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September 2010 Archives

anti texting laws are not working

CNBC just released a very disturbing story that suggests that laws making it illegal to text while driving are actually having the opposite effect. That's right - accidents related to texting while driving have actually gone up. According to a report from the Highway Loss Data Institute laws prohibiting texting are ineffective. Accidents related to texting actually went up in three of the four states examined. The texting laws are having the same result as those laws restricting the use of cell phones. Here is the most interesting part - they believe the reason for the increase may be that users are trying to do the texting indiscriminately. Yes - trying to hide their texting from open view which makes the conduct even more dangerous. Also, not surprising, is that the age group with the highest incident rating is the under 25 group. It has become increasingly more apparent that a more effective education process is necessary. We are not going to change the problem overnight. Just like with the seatbelt and smoking campaigns we must start indoctrination at a very early age. When the 3 year old in the back seat tells mommy that what she is doing is "bad" maybe then we will turn the corner. In the meantime do what I do every time I come to an intersection with another car - look to see if the other driver is using a cell or texting. I have been cut off way too many times. The other old cliché comes to mind - monkey see monkey do. Let's start the example now. Dennis F Feeley

how much do we really know about head injuries to football players

  The young man from Parkland who died from suicide related to an undiagnosed condition called traumatic encephalopathy shocked all of us local football fans and parents. The truth is that it should come as no surprise to anyone who has watched this game played with the intensity that good athletes bring to the field. The line from the Jack Nicholson movie comes to mind about not wanting to hear the truth, because maybe we can't handle it. Football-related injuries have been a concern since President Theodore Roosevelt convened representatives from academic institutions to reform the rules of football. The more research I did the more I realized that contact sports like football place our kids at risks well beyond the obvious. As a lawyer who has represented way too many clients with brain injuries, I know how these injuries can change the lives of the injured and their families. Over one-and-a-half-million high school and college boys play football each year. A football-related fatality has occurred every year from 1945 to the year 2000 except for one year. According the U.S. Product Safety Commission there were over 36,000 football-related head injuries in 2007. Cycling is the only other activity that has a higher incidence rating. Concussions, like the one suffered by Kevin Kolb of the Eagles two weeks ago, are the most common type of traumatic brain injury (TBI) sustained by football players. According to the journal of Athletic Training there are over 250,000 diagnosed cases of concussion a year. This injury had been labeled the silent epidemic because it receives very little attention. Troy Aikman has admitted to at least eight of them during his career. What are the signs of post concussive syndrome? According to a study conducted by the American Neuropsychiatric Association they "may include persistent headache, irritability, inability to concentrate, memory impairment, general fatigue, dizziness, or a generalized loss of well-being" In most cases the condition usually resolves in six to eight weeks from the onset. My first concussion occurred as a senior while making a shoe-string tackle late in the fourth quarter of a close game. I remember the excruciating headaches that occurred during practice the following week as we did drills on the hitting machine. My coaches were smart enough to send me to the doctor who diagnosed the condition that resulted in me having to sit out the biggest game of the year against Liberty High. However, I lived to play another day.  Now - here's the really scary part about concussion injury. It's called second impact syndrome. If a concussion is left untreated or undiagnosed and the player continues to play, he is left at risk for a much more serious and life threatening consequence. The American Orthopaedic Society for Sports Medicine says that patients suffering from head injury are "extremely vulnerable to the consequences of even minor changes ..." to the brain chemistry. Repeated mild brain injuries can be "catastrophic or fatal." Football players who sustained one concussion in a season are three times more likely to sustain a second concussion in the same season when compared with uninjured players as cited by Journal of Athletic Training. The good news is that in the last decade the numbers have gone down because new rules prevent tactics like spearing, butt blocking, and face to the numbers. Interestingly, the statistics actually jumped in the 60s and 70s as coaches encouraged players to use these methods. Huh? No one has to be trained in physical anatomy to know that hitting with your head is going to be dangerous Ok. What can we do to prevent these injuries and catch them when they happen? *   As parents, and coaches, look for the obvious symptoms and those cited above. Not every concussion causing impact is obvious. Most high school players are still learning and make mistakes like missing blocks and tackles and end up -- well -- hitting the ground instead. When your son comes home from a game pay attention and ask. * Make sure he sees a doctor before the season and has a routine exam. Maybe such an exam could have prevented what happened to the youngster from Parkland. * Talk to the trainer and coach if you have any concerns at all, but don't always rely on them because as a parent you have instincts they don't. The sport of football has become tougher, kids train harder and hit harder than when I played. All good reasons to be more careful now than ever. Dennis F Feeley

