DrPJax

With the injury to Mahomes , a dislocated ( subsequently reduced ) right patella , this season has gotten dramatically more interesting from a Bills standpoint. A patellar dislocation will likely cause a 4-6 week minimum ( can be 6-8 weeks with non Surgical management) rehab period followed by the need to split the patella with a brace to prevent more dislocations. Mahomes will be limited with his mobility in a brace and like the nice gentleman who is a PT. Posted on here, he will have the need for surgery in the off-season dictated by mri results as the extent of any associated ligament injuries are determined. Next 24 -48 hours will demonstrate the individual aspects of the dislocation ( like swelling and how he responds to rest , compression, ice etc. ) will affect the short term rehab and how quickly mahomes might Return. Even if he returns he most likely will have limited mobility so he will not be h same pre injury mahomes. Given all that is going on in the AFC , I THINK this now is a season to really push for the super bowl. The injury hursts Kc who has been the 2 Nd seed prospect so far, and leaves only the Texans and Pats as our biggest threats keep in us out of the Super Bowl! With that in mind, I believe Beane needs to take one last look at the roster to give us our best chance In assuring we are deep enough for the run. This is a year ahead of what I would guess most of us thought about our chances of getting to the SB. We really are still in the division race and home field is still in reach as our schedule Is pretty favorable. While I don’t think we need to mortgage any further years , I also think we can’t waste the fact that he AFC is having a down year. The only area I think could derail us is if John Brown ( or Allen of course) is out for any period because thee is no one who has similar talents on the roster right now. I would like to see Beane try to get a 1A type guy like green , Diggs . We have depth everywhere but an experienced backup for brown so while I was not a fan of getting Green before , given the landscape of the afc after tonight , I would really try getting green for a 3 rd and 4 th , or possibly just a second round pick. Would defer to Beane’s judgement on anything more than a third, but I would support him being aggressive more so now than earlier in the season. I think our d line , o line, TEs , RBS, all are ok to make a run and if our lb Thompson is back, we prob have enough depth there as well. The landscape is the most favorable I can ever remember recently for a deep run so Beane let’s make it happen. I know everyone saw mahomes walking and smiling in the locker room post game ( however he was not flexing or bending the knee and it was wrapped ), and while it is a good sign, we won’t know the full rehab prognosis until after the mri. The surrounding ligaments are at a minimum stretched ( which will make recurrence likely ) , and it is possible there could be tears. Based seeing him not on crutches yet in the locker room and still weight bearing, I would guess he has little swelling so far. But I am sure he will leave on crutches with a brace and then it comes down to the mri results. It will take time to strengthen surrounding muscles and allow ligaments to tighten if not torn so he doesn’t dislocate with any flexing of the knee and while he looks as good as you could after a dislocation, this will still take time to prevent recurrent injury on return to play. Hopefully teams will take advantage and give the chiefs a few losses while mahomes is rehabbing ( Denver looks beyond pathetic and I can’t see this coach making it to a second season). If we keep improving and stay injury free, I think we have a legitimate shot a year ahead of expectations to actually be a contender for the SB. HOME FIELD is still possible so let’s go Beane ,,,,be sure you are content with our current depth and let’s go Bills! I think we can do some mild addition to better our depth and experience at our wr position and not hurt us with regards to future development or drafts. I think we should push for home field this year; it is sitting right in front of us and not out of realistic reach. ?

I think the team is looking good. With Singletary coming back , I think gore and Yeldon are great compliments. Now with Duke in and Zay out, foster and McKenzie should be enough for a deep threat esp since we don’t go deep much and josh Has not been accurate deep either. We will get kroft back for depth as well. I would let the year play out on O now. Doubt there is much out there to bring in. One thing i would consider strongly tho is that if the rumors are true about Denver wanting to move people, I would try to get Von Miller. Our D is how we will win most games so why not make it really dominant? We need a premier rusher and zo is getting up there. If you bring miller in somehow , you extend both their careers and can rotate and keep them fresh. Plus you have depth and even cover yourself for zo departing. That’s the only thing I would make a big move for , You are in the cusp of a really special d and just adding a premier rusher to get to Brady could make all the difference. Also would keep looking at punters but that doesn’t have to be a trade. We need a guy who kills it within th 20 more often. Just an idea if Denver really is looking to move on. What do you think ?

