Lou Gehrig may not have had Lou Gehrig's Disease

August 31, 2010 9:54 AM

According to a new study [abstract] by doctors at Boston University and the VA Medical Center, repetitive head trauma suffered by athletes is linked to the motor neuron disease CTE (chronic traumatic encephalopathy), which may have been previously misdiagnosed as ALS, a.k.a. Lou Gehrig's Disease. This result may explain the extreme prevalence of ALS-like symptoms among former athletes and people in the military and suggests that Gehrig himself may not have suffered from Lou Gehrig's Disease.

Lou Gehrig (nicknamed "The Iron Horse") was a baseball player best known for his ability as a hitter and his record-setting streak of consecutive games played. The streak ended at 2,130 games when Gehrig was diagnosed with ALS in 1939. In the course of setting the record, he developed a reputation for playing through injuries, including several concussions.

Gehrig's famous farewell speech at Yankee Stadium.

Gary Cooper playing Lou Gehrig in Pride of the Yankees.

posted by albrecht (39 comments total)

Hearing that there might be another disease out there causing people to suffer in ways similar to ALS is heartbreaking. One is enough! In fact, it's too much.
posted by ThePinkSuperhero at 9:56 AM on August 31, 2010 [1 favorite]

As I've grown older, and the consequences of head trauma become further explored, I find it harder and harder to enjoy boxing like I used to. Seeing so many tenured boxers try and speak is just becoming too much. The slur, the mumbling, the lack of coherence.

These results don't shock me, really. More of an affirmation of a terrible gut feeling.
posted by Dark Messiah at 10:02 AM on August 31, 2010 [1 favorite]

These results don't shock me, really. More of an affirmation of a terrible gut feeling.

FWIW, I tend to agree, especially when it comes to sports like boxing and (American) football. But one thing I think is interesting about these studies is the documented cases of ALS-like diseases in sports that I don't think of so much as head-trauma-oriented, like soccer and baseball. (Gehrig's an interesting case study, since he really only suffered a few bad concussions in his career, although he did also play football in college.) The evidence seems to suggest that it's more how athletes recover from head trauma that matters.
posted by albrecht at 10:15 AM on August 31, 2010 [1 favorite]

The overall effects of concussions are something that needs more research. I am by no means a doctor, but it seems like there's no hard-and-fast rules when it comes to scrambling your melon.

I've seen pro fighters take a brutal KO and come back with seemingly ill effects, meanwhile others "crack the egg" and seem to end up suffering from so-called glass jaws, getting KO'ed easier and easier every time.
posted by Dark Messiah at 10:19 AM on August 31, 2010

So now does it move up to the next most famous sufferer? Do we have to start calling it Hawking's Disease? Because I bet he'd love that.
posted by Eideteker at 10:27 AM on August 31, 2010

Related: Malcolm Gladwell wrote an article in the New Yorker last year about chronic traumatic encephalopathy resulting from chronic brain injuries from football.
posted by emilyd22222 at 10:30 AM on August 31, 2010 [1 favorite]

The overall effects of concussions are something that needs more research. I am by no means a doctor, but it seems like there's no hard-and-fast rules when it comes to scrambling your melon.

I think there is a hard and fast rule when it comes to scrambling your melon: Don't let anything hard or fast come in to contact with your melon.
posted by hamhed at 10:30 AM on August 31, 2010 [12 favorites]

Reggie Fleming of the New York Rangers was also confirmed to have CTE.

But one thing I think is interesting about these studies is the documented cases of ALS-like diseases in sports that I don't think of so much as head-trauma-oriented, like soccer and baseball.

There are a surprising amount of collisions in baseball in a given season -- players hitting other players, catchers blocking home plate, players running into the wall, and, of course, the occasional baseball-to-the-skull problem. While they don't happen nearly as often as impacts in football or boxing, or even hockey, they play 162 games a season in baseball -- so you roll that die far more often.
posted by eriko at 10:31 AM on August 31, 2010 [1 favorite]

albrecht: Gehrig's famous farewell speech at Yankee Stadium. (YT: \"The Luckiest Man on the Face of the Earth\", Lou Gehrig)

You know, if I wanted to cry today I could have just looked that clip up on YouTube on my own.

