Pacemakers are electronic devices that stimulate the heart with electrical impulses to maintain or restore a normal heartbeat. In 1952, Zoll described an effective means of supporting the patients with intrinsic cardiac pacemaker activity and/or conducting tissue by an artificial, electric, external pacemaker. The pacing of the heart was accomplished by subcutaneous electrodes but could be maintained only for a short period. In 1957, complete heart block was treated using electrodes directly attached to the heart. These early observations instilled the idea that cardiac electrical failure can be controlled. It ultimately led to the development of totally implantable pacemaker by Chardack, Gage, and Greatbatch. Since then, there have been several advancements in the pacemakers, and the modern-day permanent pacemaker is subcutaneously placed device.

There are several different types of pacemakers.

The main types are:

• single-chamber pacemaker – this has 1 wire, which is connected to either the right atrium (upper heart chamber) or right ventricle (lower heart chamber)
• dual-chamber pacemaker – this has 2 wires, which are connected to the right atrium and right ventricle
• biventricular pacemaker – this has 3 wires, which are connected to the right atrium, right ventricle and left ventricle

There are 4 types of artificial pacemakers:

1. Implantable pulse generators with endocardial or myocardial electrodes
2. External, miniaturized, patient portable, battery-powered, pulse generators with exteriorized electrodes for temporary transvenous endocardial or transthoracic myocardial pacing
3. Console battery or AC-powered cardioverters or monitors with high-current external transcutaneous or low-current endocardial or myocardial circuits for temporary pacing in asynchronous or demand modes, with manual or triggered initiation of pacing

All cardiac pacemakers consist of 2 components: a pulse generator which provides the electrical impulse for myocardial stimulation and 1 or more electrodes or leads which deliver the electrical impulse from the generator to the myocardium. This discussion focuses on the indications of pacemaker placement.

The type of pacemaker you need will depend on your specific heart problem.

Indications:

The most common indications for permanent pacemaker implantation are sinus node dysfunction (SND) and high-grade atrioventricular (AV) block. Guidelines for implantation of cardiac pacemakers have been established by a task force formed jointly by the American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Rhythm Society (HRS). The European Society of Cardiology has established similar guidelines.

ACC/AHA/HRS divides indications of pacemaker implantation into 3 specific classes:

• Class I: These are conditions where implantation of a pacemaker is considered necessary and beneficial (benefits much greater than risks).
• Class II: These are conditions where placement is indicated, but there is conflicting evidence or divergence of opinion. In Class IIa weight of evidence is in favor of efficacy (benefits greater than risk), while in class IIb, the efficacy is less well established (benefits ­greater than or equal to the risks).
• Class III: These are conditions in which permanent pacing is not recommended, and in some cases, it may be harmful (risks greater than the benefits).

Complications:

The pacing and CRT are associated with complications. The majority of complications occur in the hospital or during first 6 months. Lead complications are the main reason for the re-implantation of the pacemaker and CRT devices. Other complications include, but are not limited to infections, hematoma formation, pericardial effusion or tamponade, pneumothorax, coronary sinus dissection, or perforation. Some old pacemakers are not MRI safe.

Pacemaker procedures tend to have few complications, which you can discuss with your healthcare provider. In general, the following complications that are possible:

• Allergic reactions: These may happen because of a medication you’re given or you may be allergic to one of the materials used in the pacemaker itself.
• Blood clots: Your healthcare provider may prescribe blood-thinning medications to reduce the risk of developing a blood clot.
• Malfunctions of the pacemaker or its leads: In some cases, a pacemaker lead may get jostled out of position or might break free. Your healthcare provider will recommend limiting your activity for a while after your procedure to avoid this.
• Malfunctions caused by sources outside of your body: Your healthcare provider will give you instructions on devices or machines to avoid so you don’t have pacemaker problems caused by outside electrical interference. Fortunately, advancements in pacemaker technology mean these situations aren’t common.
• Unexpected heart rhythm problems: Some people develop heart rhythm problems — in rare instances — because of the pacemaker. Your healthcare provider can talk to you about these risks and help you avoid them.

Pacemaker implantation has shown a mortality benefit overall.

