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The highlights were plentiful during Ben Utecht's football career. He led his Minnesota high school to unprecedented success and was a four-year starter for the University of Minnesota's Golden Gophers. In his first game as a National Football League (NFL) player, Utecht caught a pass from Peyton Manning and barreled over Deion “Prime Time” Sanders for a touchdown. “I caught a pass from a future Hall of Famer and ended up scoring over another Hall of Famer,” Utecht says with pride. And in 2007, at Super Bowl XLI, he was a starting tight end on the Indianapolis' Colts championship-winning team.
Today, Utecht isn't sure those memories were worth the cost. After his six-year NFL career (2004–2009) ended because of concussions, Utecht can still feel their effects. “There have been changes in my cognitive functioning,” Utecht says.
Utecht mentions how difficult it can be, at times, to reminisce with his family. He can't remember being at a friend's wedding, even though he was a groomsman and a singer at the event. And he worries about the future he'll have with his wife, Karyn, and their three daughters.
“At 32 years old, there are some tough moments, to be honest with you,” Utecht says. “It scares me to death to think about waking up some day and not being able to recognize my family.”
But Utecht has also found a renewed sense of purpose, embarking on a career as a recording artist and motivational speaker, as well as working with the American Academy of Neurology (AAN) and American Brain Foundation (ABF) to help raise awareness of traumatic brain injury (TBI) in general.
A concussion is considered the most minor and common type of TBI. A concussion can be caused by a bump, blow, or jolt to the head. It can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth.
“Concussions are caused by a rapid acceleration and deceleration of the head. This is commonly caused by an impact to the head, but there doesn't have to be impact,” says Michael Lipton, M.D., Ph.D., associate director of the Gruss Magnetic Resonance Research Center at Albert Einstein College of Medicine in New York City.
“Think of the brain as sitting inside the hard skull, floating in fluid. If that brain is moved quickly enough, it can disrupt the signals between neurons,” explains AAN member Jeffrey Kutcher, M.D., director of Michigan Neurosport and associate professor of neurology at the University of Michigan.
Although concussion is considered a milder form of TBI, it can have serious symptoms and consequences.
“The main symptom of concussion is disturbance of consciousness,” Dr. Lipton says. This can show up as memory problems, difficulty concentrating, personality changes, mood problems, and cognitive performance changes, according to Dr. Kutcher.
“People often describe concussion as resulting in confusion, disorientation, seeing stars—a common expression is ‘having one's bell rung,’” Dr. Lipton continues. “Balance can be impaired as the result of concussion. People can also experience vision and hearing changes and headache or head pain.”
According to the Centers for Disease Control and Prevention, “more than 1,000,000 athletes experience a concussion each year in the United States.” However, the challenges of diagnosing concussions mean that number may not be accurate. “We have no idea how many concussions really occur because a large number of them are not recognized or are brushed off,” explains Dr. Lipton.
This lack of awareness often results in athletes returning to the field before their brains are ready, which happened throughout Utecht's career. Along with five documented concussions, Utecht remembers numerous others that affected him but didn't stop him from playing. He cites an exercise from his high school days called “Bull in the Ring.” The drill entailed young athletes running into each other, headfirst, to gauge their toughness.
“I think back to starting tackle football in fourth grade, and how many times I remember blacking out and coming right back, or my vision going blurry, or headaches afterwards, and I know the list of concussions I had really begins to grow.”
Utecht didn't complain about the effects of such hits because he didn't want to lose the respect of teammates and coaches—and because he understood that a place on the field was never guaranteed. “There were times in college and the NFL where I knew I had a concussion, but I wasn't about to share that information because I didn't want to lose my job,” he admits.
On average, the symptoms of a concussion last for approximately 10 to 14 days, although the underlying brain injury may last longer. The only treatment for concussion is rest, which is why a new AAN guideline on sports concussion says “any athlete suspected of experiencing a concussion [should] immediately be removed from play.” (See Resource Central, page 45, for a link to the guideline and for more information.)
“If in doubt, sit it out,” Dr. Kutcher says.
In retrospect, Utecht realizes he should have sat it out more. After he experienced his first documented concussion as a college freshman, Utecht quickly returned to the field even though he'd been completely knocked out. “The saddest thing is that I was back practicing a day later.” After his second concussion in college, he returned to practice after two days.
Playing for the Indianapolis Colts in 2006, Utecht was viciously tackled by a Houston Texan defender. The two players' helmets smashed together, resulting in Utecht's neck becoming severely contorted. “My vision was completely gone,” he recalls.
Then, “like a transition in a movie,” Utecht says, his vision came back. Responding to the taunts of the player who'd hit him, Utecht jumped to his feet to celebrate that he'd kept possession of the football and earned his team a first down. “The crowd went crazy,” he laughs, “and I threw my helmet back on and finished playing.”
Utecht can't remember what occurred on the field for the next few minutes. Shortly thereafter, team doctors removed him from the game because of a concussion. The next year, Utecht had another concussion. He has no recollection of it today. Utecht knows only what he saw on game film: a Bronco defender clipped Utecht's head as he jumped over him. The contact seemed slight. “But all of a sudden, you see my body go completely limp,” Utecht says. “I was totally knocked out for somewhere between 15 to 20 seconds.”
Another seemingly slight collision he experienced as a Cincinnati Bengal during the 2009 preseason led to similarly dramatic results. Utecht has no memory of that incident either.
I had some tingling in my fingers,” he explains, “and all of a sudden they're putting me in an ambulance.”