Poor Lou.
posted by paisley henosis at 10:33 AM on August 31, 2010

Hearing that there might be another disease out there causing people to suffer in ways similar to ALS is heartbreaking. One is enough! In fact, it's too much.

I don't think this means that more people are suffering ALS-like symptoms than we thought. It just means that, of the people who were previously diagnosed with ALS, some of them actually had a different disease.
posted by magnificent frigatebird at 10:36 AM on August 31, 2010

I think there is a hard and fast rule when it comes to scrambling your melon: Don't let anything hard or fast come in to contact with your melon.

Agreed, absolutely. But there are still degrees of severity. I don't think anyone intends to "smash their melon", but should it happen then it's prudent to know what steps to take in future to minimize any potential damage.
posted by Dark Messiah at 10:36 AM on August 31, 2010

Reminds me of the player I saw on TV, saying, "the injury rate in the NFL is 100%."
posted by StickyCarpet at 10:37 AM on August 31, 2010

sports that I don't think of so much as head-trauma-oriented, like soccer and baseball.

Really?
posted by HumanComplex at 10:38 AM on August 31, 2010 [1 favorite]

One wonders how ancient humans may have fared in this regard. Presumably there was a pretty high incidence of head trauma and presumably this caused some mental problems. Possibly partly to blame for the slow pace of development during some of the early years? Nobody lives long enough to get enough perspective to invent anything and those that do can barely think (or even stand) straight.

I guess this is easy to test. What do skulls show? A lot of trauma?
posted by DU at 10:40 AM on August 31, 2010 [1 favorite]

thanks, i never liked watching boxing, this post gives me another good reason to explain why i do not watch boxing, ever.
posted by tustinrick at 10:44 AM on August 31, 2010

DU, I think the study is showing that chronic blows that may not have caused obvious cranial deformation or damage are still correlated with traumatic encephalopathy. So, in this case, looking at the skulls wouldn't necessarily test the hypothesis.
posted by Uniformitarianism Now! at 10:46 AM on August 31, 2010 [1 favorite]

RYAN
GRANT'S EXAMPLE new nfl rule on concussions.
posted by tustinrick at 10:54 AM on August 31, 2010

DU, I would imagine that most of the early humans (and other hominids for that matter) who suffered serious or even moderate brain trauma died either directly or indirectly as a result. We take a lot of things for granted these days, but back then a severely sprained ankle was probably a death sentence in most situations, so I feel fairly confident in my assumption.
posted by BobbyDigital at 10:58 AM on August 31, 2010 [1 favorite]

One wonders how ancient humans may have fared in this regard. Presumably there was a pretty high incidence of head trauma and presumably this caused some mental problems.

It's hard to say. The treatments were probably worse than the survivable head injuries themselves. Combat injuries from clubs, slings and hammers were probably not as survivable then, but you probably didn't have a long career as a soldier, either. And then you had combat sports like boxing, but not so many professional fighters or professional athletes as today.
posted by Hylas at 11:00 AM on August 31, 2010 [1 favorite]

Agreed that they would have a lower threshold of survivability, but that's not what I'm talking about. What I'm talking about is the (to my mind obvious, but possibly wrong) fact that they'd have a higher rate of (possibly-lower seriousness) injury due to a hunting lifestyle, living in a cave with low ceilings, etc.
posted by DU at 11:04 AM on August 31, 2010

"One wonders how ancient humans may have fared in this regard. Presumably there was a pretty high incidence of head trauma..."

That's a huge presumption! We have depth perception and color vision, we have hands to catch and block things, we respond reflexively to things coming at our face.

