Monday, June 13, 2011

Day 12 - Major Presention and then to Northern Ireland

Presentation at Beaumont Hospital

I was invited to present to about 40 members of neurological faculty at Beaumont Hospital by Dr. Michael Farrell. Dr. Farrell is a neuropathologist who runs the Dublin Brain Bank out of Beaumont Hospital. It was a tremendous opportunity and a well-run morning chaired by Professor Tim Lynch. In the audience were the best experts of Ireland, including Professor Orla Hardiman, an international motor neuron disease expert, as well as Professor Jack Phillips, author of the Ireland national report on traumatic brain injury.

After my presentation, a team presented a case study of an Irish farmer who used to be a boxer and developed cognitive problems, paranoia, and motor issues beginning in his late 50’s. It was interesting – in the discussion of potential diagnoses, the doctors in the audience leaned on a probably diagnosis of Alzheimer’s disease. They interpreted the farmer’s cognitive test scores over time along with imaging of the brain as likely Alzheimer’s. To me, it illustrated the urgency for developing a clinical diagnostic test for CTE. The doctors couldn’t discuss CTE because they have no familiarity or training with CTE, so the discussed what they knew (which is of course what they should do in this teaching situation). Dr. Bob Stern will be launching a very interesting clinical research program soon, and I am hopeful we can eventually provide them with tools to discuss CTE this situation.

Next came the pathology report – I shouldn’t discuss the findings as they may be published, but there was obvious interest in this case being a possible case of CTEM. My new Irish generously offered to send slides to Dr. McKee for her review.

It was a great experience – Professor Phillips said – and I’m paraphrasing here because I’ve had too many concussions - “We’re hearing what is happening in the US and we’re on board.”

In the audience also was the top journalist on the issue of rugby and concussions for the Sunday Independent, who conducted a short interview and then was roped into driving Nicole to the train station for our 11 am to Belfast. Along the way I told him the difference Alan Schwarz of the New York Times made in advancing and accelerating concussion policy change in youth sports by committing the time to learn about the history and science of the issue. I hope this journalist takes a similar interest for Ireland, where just last week a top player in the Ireland League championship game was clearly concussed on the pitch. Instead of removing him from play, they stalled the game for a minute or two until he could balance again and then left him in. Two minutes later they asked him to perform a free kick (like a field goal in football), which is usually a simple maneuver for him. Guess what? Shanked in wide right, as he was suffering from the acute effects of brain injury… we have work to do here, but at least the positive was that no less than a dozen doctors, taxi drivers, and athletes mentioned their unease with it to me.

Trip to Belfast, Northern Ireland

Meeting Dr. Webb

The train to Belfast took us up the eastern coast of Ireland, and I understood why so many people visit the countryside. Too bad I didn’t have the time. More on Belfast tomorrow, but I was put to work immediately meeting with Dr. Michael Webb, one of a very small number of concussion experts treating elite athletes in Northern Ireland. We discussed the problems with rugby – in fact Dr. Webb gave a presentation to the Irish Rugby Board last year pushing hard and providing evidence for a 10 minute “brain bin” to evaluate players with suspected concussion. At the time, he said it went over like a lead balloon. I think he will be successful in the future.

Presentation and Dinner with Ireland Football Association Doctors

We were then picked up by Dr. Sarah Lindsey and her husband Dr. Andy Massey, who were essentially the other two doctors in Northern Ireland interested in concussions and working as team docs for pro sports teams. They asked me to put a presentation on at the Irish Football Association – where Dr. Massey is the top doc - and invited other doctors and people interested in the issue. There is an article about it here.

Sarah is the team doc for the minor pro hockey team in Belfast, the Giants, where she often pulls double duty for both teams. She said multiple times she has evaluated an opposing team’s player, diagnosed a concussion, and told the coach he can’t continue to play – only to see him back on the ice in a few minutes. She said the referees have been no help in these situations.

One of the docs who did join, however, was a world renowned expert in knee constructions. He gained that reputation by fixing so many of the ‘knee-capping’ shootings from the “Troubles” that existed in Northern Ireland through 1998. Shootings and bombings were so common that the two major hospitals for Northern Ireland – one for Catholics and one for Protestant – became top hospitals for trauma injuries simply due to experience.

It’s amazing to think of the old struggles. For those who are too young to have this taught in school, the Troubles was a 30 year campaign of terrorism between a group of primarily Irish and Catholic nationalists who wanted Ireland to be reunited under Irish rule, and primarily Protestant loyalists that wanted Northern Ireland to remain part of the United Kingdom. Over 3,000 people were killed since the Troubles began in the late 1960’s, and things are now recovering since the 1998 cease-fire. Andy’s father was a police officer when he grew up, and he said that the routine growing up was that to go to school, his father would look under the car for a bomb, then drive up and down the street just in case he missed it, and then return to let Andy and his sister in the car. Every day. They also informed me that the Europa, where I was originally staying, was famous for being the second most bombed hotel in the world, with 38 successful out of 67 attempts. Lucky break on the change. I’ll be taking a tour of Belfast tomorrow before heading back to Dublin.

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