Solingen 93

Domestic Violence and Abuse

Concussions Part 1: Head Injuries and CTE In Pro Athletes


‘ the sports world has long glorified athletes
who play through pain they’re gritty they’re gamers they have
heart all positive attributes their creaky knees and aching backs are
testaments to their warrior like playing days but this play at all costs mentality is
creating an epidemic that in some cases carries the ultimate price in a four month span in two thousand eleven
three former n_h_l_ enforces passed away all under the age of forty at least one of them was known to have
chronic traumatic encephalopathy or c_ t_ e_ damage to the brain as a result of
repeated blows to the head among many others one of the effects of
c_t_e_ is depression the two players whose autopsies were not made
public committed suicide and two of the players struggled with
substance abuse you know it’s it’s pure speculation to
assume some of the recent NHL deaths are associated with brain injuries until you study the
brain our experience has been that we’ve
studied the brains of two enforcers both who had those sorts of issues including
depression and and strange behaviors both of them were suffering from chronic
chronic traumatic encephalopothy would i be surprised i would be most
surprised if any of those three athletes did not have CTE so would could CTE have
contributed to their outcomes absolutely do we know for sure we’ll you
can never know but our c_ t_ people in the brain bank now
many of them committed suicide most of them suffered from depression
most of them suffered from uh… impulse control issues most of you know many of them suffered
from drug overdoses that had late onset drug
addictions of you know within the last few years of their life didn’t it wasn’t something
a life issue so um… I would be surprised if one of you know any of those three did
not have the disease to be honest well let’s kinda think about what goes on in the medial
temporal lobe of the brain and think about where c_ t_ e_ is most
maximally involved the abnormal tau protein deposition is in the
medial temporal lobe and the medial temporal lobe of the brain
along with the under surface and tip of the frontal lobe is the part of the brain that most often
is injured with these jarring shaking movements that occur so not just in c_t e but in concussive
injury you can have injury to the medial
temporal lobe in the medial temporal lobe is housed our
memory uh… especially recent memory and with
it’s connections to the frontal lobe is housed our what we call executive function our abilities to multi
task to do multiple things at the same time so cognitive functions are medial temporal
lobe addictive behaviors are medial temporal lobe it also houses uh… in the amygdala and inter rhinal
our limbic system which is our emotions panic anxiety depression all of that’s medial temporal lobe so if you injure that area of the brain you can have dysfunctions in any and or
all of those areas chris nowinski is a former college football
player and professional wrestler and the author of head games football’s concussion crisis after absorbing numerous blows to the
head both in football and especially in wrestling chris now suffers from post
concussion syndrome and not a week goes by in which he does not
feel its effects uh… but it’s it’s day to day i actually feel terrible today and uh… you know it’s just one of those things
you wake up and and everything seems a little fuzzier than usual uh… you know I tried to have four or five coffees to kinda get my
brain to where i feel it was yesterday I don’t know uh…
just not consistent like I was but uh… but I you know i’ll take what i have today I don’t want it to get much worse but I’ll take what I have today well i didn’t realize i was getting
concussions at any point along the way until i actually had to retire um… the last concussion the only one
that ever made me tell anyone uh… i was wrestling the dudley boyz in
hartford connecticut and bubba kicked me in the chin really hard and
when i hit the ground i remember a throbbing headache and complete
disorientation where I didn’t know where I was what we were doing how we were supposed to finish the match or
anything and so when i got we finished though of course we didn’t
stop this was two thousand three you didn’t call time out and we went backstage and the
trainer stopped me and he said you look like something went wrong you know
did you get hit in the head and i told them to leave me alone and uh… those headache though never went away and so i i remember holding my head it’s throbbing uh… on
the ground for hours before i left the arena that night and for five weeks with a headache and with
memory problems i kept wrestling and working out every day for the
first the time in my career I was forgetting spots in matches and things I was supposed actually during a live broadcast
I forgot my lines like that stuff had never happened to me uh… then uh… i had to stop and
then I met doctor robert cantu who became my first my doctor now my mentor but he was the first doctor to help me appreciate the fact that
I had been getting concussions all long simply by asking me two questions
first one was have you had concussions before i said no and he said ok have you been hit in the head or
seen stars or got dizzy or got confused I was like yeah a lot he goes okay those are concussions
I’m like really you know twenty four college graduate I should know that been banging my head for
nineteen years at that point uh… so then in his office just
remembering I could remember at leaset five others actually I was just uh… exchanging emails with
one of my concussors a guy named spike dudley who in our match had elbowed me in the face and
given me this scar and uh… i remember having double
vision for the rest of the the match and so i wouldn’t tag back in but after the match the only concern was
gluing my face back together and not anyone asking why I didn’t tag back
into the match they thought it was the cut uh… in football the sky would change
colors on me a lot when i got helmet to helmet hits at
least a few times it would go orange and that’s how i would remember that something was a little wrong but that’s you know they weren’t
that spectacular you know one was a kick to the head that caused a about a ten-second blackout I remember being on one
side of the ring and realizing I’m on another but in the match I also broke my nose so
again I never spoke up in two thousand seven chris and doctor
robert cantu founded the sports legacy institute a non-profit organization devoted to
sports concussion advocacy research and education a year later the institute collaborated
with boston university school of medicine to form the center for the study of
traumatic encephalopathy the center for the study of traumatic encephalopothy
here at boston university uh… we’re trying to understand the
long-term effects of repetitive brain trauma which come in the form of the