That hit would be Utecht's last as a professional football player. His fifth documented concussion kept him on the sidelines for eight months and effectively ended his chances of earning a place on an NFL roster.
According to the AAN guideline, neurologists should “counsel athletes with a history of multiple concussions…about the risk factors for developing permanent or lasting neurobehavioral or cognitive impairments.” In addition, neurologists who care for “professional contact sport athletes who show evidence for persistent neurologic/cognitive deficits…should recommend retirement from the contact sport.”
Utecht's final concussion also led him on a path that would result in his beginning to understand the importance of brain health and the risks of his chosen profession. Utecht says that, during his career, “the long-term effects of concussion were never made known to me.” It was only after seeing Robert Cantu, M.D., clinical professor in the department of neurosurgery and co-director of the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine—after the fifth concussion—that Utecht began to see the gravity of the situation.
“Dr. Cantu opened my eyes to all of these aspects of brain health that I had never known,” Utecht says. “And I'm thinking, man, if I had this information six years ago, would it have changed my mind about going into professional football?”
One thing Utecht learned is that the only effective treatment for a concussion is rest. “The cornerstone guiding someone in the recovery period is that they need an initial period of rest,” Dr. Lipton says, “and then a very gradual step-wise reintroduction of normal activities.”
Fortunately, rest can allow the injury to fully heal, according to Dr. Lipton. “Most people recover fully from a concussion over a period of up to weeks or a few months,” Dr. Lipton says.
“If you're concussed and that injury is identified and you're treated appropriately and allowed to recover,” Dr. Kutcher says, “then you go back to your previous concussion risk.” If a first concussion is not treated appropriately, subsequent concussions seem to happen more easily—and can cause more harm.
“Prior concussion predisposes someone to a worse outcome from a future one,” Dr. Lipton says. “That's especially true if the time between those injuries is relatively short because your brain has not fully recovered. Subsequent impacts—although seemingly minor—can have a magnified effect because the brain has already been made especially vulnerable.”
Lack of appropriate treatment may help explain Utecht's experience. “After the last concussion in Indianapolis, I experienced memory loss, both short and long term. At times I'd have trouble speaking, almost like I had a little stutter. In my mind I knew what I wanted to say, but I couldn't get it out,” Utecht says.
Playing a sport like football is one risk factor for getting a concussion, but so is the brain and body you're born with. “There's a threshold that your brain has that you've been given genetically to produce injury,” Dr. Kutcher says. “That's something that's variable from person to person.”
Specific genetic factors include the gene apolipoprotein E4 (APOE4). Having the gene results in increased risk of cognitive impairment, Alzheimer's disease, and the early onset of dementia after moderate and severe TBI, according to Dr. Lipton. Blood tests done by Dr. Cantu confirmed that Utecht has a form of the APOE4 gene.
“If you take any individual person, the likelihood is that they will fully recover from a concussion,” Dr. Lipton says. “But 20 to 25 percent of people will have long-term effects.”
Utecht continues to experience memory problems. “When the symptoms last several months or years, you're no longer dealing with concussions but probably with post-concussion syndrome,” Dr. Kutcher says. “This requires much more complex treatment. Especially in these cases, it's important to seek the care of a neurologist who can take a comprehensive approach.”
After his final concussion in the NFL, Utecht wasn't given full clearance to return to the field for eight months. By that time, he'd been released by the Bengals and had begun to realize his concussion history would prove a significant hurdle to finding another job in the NFL. “I still had a passion for the game,” Utecht says, “but the decision to retire was kind of made for me.”
He knew the decision was probably for the best. During the rehabilitation process after his fifth concussion, he'd visited a number of neurologists. Most gave him the same off-the-record advice: if he were their son, they wouldn't allow him to keep playing football.
Today, Utecht realizes his brain will never be what it used to be because of the many concussions he sustained. “It's never going to be the old normal. It's going to be a new normal,” he says. Since his retirement five years ago, Utecht has seen no real changes in how his mind works, for better or worse. “I have had no improvement, and I can't say I've had any noticeable decline.”
Utecht came from a musical family and was always interested in making music. He notes that he was in more choirs in high school than sports teams. Since retiring from football, Utecht has released four albums and performed with the Cincinnati Pops Orchestra and the Indianapolis Symphony Orchestra, among others. Much of Utecht's music (ben-utecht.com ), which is in the adult contemporary/pop country genre, tells the story of how he's dealing with his own brain issues.
“The song ‘You Will Always Be My Girls’ is a love letter to my wife and three daughters, told from the standpoint of a man that doesn't remember who they are any more,” Utecht says. “We did a music video. My wife and daughters were the actors in it.”
For three years, Utecht was a spokesman for the Minnesota Brain Injury Alliance. In 2013, the guitarist Billy McLaughlin (who appeared on the cover of Neurology Now in July/August 2010; go to bit.ly/cugBZ4) connected him with the AAN and ABF.
“I've been sitting here for three years trying to redefine myself and find relevance as a man,” Utecht says, “and between my music and the AAN and the ABF, it just seems like all these pieces are coming together.”
The AAN and ABF recently announced that Utecht will be the recipient of their 2014 Public Leadership in Neurology Award, which honors someone outside of the medical profession. Honorees are known for advancing public understanding and awareness of neurologic disease. Utecht will receive the award, for raising awareness of concussion and TBI, during the AAN and American Brain Foundation Awards Luncheon held on Wednesday, April 30, 2014, at the Pennsylvania Convention Center as part of the AAN's Annual Meeting in Philadelphia.
“I want to go around the country and campaign and connect people to neurology,” he says. “I want people to understand that the brain is the foundation of who they are.”