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Tragedies propel Iowa Athletic Trainer to take leading role in concussion research

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Research

Tragedies propel Iowa Athletic Trainer to take leading role in concussion research

Article reposted from The Des Moines Register
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Mike Hadden couldn’t comprehend what was happening to his beloved niece.

Alex Hermstad was 12 years old when she started experiencing weakness in her hand, leading to an alarming diagnosis — amyotrophic lateral sclerosis, commonly known as ALS, a disorder that typically doesn’t strike people until their mid-50s. Her identical twin sister, Jaci, had no such symptoms. On Valentine’s Day in 2011, Alex died at her Storm Lake home. She was 17.

Hadden, a scientist and a health care professional who is one of The Des Moines Register’s People to Watch in 2017, restlessly probed for an explanation. As director of athletic training at Simpson College, he was also troubled by seeing the damage young athletes were suffering from concussions. He searched for a link, theorizing there had to be something in the environment making young people more susceptible to such trauma.

He devoured some 15,000 scholarly articles, and took a sabbatical year from Simpson to conduct his own research.

Hadden returned to work only to confront another family’s grief over another incomprehensible death to someone far too young. Zac Easter was 24 years old when he took his own life Dec. 19, 2015, driven to despair after six diagnosed concussions left his brain ravaged by chronic traumatic encephalopathy, also known as CTE. Repeated concussive blows to the head have been shown to lead to CTE. Hadden had known the Easters for years, from the time Zac’s father, Myles, was the football coach at Simpson.

That was when Hadden — with assistance from Jill Wilson, who was the athletic trainer at Indianola High School when Easter played football there — embarked on a potentially game-changing research project on concussions from his modest office at Simpson College, a liberal  arts school in Indianola with fewer than 2,000 students.

‘Something’s going on’

Hadden immediately reached out to a family that wanted the same thing he did — for something positive to emerge from tragedy.

“I had experience with a severe loss like that, and I knew the terminology. I knew how to get things moving. I knew what had to be done. We made sure to save tissue from Zac in case we wanted to do further tests,” Hadden said.

“There’s obviously something going on. ALS in a 12-year-old? CTE in a 24-year-old? That kind of stuff doesn’t happen.”

Hadden sent tissue and fluids from Easter to Dr. Bennet Omalu in California. The forensic pathologist — famously played by Will Smith in the movie “Concussion” — confirmed that Easter suffered from CTE.

The Easter family enlisted Hadden’s help in establishing a nonprofit organization called CTE Hope. The goal is to fulfill Zac Easter’s dying wish of making football a safer sport and to establish a reliable return-to-play protocol for athletes who have been concussed.

MORE: Zac Easter’s battle with CTE

Hadden obtained saliva samples from three Simpson football players who suffered concussions, carefully storing the samples in minus-80 degree temperatures. Hadden and others hope that doctors and sports trainers worldwide will be able to use a simple test to determine when an athlete has a concussion and, more importantly, when it is safe for him or her to return to the sport.

All from a simple spit test.

“That’s our missing link in all of this. Because we can’t evaluate the brain like we can a knee, shoulder, ankle,” said Wilson, who is also an adjunct professor at Simpson. “It’s going to take the discussions out and the questions out from parents, coaches and athletic trainers. Because it’s not fun to be that person on the sideline to release them to play and every time they take a hit, you cringe, because you don’t know what’s going to happen.”

The spit test

It is estimated that 1.5 million athletes suffer concussions each year. But experts fear 60 percent of concussions — potentially an additional 2.5 million — go undiagnosed under the current protocols. Also of concern is that the current five-step protocol for allowing an athlete to return to his or her sport — the so-called Zurich guidelines developed in 2008 — is imperfect. Those guidelines call for the gradual increase of physical activity before a concussion-sufferer returns to play.

The idea for a solution came to Hadden last March, when he read an article by David Walt, a professor in the chemistry department at Tufts University in Boston. Walt’s group is at the forefront of efforts to diagnose illnesses from saliva rather than blood using a “single molecule analysis.”

Concussions have long been linked to a spike in certain protein levels in the brain. If those “biomarkers” can be detected through a patient’s saliva, in theory doctors and athletic trainers could keep collecting samples until they knew those proteins had returned to the normal range, taking the guesswork out of the diagnosis.

To start, Hadden collected saliva samples from 93 of Simpson’s 130 football players this fall, plus another dozen from women’s soccer competitors, all of whom volunteered to be part of the project. These were stored to establish a baseline of the protein levels that were present in the saliva of the healthy athletes.

The sports seasons unfolded with relatively few concussions — great news, Hadden is quick to point out — but he did diagnose three football players who suffered concussions at home games. The initial saliva sample needed to be gathered in the first 20 minutes after the injury, then stored at minus-80 degree temperatures while transported to the freezer being used by Hadden. He kept a cooler and a supply of dry ice in his office, to be prepared.

Hadden kept gathering saliva from the injured players — 24 hours out, again at three days, at one week and, ultimately, after they were pronounced symptom-free. All of the telltale spit will be shipped to Tufts this winter, when Walt and his crew have some room in their schedule of tens of thousands of analyses they conduct each year. Walt said the tests take about four hours, and he hopes to have results within two days. He’ll be looking for elevated protein levels and how quickly those moved back to the athlete’s “baseline” stage.

Hadden said two of the football players progressed normally from their concussions, but the third had a relapse. He is curious to see what the difference was in their saliva.

If successful, Hadden envisions a time when trainers like himself can diagnose concussions armed with not much more than a cotton swab.

Hadden hopes to be able to release the results to the medical community by the next CTE Hope fundraising gala on April 21 in Indianola. He’s also hopeful that his studies can be broadened to include other universities in Iowa, so that the sample sizes can be much larger going forward.

Providing ‘Hope’

It’s this kind of work that drew the Easter family to Hadden when they started the nonprofit. Brenda Easter — Zac’s mother — said Hadden provides the scientific mastery while she handles public relations for CTE Hope.

“I have all the confidence in Mike and the work that he has started. If the saliva testing isn’t the right method to evaluate a trauma to an athlete, then we go to blood or we go to urine. He’s going to pave the way. He’s that committed and he’s got that kind of energy,” Easter said.

“We do have a bond. He lost his niece to a horrible disease. And while they’re a little further ahead with ALS testing, CTE is in the same boat. Neither one has a whole lot of firm treatment programs or protocols to follow when people are diagnosed,” she said.

Now Hadden’s work with CTE Hope, a mission that arose out of the deaths of Alex Hermstad and Zac Easter, may put Hadden on a national stage. If so, it would be their legacy, not his, Hadden said.

But he’s already fulfilled Brenda Easter’s late son’s dying wish.

“If something like (CTE Hope) existed when my son started to have the symptoms, I would have just been so blessed to know that there is a place and they know how to treat it. Zac said to me more than once, ‘Mom, there is no hope for me.’ And he wasn’t wrong,” Brenda Easter said.

“This work was Zac’s wish. It’s not like you can buy a gift for him any longer, and so the only gift I can give him now is to carry out his wishes. And we’re so blessed to have someone as compassionate as Mike to lead the way.”

MIKE HADDEN

AGE: 50

LIVES: Indianola

EDUCATION: Bachelor’s in biology/physical education at Buena Vista, 1990; master’s in sports administration/biomechanics at Kansas, 1997.

CAREER: Director of athletic training and professor in department of Sports Science & Health Education since 1997; head athletic trainer at Mercy-Des Moines Sports Medicine and athletic trainer at Des Moines Roosevelt High School, 1991-97