disease chronic traumatic encephalopothy or CTE we have a number of programs really to help us
appreciate what the disease is and with the end goal being treating it
and hopefully curing it uh… it’s been a incredibly neglected
disease it was first actually appreciated and
named in nineteen twenty eight as punch drunk disease but it was found in boxers which is why they called it
and I don’t know if none had sympathy for boxers or something but there was no doctor or research center
ever in the next eighty years that was ever focused on this until we
started ours and so um… we have now the world’s
largest athlete brain bank with ninety six cases of uh… of athletes who’ve past away and their families have
donated uh… doctor ann mckee runs that study
she’s completed over seventy analyses and over fifty have shown this
disease which tells us it’s must be more widespread than anyone ever
realized and then uh… we have a basic sciences
program to appreciate how the disease how the disease actually starts and then
we have a clinical program of a five hundred athletes that are signed up
to donate their brains when they pass away including me uh… of which the high-risk group is
being tracked annually with cognitive evaluations and phone calls and with that that’ll be the population that we
actually do intervention studies with and one
we’re kicking off shortly will involve actually trying to find what’s called a
biomarker for the disease or a way to diagnosis it in living people so that’ll mean
that now we’ll be scanned with m_r_i_’s and DTIs and MRS and they’ll be taking
blood and spinal fluid and genetic material and all these different ways that hopefully
we can find a pattern that’ll tell us this you have this in living
people what are you doing now to raise awareness
for concussions well I donated my brain uh… that’s that’s a tough one when you sign that paper uh… that allows ah… doctor cantu or someone from the institute to uh… essentially cut off the top of your
head and remove your brain uh you know you’re you’re walking the walk as we say uh… so so that’s my primary contribution uh… to to the issue why is this cause so important to you it started uh… because i couldn’t simply couldn’t believe that
i didn’t know the information that i was taught
by dr cantu as an athlete that i was out there completely
recklessly uh… getting hit in the head and and didn’t care i know i would have changed my behaviors
had i had this information i know that i wouldn’t have gone through five years of
post concussion syndrome and I it became readily apparent that other
people wouldn’t be doing this to themselves either you know there’s a few kids every year
who die from second impact syndrome because they think they’re being tough by not talking
about their concussions there’s now you know hundreds thousands tens of thousands
hundreds of thousands of ex-athletes walking around with CTE in their brain that are
e-mailing calling us every day going i wish i knew about this because i didn’t need to lead with my head i didn’t need to
lie about my concussions and so the goal when I originally wrote head games
was just to simply give everybody a choice to say i i i tanked my own career out of pure ignorance I
wouldn’t have done it this way again if you have this information you won’t do the
same thing tom mchale was an n_f_l_ offensive lineman
for nine years he died at age forty five leaving a wife
and three children the oldest of whom has cerebral palsy after allowing his brain to be examined
by the center tom’s widow attributes his death to the concussions he suffered
during his career and clearly now when you look back and i
see the images of his brain and I hear doctor mckee you know say his area his
brain was it was damaged significantly in the areas that control impulses and
decision making and you know emotional liability all the things that are
seriously hampered you know by that that you need to get in order with substance
abuse and i believe uh… with all my heart that he’s dead because of chronic
because of CTE did you know your husband was suffering
from the effects of head trauma had absolutely no idea in fact uh… when i got the phone call about
donating his brain it was really the first time that uh… I had ever thought about at all and in fact i said
you know i guess uh you can have his brain but you’re
not going to find what you’re looking for because I had never know tom to have had a concussion uh had never heard of chronic traumatic
encephalopothy and uh you know in fact of all the in in watching him
struggle for all for really a number of years uhm it never once crossed my mind never occurred to him that it could have anything to do with playing
sports ron johnson was an nfl running back
from nineteen sixty nine to nineteen seventy five the majority of that time with the new
york giants with whom he earned two pro bowl honors his wife started noticing changes in his
behavior in two thousand five three years before his diagnosis of
alzheimer’s my husband uh is going to be sixty four next week and he was diagnosed officially july of ’08 when he was sixty so we started noticing as a family two to three years prior to ’08 as early as ’05 when he was in his late fifties mid to late fifties just so many
things initially it was flukish losing his keys not remembering where he parked the car getting maybe an extra speeding ticket that you know just erratic type things not following up with business things we
have a family business and uh my son our son works with their uh…my husband in the family business after undergrad he went into the business so he was noticing it at the office on a day in and day out basis and
I was noticing it at home on a personal level and his moods and his behavior
personality changed
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he became much more highly agitated much more frequently about inconsequential things I mean small things would just set him off I subsequently learned from the doctors
that this was his way of covering he understood that he was uh having
diminished cognitive funtioning
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and because he’s such a bright person this was his way of compensating for it and when he failed
he was angry with himself and so he vented outwardly
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because he was so frustrated so this went on and on you know for
two or three years and then it just became increasingly increasingly obvious
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that there was a disconnect that something was terribly terribly wrong and he himself started to withdraw because he understood he was not able to function how many concussions would you estimate he had well that’s just it technically my husband’s never been diagnosed as concussed and you know as I’ve educated myself my husband stopped playing in
1978 back then
