Preventing Concussions: Can Help be on the Horizon?

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Concussions and preventing concussions continues to be a hot topic in the media, particularly when parents decide whether to allow their kids to play contact sports.

Treating PTSD and TBI also receives its share of attention, but most of the media coverage seems to be focused on coping with the symptoms of brain injury rather than offer any meaningful long-term solution for Veterans with these conditions.

Far less attention is devoted to preventing concussions in the first place.  Perhaps, we should be moving forward on all fronts simultaneously.

military drugs

Just this week the FDA just approved a series to trials to evaluate ecstasy to help people cope with PTSD.

After successful preliminary trials, the FDA is moving forward with a large scale study for using Ecstasy as a prescription drug to treat post-traumatic stress disorder.

The study approved on Tuesday would be the final measure necessary before the agency could legalize the drug, according to the New York Times. If the results are favorable, the drug also known as MDMA would be available to patients as early as 2021.

While some may view this new FDA initiative with relief, I am not encouraged by yet another new drug that treats the symptoms of PTSD rather than drugs that permanently reverse brain damage itself.   As we have seen with opioids, treating symptoms opens up a pandora’s box of other medical and neurological problems, particularly when these medications are combined with other prescription drugs.

Granted, reversing brain injury is new uncharted territory, but many Veterans seem to have lost hope that permanently improving  brain “wellness”  is considered to be a high priority for either the VA or the FDA.

If this is the case – and I hope it is not – then studies focused on reducing the incidence of concussion certainly take on far more importance.  Found below is a recent Ted Talk  by David Camarillo focused on developing new protective gear to reduce concussions:

Mr. Camarillo takes issue with both the CDC and NFL models of what happens when a concussive-event occurs. Swedish scanning imagery points to something far different occurring within the brain than what is argued by conventional sources.

Could it be that existing helmet designs for the military and the NFL are based on flawed models and questionable scientific research?

I don’t know the answer to that question, but I continue to be disturbed by the conflicting messages sent out by the VA, the FDA, the CDD and the NFL.  Surely, “I don’t know,” is a far more honest answer than continued claims by those in authority that “we are making progress” in helping Veterans with PTSD or protecting NFL players.

If the flawed product were an automobile which caused a fatality, a recall notice would be issued.  How is it possible that the NFL continues to operate with impunity when the evidence strongly suggests that repeated concussions causes chronic traumatic encephalopathy (or ”CTE’)

The recent FDA “Ecstasy” trial isn’t particularly reassuring, particularly knowing that the results will not be available until 2021.

Questions that seem more relevant would be these:

– Will Dr. David Cifu continue to dictate VA protocols in treating concussive events?

– When will military helmet sensor data be released to the scientific community to help provide our brave military personnel with better helmets?

– Can the VA provide any clinical evidence that it has successfully treated and “cured” PTSD and/or TBI?

– Are more drugs the answer to treat PTSD?

I can’t answer these questions, but tens of thousands of brave men and women with PTSD and TBI deserve an answer.

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Mixed Signals for Veterans with PTSD

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It is reassuring to learn that Brig. Gen. Donald C. Bolduc encourages troops under his command to seek help when dealing with the symptoms of post-traumatic stress.

Many in the military believe that headaches, depression and mood swings are simply job fatigue symptoms and that it is “not macho” to seek out treatment.  As Gen. Bolduc knows, these common wartime symptoms may be a clear signal of post-traumatic stress (PTSD) or traumatic brain injury (TBI).

In a recent article featured in the New York Times, Gen. Bolduc made the following observation:

General Bolduc wants soldiers under his command — who are stationed in some of the continent’s most difficult parts — to know that seeking help will not hurt their careers. In his opinion, PTSD is the same as a broken arm.

“The powerful thing is that I can use myself as an example,” General Bolduc said. “And thank goodness not everybody can do that. But I’m able to do it, so that has some sort of different type of credibility to it.”

SFTT applauds Gen. Bolduc for taking the lead in encouraging troops under this command to seek out help without the repercussions of a punitive career backlash.  Nevertheless, effective treatment options for PTSD are severely limited by current DoD protocols.

Nowhere is this more evident than within the Department of Veterans Affairs (“the VA”). Currently, the VA provides two forms of cognitive behavioral therapy to Veterans with PTSD: Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy.

Also, to address the symptoms of PTSD the VA may authorize “selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant medicine. These can help you feel less sad and worried. They appear to be helpful, and for some people they are very effective. SSRIs include citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil), and sertraline (Zoloft).”

As SFTT has reported on numerous occasions, masking the symptoms of PTSD through cocktails of powerful prescribed drugs has not proved successful and may in fact have triggered suicidal incidents.

