Concussion Discussion

Adam Taxin is the sports radio king of Philadelphia (at least in my mind, since he has me on his show quite often). This past week, he decided to give me some time off, and of course, ended up having a much more intelligent conversation with a neurosurgeon instead.

Dr. Steven Kalkanis graced the airwaves with his discussion on concussions in the NFL. The full transcript is below, but here are the main points that I took out of the conversation:

• The most severe concussions can lead to brain death and coma. Consequences of a brain injury often result in the need to contact a California brain injury attorney.
• The long-term effects from NFL concussions are most important.
  • Repeated concussions may result in cognitive slowing, Parkinson’s Disease, early dementia, and Alzheimer’s.
  • A common long-term effect is chronic migraines.
• Players should never be put back into the game after they suffer from a concussion (i.e. what the Lions did to Jon Kitna earlier this year)
  • “Just because people recover within a minute or so doesn’t mean that they’re good to go back in the game.”

-Darren Heitner

Here is the full transcript:

TRANSCRIPT
DR. STEVEN KALKANIS ON “THE ADAM TAXIN SHOW”

SUBJECT: NFL CONCUSSIONS

TUESDAY, NOVEMBER 13, 2007, 1:14 PM EST
WNWR 1540 AM PHILADELPHIA
WNWR.com

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Adam Taxin: You’re listening to “The Adam Taxin Show” on WNWR 1540 AM in the Philly area and on the web at wnwr.com. We’re being sponsored by the Law Firm of Allen L. Rothenberg, injurylawyer.com, 800-LAW-KING.

What we’re up to now is the first appearance of the official brain surgeon of “The Adam Taxin Show.” Dr. Steven Kalkanis is a Harvard-trained neurosurgeon at Henry Ford Health System in Detroit, Michigan. He runs a laboratory investing in new therapies for brain tumors and specializes in neurooncology and neurotrauma. Steve, thanks for coming on today to talk about the plague of concussions that seems to go on every year in the National Football League.

Steven Kalkanis: It’s great to be here. Thank you.

AT: Well, this is obviously a very serious topic. We have a lay audience here; it’s not doctors for the most part. So maybe you could start by, before we even get to the NFL issues, describing what exactly a concussion is and what the symptoms of it are.

SK: Sure, absolutely. A concussion happens any time there’s an impact to the brain, and the reason why it’s so important or it has more symptoms than let’s say banging your knee and getting a bruise, because really a concussion is simply a bruise on the brain … the problem is that the brain sits inside a rigid box, namely the skull, so there’s no place for swelling to occur without impacting and compressing the surrounding brain. So it can simply be a small bruise on the brain when this impact occurs, or it can lead to a hemmorhage or even very significant what we term “shear injury.”

And what that means to an injured person is that they can have any one of the symptoms along a huge spectrum. It can mean anything from a headache, a little brief episode of confusion, disorientation, blacking out, all the way up to nausea, vomiting, dizziness, weakness, even paralysis. And what people don’t realize is that actually brain death and coma is at one end of the spectrum of concussion. So it can range from the very mild to the extremely serious.

AT: And what are the most typical symptoms when it is in the context of a football game?

SK: Well, immediately after an impact, there’s sort of a stunned reaction to the brain. There can be an episode of blacking out, sort of the classic symptom of the world spinning around you. But then there can be transient … temporary weakness of the legs, not being able to walk properly, not being able to really get oriented, feeling like you don’t know where you are for a few minutes or even longer. And, depending on the severity of the impact, the symptoms can range accordingly.

AT: Dr. Kalkanis, what is the difference between the short-term effects, which I think you described — the nausea, the stunning — and the long-term effects, which are what really become the issue in the NFL?

