#injury-duty health

Last week, former Ultimate Fighting Championship (UFC) Welterweight Champion Matt “The Terror” Serra, decided to hang up his gloves and retire from the sport of Mixed-Martial-Arts (MMA).

In an interview with Newsday, Serra recalls the beginning of what ultimately sealed his fate to walk away from the sport he loved.

The beginning of what would prove to be a crazy ride started when Serra felt a pain in his left arm after a Brazilian Jiu-Jitsu session at one of his academies on April third. The scrappy 39 year-old chalked it up as nothing more than a pulled muscle, and didn’t give it much more thought.

Two days later, while working as a corner man for one of his fighters, the pain was back and worse than before. By 2 a.m. he couldn’t even lift his hand to touch his neck, that’s when he finally decided to drive himself to the emergency room at Winthrop University Hospital in Mineola, New York.

After a few tests, two blood clots were found in his arm and another in his lungs. Doctors put Serra on blood thinners to address the clot in his lungs. For now he’ll be injecting himself in the abdomen with a high dose of Lovenox (a drug that prevent blood from clumping up as is flows through your body), every day for at least the next three months. A thankful Serra recalls:

“Then I got freaked out. You don’t catch that [and] after the lung, that stops your heart or your brain. Then you’re done. I’m very fortunate to, basically, be here. Sounds kind of morbid. If I didn’t catch that – I was about to go to bed. I’m like, man, something’s not feeling right.“

Terrorizing the Terror: 

Last week, while giving an interview to the MMA Hour’s Ariel Helwani (May 27^th, 2013), Serra was asked what exactly the name of the medical condition was that landed him in the emergency department, and in classic Serra fashion he responded with:

“I have a weird disorder, or whatever you wanna fuckin’ call it. It’s some kind of… what is it called? The boom-boom syndrome. Ah, I forgot the fuckin’ name of it. My wife knows.”

So, instead of bugging Serra’s wife with your questions, we here at Injury-Duty figured it’d be a perfect opportunity for us to help clear things up.

Anatomy Of A Fighter:

What finally got Serra to make a visit to the emergency department was the pain in his arm, which was the result of blood clot, as we now know. But, what caused the blood clots in the first place you ask? Well, to better understand that, lets take a quick Injury-Duty anatomy crash-course.

On both the left and right sides of your upper chest, you have a relatively snug space between your collarbones (in medical jargon, your clavicles) and your first ribs (click for an image), which sits right behind the collarbone. In that space run three important structures:

1. Brachial plexus: This is essentially a thick bundle of nerves responsible for taking all signals from your brain to your arm (and vice versa).
2. Subclavian artery: This artery’s job to supply your arm with “fresh” (or oxygenated) blood.
3. Subclavian vein: This vein’s job to remove “used” (or deoxygenated) blood from your arm, and return it to your lungs where it can pick up more oxygen.

What Went Wrong?:

After a thorough evaluation by his medical team, Serra was diagnosed with what is known as thoracic outlet syndrome (TOS), which is just a fancy way of saying that the “snug space” we described above (known as the thoracic outlet) is being smooshed. What is doing the smooshing? It can be do to a lot of things, but here is a list of the most common causes:

1. 
A broken first rib or collarbone
2. Neck muscles that are too large (from such things as bodybuilding. We’re pretty sure this is what Serra would say happened.)
3. Extending the arm above the head for a long period of time (during sleep or while unconscious)
4. A congenital anomaly (nerd speak for having something in your body that developed abnormally)
5. Tumor (pretty rare)

 As for what exactly is being smooshed, well here are the most common suspects:

1. Brachial plexus (i.e. Neurologic type of TOS)
2. Subclavian vein (i.e .Venous type)
3. Subclavian artery (i.e. Arterial type)

The symptoms a patient might have due to TOS are divided into categories, all depending on what exactly is being smooshed:

1. Neurologic (meaning involving the nerves): Most common, making up about 95% of all cases.
2. Venous (meaning involving the veins): Responsible for 4% of all cases.
3. Arterial (meaning involving the arteries): Rare. Occurring only in about 1% of all cases, but is potentially the most serious of the three types.

What The Blood Clot?:

Serra’s case was actually pretty “text-book”. The quickness with which the pain, swelling and bluish discoloration of his arm hit are classic hallmarks of the venous type of TOS (again, the smooshed subclavian vein variety). These patients are typically males, in their late 20s to early 30s who have participated in some form of strenuous physical activity with the affected arm (insert masturbation joke here… come on. You know you were thinking it in your head).