There are some areas where the indications for a pacemaker are clear, but there are few areas where clinical judgment and expertise plays a greater role. Although the guidelines attempt to define practices that meet the needs of most patients, the ultimate decision for the patient should be based on particular patient presenting scenario, clinician judgment, and discussion with the patient about risks and benefits of the procedure. There are specific pacemaker generators that are used for patients with AV block and sinus node dysfunction depending upon presentation. The different types of generators include a single chamber, dual chamber, and biventricular. A cardiology consult is highly recommended prior to the insertion of a pacemaker.

“Atrial fibrillation (AFib) is an irregular and often very rapid heart rhythm but it can also be a in slow rate for some. An irregular heart rhythm is called an arrhythmia and that is all AFIB patients who are diagnosed with it. AFib can lead to blood clots in the heart. The condition also increases the risk of stroke, heart failure and other heart-related complications.

During atrial fibrillation, the heart’s upper chambers — called the atria — beat chaotically and irregularly. They beat out of sync with the lower heart chambers, called the ventricles. For many people, AFib may have no symptoms. But AFib may cause a fast, pounding heartbeat, shortness of breath or light-headedness due to the rapid heart rate.

AFib can also be bradycardia (a slow heart beat rhythm).

You could have pauses  in that AFIB bradycardia that are called sick sinus syndrome or a longer pauses causing sinus arrest.  Each pt’s heart is unique on how it operates.”

MAYO CLINIC

   TopBox-Normal Sinus Rhythm

Normally, the heartbeat starts in an area in the top chambers of the heart (atria). This area is the heart’s pacemaker. It is called the sinoatrial node, sinus node or SA node. Its role is to keep the heart beat steady and regular. This creates the normal rhythm of the human body call Normal Sinus Rhythm (listed above in pictures in 2nd box call NSR).

Sick sinus syndrome is a group of heart rhythm problems due to problems with the sinus node, such as:

• The heartbeat rate is too slow, called sinus bradycardia
• The heartbeat pauses or stops, called sinus pauses or sinus arrest
• Episodes of a fast heart rate
• Slow heart rhythms that alternate with fast heart rhythms, called bradycardia-tachycardia or “tachy-brady syndrome”  Tachy meaning fast and Brady meaning slow.

Alternative Names

Bradycardia-tachycardia syndrome; Sinus node dysfunction; Slow heart rate – sick sinus; Tachy-brady syndrome; Sinus pause – sick sinus; Sinus arrest – sick sinus

Causes

Sick sinus syndrome most often occurs in people older than age 50. It is often due to scar-like damage to electrical pathways in the heart muscle tissue.

In children, heart surgery on the upper chambers is a common cause of sick sinus syndrome.

Coronary heart disease, high blood pressure, and aortic and mitral valve diseases may occur with sick sinus syndrome. However, these diseases may have nothing to do with the syndrome.

Sick sinus syndrome is uncommon, but not rare. It is the most common reason people need to have an artificial pacemaker implanted. Sinus bradycardia occurs more often than the other types of the condition.

Tachycardias (rapid heart rhythms) that start in the upper chambers, when the SA node can’t work to intiate the person’s rhythm,  atrial rhythms start to take over as the pacemaker of the heart that may be part of the sick sinus syndrome for people who have it. These atrial rhythms include atrial fibrillation, atrial flutter, atrial tachycardia-all are types of upper chamber heart rhythms, where they intiate from. A period of fast heart rates is often followed by very slow heart rates. When there are periods of both slow and fast heart rates (rhythms) the condition often will be called tachy-brady syndrome; this is what makes up atrial fibrillation (a fib) irregular rhythm/slow and fast heart beats and due to this allows pooling of blood in the heart chamber putting it at a potential to clot and could be passed on from the heart into circulation if the clot breaks off and if it reaches the brain puts the patient at risk for stroke.  Or A Fib can cause heart failure or other cardiac problems.

Some medicines can make abnormal heart rhythms worse, especially when doses are high. These include digitalis, calcium channel blockers, beta-blockers, and antiarrhythmics.

Symptoms

Most of the time, there are no symptoms.

