Latest / Broken Brains with Bruce Parkman / Dr. Julie Stamm: The Hidden Dangers of repetitive Head trauma.

Transcript

Dr. Julie Stamm: The Hidden Dangers of repetitive Head trauma. · Broken Brains with Bruce Parkman

• 0:11
  Speaker 1: Folks, welcome to another edition of Broken Brains with Bruce Parkman.
• 0:15
  Speaker 1: I'm your host, of course, bruce Parkman, sponsored by the Mack Parkman Foundation, and as we continue to dive into the subject of repeated head impacts, the impacts on brains of our kids, of our athletes and our veterans, we keep bringing the best possible folks in the country to come and speak on these issues Researchers, veterans, leaders, politicians.
• 0:39
  Speaker 1: And today we've got another amazing guest who's been on our last podcast back in the day, dr Julie Stamm.
• 0:46
  Speaker 1: Dr Julie Stamm, welcome today.
• 0:49
  Speaker 1: How are you doing, ma'am?
• 0:50
  Speaker 2: I'm great.
• 0:51
  Speaker 2: Thank you for having me.
• 0:52
  Speaker 1: I do love it.
• 0:53
  Speaker 1: A little introduction here, of course, man.
• 0:54
  Speaker 1: I've known Julie for a while, ever since we wrote our book.
• 1:00
  Speaker 1: She is the author of the book the Brain on Youth Sports right here Very good reading.
• 1:06
  Speaker 1: If you're a parent, anybody out there I highly recommend you get that book.
• 1:11
  Speaker 1: She's a three-sport athlete and she studied under the renowned Dr Stern covering the subjects of repeated head impacts, where she got interested in the subject due to her past as a student athlete.
• 1:25
  Speaker 1: She's published quite a number of papers, she's spoken at conferences around this country and I've actually listened to some of her podcasts other podcasts that she's come on.
• 1:34
  Speaker 1: She has a doctorate in anatomy and neurobiology from the BU School of Medicine and she's a proud alumna of the athletic training education program at the University of Wisconsin-Madison and I think you're still teaching it, correct?
• 1:46
  Speaker 1: Yes, sam, yep, absolutely so.
• 1:48
  Speaker 1: Anyways, we really welcome you to the show and uh and thank you for coming on.
• 1:53
  Speaker 1: So, uh, yeah, so I guess it's been a couple of months since the conference, since we saw each other last.
• 1:58
  Speaker 1: Uh moving to DC this year, we're already making plans and uh hope that you can attend and we'll we'll dive into a little bit of what you have going on towards the end of the podcast, but you know we we talk about RHI.
• 2:12
  Speaker 1: I mean you've studied under Bob Stern and and and and your in your opinion, julie, why is RHI just so unrecognized, so unknown?
• 2:21
  Speaker 1: And and in your words, you know how important is this for parents and athletes to understand.
• 2:28
  Speaker 2: Yeah, I think you know.
• 2:29
  Speaker 2: Even looking at concussions, for years, for decades, we used to think that if you didn't lose consciousness, it didn't matter, it wasn't a big injury, or if you didn't have really significant symptoms, it wasn't a problem.
• 2:44
  Speaker 2: Really significant symptoms it wasn't a problem.
• 2:45
  Speaker 2: So now we know that these impacts, even if you don't have concussion symptoms, affect the brain.
• 2:55
  Speaker 2: For a while, after we learned that any concussion symptoms matter, now we know that these impacts without symptoms matter too.
• 3:05
  Speaker 2: When I first started talking about this, I had a few studies that would pop up on a slide and now there are just countless studies that show all sorts of changes in the brain, from differences in connections in the brain changes to connections in the brain.
• 3:18
  Speaker 2: Chemical levels in the brain change Functionally.
• 3:23
  Speaker 2: Sometimes we don't see those changes right away because we're really good at compensating, but those underlying structures in the brain and chemicals in the brain are changing and that over time builds up.
• 3:36
  Speaker 2: We also know that to get a disease like CTE you don't have to have a history of concussions.
• 3:42
  Speaker 2: These repetitive impacts are what has been associated with the development of CTE and severity of CTE, not the number of concussions you've had.
• 3:51
  Speaker 2: So I think parents need to understand that, while concussions are very important to recognize and manage, they're very important injuries that we need to take seriously.
• 4:01
  Speaker 2: We also need to take these repetitive impacts seriously and minimize them as much as possible.
• 4:09
  Speaker 1: And how long do you think it's been since our repeated or repetitive impacts has been?
• 4:14
  Speaker 1: We have been aware of this.
• 4:15
  Speaker 1: I mean, when did you study under Dr Stern?
• 4:18
  Speaker 2: I was there from 2010 to 2015.
• 4:21
  Speaker 2: And we really were just starting to understand that it was these repetitive impacts.
• 4:26
  Speaker 2: At the time, the research was still and it's still really in its infancy, but the research really hadn't shown that it was the repetitive impacts in particular.
• 4:38
  Speaker 2: Even at that time we had an idea, but we didn't know necessarily yet that we didn't have the good data yet to show that the repetitive impacts were what really mattered.
• 4:48
  Speaker 2: So it's, you know, really, in the past decade or so, I'd say it's the data has grown to show that this is really a problem.
• 4:58
  Speaker 1: And it is a problem.
• 4:59
  Speaker 1: I mean, I think we can both say, having both authored books on the subject, that this is a problem.
• 5:05
  Speaker 1: And yet you know you're saying that research is in its infancy age.
• 5:10
  Speaker 1: Why does it take so long for the urgency to settle in?
