy, personality and emotional residuals as well.  In short, she suffered a catastrophe.  Fortunately, she didn’t end up vegetative, especially since the accident occurred in Florida, where adults with 600 gram brains are felt by cardiac surgeons to be conscious and doing well, because they smile even if they can’t comprehend 15 years after the insult.

Florida and the 109th Congress aside, what is finally occurring is a helmet debate in the equestrian community, similar to the helmet debate seven years ago in the cycling community, where 9 years earlier, almost to the day, Andrei Kivilev, a superb Kazakh rider, collided with two other riders on the Paris-Nice race.  The other two were fine; Kivilev, 29, hit his head and died the next day, leaving behind his widow and six month old daughter.  His death was a catalyst for mandatory helmets in major cycling races, which first did not mandate helmets for mountain top finishes, but now do.  Every cyclist in every major event wears a helmet.  Something good came out of Kivilev’s death; hopefully the equestrian community will do the same.  Already, several equestrian riders have stated publicly that they were saved by a helmet they began wearing.

But there is still no mandate.  Dressage riders must dress formally; indeed, proper riding attire is considered appropriate dress anywhere, something I often kid my wife about.  Helmets are not part of dressage riding.  Well, the judges need to get over it and deduct points should someone not be wearing a helmet.  Better yet, it should be cause for immediate disqualification if any rider on a horse at any time at a horse event is not wearing a helmet.

In 1976, Arizona allowed motorcyclists not to wear helmets.  I remember the demonstrations at the Capitol.  I wonder how many have since died or been permanently maimed as a result of not wearing a helmet.  It is time for a helmet debate in this country.  At what point do an individual’s rights conflict with the rights of his loved ones to have him (usually a him) around and whole, and society’s rights to pay for the extra care that going without a helmet and having an accident causes?  It’s a fair debate.  I know where I am on this issue.  I, like many of my former colleagues, bitterly remember coming into an ED at 2 a.m. to take care of another drunken biker who wasn’t wearing a helmet.  In my case, the lack of payment was a minor annoyance.  The sleep I lost was not so minor.  We live in a republic.  We have a government, and by definition, that government has some control over us, even in the hinterlands of Alaska.  We need an honest, factual debate on regulation, without Rush, Bill, Glenn, Sarah, Keith, Jon, Rachel or Steven.  In my view, failure to regulate almost took down the world’s economy and has given us wireless service that is worse than many third world countries.  There is an imperfect but better middle ground out there that we need to find; otherwise, Zappa’s Law about universality has a third part:   hypocrisy, in addition to hydrogen and stupidity.

Growing up, I didn’t know about seat belts; today, even in Arizona, 75% wear them.  I skied for 40 years without wearing a helmet; I didn’t know better.  Or didn’t want to know better.  I knew that ½mv2 =mgh, and a fall at 25 mph was like falling off the roof.  I would wear a helmet today if I skied.  In my three major bicycling accidents, my helmet was significantly damaged, damage my skull didn’t have.  I was not knocked out, even when I could hear the back of the helmet go WHACK! on Moore Road, the day I broke my clavicle.

Physicians need to frame the helmet issue and lead the debate.  And after we deal with helmets, we will have to deal with a hot, extremely difficult issue:  the long term side effects of playing football as the game is currently played, for the data show that the sport is far more dangerous than anybody ever realized.

For now, the equestrian community must recognize the dangers of being 10 feet off the ground on an unpredictable animal, and where a head might hit if the animal bucks.  It won’t be the only buck in the equation.

We will never drive trauma centers out of existence, but every physician should want to.  I hope most trauma physicians would be among the first to agree.


September 16, 2009





September 11, 2009