AAron Ontiveroz, The Denver Post More photos

Game of Pain, part 2: Untangling the knots

Why former Bronco Jeb Putzier has turned to an array of therapies to ease his post-football pain

Published June 17, 2016

Editor’s Note

Second in an occasional series looking at issues surrounding pain management for football players.

With a greater awareness of football’s long-term effects on their health, many ex-players are anxiously searching for ways to not only treat pain but also prevent the onset of additional symptoms. Specialists in Colorado have joined the hunt.

Editor’s Note

Second in an occasional series looking at issues surrounding pain management for football players.

Jeb Putzier knows how he got here, sitting on his couch on a recent Tuesday morning, his hair disheveled and his daily regimen of therapy and supplements scribbled on a calendar on the kitchen table. His thoughts can often be muddled, but some replays remain vivid.

He remembers the brutal blow delivered by New England cornerback Asante Samuel in 2005 that left him with six stitches and a jaw that still pops out. Putzier remembers the crushing hit by San Diego linebacker Steve Foley later that season that is still floating around the internet titled “Steve Foley almost kills Jeb Putzier.”

Putzier remembers his release from the Broncos seven years ago, and he certainly remembers the steep drop that followed: his suicide attempt and an acrimonious end to his marriage that limits visitations with his two young children to once every few weeks.

“My kids. If my kids weren’t here,” he says, “I’d already be dead.”

After suffering what he estimates were more than 1,000 concussions, as well as an array of physical injuries during his eight-year professional career as a tight end, seven of those in the NFL, Putzier now spends his time searching for ways to clear his mind and end his pain. His joints ache. His head hurts. And although his injuries are far from debilitating, his mind is constantly in overdrive, causing otherwise routine activities to exhaust him.

Patriots cornerback Asante Samuel pummels Putzier

John Leyba, Denver Post file Patriots cornerback Asante Samuel pummels Putzier during a game in 2005.

Putzier is hit hard by Giants linebacker Antonio Pierce

Associated Press file photo A week later, Putzier is hit hard by Giants linebacker Antonio Pierce.

At 37, the hope of someday being able to physically sustain a full-time job is just that — hope.

“When he shuts down, it’s like watching a wind-up toy come to the end of its line,” says his longtime girlfriend, Bailey. “He looks like a strong, healthy, able-bodied person, but you don’t see the stuff that goes on behind closed doors.”

Cannabidiol

Former Broncos tight end Jeb Putzier consumes Charlotte’s Web, a hemp extract produced by Colorado’s CW Botanicals that is high in cannabidiol (CBD) and contains only trace levels of tetrahydrocannabinol (THC), the compound in cannabis that gets users high. Among its many benefits, CBD is found to relieve neuropathic pain and reduce inflammation. Former Broncos quarterback Jake Plummer and current offensive tackle Eugene Monroe have backed research studies of CBD with the hope the NFL will allow active players to use it as a safer alternative pain reliever than opioids.

Yes, the punishment he took on the football field is how Putzier got here, holed up in his Centennial home with a daily to-do list that includes physical therapy or music therapy or light therapy, or all three, and consuming a cocktail of supplements such as fish oil capsules and cannabidiol that has turned his kitchen cupboard into a mini-GNC.

Certainly not every former football player experiences the symptoms Putzier does. But with the heightened awareness of the long-term damage football can do to the body, many ex-players, regardless of their condition, are anxiously searching for new ways to not only treat pain but also prevent the onset of additional symptoms.

The hunt for answers when so much is still unknown about traumatic brain injuries has created a wild west for players unsure where to turn. Specialists in Colorado have joined the quest and could be on the forefront of significant progress.

Putzier doing light and music therapy

AAron Ontiveroz, The Denver PostRachel Ragsdale, a counselor and neurofeedback specialist, examines a live reading of Putzier’s brain-wave activity as he holds a stuffed animal equipped with more sensors. More photos

Blueprint for recovery

At least twice a month Putzier voluntarily visits his version of hell. Beads of sweat dot his forehead as he slowly makes his way inside the windowless room in the office of Dr. Shane Steadman, a chiropractic neurologist with Integrated Health Systems in Englewood. There is no wall art, and the only furniture is an outsize barber’s chair that beckons Putzier with its soft black leather and plush armrests.