• 5:16
  Speaker 2: Yeah, you know, I think when we look at something like Alzheimer's disease, it's been studied for many, many, many decades and we still can't technically diagnose it with certainty during life, right.
• 5:28
  Speaker 2: So I think, you know, research is slow.
• 5:31
  Speaker 2: I think we have a lot of evidence now to suggest that this is a problem.
• 5:35
  Speaker 2: But you know, research is just slow when it comes to really having more definitive I want to say proof.
• 5:43
  Speaker 2: But definitive proof is almost impossible to come by in a scientific level.
• 5:48
  Speaker 2: It just takes a lot of time to do these studies and really know for sure.
• 5:53
  Speaker 2: And 10 years, while it seems like a long time on a research level, it's really actually not that much time.
• 5:59
  Speaker 2: And then the buy-in from the community also takes a lot of time, right.
• 6:03
  Speaker 2: So once we find this out, we have to get that information out there, which is part of what you're doing here with this podcast and all the great work that you do.
• 6:11
  Speaker 2: It just takes time, and there's also just such a culture within a lot of sports that, well, I played and I'm fine, are you Is a good question.
• 6:21
  Speaker 2: You know, maybe is that short views, or you know other things that we call personality flaws.
• 6:27
  Speaker 2: Is that actually from these repetitive impacts.
• 6:30
  Speaker 2: You know we can't say for sure, but I think that's always a question that I wonder about and I think you know it just takes a lot of time for a culture that is so used to the violence of some sports to really buy into the fact that this probably isn't good and we need to make some changes.
• 6:50
  Speaker 1: And I think we are seeing that, you know, from generation to generation.
• 6:54
  Speaker 1: I think we see a lack of interest in some of these more violent sports.
• 6:58
  Speaker 1: I mean, I'm aware that you know the younger generation now football is like.
• 7:02
  Speaker 1: Of course they want to make all the old people mad by saying I don't like football or whatever.
• 7:07
  Speaker 1: But I think as we talk to you, know people, as I talk to people, the younger they are, the more aware they seem to be that this is an issue and they are willing to look at how they're going to allow their kids to participate in that, allow their kids to participate in that.
• 7:25
  Speaker 1: And from your perspective I mean you are one of the few researchers that has really come out, you know and spoken on the subject, and I think that is I think personally, that might be part of the problem is the research community is so focused on research and they find these amazing problems and they get this.
• 7:41
  Speaker 1: I mean the research papers I've read are just oh my God, everybody should know this and that.
• 7:44
  Speaker 1: You know, how do we get researchers you know with with the microphone as well, like yourself?
• 7:50
  Speaker 1: I mean, how do we get more Julie Stams out there saying we have a problem and we have to make change, because we're hurting our kids, we're not identifying adults that have problems, so so yeah, I think it's.
• 8:02
  Speaker 2: It's tough in the research community at times because we're kind of taught as we come up to focus on science and just do the science and let the science speak for itself.
• 8:13
  Speaker 2: But I think that we need to do a better job, across many different parts of science, of being science communicators and talking about what that research means, but doing it also in a way that is common sense.
• 8:28
  Speaker 2: You know, I think that for me, the research is supporting common sense.
• 8:34
  Speaker 2: It doesn't make sense to hit your head repeatedly.
• 8:36
  Speaker 2: You'd be concerned if someone was doing that.
• 8:39
  Speaker 2: You know, hitting your head against a wall why is it okay on a football field or a rugby pitch or a soccer field or soccer pitch?
• 8:46
  Speaker 2: You know, I think it's just that cultural piece.
• 8:49
  Speaker 2: And I think that you know there are some big entities like the NFL, for example, that it can be intimidating to speak out.
• 8:59
  Speaker 2: And then you know they obviously have a lot of money going towards these sports.
• 9:02
  Speaker 2: And you know they obviously have a lot of money going towards these sports.
• 9:07
  Speaker 2: But I think that we also as researchers, there's kind of this spectrum of this study showed this.
• 9:13
  Speaker 2: We should really do, you know, make this change, and then these studies show this, but we don't have definitive proof.
• 9:18
  Speaker 2: But, as I said earlier, definitive proof is really hard to come by in science.
• 9:21
  Speaker 2: It's almost non-existent to have 100% proof.
• 9:24
  Speaker 2: You know it takes a lot to get there.
• 9:29
  Speaker 2: So we have to act with what we know now, in the situation that we're in, knowing that science evolves.
• 9:35
  Speaker 2: For example, we used to say if you have a concussion you should be in a dark room and no activity, mental or physical activity, let the symptoms resolve.
• 9:43
  Speaker 2: And now we know that actually impairs recovery.
• 9:46
  Speaker 2: We know that increased blood flow to the brain is good for recovery.
• 9:48
  Speaker 2: It made sense to say if something makes symptoms worse, then don't do it.
• 9:54
  Speaker 2: But now we know it's okay if it gets a little bit worse.
• 9:56
  Speaker 2: And that's just one example of science evolving and we were doing the best we could with what we had at that time.
• 10:04
  Speaker 2: And I think we need to do that with more things like the precautionary principle in public health says you do the best you can with caution.
• 10:11
  Speaker 2: So we're not harming someone by saying you can play football but flag and don't hit.
• 10:17
  Speaker 2: Yet you know, but that's not harming someone.
• 10:19
  Speaker 2: But it could be harming someone to say you know, take all these tackles because we don't know everything, we know nothing.
• 10:26
  Speaker 2: So I think we need to get a little bit further from this.