Symptoms that do occur may mimic those of other disorders.

Symptoms may include:

• Chest pain or angina
• Confusion or other changes in mental status
• Fainting or near-fainting
• Fatigue
• Dizziness or lightheadedness
• Sensation of feeling the heart beat (palpitations)
• Shortness of breath, possibly only with physical activity like walking

Exams and Tests

The heart rate may be very slow at any time. Blood pressure may be normal or low.

Sick sinus syndrome may cause symptoms of heart failure to start or get worse. Sick sinus syndrome is diagnosed when the symptoms occur only during episodes of arrhythmia. However, the link is often hard to prove.

An ECG may show abnormal heart rhythms related to this syndrome.

Holter or longer term rhythm monitors are effective tools for diagnosing sick sinus syndrome. They may pick up very slow heart rates and long pauses, along with episodes of atrial tachycardias. Types of monitors include event monitors, loop recorders, and mobile telemetry.

An intracardiac electrophysiology study (EPS) is a very specific test for this disorder. However, it is not often needed and may not confirm the diagnosis.

In some cases, a person’s heart rate is observed when walking or exercising to see if it increases enough; a stress test.

Treatment

You may not need treatment if you do not have any symptoms. Your health care provider will review the medicines you take to make sure they are not making your condition worse. Do not stop taking any of your medicines unless your provider tells you to do so.

You may need a permanent implanted pacemaker if your symptoms are related to bradycardia (slow heart rate or with long pauses or rhythm arrest (completely stops).

Part II reviews Concussion-The symptoms/grade levels/diagnostic tooling with treatment and  CTE=Chronic Traumatic Encephalopathy

 The signs and symptoms you may see indicating a concussion aren’t immediately present where in other situations observed immediately; it depends on the impact of the hit to the brain and location. Concussions are fairly common. Some estimates say a mild brain trauma is sustained every 21 seconds in the U.S. But it’s important to recognize the signs of a concussion so you can take the proper steps to treat the injury.

There are some common physical, mental, and emotional symptoms a person may display following a concussion. Any of these could be a sign of traumatic brain injury: confusion or feeling dazed/clumsiness/slurred speech/nausea or vomiting /headache /balance problems or dizziness /blurred vision/sensitivity to light/sensitivity to noise/sluggishness/Tinnitis – ringing in the ears/behavior or personality changes/concentration difficulties/memory loss.

Concussions are graded as mild (grade 1), moderate (grade 2), or severe (grade 3), depending on such factors as loss of consciousness, amnesia, and loss of equilibrium.

-Grade 1 concussion symptoms last for less than 15 minutes. There is no loss of consciousness.

-Grade 2 concussion there is no loss of consciousness but symptoms last longer than 15 minutes.

-Grade 3 concussion the person loses consciousness, sometimes just for a few seconds.

The seriousness of a concussion dictates what kind of treatment you should get. Most people with concussions fully recover with appropriate treatment. But because a concussion can be serious, safeguarding the person who got the concussion is important.   Seek medical attention. A health care professional can decide how serious the concussion is and whether you require treatment or not.

If you have suffered a grade 1 or grade 2 concussion, wait until symptoms are gone before returning to normal activities. That could take several minutes, hours, days, or even a week but still see a MD to know the level for sure.

If you have sustained a grade 1,2, or 3 concussion, see a doctor immediately for observation and treatment since most people don’t know the different levels or what level they have had. A doctor will be able to tell all through diagnostic tooling.  The M.D. will need to know details about how the concussion even happened including the symptoms you or the patient is having.   The doctor asks simple common questions to evaluate memory and concentration skills (your name, the present year, where you are, etc…).

REGARDING DIAGNOSTIC TOOLING:

The doctor may test coordination and reflexes, which are both functions of the central nervous system. The doctor may also order a CT scan or an MRI to rule out bleeding or other serious brain injury especially if he feels it was a grade 3 concussion.

If hospitalization is not required, the doctor will provide instructions for recovery. Aspirin-free medications may be prescribed and you will be advised to take it easy. Experts recommend follow-up medical attention within 24 to 72 hours if symptoms worsen.