I get your point Promo, not arguing that. I just wonder tho if they make those if the momentum stays the same. Also if one of those missed fgs turned out to be a td ( the one where mariotta crossed the line ) we are looking at them scoring 20. He only missed it by a foot and I bet you were holding your breath like I was during the break that the refs were going to give that too the titans. In fact the ref on tc was saying he would have given it tenn so it was a really fortunate win. Glad we got it but I think this team has the talent to be better. Need some coaching things cleaned up. Hey I think it’s ok to still love your team but be critical of stretches of poor play as well. I mean part of the fun of football if Monday morning qbing. How many of us called for duke two weeks ago and they finally , finally pulled the plug on the Zay excuses. Without duke they don’t win today and many on the board were harsh to people who were crtical of Zays play; turns out people should have been critical of his play. But that doesn’t negate loving the bills , at least for me my friend. Always like reading your insights for quite a few years now ! ? e

It’s a good win,,, better than any loss. But you are not going to have many teams miss three fgs like that. We also had our OC call three pass plays when we finally got the lead and we burned zero clock. Luckily Dabol got a chance to redeem himself and saw that had should have called the gore runs sooner. We got some luck there , also titans had a holding , illegal formation , and we still have up a td before it was nullified by Mariotta crossing the line and he did that by literally a foot. I mean it’s great to win and enjoy it but you also have to not accept this as the standard you want to hold your team to. Good news is we somehow won and we hopefully can build on this from a confidence standpoint. Young teams need to learn how to win and we are developing that winning culture. But to be there at the end of the season we need to clean a lot up. We had another bad int that resulted in the game being tied and we should have kicked that fg early when points were hard to come by yet we choose to call a bad qb sneak. Just need to clean this stuff up so Sunday’s keep us all smiling! ??

Yep. He made a clutch adjustment with josh on that td. Josh moved him toward the line and it allowed an inside release. He was on same page with josh and he also caught it in traffic in a clutch play. Zay wa not doing that very often esp the catching part

McKenzie with honorable mention on that jet sweep after misses fg and marriota crossing the line. That was great run.

Saw him run on in the failed 4 th down qb sneak. Never after that

No kidding. But hey they deserved that after gloating about that miracle thing! We got the miracle partially redeemed. Thought they might give one to marriota when he crosses the los but we lucked out!

GTA V rp at its best!

Ok now we are going to have to consider entering you in the TBD concussion protocol ,,,,,let’s see what posters think that protocol should be ! I am thinking one or two dirty martinis prior to reading any further posts about Josh and this dam concussion protocol ! ?

I think you are right , there is really no diff between stage 4 or 5 for a QB , except that stage 5 would imply a second day of full practice , followed by a computer test called the IMPACT test the next day to be sure josh has reached his baseline scores ( prior to the injury) and that his scores remain stable. If his score regressed tomorrow it would probably mean another day in stage 4 of the protocol which really only means he would be retested on computer again on Saturday. I believe if his score is stable tomorrow ( test done after sleeping after having finished a full practice ; the normal sleep part is important as many times patients with lingering symptoms or post concussion syndrome will have difficulty sleeping after exertion ) theoretically he would no longer need to be tested past Friday. The IMPACT test is the only FDA approved protocol for management of concussion and used by the NFL, olympics , FIFA, most high school athletic associations across the country and many colleges as well. Here is a link to the impact test site with a short video explaining its use. https://impactconcussion.com/?utm_source=google&utm_medium=paid_search&utm_campaign=impactproduct&ads_cmpid=6549852907&ads_adid=76904728725&ads_matchtype=b&ads_network=g&ads_creative=385367805553&utm_term=impact concussion&ads_targetid=kwd-314225683657&utm_campaign=&utm_source=adwords&utm_medium=ppc&ttv=2&gclid=Cj0KCQjwuNbsBRC-ARIsAAzITufx6xQwglg6Gk2R2C4wShszuAnxePkx9hEGac068cFN6ezuZRApp5gaAuudEALw_wcB ( hope that works ) . Here is a link for the SCAT5 ( sport concussion assessment tool version 5 ) that has a really nice handout used by clinicians and the last two pages really define the protocol stages for progressive return to exercise , school and studying that is a nice resource and defines what a concussion is and what cardinal signs to look for. This is used for quick ( ten min test Immediately after a witnessed possible concussion or brain injury) on the field ; sideline assessment for initial screening, then formal IMPACT testing occurs later or 24 hours after injury and compared to baseline. https://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097506SCAT5.full.pdf The following is the actual consensus statement on concussion in sport that was published from the conference in Berlin in 2016 and shows the multitude of experts brought together to develop the protocol or concussion policy that is in use today by the NFL. Don’t be put off by now formal it looks. It is nicely summed up in italics as you scroll thru the short paper. Pretty ingesting to see the actual report that was the basis for everything. https://bjsm.bmj.com/content/bjsports/51/11/838.full.pdf. Hope that is helpful. I think you are spot on tho that for a qb there is no function diff between stage 4 or 5 , except for just an additional 24 hours to show stability and no regression post exertion. ?