• 10:29
  Speaker 2: We don't know everything we don't, so we know nothing, idea and do what we can to educate with the knowledge that there's so much more we have to learn could even take that a step further to your point.
• 10:47
  Speaker 1: You know we're not harming anybody, but maybe the one tenth of one percent that might make it to the nfl if we say don't play contact sports.
• 10:51
  Speaker 1: But this is not about playing, not playing contact sports, it's about playing safe and making these sports safe.
• 10:57
  Speaker 1: Uh, you know our our positions, that we think that, with the science, contact sports should be basically an adult sport.
• 11:04
  Speaker 1: I mean, you're an adult, you are informed, which is that, with the science, contact sports should be basically an adult sport.
• 11:06
  Speaker 1: I mean, you're an adult, you are informed, which is that's the other problem.
• 11:09
  Speaker 1: We have no informed consent, and I'll ask you about that in a second.
• 11:13
  Speaker 1: But you know you can make a decision to hurt yourself.
• 11:16
  Speaker 1: I mean, where would you sit on the threshold of?
• 11:19
  Speaker 1: You know, do we?
• 11:20
  Speaker 1: You know contact sports till 14?
• 11:22
  Speaker 1: You know we're never going to get contact sports out of high school.
• 11:25
  Speaker 1: You know what is the compromise, the area that you would, as a researcher, kind of advocate for out there, when it comes to parents, you know, allowing their children to play these types of sports.
• 11:36
  Speaker 2: Yeah, I would say no contact prior to high school.
• 11:40
  Speaker 2: You know, I think there has to be a reasonable compromise and, like you said, we're never going to get it out of high school.
• 11:46
  Speaker 2: But no contact prior to high school and then, when they're in high school, minimizing as much as possible.
• 11:53
  Speaker 2: So in high school, yeah, don't tackle in practice.
• 11:57
  Speaker 2: There have been several schools, many schools around the country who have won state championships and they don't tackle in practice except if at all.
• 12:05
  Speaker 2: You know they might practice, tackle and practice.
• 12:08
  Speaker 2: You know a couple of days of preseason camp and that's it, or they're, they're just tackling and tackling dummies.
• 12:13
  Speaker 2: They don't take each other to the ground.
• 12:15
  Speaker 2: You can be a great team and not not do that or not head the ball, or you know there's not checking in hockey, right.
• 12:23
  Speaker 2: So we can delay these, these aspects of these contact sports or the sports that involve a lot of repetitive brain trauma, and still learn the game, learn important aspects of the game.
• 12:34
  Speaker 2: There just might be these pieces that are missing until they get a little bit older, and there's no evidence whatsoever support the idea that you have to tackle young or or check young or head the ball young to be a professional athlete and have success.
• 12:47
  Speaker 2: There are many who didn't.
• 12:49
  Speaker 2: Tom brady chris forland had a great uh rookie season in the nfl before he retired out of concern for brain trauma.
• 12:57
  Speaker 2: Michael strahan didn't play football until he was a senior in high school, you know.
• 13:03
  Speaker 2: So if you're a good athlete, you can pick up those skills later, develop your athleticism young and it might actually prolong your career if you don't hit when you're younger.
• 13:14
  Speaker 2: That's really what the data supports too.
• 13:17
  Speaker 2: We know that the risk of CTE is substantially higher the more years you play, and your risk is 10 times lower if you compared to others if you play four years or less of contact sports, especially if you minimize those impacts in those four years.
• 13:32
  Speaker 2: We also know that your brain needs time to develop, and while it's not done developing at 14, much development has been done by that point.
• 13:41
  Speaker 2: So it really seems like the best compromise, both in the data and the common sense and the timeline of progression through school, to just wait until high school that's right, I wrestled.
• 13:56
  Speaker 1: But I I've got plenty of friends that played ball in college and played, you know, you know, semi-pro, or played all army rugby, whatever, and they're they're doing okay now that we're in our 50s and 60s.
• 14:06
  Speaker 1: You know, some of us are having problems, but I I think you're on to something here, and this is what we've been pushing for is, I mean, if we eliminated the, just the exposure in practice, we could get rid of probably 60 to 80 percent of the aggregate exposure that a child would take and allow them to play the games and then have a successful post career.
• 14:28
  Speaker 1: Because that's and I think that's that's key is that the sport can be played safer.
• 14:34
  Speaker 1: I'm talking to an NFL veteran who's at our panel, who's just took over high school football team.
• 14:40
  Speaker 1: We're going to sponsor his team as long as he doesn't have contact drills in practice.
• 14:44
  Speaker 1: So we're, you know, we're trying to push on that button right now because we have to compromise.
• 14:52
  Speaker 1: I mean there are people out there that want contact sports to completely go away and that will never happen and even banning them we've seen what banning did in California.
• 15:02
  Speaker 1: I testified out there on at least waiting until 14 and eliminating exposure.
• 15:08
  Speaker 1: What's your, you know and of course, you know I've got the experience with my boy.
• 15:12
  Speaker 1: You know, and eliminating exposure is one thing, but it's also the amount of sports you play.
• 15:18
  Speaker 1: You know you can play and and and.
• 15:18
  Speaker 1: Eliminate exposures one thing, but it's also the amount of sports you play.
• 15:19
  Speaker 1: You know you can play football year round.
• 15:21
  Speaker 1: Now I mean you can play.
• 15:22
  Speaker 1: You know you can play like my son was a back-to-back contact sport.
• 15:25
  Speaker 1: Nobody ever said you really shouldn't play back-to-back contact sports for months, and I think this is another aspect of RHI.