The trouble with smooshing the subclavian vein (or any vein, actually) is that doing so causes a sort of back-up of blood. And, since veins are under pretty low amounts of pressure, it doesn’t take much to clamp down on one. For example, this is why it’s advised when on a long trip (a plane flight for example) that you stand up and stretch every two hours or so. The simple action of your knees being bent (along with the pressure of the seat your in pushing down on the veins in the back of your knees) can cause blood flow to slow down. What’s the problem with that you ask? Well, when allowed to sit around in one place for too long, blood likes to clump up and form a clot. Trouble is, when the clots are able free themselves up, or whatever it was that was sloshing the vein to begin with is moved, these clots are free to plug up another spot in your body, and too often that spot is in the lung, this is known as a pulmonary embolus (PE). Sometimes the PE is small and easily managed, but it is not uncommon for larger one to kill a patient, quickly.

The Fix:

Once the blood clots in Serra’s arm and lung were confirmed (probably using venography) he was likely given tissue plasminogen activator (tPA), often referred to as the "clot buster”, to help breakdown the clots that had already formed. And, to prevent new clots from forming, he was started on Lovenox (a drug that prevents blood from clumping up as is flows through your body).

Now that the medical team had figured out what exactly was going on, the next step was to figure out how to prevent it from happening again. For that, the treatment for TOS is surgery, with the goal being to remove whatever it is that’s responsible for smooshing the vein in question. And, because the structures that are being smooshed in patients with TOS can vary, surgeons have preferences as to where they feel the best place to enter the body is to correct the problem. In Serra’s case (venous TOS), many doctors believe that the transaxillary approach (in simple terms, that means through the armpit. Yes, sounds odd, but take a look at the picture to get a better idea). This approach allows for the surgeon to best see the important structures that may be playing a role in the problems being caused. The surgery was done almost exactly one month after Serra had initially presented in the emergency department with arm pain. 

Had Serra opted to not have surgery, chances are pretty much 100% that he’d have another clot form (even if he continued to use medications that prevent his blood from clotting).

BOTTOM LINE:

• Is TOS enough to force somebody into retirement: Generally speaking, no. Serra will likely be allowed to return to physical activity in 6-8 weeks. But, he is 39 years old and has a successful BJJ gym he runs, which both are likely factors that went into his decision to leave the sport.
• Will he have to worry about contact sports now?: No, he will not have to alter his training or recreational activities after his surgery. 

On behalf of one Long-Island based team to the another, we here at Injury-Duty would like to wish Matt Serra a speedy recovery all the best in his future endeavors! 

According to the calendar, spring is supposedly in the air. I don’t know about the rest of y’all, but I can still see my breath when I go outside every morning. My crate of flip flops is still stuck in my closet waiting to be used. And I can drive with the windows down for exactly 30 seconds before the wind gets too damn cold for me and I have to roll ‘em back up. Weak.

Even though it doesn’t feel like spring yet, it’s officially here. And if that’s the case, that means Memorial Day aka the unofficial start of summer is right around the corner! That means beaches, backyard barbecues, backpacking, and bathing suits!

Bathing suits. Ugh. If you’re like a good chunk of the population and spent Winter huddled up indoors, under mounds of blankets, avoiding the frigid temperatures any kind of attempt at shoveling, chances are you might be a little rounder around the edges. Or you might be the kinda person with a ridiculously fast metabolism that burns calories in their sleep. In which case, I hate you. Kidding. Only slightly.

But I digress. Bathing suit season is around the corner and if you’re gonna rock a one piece, or a two piece, or swim trunks for that matter, chances are you wanna look good doing it. Now if all of us were born with that perfect bathing suit bod, there’d be no point to writing this article. But since we’re not, we at Injury Duty wanted to offer you some tips to help you put your best food forward.

Now you can make like Fergie and be up in the gym, working on your fitness. That’ll certainly help you drop pounds and tone up. But a proper diet goes hand in hand with exercise when it comes to making a difference in how you look. You can choose to diet and eliminate all the high fat, high carb, processed foods and that’s a pretty solid way to shed some unwanted pounds. BUT, you can also choose to incorporate some very specific foods that help your body burn fat more efficiently. That said, we bring to you five foods and/or beverages that’ll help you kick your metabolism up a notch and burn fat.