• Take a break. If your concussion was sustained during athletic activity, stop play and sit it out. Your brain needs time to properly heal, so rest is key. Definitely do not resume play the same day. Athletes and children should be closely monitored by coaches upon resuming play. If you resume play too soon, you risk a greater chance of having a second concussion, which can compound the damage. The American Academy of Neurology has issued guidelines about resuming activities after a concussion.
• Guard against repeat concussions. Repeat concussions cause cumulative effects on the brain. Successive concussions can have devastating consequences, including brain swelling, permanent brain damage, long-term disabilities, or even death. Don’t return to normal activities if you still have symptoms. Get a doctor’s clearance so you can return to work or play with confidence.

Can I Prevent a Concussion?

NO, since normally a concussion is unexpected, so it is tough to prevent. But there are several common-sense precautions you can take to lessen the possibility of traumatic brain injury.  What you can do is PREVENTION by wearing proper protective equipment in high contact sports from football to hockey to boxing and even soccer (all increase the chance of a concussion).  Bicycling, skateboarding, horseback riding to roller blading all can be a threat of a concussion due to a fall to the head.  Wear head gear, padded guards for knees/elbows and even mouth gear or eye guards especially in racquet ball.  Believe it or not a bike helmet can lower the risk of traumatic head injury by 85%. Ensure that the equipment is properly fitted, well maintained, and worn consistently.

For athletes and non athletes, always wear a seatbelt, obey posted speed limits, and don’t use drugs or alcohol, don’t be foolish texting or using the cell phone while driving because they can impair reaction time. Obviously, don’t fight to cause a blow to your head from occuring, and more males than females report traumatic head injuries.

Look what can happen after repeated blows done to the head over a long time – Chronic traumatic encephalopathy (CTE) is a form of encephalopathy that is a progressive degenerative disease, which can currently only be definitively diagnosed postmortem.  Let us look at the meaning of the word actually in medical terminology=Chronic (meaning over a period of a long time) Traumatic (meaning the blows to the head) Encephalopathy (swelling of the brain definitely is a part of what happens but in all types of encephalopathy there is a brain malfunction.  Know there are over 150 different terms that modify or precede “encephalopathy” in the medical literature.

In March 2014, researchers announced the discovery of an exosome particle created by the brain which has been shown to contain trace proteins indicating the presence of the disease  Baseline testing has been created to assess potential cognitive impairment in athletes in contact sports, but a test to determine the presence of CTE while the person is alive and a conventional postmortem diagnosis is not yet available.

The disease was previously called dementia pugilistica (DP), i.e. “punch-drunk”, as it was initially found in those with a history of boxing. CTE has been most commonly found in professional athletes participating in American football, Association football, ice hockey, professional wrestling and other contact sports who have experienced repetitive brain trauma. It has also been found in soldiers exposed to a blast or a concussive injury, in both cases resulting in characteristic degeneration of brain tissue and the accumulation of tau protein. Individuals with CTE may show symptoms of dementia, such as memory loss, aggression, confusion and depression, which generally appear years or many decades after the trauma.

CTE is a progressive degenerative disease of the brain found in people with a history of repetitive brain trauma, including symptomatic concussions as well as sub-concussive hits to the head that do not cause symptoms. In the case of blast injury, a single exposure to a blast and the subsequent violent movement of the head in the blast wind can cause the condition.  Look at the perfect example of who this happened to that most of Americans know or heard about what the famous boxer Muhammed Ali.

Unfortunately chronic traumatic encephalopathy (CTE) at this time can only be diagnosed 100% after death. Below is a list of confirmed cases of CTE and the breakdown by sport. It should be noted that this is a small list compared to doctors understanding of the problem of CTE and the many undiagnosed cases. Through the work of the Center of the Study of Traumatic Encephalopathy researchers have been successful in securing donations of professional athletes brains after death for further study so researchers can better understand CTE and how to better prevent it. Many on this list were identified this way.