• 15:33
  Speaker 1: So, um, you know what is you know, when you, when we start talking about the aspects of RHI, there's how much exposure you get playing one sport.
• 15:41
  Speaker 1: But when you start talking about kids playing multiple contact sports, you know, and eating up large chunks a year, what would you say to parents that are considering allowing their kids to do that?
• 15:53
  Speaker 2: I would say proceed with caution and really think about the amount of cumulative impacts that they're sustaining.
• 16:00
  Speaker 2: It's possible that if they're not tackling in practice and they're going out and the number of games are limited, maybe it's not a large enough cumulative amount that they're going to have difficulty.
• 16:18
  Speaker 2: Maybe if there's enough time between games or between seasons, giving a little bit of time off between seasons too, maybe the total cumulative amount isn't as much.
• 16:28
  Speaker 2: But really proceed with caution and, if possible, look at other avenues or other sports.
• 16:34
  Speaker 2: You know you can play football and hockey and you know soccer, depending on where you are and when the soccer season falls spring or fall.
• 16:45
  Speaker 2: You know rugby being another one.
• 16:48
  Speaker 2: So I think really thinking about it in the cumulative sense is really important.
• 16:53
  Speaker 2: You only get one brain.
• 16:55
  Speaker 2: You need to protect it important.
• 17:00
  Speaker 1: Uh, you only get one brain.
• 17:01
  Speaker 1: You need to protect it.
• 17:03
  Speaker 1: So I mean, let's talk about that.
• 17:03
  Speaker 1: I mean, you are a brain scientist.
• 17:04
  Speaker 1: So to a parent now you're talking to a dad here and a rugby player I've had multiple losses of consciousness on the field.
• 17:10
  Speaker 1: Um, you know I, you know I've had a lot of trauma from explosions and being shot and stuff like that.
• 17:17
  Speaker 1: How do we, you know, how do we, you know, explain to parents how important the brain is?
• 17:30
  Speaker 1: Because we focus on the skull and we put helmets on it and we think everything's good.
• 17:33
  Speaker 1: But I just don't think parents understand how vulnerable our brains are because it's inside here.
• 17:39
  Speaker 1: What do you?
• 17:40
  Speaker 1: What do you?
• 17:40
  Speaker 1: How would you tell a parent, you know, just to, just to get them to the?
• 17:43
  Speaker 2: you know, dude, you only got one of these things and you just said yeah, one thing I think people don't know is that we are born with pretty much all of the neurons and the nerve cells in the brain that we will have in our entire life, right?
• 18:00
  Speaker 2: So we have maybe a little bit of development of new brain cells later in life, but it's very, very, very limited.
• 18:08
  Speaker 2: We're pretty much born with what we get.
• 18:10
  Speaker 2: So if we lose those brain cells, that's it.
• 18:13
  Speaker 2: Now we have a lot and a great ability to compensate, but we can't make new ones, even in childhood development.
• 18:22
  Speaker 2: What we're doing in development is we're making many, many new connections and laying down myelin, which is this insulating layer around the connections or the axons in the brain that helps signals travel faster.
• 18:35
  Speaker 2: It's very important for normal processing in the brain.
• 18:39
  Speaker 2: So we're doing these other changes, which also are really important and are vulnerable potentially with these repetitive impacts.
• 18:48
  Speaker 2: We know that other environmental factors affect the brain, like lead poisoning.
• 18:53
  Speaker 2: We know that emotional trauma, adversity, can affect the brain.
• 18:58
  Speaker 2: There are many other things that can affect the brain.
• 19:00
  Speaker 2: Why would we think repetitively hitting our heads would be different, right, we shouldn't really think that.
• 19:06
  Speaker 2: So we need to also consider the fact that the developing brain is more vulnerable because we don't have as much myelin which protects the axons, we might disrupt the process of laying some of that down.
• 19:19
  Speaker 2: We're making all these connections and then pruning some of them in order to make our connections more efficient, and all of that can be disrupted, potentially by repetitive impacts, like with other environmental factors.
• 19:34
  Speaker 2: So we need to consider that these processes need time to happen and happen in the way that we want them to as well.
• 19:42
  Speaker 2: So the brain we only get one.
• 19:44
  Speaker 2: We're born with all of those neurons.
• 19:46
  Speaker 2: If we lose them, that's it, and we need to build as many connections as possible and build that reserve and give ourselves the best potential for lifelong brain health.
• 20:01
  Speaker 1: And that's you know.
• 20:01
  Speaker 1: Every parent should know this and we don't.
• 20:04
  Speaker 1: I mean, it's just, you know, for some reason we have been I've heard and used the term groomed before Like we've been groomed by sports society.
• 20:15
  Speaker 1: You know, our parents that you know, know sports are safe.
• 20:18
  Speaker 1: You know, you know this is the way it's always been done and I think it's going.
• 20:22
  Speaker 1: I think understanding how vulnerable the brain is is going to go very far for any new parent to go.
• 20:27
  Speaker 1: Ah, I don't think so.
• 20:30
  Speaker 1: And and uh, you know and that brings me to the other point, and you mentioned on this earlier.
• 20:34
  Speaker 1: So you know, michael stran not start starting till he was 16.
• 20:37
  Speaker 1: We talked to a mom the other day who knew of an NFL player whose wife said I don't care, 16 is when you're starting.
• 20:44
  Speaker 1: Both those kids got the vision right.