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the definition of concussion was so very very narrow a player had to be literally knocked out unconscious taken off the field on a stretcher before someone would say mm maybe something’s going on here you know fortunately my husband was always able to jump up you know he might have been down briefly and we we’re always more concerned he was a running back about the appendage injuries which my husband did he had two zippers one on each knee and a thigh a hematoma and later on after he retired he had a uh two vertebrae replaced in his neck so it was always appendages never every did we think about
any type of cognitive injury or whatever but obviously it was there just latent we didn’t know about it so uh… that’s our story that technically there’s no concussion history but there definitely is a
trauma
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a head trauma there’s no doubt about that part of the problem is that players may
hesitate to report symptoms they may believe their injuries are no
big deal or they’ll try to tough it out and return to
the game for their team there maybe pressure from parents other
adults or other players to keep playing don’t let your athlete convince you that they’re
just fine or that they can tough it out emphasize to athletes and parents that
playing with a concussion is dangerous if a coach suspects a concussion in a young
football player it is critical that that player not return to play or practice if one of your players has a concussion
their brain needs time to heal a repeat concussion one that occurs in
a short time period before the brain recovers from the first can be very
dangerous as it may slow recovery or increase the chances of long term
problems it can even be fatal most people who suffer a concussion
fully recover however returning to sports and other regular activities to
quickly can add weeks or months to an individual’s recovery time for boys and girls who are in school concussions
not only affect sports performance they can affect school performance as well students may find they can’t do their homework they can’t concentrate or study
because it prolongs their symptoms jus like a premature return to sports exercising or activities that involve
concentration such as studying working on the computer and playing video games
may cause concussion symptoms such as headache or tiredness to reappear
or get worse after a concussion physical and
cognitive activity such as studying and learning should be carefully managed and
monitored by a health care professional doctor eleanor perfetto serves on
the board of directors for the sports legacy institute her husband ralph wenzel was an offensive
linemean for the pittsburgh steelers san diego chargers and st louis cardinals and
he has resided in an assisted living facility for the past five years he is sixty eight i’m when we first had an appointment with the neurologist who who was diagnosing him at that time the
neurologist said to him have you ever had concussions he laughed and he said yes of course i played professional football and the neurologist said how many and he said to many to even count and he said you ever get completely knocked out and he said yeah a few times and he said did you ever get completely knocked out and when you came to you really had no idea where you were or
what you were supposed to be doing and he said oh yeah i did and he said I got up and I
continued to play and i was running the wrong way on the field and my my fellow football players got me off the field ’cause i was running in the wrong
direction dr cantu one of the leading experts on
concussions is a co-director of the center he explains that a concussion is more
properly characterized as a process than an event concussion comes from the latin
word concussus which means to violently shake the brain is violently shaken inside the skull the frontal parts of the brain bounce off
the inner surface of the skull the
occipital parts of the brain bounce off the uh… occipital part of the skull and
then the temporal lobes are very much traumatized in the middle
faucet and in reality the brain is experiencing
both linear which means longitudinal or in one plane stretching forces as well as rotational
forces which are twisting forces that stretch brain tissue even more
and as a result of those uh… stretching of brain tissue axons and neurons are rendered dysfunctional well the event is the sudden violent
shaking and then the process is that over a
period depending upon the severity of the concussion uh… that can be minutes hours days
weeks sometimes years recovery has to happen and recovery is reestablishing the correct ionic uh… makeup and the correct neuro
transmitters back on the axons that can be negatively influenced if the
concussion is not managed properly and the symptoms can be made to last a
lot longer and sometimes can cause some cells to die that wouldn’t otherwise
have died how does one diagnose a concussion it’s a clinical diagnosis in every case
and you make the diagnosis by virtue of one of two or both changes that happen to the brain after it is uh been
subjected uh… to traumatic forces linear and
rotational forces most of the time those forces are traumatically induced by a
direct blow to the brain or the head striking an object but they can be indirect blows as well a violent
blow to the chest that snaps your head forward a violent blow to the back of your thorax that snaps your head back that also if
they’re violent enough can produce concussion symptoms what are the symptoms well the symptoms
are either A uh… an alteration in level of
consciousness which on one extreme is coma unconsciousness which is uncommon
but happens about five to ten percent of the cases on athletic fields uh… or simply being stunned losing orientation for a period of time so it can be either that and or any one of the other twenty-six post
concussion symptoms that can be brought on by these
traumatic forces such as difficulty remembering difficulty
concentrating headache dizziness light-headedness sensitivity to light sensitvity
to noise trouble with balance trouble with coordination and so on so you can have no alteration in level of consciousness just
those symptoms occurring and it’s a concussion or you can have just alteration in con
uh… consciousness without those other symptoms but more often you kinda have both how many concussions do you think and i know it’s
impossible to know for sure go undiagnosed probably somewhere between sixty
and eighty percent and it depends upon the sport sports that are at high risk of concussion like football ice hockey for sure there have been studies I’ve
been a part of an ice hockey study where they put observers up in the stands and
their job was to look at the rink and when somebody got up slowly and looked
like they may be a bit stunned yet went back in to play to examine them between
periods and determine whether uh… they felt they had a concussion or
not and they found the incidence of
concussion was seven times higher from these physician observers than from
the medical personnel on the bench and there’ve been rumors football studies by