“I hate this,” he says as a wave of anxiety and nausea rushes over him. “I hate this so much.”

As Putzier eases into the chair, Steadman straps a pair of infrared goggles around his head. Putzier’s enlarged pupils, bouncing side to side, are projected onto a nearby laptop computer. Faster and faster they bob as the sweat drips down his face and his fingers dig into the leather.

CereScan joins quest for research, answers

Extensive news coverage of the dangers of concussions in recent years has led some NFL players to retire early to avoid the possibility of further brain damage. And many retired players have taken steps to not only alleviate their postfootball pain but to try to fight the onset of additional complications.

But the science behind traumatic brain injury (TBI), and especially chronic traumatic encephalopathy (CTE), is still in its infancy.

CereScan, a functional brain imaging and data analytics company in Littleton, is working to change that. Using quantitative single-photon emission computed tomography (qSPECT) imaging to measure blood flow in up to 160 regions of the brain, CereScan’s technology, combined with clinical assessments and previous imaging, can offer a more complete picture of a patient’s brain function than structural images, like MRIs and CT scans, alone can provide.

Blood flow in the brain, which indicates how cells are working, is diagnosed and displayed on a color spectrum. Blues and greens show areas with less blood flow, and oranges and reds indicate normal or above-average blood flow. The diagnostic report and imaging, which can cost $2,400 to $4,200 per patient, provide a starting point in recommending treatments that can include infrared light therapy, functional neurology, hyperbaric oxygen therapy, neurofeedback or even yoga.

CereScan stores and catalogues all information in its database, CereMetrix, without using patient identification. CereMatrix now includes about 7,000 scans from patients in 40 states and four countries. In that database are records of dozens of current and former NFL players, Broncos included. CereScan hopes the extensive database will aid practitioners and also advance research of brain injuries and diseases.

The company, with funding from the Tug McGraw Foundation and in partnership with the Colorado Neurological Institute, is nearing completion of a study called The Invisible Brain Injury Project on the effectiveness of near-infrared light therapy as treatment for TBI in military veterans and former NFL players.

“There are some positive indications emerging from various therapies, and we’re as anxious as anyone to help in verifying which offer the most promising results,” says John Kelley, CereScan’s chairman and CEO. “Hyperbaric chamber, yoga, dietary changes, all sorts of things. Sometimes they show good things, sometimes not. But how do you know? We can provide measurements and precise locations of those functional changes.”

Locally, word has gotten out about CereScan’s research. The next step? Getting the NFL and NFL Players Association to buy in. CereScan has had multiple meetings with league and union officials about offering its technology to help active and retired players. But the conversations — much like the research of TBI — are just getting started.

“The NFL is appropriately skeptical of people bearing gifts,” Kelley says. “Over time, we’re gaining credibility with them. We don’t want anything. We’re not asking for anything. We’re saying look, we’re providing technology you guys should be familiar with or take advantage of.”

Putzier says he was diagnosed in April with postconcussion syndrome, attaching a label to myriad symptoms he has dealt with since he retired. Steadman, an expert in functional neurology, is one of many specialists Putzier and other former players see to try to find peace.

“The goal is to try to understand the function or, in many of our patients’ cases, we’re trying to understand their dysfunction,” says Steadman, who also does full blood and hormonal evaluations to connect the physical symptoms with the neurological causes. “(We’re) trying to figure out how areas of the brain integrate with other areas of the brain and also how it integrates with the body.”

With interactive technologies such as a Neuro Sensorimotor Integrator, Steadman tests Putzier’s balance and motor skills. The videonystagmography (VNG) goggles Putzier hate so much record his drifting eyes, offering signs of how his brain is working. Coordinated head-and-eye movements target certain areas of the brain that are underperforming.