I think you are right on it Kelly, he did take all the snaps and the PROTOCOL by definition means he has to have done or survived a normal practice ( which is everything but contact I would think for a QB, for a non QB contact would be the last step of the protocol ) and then NOT HAVE any recurrent symptoms tomorrow. I think by definition if wed was stage 4 , todays practice would be stage 5 . I believe by definition he has to take the computerized IMPACT testing tomorrow to be sure his reaction times , memory , impulse control , etc all have returned to baseline and remain at his baseline 24 hours after last full practice to fulfill the final step of the protocol. So I think by definition he could really only FULLY clear the protocol by as early as tomorrow so today’s announcement I believe still fits with normal progression and no one can say he definitely out yet. Initially this protocol was set up to be a minimum of 24 hours per stage , however that has been modified for adults allowing faster progression. I think he is following an early course and I bet he will clear it tomorrow only based on the fact that he got all the reps and the focus wasn’t on getting Barkley ready. I don’t believe they have Barkley Standing around like has been reported , without activating the other QB additionally, unless they are almost certain that Josh will be cleared. If for some reason he is not cleared by tomorrow, I don’t see how they could avoid letting Barkley get the lions share of reps. To me tomorrow is the telltale day. if I may, for all those guys ( not you Kelly ) posting that he probably wasn’t concussed or “ was barely “ concussed , you are missing the point. It doesn’t matter how he looks to untrained people on a video. The computerized testing picks up on memory and coordination and reaction times and then compares them to HIS baseline normals. He would not be in the protocol if he had all normal tests to begin with; there is no debate he had a concussion. This as stated is taken control of by outside independent neurologists so there is no way the team puts him in it ( esp since they have no control over the situation once he is in it ) to just protect him or to be cautious etc. By definition the whole process/ protocol is out of team control. To say he was “ never really concussed “, or this was for “ optics “ is laughable and shows how little some people still misunderstand concussions and why independent people are needed to protect the safety of players. How would you like someone with that type of understanding making a decision about the future brain health of your son or fiancé if you are in Allen’s camp ? Thank goodness we are beyond that.

Wow , sorry to hear your kids have had those issues but imo sports are such a vital part of growing up and learning life lessons. I did tons of presports exams / clearance exams and we rarely try to disqualify anyone if there is a sound medical way around it. That one website , the impactconcussion.com, would be really useful for you I think. You can sign your kids up for baseline testing and they also have an app listed on the website for your phone that allows you to keep tract of all the testing related to your kids done on their site ( perhaps more as I haven’t downloaded the app yet.). They also have links to providers in your area tans have been certified by them in concussion protocol testing and interpretation. For someone with family in sports I believe it’s really important knowing the providers your kids are seeing have appropriate credentials. I think the fact that the olympics , NFL, FIFA, Imternational hockey association, etc have all contributed to their research and use the exact testing that is available to you thru the site. Also all the thousands of high school associations and colleges also use that site. BYW, I have NO affiliation financially with the site but thru my clinical research I believe they are currently state of the art for concussion management etc. Thanks for the feedback and wish you and you kids great health. Protect their health because without that nothing else matters much. If I can help with anything like Questions, just let me know, I am not a concussion expert but am a general clinician and have enough credentials that I am used for malpractice cases in family practice and urgent care as an expert to determine the merit of cases. Go bills !