Professional Football Players:

• John Grimsley – Houston Oilers, Miami Dolphins – February 2008 (45) – Case Study
• Chris Henry – Cincinnati Bengals – December 2009
• Dave Duerson – Chicago Bears – Suicide – February 17th, 2011 (50)
• Lew Carpenter – Detroit Lions, Clevelend Browns, Green Bay Packers – November 14th, 2010 (78)
• Lou Creekmur – Detroit Lions (NFL Hall of Fame) – July 5th, 2009 (82) – Case Study
• Shane Dronett – Denver Broncos, Detroit Lions, Atlanta Falcons – January 12, 1971 Floyd Patterson

Professional Boxers:

Bobby Chacon/Jerry Quarry/Mike Quarry/Wilfred Benitez/Emile Griffith/Willie Pep/Sugar Ray Robinson/Billy Conn/Joe Frazier/Muhammad Ali (suspected)

How many non professionals have been injured due to TBI’s  with not any better.  We know now and are taking action in awareness to the public to decrease the occurrences of these brain injuries from happening!  Help the community with awareness too!!

If you notice in most of my articles there is a key to prevention in getting a illness or disease.  Start taking the step towards prevention and not waiting till it happens especially CTE since the symptoms tell the M.D. the patient has high probability of the disease but can’t be actually 100% diagnosed till death in the morgue.

SO TAKE THE STEP IN MAKING A CONCUSSION NOT HAPPEN=PREVENTION, it is so simple.  Which decreases the chance of dementia, memory loss, depression from repeated blows to the head. PROTECT YOURSELF!

You may not be happy with the results especially if the cause of death was hemmorage in the brain!

“A direct blow to the head, or a blow to the body that suddenly rotates the head, can lead to a concussion, causing the brain to rapidly move back and forth inside the skull. “You don’t need impact to the head to have a concussion,” Dr. Sethi notes. For example, a football tackle or a fender bender may involve no head contact but could cause the head to whip around fast enough to cause a concussion.

Concussions typically do not damage the brain. “In the majority of cases, CAT-scans of concussion come back negative,” Dr. Sethi says. Yet, a concussion can temporarily stop the brain from working properly.

The danger is in not recognizing the signs of a concussion, especially since they are not always obvious, Dr. Sethi stresses. “Parents should know that concussion symptoms—a headache, dizziness, difficulty tolerating light or noise–could be very subtle,” he says. Athletes who have sustained a knock to the head commonly insist that they’re fine so that they can keep playing. “If you’re a coach on the sideline you may not notice anything wrong until you see that a player is off balance, looks confused or disoriented, or has a glassy look in his eyes,” he says.

Even severe head injuries, like hematomas, do not always produce immediate symptoms, Dr. Sethi says, recounting the late actor Natasha Richardson, who fell off her skis and hit the back of her head, insisted she felt fine, and refused medical care. “We call these injuries walking, talking, and dying. By the time she got to the hospital, her brain was hemorrhaging.”

Weill Cornell Medicine (https://weillcornell.org/news/national-winter-sports-traumatic-brain-injury-tbi-awareness)

We are in winter now with the sports this season that can be very dangerous.  Football with hockey and boxing already started and yet they maybe very exciting they unfortunately can still can be severely dangerous.  One of the reasons when a football quaterback catches after hiked the ball or in a kick off to the other team the player who catches the ball and not running it out starts no longer at the 20 but the 25 yard line, is done all for more safety even though some of us football fanatics think how wimpy.

The NFL now even takes action.  Through Fall and Winter Sports TBI Awareness Month, The Johnny OTM Foundation (Johnny O) is hoping to raise awareness regarding the health risks athletes face when they participate in winter sports, specifically traumatic brain injuries and concussions. September is a great time to put a spotlight on fall/winter sports safety and preventive measures athlete can take to avoid TBIs and concussions.

The mission of Johnny O “is to educate the American public to the growing seriousness of Alzheimer’s, Dementia and Traumatic Brain Injuries in the American population by raising the necessary donations through strategic research initiatives and heightened public awareness to accomplish our objectives.”1 Fall and Winter Sports TBI Awareness Month is one of many initiatives Johnny O is undertaking to not only raise public awareness, but also improve safety and reduce TBIs in Americans of all ages.

 A concussion is a traumatic brain injury that alters the way your brain functions. Effects are usually temporary but can include headaches and problems with concentration, memory, balance and coordination.