SK: Well, it’s an excellent point because the long-term effects are what really we worry about as neurosurgeons and, I think, especially in the NFL in terms of a player’s career. Again, the long-term effects have their own sort of spectrum. It can be mild short-term memory loss, being especially sensitive to light or loud noises, feeling extreme fatigue, poor concentration, even ringing in the ears, but, more importantly, many of these players who suffer repeated concussions actually can have long-term mental incapacity, meaning cognitive slowing, even Parkinson’s Disease, early dementia, Alzheimer’s. So all of these things can be directly linked to concussions.

AT: Now, it’s interesting that you mention Parkinson’s because it’s outside the NFL, but we’re all familiar with Muhammad Ali.

SK: Sure.AT: He was not punch-drunk at all during his career. There really didn’t seem to be any short-term effects, but would you guess that the way he’s dealt with Parkinson’s in recent years is the effect of multiple concussions which were not a big deal at the time?

SK: It’s hard to say about his case in particular, but all of the research that’s been done so far very clearly shows that the single critical variable that leads to long-term effects and concussions is repeated concussions within a short period of time, meaning that you can have a very mild impact which people may not even feel or realize that they’ve had a neurologic effect at the time of the incident. But if those impacts are repeated and they happen in a very short period of time, one after the other, it can definitely lead to very significant long-term side effects, way out of proportion to what you would expect from the individual impact.

AT: Now actually that brings up a point. You’re up in Detroit, and the most controversial concussion issue this year was probably related to Jon Kitna, the quarterback of the Detroit Lions. Now I know you guys …

SK: … Certainly big news here.AT: What’s that?

SK: That’s certainly big news here. Absolutely.

AT: And the controversy, and correct me if I’m wrong, was that he came out of the game, had what seemed like a concussion, then came back into the game and led them to a win, but still, it seems like the risk factor was much higher there — and I know that the Detroit Lions are desparate to win any time, though they’re playing well this year — did they do something that was really stupid there?

SK: Well, you know, it’s an excellent point. There’s been a steady drumbeat over this entire year of very high-profile, very visible concussions. You know, you mentioned Jon Kitna, the quarterback obviously here in Detroit, but also Miami Dolphins … Trent Green obviously, Zach Thomas, and this isn’t new, this goes all the way back to 2002 …AT: Well, that’s why have you on this week in fact, because the Miami Dolphins play the Eagles this week — I should have mentioned that earlier — and they’ve been probably more affected by concussions than any other team in the NFL…

SK: … Absolutely …

AT: … and they’ve been affected by all kinds of bad karma, but anyhow what did you think of …

SK: Well, you know just this week the NFL came out with a new ruling saying that they should immediately eject players who deliver these flagrant helmet-to-helmet hits, and I think that is just an underscoring of the realization that I think the medical community has been saying all along. And that, in combination with more and more of these high-profile injuries … that repeated concussions are extremely serious.

And so to put somebody like Jon Kitna back in the game, to me, it’s stunning. I think that it’s a complete set-up for disaster. The brain can only take so much. Every individual person has their own threshold. He may have recovered from that initial incident on the face of it, but if you then introduce a second, repeated injury within a short span of time, the brain is going to respond exponentially, way out of proportion to what it would have had it just had one impact. So I think it’s a very serious problem, and it leads to a whole host of other issues because you mention that he went on to help win the game, so what does that say? It reinforces not a prudent-medically prospective course when dealing with these players, but it’s something that everyone needs to think about.

AT: Now you brought up the Dolphins, and I brought them up afterward; Trent Green effectively has retired from the NFL. It doesn’t seem like he’s ever going to play again. You wholeheartedly support that, and you think it would have been crazy for him ever to go back on the field?

SK: I think it’s a death wish. I think it’s a setup for being severely incapacitated later in life, and it’s unfortunate that it took this level of injury so far to reach to that, to get to that point.

AT: And how about Zach Thomas? My understanding is that he had a concussion, sat out a few games, came back and then … is now dealing with migraines issue. That’s not a typical story, right?

