This month's cover features photos of Zac Easter, an Iowa athlete who developed chronic traumatic encephalopathy (CTE) after suffering numerous concussions during his decade-long school football career. CTE is a progressive degenerative disease that most commonly affects athletes-especially those who play contact sports-and military veterans. While much remains to be learned about it, researchers believe that CTE occurs when repetitive head trauma triggers the deterioration of brain tissue and the buildup of abnormal tau protein in the brain. Individuals with the disease experience debilitating symptoms like memory loss, confusion, depression, aggression, anxiety, impaired judgment, and impulse-control problems.
Easter started playing football in the third grade and continued through high school, earning a reputation as tough and fearless on the field. He wrote in a journal that because he was shorter than other players, he learned to put his head down and use it "as a weapon" to give him a strategic edge. Easter was proud of his identity as an athlete and determinedly played through pain. "I never wanted to tell anyone about the headaches I got from practices and games," he wrote in his journal.
By senior year, Easter had been diagnosed with concussion five times-the final one put an end to his football career. He often felt dizzy and sick, and he became depressed. He experienced a worsening array of symptoms in the years that followed: excruciating headaches, mood swings, anxiety, tremors, disorientation, nausea, slurred speech, and balance issues. After researching online, he came to suspect he had CTE; the disease, however, can only be diagnosed after death. He sought medical help but continued to struggle. Tragically, in December 2015, Easter died by suicide at age 24. His suspicion about having CTE was later officially confirmed.
"It was devastating to see Zac's progression-to see him lose himself and no longer recognize who he was-and it was devastating to know I could never truly understand what was happening to his brain. No one could," Alison Epperson, Zac's former girlfriend, told AJN. "As his disease progressed, his depression, anxiety, and social isolation dramatically increased. His short-term memory loss also got a lot worse during his last year of life. Most of all, though, Zac had an increased feeling that he was just not OK-something was off and he no longer felt like himself."
Easter left behind a document titled "Concussions: My Silent Struggle." In 39 pages, he detailed his football head injuries and his CTE symptoms, which he believed were the result of his concussions. He asked his loved ones to share his story with others. Soon after his death, Easter's family and Epperson started a nonprofit organization, CTE Hope (https://ctehope.com), to raise awareness about CTE, support research efforts, and offer resources to individuals who have experienced concussions and traumatic brain injuries.
As Katy Pietz and colleagues note in this month's original research article, "Concussions at School: The Experiences and Knowledge of School Nurses," the first health care providers to care for concussed students are often nurses, and they play a critical role in facilitating these students' eventual return to class and sports. Epperson, who serves as CTE Hope's chief communications officer, cautions that injured student athletes may resist being sidelined. "Often, athletes will do anything to keep playing-they do not want to be taken out of the game. Zac memorized how to pass his concussion tests in high school so he could be cleared to play," she says. "He never wanted to admit how much he was still struggling because he didn't want to be benched. I think it's important for nurses and other medical professionals to be aware of this so they know to dig deeper and really make sure someone is OK before they are allowed back onto the field."
Epperson also adds that despite seeing many heath care providers about his CTE symptoms, Easter was never asked whether he had a history of head trauma. Being aware of this history, she says, is critical, as is taking a holistic approach when caring for patients who have experienced head injury. "Head injuries and their long-lasting effects, like CTE, impact a person's whole body-their vision, balance, speech, and mental health."
Easter's life and struggle with CTE is discussed in a new book by journalist Reid Forgrave, Love, Zac: Small-Town Football and the Life and Death of an American Boy (Workman Publishing, 2020). Additionally, a short GQ Sports film about him is available at https://youtu.be/9TrCZcsSyA8. To learn more about CTE, visit the website of Boston University's CTE Center: http://www.bu.edu/cte.-Diane Szulecki, editor