1. Chili Peppers- The next time you’re whipping up something spicy in the kitchen, feel free to turn the heat up a notch by adding chili peppers to your dish. Although not for the faint-hearted (or the bland-tongued), chili peppers to do a lot more than set your tastebuds on fire. A study done at the UCLA Center for Human Nutrition showed that chili peppers contain a compound called capsaicin which helps the body burn fat at a faster rate and may help boost metabolism. Habaneros are particularly full of the stuff. So put down the hot sauce and add the real stuff and you may be pleasantly surprised.

2. Green tea- Swap your quadruple mocha-choca-frappa-whatevertheheckitscalled-ccino at your favorite overpriced coffee chain for a venti green tea. Green tea contains a compound called EGCG which is thought to be a potent anti-oxidant and metabolism booster. Some opponents argue that green tea doesn’t do much in the way of fat burning, but even in that case, it’s a helluva lot healthier than all the sugar, caffeine, and carbs in your quadruple-ccino. Brew a pitcher of iced green tea and keep it handy. 4-6 cups a day works best.

3. Whole grains- Put down the doughy mass of goodness that is your daily bagel and reach instead for products made out of whole grains- like quinoa, brown rice, and oatmeal. Because whole grains are high in fiber and come to you in their most organic form, the body has to work harder to break them down to digest. In contrast, processed foods slow the body’s metabolism down because it doesn’t have to expend as much energy to break them down. You can eat to make your body work harder? Sounds like a win-win to me.

4. Greek yogurt- this might be the best thing to come outta Greece since the gyro. Kidding. Kinda. Greek yogurt is chock full of proteins which is great for many reasons. If you’re looking to put on some muscle for bathing suit season, increasing your protein consumption will definitely help. Furthermore, Greek yogurt has twice as much protein as other yogurts, which means you stay fuller longer after eating it. Like whole grains, the body burns off more calories when its digesting protein, making Greek yogurt an excellent choice! Bonus- it’s also full of calcium which promotes strong bone health.

5. Water on the rocks- Anyone who is trying to lose weight will always be told to drink lots and lots of water. Why? It’s simple. For one thing 2/3 of your body is comprised of water, so it’s important to constantly stay hydrated. More than that, drinking water will keep you full and less likely to reach for temptations. In fact people who frequently feel hungry and subsequently reached for food are actually encouraged to drink a tall glass of ice water first, lest the hunger pangs actually just be thirst pangs. The “ice cold” part is key because the body has to expend energy to warm the water up to your body temperature.

-Team [Woman] Injury-Duty

If you’re a fan of hip-hop, or maybe just a hater of rapper Lil Wayne, chances are you heard all about him being hospitalized a week or so back after suffering a seizure or two. And, in classic hip-hop-hype fashion, rumorville went crazy with stories ranging from Wayne was in the ICU, on his death bed and ready to meet his maker, to he was doing just fine in his hospital bed watching the Syracuse game. Up until this past Friday only one thing was for sure, Wayne was in the hospital for a bit and he didn’t die.

The speculation as to what caused Wayne to have the seizures that eventually landed him in the hospital were a whole other source of gossip. Was it weed? The molly? Nah, had to be the sizzurp he was drinking. No, no, he’s just “working too hard”, that’s gotta be it. But, on Los Angeles radio station Power 106, the rapper did his part to address rumors, attributing the seizures to his epilepsy:

“Like, this isn’t my first, second, third, fourth, fifth, sixth, seventh seizure. I’ve had a bunch of seizures, y’all just never hear about them. But this time it got real bad ‘cause I had three of them in a row and on the third one, my heart rate went down to like 30 percent*. Basically, I could’ve died, so that is why it was so serious. But the reason being for the seizures is just plain stress, no rest, overworking myself.”

Ah, if it were all only that simple, Lil Weezy. But, we know that’s why y’all are here, so lets jump in and make some sense of this mess!

THE BASICS: We think it may be helpful to understand what exactly a seizure is before we dive too deep. So, try thinking of the brain as your personal computer, or laptop. In your computer are a bunch of wires with electricity flowing through them. And, believe it or not, in your brain you have electricity flowing as well (literally), but in your brain the “wires” are known as neurons.