• 20:46
  Speaker 1: I am of the opinion that and you're an athlete, I'm an athlete I'm of the opinion that if you're going to go and be in the Olympics, if you're going to be in the NFL, if you're going to be in the NFL, if you're going to be on NHL or the women's soccer team in America, you cannot hide that skill.
• 21:06
  Speaker 1: That skill is something that God gave you, it's innate, it's native to you, and then by starting earlier, you actually go a long way to reducing your chances of being that professional athlete that you could have been by exposing both your brain and body to you know, to trauma.
• 21:20
  Speaker 2: Yes, couldn't agree more yeah.
• 21:22
  Speaker 1: It's, yeah, and it's, and it's, you know it's.
• 21:25
  Speaker 1: It's all about grabbing the microphone and getting out there.
• 21:28
  Speaker 1: Now you've studied under.
• 21:31
  Speaker 1: You know Bob Stern again, who came up and was very, very critical with the, the diagnosis of traumatic encephalopathy syndrome, and I don't know if you participated in the NINDS study.
• 21:43
  Speaker 1: That was done a couple of years ago.
• 21:46
  Speaker 1: Were you part of that?
• 21:47
  Speaker 2: I participated in the early versions of that, so the early detect study with the first round of NFL players that we brought in and helped write the grant for the later ones, but then I was not there anymore.
• 22:02
  Speaker 1: Okay, well, I mean we're moving a little bit from the kids now to mature adults like us who have played back in the day.
• 22:08
  Speaker 1: You know what described to us, what TES is means to, to means to the audience, because I think a lot of folks are looking for answers.
• 22:19
  Speaker 1: I played a lot of contact sports, like a lot, and I was in the army or whatever, and now I'm depressed, I'm impulsive, I'm hostile, I'm having these mood issues and so on and so forth.
• 22:36
  Speaker 1: How would I know that?
• 22:39
  Speaker 1: What is this condition and what would I be looking for?
• 22:43
  Speaker 2: Yeah, so when we are trying to describe a new disease, it's really complicated, more complicated than we would think.
• 22:52
  Speaker 2: So chronic traumatic encephalopathy is the disease that we can see in the brain.
• 22:58
  Speaker 2: It is this buildup of this tau protein that is misfolded and toxic and it's this disease that we can look at the brain after someone passes away and we can see it there.
• 23:11
  Speaker 2: But we can't 100% for sure at this point say that the symptoms that we're seeing during life are CTE or are caused by what we're seeing in the brain, because we don't have the ability to see CTE during life.
• 23:26
  Speaker 2: We can't follow the progression and watch the disease progress alongside the symptoms and say for sure that that's what we're seeing seeing.
• 23:40
  Speaker 2: So the best we can do is talk to the families, in some cases study the individuals before they pass away which is happening now, but of course we want them to live as long as possible and then try to describe what we're seeing during life and compare that to what we see after they pass away.
• 23:53
  Speaker 2: But even that is not perfect.
• 23:56
  Speaker 2: And so TES, this traumatic encephalopathy syndrome, is this collection of symptoms that we think is related to CTE.
• 24:04
  Speaker 2: That, we think, is what the pathology of CTE is causing during life, causing us to see, we just can't say for sure yet, even though we have a pretty good idea.
• 24:14
  Speaker 2: We just can't say for sure 100% at a scientific level yet they are the same.
• 24:19
  Speaker 2: And I think it's complicated by the fact that this repetitive brain trauma, concussions can cause a lot of symptoms that might not be CTE.
• 24:28
  Speaker 2: So a lot of mental health psychiatric conditions have been linked now to repetitive brain trauma and concussions and that could be completely separate from CTE, and that's still a problem.
• 24:41
  Speaker 2: Cte or not, it doesn't matter, it is still an outcome that we need to do something about.
• 24:48
  Speaker 2: Even prolonged post-concussion symptoms can sometimes be hard to tease out from the CTE disease versus is it just the not just, but is it the lingering symptoms from the concussion?
• 25:01
  Speaker 2: So that's what makes it really complicated now to say for sure is this CTE and is this the TES that we think is the symptom during life of CTE or is it not?
• 25:13
  Speaker 2: And for that reason too, I think it's really important for anybody who's concerned that they have these symptoms and they have this history of contact sports or brain trauma from whatever the source may be, to reach out to foundations and talk to their health care provider, because you can treat things like depression and anxiety and, you know, I think it doesn't necessarily mean it is CTE.
• 25:36
  Speaker 2: It could be related to the brain trauma and not be CTE and there are also, you know, many causes of, you know, depression and some psychiatric conditions that might be exacerbated by the brain trauma.
• 25:50
  Speaker 2: But I think it's important to keep that in mind, that you know there are ways to treat these symptoms, that there are ways to treat these symptoms.
• 25:59
  Speaker 2: We need to do a better job of finding more ways to treat these symptoms and we need to find a way to see CT during life so that we can find ways to treat CT itself.
• 26:03
  Speaker 2: But it is really a complicated symptomatic profile because of the fact that there are so many different potential poor outcomes that could come from these repetitive impacts.
• 26:16
  Speaker 1: No, that's an excellent description.
• 26:18
  Speaker 1: Thank you for that, because you know we've been looking at the research and you know, right now, in the gap where we have no way of identifying CTE, you know it is a.
• 26:32
  Speaker 1: You know it's always, like we talked about earlier, with kids it's all about caution, all right, if you do have these issues, at least be aware that the possibility of repetitive head impacts could have something to do with it.
• 26:45
  Speaker 1: And then when we start looking at diagnosis we're now aware of you know there's several scans, you know, that have come out in the last two to three years DTI scans, functional MRIs, qegs that, can you know, highlight, have come out in the last two to three years.
