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The wars we wage – of sport, concussion, and our warrior style – Part II

Posted Feb 08 2012 8:53am

This series of posts comes as a response to a lot of discussion that’s been happening, lately, about concussions in football — who knew what, how they handled it, who’s responsible, and what might be done about it all… for the sake of our (and our kids’) future. I started out intending to write one post about this, but the issue is much larger, and my time is not as plentiful for one long extended post, so I’ll break it up into several. Part I is here . Please hear me out in the entire thing, before jumping to conclusions.

Football ~100 years ago Warfare ~100 years ago

Part II – What Do We Expect?

Without meaning to sound cynical or sarcastic, I have to ask it — After years and years of continuous hits to the head in organized football, hockey, soccer, etc., and knowing what we now know about the effects of continued knocks to the head over time , what do we expect to happen, when we subject ourselves — and our kids — to years and years of hits to the head?

It surprises me a little that it comes as a surprise to so many that the kinds of hits that don’t knock you out can add up. But then, I guess that’s to be expected, as the medical establishment has only recently got on the ball about a loss of consciousness not being necessary to experience concussion, even brain injury. When I say “recently” I mean in the past decade or so. And even if the medical establishment is (a bit more) on the ball about traumatic brain injury, that doesn’t mean that every doctor is up to speed on it, let alone the general populace.

What worries me more than widespread ignorance, however, is something much deeper, something much more pervasive, and ultimately far more dangerous – it’s the denial so many of us are under, the refusal to entertain the possibility, even probability, of the worst happening.

What’s driving the headlong rush into brain trauma, is, of course a complex and many-faceted set of issues. There’s no one easy explanation for it, though I’ve heard different theories about how it has to do with the changing face of masculinity and the altering of “norms” for behavior. Or it has to do with our innate need for conflict. Or it has to do with the struggle of good vs. evil. Or it has to do with cultural insecurities that drive one society to attack another. Or it has to do with oil. Or it has to do with weeding out the weak and unfit. I’ve also heard folks say that we need our war and our warlike games, because it’s a proving ground for adulthood.

On the last count, I probably agree. Not because I believe that is necessarily true, but because I’ve seen it in action, time and time again. And the folks who seem to be the most compelled to launch head-first (literally as well as figuratively) into combat of one kind or another are often young and have something to prove.

I can’t help but think, time and again, of the young man at the farm stand down the road from me who announced, immediately after the September 11th attacks, that he was going to sign up with the armed services and go teach those %(&^$*& a lesson. He was totally focused on his goal, his mission — to exact revenge — and he was going to put everything on the line for it. I heard that a lot after 9-11, and if I hadn’t spent a decade married to someone whose father was a WWII veteran who paid an unbelievable price — and exacted the same from his family — thanks to the effects of what was arguably our last “justifiable” war, I might have felt the same way.

But you see, having seen first-hand what war will do to people — even if they are fighting for the right side, even if they do survive the horrors — I chose not to take myself to the front lines in that way, though so many did make that choice.

Don’t misunderstand me — It’s not that I don’t believe that war is sometimes a necessary part of life. It’s not that I don’t respect the choices of others who take themselves to the front lines. I do, on both accounts. My point is, if you’re going to put yourself out there and lay it all on the line, you can expect to get hurt. And badly. If you make it home alive. Even if you aren’t injured, you will be changed. Irreversibly. So, choose well, whether or not you can pay that price.

The same holds true, I believe, with collision/contact sports. Football, soccer, hockey, even baseball and basketball to some extent. And extreme sports, too. People run into stuff, and they run into each other — and get hurt — in the course of play. It comes with the territory. So, we can expect there to be sprains, strains, broken bones, and concussed brains. We can expect it. We can count on it. And we need to quit fooling ourselves about being able to prevent it.

When you give yourself to something wholly and completely and without reservation, be it a game or armed conflict, you can expect some nasty sh*t to go down. And it will leave you changed.