Thanks ! Hope it was useful with all the talk about the concussion protocol. It also points out despite the objective tests it still comes down to individual clinician judgement approval for final clearance. ?

https://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097506SCAT5.full.pdf Public service post. Hey guys with all the concern over Josh, I thought it might be a good opportunity to post a couple of links to help us all be in the same page with concussions. The link above is to the SCAT5 ( sport concussion assessment tool 5) and I like it because while it is for a clinician to use on field / immediately post injury, it’s pretty basic and has good info on what symptoms are looked for , what are worrisome or red flag things or observations, and it talks about the things for clearing ( the protocol for increasing activity ) for sports and even for returning to school and studying. It has a good explanation on its last two pages. This information is collected prior to injury and then after for comparison. This is used quickly to determine need for transport to hospital, need for cat scans etc. I am sure Josh was examined by trainers or docs quickly after the injury. Note in red print about player not returning to action on day or injury and this is mandated in all 50 states for high schools. Just wanted you to see the various symptoms and also the protocol for returning defined. Josh is in stage 4 on wed which is good but all that means is he is progressing. So if he is symptom free after practicing Thursday, he MIGHT progress thru stage 5 which means he is ok after full practice (I doubt they allow anyone to have “ contact “ with their qb). That still doesn’t mean he will play. There is a known buffer zone where clinical symptoms ( patient feels better ) improve before physiological complete healing. A big study of around 3000 college athletes with concussion showed the biggest risk for further injury or second impact syndrome was within the first 7-10 days of the initial injury. About 1 in 15 had another concussion within the same year, most within that 7-10 day period. If someone had 3 concussions their risk for more was 3x that of someone with no concussions, so you can see the associate worry surrounding CTE. https://scipol.duke.edu/track/immediate-post-concussion-assessment-and-cognitive-testing-impact The second link is about “ impact”., immediate post-concussion assessment and cognitive testing. This is the computer testing that is the only FDA approve program I know of for managing concussion and returning to participation and one that the NFL , Olympics, FIFA and others use. Also your your high school students do this. It is done prior to injury for baseline and then post injury for management. After a concussion the test would be done 24 hours later by using a computer online portal with a certified trainer present. So I would think Josh is doing this daily. This test has to do with memory, impulse control , reaction time, processing etc. This is important as these things are objectively measured so a competitor athlete can’t underreport symptoms just to be able to play. Also , as some of you have addressed, this is hard to fudge initially by underperforming because if an athlete attempts that, red flags stand out showing statistical things that trained observers catch and make the person perform the test again. This does happen about 10% as self reported on the website, and apparently they have a good success rate catching this. So to be clearer to play the athlete has to return to baseline at a minimum to be cleared. Even doing that tho does not guarantee they will be cleared to play. These tests are all still just clinical “ guides” and it still comes down to the clinical judgment of the independent neurologist to give the full go ahead. That is just a legal way to protect the testing comapny and it does out the onus on a seasoned real life dr and I think that’ s good as these computerized tests are still building data and there is much ongoing research about brain injury. https://impactconcussion.com. BTW, this is the link to the actual company website where the computer testing was developed and marketed. You can actually even purchase a baseline test for your son/ daughter if you wish to have that data. I think the cost was around 20$ or so. Most high schools should be doing this already but I put the link there just for you to see the actual site and place the NFL does use. ( guys I couldn’t test the links prior to posting ,,just a doc and not an IT guy . All the links are public tho so I am sure you can google the info if links don’t work for some reason. ). So , it looks good that Josh is progressing and I expected that for a young healthy guy. He looked good in the video I saw of practice. Will probably know more on Friday if he fully practices Thursday and has no recurrence of symptoms. The one thing I am a little concerned about regarding him playing ( from my fanboy standpoint) is that Mcd is very conservative ( this is obviously a good thing ). He doesn’t even commit to Knox getting more plays when listening to him At the presser almost saying they won’t overload expectations on young guys. Mcd still emphasizes Josh being young and inexperienced. So that makes me LEAN, imho, to a position where I am thinking regardless of protocol, Josh may be sitting until after the bye. I just think Mcd errs on being conservative and just passing a protocol , while that would justify Mcd allowing josh to start, won’t be the only factor in his decision. I know it’s a huge game, yet I am ok with Barkley (sp) with a week of full reps. I would love watching Josh get a chance to “ redeem” himself, but maybe it’s best to believe you have Barkley on the roster just for this purpose and better to give Josh no pressure to recover so quickly. Don’t shoot me, it’s just an opinion and I have no idea what actually will happen. Hope the links provide some basic info so we don’t have to rely on opinion regarding how a concussion is evaluated and followed. ?

