Making Contact

 

Making Contact: Truths About Concussions and CTE

 

STAPLES

I came to with the youth pastor holding me down by the shoulders. My best friend’s dad Pat was applying pressure to the back of my head and telling me to stay down. A handful of my friends were circled around me and staring. Frankly, they all looked scared. I just wanted to stand up and get a drink of water from the fountain, but Pat showed me what he’d been holding against my head – a very bloody washcloth. I realized I must be pretty hurt if that was my own blood plus the youth pastor had me pinned and was keeping me from moving. When my mom got there to haul me to the emergency room, she was crying. Turns out I had a big gash in the back of my head and needed 8 staples to close it up. Worst of all, I wasn’t allowed to sleep that night because the doctor noticed my pupils were dilated which meant I had a bad concussion.

            Concussions are not to be taken lightly. A concussion occurs when a person’s head or neck is impacted in such a forceful manner that their brain strikes the inside of the skull. Usually, it strikes twice; once at the point of impact and then when the brain rebounds back the other direction. One of the scariest things about this traumatic injury is that it doesn’t show up on MRI scans or on CT scan imaging, which are scans specifically done on a person to determine if there are anomalies in the body or brain. Most often, concussions occur when someone is in a vehicle collision, takes a hard fall, or is otherwise impacted directly. The last bit is why there are so many concussions in heavy-contact sports such as American football, ice hockey, or boxing. Members of the military are also very susceptible to concussion because they are often in harm’s way in some form or another.

            Someone who has recently had a concussion may show some of the symptoms that common across the injury’s long history. For me, I had nausea, a splitting headache, I felt groggy, and I had bad anxiety for about 3 days after. Additionally, I had dizzy bouts for a year afterward and still sometimes lose my balance while standing still, and to this day I don’t remember the moment that the other kid threw me backward into that wall. I only remember him grabbing me, and then being on the ground in a different room.

 

 

 

SIDELINED

 

            These days, if you’re a sports fan you’ve probably heard something about concussions and protocols and players missing time on the field or court or the ice because they have had a bad head injury. If you’ve heard these news stories and wondered why they are significant or why they keep athletes from competing for a little while, then you may have also been curious about an acronym that is often involved in the discussions of these injuries – CTE. CTE stands for chronic traumatic encephalopathy and is a degenerative brain condition that is likely caused by repeated head traumas.

Recently, a football player named Tua Tagovailoa has suffered at least one concussion. During the Miami Dolphins’ September 25^th game against the Buffalo BIlls, Tagovailoa was tackled to the ground by an opposing player rather solidly, and Tagovailoa was seen stumbling over to his team’s sideline rather than walking correctly to it. Tagovailoa was removed from the game and evaluated by team doctors and by an independent neurologist. The independent neurologist cleared Tagovailoa to compete in the Dolphins’ next contest only four days later on September 29^th against the Cincinnati Bengals.

Doctors who have extensively studied concussions have made it very clear that they believe a person is possibly three times as susceptible to a second concussion soon after suffering the first one because of things like reduced reaction times. Unfortunately for Tagovailoa, being cleared to compete was not the right decision by the independent neurologist. During the game versus Cincinnati, Tagovailoa was tackled to the ground awkwardly and his head (in a helmet) was thrown back and into the turf. The images of that moment were frightening.

            What you see in this image is Tagovailoa’s hands in what is known as a “fencer’s pose”. This is a neurological response at the extremities of a person who has had a very serious head injury, and the hands of Tagovailoa are visibly spasming, his fingers twisted into odd positions. His night was ended, and he was carted off the field.

The following Wednesday, he admitted to reporters that he remembered nothing of the impact or of being carted off the field to the locker room. It was later determined that Tua Tagovailoa should never have been cleared to play in the Cincinnati game, and that the independent neurologist did not do his job properly in several ways. That neurologist has since been relieved of his position. Tagovailoa did miss the next two Dolphins games but has since been cleared to play again. It should be noted that since Tua returned from the concussion protocol, he has been more hesitant to leave his pass protection in order to take off running with the football. He is actively changing his play style in order to limit the risk of another head injury.