Now, you may have noticed that every once in a while when you try to do too much on your computer (for example when you have too many programs opened at once, plus you’re trying to download some file at the same time), your computer will “spaz out”. Sometimes the screen will freeze up for a minute, other times your mouse won’t work for a few seconds, and sometimes it’ll just shut down and reboot! It all depends on where the “hiccup” took place in your computer, and if it can figure out the problem.

Well, our brains are very similar to the computer in a lot of ways. There is a constant flow of electricity firing through the neurons in our brains, even when you’re not “using it” (i.e while sleeping)… which is more often the case for some people than others. Just like your computer, your mind gets revved up when you’re using your brain to do more complex activities, for example when you’re stressed out and have a ton of thoughts racing through your mind, or when you simply get excited and are feeling great. All those feelings cause all sorts of different parts of your brain to fire off electrical signals, but how well our brains handle those huge waves of electrical signals varies from person to person.

Ever notice how some people get excited and instantaneously start to cry? Some people get lightheaded when they’re upset and need to sit down. Others may get headaches if they’re watching a movie with too many explosion scenes. And, some people have seizures if they watch a movie with too many flashing lights. In most cases it all has to do with how the person’s brain processes the information and signals it is taking in, and whether their brain is able to not be overwhelmed by it all. The brains “ability to not be overwhelmed” is what brings us to the main point of this discussion: Seizure Threshold.

SEIZURE THRESHOLD:For the most part, our brains are wired the same way. But, much like our computer analogy, we know that despite looking the same, computers differ in what they can do. The brain is similar in this respect. Our brains are constantly processing information and that information “travels” from place to place in our brain, in the form electricity. The more excitement, information or emotions racing through your brain, the more electricity it calls for.

Taking a look at our diagram below, you’ll see the gray area labeled “brain activity”, this just represents the “work” you brain is doing. The blue line represents the level of “brain work” most people would have to reach before they tipped their brain past its breaking point (i.e. their “seizure threshold”) and suffered a seizure. The redline is the threshold of a person who is already prone to having seizures. If you already have epilepsy (like Weezy does), the level of “brain work” that it takes to reach your breaking point is already pretty low. Now, if you take a look at the purple line, you’ll see that the threshold drops even lower for people using/abusing certain substances (which we’ll talk about next), making it “easier” for them to have seizures.

BREAK ON THROUGH: Each and every one of us has a seizure threshold, but there are two things to keep in mind about them:

1. We do not all have the same threshold levels.

2. Our threshold levels can be moved (up or down).

There are medications that people can take to help raise their seizure threshold (i.e. make it “harder” for them to have a seizure), and we can only assume Wayne is being treated with one of those meds.

But, we can also assume that he is a fan of the stereotypical “hip-hop party lifestyle” being portrayed in most of his videos and rhymes. So, lets take a look at things that may actually be lowering this dudes seizure threshold:

A) Molly: This is the more pure form of its sister drug, ecstasy (in nerd-speak, the name is 3,4-methylenedioxy-N-methamphetamine [MDMA]). It’s hard to do actual scientific studies using “illegal” drugs in the United States, but based on animal studies, and the data collected from people that show up in the hospital after a bad trip on molly, the science shows that using molly can not only cause otherwise “normal” brains to have a seizure, it can actually permanently lower your sezure threshold, making you more likely to have seizures in the future, even when you’re not using the drug.

CONCLUSION: Poppin’ mollies raises the risk that you might be poppin’ and lockin’ (and not in the b-boy sense) forever.

B)Sizzurp: This little home-brew calls for one part promethazine/codeine syrup, some purple-drank(orMountain Dew, if ya want to get fancy), and your favorite flavor of Jolly Rancher, for that smooth after taste. And, as we’re pretty sure you’ve gathered, the purple drank and the Jolly-Rancher aren’t the main offenders in this mix. Promethazine is an anti-histamine drug and is most often prescribed for its sedative properties (aka tranquilizer like effects). Problem with it? You guessed it; this stuff mos-def lowers the sezure threshold. As for the other ingredient, codeine, this is mainly prescribed for its strong sedative and pain reliever effects. If you’re looking to slow down your breathing and heart rate, as well as drop your blood pressure to dangerously low levels, go’head, drink up because that’s exactly what too much of this stuff will do.

CONCLUSION: Tired of waiting for your next epileptic seizure to happen? Try sippin’ on some seizure-urp.

