Kate Van Pelt, PhD
I’ve always been an active person and had an interest in sports. During my headache fellowship in 2004-05, I was lucky enough to have a mentor (Dr. Ninan Mathew in Houston, TX) that not only treated different types of headache disorders, but also cared for patients with various concussion-related challenges. It was then that I realized I could marry my two interests of neurology and sports in what would ultimately become my practice niche. Concussion and headache are now about 95% of my patient base. I’ve been very blessed to have a job that I greatly enjoy.
Society’s evolving interest in sport-related concussion over the last decade has had a positive impact the lives of many. This interest, however, has also been associated in some circles with tremendous criticism of certain sport types/disciplines. While some of this criticism is certainly not without merit, I also oppose a complete abolition of combat/collision/combat sports. There will always be risk vs benefit ratio to consider in these contexts; however I’m wholeheartedly convinced that with continued medical advances, rule changes, and educational efforts, these sports can continue to thrive, while concurrently decreasing risks for those involved.
I’ve long held an interest in combat sports. Among my earliest memories are sitting with my father and watching some of the late career fights of Muhammad Ali. After moving to Louisville, I had the opportunity to help with ringside/cageside coverage for area boxing & MMA. Over time, this evolved to becoming involved with the state’s Boxing & Wrestling Commission. That experience has been some of the most enjoyable times in my career. I have an incredible amount of respect for the men and women competitors within combat sports.
There are still many challenges ahead; however, I’m most concerned with the difficulty of access to care. My home state of Kentucky is a great example of this. Urban areas, such as Louisville, Lexington, and northern Kentucky, have ready access to providers well-equipped to treat sport-related concussion. Rural areas, however, can often have a much more challenging time securing similar specialized care for their student-athletes. Luckily, this state is fortunate to have some of the best athletic trainers in the business. Yet, with that being said, I fear that often we’re leaving our athletic trainers and student-athletes on an island without access to the resources they need and deserve.
The primary barrier in the treatment of PTH is a continued paucity of high quality evidence-based treatment paradigms to help guide treatment. This routinely leaves providers with no choice but to treat strictly based upon anecdotal evidence and experience. There are, however, potentially new treatment options on the horizon. The most exciting of these is arguably the new CGRP class of medications recently approved for the prevention and treatment of migraine. Although these are not yet endorsed for the treatment of PTH, they will undoubtedly offer us another potential treatment option in years to come.
For some time I’ve hoped to establish a telemedicine capability within my practice. For various reasons (rural location, lack of transportation, class schedule, etc.) a physical trip to the office has sometimes been challenging for my patient base. The COVID-19 pandemic has allowed my employer, Norton Healthcare, to more rapidly deploy telemedicine for routine use. I’m currently in the second week of its usage and definitely anticipate it will maintain a permanent presence for some of my patient base, even long after this current health care crisis has subsided.
The genesis of the online journal club was 100% the result of my own boredom. I was laying on the couch one evening early in the course of our state’s stay-at-home order. Boredom and lack of structure are historically a dangerous zip code for my brain. I thought it might be nice to connect with my area athletic trainers in an attempt to maintain some communication and camaraderie in what I know is an extremely challenging time for them while being away from their student-athletes. I floated the idea out on Twitter and it’s essentially taken on a life of its own since. If the interest remains, I’ll likely continue it for the next few weeks until we’re all out of societal lockdown. If something as simple as a journal club can help provide a temporary distraction for an hour every week or two, I’m happy to do it.