delaney and others that have shown that if you ask players
at the end of the season when there isn’t an issue with peer pressure and
coaches looking down on them and all that kind of thing about whether they’ve had concussion
symptoms like after a hit have you ever seen stars have you ever lost
orientation could you not remember the place um about sixty to seventy percent of
individuals will say yes during the season at some point they’ve had these symptoms so
they’ve obviously had a concussion and yet only about five to eight or
nine percent of concussions are recognized uh… in football during a season so the unrecognized group far exceeds the
recognized group is it because of the athlete mentality i don’t
want to miss any playing time i want to get back into the game pain is normal or is it i had no idea that I even had a
concusssion well i think it’s all the above uh… mike mcrae a neuro psychologist it’s
done a lot in the athletic arena once wrote a paper on exactly that subject when concussions were missed what were the reasons and the most
common reason at the time i hope that’s not true now and i certainly commend you for what you’re doing with
your program because it’ll make it less likely in the future but the most common um… reason at the time he wrote the paper a
few years ago was that the athletes didn’t know what concussion symptoms
were were not aware of the severity of uh… playing through them and essentially
life altering changes that could happen uh… receiving a concussion while already
symptomatic um but yes the warrior mentality of collision sports the not wanting to let your teammate
down the fear of losing your position if you let somebody else get in while
you’re on the sideline all of those things were reasons that they gave as well what is second impact syndrome second impact syndrome is an individual that’s still symptomatic from an
initial brain injury and because the most common athletic brain
injury is concussion most of the injuries were concussions but not all of them some were subdural
hematomas that were missed some were brain contusions or bruising
of the brain so the brain is injured you have post concussion symptoms you
have brain injury symptoms and then the individual’s subjected to another brain
trauma sometimes very minor and the brain loses its ability to
control blood flow it’s a loss of auto regulation blood flow rushes in the brain pools because it can’t get out fast
enough and increases intracranial pressure and sets up a scenario that’s very
unique to this condition where somebody is subjected to brain trauma sometimes not
all that dramatic uh… may get up a little stunned but within minutes two three four five goes from this alert conscious state to
being comatose fixed dilated pupils respiratory embarrassment due to bring
herniation and it’s a life threatening condition m_r_i_ that shows evidence for
intracerebral bleeding what you see is this dark area here uh… within the ventricle which is
largely filled with blood this is an individual that had quite
severe intracerebral bleeding as a result of his brain injury while concussions have always existed awareness about the severity and
pervasiveness of the problem has increased in the past decade thanks in
large part to nowinski and doctor cantu their center and nowinski’s book head games have played a large role in helping
people to understand the long-term damage that results from repeated blows
to the head it was through nowinski’s desire to
educate himself during his own recovery that he realized how little had been
reported about such a big problem i couldn’t simply couldn’t believe that
i didn’t know the information that i was taught
by dr cantu as an athlete that i was out there completely recklessly uh… getting hit in the head and and didn’t care i know i would have changed my behaviors
had i had this information i know that i wouldn’t have gone through five years of
post concussion syndrome and I it became readily apparent that other
people wouldn’t be doing this to themselves either you know there’s a few kids every year
who die from second impact syndrome because they think they’re being tough by not talking
about their concussions there’s now hundreds thousands tens of thousands
hundreds of thousands ex athletes walking around with CTE in their brain that are e-mailing and calling us every day going i wish
i knew about this because i didn’t need to lead with my head i didn’t need to lie
about my concussions and so the goal when i originally wrote head games
was just to simply give everybody a choice to say i i i tanked my own career out of pure ignorance I
wouldn’t have done it this way again if you have this information you won’t do the
same thing what grew out of that though was the
appreciation that the long term affects were much worse than i realized in two thousand and
six the concussion problem itself has not gotten
worse it merely seems that way because people have become more educated on what
actually constitutes a concussion well it’s a traumatic brain injury that
causes your brain to function differently at some threshold of force uh… you get actually these chemical and
metabolic changes within your brain and your brain actually becomes injured
and injured for a period of time not unlike a broken bone where it’s very vulnerable and it needs time to
recover and and people didn’t appreciate that
this window is very long it used to be if you were knocked out and you woke
up and you could remember your name you were good to go the concussion was over we’ve now learned that everybody
it takes days or weeks for those chemical changes
those metabolic changes even some physical changes to go away if they go away completely the definition of concussion is a
clinical one and people make it different ways some people are very careful about utilizing neurologic exams and symptom checklists and uh… a variety of tools so to speak to come to the
conclusion somebody’s had a concussion and other people or more superficial and they’re willing to say
that a given tool or two may be enough to make the diagnosis so there’s a lot of literature out there
that is based on primarily neuropsychological tests not taking into consideration also that um… you need a neurologic exam
you need a symptom checklist or you’re going to miss uh… concussions if you just base them
only on a neuro psychological test score because a neuropsychological test score is
testing cognition it’s not testing balance issues it’s not
testing sleep issues it’s not testing visual issues it’s not testing a lot of
things that can be off with a concussion when you have a concussive injury you have this metabolic chaotic event where the potassium that normally is
inside the cell goes outside the cell so it goes from the inside to the
outside extracellular space it allows the positively charged calcium
ions to replace them inside the cell but these calcium ions shutdown the