Driving on Interstate I-78 is like Russian roulette

Two fatal accidents in two days on the same stretch of highway going in the same direction make you stop and think that something has got to be wrong. Those of us who travel this stretch of I-78 regularly, like me, know that driving this route is a bit like Russian roulette. Cars constantly weave around and through the trucks that seem hell-bent on passing every other truck - even if it means that they slow down to 25 mph in the passing lane as they go up and down all of the hills between Cedar Crest Blvd. and the Pa/NJ toll booth. In some areas, the highway goes from three lanes to two lanes without much warning. Who hasn't been caught in the pinch point where it goes from three lanes to two (traveling eastbound) about a mile east of the route 309 exit. On a couple of occasions I thought I was a goner. Let's look at some very poignant statistics published by NHTSA (National Highway Traffic and Safety Administration). These guys are the nation's most knowledgeable accountants of highway statistics. They are also the nation's watchdogs for proper design, maintenance and signing of our highways. According to NHTSA in 2008, there were 4,006 accidents involving large trucks resulting in 4,229 deaths. One out of nine traffic fatalities in 2008 resulted from a collision involving a large truck. Pennsylvania ranked fifth in the country for fatal crashes with trucks, equaling 195 people. In the three years from 2006 to 2008, there were a total of 15 deaths involving large trucks in Lehigh County and five in Northampton. At our current rate, based on the last two weeks, we could easily surpass those stats. I am not accusing truck drivers of causing all these accidents. In fact the latest Morning Call report that the most recent accident was caused when a young man failed to yield as he entered the westbound lane of traffic forcing the truck to lose control and cross into the eastbound lane. Keep in mind that 24% of all traffic on our roads consists of trucks. Take into account that they are several times the size of a car and - well you get the point. A corridor transit study was completed in 2008 by the Jersey Transportation Authority that analyzed the amount of truck volume on I-78  (www.njtpa.org). The study published some interesting results which indicated that during the morning rush hour period truck traffic constitutes as much as 40% of the moving vehicles. This is in the area of our two recent accidents.       What can we do? I would suggest: 1. Let's all exercise more caution and awareness, especially at the on and off ramps. Does it really make a difference when human life is concerned who has the right-of-way and who should get over or yield?  We all know that the trucks rule this section of highway. Why mess with them? 2. Put away those cell phones and other devices that are just plain distracting. 3. Just because your new Hyundai can do 100 mph, doesn't give you the right to push it to its limits in heavy traffic. Over the years I have spent much too much time with accident reconstruction engineers who have proven that normal reaction time is a fraction of a second in order to get your foot off the accelerator and onto the brake from the time you recognize the danger. Do you know how far a car can travel in that distance at speeds in excess of 60 mph? Further than you can stop when you are only 10 to 20 feet behind the person in front of you. Then there are the skidding distances, tire conditions and road surface co-efficients. Bottom line - it's just crazy to tailgate or play games with other cars. Better law enforcement? Maybe, but it can be dangerous to conduct traffic stops on busy highways, especially at rush hours. Maybe living in the third largest region of the state carries these risks but it's never easy to accept tragedies that could be prevented. Dennis F Feeley (note: the above piece appeared in the Morning Call newspaper on Sunday September 12,2010)

will overtreatment of the terminally ill bankrupt america?

For those of us who saw a re-run of a "60 Minutes" piece last weekend titled "The Cost of Dying: End-of-life-Care watch here  for a summary of its content. For those who did not consider the following.  We spent $55 billion last year in Medicare payments made to doctors and hospitals for treatment rendered to those who are suffering through the last two months of their lives. That's more than the budget for Homeland Security or the Department of Education. The cost of treating the terminally ill will bankrupt America unless out-of-control health care costs are contained. This according to David Walker the former head of the GAO (Government Accountability Office). Why are we spending this much money on those who cannot be saved? Well it should be no surprise that doctors and hospitals get paid based on the number of patients they see or admit. According to Dr. Elliot Fisher, a doctor who specializes in treating the terminally ill, about 30% of all hospitalizations for these patients are unnecessary. Not only that, but once an elderly patient is admitted, testing and screening occur at blazing speeds. Procedures are done which are questionable, like one instance where a 90 year old patient received a $40,000 defibrillator. Another case is cited where a dying woman received a PAP smear. The news story reported that the average cost of a patient receiving terminal care is $10,000 a day. According to Dr. Fisher, we have become so good at treating the complications associated with dying that we can keep people alive for months or in some cases years.  The other question is of course what about the quality of life? That's another story. Apparently, if a patient requests that a recommended test or treatment be performed Medicare is obligated to pay. This is the only country in the world that imposes this kind of tax burden on the living. Who wants to be the one that says, "pull the plug on grandma"? The sad reality is that we will not have the money to continue these kinds of unnecessary treatments to the millions of baby-boomers who will be heading out the door in the next 20 years (myself included). Interestingly, the new medical care act does not directly address this problem. Why does a 90 year old woman who is dying need to have 13 costly tests administered upon admission as one daughter who was interviewed confided? If a doctor orders a test who among us is going to challenge his or her order? Most likely - very few of us. Most people, according to the piece, never closely examine the doctor or hospital bill.  Most of the time it's just a notice of payment made. Even though most people who were interviewed say they would prefer to die at home, the actual statistic is that 75% of us die in hospitals or nursing homes. The moral question will continue, but the economic question will not wait. I have blogged in the past about doctors and hospitals committing errors because of unnecessary testing, but this goes far beyond that issue. This is about making hard life and death decisions about those we love the most. I guess we can say "damn the dollar" and keep her alive for a while longer regardless of the quality of that life: or use that $55 billion a year to care for the 40 million uninsured Americans who not at death's door. David Walker says that if we properly managed the care of these terminally ill patients, the money we would save would be more than enough that we can avoid rationing their care in their remaining days. Tough questions, but ones that we will not be able to avoid much longer. Dennis F Feeley

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