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Medicine and Society, Neuroscience, Sports

New concussion guidelines for NFL players

New concussion guidelines for NFL players

The bone-crunching violence of football is part of the appeal. (I submit as evidence the fact that this YouTube video, which consists of three minutes of people running full-speed into each other, has garnered close to 500,000 views.) But critics have long warned that the neurological effects of some of these hits can be extreme, even deadly. Now, the National Football League is changing its guidelines to prevent players with concussions from returning to play before they are healed.

The New York Times reports:

The new rule, which will take effect in this week’s games, still allows players with some fleeting concussion symptoms to return to games.

Symptoms that require immediate removal include amnesia, poor balance and an abnormal neurological examination, whether or not those symptoms quickly subside. For symptoms like dizziness and headache, however, a player can return to the field unless they are “persistent,” the statement said.

The NFL has been under fire for its head injury policies for years. First, wives of former players began coming forward with stories of their middle-aged husbands falling prey to dementia. Then came studies linking concussions to depression. And then there were the disturbing postmortems, which found extensive damage in the brains of young ex-players. Still, the NFL was slow to change, insisting that the studies were flawed and the dementia unrelated to football.

But this September, the NFL’s own study on the long-term effect of concussions came to the same conclusions as those before it: Former players were much more likely to be diagnosed with Alzheimer’s or other memory disorders than the general public. The study relied on self-reports and had its shortcomings, but as Dr. Julian Bailes, the chairman of the department of neurosurgery at the West Virginia University School of Medicine, told the Times: “This is a game-changer.”

Indeed, the chairmen of the NFL’s committee on brain injuries, both of whom had consistently denied that concussions could cause long-term damage, stepped down last week. The guideline change soon followed.

The good news is that these guidelines will likely make waves far beyond the NFL. College and high school teams lack widespread concussion guidelines. This is especially worrisome in high school, where “getting your bell rung” is often considered more “badge of honor” than “medical emergency.” With the granddaddy of football changing its tune, we may see coaches and trainers on every level taking concussions more seriously.

Stephanie Pappas is a guest blogger based in Houston, Texas, where the Friday night lights shine bright. She was formerly an intern for the Stanford School of Medicine Office of Communication and Public Affairs.

Mental Health

Battling PTSD

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As Krista points out, Austin, Texas saw a temporary bump in its population of science writers during the past few days. Being a newly minted Texan, I was able to attend, and I can affirm that, yes, the talk titled “Why Women have Sex” was particularly popular. (The answer? Mostly for the same reasons men do. Sorry to all the Mars/Venus theorizers out there.)

But it wasn’t all sex talks at Science Writers ’09. We also talked about war.

We’ve all heard the stories. Soldiers return from Iraq and Afghanistan to the United States only to find that haunting memories of combat have followed them home. Between 13 and 18 percent of Iraq veterans develop full-blown post-traumatic stress disorder. In an environment where 90 percent of soldiers report being shot at, mental health problems aren’t such a surprise. What researchers don’t know is why some people struggle to cope with trauma while others sail through combat relatively unscathed.

To find out, Michael Telch, a UT Austin psychologist and Stanford alum, came up with a novel idea: Look at soldiers before they’re deployed. Previous researchers have questioned veterans after their return from combat, but such retrospective studies are limited because the respondents’ memories of their experiences may be flawed.

So Telch worked with the army to find volunteers who would be deployed within the next 60 days. These soldiers went through a battery of tests, surveys and psychological assessments to measure their baseline responses to stress. They also gave saliva samples for genetic testing, had their brains imaged and inhaled a mixture of 35 percent carbon dioxide and 65 percent oxygen to induce breathlessness and lightheadedness, which many people find very frightening. Telch and his team measured changes in the participants’ levels of the stress hormone cortisol in response to the test.

The hope, Telch said, was that the diversity of data would help psychologists pinpoint subtle risk factors for later psychological problems. “What we’ve done is to try to go beyond,” he said. “The kind of data we’re collecting cuts across multiple systems of human functioning.”

Next, the researchers set up an online “stress log” for deployed soldiers to fill out every 30 days. These logs captured information on the soldiers’ experiences and their responses to those experiences. Though you might expect participation in this step to be low – war can be chaotic, after all – 162 of the 178 deployed soldiers completed all of their logs.