a_t_p_ which is the energy pump that’s needed to pump them out and pump the potassium back in uh… so it leads to this metabolic
dysfunction and it’s at this stage that the cell is
alive but the cell is not functional functioning and if you stress it either physically
or cognitively you can tip the balance and cause this cell to die and that’s why the hallmark of
concussion management is physical and cognitive rest until
symptoms have cleared so uh… i think it’s important that that all of the tools in the tool box
get used now you write in your book that one of the reasons for this
concussion epidemic is the lack of education awareness of
high school and college athletes why is that you know one of the things that first made me
realize that no one has their handle on this issue was the fact that we have
never really appreciated how many concussions
actually happen when medical professionals talked about
this five or ten years ago they would confidently say that only
five or ten percent of athletes got concussions each year and they were using data
that was taken from athletic trainers i knew and there were luckily some other
doctors who new as well that athletic trainers don’t hear about every concussion symptom that an athlete
experiences and so by asking the athletes themselves we found the
concussion rate is not five or ten percent it’s more like fifty or seventy percent
in contact sports like football soccer hockey every season so half the kids out there are
getting a concussion every season the only reason they haven’t we haven’t
heard about that is because the athletes have never known to say anything we used to think it was ’cause athletes
actually wanted to hide the injury when someone actually did the study and asked the
athletes they found out no it wasn’t that this was a choice this was that they
didn’t think a headache was worth talking about or the fact that they saw
stars for a few minutes and so uh… that was kind of step one
if you want to solve this problem you’ve got to tell the athletes what’s happening you know you get a hard hit and your head doesn’t feel right it’s
diagnosed as a concussion uh when we were younger i believe that you know you
had your bell rung and take a couple deep breaths and relax and and you were right back
at it you know i was diagnosed with probably two as a player uh… you know mild ones but i’m sure i
had a few more than that not the ones where you get knocked out
unconscious but that’s you know we’re learning now more about
concussions and it’s more than just a the high end ones so i probably had you know a handful i think that it’s it’s become okay to say you don’t feel well there’s just so much more or there’s more knowledge on the
concussions where at the time you just sorta your head hurt and you just squirted some water on
your face and just went out there and kinda gutted through it i guess i think all the leagues from from the lower
leagues right up to the n_h_l_ have been more proactive and i think that now you know when kids when you can see a kid get hit on the
ice i think they’re doing a better job right away of of taking the kid and and finding out what you know how they feel one report investigated the frequency of
unreported concussions and estimated more accurately the rate of concussions in high school
football players this report showed that the most common
reasons for concussions not being reported included a player not thinking the
injury was serious enough to warrant medical attention sixty six point four percent of
unreported injuries motivation not to be withheld from competition
forty one percent and lack of awareness of probable concussion thirty six point
one percent concussions and other head injuries must be taken
seriously if you’re a player protect yourself and
your teammates if you think you’re hurt don’t hide it report it and take time to recover if you’re
a coach or parent know concussion symptoms and warning signs and never let athletes return
to action before a health professional says it’s okay help take head injuries out of play to learn more contact the cdc nowinski reports in his book that ten to
fifteen years ago six separate studies of high school and college football
players revealed a concussion incidence rate of
four to eight percent those studies were conducted by asking
the trainers how many concussions they treat each season when the players were asked anonymously
however the numbers jumped to fifteen to seventy percent what can coaches or what should coaches and
schools be doing now to reduce the number of concussions well i think the most important thing that
coaches and schools can do is to have a concussion management
plan in place at all levels and most importantly for the coach the
athletic director uh… is that if they don’t have a certified athletic
trainer as part of their staff if they don’t have employed team physicians
as part of their staff that anybody suspected of having a
concussion needs to be pulled out of play pulled out of game
play and or practice and cleared only by somebody with that proper expertise with a concussion you can’t do a study that will show you the injury c_t_ is normal routine m_r_i_ is
normal it’s a clinical diagnosis it needs to be made based on the symptoms a symptom checklist in going very
carefully through every one in terms of whether they’re there or not a neurologic exam and part of the neurologic exam is a
cognitive assessment and yes a cognitive assessment is done in a more refined manner with computerized neuropsychological
testing but that’s only testing cognitive
function so it can’t be used as a red light green light or you’re going to miss
concussions um for a coach to suspect a concussion he’s gonna have to
have concussion education himself and the same goes for the player and the same
goes for the parent it was between you know yourself and
the trainer a lot of times uh…you saw a doctor but at the end of the day it
was a dialogue between uh… yourself and a trainer and how you felt and uh… you know as a competitive
athlete at the time you want to get out there and play and sometimes you dis disregard uh… you know your body a little bit well everybody I played with really well i mean you know we’re all we’re all
exposed to the same trauma i was not special you know the only thing that i did differently was
three years of wrestling and get a few extra concussions but you know everyone I played with in high school everyone I played with in
college you know we all talk about this as we all know we’re in a high-risk
bracket uh… since then you know a day
doesn’t go by where i don’t have a conversation with somebody who’s suffering in their forties fifties sixties uh who believe i mean i just got an
email this morning from one of my old colleagues from the WE saying hey my primary care
just told me that he’s worried about my brain from
all the knocks around you have someone i can go see you know and this guy’s uh… early
forties and he’s already obviously symptomatic and so um… there’s a lot more people walking