Yep it is scary seeing a loved one go thru a head injury. Hope your son is well and never had further episodes. Funny story I grew up in Ohio, trio state area around Pittsburgh pa, wheeling wva, and Steubenville Ohio ( home of Dean Martin of rat pack fame ). So I was a huge skynerd fan growing up. So moved to jacksonville, Florida after getting done with Med training in Toledo, Ohio in 1985. So one night I am in a bar and there is Leon Wilkerson , bass player of skynerd partying at the bar. Introduced myself and ended up driving him to some other places that night. Man , no wonder these guys had short life span. Anytime I ran into him he was “ partying “ and people were always Buying stuff for him at bars. Later on I met Ronnie vanzants wife who opened a bar called free bird here in Jacksonville beach. I was able to have her become a patient and got to know her over several years. Also her daughter became a patient and her daughter was married to the original lead guitar player of shinedown. I was lucky enough to get to know him and his wife and they were all really neat down to earth people. Got to meet some other members of the various incarnations of the band over the years and they were all talented but humble people. Just a neat thing for a small town guy like me who grew up as a fan starting in high school, only to end up being fortunate enough to give back some to them with medical advice as I got older and moved to Jax where I never expected to end up! Life is amazing and good and I will always be a rock fan till the day I am gone. It just boggles my mind that someday I would meet the guys who played on ONE FROM THE ROAD, after I had cranked that album so many times getting psyched for the weekend to arrive in small town rural Ohio ! Love your screen name and thanks for indulging me with my trip down memory road! Go Bills!

I think the only thing you can conclude is that the medical staff examined him and he was alert and able to respond correctly to the brief neurological exam done on the field at the time. For example, he was able to know where he was , situation , had short term recall ( like able to repeat three random objects or names back to the examiner ), and his basic neurological exam field side was normal. This is a very basic exam and is one point in time and has to be interpreted as such. Things can change as time goes on ; doesn’t mean they will but it is possible. So think of it as a Polaroid snapshot of his function right at that moment. That’s all that can be surmised. I was a little surprised he was not accompanied by someone just for legal purposes in today’s litigious environment. On the other hand there are so many people around he was really probably never out of the view of someone on staff. Hard to imagine a scenario where he was confused enough to just run off somewhere randomly without it being caught but you usually do see a trainer at least accompanying a player after that. He is a daredevil and may have taken off before they could keep up with him ! ?

Great question, not dumb at all! Just imagine any bruise you have had in the past anywhere on the body. There is some leaking of fluid from damaged small blood vessels in the area of trauma. The bruise you see is actually from the breakdown of hemoglobin from red blood cells that have been leaked into the surrounding tissue in the area of trauma. Fluid leaks out of the blood Vessels as well ( fluid is predominantly within,the vessels as part of normal circulation ) and as the fluid leaks swelling occurs. The brain is somewhat unique because it sits on a closed space , the skull , and has little tolerance for the swelling as opposed to other non- closed areas of the body. As swelling occurs pressure increases. This presses on small neurons and causes them to have difficulty sending their electrical impulses or signals. Also the swelling compromises oxygen supply to Neurons and brain cells and which contributes to cells not firing like normally. Symptoms like headaches, nausea , vomiting , confusion can develop in the area because of the cells not working normally. As time goes on and the blood vessels stop leaking and inflammation from the immune response subsides , the fluid is reabsorbed and normal pressure is reestablished and oxygen content returns to normal. Think of how a bruise color fades on your skin over time as the damaged red blood cells are broken down and the swelling goes away. When this happens in the brain normal cell and neuron function returns and symptoms get better. So as edema , swelling fades , brain function and how you feel return to normal. Simplified explanation but I hope it helps. ?

Just my opinion from seeing him unresponsive on the field. I was not there obviously but he immediately quit moving and the players around him signaled for help I believe. Just an educated opinion, and given that he didn’t return I am betting he lost consciousness for at least some brief period. Doesn’t meant he is not fine or won’t be , just that it explains why he didn’t return immediately. I’m sure given his past history being negative for multiple concussions as far as I am aware that he will be return quickly. I hope so because I love watching him!

