I was, am, and hope to always be naïve.

I hope you think the picture is pretty, but I don’t expect you to be as taken away as I am: I understand that discovering the sight was part of the fulfillment’s process. I take that back, actually. I didn’t discover anything. I just observed some already-well-characterized phenomena.

A couple of months ago, when I just started my PhD training, I saw this image under the microscope. I forgot how much time I spent staring at all the different motor neurons, how they extended their processes to hold figurative hands and pass along chemical love messages. I spent more time taking the highest resolution picture I could, which has been edited to its current state.

If I gave this image to a polite, random neuroscientist, he/she would give me a coy smile and say that the picture was “nice and the TUJ1 antibody stained very well.” If I gave this image to an impatient and nasty, random neuroscientist he/she would scowl at the piece of paper and ask me why I was wasting his/her time: I’m not showing anything new!

I hope this figure will be as stunning to me in a few years, when I’ve read more literature and seen more figures and done more research and graduated with a PhD. Sure I’ll see a lot of similar images; I might be bombarded by them. But I hope to appreciate that the ordinary is beautiful too: because you see it once, doesn’t mean the allure has to fade.

Monday afternoon football update

This weekend in American football:

1. A Rutgers' University student athlete was paralyzed from the neck down after an in-game incident against Army.
Update (10-19-2010): The most recent medical literature says that 90% of patients with complete tetraplegia (aka quadraplegia) at one month post-injury remain complete tetraplegics for good.  After 6 months, there is little change in a person's neurological status caudal to the spinal injury.  In other words, the coming days and weeks will be hugely informative of the athlete's function long into the future.  Here's hoping he regains function.  Also, from what I have gleaned from the news reports, it does not appear that therapeutic hypothermia (TH) was tried.  Recall that TH was used when Buffalo Bills' player Kevin Everett was injured back in 2007.  Although the use of TH in his case is still being debated, he was able to walk within ~one month of the injury.


2. Yesterday's NFL games featured several instances of traumatic brain injuries.

walking, chewing gum

In my recent interactions with one of UCLA's true physician-scientists, I start to get the sense, more than ever before, how this journey is about learning to walk and chew gum...at the same time! Hackneyed cliche aside, I guess I have begun to realize how all of this research and medicine "stuff" isn't so incredibly difficult, but juggling different responsibilities requires intra- and inter-personal patience: transitions are hard, and a deep breath and calm go a long way.  But it's still hard work.

Rethinking traumatic brain injury and its consequences: “repeated brain injury can change your life and your family’s life forever.”

I watch the NFL most weekends, and I won’t lie: I’m mesmerized by the horrific collisions and the looped instant replay that progressively slows down so that I can see faces grimace on impact. After most hits, the players bounce back up, dust and readjust their jerseys, and run back into position to get hit again. After the bad hits -- a lot of the times on the quarterback -- the trainer and then the team physician and then the medics come to the field. An awkward fall or collision can cause a player’s helmet to hit the ground at a ridiculous velocity.

In 2009 Roger Goodell, the NFL commissioner, testified in front of the House Judiciary Committee and did not recognize an association between head trauma suffered in games and brain diseases later incurred by those players. The league promised to “do better” and later that year issued “stricter” concussion guidelines.

Since Goodell’s testimony, the NFL has slowly changed its outlook regarding traumatic brain injury. A sobering poster in team locker rooms acknowledges that concussions can cause “problems with memory and communication, personality changes, as well as depression and early onset of dementia.”

Omitted in the list of concussion-associated conditions is a Lou Gehrig’s-like disease. Lou Gehrig’s disease (amyotrophic lateral sclerosis (ALS)) is a progressive, neurodegenerative condition that affects upper and lower motor neurons. Patients, like Stephen Hawking, are left weakened and atrophied to the point where they can no longer support breathing. The etiology of ALS was thought to be primarily organic. Current studies, however, suggest head trauma can cause a similar disease state. So Lou Gehrig may not have had Lou Gehrig’s disease. A New York Times article reviews his well-documented history of head trauma. Spinal cord pathology samples have shown that others athletes -- boxers and football players -- have been misdiagnosed with ALS. It is hypothesized that the neurodegeneration related to chronic traumatic encephalopathy (CTE) is mediated by neurofibrillary tangles, which are also seen in Alzheimer's.

Whether the neurofibrillary tangles and neurodegeneration are taking place in the motor neurons or temporal or frontal lobes, the fallout is real and serious. Chuck highlighted the sad story of Chris Henry, a former wide receiver for the Cincinnati Bengals, who demonstrated behavioral changes leading up to his accidental death. An autopsy revealed CTE. Malcolm Gladwell surveyed some of the NFL’s horror stories:

“Mike Webster, the longtime Pittsburgh Steeler and one of the greatest players in N.F.L. history, ended his life a recluse, sleeping on the floor of the Pittsburgh Amtrak station. Another former Pittsburgh Steeler, Terry Long, drifted into chaos and killed himself four years ago by drinking antifreeze. Andre Waters, a former defensive back for the Philadelphia Eagles, sank into depression and pleaded with his girlfriend—“I need help, somebody help me”—before shooting himself in the head.”

The sad stories aren’t limited to professional sports. This past April a University of Pennsylvania football player committed suicide. An autopsy revealed CTE, a surprising finding considering his age. These stories are receiving more and more attention, and congress is listening. House committees are working on the Concussion Treatment and Care Tools, and Protecting Student Athletes From Concussions Acts.

While the sports community has slowly increased the awareness of traumatic brain injury, the US Army has some work to do. An NPR investigation reported that Army officials have denied Purple Hearts to soldiers who suffered concussions following explosions. The denial is not a surprise to Gen. Peter Chiarelli who acknowledges the “ongoing resistance to awarding the Purple Heart for so-called ‘invisible’ wounds.” The Purple Heart is a “badge of courage” and a medical resource: recipients receive prioritized medical care from Veterans Affairs hospitals.

Soldiers shouldn’t need a Purple Heart, though, to receive appropriate medical care. Physicians should investigate the association between psychiatric and neurological conditions and traumatic brain injury. Soldiers should be warned of the risks. And the institutions should provide the appropriate medical and social resources. The consequences of traumatic brain injury do not happen overnight.