Our close genetic relatives, chimpanzees, are able to hunt in dense forests.
posted by the young rope-rider at 11:15 AM on August 31, 2010

"back then a severely sprained ankle was probably a death sentence in most situations,"

Hmm. Humans tend to be very altruistic to close relatives, so I don't think this is a good assumption.
posted by the young rope-rider at 11:21 AM on August 31, 2010

ALS and Motor Neuron Disease are the same thing. ALS is the US name.
If a disease buggers up your motor neurons, whatever the details, it's Motor Neuron Disease and Americans will call it ALS or Lou Gehrig's disease.

Now we know that head trauma can cause Motor Neuron Disease by an entirely different pathway, you might want to say that he had trauma-induced Lou Gehrig's disease.
Maybe they should save his name for the subset of ALS that's caused by head trauma.

Never mind that whatever disease he had is by definition Lou Gehrig's Disease anyway.
posted by w0mbat at 11:27 AM on August 31, 2010

I was pleased to note in this morning's edition of my small-town newspaper that head trauma among athletes is being taken seriously.
posted by workerant at 11:31 AM on August 31, 2010

Gehrig himself may not have suffered from Lou Gehrig's Disease

Not to get all technical on you, but wouldn't this actually mean that Lou Gehrig's disease was not ALS? I'm pretty sure the disease he had was the disease that he had. The disease that other people have may not be the one that he had and instead may be the one that people thought he had.
posted by The 10th Regiment of Foot at 11:44 AM on August 31, 2010 [1 favorite]

ALS and Motor Neuron Disease are the same thing. ALS is the US name.

I think you may be right about the ways the terms are generally used, but technically the two things are not the same. From the NYT article:

The study, to be published Wednesday on the Web site of the Journal of Neuropathology & Experimental Neurology, represents the first firm pathological indications that brain trauma results in motor-neuron degeneration, and that the resulting disease (at least in the three men studied) is actually not A.L.S. It is a different disorder with different markings, specifically a pattern of two proteins in the spinal cord that compromise nerve function.

The whole "Lou Gehrig didn't have Lou Gehrig's disease" time-paradox is a good media angle but a little beside the point.

Pedantry aside, what seems to matter more here is the possible verification that head trauma in athletes and soldiers is what's responsible for so many of them suffering from motor neuron degeneration (whatever you want to call it). Looking through the wikipedia pages, it seems like even until somewhat recently the dominant theories were that soccer players were getting ALS as a result of fertilizers used on the playing fields and that soldiers were being exposed to some kind of neurotoxin, as well. Head trauma sounds like a more reasonable explanation.
posted by albrecht at 11:56 AM on August 31, 2010 [1 favorite]

head trauma in athletes and soldiers is what's responsible for so many of them suffering from motor neuron degeneration . . . until somewhat recently the dominant theories were that soccer players were getting ALS as a result of fertilizers

Hmm . . . time to ban headers in soccer/football?

If a link between them and these motor neuron diseases is well established (and I'm not sure we're quite there yet), it would seem the logical move.
posted by flug at 12:11 PM on August 31, 2010

I work for the MDA. We have an entirely separate division dedicated to ALS, and this idea is really very frustrating. Why? Because this is preliminary research, the test group was very small and the idea that Lou Gehrig did not have Lou Gehrig's Disease is a very dramatic assumption to make.

The research is significant, and is good because it raises awareness of the issue, but there simply isn't enough evidence to make this claim.
posted by glaucon at 12:14 PM on August 31, 2010 [1 favorite]

wow! a retired NFL lineman on Monday Night Football interview stated during most games he played in (on the line as a guard) he had as many as 4 or more concussions occur during the game, week after week, never telling the coaches anything about the minor head trama he experienced.
posted by tustinrick at 12:27 PM on August 31, 2010

This is frustrating for me because I'd prefer to continue playing rugby, but not if it's going to scramble my brain.
posted by electroboy at 12:30 PM on August 31, 2010

Our close genetic relatives, chimpanzees, are able to hunt in dense forests.