The yet-unpublished results have Telch and his fellow researchers excited. Several of their pre-deployment tests did indeed predict later mental health during and after combat. A prior history of mental illness put soldiers at a greater list of both combat-related PTSD and depression. Soldiers who had strong reactions to the carbon dioxide breathing test were significantly more likely to have problems with stress and PTSD upon deployment. And those who showed high “anxiety sensitivity” – fear of experiencing anxiety, or anxiety about anxiety – also had increased risk for both anxiety and depression.

Many of these tests take just minutes to complete and could easily be used to screen for vulnerable soldiers, Telch said. Then, instead of trying to pick up the pieces after a soldier already has PTSD, army psychologists could work to prevent the disorder in the first place, perhaps by better preparing the soldiers for the emotional side of combat and keeping a close eye on them in the field.

“Some of these risks really are modifiable,” Telch said. “One could actually begin to identify soldiers in-theatre who are starting to have problems.”

Photo via the U.S. Army

For more on mental health and veterans, see this story in Inside Stanford Medicine.

Stephanie Pappas is a guest blogger based in Houston, Texas. She was formerly an intern for the Stanford School of Medicine Office of Communication and Public Affairs.

Autism, Medicine and Society, Myths

Wired tackles the vaccine controversy

This week in Wired magazine, Amy Wallace attempts to inject some science into the controversy over vaccines and autism. She also gives her readers a peek into the life of Paul Offit, a high-profile Philadelphia pediatrician who has been targeted by anti-vaccine advocates for his defense of childhood vaccination. The man receives death threats.

Wallace herself comes out strong in defense of vaccines, writing:

Twelve epidemiological studies have found no data that links the MMR (measles/mumps/rubella) vaccine to autism; six studies have found no trace of an association between thimerosal (a preservative containing ethylmercury that was used in vaccines until 2001) and autism, and three other studies have found no indication that thimerosal causes even subtle neurological problems. The so-called epidemic, researchers assert, is the result of improved diagnosis, which has identified as autistic many kids who once might have been labeled mentally retarded or just plain slow. In fact, the growing body of science indicates that the autistic spectrum – which may well turn out to encompass several discrete conditions – may largely be genetic in origin.

Unsurprisingly, the article has touched off a firestorm of debate in the online comments section. Instead of simply letting the anonymous arguments rage, however, Wired is experimenting: They’ve set up a page where users can post questions about the article’s sources. Wired‘s writers and editors will then answer the questions over a period of several weeks. It’s an interesting (and interactive) idea, and I’ll be watching to see whether it cuts down on the sort of misinformation that often rules online comments.

For more on vaccines and autism, see “Why this fear of vaccines?” and the Spring 2009 issue of Stanford Medicine.

Stephanie Pappas is a guest blogger based in Houston, Texas. She was formerly an intern for the Stanford School of Medicine Office of Communication and Public Affairs.

Applied Biotechnology

The blind can see

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Via the New York Times, here’s a story that gadget-lovers and medical professionals alike can appreciate: With the help of a tiny camera and an even tinier patch of electrodes, people with certain types of blindness are regaining their sense of sight.

The device, known as the Argus, is simple in concept: The camera, mounted to a pair of glasses, picks up images and wirelessly beams them to a receiver implanted near the eye. The receiver sends data to an electrode array tacked inside the eyeball. The electrodes stimulate receptor cells in the retina, which signal the visual processing centers of the brain, which translate the signal into the experience of sight.

Making all this happen is quite complicated, requiring careful attention to everything from the frequency of the wireless signal to the heat generated by the electrode patch. But so far, almost 40 people around the world have enrolled in clinical trials testing the device, and it’s worked – to varying degrees – in all of them.

One such pioneer is Palo Alto lawyer Dean Lloyd, pictured above. I interviewed Lloyd for a feature story I wrote on the retinal implant project this spring. He’s a former biochemist with a booming laugh who began to lose his vision to retinitis pigmentosa as a young medical student. It would take him decades to become fully blind, but these were the days before the Americans with Disabilities Act, and the diagnosis alone was enough to torpedo Lloyd’s dreams of becoming a doctor.

He agreed to join the retinal implant trials two years ago because he “didn’t have anything to lose.” As it turns out, he’s gained lots: He can make out door frames, sidewalks, cars in the street, glass windows, and even the glint of other people’s eyes, he says, “like a cat under a bed where you shine a flashlight.”

Though the Argus is the farthest along in the development process, it isn’t the only artificial retina out there. At Stanford, physicist Daniel Palanker is working on a similar implant. His group hopes to avoid some of the problems inherent in cramming more and more electrodes into the eye by using video display goggles as an intermediary between camera and eye.

