Ask Dr. RamsHerd: What’s wrong with Jason Smith?

There’s a particularly troubling quote (emphasis mine) from Coach Spagnuolo about Jason Smith’s status in yesterday’s Around the Horns:

St. Louis Rams offensive tackle Jason Smith didn’t even watch practice Thursday, staying off his feet until the final minutes of the team’s indoor workout at Rams Park.

“We just decided to go a different way,” coach Steve Spagnuolo said. “I’m trying to get him through a few days where he doesn’t have any, I’m going to say, symptoms. So we thought rather than put him on his feet out there — we’re trying to get him back. Moving around seems to give him some issues.

It just goes to show, there are concussions and then there are CONCUSSIONS. Holding him out of the practice facility completely is a new step, one that might have been triggered by his third failure of the baseline neurological test on Tuesday — and the subsequent visit to an independent neurological examiner, as reported by Jim Thomas. So what might be going on here, and is a return to work likely for the putative stud tackle?

I did some digging around the web, based on the symptoms that we know he has:

  1. Extreme dizziness or dysfunction when moving
  2. Extreme sensitivity to noise — evidenced by his in-game “concussion-related symptoms” (later described by D’Marco Farr as puking on the sidelines) during the Seattle game, despite not even playing
  3. Long-lingering effects, evidenced by his continued failure to get back to his baseline level, three weeks after the blow.

One possibility? Post-Traumatic Vertigo, with a possibility of a rupture (or “fistula“) in the inner ear.

The symptoms of perilymph fistula may include dizziness, vertigo, imbalance, nausea, and vomiting. Usually however, patients report an unsteadiness which increases with activity and which is relieved by rest. Some people experience ringing or fullness in the ears, and many notice a hearing loss. Some people with fistulas find that their symptoms get worse with coughing, sneezing, or blowing their noses, as well as with exertion and activity…. It is not unusual to notice that use of ones own voice or a musical instrument will cause dizziness (this is called the “Tullio’s phenomenon”).

Vertigo is treated with a series of balance exercises — everything from directed “Vestibular Rehabilitation” to practicing Tai Chi or even the Wii Fit. But treatments are not especially powerful, and relief is a long time coming — 3 to 9 months in most cases, longer than that in a few. If there is a rupture found in his ear, the surgery would definitely be necessary.

Ironically, immediately beneath the listing for the Fistula in the list of common causes of vertigo is the condition that some disgruntled jackasses on the local talk radio are accusing him of: “Psychogenic vertigo,” otherwise known as malingering. Don’t put me in that camp. Given how hard Smith has worked with the team to earn his starting job, I just don’t see it. And the team wouldn’t be treating malingering as cautiously as they are now doing.

I’m hopeful that Smith will make a full recovery and get back on the field. But the possibility is there that he will not see game action again this season, and that the Rams will have a serious decision to make next year, with the left tackle spot open. If the Rams don’t know what they have in Smith, would they be tempted to resign Alex Barron? Will they need to prioritize the tackle spot again in the 2010 draft?

Either way, it’s not a pleasant thought.