Great point about the epidural hematoma. Nice to meet another Md bills fan in the board! I have been a bills fan since 63 , born and raised in Ohio but moved to Jax after residency / meds school in Toledo in 1985. Been on the board a long time and have met some wonderful people on here. Don’t post a lot as over the years the environment has gotten “ less supportive “ , as people become very negative and critical surprisingly on an opinion based format. Hard to figure why people attack each other and heaven forbid if you are critical of the performance despite the result. It’s like am Md who is still practicing despite multiple malpractice cases; an md but doesn’t mean his practice is sustainable and that he/ she will be ok despite repeating the same mental errors! Lol! Three of our 4 wins have been “ malpractice “ with performance and I just hope Allen can get past being a resident to become a full outstanding attending! ? What type of medicine are you in? How are things going for you and your career in today’s environment? Corporate medicine took over in my lifetime ( I am 62 now ) and it took so much enjoyment out of everything I love about medicine. Still would not change being in the greatest profession and all the amazing people who allowed me in their lives because of it. I have been exiled into just being a malpractice consultant now as 3 years ago I had 4 discs collapse in my cervical spine without much warning ( was walking down the hall seeing patients when my leg gave out and I fell against the wall) . Had urgent 4 level anterior decompression but my cord was permanently damaged and I have no feeling in either upper extremity , some muscle wasting , upper motor neuron hyperreflexia in my legs , and it knocked me out of seeing patients safely. I miss that part so much despite all the management changes with insurance etc Well forgive the long note, just nice to see a colleague and fellow Bills fanatic on here. Wishing you the best and much enjoyment of the season !

I am just writing this for information and not to be a smart a**. I am a board certified family practice and er dr with over 33 years in practice so I am giving you accurate info. There are well known cases of people surviving terrible traumatic things like car accidents and they miraculously get up and walk away from the scene, only to drop over unconscious or dead several hours later. The first 24 - 48:hours are a critical time for observation after a trauma , especially one where the person has lost consciousness. It’s why even after being cleared to go home after being seen in an er that every patient is discharged with the written instructions for for them and family listing symptoms to look for and why it’s necessary to immediately return to the er if things such as nausea or vomiting recur. Bleeding into the brain or around it into the closed space of the skull can have delayed symptoms and brain herniation can result with the patient dying. Even ct scans can miss a delayed bleed so no initial screening test is infallible. Look up subdural hemorrhage or sub arachnoid bleed for explanations of this scenario. So yes, it’s possible to easily get up and jog immediately after a very serious brain injury only to succumb later. That’s not the “ typical “ presentation , but medicine is anything but typical. Hope that helps .?

