DEAR DR. DONOHUE: I am a new teacher and a new football coach at a high school in a small town that has no doctor. I am concerned about handling head injuries in my players, and I wonder if you would provide some information, especially about returning a player to a game after a “ding.” – R.O.

ANSWER:
A “ding” or “bell ringing” is a concussion. In the bad old days, unconsciousness, no matter how brief, was a criterion for a concussion. It no longer is. Any head injury that causes even a minor change in mental status is a concussion. Such a change includes things like confusion, dizziness, headache, amnesia, imbalance and difficulty in retaining new information. Concussions happen in all sports – baseball, basketball, soccer, hockey and, I suppose, even Ping-Pong.

A concussion, even a slight one, makes an athlete prone to have another. If a second brain injury occurs before the brain has completely recovered from the first, disastrous consequences can happen.

In a grade 1 concussion, there is no loss of consciousness and symptoms resolve in less than 15 minutes. Some say that a player who fully recovers can return to play that same day, but others do not allow same-day play. A grade 2 concussion has no loss of consciousness but symptoms that last longer than 15 minutes. A player who suffers a grade 2 concussion should not be allowed to play for one week, and then only with a clearance from a doctor. A grade 3 concussion is one where there is loss of consciousness, even a brief loss. This injury puts a player out of competition for one month and calls for an examination by a neurologist quickly.

Reader L.M. put me on to a great testing service available online at www.impacttest.com. And the Centers for Disease Control and Prevention furnishes a concussion testing kit for coaches at www.cdc.gov/ncipc/tbi/Coaches-Tool-Kit.htm.

DEAR DR. DONOHUE: I guess tennis elbow is a specific injury and not just a sore elbow. My tennis elbow was cured by learning to hit a backhand properly – with the elbow down by the waist instead of 6 to 10 inches in the air. – F.C.

ANSWER:
Hitting a backhand with the elbow leading is a perfect way to develop tennis elbow. Your advice is good.

Do you have any hints for carpenters who get tennis elbow from pounding nails and turning screws?

DEAR DR. DONOHUE: I know you can’t remove fat from one particular body area. You have taught me that. But I would like to build muscles in one particular area. That’s possible, isn’t it? The area of concern is my rear end. It is perfectly flat. I want some curves. What sort of exercise do you recommend? – S.F.

ANSWER:
It is possible to build muscle in a particular body site. Young boys get hung up on building their biceps muscles, the front muscle on the upper arm, the Popeye muscle.

For you, the gluteus muscle is your target. The standard squat exercise targets the gluteus. You bend the knees until the thighs are parallel to the ground. You don’t have to go any lower. If you do, you put too much stress on the knees.

When you’re proficient with the regular squat, you can try a single leg squat, a more difficult exercise.

A third gluteus exercise is the front lunge. Step forward with the right foot. Then drop the left knee to the floor. The next motion is a return to the starting position.

Practice these exercises without any added weights. When you become proficient, let a weighted barbell rest behind your neck and on your shoulders.

DEAR DR. DONOHUE: Does regular running cancel the danger of smoking cigarettes? My boyfriend says it does. – K.H.

ANSWER:
Your boyfriend is delusional.

DEAR DR. DONOHUE: I am 79 and of reasonably good health. I had a physical exam, including a CT scan of my abdomen. The scan showed a gallbladder that is filled with stones (a porcelain gallbladder). Is this a dangerous condition? Is it cancerous? Is it urgent? – T.W.

ANSWER:
It depends on where you heard the term “porcelain gallbladder.”

It’s not generally used to refer to a stone-filled gallbladder, but if that’s how your doctors used it, then further study isn’t needed and the situation isn’t urgent. If gallstones aren’t causing pain or other symptoms, they can be put on a very-back back burner.

If your gallbladder is one whose walls have been infiltrated with calcium – and that’s the more common meaning of porcelain gallbladder – then the situation is urgent. Porcelain gallbladders can become cancerous gallbladders, and they should be removed as soon as possible.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.


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