• 27:00
  Speaker 1: Dti scans, functional MRIs, qegs that, can you know, highlight differences and changes to the brain.
• 27:06
  Speaker 1: Um, is that something that you know?
• 27:07
  Speaker 1: Parents should, or or individuals, you know, usually older guys or kids um could take a look at.
• 27:11
  Speaker 1: That would at least give them an idea that they might be having some impacts in the brain and then they can, you know, move on to at least trying to treat the brain, you know, from a physiological perspective.
• 27:26
  Speaker 2: I wish I had more to say in that, more or better to say that, but right now we're just not quite there.
• 27:32
  Speaker 2: What we could see potentially is if you did a structural scan, you know, went into the clinic and did a structural scan and saw you and saw differences in the size of different structures in the brain, that might give an idea of what's going on, but it's not specific to CTE, because we see loss of neurons and atrophy in the brain from Alzheimer's disease and other diseases too.
• 27:53
  Speaker 2: There's a lot of promise, though.
• 27:56
  Speaker 2: Dti is looking at those white matter pathways in the brain.
• 28:00
  Speaker 2: The problem is that the numbers are so, so small that you really need kind of a pre-scan and then a follow-up scan to see how your brain is changing, because when you try to compare it to another person or a normative data set, your baseline may be different, and it's such a small number that it's really hard to say for sure if that's what might look normal is actually not normal for you, and so that's a hard one that I think there's a lot of potential there.
• 28:31
  Speaker 2: We just need a little bit more time.
• 28:33
  Speaker 2: I think the most promising thing is the PET scans.
• 28:35
  Speaker 2: So these are scans where you inject a radioactive ligand that binds to the tau in the brain and then the tau lights up on the scan.
• 28:43
  Speaker 2: So in that case you can actually see the tau.
• 28:46
  Speaker 2: And then we could say, okay, you have this tau.
• 28:49
  Speaker 2: And let's say in the future, I know there are studies going on for medications that would get rid of the tau in the brain, this toxic version of the tau.
• 28:58
  Speaker 2: So if we could see the tau in the brain and say it's there, let's give you this medication and clear it, that would be amazing, right, that would potentially solve the problem and especially if we could see it early enough, that it's before someone has symptoms, which is really likely.
• 29:13
  Speaker 2: We're just not quite there yet because with these studies of the tau we have to be able to compare it to the brain after someone passes away and we're only maybe a decade into this research.
• 29:27
  Speaker 2: So it's going to be slow.
• 29:28
  Speaker 2: But I think there is a lot of promise with imaging.
• 29:31
  Speaker 2: I just don't know that we're quite there yet to make it as useful as we want it to be, which is really frustrating.
• 29:40
  Speaker 2: You know it's that's one of the hardest parts of this research is just that it's slow it definitely is.
• 29:47
  Speaker 1: I mean, it's um, unfortunately, now that we're aware of it.
• 29:49
  Speaker 1: That's why, you know, the urgency comes from foundations like ours, because we know we have a problem, we know that that problem is impacting children, which you know.
• 29:59
  Speaker 1: That was.
• 30:00
  Speaker 1: That's our heart, I mean, and you're a newborn mom, right?
• 30:03
  Speaker 1: Yeah?
• 30:04
  Speaker 2: Yeah, little boy.
• 30:09
  Speaker 1: I think it might be a way.
• 30:10
  Speaker 1: It might be a while if I'm not just guessing that he might be playing contacts for us.
• 30:15
  Speaker 1: I think he'll be waiting, yes.
• 30:17
  Speaker 2: Yes, absolutely Not before high school Good.
• 30:19
  Speaker 2: If he's built like my husband and I, he'll probably just be a volleyball player or something, because he's not.
• 30:26
  Speaker 1: you know, we're not particularly built people, but yeah, I wish my son would have played golf, but you know, but you know, it is all about, you know, understanding the potential, the impact that's had on to date.
• 30:41
  Speaker 1: I mean the billions of kids that have played sports.
• 30:43
  Speaker 1: We have an untrained, you know, coroner community, untrained psychiatric community.
• 30:49
  Speaker 1: I mean our nurses and doctors aren't even trained.
• 30:52
  Speaker 1: As a matter of fact, there was a recent study by the New Journal, new England Journal of Medicine.
• 30:56
  Speaker 1: They had a survey.
• 31:03
  Speaker 2: I think it was like 60% of doctors would recommend contact sports to a father, have you seen that?
• 31:05
  Speaker 1: I actually haven't seen that one, but oh my gosh, yeah, I mean.
• 31:07
  Speaker 1: So how do we fix that?
• 31:08
  Speaker 1: I mean, how do we fix the education?
• 31:09
  Speaker 1: We know we have a problem, we know that this is not good.
• 31:12
  Speaker 1: I mean, how do we even get basic doctors to sit there and go?
• 31:16
  Speaker 1: And we do know that these children, like my son, that have taken their lives have suffered, all of them from psychiatric illness.
• 31:24
  Speaker 1: I mean, that was the result of the study that we funded, that Dr McKee did last year.
• 31:28
  Speaker 1: Out of 162 brains under 30, 100% of them were structurally damaged and 100% of them had manifestation of psychological disorders.
• 31:38
  Speaker 1: So we know mental illness is kind of tied to a damaged brain.
• 31:42
  Speaker 1: And we have a kid that's been playing sports since six.
• 31:44
  Speaker 1: How do we educate nurses and doctors to say stop, stop.