In fact, the track record of the VA in treating PTSD has been notoriously ineffective as Maj. Ben Richards pointed out recently in this comprehensive discussion of VA procedures to treat PTSD and TBI:

Contrast Maj. Richards experience, with VA spokesman Dr. David Xavier Cifu to a Congressional Committee:

Personally, I find Dr. David Cifu’s treatment recommendation: “get back to activity as soon as possible” to be particularly disturbing. Not only is Dr. Cifu’s judgement questioned by his peers, but even the NFL has instituted “concussion” protocols which REQUIRE a mandatory rest period after a concussion.

In effect, a battlefield commander could encourage troops under his command to “get treatment,” yet the medical gatekeepers could simply prescribe antidepressants and quickly put the troops back into harm’s way.

Gen. Bolduc is to be complimented on his leadership, but the medical support in the military and VA needed to effectively treat men and women in combat for brain-related issues doesn’t seem to be on the same page.   How sad!

Why?  Good question, but one can only speculate on the “right” answer.

NFL and the Concussion Settlement

While the VA continues to “whistle Dixie” as the lives of Veterans and their loved ones continue to deteriorate, the leadership of the NFL is finally beginning to acknowledge the terrible harm done to professional athletes caused by repeated concussions.

Joe Nocera of the New York Times reports that a “Crack Appears in N.F.L.’s Concussion Settlement.”   NFL leadership has fought tooth-and-nail to hide the corrosive effect of repeated concussions from its players and the public.   Nevertheless, thanks to the courageous effort forensic pathologist Dr. Bennet Omalu, popularized in the film “Concussion” starring Will Smith, the NFL acknowledged that Chronic Traumatic Encephalopathy or C.T.E. was a serious health concern.

chronic_traumatic_encephalopathy

Now, a Doctor at Boston University’s Chronic Traumatic Encephalopathy Center believes that “I really do foresee being able to diagnose C.T.E. pretty accurately while people are alive sometime in the next five to 10 years,” he said. “Hopefully, even earlier.”

While this is helpful, one must ask what preventive measures can be introduced into football now to prevent C.T.E. from occurring in the future.  More to the point, if C.T.E. is predictive, what about the large number of professional players who have settled with the NFL to keep this problem from gaining traction with the public.

The Leadership of the NFL and the VA Have a Problem

The leadership of the NFL and the VA can continue to stonewall investigative committees and deceive themselves, but lives are at risk.  Isn’t it about time that the leadership of both organizations step up and “own the problem” and do their best to help players and servicemembers recover their lives?

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NFL Reluctantly Opts to Research Concussions

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In yet another token concession to those concerned with repeated trauma of concussions on NFL players, Commissioner Roger Goodell announced a new initiative “intended to increase the safety of the game, specifically by preventing, diagnosing and treating head injuries.”

As reported by CNN, Goodell said:

. . . the league and its 32 club owners will provide $100 million in support of engineering advancements and medical research — in addition to the $100 million previously pledged by the league to medical and neuroscience research.

The Play Smart Play Safe initiative also requires hiring a physician to serve as the league’s chief medical officer.  The physician will work with each team’s medical staff and establish an independent scientific advisory board to consider head injury research proposals.

Concussions and, more importantly, chronic traumatic encephalopathy ( or”CTE’) continues to be a subject that is only whispered about behind closed doors at the NFL.  Nevertheless, it is a problem that will not soon disappear and SFTT remains hopeful that researchers will be able to improve the safety of the game and provide insights into how this horrific “sport” injury can be prevented and,  hopefully, treated more effectively.

chronic_traumatic_encephalopathy

While the NFL has been slow to address this problem, the Department of Defense and the Department of Veterans Affairs (the “VA”) have been even slower.  Consider what SFTT stated in March, 2016 in its article entitled “NFL Preempts Veterans with Brain Injuries“:

With hundreds of thousand of Veterans suffering from brain trauma, isn’t it about time our political and military leadership quit burying their heads in the sands and deflect public scrutiny by investigating the NFL, which has Congressional immunity from antitrust regulation?  What a strange but convenient retreat for our feckless political leadership.

If the NFL owners had any sense, they would embrace the battle against brain trauma and work with the military to help both its gladiators and the brave men and women suffering from PTSD. Indeed, this public relations initiative could help deflect “public” outrage and provide the medical profession and others with the resources and impetus to deal with the silent wounds of war.

While the causes of brain trauma are different, shared research could go a long way in helping both Veterans and NFL players deal with the problems of repeated concussions.  No one expects easy answers, but the military has collected a wealth of data on concussions over the last six years from sensors implanted in helmets of soldiers serving in combat.

The first step in solving a problem is to admit you have a problem.  Sadly, both the NFL, the VA and the DoD have been slow to address this most serious problem and one wonders how committed either organization is to do so.

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PTSD and the Super Bowl

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As we all settle in to watch the Super Bowl tomorrow, let us reflect on the large number of brave Veterans who have suffered from PTSD and traumatic brain injury (TBI). Indeed, there are enough wounded Veterans from our wars in Iraq and Afghanistan to fill several Super Bowl stadiums.