C)Stress / Lack of Sleep: There is absolutely no doubt that lack of proper rest and high levels of stress can lower a persons seizure threshold. And, if you’ve paid any attention to Wayne’s career, there is no doubt that the dude is constantly on the move. But, unlike the substances we’ve mentioned above, it’s hard to not get stressed out. That being said, staying well rested and staying away from things that may lower your seizure threshold are probably two good bets to staying out of the seizure zone.

CONCLUSION: Get your rest on.

D) Alcohol: From the best we can tell, drinking alcohol in small amounts (1-2 drinks per day) usually does not lower a person’s seizure threshold. Even those with epilepsy should be allowed to drink alcohol in limited amounts. There are exceptions though, of course, like those with a history of alcohol abuse, or a history of alcohol-related seizures. The other thing to keep in mind here is that the most serious risk of seizures in connection with alcohol use is when a chronic boozer hasn’t had a drink in days and finds themselves in withdrawal, that is “the hangover” period. This can last up to 7-9 days after the last drink.

CONCLUSION: Be easy with the get-loose-juice.

E) Marijuana: According to several research studies over the past fifty years in both humans and animals, marijuana may have ANTIconvulsant properties, which means that they may actually prevent seizures. Yup. In fact, there have been accounts from the 15th century (back in the day-day-day) of marijuana being used to treat Epilepsy. A study by Columbia University actually showed that marijuana had a protective effect against first time seizures in men.

CONCLUSION: Puff, puff, pass… if you’ve been properly diagnosed by a medical professional, are being managed by a licensed physician and you live in a state where the use of medicinal marijuana is legal, of course.

Injury-Duty Insight: Yes, we’re sure there are a ton of drugs, both prescribed and not so prescribed that could have played a role in Wayne’s recent hospital stay, but we wanted to be fair and only address the stuff he’s most recently “told us” he’s been gettin’ into as of late. As for our professional recommendation, we’d advise less emphasis on “keepin’ it gangsta” and more emphasis on “keepin’ Wayne alive”.

-Team Injury-Duty

*We’re pretty sure he meant 30 beats per minute, not 30%. Just wanted to clear that up. And, unless you’re an elite athlete, 30 bpm is not good.

Everybody is talking about it. It’s shaping up to be one of the worst flu seasons in years. And, with all the commotion It never fails, we hear it every year-“Nah man, I don’t mess with the flu shot! The last time I got it, it gave me the flu!” Or, the always classic “Why would I get that shot again? Last year I got it, and still got the flu!”. With that being said, we decided to sit down and put together a short article on why getting the flu shot won’t give you the flu, but also why it can’t guarantee you won’t get it either.

THE BASICS:Without getting too “sciency” on you, lets talk about the flu shot itself. When you get a flu shot, what you’re actually getting is what’s known as a “dead virus”, which means the virus in the shot is, well, dead. “There is simply no way that the flu vaccine can give you the flu,”saysChristine Hay, MD, assistant professor at the University of Rochester Medical Center. “It’s impossible” (we’ll explain why it’s impossible later).

“WHERE MY DOGS AT?”: At this point, you’re probably wondering to yourself, if what’s in the flu-shot is “dead” then what’s the point of getting it, right? Fair question, and here’s a simple way to think of it. Your body has its own defense against “intruders” (i.e. your immune system), you can think of these as guard dogs, running throughout your body, attacking suspicious looking characters who might otherwise do you harm. These guard dogs have been trained to sniff out your run-of-the-mill “home intruders”, so most of the time when an intruder (playing the role of a virus in our scenario) tries to make its way into your body, your dogsare on the prowl and ready to handle your dirty work!

There’s only one problem in this hypothetical scenario. Every year the home intruders get a little more clever, and they switch things up. Maybe they ditch the ski mask, its too obvious. Instead, this year they decided to roll with the hoodie instead, it’s a little less suspicious. Now imagine the intruder makes his way inside your house, and it isn’t until he starts wrecking shop that your guard dogs realize “Aww snap! We have a problem here!” at which point they jump into action and try their best to control the situation. But, they’re a little late to react to the intruder (they didn’t know what to make of their new disguise at first), and he was able to break a few things and got away with some property.

Granted, the dogs eventually sprung into action, but the damage had already been done. They only upside to this scenario is that if the home intruders come around again, dressed similarly to the recent intruders (i.e. wearing hoodies), your dogs will be ready to spring into action.