• 31:48
  Speaker 1: You know Tommy needs to stop.
• 31:51
  Speaker 1: You know, I mean you know Susie needs to stop hitting soccer balls.
• 31:55
  Speaker 1: I mean, what are your recommendations, being a doctor, that we could start building that awareness within the community?
• 32:03
  Speaker 1: I know it's a big problem.
• 32:04
  Speaker 2: Yeah, I think we need to keep talking Things like this, this podcast and the work that you're doing and keep spreading the word.
• 32:13
  Speaker 2: It is hard as a practitioner there are a million things that you need to know a lot about, so I understand that it's hard to be up to date on everything.
• 32:23
  Speaker 2: But this is so important and this is something that we really just need to keep starting the word, keep doing continuing education, keep talking about it, keep reaching out to provider communities, whether that's locally, doing continuing education at your local clinics or hospitals, at, you know, state chapters of nursing societies or things like that.
• 32:45
  Speaker 2: And going bigger you know, out to you them.
• 32:48
  Speaker 2: Also played contact sports, right.
• 32:50
  Speaker 2: So it's still, even though they are talking about that, you can play sports.
• 32:54
  Speaker 2: We're just not going to hit until later.
• 32:56
  Speaker 2: I think you know when the conversation turns to.
• 32:59
  Speaker 2: We just need to get rid of these sports.
• 33:02
  Speaker 2: People shut off right, understandably.
• 33:04
  Speaker 2: So it's talking about how can we do this in the safest way possible while still allowing for physical education or physical activity, still allowing for the many, many, many many benefits of sports, but taking that one piece out to protect the brain and the body until they're a little bit older.
• 34:00
  Speaker 1: Like we got these doctors that run around with these NFL and USA rugby funded speeches.
• 34:07
  Speaker 1: I cornered one girl who got up there and said well, I've been told by rugby players that tackling and without if you don't tackle in rugby then it's not rugby.
• 34:16
  Speaker 1: If you don't tackle in rugby then it's not rugby.
• 34:17
  Speaker 1: And she was literally advocating for children, girls, because girls rugby is the fastest growing sport in Canada.
• 34:26
  Speaker 1: And now with this monster we had on the USA rugby team and I'm a rugby player and she's impressive Guess what's going to happen here.
• 34:32
  Speaker 1: But you know, and I cornered her after that.
• 34:35
  Speaker 1: I said how can you get up there and say that?
• 34:37
  Speaker 1: And of course you're sponsored USA rugby, nfl, you know nfl and they're out there spreading this disinformation that you know and of course they.
• 34:45
  Speaker 1: And then you do an amazing job in your presentation of tearing apart some of these studies and and and showing like what really you know.
• 34:53
  Speaker 1: You know how they get to these numbers and how they say because, from what I saw, most of studies they don't even consider mental illness as part of a symptom of contact sports.
• 35:03
  Speaker 1: They don't even bring it up.
• 35:05
  Speaker 2: Yeah, I think that's a really important thing.
• 35:07
  Speaker 2: That makes it really hard for parents and coaches and even the medical community who has.
• 35:13
  Speaker 2: You know, there are so many studies coming out it's hard to really dive in and look at the details of it and you know like some of these studies looking at it's hard to really dive in and look at the details of it.
• 35:23
  Speaker 2: And you know like some of these studies looking at you know we did our research on the age that you started playing contact sports and later life difficulties and we've seen differences.
• 35:29
  Speaker 2: You know, greater rates of depression and anxiety or apathy, excuse me and difficulties with higher cognitive thinking, things like that.
• 35:38
  Speaker 2: But you, but other groups haven't.
• 35:40
  Speaker 2: There was just a paper that came out that was solely dedicated to that.
• 35:44
  Speaker 2: There's no consequences of hitting your head when you're younger, based on a two-question survey of depression, and when you really dive in and realize that's what they're using.
• 35:55
  Speaker 2: Okay, so maybe you didn't find something, but it doesn't mean that it's not there.
• 35:59
  Speaker 2: You just need to use the right measures.
• 36:00
  Speaker 2: I've also seen studies where they either maybe just use the same age cutoff.
• 36:06
  Speaker 2: In our studies we used age 12 because it made sense with the development, brain development and what we're looking at, but it doesn't make sense for every function and every structure, because the brain develops at such different rates, different structures at different rates, and so you really have to be specific about how you're designing the study.
• 36:22
  Speaker 2: And so you know, maybe they didn't see it in that group, but they may not have been looking at it the right way and in many cases they haven't been.
• 36:29
  Speaker 2: So it's hard to do that when you don't know the nuance of that.
• 36:34
  Speaker 2: You know I study this and you know I'm in it all the time, but if you're not, it's really hard to know that, Even if you are a scientist, if you don't know brain development, it's hard to interpret.
• 36:43
  Speaker 2: So I think that's a really big problem.
• 36:48
  Speaker 2: And then there are the affiliations with many different leagues NFL, NHL, rugby, world rugby, Australian rules, football is seeing this in Australia Like there's it's all over FIFA.
• 37:06
  Speaker 2: So it is really important to have independent researchers looking at this data, the leagues to want the good research too.
• 37:17
  Speaker 2: Because if they are, you know if the nfl came out and said we don't want kids hitting until they're older so that they're healthier, and you know they're, you know, going to get into the game, they just need to be a little bit older.
• 37:31
  Speaker 2: I actually think the sport would grow when maybe that's what they're trying to do now with promoting more flag football you know the idea that you can become a fan of the game and still protect your brain when you're younger and then you can get into it when you're older.