PTSD and CTE

Nevertheless, I suspect that sports’ pundits will be more focused on CTE – chronic traumatic encephalopathy – found on the brain of former pro quarterback, Kenny Stabler caused by “repeated blows to the head.” Indeed, there is now a list on Wikipedia that lists the number of deceased pro football players that were diagnosed with CTE.

Veterans with post traumatic stress disorder and/or TBI now exceed some 200,000 and they are simply not receiving the treatment they require to reclaim their lives.  The Veterans Administration’s preferred solution is to mask the symptoms of brain trauma with an often lethal cocktail of pharmaceuticals. At the same time the VA blocks other far more inexpensive technologies, like Hyperbaric Oxygen Therapy,  used around the world.  Why?

PTSD by the Numbers

Less we forget, please find below a video from the late Navy S.E.A.L, Chris Kyle who explains how difficult it is for some Veterans to adjust after they come home from war.  We now believe that some 20% of Veterans are affected by some form of brain trauma, although many experts believe that the number is far higher.  Listen to Chris Kyle:


via: PTSD by the Numbers: Battling Post Traumatic Stress Video

As we watch the Super Bowl, let us reflect on the conditions of our brave Veterans and the personal demons they face each day.

UK Troops Suffering from PTSD and Depression

Traumatic brain injury is not only prevalent in the US, but the British Armed Forces are also coping with serious problem.  Based on the statistics below, they are probably underestimating the scope of the problem, but it is clear that they see clear evidence of “alcohol-related” behavioral disorders and Veterans try to “self-medicate.”  Substance abuse is rampant among Veterans in the US, particularly with those who suffer from PTSD.   One health specialist suggested it could be as high as 90%.

See what the British say about traumatic stress among their own troops:

Of those, 1,235 have been awarded compensation and discharged with post-traumatic stress disorder. The figures, obtained under a Freedom of Information request, show 718 were discharged for depression, while 130 were suffering from alcohol-related behavioral disorders.

Speaking yesterday Patrick Rea, of the charity PTSD Resolution, said: “Assuming that most of these cases involve the Army, it brings us to a ratio nearing one in 10. Previous figures suggest that around two per cent of troops across all branches are suffering from PTSD. Of course, the problem is that there is a latency about PTSD that may not show up in official figures.Then, five years after they leave, it results in breakdown of their marriage, loss of employment and even criminality.”
via: Rising toll of stressed out troops suffering from PTSD and depression

Mental Health Week: PTSD and Suicide

Jenny Hale, a Public Relations graduate student at the Newhouse School of Public Communications, discusses below the relationship between PTSD and suicide.   While Jenny is right to suggest contacting the CRISIS LINE at 1-800-273-8255 for help, the Veterans Administration has not done a good job in helping Veterans with PTSD.  I would take the advice provided below with a grain of salt.

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Post-Traumatic Stress Disorder (PTSD) is a mental health problem that can occur after someone goes through a traumatic event like war, assault, an accident or disaster. Symptoms can start immediately after an event or can develop years later. These symptoms usually include flashbacks or memories, sleep problems or nervousness. Indicators lasting longer than a month may be related to PTSD.

Since 2002, 128,496 service members have been diagnosed with PTSD after being deployed in post-9/11 wars. The highest numbers reported were in the year 2012, with over 20,000 total cases between deployed and non-deployed soldiers.

If you or someone you know is suffering from PTSD, there are several outlets for both civilians and military to find help.

  • VA Center—All VA hospitals have care for PTSD. Contact your nearest VA Medical Center for an appointment.
  • Consult a therapist—The International Society for Traumatic Stress Studies can help locate a clinic near you. Find a list here.
  • Call the Veterans Crisis Line—Family and friends, as well as veterans, can speak to VA workers 24/7 online or by phone for confidential support. 1-800-273-8255 or chat with a professional here.

Suicide is another serious mental health issue among veterans. A veteran commits suicide every hour, while a service member commits suicide every day. 8,000 veterans commit suicide every year.

24 percent of suicides include veterans with PTSD symptoms and 66 percent of those have been deployed. Over 50 percent of veterans had no sign of behavioral health disorders prior to their death.

Suicide is preventable. If you or someone you know is showing feelings of guilt, saying that life isn’t worth living or expressing failure, seek help through the Suicide Prevention Line at 1-800-273-8255.
via: Mental Health Week: PTSD and Suicide

While I too will be sitting around the television watching this great American tradition of the Super Bowl, I will think of our many Veterans suffering from PTSD who don’t have access to the latest therapies available to help them reclaim their lives.  CTE has surfaced as a “big issue” within the NFL.  I only wish Veterans with PTSD and/or TBI would receive the same level of national attention.

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