HJAR Jul/Aug 2024

CTE 10 JUL / AUG 2024 I  HEALTHCARE JOURNAL OF ARKANSAS NFL players now openly admit they are experiencing the effects of CTE to the media, and we laugh it off as a society; but when you are experiencing it or witnessing it, there is nothing funny about an irreversible neurodegenerative disease that affects executive function in the beginning and presents later as early Alzheimer’s, amyotrophic lateral sclerosis (ALS), Parkinson’s, and, in some, brain cancer. My perspective of the game changed when my husband’s, Smith “Wally” Hartley’s, brain donation came back positive for CTE. This former college football player and healthcare executive-turned- journalist started experiencing symptoms of CTE several years before he was diagnosed with glioblastoma. He died at 54, and we spent almost five years dealing with the effects of CTE/glioblastoma. His CTE pathology did not surprise me, although we had been told for years by doctors his issues were not from playing football. The well-meaning ones never suspected college football could result in this; and the providers we sought who deal with many professional players, I now realize to my horror, were paid in part by the NFL, an entity struggling to eliminate any possible causation at any level because it may affect their pipeline of players. That CTE pathology divulged that if Smith hadn’t died of brain cancer, he would have walked, perhaps decades more, with a cruel brain disease from a game we all cheered for and hits we thought were benign. He never played pro; he played through our education system. Our schools recruited him, handed him the football, held the pep rallies, and built the stadiums for the sport; and yes, he played willingly, but I held him at the end — he would gladly have gone back in time and played tennis or golf or baseball or basketball in exchange for years more of a life he loved with a functioning brain. I am horrified we are continuing to do that to boys now. Don’t believe me? I encourage you to start asking around about the wellbeing of former college players. You will find, like I have, too many who have gone “dark,” trapped in brains that are not functioning well while trying to navigate life, those they love, and a healthcare system with providers who have little understanding of what these guys are going through and no ultimate solution for them. These guys who played at public universities have no recourse from the colleges that earned billions from their efforts, unlike their vetted NFL brethren. “What is happening to former college players is currently being denied and not being counted,” I was told by a leading sports concussion specialist, “because if colleges and the NCAA acknowledge the damage, the house of cards falls, and they are now on the hook for ‘knowing and continuing the game.’” So, the charade of schools claiming the inability to contact former players about their health and causes of death, and refusing to publicize the records they do have, continues. The Big Tobacco play has moved to the college level. The NFL guys called this ruse “delay, deny, and hope they die.” The college guys are just not organized to effectively push for damages, and families of the dead are perhaps still struggling with the stigma of a man who changed into an unrecognizable version of himself, not aware it is happening to a lot of them. These families were not contacted about brain donation. Their men are not counted. They just went away quietly. It makes you wonder when the damage starts. One tackle football hit can cause a concussion. Concussion symptoms include confusion or feeling dazed; clumsiness; slurred speech; nausea or vomiting; headache; balance problems or dizziness; blurred vision; sensitivity to light; sensitivity to noise; sluggishness; ringing in ears; irritability or other behavior or personality changes; difficulty concentrating; loss of memory; fatigue or sleepiness; loss of consciousness; forgetfulness such as repeating oneself; slowed response to questions; problems with sleep; depression; and problems with taste or smell. One concussion, a form of traumatic brain injury, gives you a 40% increased risk of developing a mental health issue 2,3 and makes you three times more likely to have another concussion 4 . Two concussions in a short amount of time (second hit syndrome) can kill you. Concussed students often have difficulty with schoolwork. Symptoms may last days, weeks, months, or, in some cases, may be permanent. One season of playing tackle football can cause changes in white matter, the part of the brain that delivers brain signals. 5 Repeated hits to the head at a concussive or non-concussive level can cause long- term neurodegeneration, including chronic traumatic