• 37:47
  Speaker 2: I think they would get more participants that way and more people to enjoy the game that way, compared to now.
• 37:54
  Speaker 2: People are so concerned that they're walking away from the sport.
• 37:57
  Speaker 2: We've seen numbers drop a lot um, and so I think you know the denial isn't necessarily helpful for these sports.
• 38:06
  Speaker 1: It actually, I think, is hurting some of these leagues and some of these sports I, I absolutely agree and and and I've talked to nfl players, um talked to some pretty serious n executives and it's like this can save your sport.
• 38:21
  Speaker 1: Because if you look at what's going on in Europe right now with litigation I mean now the insurance companies, they're not paying the sport no more, they turned them off and that's I mean it's unfortunate that that denial is going to cause them a lot of financial pain, Because once these lawyers figure this out, no matter what the sport, it's going to be very painful and we could lose our sports or we're going to lose our professional organizations just because of the financial impact of litigation.
• 39:00
  Speaker 1: It's like cigarettes and cancer.
• 39:03
  Speaker 1: It's going to be like opioids and addiction.
• 39:07
  Speaker 1: It's going to be massive.
• 39:08
  Speaker 1: And I think they should take a proactive sport and if they did come up, just like you said, stop hitting until at least the age of 14, eliminate all contact in practice.
• 39:19
  Speaker 1: Save these kids so they can be adults, so they can play in college and get paid millions there.
• 39:24
  Speaker 1: I mean I don't even know why you want to go to pros, Make millions, get your degree and go get a job before you get your brain busted right and then come play for us, whatever, right.
• 39:33
  Speaker 1: I think all the leagues that are involved with this lacrosse a whole nine yards should be much more, and it's all about protecting our children.
• 39:42
  Speaker 1: So I think you're absolutely right and that's great.
• 39:50
  Speaker 1: Look towards the end of our podcast.
• 39:52
  Speaker 1: I always like to give our guests a chance to talk about what they got going on.
• 39:55
  Speaker 1: What's going on with Julie St stam right now?
• 39:59
  Speaker 1: What are you doing?
• 40:00
  Speaker 1: You got you I mean, it's uh, obviously your new mom, so I know you're very, very busy, yeah.
• 40:06
  Speaker 1: So, uh, what else is going on in your professional life that we should know about?
• 40:10
  Speaker 2: yeah, uh, being a new mom and, uh, I've had a.
• 40:13
  Speaker 2: It came off of leave right into a new course that I'm teaching, which has been a whole thing, so I've been a little busy, very busy with that, but continuing to do some work with, you know, have some papers in the works with rugby, major league rugby.
• 40:32
  Speaker 2: We have my hands in a lot of different pots right now.
• 40:38
  Speaker 2: We have my hands in a lot of different pots right now.
• 40:41
  Speaker 2: We have a college football study, have some work going on some high school concussion data, looking at access to health care providers at the high school level and how we can improve that so they can get the treatment that they need faster, because studies have shown that the sooner you get into that treatment, the better your outcomes.
• 41:06
  Speaker 2: So, yeah, a lot of things and a lot of different pots going on right now.
• 41:12
  Speaker 1: Good on you.
• 41:12
  Speaker 1: And we do know that.
• 41:13
  Speaker 1: You know female studies are incredibly I mean females in the population are incredibly underrepresented in any concussion studies out there, and I do know that in the Reap Headed Impact study.
• 41:25
  Speaker 1: I hope that's correct, that they do look at these female populations because they are.
• 41:29
  Speaker 1: You know, and you know there are studies indicating that.
• 41:33
  Speaker 1: You know young girls are more susceptible to the impacts of balls due to a longer neck-to-body ratio and weaker neck muscle structure.
• 41:41
  Speaker 1: So you know that's something that's hard.
• 41:45
  Speaker 1: It was great having you on the show.
• 41:48
  Speaker 1: I cannot thank you enough for coming on.
• 41:50
  Speaker 1: I hope to have you on again.
• 41:51
  Speaker 1: We're out there.
• 41:53
  Speaker 1: Danny's got us on all kinds of Spotify, youtube-y things, all kinds of stuff.
• 41:58
  Speaker 1: We'll definitely get that out there.
• 41:59
  Speaker 1: But really appreciate you coming on the show.
• 42:03
  Speaker 1: And, just as a parting shot once again, can you just explain to parents why they should be concerned about RHI?
• 42:10
  Speaker 1: Give them one last tidbit of information to think about when they think about their kid's place in sports.
• 42:19
  Speaker 2: Yeah, you only get one brain.
• 42:20
  Speaker 2: You're born with all the neurons you will have for the most part during your life and you need to protect it.
• 42:27
  Speaker 2: It's not just the hits that cause symptoms.
• 42:30
  Speaker 2: Those hits that don't cause symptoms change the brain and that adds up over time and increases your risk for a host of different problems like psychiatric issues, cte.
• 42:41
  Speaker 2: Protect the brain and you can have your sports and protect the brain at the same time.
• 42:48
  Speaker 2: We can do it.
• 42:50
  Speaker 1: Julie.
• 42:50
  Speaker 1: Thank you so much, folks.
• 42:52
  Speaker 1: Dr Julie Stamm again the author of your Brain on Contact Sports.
• 42:56
  Speaker 1: If you are a parent, you've got to read this book.
• 42:58
  Speaker 1: It's amazing.
• 42:59
  Speaker 2: Thank you so much for having me.
• 43:00
  Speaker 2: It's always a pleasure to talk with you you.