around with this than we think because it’s not just the guys who played
pro or college we even have a lot of people in the brain bank who just
played high school sports and when do you think you suffered your first concussion uh you know that’s it’s it’s a tough
question i i would say probably uh…high school probably was was the first time that you know i was never diagnosed uh… i think at at
that time we kind of said you know you got your bell rung how many do you think you’ve had since
then you know i was diagnosed with probably two as a player uh… you know mild ones but i’m sure i
had a few more than that did you ever return too soon for what you thought like maybe i
shouldn’t be out here yet there was one a little later in my career where uh… you know i i know i didn’t feel well uh… actually during that game and i talked to the trainer i get hit in the
head and and uh… we discussed whether i should
play or not and and i you know i said i was fine and went out and played and and you know that was a something that i i wanted to be out there i didn’t want to miss
time but in hindsight it probably was uh… probably the wrong decision mick foley has been a professional wrestler
for more than twenty years he is best known for being thrown from
a cage sixteen feet above the ring one-time into the announcer’s table and
another with a metal chair falling on top of him a stunt that knocked him
unconscious knowing what you know now about
concussions would you have done this would you have wrestled and done all the crazy
stunts that you did well yes i would have wrestled uh… i would have uh… changed a
couple things around uh… we didn’t know at the time that uh
one need not be hit in the head to suffer uh…a brain injury so a lot of the things that i did were
actually just very impactful to the body but also you know kind of sent my uh my
brain uh… bouncing around in the skull so had i known that i may have done things
a little bit differently I probably would have blocked a few of those chairs uh… which is the normal reaction to a a hard metal object uh… arriving at high speeds but uh…
i was you know I was young and naive at the time did you ever return in the match
when you knew you might not have known you had a concussion but you knew you
didn’t feel right did you ever return in the same match there was uh… one notable
match where the only time I was ever knocked
unconscious uh… you know i guess if it had been uh…
you know uh… quote and i won’t do the air quotes but
quote unquote real sport the match would have stopped but probably my most famous or infamous match involved me
being knocked unconscious and uh… and returning uh… which is not something that would
happen now i think that was the last time you will ever see a wrestler knocked out and uh… and uh… and continue out of the for you know for the well-being of the performers was there pressure to return when you wrestled always internal pressure i don’t think there
was ever external pressure i think now uh… guys are finding out that uh… it
takes a tougher man to admit when he’s hurt than uh than to pretend when he’s not so I definitely see a uh… a change in mindset for the better when it comes to head
injuries jay fiedler was an n_f_l_ quarterback
for eleven years leading the miami dolphins to a division title in two
thousand kyle turley was an offenive tackle for
this for nine seasons playing for the new orleans saints saint louis rams and the
kansas city chiefs while both players acknowledge having
suffered concussions only turley is believed now to be suffering from the
effects of c_t_e like foley neither regrets his decision
to play the sport and both concede that they would do it again you know I knew about concussions with you know when i was growing up concussion
was defined by being out cold pretty much uh… and seeing stars uh… you know not like it is today did you know or think that you had concussions you know there were a couple times that i
you know probably in my college and pro career that you know at the time i got dinged up and you know a little dizzy and kinda knew that it was a concussion but uh you know it definitely wasn’t a diagnosed
concussion at the time how many do you think you had before you
actually knew you were having concussions I didn’t I don’t think I had very many but you know uh… I mean the ones that i knew
about i i i knew about uh… i’m not sure if there was any
that uh… would be diagnosed now that you know i would have felt uh back when
i was playing how many of the ones that you knew about did you have ’bout three or four would you have continued to play if you knew now knew then what you know now about concussions ooh you know that’s a tough question i
probably would you know … i’d want to be out there uh… you know none of my concussions uh you know had me
out cold
0:42:18.909,0:42:23.309
uh… had me you know in a state where i felt i was uh you know not uh… able to perform and go out there and and have my senses
and wits about me but I’m sure now you know with all the you know with all the studies and
research that’s out there you know i know now that I really didn’t
have all my wits uh you know even though that i felt that i did would you have done anything differently no I don’t think I would have uh… you know i’d probably do do
everything all over again I’d expect the medical staff would uh… you know might have kept me out of
one or two of those games though speaking of medical staff and trainers and
coaches did you ever feel pressure to return too soon either in the same game or a subsequent
practice or game you know I never felt pressure from anyone else uh… that was
more more internally uh… you know i wanted to be out there i was
always you know a job security issue uh… you know as an athlete you always uh you
know you never want anyone else to take your place so uh… you know whether it was a head injury or any
other injury you know if i was able to go out there and perform that’s what i wanted
to do I uh… I’ve had over my career I played about ten years
and had a number of concussions looking back and then some a
couple very serious ones uh… was hospitalized once and and then post career had an episode of blackout episode and was hospitalized
for a few days and the doctors didn’t know what was happening and then
real severe vertigo and vomiting all over and and uh some seizure activity and things like
that um which was quite concerning and to not only me but to the doctors ’cause they
didn’t know what’s going on uh… so the answer pretty much just came back the
only thing they can relate it to is my activity from playing football and the multiple concussions that I received did you ever feel pressure to return to a game either when you had a concussion or too
soon to practice oh yeah yeah yeah I mean the sport of football especially is uh… you know one of those sports
that you’re expected to go it’s not a question you know uh as as a player you pride yourself on being there that’s part of it you know that toughness side of it that that was