Experts in the medical field believe that this type of repeated brain injury and concussion treatment is precisely the type of occurrence that leads to CTE. Other NFL players have had their careers and lives cut short by concussions and CTE, including former All-Pro wide receiver Demaryius Thomas as well as Hall of Fame inductees Ken Stabler and Junior Seau.

 

“A DEGREE NEVER BEFORE SEEN”

            The mention of Junior Seau is a particularly bittersweet one for longtime fans of the game of football. Seau’s playing days in the 1990’s with the San Diego Chargers franchise had netted him a reputation as a quick-thinking, nimble, reliable playmaker from the linebacker position and was known for how solidly he could make contact with other players. It was fitting that his surname is pronounced “SAY-ow”, as he leaned into a reputation for making opponents say “ow” and eventually started an apparel branded with the nickname.

            However, it would seem that these hard hits and their frequency led indirectly to Junior’s eventual decision to take his own life. Seau shot himself in the chest in May 12, 2012, aged only 43 years. In the times leading up to the fatal decision to end his own life Seau had been accused of domestic abuse, and he had survived a one hundred foot fall down a cliff in his SUV. Seau didn’t leave any sort of note for his surviving family or for his girlfriend, the person who discovered his body with the gun nearby.

            Seau’s brain was examined by experts, and in a report publish by the NIH it was revealed that the brain had indeed experienced cellular changes consistent with CTE. The study had been led by Dr. Russel Losner, chairman of Ohio State University’s Department of Neurological Surgery, who delivered the report from NIH. However, Seau is not the only notable case of a life cut short by CTE’s impact on the brain, though he may be the most well-liked.

            Unlike Seau, Aaron Hernandez was seen as a villain. This perception of Hernandez was well-earned due to his participation in the first-degree murder of Odin Lloyd in 2013. Prior to the murder and subsequent conviction for it, Hernandez had been seen as a very promising young tight end that could compliment the talented roster of the Tom Brady-era New England Patriots. His professional career lasted only three seasons. On April 19, 2017, Hernandez was found dead in his cell, hanging by bedsheets. Despite his life-without-parole sentencing, Hernandez’s body was found to contain a synthetic cannabinoid drug known as K2, according to the toxicology report. Hernandez was 27 years old at the time of his death.

            Perhaps most troubling about the physical condition of Hernandez that was uncovered by examiners was the degeneration of his brain. Boston University conducted the research into Hernandez’s brain and found that Hernandez had “suffered from chronic traumatic encephalopathy (CTE) to a degree never before seen by BU researchers in such a young person.”

            Football is a fast-paced and violent sport. The lives of the men who play it are often shortened by forces other than nature. Hernandez’s case of CTE is very unique among football players. Yet, he isn’t the only athlete whose life was cut significantly and tragically short due at least in part to severe CTE.

 

2 MINUTES FOR ROUGHING

            I’m a lifelong Minnesotan. I grew up in skates and on the ice. Hockey is in my blood. When I was a kid, one of the best players in the world was a man named Eric Lindros. His most prominent playing days were in the 90’s and early 2000’s with the Philadelphia Flyers and New York Rangers. Back then, the experts who truly knew the game believed that he was going to be the next entrant into the conversation of the best players of all time. He could score like Wayne Gretzky, pass like Mario Lemieux, skate like Pavel Bure, and was built like a Mack truck. He was a sure thing. At least, he was until he wasn’t anymore.

            Between the years of 1998 and 2000, Lindros suffered 6 concussions on the ice. These injuries and the extended time off of the ice that came from them shortened his playing career. He retired in 2007 at the relatively young age of 34. During his retirement, Lindros has been prominently involved in the See The Line concussion research group out of University of Western Ontario. One of the important things that Lindros wants people to know is that he isn’t showing symptoms of CTE yet, but that he does worry that the concussions will bring about significant trouble later in life.

            Interestingly, Lindros is also quoted as saying that long-term injury to the brain is “not so much caused by the big hits, it’s the continuous smaller hits that accumulate to be a problem”. There does seem to be a particular case from the world of hockey that points to the possibility that this is true. On May 13, 2011 the dead body of Derek Boogaard was found in bed, having overdosed on pills which were exacerbated by alcohol. He was only 28 years old. Boogaard was also an NHL player, spending his career with the Minnesota Wild and New York Rangers. He had been known not for his scoring or fine playing skills, but for his toughness. He was known by teammates and opponents to be a tough-as-nails bruiser, an enforcer, and he infamous for how hard he could hit during a fight on the ice. He’d earned the nickname “Boogeyman” for how violent his fights were.

