Progress on Concussions

This past week, the Colorado Legislature introduced SB 40.  SB 40 is also called the Jake Snakenberg Act: it is a bill proposed in memory of a young man who died from having a second concussion only one week after a first concussion, one so mild that it went undiagnosed. Former Bronco and fan favorite Ed McCaffrey was one of the people who spoke at the news conference that announced the introduction of the bill, which is expected to pass with little or no opposition.

I can’t say enough about the potential positive implications of this bill. It’s a big start in controlling the life-long effects of concussions, and that will have eventual repercussions at the college and NFL levels, areas where the issue is starting to be dealt with in a far more medically appropriate way. The designs of helmets are undergoing some radical changes, and even the way that we view how a helmet does and doesn’t help with this problem are coming into the equation. Fewer and better treated concussions in young people will eventually mean fewer among the students who move on to college and NFL sports. It also means that average people who are athletes in high school only would later deal with fewer concussion-related health problems, some of which we’re just now understanding.

We’ve been talking about concussions for the past couple of years now, and in that time we’ve seen the NFL go from actively sweeping the issue under the rug to taking a proactive role in the prevention and treatment of the disorder, and that’s a substantial amount of progress. Even so, at least some of the players in the playoffs were on the field after suffering a concussion the week prior, inviting an incident of Second Impact Syndrome. It’s really not a question of whether that’s going to happen to an NFL player. It’s a question of time. Sooner or later, the decision to let a player back on the field in the week following a concussion is going to end in that player’s death. It’s far more common with younger players, and that’s certain. It can happen to older players, though, and sooner or later, it will. Yet, the odds are low per player and there are more common problems to deal with.

Former Bronco Brandon Stokley is still playing up in Seattle. He said that he lost track of the numbers somewhere around 12 or 14 concussions. He may have had more. He was and is the Slot Machine, a player you know you can trust, the one who goes over the middle on 3rd and 5 and gets you those yards and more. He knows that he’s going to get hammered when he does, and he takes great pride in his ability to take the hits, hold onto the ball, and get the yards when you need them. I have nothing but admiration for Stokes. He’s one of my favorite players, and one of the few that I still look for, despite his change of address. I don’t have a bad thing to say about him, I’ve never heard of one, and I wouldn’t listen if someone did. He’s always been a class act. I just want to keep him that way.

Here’s the reality of the future for players like Stokes, players who only report concussion symptoms if their eyes won’t focus on the ball anymore, or who are too dizzy to run a route. I admire the sheer courage that they show. I know that most of them have a short run on a big stage, and that many of them know that they may need every shekel they can tuck away for the future. Living post-career with football injuries can be a bigger challenge than 4th and 2 in the Super Bowl. On 4th and 2, you run the play and you make it or you don’t. With multiple concussions, after you retire you often wake up the next day, and the next, and fight the same battles, over and again. It doesn’t end. It’s hard to imagine that kind of future if you’re a professional athlete, with such magnificent reflexes, abilities, control of your body and the skill to do things that most people couldn’t even imagine. But here are a couple of realistic scenarios for that future that no NFL athlete can afford to ignore.

In one of them, you don’t know who the hell you are. Alzheimer’s and other, similar brain disorders become far more common as the number of concussions rises. We’ve known this for years, but it took the full power of the slow-growing but powerful anger of the football-watching public breaking out before Congress started calling witnesses on the subject. The NFL eventually was forced to fire a couple of bought-and-paid-for medical shills who were running their pet in-house committee on the subject, and to open up the doors to modern medical knowledge with its understanding of the stakes and the perils of the problem. They’re taking it more seriously, and I applaud that.

A player who’s had one too many concussions may have one, two, even three Super Bowl rings, but he will go through the recurrent nightmare of waking up, briefly, and remembering pieces of his life - and then sitting or walking around, completely engrossed in nothing at all, or wandering in some distant field of the mind, lost to his own accomplishments as the neurons that comprise his consciousness slowly sift down to a halt. The odds increase with each concussion.

Some of the victims of multiple concussions grow so sensitive to any additional impacts that just going though a rough bout of turbulence when riding in a commercial plane can set off an event in which the person becomes totally disoriented for 1-5 days at a time. Afterwards, they will have only intermittent memories of the experience, which is probably a blessing. It’s frightening to lose control of your mind.