Although concussions usually are caused by a blow to the head, they can also occur when the head and upper body are violently shaken. These injuries can cause a loss of consciousness, but most concussions do not. Because of this, some people have concussions and don’t realize it.

Concussions are common, particularly if you play a contact sport, such as football. But every concussion injures your brain to some extent. This injury needs time and rest to heal properly. Most concussive traumatic brain injuries are mild, and people usually recover fully.

Remember the key to a brain concussion fully recovering is not to have impact to the head happening over and over again.  Based on the same concept if you get hit in the same spot over and over again anywhere in the body bruising to actual injury will happen whether it be muscle or bone.  Well get hit in the head over and over again like in sports especially boxing but now the big conversation with football even with a helmet on you will cause a permanent damage to the brain.   A perfect example of this is a boxer that gets hit over an over again to the head in a boxing ring.   The head is just another area of the body and no different than other areas of our body.

What actually happens is the concussion is most often caused by a sudden direct blow or bump to the head.  The brain is made of soft tissue. It’s cushioned by spinal fluid and encased in the protective shell of the skull. When you sustain a concussion, the impact can jolt your brain. Sometimes, it literally causes it to move around in your head. Traumatic brain injuries can cause bruising, damage to the blood vessels, and injury to the nerves.

The result? Your brain doesn’t function normally. If you’ve suffered a concussion, vision may be disturbed, you may lose equilibrium, or you may fall unconscious. In short, the brain is confused. That’s why Bugs Bunny often saw stars after getting whacked in the head in his cartoon by some other character.

The new uptake with football is being concerned with players getting concussions from getting hit by their opponent players whether it be defense or offense while playing the game. Concussions have become big business in the football world. With 1,700 players in the NFL, 66,000 in the college game, 1.1 million in high school and 250,000 more in Pop Warner, athletes and families across the country are eager to find ways to cut the risks of brain injury, whose terrifying consequences regularly tear across the sports pages. And a wave of companies offering diagnostic tools and concussion treatments are just as eager to sell them peace of mind.

That’s actually a slogan for one company.   ImPACT, the maker of the world’s most popular concussion evaluation system, offers a 20-minute computerized test that players can take via software or online to measure verbal and visual memory, processing speed, reaction time and impulse control.  The idea behind ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) and similar batteries is that doctors or athletic trainers can give a baseline test to a healthy athlete, conduct follow-up tests after an injury and then compare the results to help figure out when it’s OK to return the athlete to play. Selling itself as “Valid. Reliable. Safe,” ImPACT dominates the testing market and has spread throughout the sports world: Most NFL clubs use the test, as do all MLB, MLS and NHL clubs, the national associations for boxing, hockey and soccer in the U.S., and nine auto racing circuits.

A total of 87 out of 91 former NFL players have tested positive for the brain disease at the center of the debate over concussions in football, according to new figures from the nation’s largest brain bank focused on the study of traumatic head injury.

Researchers with the Department of Veterans Affairs and Boston University have now identified the degenerative disease known as chronic traumatic encephalopathy, or CTE, in 96 percent of NFL players that they’ve examined and in 79 percent of all football players. The disease is widely believed to stem from repetitive trauma to the head, and can lead to conditions such as memory loss, depression and dementia.

In total, the lab has found CTE in the brain tissue in 131 out of 165 individuals who, before their deaths, played football either professionally, semi-professionally, in college or in high school.

Forty percent of those who tested positive were the offensive and defensive linemen who come into contact with one another on every play of a game, according to numbers shared by the brain bank with FRONTLINE. That finding supports past research suggesting that it’s the repeat, more minor head trauma that occurs regularly in football that may pose the greatest risk to players, as opposed to just the sometimes violent collisions that cause concussions.

But the figures come with several important caveats, as testing for the disease can be an imperfect process. Brain scans have been used to identify signs of CTE in living players, but the disease can only be definitively identified posthumously. As such, many of the players who have donated their brains for testing suspected that they had the disease while still alive, leaving researchers with a skewed population to work with.

