PUTTING HEADS TO­GETHER Bat­tle­field vs. ball­field brain in­juries stud­ied

The Washington Times Weekly - - National - BY JAC­QUE­LINE KLIMAS BY MERED­ITH SOMERS

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.”

AS­SO­CI­ATED PRESS

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.

U.S. NAVY

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