There’s a second option out there - this is one that we have only recently begun to understand. New research recently showed that as the number of concussions rises, the chances of living with a neurologically-based chronic pain disease rises dramatically. One such disorder is Central Sensitization, also called Central Sensitization Syndrome. The body can only absorb so many impacts, and the brain so many shocks and injuries, before the central nervous system begins to send out pain signals long after the injuries have healed. The chemicals in the body that are called neurotransmitters become imbalanced, and an inability to sleep often accompanies the pain, muscle spasms and inflammation. Blood cholesterol rises in response to the inflammatory process, and vascular disease and stroke become more common.

We have only began to truly understand this disorder, starting with the work of one Dr. Eric Kandel, who won the Nobel Prize for Medicine and Physiology for his work on it in 2001. There are various levels of the disorder, but in all of them, the patient lives with endless cycles of severe pain. They range in severity from the difficult to the unbearable. Pain flares often get worse in the later hours of the day and during the night. In such times, the patient may be unable to sit, stand or lay in one position for more than one or two minutes before being forced to get up and change postures, again and again. They sometimes walk, hunched and shaking, for hours, until exhaustion forces them to sleep, often where they have finally dropped to the floor. It isn’t pretty.

Sleep usually breaks the cycle. Sometimes it doesn’t, and due to the disorder, the patient may not sleep for one, two or three days at a time. I’ve had strong men describe to me holding a pillow over their faces so that other people living in the house couldn’t hear them scream in pain. Every concussion raises the stakes and the likelihood that this will happen. The disorder is growing in numbers in our society, both in and out of sports (motor vehicle accidents are a common cause), and it is growing most rapidly among younger males, ages 25-40. That makes the NFL players classic candidates to eventually live with it. No documented research study has been done on those players as of this date. We haven’t known about the disease for that long.

There is still another side effect of the disease - the effects of medication on the body. We now know that extensive use of the types of medication that are normally used to treat this disorder can (and often do) cause damage to the liver and the kidneys. Such damage can be fatal by itself. Some effective options, such as the use of medical cannabis, are still illegal in most of the country. So far, the synthetic forms of that herb such as Marinol have been slow in the onset of their effectiveness, and don’t provide the same level of relief as using the plant itself. In just the past two years, we also found that it takes 8 times the amount of morphine to stop such a pain cycle as it does to prevent one;  that’s encouraging, and may lead to better approaches to treatment. But there’s no getting around the fact that the treatments can be as dangerous as the disease itself. We know that NFL players die a decade and more earlier than the rest of us. These are among the reasons why.

On a more positive note, the NFL has begun to take a more aggressive role in looking at the options for dealing with concussions and multiple concussion symptoms. Former players like Easy Eddie McCaffrey have taken on the responsibilities of making sure that communities recognize the dangers of concussions and they should be commended for their dedication to the youths and young players among us - our children, our nieces and nephews, our grandkids. Guidelines are now available that are approved by the Centers for Disease Control. There is also Youth Sports Concussion: Recommendations for Enhancing Athlete Safety, highly recommended reading, which is available at The Brain Injury Alliance of Colorado. As a culture and as a society, we are learning about the outcomes of these dangers and taking proactive steps to prevent the things that can happen to our youths from becoming a danger to life or health. It’s wonderful to see this becoming a reality.

As a former athlete and physician, I’m very pleased to see the kind of recognition of the depths of this problem and the proactive steps, including this piece of legislation, that we are taking. It’s a very good thing, to take care of the minds and health of our young people. It’s also one step towards a more sensible and effective set of policies for NFL players - and a committee that includes HOFers John Madden and Mike Ditka will be making further recommendations in the near future. Ditka, in particular, has been at the tip of the spear in making the plights of former players and the need for improvements in the policies of the NFL, and I’d like to salute him for that.

We take so much enjoyment from watching the contests among football players from our very young players to the NFL athletes that we owe all of them every effort that we can reasonably make to keep them safe, healthy, and whole. Watching the change come over the country, from the fans, to players, and to the legislature, is a delight to see. Sometimes, the good guys do win. Let’s never forget the people who have suffered greatly, in bringing the pleasures of athletic competition to all of us. Be well, my friends. 

Learn to laugh at yourself. You will be ceaselessly amused. - Sri Gary Olsen

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