Lately I’ve been talking to a few impressive, inspirational men- specifically wounded military vets and former football players. Of course, the context of their heroism cannot be measured apples to apples, but the lives they are leading today, now that they’ve left their very physical careers and have faded back into “normal” life, are anything but normal.
These men experienced multiple head traumas acquired in the line of duty. Injuries sustained as a soldier or football player go with the territory, and it’s a risk they voluntarily accepted. Battle injuries become part of one’s personal story, and scars and limps can be viewed as well earned badges of honor. But chronic neurodegenerative decline is much more complex and harder to correct than musculoskeletal issues. The insidious nature of CTE leaves these guys desperate for relief from suffering that no one can truly understand.
Their problems just aren’t the same as the typist with carpal tunnel syndrome. Hair dressers often experience repetitive strain injuries to their upper extremities. Baseball catchers have bad knees. Golfers get skin cancer. Farmers have bad backs. There are risks of injury at almost any job, but not the risk of dementia.
Chronic Traumatic Encephalopathy is diagnosed long after the injury is sustained. Initial problems may clear up completely, or symptoms like headache and mental sluggishness may continue for years. CTE is a form of progressive dementia; a retired 27 year old football player with frequent headaches may very well devolve into a depressed and confused 45 year old who is unable to work or maintain relationships. A 30 year old veteran- who managed to keep his limbs while serving in Afghanistan- may not have been so lucky with his head. Mild head blows and exposure to blasts can lead to CTE.
For decades, the VA and the NFL have handled this issue with the same heavy-handed, short-sighted approach: let’s treat them with pain killers. So in addition to physical pain, mental illness, and social isolation, these guys become drug addicts too.
The class action law suit against the NFL has improved awareness about the risks of repetitive head trauma and concussions. The recent shake up in the VA healthcare system may lead to improved care for our vets as well. Hopefully both organizations will work to prevent repetitive head injuries, treat them appropriately, and limit the use of pharmaceuticals from the broad spectrum of pain management options.
But let’s talk about their dementia- the guys at risk for developing it and the guys in the thick of it now. This isn’t your grandmother’s Alzheimer’s (not to minimize your grandmother’s Alzheimer’s), and we need to offer better strategies to a segment of the population with very different needs. These men are typically younger than most Alzheimer’s patients, and have families to support. They have not yet reached mid-life, yet are faced with the same declining cognitive function seen in much older brains.
People with CTE need mental health services. Depression, chronic pain, and PTSD can eat away their sanity.
People with CTE need non-pharmacological pain management options. Drug addiction is an unnecessary evil.
People with CTE need opportunities to work in low stim environments. They need patient (and grateful) employers.
People with CTE need cognitive retraining. Cognitive impairment is not always irreversible and hopeless.
People with CTE need other people to understand CTE. It’s not a disease exclusive to football players, soldiers, or other high-risk occupations. Any blow to the head can put someone at risk for long term, chronic encephalopathy.