instilled in you as as a kid that you’ve gotta push it that you gotta
go you’ve got to be there for your team and your teammates so that overrode a lot of you know decisions that would make more sense to not play uh you know because you had to be there for your guys and your team how are you feeling these days you still feel the effects of the concussions you know what i realize that uh… when they occur they A occur more easily and B require more
time off so i may have had my last match I may have uh… one more left in me but i the last
time i felt I got a concussion I I drew the line and said i can’t i can’t do this
anymore you wrote in head games about two incidents
in which NFL quarterbacks brett favre and kurt warner suffered a concussion during the game
yet finished the game anyway per their coaches decision who makes the decision is it the
coach is it the trainer is it the medical the team doctor and who should make the
decision today medical professionals are the only
ones making the decision and that hasn’t always been the case so if
you do have a team with multiple medical staff your most senior person or
your expert should be making that decision athletic trainers are incredibly well
trained on this issue and often better than a lot of doctors but historically we’ve been letting coaches make that
decision and there’s a lot of reasons why that was that some of it was ignorance but not
all of it some of it was that at the pro athlete
level the doctors have a huge conflict of interest and a lot of them like being the team
doctor and if they hold the star quarterback out in the fourth quarter they would be fired
and the fact that there haven’t been doctors fired every season out of the
n_f_l_ means that they’ve been doing what the coaches have asked even if it was against their better judgment and
there’s overwhelming evidence of that and i know
this from you know friends of mine that have played in the NFL so um… yeah unfortunately we’ve been leaving medical
decisions about the most important organ of the body up to coaches who are paid
millions of dollars to win now you mention team doctors how do team doctors who frequently as
you revealed in your book pay for the right to be the team doctor how does how do they
contribute to the concussion problem it’s amazing the power that that team
doctors have contributing to the problem because everybody models themselves off of the pros
whether it’s doctors themselves the players coaches and so you know the best example
is is wayne chrebet in two thousand five who was knocked unconscious playing for the new york jets face down in the field for a minute every published guideline since doctor
cantu first published guidelines in eighty-six says they’re knocked out they aren’t going
back into the game it was even his eighth diagnosed concussion in the n_f_l_ but the team doctor who happened to be the
head of the n_f_l_’s concussion committee elliot pellman who was not
trained in concussions he’s a rheumatologist put wayne chrebet back into the game ten minutes
later and he finished the game and what that tells everybody watching which is a you know these are the most popular things
on television is that kids know that they should be tough and get back in
there the doctors believe that that’s if the NFL doctors are doing
it that must be the standard of care and and therefore they were kind of
complicit in perpetuating this myth that you recover from a concussion if
you wake up from being knocked unconscious when that you know you you could say you look at various points
in time where that shouldn’t have been based on the literature it goes pretty far back we should have we’ve probably known this for a long time well you know i think there’s risk in in
any sport that you play you know football’s not the only sport that concussions are prevalent in uh you know i think uh… you know i i think personally the
lessons that you learn from football and the life experiences that uh… that that you can gain from it uh…
you know have tremendous value you know I think you also have to be aware
of you know what the risks are and make sure that you know if uh you know you come into a situation where the
risk factor all of a sudden increases a significant amount you know whether it be a concussion or or other injuries you have to know what you’re what you’re getting into ahead
of time knowing what i know now i could’ve
addressed those you know situations a lot better when i
had a concussion i can say alright I’m out and uh…I need to wait until i’m not
experiencing these things anymore before I come back to play especially on the serious uh you know cases where you know you get the real bad concussion symptoms uh you know the dizziness the almost slight blindness at times uh… blurred vision and all these other
things uh and knocked unconscious where i was uh…
I had one of those uh you know where I spent three two days in the hospital and was let out and then right back to practice you know and played in the next game so knowing what i know now yes I’d still
play the game of football ’cause I love it but that’s never it hasn’t been the problem the problem has been uh the way that they’ve addressed the injury turley a first round draft pick is one of twenty one former players who
filed suit against the n_f_l_ in december for deliberately ignoring and
concealing the risks and permanent affects of repeated head trauma the suit also alleges that player’s were
returned to the field too soon often in the same game in which they suffered the
injury he is not only suing the n_f_l_ to
make it accountable but he also wants the league to seriously address the
concussion problem well there’s a lot of things they can do uh… you know there’s many ways that
they can definitely address this problem and uh the sports legacy institute has done uh…
tremendous job of uh being there to inform them of how they
can make it better but uh they’re unfortunately it’s a reactive frame
of mind as a opposed to a proactive frame of mind and so I wanna hopefully see changes made uh… doctors on the sidelines and you know people in the booth reviewing I mean i guess if i could sit on my couch
at home and see a guy get a concussion i know they can see it so you know when i see guys like that go back in the
game uh… that really makes me upset and those are the type of things that i want
to see change personally the potential linkage between ALS even
now and uh head trauma uh traumatic brain injury is a very serious thing uh you know we’re not talking about just a game we’re talking about life-and-death
and uh… so I just I just hope one day that
everybody will see that light and get past the archaic
mentality of you know we’ve got to be tough you know and that’s because it’s still it’s just a game at the end of
the day and i don’t know any parent that’s lost a
child because of the game of football or any other sport for that matter because
