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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

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Athletic Trainer Organizes CTE Forum, Recognizes Victim

Article reposted from The Des Moines Register
Author: Morgan Gstalter

Symptoms of CTE include memory loss, confusion, mood problems, anxiety, depression, dementia and aggression.

“The most important symptom is when they say, ‘I don’t feel right,'” Hadden said.

CTE can only be officially diagnosed during an autopsy, and there are few confirmed cases for researchers to study.

Easter suffered five concussions while playing football at Indianola High School. The pressure to do well in sports and be the football star was documented in his writings, titled “My Silent Struggle.” His mother read some excerpts from his journals written before his death, in which Easter documents his struggles with post-concussion syndrome and CTE, starting in his sixth-grade year.

“I would literally use my head as a battering ram because I loved being able to bring it ,” Easter wrote, saying that he would use his head to blow down other players on the field who were bigger than him.

Easter’s former athletic trainer at Indianola, Sue Wilson, said that was part of the problem —  that children playing tough contact sports at such a young age don’t know the fundamentals of the game.

“We have to teach them how to control their bodies,” Wilson said.

Easter suffered from chronic pounding headaches, shoulder and neck aches and arm spasms throughout high school. He wrote that he was scared to tell anyone, because he knew he wouldn’t be allowed to play. And football is what made him feel good.

It was Zac Easter’s last wish that his family spread the word about his “silent struggle”  with CTE.

Chronic traumatic encephalopathy, or CTE, is a progressive, degenerative brain disease in people who have suffered severe head trauma. Easter had suffered seven concussions over the course of his 24 years, most of them from playing high school football. All of them led to a life of pain, medical uncertainty and emotional inconsistency.

Easter died in December, and to help accomplish his goal, his family and friends, his former athletic trainer and a college professor hosted a forum for about 100  Sunday at Simpson College through their nonprofit CTE Hope.

“His last wish was for us to provide education and awareness to families, athletes, people with trauma, so they can have information, hope, awareness and a prevention plan to help make football safer,” said Brenda Easter, Zac’s mother. “But most importantly, to help prevent another family from going through the nightmare that we went through.”

Mike Hadden, a professor in Simpson’s department of sports science and health education, has been a certified athletic trainer for more than 25 years. There’s so much we don’t know about CTE, he said, which has degenerative patterns similar to Parkinson’s disease and amyotrophic lateral sclerosis, or ALS, which also is known as Lou Gehrig’s disease.

Eventually, he told his mother and he began a series of doctor visits that led to expensive testing and a range of unnecessary medications.

“Not one doctor asked me if I played football,” Easter wrote.

Easter began suffering from constant and severe headaches, slurred speech, blurred vision, loss of balance, brain tremors and dementia. He sunk into a deep depression, and while attending Grand View University, he abused alcohol and his Adderall prescription, which was given to him after a misdiagnosis  for attention deficit hyperactivity disorder, or ADHD. He ended his life in 2015 in order to donate his brain to medicine so he could “tell his story.”

“I know there’s a kid out there going through something similar,” Easter wrote. “I beg that you get help.”

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Simpson College Athletic Trainer Seeking Medical Breakthrough

For as many concussions that have been detected among student-athletes, many more go undiagnosed.

Either the athlete doesn’t disclose their symptoms, or coaches, trainers or parents don’t see them.

WATCH VIDEO HERE. 

But a solution may be on the way.

Allison Klapperich, a Saydel athletic trainer, needs to ask questions and look for symptoms of head trauma.

“Usually they’re pretty honest with me because their heads (are) hurting pretty bad,” she said.

But sometimes, Klapperich said, athletes want to get back in the game so much they don’t reveal everything.

One professor at Simpson College is hoping to be part of a medical breakthrough when it comes to detecting concussions.

Mike Hadden, an athletic trainer and professor of sports science at Simpson, wants to start clinical trials on an instant concussion test.

It takes a drop of the athlete’s blood. If it detects the proteins that release into the bloodstream after a concussion, it will come back positive within a minute, like a pregnancy or blood sugar test.

“Hopefully within two hours of this concussion, find the protein, take their blood, find the protein, study it and see if it can be a valid and reliable bio-marker for a concussion,” Hadden said.

Simpson has applied for grant money to start testing concussed athletes next year.
“Put some blood on here, then mix it with some fluid that will actually react with the protein,” Hadden said.

The Indianola College is just one of dozens of institutions around the country trying to find a way to make diagnosing concussions more clear-cut and conclusive.

“It’s a race. It’s an arms to race to see who can find the concussion sideline tests,” Hadden said.

“That would kind of take the guesswork out of if they’re not showing symptoms. Do they have a concussion or not? We’re going to see it in the next five minutes,” Klapperich said.

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