Both methods have their pros and cons, and it’s not clear if the technology will enable people to see fine detail or read words on a page. Still, as the Times article points out, the problem of blindness will only increase as the population ages. The artificial retina might be one way to fight back.

Previously: Lia Steakley on treating colorblindness with gene therapy

Stephanie Pappas is a guest blogger based in Houston, Texas who managed to get through this entire post without using the phrase “bionic eye.” She was formerly an intern for the Stanford School of Medicine Office of Communication and Public Affairs.

Aging, Health Policy

Facing mortality

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Like most people, I have a vision of a “good death” that doesn’t include respirators, gurneys, IVs or ICUs. And until reading Newsweek this week, I believed that, given clear directives and a supportive family, such a death is not out of reach.

As it turns out, a non-medicalized death is harder than you’d think, writes Jesse Ellison in a piece on her 91-year-old grandmother’s death:

When you’ve lived to be 91, death is not untimely. It is not a tragedy. And my grandmother’s death, in particular, should not have been so cruel. Money was not an issue. She had great insurance, and enough savings to pay for anything that Medicare and her insurance company would not. She had signed all the right forms. And she had the support of her family to die on her terms, as peacefully as possible.

Yet there was nothing peaceful about her death. She was forced to endure exactly what she had been so afraid of.

Ellison’s grandmother spent her last two weeks being shuffled from one facility to another. She was in hospice – until she got too well. Then it was assisted living – until she was deemed too sick. She was admitted to the hospital, and finally to a second hospice, where she died minutes after arrival. All of this after months of “palliative” chemo, radiation and surgery.

The process was agonizing for both the family and the patient. It was also expensive: tens of thousands of dollars, according to Ellison.

All of this is why we need to talk about death, writes Evan Thomas in an accompanying, rather sensationally titled piece, “The case for killing granny.” Thomas calls the need to reduce end-of-life medical costs the “elephant in the room in the health-reform debate,” and breaks down some of the cost-drivers, including the fee-for-service model and cultures of care in different regions and hospitals. (This New Yorker piece from June covered the latter issue in greater depth.)

What’s the solution? Well, Thomas writes, maybe those “death panels” aren’t such a bad idea after all:

Although demagogued as a “death panel,” a program in Wisconsin to get patients to talk to their doctors about how they want to deal with death was actually a resounding success. A study by the Archives of Internal Medicine shows that such conversations between doctors and patients can decrease costs by about 35 percent -while improving the quality of life at the end.

So while no one is proposing a health reform bill that would force citizens to face government death panels, perhaps we’d all be better off if we faced our own mortality.

Previously: Fighting for God
Photo of grave markers in Reefton, New Zealand

Stephanie Pappas is a guest blogger based in Houston, Texas, which, in keeping with the theme of this piece, is the home of the National Museum of Funeral History. She was formerly an intern for the Stanford School of Medicine Office of Communication and Public Affairs.

 

Imaging

Mummyblogging, round two

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Last week, I posted a few photos of a Stanford effort to image the mummy of a 2,500-year-old priest. For those of you who like a little more context with your mummy-in-a-scanner shots, see my full article and a photo slide show here. Our multimedia team is working to put together a video on the mummy scan, which is sure to be fantastic; watch for it in the next month or two.

For now, I thought I’d put up a few more pictures, representing the lighter side of hanging out with a dessicated ancient Egyptian all day. Click through for more.

Continue Reading »

Aging

Checking in early

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Very few people look forward to the day when they’ll have to check into a nursing home. So why would a perfectly healthy 38-year-old move in voluntarily?

To prepare for a career as a geriatrician, according to this New York Times piece:

[Kristen] Murphy, a medical student at the University of New England in Biddeford, Me., who is interested in geriatric medicine, came to New York for a novel program that allowed her to experience life as a nursing home patient.

I won’t try to recap the piece further here; it’s worth reading in its entirety. But I was struck by these statistics, also from the story:

In 2005, there was one geriatrician for every 5,000 people over 65, according to the American Geriatrics Society; by 2030 that ratio is expected to increase to one for every 8,000 patients. Geriatricians must participate in a two-year fellowship program after medical school to become certified. In 2007, only 253 of 400 fellowship slots were filled, and only 91 of the physicians graduated from medical school in the United States.