of a head injury or any other injury um would say well they you know it was worth it you know so the serious side of it is is the death
side and that’s what we need to start eliminating i think what they’re doing to
protect the players is something that’s necessary I think they’re doing a lot right now i
think uh… there’s definately an increased focus on uh…on player safety right now you know with the penalties that are
being uh… instituted and with the the focus on um you know reducing the the high impact hits the helmet to helmet hits the the head hits
uh… you know i think uh… you know some rules changes could could
possibly do that but you know until the rule changes are instituted and you
see what the effect is you know sometimes you know some rules you know have
adverse effects so you know you have to you have to try different things and see what’s
what’s working ah… and i think you know a lot of it starts from you know the youth and and high school level to and just teaching the
right techniques of uh… of hitting and playing the game
to uh… you know to not always lead with
the head and and go for the helmet to helmet hits for its part one example of commitment
that the n_f_l_ is showing to this crisis is the announcement that it is
going to expend one hundred million dollars to the study of concussions over
the next ten years good that the n_f_l_’s is going spend a hundred
million dollars over ten years you know brain injury is historically a
terribly under funded uh… research area uh… we the n_f_l_ gave us a one
million dollar unrestricted gift last year which has been very helpful to advancing research a hundred million dollars is a legitimate
amount of money so i’m hopeful that that the right studies are done uh… with that money to get us somewhere uh… you know i what i’ve heard about
some of the things some of that money might go to a havn’t been overly excited about i mean the n_f_l_ started their concussion committee in
nineteen ninety four and it’s two thousand and eleven and most of the money they spent on
studies was wasted and it was done to do the wrong studies the wrong
way ticket they gave bad information uh… I hope they have the right
people in place i don’t know if i believe it uh… some of the comments made by some of
the leadership who will be determining where that money’s spent has been i would say foolish so i don’t know we’ll see which way that
goes you think the n_h_l_ will follow suit the NHL doesn’t have the same amount of money
to share unfortunately so i do hope the n_h_l_ will invest in
in concussion research as well I let’s be honest if they how much how what was the value to them if they
could have prevented sidney crosby being out a year and possibly longer
or his career being jeopardized any amount of money would’ve protected that and i they should realize that if they had
sat the athletes down at any point in the last five years and really pushed the old if you don’t speak up when you’re hit in
the head you’re going to jeopardize your career maybe sydney would’ve spoken up and so i think we
have not invested in prevention we have not invested in education and i’m hoping that the professional
sports leagues don’t just see this as a long-term liability issue but they see
this is as a keep my best players on the field issue and increase revenue is wrestling doing anything to
minimize the risk oh sure wrestling has done quite a bit
uh after that match i mentioned which was in
nineteen ninety eight i mean you know anyone who wanted to try
something that would be considered out of the ordinary you know had a professional coordinator uh playing a hand in it uh
they’ve completely in wwwe at least completely banned ah… shots to the head with chairs and luckily we are in a
form of entertainment where you can work around injuries uh… and so we are able to provide uh… an entertaining event spectacle if you want to call it that with with while putting uh…you know uh… a minimum on the uh… potential damage at least that’s the way i feel it’s a very tough business when you
combine the pressures that go along with it uh… the sense that some people are living out their dreams only to
find out that it’s a very tough row to hoe uh… and when you compound
that with head injuries uh… the depression can uh…you know apparently lead some people to believe
that you know the life they have uh… remaining is
uh… is not as good an option as no life at all but i
think we are uh making a lot of progress with that by
determining head injuries and uh…also you know assigning some people to work on guys uh uh mind sets to keep them from wishing such uh…you know such terrible outcomes for themselves while professional leagues have started to
address the concussion crisis much more can and should be done
beginning with the earliest levels of sports join us next week as we examine the
safety of the equipment the effects of concussions in children and the
importance of concussion education I’m holly vietzke and this is the
educational forum the massachusetts school of law legal education that is practical
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full or part-time studies where candidates are assessed not on the LSAT but their academic and other
accomplishments providing more professional skills training than any
other law school in new england massachusetts school of law visit us
at mslaw.edu training students to become successful
lawyers and advocates not just legal scholars at the new american college of history and
legal studies in Salem NH you can finish your bachelor’s degree affordably and get on the fast track to law school we teach american history and you will receive a rigorous education at a very low cost
the small day and evening classes allow you to interact closely with the distinguished faculty at the american college of history and legal studies professors don’t lecture through the discussion method of teaching you’ll be engaged in the issues raised in class you’ll learn to be a critical thinker a better writer and a polished public speaker and you’ll be able to compete with anybody in today’s marketplace you can also get on the fast track to law
school qualified students gain early admission into the massachusetts school of law the new american college of history and legal studies offers the junior and senior years of undergraduate education to finish
your bachelors degree with the opportunity to start your law degree early call or visit today each year more than three million
athletes suffer a sports related brain injury known as concussion sometimes the effects can be serious
especially if they return to play too soon before it’s safe according to the
american academy of neurology any athlete who is suspected of having a
concussion should be removed from play until evaluated by a doctor who has training
in sports concussion this is for all athletes in all levels play it safe protect your brain from
concussion a message from the american academy of
neurology learn more at aan.com

Cesar Sullivan

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