The Ultimate College Student Health Handbook
The COVID pandemic has focused our attention on health like never before, and soon millions of students will graduate from high school, excited to ﬂy the nest and begin their college careers. As these young people begin to take responsibility for their own health, they will be dealing with the added challenges of issues like homesickness, close quarters of dormitories, test anxiety, and even hangovers, in addition to illness and injuries. As a physician working part-time in the University Health Services at The University of Texas, and as a mother of two college students, Grimes began writing helpful tips and creating ﬁrst aid kits for common college ailments, which steadily evolved into The Ultimate College Student Health Handbook (May 5, 2020, Skyhorse Publishing).
Dr. Grimes makes it clear from the beginning: the book is not intended to replace your next doctor appointment. However, armed with quality information, students will know when to seek medical help, how to describe their condition, what questions to ask, and what dorm-friendly tips and tricks might help before they are seen. The book is organized literally from head to toe and goes far beyond “Dr. Google” to provide the knowledge of evidence-based medicine every college student should know.
Chapter 3 I Hit My Head— Do I Have a Concussion?
What If: I Hit My Head. Do I Have a Concussion? Medical Name: Mild Traumatic Brain Injury (Mild TBI)
What most likely happened: Scenario A: Playing intramural “noncontact” sports when a high-speed ball or another player directly hits your head, knocking your body to the ground and possibly knocking you briefly unconscious. Symptoms may begin immediately or a few hours after the injury.
Scenario B: Rental E-Scooter accidents. Same song, different verse— this time with your head hitting the pavement, a car, or a wall rather than a ball or person hitting you.
Scenario C: Party scene, doing shots . . . and that’s all you remember. You wake up with a wicked headache, confusion, and possibly a bump on your head or scrapes and bruises on your hands/arms/legs that suggest you took a fall. This version typically includes backstory as friends text asking if you recovered from your fall or from “blacking out” last night.
What’s going on? A concussion is often described as a “brain bruise” that occurs from either a physical blow directly to the head or injuries elsewhere that transmit that force to the head, causing a functional—not structural—injury to the brain. The brain circuits are “shaken,” but no bleeding or direct tissue damage occurs.
Therefore, CT and MRI scans cannot determine whether you have a concussion. These scans may occasionally be used to look for additional injuries or complications, but they neither confirm nor deny the presence of a concussion, so do not automatically assume you will need one.
Concussions may create numerous temporary neurologic changes, most commonly:
• Mood changes (anxiety, depression, irritability)
• Sleep disturbance (too much or too little)
• Nausea and/or vomiting
• Balance issues
• Light and/or noise sensitivity
• Difficulty focusing or “brain fogginess”
Treatment: The answer is complete brain rest for twenty-four to forty-eight hours, then start low, go slow as you return to activities. Brain Rest means: no screens, no texting, no reading, no listening to lectures. You need a quiet, darkened room where you can comfortably sleep. The sooner and more completely you comply with complete brain rest, the sooner your brain will heal and you can return to activities. Note that full academic return without worsening symptoms should happen before you start back on exercise, sports, jobs, or clubs.
Basic Concussion Rehab Each step should be twenty-four hours. Go back a step if symptoms worsen.
Step 1: Complete cognitive rest for twenty-four to forty-eight hours.
• Step 2: Light routine physical activities (cooking, light house work) and trial of thirty-minute segments of cognitive tasks, such as reading/studying. When you are able to tolerate forty-five minutes of academic effort without worsening symptoms, you may return to class. (No work, no extracurricular, no sports yet.)
• Step 3: Full return to academics without worsening symptoms (headache, nausea, fatigue)
• Step 4: Light, nonimpact aerobic exercise (walking, exercise bike)
• Step 5: Moderate activity (treadmill, elliptical)
• Step 6: Return to work (low- or no-impact jobs) and nonphysical extracurriculars (meetings, etc.)
• Step 7: Sport-specific drills
• Step 8: Sport practice: noncontact
• Step 9: Sport practice with contact
• Step 10: Return to playing sports and full life activities
When to head to your doctor:
As a college student, if you have a head injury significant enough to lose consciousness or have any concussive symptoms, please get checked out. At a minimum, concussion inventory scales will give your doctor a baseline to reassess you if your symptoms persist. Professors are far more understanding when they see documentation that a doctor has placed you on short term “complete brain rest” so you cannot prepare for a test, versus telling them the day of the exam that you couldn’t study the last few days because you think you might have a concussion.