Long-term dangers of pediatric concussion/brain injury

Football less dangerous for kids?

The Concussion Blog has another thought-provoking post about an announcement made by Dr. Howard Derman, co-director of the vanguard Methodist Hospital Concussion Center that children’s brains are (apparently?) better able to tolerate the effects of concussion. From what I read — also in the orginal article at Beyond Chron — the plasticity of a kid’s brain, along with its greater amount of room to handle swelling, makes (football-related) concussions “less of a concern” for children.

“I’m not saying it’s safer to play football as a child,” said Dr. … Derman,… “but the plasticity – flexibility, in layman’s terms – in the brain is greater in a child, and it has more room to swell. So things we see in adult football players are slightly less of a concern in children. That’s just a statement of fact.”

Okay, so let’s assume that the doctor has his facts right, which is up for dispute by a number of truly independent writers and investigative journalists. Even if a kid’s brain is more resilient (and I’m not agreeing that this helps), another fact to be taken into consideration is that having a concussion makes you more susceptible to having others. And speaking from experience, the cumulative effects of childhood concussion into adulthood (which brought with it yet more concussions/tbi’s), can wreak havoc long after the initial injury was sustained.

What concerns me about this statement — aside from the fact that it was made by a physician with ties to professional sports teams, whose word is probably taken as gospel in certain circles — is that it treats childhood concussion/brain injury as an isolated incident that you really don’t need to worry about, because, well — as so many people have said over the years — chances are everything will clear up and things will go back to normal.

I truly wish I could say that was true for me, but from where I’m sitting, those supposedly harmless blows to my head when I was younger, led to more supposedly harmless blows… which ended up sidelining me not only from games, but from the game of life.

And this was some 30 years after my first concussion — the first of many, which had cumulative effects over time.

Where does that leave me? Still working to pick up the pieces, still trying to avoid meltdowns, still trying to keep my act together at work, still hassling with light and sound sensitivity, as well as continuous fatigue. I won’t say “chronic fatigue” because chronic implies that it comes and goes indefinitely. With me the fatigue just never goes away. Oh, well.

And where does that leave the people around me? Stressed out for reasons they don’t fully understand, and scratching their heads wondering WTF?! when I do something truly boneheaded.

And where does that leave my community? Well, my immediate community as well as my country, have lost about 40% of my original tax revenues since late 2004, when I left a good job because I just couldn’t hang in there after my last TBI. Say what you will about the individual being responsible for pulling themselves up by their bootstraps. Thanks to (undiagnosed and underestimated) TBI, my employment situation is at 60% of what it should be. And in the past seven years, the loss in tax revenue is thus equal to about three years of full-employment tax revenue. By the time I stop working (if I ever do), thanks to the TBI-related gaps in my employment history, the lost tax revenues will probably be equivalent to me retiring and no longer contributing to the collective kitty at least 10 years early. If not more. Can the government afford this? I’m not sure — especially considering that I was born at the tail-end of the Baby Boom, and it’s my tax dollars which will be buoying up the aging generation of retirees right before me, as the younger generation struggles to just pay off their credit cards and student loan bills.

It’s tax time, and I’m hassling through yet another data collection process — which is so much harder than it used to be, even though my taxes are significantly less complicated than seven years ago. In the process, I’m thinking about the effects of my injury on my tax rate. And while I don’t really chafe at how much money the government is scooping out of my pay (so long as I can just live my life and I’m not being totally flayed), if Uncle Sam did the math on how much revenue is lost to TBI each year, thanks to fully employed people becoming under-employed (or un-employed), I’m guessing they might take it a little more seriously.

Seriously, we live in expensive times, and I’m willing to help pay for roads and schools and infrastructure and War on Terror and national parks and all the things we tend to happily take for granted. Somebody’s got to. But it’s difficult to really contribute when you’ve got this whole… deal going on. And it’s difficult to take seriously a prominent doctor who claims that a contact/collision sport like football poses less of a problem to kids than to full-grown adults. Especially when I look at the long-term effects that one seemingly innocuous concussion after another can — and in my case, did — have on a young brain, and a young life.