 Even with those caveats, the latest numbers are “remarkably consistent” with past research from the center suggesting a link between football and long-term brain disease, said Dr. Ann McKee, the facility’s director and chief of neuropathology at the VA Boston Healthcare System.

“People think that we’re blowing this out of proportion, that this is a very rare disease and that we’re sensationalizing it,” said McKee, who runs the lab as part of a collaboration between the VA and BU. “My response is that where I sit, this is a very real disease. We have had no problem identifying it in hundreds of players.”

In a statement, a spokesman for the NFL said, “We are dedicated to making football safer and continue to take steps to protect players, including rule changes, advanced sideline technology, and expanded medical resources. We continue to make significant investments in independent research through our gifts to Boston University, the [National Institutes of Health] and other efforts to accelerate the science and understanding of these issues.”

The latest update from the brain bank, which in 2010 received a $1 million research grant from the NFL, comes at a time when the league is able to boast measurable progress in reducing head injuries. In its 2015 Health & Safety Report, the NFL said that concussions in regular season games fell 35 percent over the past two seasons, from 173 in 2012 to 112 last season. A separate analysis by FRONTLINE that factors in concussions reported by teams during the preseason and the playoffs shows a smaller decrease of 28 percent.

“Esophageal Atresia is a congenital disorder in which a baby’s esophagus does not form properly during pregnancy.  Symptoms include include white, frothy bubbles in the mouth, vomiting, and coughing/choking when feeding.  Treatment includes surgery”.

Yale Medicine (https://www.yalemedicine.org/conditions/tracheoesophageal-fistula-and-esophageal-atresia)

Esophageal atresia is a birth defect in which part of a baby’s esophagus (the tube that connects the mouth to the stomach) does not develop properly.

Esophageal atresia is a birth defect of the swallowing tube (esophagus) that connects the mouth to the stomach. In a baby with esophageal atresia, the esophagus has two separate sections—the upper and lower esophagus—that do not connect. A baby with this birth defect is unable to pass food from the mouth to the stomach, and sometimes difficulty breathing.

Esophageal atresia often occurs with tracheoesophageal fistula, a birth defect in which part of the esophagus is connected to the trachea, or windpipe.

Types of Esophageal Atresia

There are four types of esophageal atresia: Type A, Type B, Type C and Type D.

• Type A is when the upper and lower parts of the esophagus do not connect and have closed ends. In this type, no parts of the esophagus attach to the trachea.
• Type B is very rare. In this type the upper part of the esophagus is attached to the trachea, but the lower part of the esophagus has a closed end.
• Type C is the most common type. In this type the upper part of the esophagus has a closed end and the lower part of the esophagus is attached to the trachea, as is shown in the drawing.
• Type D is the rarest and most severe. In this type the upper and lower parts of the esophagus are not connected to each other, but each is connected separately to the trachea.

How Many Babies are Born with Esophageal Atresia?

Researchers estimate that about 1 in every 4,100 babies is born with esophageal atresia in the United States.¹ This birth defect can occur alone, but often occurs with other birth defects.

Causes

Like many families of children with a birth defect, CDC wants to find out what causes them. Understanding the factors that can increase the chance of having a baby with a birth defect will help us learn more about the causes. CDC funds the Centers for Birth Defects Research and Prevention, which collaborate on large studies such as the National Birth Defects Prevention Study (NBDPS; births 1997-2011) and the Birth Defects Study To Evaluate Pregnancy exposureS (BD-STEPS; began with births in 2014), to understand the causes of and risks for birth defects, including esophageal atresia.

The causes of esophageal atresia in most babies are unknown. Researchers believe that some instances of esophageal atresia may be caused by abnormalities in the baby’s genes. Nearly half of all babies born with esophageal atresia have one or more additional birth defects, such as other problems with the digestive system (intestines and anus), heart, kidneys, or the ribs or spinal column.

Recently, CDC reported on important findings about some factors that increase the risk of having a baby with esophageal atresia:

• Paternal age – Older age of the father is related to an increased chance of having a baby born with esophageal atresia.
• Assisted reproductive technology (ART) – Women who used ART to become pregnant have an increased risk of having a baby with esophageal atresia compared to women who did not use ART.

