PUTTING HEADS TOGETHER Battlefield vs. ballfield brain injuries studied
The gridiron and the battlefield have little in common, but brain injuries plaguing combat veterans and former football players have doctors and veterans’ advocates eager to bring brain injury research out of the “dark ages.”
It’s too early to determine the similarities and differences of brain trauma between veterans and football players.
In the days immediately after their injuries, both are treated the same way: with rest and treatment of pain and other symptoms.
“We still don’t know what the complete answer is,” said Dr. Ann McKee, the chief of neuropathology in the VA Boston Healthcare System and a professor of neurology and pathology at the Boston University School of Medicine. “I can tell you there are some parallels, and also some differences, but it’s very early on in research.”
Mike Helm, the new national commander of the American Legion, said it’s time for researchers to learn from one another.
He said new Veterans Affairs Secretary Robert McDonald has the same idea.
“He wants to have a summit,” Mr. Helm said. “The veteran population is not the only one suffering from traumatic brain injury and post-traumatic stress. You have your football population, you have any of your athletics deal with that, so it’s not just a veteran population problem, it’s a national problem. And he wants to bring everyone onboard and have a summit of some kind and fix it as well as he can.”
Though no summit is scheduled, Mr. Helm said, he is happy that the VA secretary is making a priority of traumatic brain injury and post-traumatic stress disorder.
Since 2000, more than 300,000 cases of traumatic brain injury have been diagnosed among active-duty troops, according to data from the Defense and Veterans Brain Injury Center, though the rate has fallen from a record 32,000 diagnosed in 2011 to 12,000 in the first half of 2014.
Although a link between the two illnesses hasn’t been proved scientifically, more than 50 percent of veterans with TBI have PTSD, Dr. McKee said.
Even as more brain injuries are diagnosed among military veterans, football leagues at all levels, from children to the pros, are increasingly worried about concussions. President Obama has weighed in on the question of football concussions.
One of the problems, researchers say, is that the study of brain injuries remains in the “dark ages” and that a summit could help answer major questions.
In football, a concussion is usually the result of a helmet-to-helmet collision or a player’s head striking the ground after a hit.
Military troops involved in explosions, however, usually face a combination of injuries, said Dr. Brent Masel, director of the Brain Injury Association of America. An improvised explosive device, for example, could throw a soldier into a doorway or send a piece of debris flying into his head.
The brains of deceased veterans and athletes look different, Dr. McKee said. Veterans who have suffered injuries typically show more damage to the white matter, which includes the neurons that form connections in the brain, as well as more damage to the small blood vessels.
Athletes are more likely to have repeated injuries, leaving them more likely to suffer from chronic traumatic encephalopathy, a degenerative disease. Symptoms include memory loss, confusion and depression and can appear years or decades after the injuries.
Even there, the distinction may be overstated.
Dr. Michael Lipton, a professor of radiology at Albert Einstein College of Medicine, said veterans may suffer daily low-level trauma that accumulates over time — especially troops who use small explosives regularly to clear houses or knock down doors. Their injuries may be similar to those sustained by athletes, he said.
“It’s not a matter of being in the vicinity of an explosion once. It happens repeatedly over a prolonged period of that,” he said. “In a cohort of vets we’ve studied recently, in speaking with these people, they’re exposed, some of them virtually on a daily basis, to blasts which are not anything that knocked them out of commission, but they’re real exposures.”
Researchers said they are sharing information about athletic and battlefield injuries at conferences and through journals. Dr. McKee said all brain injuries have some similarities that could help medical professionals learn a lot from one another.
“Your brain really doesn’t care what the trauma is from. It generally has a fairly standard way of reacting to trauma,” she said. “So we could really learn from each other, and I think that would speed up development of ways to identify the disorder and treat it.”
More petitions for annulments are opened by Catholics in the U.S. than in any other country, but the number has dropped in the past two decades amid declining numbers of marriages, fewer divorces and perceptions of a stigma from the church, analysts say.
Often misunderstood as simply a “Catholic divorce,” the subject is one of the prominent family issues under discussion during this month’s Extraordinary Synod of Bishops and one area in which the church might see some tangible changes in practice.
The most recent numbers available from the Annuarium Statisticum Ecclesiae, which compiles statistics about the Catholic Church and its members, show that 24,010 cases, or 49 percent of annulment cases, were petitioned from the United States in 2012. Poland, the country with the next highest number of petitions, accounted for 6 percent, with fewer than 3,000 cases.
But the U.S. figure is down sharply from the 72,308 cases introduced in the United States in 1990, as are figures for requests worldwide.
“The number of annulment cases introduced each year is declining,” said Mark Gray, senior research associate at the Center for Applied Research in the Apostolate at Georgetown University. “In part, this is related to fewer divorcing and fewer ever marrying.”
What hasn’t changed, Mr. Gray said, is the percentage of annulments that are granted.
“In most years since 1980, this has fluctuated between 85 percent and 92 percent,” Mr. Gray said. “In 2012, nine in 10 cases resulted in a ruling of nullity.”
The ruling itself is often misunderstood. Rather than dissolving a marriage, an annulment declares that a union thought to be binding according to church law fell short of at least one of the five essential elements.
For a marriage to be valid in the eyes of the Catholic Church, the man and woman must be free to marry; must freely give their consent; must marry with the intent of staying married for life, as well as faithful and open to having children; must marry with good intentions for their spouse; and must be married by a church minister in front of at least two witnesses.
Maureen Ferguson, senior policy adviser for the Catholic Association, described the annulment process as “an investigation that shows that a marriage that was thought to be valid at time of the wedding, actually fell short of at least one essential element of sacramental marriage.”
The process “can be quite cumbersome,” she said, but an annulment “can be a source of hope for many people who went into marriage without proper understanding of the proper sacramental marriage.”
An annulment can take anywhere from a year to 18 months, according to the U.S. Conference of Catholic Bishops, though each case is different.
On paper, annulments are not cheap. The bishops conference stated that most tribunals — the church panels that consider the requests — charge $200 to $1,000, though fees can be reduced or waived.
Another widely held belief is that the speed and processing of a request for an annulment can be influenced by donations — a suggestion Catholic leaders are quick to dispute.
The Rev. Anthony McLaughlin, an assistant professor at the Catholic University of America’s School of Canon Law, served on the church tribunal that handled annulment cases in the Diocese of Tyler, Texas. He said a donation of $400 was suggested, but “I couldn’t tell you of any diocese that would forbid a process if [a petitioner] didn’t give you a donation.”
Troops injured by explosions have some similarities and some differences with football players when it comes to brain trauma. Researchers are working to move beyond the “dark ages” to better understand such injuries, which are treated the same way immediately — with rest and pain relief — but can have long-term consequences.