So, in the end, it’s caveat emptor as usual. Be smart. Consider the sources, and draw your own conclusions. And remember, just because you have “M.D.” after your name doesn’t make you the ultimate authority… even in your chosen field.

My nephew has had at least 12 concussions

Or so he proudly announced to the family the other day, after he had a hard fall while sledding and was knocked loopy for a bit. He sledded down the hill to a ramp some kids had built, lost control of his sled, and landed flat on his back from six feet up. He said he got knocked out a bit, but nobody saw him hesitate. They say he looked like he just got up and went back to sledding.

My sister, who was supervising all the kids while they were sledding, was concerned. The last thing she wants is to return the kid to his mom worse than when she picked him up. But there’s only so much you can do with young teenage boys. Especially when they’re into extreme contact sports, which this kid is.

This nephew is a relatively recent addition to our family, the son of a new spouse who married into the extended family a few years back. I don’t know him well, and I don’t see much of him, as he lives a couple of states away, and I don’t get on the road much, between my job responsibilities and money and fatigue. But he’s always seemed like a decent kid, and I hate to think of what this may eventually mean for him, his behavior, and his cognitive future.

Then again, you never know what the future holds for anyone. If I fretted about all the head injuries I had when I was a kid — and there are a bunch that I don’t remember ultra-clearly, but I know did happen — I wouldn’t have any time for the rest of my life. And the fact that I have the excellent life I have, is proof that a series of concussions doesn’t have to ruin your life.

But still, it does give one pause. It makes me wonder if this kid is showing off, telling folks he’s had all those concussions. It makes me wonder if it’s a badge of courage for him — it sounds like it is. I wonder if anyone has explained to this kid what happens to football players and the brains of people who sustain repeated concussions. I’m not sure there’s much point.  It’s really his parents who should be spoken to. But his dad is really into “boys being boys” which to hims mind involves a fair amount of contact sports, falling down, brawling, and general roughness that — as I’ve witnessed — involves at least some level of head trauma.

It makes me wonder… How much is head injury actually an accepted part of life, even an encouraged one, for some people — and their kids? How much are concussion and subconcussive head injury, which are quite widespread,  a standard-issue part of some lives? What kind of future do people have, if they’re neurologically compromised by head traumas they embrace as a sign of toughness? And how much does head trauma have to do with the endemic social ills we have to content with daily?

I don’t know my nephew’s biological parent well enough to say anything about this, without seeming like I’m meddling. And I don’t know enough about childhood concussions and their prospective outcomes to say much that’s hopeful or constructive. I guess all I have to offer is my own experience and my own example of how I’m getting along in life. My nephew is a really good kid. He truly is. He’s well-spoken and intelligent, and he’s doing amazingly well with his new brothers, now that he’s in the family. I just hate to see him end up disadvantaged in life because of after-effects from all those concussions. And I’d hate to see his family suffer under the misguided assumption that behavior problems he may eventually exhibit are about the kind of person he is, rather than the brain he’s got which has been shaped and reshaped by repeated trauma.

It could be that I’m concerned over nothing. It could be that he keeps his act together and is able to build for himself a positive and pro-active life. Maybe he won’t get into drugs and alcohol, like I did. Maybe he won’t get into trouble at school. Maybe all the things that made my life next to impossible for so many years won’t be his lot in life. One can hope.

Well, you never know. Every brain is different. Every body is different. And for the most part, we all have at least a fighting chance. I’ll just keep an ear open for news of how he’s doing, and spend some time figuring out what, if anything, I can say to his folks to help them understand what concussion can do.

But I’m not going out of my way to prompt any scare stories. It could be, with this kid, we’ve all got nothing to worry about.