Chimps are 3 - 5 times stronger than the strongest humans. You can't learn much about human capabilities by studying chimps.
posted by rodgerd at 12:31 PM on August 31, 2010

When it comes to avoiding head injury I think that vision (ours is better than chimps) is much more relevant to strength. With their vision they're able to move quickly through complex environments while generally avoiding injury.

I think that it's fair to consider their ability to locomote and hunt without sustaining significant brain injury and presume that prehistoric humans had similar abilities.

There is also the lack of ethnographic evidence of similar community-wide issues among modern peoples--except, of course, our modern, high-tech, industrialized athletes.

Obviously humans are not immune to injury, but it seems doubtful that prehistoric humans suffered persistent head injuries that affected the ability of people as young as their 30s to function normally.
posted by the young rope-rider at 12:50 PM on August 31, 2010 [1 favorite]

If my son takes after me and his Dad, he'll never be much into sports. But if he takes after the other 80% of our relatives, he will.

I don't want to keep him indoors (I'd love for him to love hiking too), but if he wants to seriously play soccer/football/baseball...eh. Going to be hard to not think about this sort of thing. Do what you love, son, but please, try not to love something that scrambles your brain.
posted by emjaybee at 12:57 PM on August 31, 2010

...suggests that Gehrig himself may not have suffered from Lou Gehrig's Disease...

Lou Gehrig most certainly did have Lou Gehrig's disease. It may not have been ALS, but whatever he had, it was his disease.
posted by Mental Wimp at 1:31 PM on August 31, 2010 [3 favorites]

This puts a whole new perspective on an incident about 35 years ago, when my landlord (A shell-shocked Korean War veteran) came home from a doctor's appointment one evening, sent his family out for ice cream, and blew his head off with a revolutionary-war muzzle-loader that had set on his mantelpiece for years. I was upstairs with my wife and new baby at the time, and heard an unremarkable *thump*, dismissing it as "clumsy old Melvin downstairs dropping something again".

It turned out that the doctor had told him he had ALS, and had laid out the future course of the disease. Melvin wasn't having any part of it.

Now I wonder if the shelling had something to do with it. Poor guy.
posted by pjern at 1:37 PM on August 31, 2010 [2 favorites]

Can't believe I'm the first person here to say dementia pugilistica.
posted by neuron at 8:42 PM on August 31, 2010 [2 favorites]

> One wonders how ancient humans may have fared in this regard.

Not very well. Lou Gehrig died at 37 from ALS (or possibly this head trauma related disease), and living past 35 is kind of a new phenomenon. You may have had a select few who managed to live past that, but on a whole, chances would say that if they weren't dieing specifically because of head trauma related illnesses, they weren't living very long for those to become a problem (as it appears CTE takes until later adulthood to really manifest). From an evolutionary biology perspective, reproduction was capable long before any of those other illnesses could really take hold, if you could live to 14 and reproduce, you were considered 'fit'. At the age most of these athletes are starting the semi professional careers, our ancestors were already raising their children, that is the ones that survived the birth, were not suffering from malnutrition and other common early childhood illnesses.

If someone was in a circumstance to sustain a concussion, such as a tribal skirmish or a roman battle, do you think whoever gave them that concussion would stop at that? Not just kill them outright? I mean there was some ancient sporting events, but I would assume the majority of concussions experienced were closely followed by death, either by poor treatment related to the concussion, or the second swing of the hammer. Only within the last few hundred years has there been any sort of ability or reasoning for as many people to endure a concussion and then go back to whatever they were doing that gave it to them.
posted by mrzarquon at 10:39 PM on August 31, 2010 [1 favorite]

Can't believe I'm the first person here to say dementia pugilistica.
posted by neuron at 11:42 PM on August 31

eponyppropriate?
posted by liza at 11:30 PM on August 31, 2010

Well isn't that just like the Yankees to name the disease after someone who never had that disease. They're so grandiose. Next we'll learn that Tommy John never had Tommy John surgery.
posted by Rarebit Fiend at 9:38 AM on September 1, 2010 [1 favorite]