Football Today Warfare Today

It’s not the changes that bother me, actually. As much press as there is about CTE and the dangers that come with repeated brain injury, those aren’t the the aspects of concussion that trouble me. I’m not keen on the business of dementia and early onset Alzheimers, not to mention insomnia and chronic pain, memory loss and personality changes, and all the other alterations that can come in the aftermath of years and years of subconcussive hits, but what truly gets to me, is our seeming inability to mentally prepare for these things as well as develop meaningful responses to them, when they do happen.

Seriously, what do we expect? That we can just use our heads as weapons, play after play, game after game, season after season, without any effects? People don’t call us “dumb jocks” for nothing. And when we do start reaping what we’ve sown, what makes us think we can just merrily continue on as though nothing is happening? It brings to mind my grandfather, who insisted on driving ten years longer than it was safe to, because he couldn’t give up on the idea of being wholly independent — even at 80+ years of age, with legs that were giving out.

It’s like we’re all living under this spell that says, “Just keep going as though nothing is wrong, and everything will be alright.” Except it’s not. And even then we ignore it and pretend that all is well. And it continues to get worse. And worse. Until we’re so collectively screwed, that the best we can hope for is not ending up in a metaphorical cardboard box under a metaphorical bridge, fighting off rats for our dumpster dinners.

I suppose it makes more sense, to talk about myself, than our collective unconsciousness. Because I’m talking about myself as much as anyone. Heck, when I was a kid, lo those 35-40 years ago, nobody knew about this concussion stuff, and when I played ball, it actually felt good when I hit my head. After the initial woozy, wobbly, sick-on-my-stomach feeling, I was overtaken by a buzz that propelled me onwards and gave me an other-worldly high. Knowing more about concussion, I suspect it was that metabolic cascade of glucose flooding into my brain to compensate for the neurons that got switched off or went to sleep.

The Neurometabolic Cascade of Concussion explains it:

Immediately after biomechanical injury to the brain, abrupt, indiscriminant release of neurotransmitters and unchecked ionic fluxes occur. The binding of excitatory transmitters, such as glutamate, to the N-methyl-D-aspartate (NMDA) receptor leads to further neuronal depolarization with efflux of potassium and influx of calcium. These ionic shifts lead to acute and subacute changes in cellular physiology.
Acutely, in an effort to restore the neuronal membrane potential, the sodium-potassium (Na+-K+) pump works overtime. The Na+-K+ pump requires increasing amounts of adenosine triphosphate (ATP), triggering a dramatic jump in glucose metabolism. This “hypermetabolism” occurs in the setting of diminished cerebral blood flow, and the disparity between glucose supply and demand triggers a cellular energy crisis. The resulting energy crisis is a likely mechanism for postconcussive vulnerability, making the brain less able to respond adequately to a second injury and potentially leading to longer-lasting deficits.

That’s what happens during/after a concussion, and by the time this takes place, there’s not much room for behavior adjustment on the part of the concussed individual.

The time for adjustment is actually before the event has a chance to take place, and/or after, led by an outside observer who can objectively direct the next actions to take. The person who’s been concussed / sustained a mild traumatic brain injury is in no shape to be calling the shots. When you let them decide what to do, you get situations like Second Impact Syndrome, or pro football players returning to play in the same game, then having seizures on their way home .

It’s when the people in charge don’t make the right calls, or they shirk their duty to protect… or they care more about winning than about the well-being of those who serve them (like in the case of my father-in-law who was shot up three times and sent back to the front twice, before they finally let him come home)… that we get into trouble. When our whole society, our whole culture is so steeped in the need to win, the desire to be Better Than, that we willingly send our strongest and healthiest into harms way to be torn down to nothing — maybe not right away, but give it a few decades — then our society can expect to find itself footing the bill in some way, on down the line.

We concuss our student athletes regularly. We have coaches and managers who are more interested in winning than protecting the brains of their star players. Some of our brightest and best are being sacrificed for the glory of Friday night lights, as well as the battlefields overseas. In another 20-30 years, if we have a healthcare crisis on our hands around these “gladiators” who have all sorts of complications… and we have a workforce crisis around a whole lot of folks who are not performing up their full potential thanks to combat TBI and sport-concussion-induced cognitive decline… and we’ve never lifted a finger to actually address these issues when they were still fresh and (perhaps) manageable, then we have only ourselves to thank.

What do we expect?


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