CDC continues to study birth defects, such as esophageal atresia, and how to prevent them. If you are pregnant or thinking about becoming pregnant, talk with your doctor about ways to increase your chances of having a healthy baby.

Diagnosis

Esophageal atresia is rarely diagnosed during pregnancy. Esophageal atresia is most commonly detected after birth when the baby first tries to feed and has choking or vomiting, or when a tube inserted in the baby’s nose or mouth cannot pass down into the stomach. An x-ray can confirm that the tube stops in the upper esophagus.

Treatment

Once a diagnosis has been made, surgery is needed to reconnect the two ends of the esophagus so that the baby can breathe and feed properly. Multiple surgeries and other procedures or medications may be needed, particularly if the baby’s repaired esophagus becomes too narrow for food to pass through it; if the muscles of the esophagus don’t work well enough to move food into the stomach; or if digested food in the stomach consistently moves back up into the esophagus.

“Radon is a naturally occurring radioactive gas emitted from the ground. Radon is odorless, tasteless and colorless, and can enter a home through cracks in floors, basement walls, foundations and other openings. Radon can be present at high levels inside homes, schools and other buildings. Radon in homes is more common than you think. Pennsylvania has one of the nation’s most serious radon problems. High levels of radioactive radon gas have been found in every county but most places in the Commonwealth remain undertested, so this isn’t something that should be taken lightly.”

American Lung Association (https://www.lung.org/media/press-releases/pa-radon-2024)

Four Things You Can Do During National Radon Action Month:

1-Test your home –

EPA and the U.S. Surgeon General recommend that all homes in the U.S. be tested for radon.  Testing is easy and inexpensive.

Learn more about testing your home, including how to obtain an easy-to-use test kit.

2-Attend a National Radon Action Month event in your area –

Look for radon events in your community.

3-Spread the word –

Spend time during National Radon Action Month encouraging others to learn about radon and test their homes.

Tell your family and friends about the health risk of radon.  Encourage them to test their homes.

Plan an activity in your community to help raise awareness.

Write an op-ed or letter to the editor using samples from the event planning resources.

Attract media attention by working with a local official to get a radon proclamation.

View or order EPA’s free radon publications.

4-Buy a radon-resistant home –

– If you are considering buying a new home, look for builders who use radon-resistant new construction. Read more about radon-resistant new construction, “Building Radon Out: A Step-by-Step Guide to Build Radon-Resistant Homes“.

Build Green: It’s Easy to Build New Homes Radon-Resistant …”The good news is you can build your customers a safer, healthier, radon-resistant home. The techniques to prevent radon from entering a home are practical and straightforward for any builder. It’s an inexpensive way to offer families a benefit that could reduce their risk of lung cancer. And it’s a smart way to build trust between you and your customer.”  Fuad Reveiz, Member of the National Association of Home Builders.

5 WAYS YOU CAN PARTICIPATE:

 Promote radon risk reduction during National Radon Action Month and throughout the year.

Set a bold goal for your community to reduce radon risk.  Whether you are conducting a single National Radon Action Month event, or developing an entire radon risk reduction program for your community, it is important to set goals to define what you will achieve.

Collaborate with local radon partners.  Coordinate with your state radon program and local radon professionals to hold events and measure results.

Plan a National Radon Action Month activity or event to kick off your campaign.  Conduct activities and events designed to raise awareness, recognize successful efforts and share best practices. Set goals and establish ways to measure results from your activities and events.

An excellent way to get your entire community involved is the National Radon Poster Contest. Students ages 9-14 are encouraged to create posters that raise radon awareness. Entries will be accepted from March through October from students in all U.S. states, tribal nations and U.S. territories.

Visit to Kansas State University National Radon Services for more information about this year’s contest and how you can get involved.

Promote your activity or event on EPA’s Web site and elsewhere. Use tools such as blogs and the Share Your Story feature on Radonleaders.org to promote your activities and share outreach ideas with the broader radon community.

Work with the media to spread your message.  Work with your local media outlets to run Public Service Announcements (PSAs) and generate media coverage of radon topics, events and activities in your community.