The good news is that Murphy, at least, was inspired by her 10 days in the nursing home. Maybe such programs could be a tool to recruit young doctors to the field.

Photo by DerrickT

Imaging

Photoblogging: mummy edition

Stanford radiologists are hard at work right now scanning a 2,600-year-old Egyptian mummy. We’ll have a full set of videos, articles and photos on this mummy madness soon, but here’s what’s happened so far today:

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The mummy arrives at the Axiom lab at the School of Medicine campus. He’s wrapped in soft white material to prevent damage. Here three de Young employees (Alisa Eagleston, assistant conservator, Jocelyn Chan, intern, and Elizabeth Cornu, head objects conservator) remove a special plastic cover meant to protect handlers from ancient dust and germs.

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Unwrapping the mummy as Stanford biophysicist Rebecca Fahrig looks on.

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Ready for scanning!

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The first scans of the skull.

Mental Health

Summer stress

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Is anyone out there having a relaxing summer? Please, speak up if you are – it’s hard to hear you over the health care reform yelling matches. Anyone?

Okay, maybe some lucky souls are relaxing on beaches far from town hall meetings and mass media. Still, anyone watching the TV news or lurking on internet comment boards in the last few months could easily conclude that our nation’s collective blood pressure is through the roof. We’re stressed that we’ll lose our jobs, or that we won’t ever be able to retire. We’re stressed that health care reform won’t pass – or that it will. We’re stressed that our soon-to-be landlord just tried to amend our lease to prevent us from flushing toilet paper down the commode. (Oh, was that just me? Never mind, then.)

Given all we have to worry about, today’s Science Times piece on stress seems particularly timely. It turns out, Natalie Angier reports, stressed-out brains are likely to get stuck in a rut. Or, as Stanford neuroscientist Robert Sapolsky says in the article:

“We’re lousy at recognizing when our normal coping mechanisms aren’t working. Our response is usually to do it five times more, instead of thinking, maybe it’s time to try something new.”

Angier focuses mostly on some research that made the rounds a few weeks ago. The study found that stressed-out rats failed to respond to new circumstances, instead falling back into old habits (in this case, pushing a bar for food pellets even though food pellets were available without all that backbreaking bar-pushing). Though these rats recover after a few stress-free weeks, humans have a tendency to fret, Angier writes, pushing their stress levels up despite the absence of immediate triggers.

So, how to chill out? Well, you could get a dog, meditate or stop and smell the roses. Or you could follow Stanford psychiatrist David Spiegel’s advice and watch the news in moderation.

But if all else fails, I hear Cute Overload is a known cure for all landlord-related ailments.

Previously: Michelle Brandt on stress and sleep
Bonus timely stress link: Mental stress training is planned for U.S. soldiers
Photo by ernest figueras

Cardiovascular Medicine

Little hearts, big tools

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Heart defects run in my family. I lost two infant sisters to hypoplastic left heart syndrome, a congenital defect in which the left side of heart fails to develop. The defect is still known as one of the most challenging heart anomalies to treat. And just a few years back, my younger brother, a college athlete, learned that he has a bicuspid aortic valve – two flaps of tissue where three should be. Fortunately, it hasn’t caused any problems yet.

Treatment options for cardiac defects have improved in the more than two decades since my sisters were born, but not as much as I thought. According to an article in today’s Wall Street Journal, “hardly any of the myriad drugs and devices developed for the multibillion-dollar market for cardiovascular disease are designed with kids in mind.”

This means that babies and kids get treatments designed for and tested on adults. In some cases, doctors use tools meant for adult kidneys on baby hearts – a clever example of makeshift medicine that nonetheless carries additional risks.

More than 35,000 babies a year are born with congenital heart defects. Not all require treatment, but many do, so it’s somewhat surprising that doctors still have to jerry-rig solutions. At least the article offers some hope:

“An FDA advisory panel recently recommended approval of a heart valve that could be used in children. Various clinical trials, sponsored by the National Institutes of Health and other groups, aim to compare different surgical approaches and different drug regimens in children with congenital heart defects. And the American College of Cardiology next month plans to launch a registry that will allow doctors to compare the outcomes of catheter-based procedures done on children at centers around the U.S.”

Such research efforts could make a huge difference for miniature hearts. See the full article for more.

Previously: Erin Digitale on safer surgery for kids
Wall Street Journal via NPR Health Blog
Illustration of heart with atrial septal defects by Patrick J. Lynch, medical illustrator and C. Carl Jaffe, MD, cardiologist

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