June 06, 2016 - Dr. David Chao
Monday Morning MD: Stop with the concussion politics
Everyone needs to stop taking sides and protecting their own interests. The NFL, team owners, Congress, NIH, concussion researchers, movie makers, medicine in general, players, coaches and media are all at fault here. Controversy was re-ignited and politics further injected recently when a congressional report criticized the NFL and their doctors. The goal should be to prevent concussions and find a cure for chronic traumatic encephalopathy (CTE), not playing politics of the blame/credit game. The NFL is wrong to play politics and deny funding for a $16 million Boston University study that was selected on merit by the National Institute of Health (NIH). Obviously the league has not yet learned from its past mistakes and being slow to react to the concussion issue. Team owners are wrong for continuing to shoot from the hip and deny links to CTE. Jerry Jones calls it “absurd” and Jim Irsay compares the risk of football to that of taking aspirin. Congress is wrong for making it a Democratic committee issue. CTE is not a partisan disease. What impartiality does a report have that harshly criticizes and singles out a “NFL doctor” when it never attempted to reach out to or speak to that physician before publishing findings? The National Institute of Health (NIH) is wrong to allow the NFL to call their $30 million grant unrestricted with “no strings attached”. In reality, the league retained “veto power”. The prestigious NIH should have never allowed itself to be manipulated that way or accept conditional monies. Concussion researchers are wrong for taking sides by becoming paid experts in concussion litigation. The different camps are wrong in pressuring families to donate to one group over another and for not sharing the brain tissue to verify findings. Movie makers are wrong for perpetuating the lies of the self-serving claims of one man that he discovered CTE. The reality is the degenerative brain disorder was first described in the 1920’s. I do applaud the awareness the Concussion movie brought to the issue but the truth would have done the same trick. The medical community in general is wrong for being slow to provide definitive care for head injury. Diagnosis is inexact and there is no proven medication or treatment. There is even disagreement on cognitive rest versus controlled brain stimulation after concussion. Players are wrong for not taking care of their own. In the much publicized Case Keenum incident, watching the film shows two of his offensive lineman clearly see their QB stagger and fall down as they try to help him up, yet neither directs him to the sideline or calls for medical attention. Coaches are wrong for downplaying concussions as mild or blaming the media. The “back when I played” philosophy just doesn’t work. Media is wrong for feeding the hysteria. Labeling members of the Head, Neck and Spine Committee as “NFL” doctors is an exaggeration. They should always point out most are tenured professors at prestigious universities that receive no pay from the league for their committee service. Also the media mantra of “a concussion is a concussion” is a disservice as medicine will indeed categorize severity and type one day. We need answers, not politics or self-serving stances. Let’s all work to a concussion solution and not worry about who gets the blame or the credit. MMMD 1: CTE happens outside of football This is not a political item. This is stating fact about an issue that is very personal to me. BMX legend Dave Mirra died four months ago and has been independently diagnosed by multiple centers to have CTE, the first action sports athlete to have the confirmed diagnosis. Clearly CTE is a societal problem that extends beyond football. It is an issue that affects me deeply as Dave is the fourth former professional athlete friend to have committed suicide. I attended and spoke at his celebration of life and hope to never have to do that again for anyone else. MMMD 2: Aqib Talib shot While details are still sketchy about the circumstances of the Dallas nightclub shooting, the medical information is clear that the Broncos cornerback will make a full recovery. The gunshot wound did not damage any major arteries (presumably no nerves) or ligaments. However, it was significant enough to warrant an overnight stay at the hospital but no surgery was required. Do not expect Talib to participate in minicamp or the rest of the offseason program, but he should be good to go for the start of training camp. How do clubs get their medical information so quickly when it is not even known how he was shot? The team medical staff is usually asked to get involved early and speak to treating physicians. During my 17-year Charger career, I was asked to immediately intervene and obtain medical information on two shootings of players, Terrence Kiel and Steve Foley. This is just one of many circumstances where the team physician’s job is not what the public thinks it is. MMMD 3: First round rookie injury ups and downs Jalen Ramsey received double good news. His meniscus tear did not require a repair with longer recovery and was not related to his previous reported microfracture surgery. Josh Doctson has an Achilles issue and minor foot injury and will be held out of practice for now. Hopefully this is all precautionary for the Redskins. Technically, Dante Fowler, Jr. (ACL), Kevin White (tibial stress fracture) and Breshad Perriman (PCL) are not rookies but all three missed their inaugural season. These three first round “rookies” are all on track to make a strong 2016 debut. MMMD 4: Offseason injury survival All 32 teams have injuries already. In my experience, half of teams will have a significant loss that affects the season. This offseason is not proving to be any different. Titans OL Byron Bell (ankle fracture/dislocation), Lions TE Tim Wright (ACL), Ravens CB Jumal Rolle (Achilles) and Jaguars DE Jonathon Woodward (Achilles) are among the few that are out for the season. Bengals TE Tyler Eifert (ankle), Bills DE Shaq Lawson (shoulder) and Cowboys DT Maliek Collins (fifth metatarsal) and among the many that have had surgery that could effect the upcoming season. Despite the current CBA with limited offseason work, the injuries will continue to pile up this summer. MMMD 5: Happy National Cancer Survivor Day Certainly Eric Berry and his family celebrated the occasion this Sunday. The Chiefs safety beat Hodgkin’s lymphoma and has returned to play football. Another less famous NFL player, David Quessenberry, has not been so lucky yet. The Texans offensive tackle has battled non-Hodgkin’s lymphoma since 2014. He was declared in remission last year and had regained the 30 pounds he lost. This week he was placed on the non-football injury list (NFI) and will not play this season. He missed the last two season to cancer and now will miss a third. If he returns, it would be unprecedented, as he will have missed four NFL seasons (first one due to ankle injury). The bigger hope is the NFI status doesn’t mean there is recurrence of cancer. MMMD 6: Stolen laptop is a big deal We are not talking team espionage here. This is not Spygate, but it is a much bigger deal. The theft of a Redskins athletic trainer’s laptop occurred during Combine medical rechecks. This surely meant that the medical records of over 300 potential draft picks were exposed. Also potentially at risk were previous Combine and team medical records as well as potentially thousands of NFL players as the league has moved to electronic medical records. The good news is that there is no indication that any medical records were accessed. The bad news is the laptop was password protected but not encrypted as required by federal HIPAA law. The Redskins could face significant fines and punishment. There is also a requirement to notify all players whose records were potentially compromised. I am sure the league has circulated a memo reminding all clubs that encryption is mandatory to avoid the risk of hefty federal fines. MMMD 7: ProFootballDoc scorecard When news of Jalen Ramsey’s meniscus tear broke, I surmised that the procedure would be a simple menisectomy (trimming) and not a repair that affects his coming season. This opinion was not based on video (as there was none), but simply my orthopedic and NFL team physician background of knowing common injury patterns. Fortunately for the Jaguars, the simpler arthroscopic surgery will have Ramsey back well before training camp. The better long-term news is the meniscus tear was in a different area of the knee than the previous high school surgery, meaning there shouldn’t be recurring problems. This takes the previous 2016 6-0 record to 7-0.