I agree with you ; it is becoming a red flag for my hope regarding Josh. He did the same things last year , in the preseason, in the prior three games and each time he has pointed out in press conferences how he is learning and won’t do the same thing again , only to exactly repeat the same obvious errors. I think it’s possible to now begin to look at this as a trend that to me suggests a possible processing error that he may struggle to overcome. Let me suggest a medical analogy since that’s what I am familiar with. In medicine students , residents , etc are given a “ playbook “ on how to deal with something like trauma patients.( advanced trauma life support , ATLS). You learn the plays/ algorithms so that you are able to perform under high stress, life/ death scenarios and you go over them until you can do those protocols almost instinctively. Before you ar cleared for the real world you have to demonstrate that you can perform under stressful , unpredictable situations. You are tested while people are screaming or nurses are panicking or not listening etc. , to be sure you can process the situation despite chaos with someone’s life on the line. Some physicians excel under these conditions, like surgeons or er Drs who are amazing people that thrive despite anything being thrown at them. However, some students/ residents just fold or don’t perform well under that type of rapid processing. They are still gifted , bright people , but they gravitate to specialties that are less likely to require that type of practice / processing and they are usually not found as career ER Drs. So I was watching Josh struggle today and he was holding and holding and holding the ball, or he was trying to “ process” what was going on leading him to finally Have to throw off his back foot , or wait until someone was grabbing him before he tried to use his legs or throw the ball away ( he just struggles to throw a ball away voluntarily) . He looks confused and it’s no secrets Dabol was frustrated with his decisions on the sidelines, suggesting he already expects more from Josh. I am beginning to have concerns that despite being a gifted, bright athlete, Josh may have issues processing under fire and sometimes people just aren’t fast processors. Not everyone can be a surgeon or ER dr! He may be a very good QB , but he may never overcome his puzzling tendencies for poor rapid processing. You don’t expect a senior resident with years under their belt to make errors that first year medical students make; and they won’t be allowed to continually to make this same errors and expect a successful career. I Expect more from Josh than continuing to make errors that frankly many good college QBS get over as they gain experience ( the buckeyes qb is young but has 0 ints this year, some guys just are different ), and I don’t expect to keep hearing how he says he won’t make the same mistakes while We are watching his actions defy that logic. I love the guy for so many reasons but I am getting concerned. His comebacks are usually associated with his athleticism, many times late he is making more plays running that going thru progressions so even those great comebacks aren’t totally alleviating the questions surrounding his baffling poor choices at times. Still have hopes but more guarded in my optimism. Also , lots of coaching errors continue with Mcd. Guy has no success at challenges and that affects his situational management. We lost all the time outs, Josh should have been coached to not burn that last time out just saving a procedure penalty ( 5 yards there not important compared to the to) , something the Pats excel at. We were in the game yet refused to take 3 when there was a lot of time left and points were obviously hard to come by. Mcd seems to lack an ability to solve the offensive lack of production. We keep seeing Zay fail , Smith on the field while Knox keeps making huge plays with very limited chances, no use of McKenzie ( again while Zay does nothing and I would argue even contributes to interceptions as he never adjusts to break up an interception while not catching in the first place lol !). He was out coached with the blocked punt that was the margin of victory and he was lucky a second punt wasn’t blocked as they didn’t adjust after first block. Doing the challenges with the first down as he questioned forward progress and then questioned offensive Pi at a time when we we already down a tie out or two. Just areas that Mcd is perhaps showing us glances of his talent ceiling. He is a good coach , seems slow to change strategies at times and his management errors contributed to the loss almost as much as Josh did today. Love the D and hope it doesn’t get wasted and that Mcd will actually try to change things not working. Go Bills ! despite it all they were in it till the end which is encouraging at least !

Running off means nothing other than right at that moment he was alert. He did lose consciousness and therefore did have a concussion and other additional things will define the severity of it. Many times patients are initially ok only to later suffer post concussion syndrome with symptoms like headaches , nausea , impaired cognitive function, mood lability etc. I would be surprised if he clears the post concussion protocols in as little as a week after a concussion / tbi with loss of consciousness that was about 1-2 min roughly. It is a staged process to return with increasing physical challenges that have to be performed with no return of any symptoms associated with the increased physical exercise demands, with additional cognitive testing as well. If any symptoms are precipitated by increased levels of exertion, things are put on hold to minimize risk of worsening outcomes with second traumatic head injuries. Since we are dealing with a literal bruise to the brain, it is easy to see how unpredictable it becomes regarding prognosis, just like you have seen as your own bruises ( a rough analogy ) heal at variable rates. I bet with a bye after Tennessee, they will be very conservative just like they have been with Singletary and I would guess Josh returns after the bye. It’s not impossible for him to make it in a week since he is healthy with no past concussion episodes / history I am aware of , but I think the odds are not in his favor to make it back for the Titans. Will know a lot more about his symptoms or lack of them in the next 24-48 hours. Will see tho, I’ve learned never to say never in medicine a long long time ago!

