NFL player recoverey

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Snake oil, anyone?

>>> "Robert F. Smith" <rfsmithmd at comcast.net> 9/16/2007 7:03 AM >>>
Here's an account of the therapy from today's NYTimes.

September 16, 2007
Doctors on the Scene Acted Quickly to Treat Everett With Cold Therapy 
By MATT HIGGINS
BUFFALO, Sept. 15 - In the moments after a serious spinal cord injury
paralyzed Kevin Everett of the Buffalo Bills below the shoulders, doctors
began an innovative treatment based on a familiar premise: apply ice to
reduce swelling.

In this case, though, instead of using ice, doctors chilled Everett from the
inside, infusing cold fluids into his veins. The treatment is experimental,
though, and medical experts caution that it is impossible to say in an
individual case whether it helped or hurt.

Even if it does work, it is not clear whether the chilling has to start
immediately, as happened with Everett, or whether it can start later, at a
hospital. But the surgeon who operated on Everett is convinced. He said the
treatment, known as moderate hypothermia or cold therapy, is responsible for
Everett's ability to move his arms and legs days later.

"I will hang a good portion of my belief in this recovery on cold therapy,"
the surgeon, Dr. Andrew Cappuccino, said by phone Friday, "because we don't
normally see this recovery in people with spinal cord injury where cold
therapy is absent."

Cappuccino treated Everett with cold therapy after he sustained direct
compression, or a bad dislocation, of his spinal cord between the C-3 and
C-4 vertebrae in his neck. In such cases, only about 5 percent to 10 percent
of patients regain normal function, Cappuccino said.

Everett was injured last Sunday on the first play of the second half of the
Bills' 15-14 loss to Denver while making what appeared to be a routine
tackle of the Broncos' Domenik Hixon. Everett lowered his head at the last
moment, striking his helmet on Hixon's shoulder pad and collapsing face
first to the turf. He lay motionless for about 15 minutes while he was
tended to by the medical staff.

On the ride to the hospital, Cappuccino began cold therapy treatment. He had
the ambulance air-conditioning set at the lowest temperature, as Everett
received two liters (about two quarts) of ice-cold saline solution
intravenously, and called the hospital to prepare a cooling blanket.

"There is no specific written protocol" for cold therapy, Cappuccino said.
But he said the goal was to lower a patient's body temperature to reduce
inflammation and the destruction of cells in the spinal cord, which can lead
to further damage.

Everett was taken to Millard Fillmore Gates Circle Hospital in Buffalo,
where he underwent four hours of surgery by Cappuccino and a team of
doctors. They realigned his neck and stabilized it in front with a titanium
plate. The rear was secured with titanium screws and short rods.

After surgery, a catheter was inserted into Everett's left femoral artery,
near his groin, to circulate ice-cold saline in his veins, lowering his body
temperature to 92 degrees for about 24 hours.

"It does seem to have some benefit," said Dr. Robert Cantu, co-director of
the Neurologic Sports Injury Center at Brigham and Women's Hospital in
Boston. "Whether it's responsible exclusively for the return or the recovery
in this particular case, it's a little hard to say. It may have happened
anyway. But nobody could say it didn't contribute to this quite remarkable
turnaround."

But studies have not always borne out the initial promise. For example,
although neurosurgeons had high hopes for hypothermia to quell damage from
brain injuries, a rigorous study showed it did not help. In fact, patients
who were chilled actually spent more days in the hospital with medical
complications than those whose bodies were kept at a normal temperature. 

Cantu said that hypothermia treatments, which date to the 1960s, fell out of
favor because of side effects, including blood clots and harm to vital
organs.

"There is a burgeoning volume of literature and research on the utilization
of limited hypothermia in the care and treatment of acute stroke,"
Cappuccino said.

But Everett's case may be the earliest application of treatment for a spinal
cord injury because doctors were on the scene.

There are 11,000 spinal cord injury cases a year in the United States,
according to the Spinal Cord Injury Information Network. Most victims do not
have doctors standing by, thus making cases of early intervention with cold
therapy difficult to study.

"How could you get treatment to a patient quickly in another scenario?" said
Dr. James Weinstein, editor of the journal Spine and director of Dartmouth
Institute for Health Policy and Clinical Practice. 

Cappuccino said he learned about hypothermia treatment in spinal cord cases
during a seminar last year conducted in part by Dr. Barth Green, chairman of
neurosurgery at the University of Miami medical school. Green is also
president of The Miami Project to Cure Paralysis, a foundation created in
1985 with Marc Buoniconti, the paralyzed son of the Pro Football Hall of
Fame linebacker Nick Buoniconti. 

Marc Buoniconti sustained an injury similar to Everett's in 1985 while
playing football for The Citadel. "When I first heard of Kevin's injury, I
was very disappointed," Buoniconti said. "I want the public to know that I
hear about this stuff every day. It's unfortunate the only time the public
hears about it is when it happens to prominent people."

Still, cold therapy will remain unavailable for most spinal cord injury
patients. Cantu said, "The only negative thing about this to me is that if
someone didn't get this treatment, that's not like saying they didn't get
appropriate medical treatment."



-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] 
On Behalf Of KMATTOX at aol.com 
Sent: Saturday, September 15, 2007 8:48 AM
To: trauma-list at trauma.org 
Subject: Re: NFL player recoverey

I have watched for follow up data about the status of this  patient.   There

was a great deal of specific data early, but none  recently.     Just WHAT
is 
the status of the muscle movement  and sensation in the hands and feet?     
Remember one of the  lead researchers in Miami stated that this patient
would 
WALK.   
 
Any data?
 
k



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