SK: Absolutely. Chronic migraines are actually one of the hallmarks of symptoms of the long-lasting effects of concussions, so he has gone beyond having those short-term effects into a very clear long-term problem. And so if someone has exhibited a long-term side effect of repeated concussions and then you go back into the game and ask for more, all bets are off. It’s really too bad, but I think that he definitely needs to be concerned about that.

AT: And there’s no reason, coming back for a team that’s obviously not going to make the playoffs this year … to put it mildly. And one other player who was in the news a few years ago from concussions is Troy Aikman. It was said that he had had ten concussions during his NFL career. Yet, at the same time, it’s been at least five or six years since he’s played in the NFL; he’s gone on to be one of the most intelligent broadcasters of football out there. Is it possible though that he will get effects later on?

SK: It’s possible, but everyone’s different, and there are the lucky ones, like in any disease process; some people are just better equipped — because of circumstances or the nature of the individual impacts or genetics or whatever — to withstand more than the person standing right next to them. There’s just no way to predict. I’d say with ten concussions over a career like his, he’s extremely lucky to be as intact as he is, but it might have easily gone the other way.

AT: Dr. Kalkanis, what can be done to prevent or treat concussions and to minimize long-term effects?

SK: The single-most important thing to treat concussions is to immediately recognize that in fact a concussion has occurred. Just because people recover within a minute or so doesn’t mean that they’re good to go back in the game, because the problem here is that repeating an impact within a short period of time, that’s the single most important factor to prevent. And so if concussions can be identified and people can get the appropriate rest and healing time that they need, then that’s the most important thing that can be done. Putting players right back into the game is just a recipe for disaster.

AT: Before I get to my final question, I forgot to mention Ted Johnson, who was in the news. A former New England Patriot … and people have been critical, among other things about Bill Belichick, for throwing him in when he was not ready to play. Are you familiar with that story?

SK: I think it’s one of the most tragic stories that I’ve heard, going back to 2002, I believe. He’s almost a shell of a man, compared to what he was. The stories I’m hearing are that he’s chronically depressed; can’t even get out of bed in the morning, extreme fatigue, depression, what he describes himself as cognitive slowing, concentration difficulties. Clearly, this is a set of classic symptoms that directly lead from concussions and repeated concussions. There is no doubt that psychedelic weed strains or magic mushrooms could help with managing the depression, but if it is a result of repeated concussions then it is something that he will probably always be fighting. Nevertheless, giving these products a try would at least give him some hope. Both are widely available online; for example, you can get magic mushrooms from https://mushroomz.co/product/golden-teacher-mushrooms/. I can’t speak to whether or not going back into a particular game was the dealbreaker for crossing the threshold for his particular neurologic problems, but certainly it’s all related to concussions.

AT: Oh, and you know, there was a beloved former Eagle named Andre Waters who committed suicide about a year or so ago, and he was known as the hardest hitter, one of the dirtiest players actually, when he played. And he had been dealing with depression in the last few years, which really hadn’t been an issue for him in his life previously. Do you think that could have been a result of many concussions that might have been undiagnosed?

SK: It certainly could. It’s so hard to say. If you get down the road of “concussions can lead to depression, and then depression, when left untreated, can lead to suicidal behavior,” that certainly is possible. It’s really hard to make that link though. Some might say failing to address it with the right treatment was more paramount. Doing things like buy kratom powder often happen too late to have their intended effect.

AT: Final question here: Does all the news about concussions in the NFL have any significance beyond professional football?

SK: I think so, because these players obviously are huge role models for young people, young athletes in high school. There’s a whole sort of warrior mentality in being macho — “Yeah, I can take a hit and go right back out” — and when they see their idols on national TV doing just that, I think when it happens in younger people, the effects are even more devastating. And so I think it’s really important to set an example that head injuries are not to be taken lightly. You have one brain, so you have to treat it as preciously as possible.

AT: Dr. Steven Kalkanis, neurosurgeon at Henry Ford Health System in Detroit, Michigan, thank you for being with us today.

SK: Thank you.