Hi. I am going to admit it was me who posted that and I said it sarcastically, jokingly, and as I was smiling as white sealed the game with the int. Sorry sometimes it’s hard to always get the right context reading a text, wouldn’t you agree? Maybe I should have put it in caps or highlighted it or put out a formal disclaimer. Well , no , I shouldn’t. I don’t owe you anything. I have been a loyal fan for 40 years plus, attended two Sb (27 & 28) ,endured losing in almost every possible fashion after becoming a non stop Bills fan in 1963. While I hate to see my Bills lose , believe me it has no effect on me past the last quarter of the game. I’ve noticed if anyone says anything at all regarding poor play at times immediately there are some people here ready to jump to personal attacks and unfortunately people are very willing to be nothing short of mean at times. I was in the shout box and was personally attacked over just making a statement that imho if the bills keep turning the ball over and the o keeps stalling , we will probably have a difficult time beating the patriots. I think history supports this fact and until the Bills best the pats a few times, logical thinking makes me take a wait and see response to the current success. Doesn’t mean I don’t love the wins, I do. But I am also not just blindly with my head in the clouds walking around thinking we are on the same competitive level with the pats yet. Hey, it’s my opinion, and I’m entitled to it. Why do I have my “ loyalty” questioned when we have two decades of frustration after all the success of the 4 SB era? Quit taking yourselves so seriously , it’s a game for entertainment and that’s all it is. I have been a practicing physician in Jax for over 30 years and my whole life has been based on helping people and I am a totally nonviolent person. If you took the time to know me as a person you would know I would never want a person to be hurt or get hit over a silly game. I was making a light hearted joke at the time because For ME , football is just a small interest in my life that has no real life day to day ramifications. I deal with real life illness , people going thru unimaginable suffering and loss, being with families as they lose loved ones from terrible REAL LIFE situations like cancer, infectious disease, and all the myriad of human conditions that we will all eventually experience. Please know Bills football is a distraction; it’s not a thing vital to you having a good quality life, won’t make you a good human who is loving to your family or community, won’t make you a good son , or parent, and your fandom will probably not be how your life is ultimately viewed as your higher purpose as a human being. Trust me in this as I have been with many people on their death beds and football has not one time ever come up as we talked about what a dying patient wished to be remembered for or what they found was important to their existence. Please remember, THIS IS A GAME, played by highly skilled athletes who participate voluntarily and know they are in a contact violent sport where it’s a given they won’t make it out without being hit at some point, but they know they are being rewarded handsomely for the risks they take. It’s like being in medicine. You are exposed to life threatening illness by body fluid exposure, and you make many sacrifices to EARN the honor of people entrusting their lives with your care. I spent my 21st birthday studying in a cadaver lab in July while most of my non-physician friends went out partying and drinking themselves silly as they became “ legal”. Good for them , but good for me too because I chose to make that sacrifice to have the honor of entering a very select field and 35 years later I couldn’t be happier having seen how kind and gracious people are in real life, facing real life and end life situations. Believe me, Bills football is not going to offer you salvation my friend. Take it and the discussions about everything associated with it as it is intended to be: a light hearted hobby with no real life consequences for you because in reality that’s all it is. I appreciate you didn’t name me outright and I only chose to reply because I don’t need your validation for anything to be happy in my life. I am replying as a public service because I am slightly saddened to see this amazing forum become a place where posters are personally attacked if they offer any opinion that is deemed inappropriate for a “ true” fan to have. I have seen whole threads being critical about people who have offered any well thought out criticism over the quality of the Bills play in these somewhat fortunate wins. Let’s not forget they have been behind in all three games. I don’t think the pats have trailed yet this year have they ? So while a win is a win, I imagine we all know there is more involved around how that end goal was reached. It just means despite the wins there is obvious room for improvement and I think the coaches and players are the first to be self critical about these past three games. To think otherwise is delusional. So if one is critical of some of their play , does that mean that person is not a fan or not as good or worthy a fan as YOU or someone who only is focused on the w or l involved? That’s a pretty superficial way of Looking at a hobby that has many different strategies and a plethora of ways to evaluate performance. My point is before calling out other posters or opinions or questioning their “ Loyalty “ , take a step back and ask why does your viewpoint have any higher intrinsic value. The fact is, it doesn’t. Have an open mind. Demonstrate some maturity and don’t strike out so impulsively. Be kind to other posters. Allow them the respect you would want as you post you non factual “ opinion”. If you don’t know a poster personally, perhaps have some pause before launching personal attacks or questioning their motives or judging their fandom. Be responsible for what you post and stop jumping to value based conclusions that are really no more than your own biased opinions about a hobby that is meant as a distraction in life and not something to determine the actual quality of your life. Be sure you are not revealing more inadequacies or superficialities about your own insights and values as you are calling out others for their supposed lack of loyalty or placing your misguided interpretations on things written in a forum where it’s impossible to know the context accurately. Is it that hard to just be nice to people, especially those already on a forum for those with a basic commonality, the Bills? Thanks and I wish you a happy week. Go Bills.

Haha! Was thinking the same thing. Ok so can he be ready to suit up for the pats against the Steelers for Monday night ? Somehow the NFL management types, pressured to win at all costs, always allow these personality types to keep having chance after chance after chance. I really wouldn’t be shocked if he ends up a Pat. Who else could even think about taking this on; only the Pats have personalities in place that still dwarf AB and his distorted self value.