            While Boogaard was not killed by CTE (the overdose was the cause of death), the medical examiners who scanned his brain post-mortem did determine that he had suffered extensive and alarming CTE degeneration, especially compared to the brains of three other former hockey players, all of whom were also older than Boogaard when they passed. In the months leading up to his untimely passing, Boogaard had also shown very worrying CTE symptoms of brain trauma. The list included memory loss and forgetfulness, compulsive behavior, and severe mood swings. He was also trying to recover from a recent concussion at the time of his death.

            I would be remiss not to wonder whether these two hockey players have had such disparate paths in the life of hockey specifically because of the roles that they performed on the ice. Lindros was a high-profile star whose job it was to score as often as possible. Boogaard was an on-ice security guard for the players of Lindros’ caliber, often throwing fists with the other big roughnecks of the league. Lindros had a short career because he failed to avoid violent contact, Boogaard’s life was likely shortened – and certainly had some unnatural difficulty – because it was his job to absorb the violence. Is Derek Boogaard dead because of years of punches to the head? If Eric Lindros is correct, then the likely answer is “yes.”

 

 

HARD HITS

 

            Perhaps the most difficult to accept aspect of the threat of concussions and treating brain injuries that lead to CTE is that after all of this time and money spent researching it (for example, Lindros has donated multiple millions of dollars to research of concussions and CTE), so little is known and even less can be done about it. To clarify, I have no issue accepting that this is reality, only that the reality is unfortunate and not getting better anytime soon.

            According to the Concussion Foundation, the “best available evidence” points to the cause of CTE being repeated blows to the head over a sustained period of several years. This is why the research available contains so many confirmed cases of CTE in football players, military personnel, hockey players, boxers, rugby players, and even professional wrestling, among other  contact sports.

            What is devastating to find, in my humble opinion, is the answer to the question of what can be done to actually treat CTE. According to the information on the Mayo Clinic’s website: nothing. Apparently, more research needs to be done in an effort to find treatment, but Mayo recommends taking preventative measures to avoid head injury and to be aware of the latest information on how to manage brain injury. Part of the problem is that at this point in time, there are no diagnostic markers to identify at-risk individuals, meaning that identifying people who definitely are suffering from CTE is impossible while they are still alive. However,

 

GAME PLAN

            With all of this information and all of the stories of how CTE has impacted the lives of folks with repeated head injuries, there is only one thing left to address: what is being done about CTE? The sad truth of the answer is that the research has stalled out a bit because of the limitations on how a human brain can be examined or sampled. There is no feasible approach to harvesting living brain tissue because removing a cross-section of a human brain is almost certainly fatal for the person whose brain is being harvested.

            If research is limited by what science currently believes is possible – or ethical – to do, then the only hope for moving beyond “best available evidence” is for further advancements in the areas of neuroscience and medicine in general. Until such advancements take place, what we know about CTE and what can be done to actually treat it have reached their ceiling.

            It should be said that when I told the story about my own concussion at the beginning of this article, I have not had repeated injuries to my head since then. I do not show the repeated history of physical trauma that CTE most often derives from. While I have a pretty awful scar on the back of my head, my life has not been impacted in the same negative and extreme ways that people like Tua Tagovailoa, Junior Seau or Derek Boogaard have had their lives changed.

            While most of the research and therefore the statistics regarding CTE research have focused on athletes, there are non-sporting situations that a non-athlete may still suffer a concussion or blow to the head. As mentioned previously, former active military service members have also been researched in significant numbers. Also of note is the potential for CTE in folks who have been victimized by repeated domestic abuse.

            In the end, when I started contemplating what is happening in regards to CTE research, I was hoping for an interesting and compelling answer. I think I did get my wish, but I should have been more careful what I wished for. CTE is, at this time, an unsolved riddle of neuroscientific progress and I had been hoping for a more rosy outcome to this research. But I believe there is a silver lining; bringing awareness to this area of medicine may be the best way to push toward advancements. It will require innovation and funding, and neither of those will happen if no one cares enough to make progress. I know I will be hoping for progress.