The process seems simple, but within minutes Putzier’s long hair is drenched, his face is pale and the energy he entered the office with has disappeared. The light-and-sound stimulation is overwhelming, and recovery can sometimes take as many as 18 hours of rest, he says.

“Because we’re using measuring tools, we’re able to see improvements within a short period of time,” Steadman says. “It doesn’t mean that they’re 100 percent resolved. But we’re able to see improvements within a few weeks.”

Progress for Putzier has been slow and unsteady, but noticeable in terms of his emotional stability, mental endurance and thought processing. But the incremental and often invisible changes in his mind are laid bare in specialized images taken at CereScan, a functional brain imaging and data analytics company in Littleton.

CereScan uses quantitative single-photon emission computed tomography (qSPECT) imaging to show how the brain is functioning. (Putzier began working with the company in 2011 and is now both a patient and a consultant.) Unlike magnetic resonance images (MRI) or computed tomography (CT) scans that show the structure of the brain, qSPECT scans measure blood flow, which can reveal how cells are working in the brain.

For Putzier and the dozens of other NFL players and military veterans CereScan has worked with, the images and medical assessments provide not only proof of their cognitive limitations but baselines for treatment, be it near-infrared light therapy (NIR), hyperbaric oxygen therapy, neurofeedback, dietary changes or even yoga.

qSPECT images

“The industry is coming to the point where the doctors need to know structural and they need to know functional,” says CereScan’s chairman and CEO, John Kelley. “Pictures are great, and the doctors rely on them. But now the brain can be mathematically mapped. So as soon as you put it into digits, now you can put mathematics to it, so the doctors will see almost like a spreadsheet of how an area, up to 160 regions, is performing.”

Surgery alternative? Why NFLers are trying stem cell treatments

In April, Jeb Putzier received stem cell therapy at Premier Stem Cell Institute in Johnstown with the hope the treatments would alleviate his joint pain and ward off the need for surgery.

Unlike the controversial use of embryonic stem cells, these treatments use adult stem cells pulled from one’s own body. The cells can then divide into additional cells and become specialized.

The mesenchymal stem cells were harvested from the bone marrow in Putzier’s iliac crest, or hip bone, and reinjected into six joints — both shoulders, hips and knees — as well as his left foot. Within a few months those blank-slate cells are expected to develop into the same type of cells that surround them to expedite healing.

The treatments typically take about 45 minutes, and a couple days of swelling and soreness are followed by a gradual return to activity, whereas surgeries typically require weeks if not months of rest, rehabilitation and medications.

The Food and Drug Administration regulates the use and research of stem cells in the U.S. It’s legal to harvest adult stem cells and reinject them into the same patient, so long as there’s only minimal manipulation of those cells.

Many former players, Broncos included, have sought the treatments to help with lingering football-related pain and have found success. But there’s no certainty of relief, and the FDA has issued warning letters to some clinics about false claims of what the treatments can do.

The treatments are costly, too, and not covered by insurance. At Premier, injections in two sites cost about $7,000, plus another $850 for each additional site. For active NFL players, sometimes a team will pay for the treatment, but many players pay out of pocket.

In October 2013, Putzier underwent a qSPECT scan that found numerous regions of his brain lacked the normal amount of blood flow; cool colors dominated many regions, accounting for his cognitive fatigue, unstable mood, light-and-sound sensitivity, balance issues and chronic headaches. Ten months later, many areas of his brain — specifically in his occipital lobe and cerebellum that were constantly rattled from hits — lit up in reds and oranges, indicative of greater blood flow.

The improvement was in part a credit to the weekly work with Steadman, but also the regular sessions of NIR, which Kelley likens to Viagra, but for the brain. Every other day for about 20 minutes at a time, Putzier wraps a foam pad dotted with small bulbs around his head to let the infrared light permeate his skull and shower the surface of his brain to increase blood flow.

But Putzier continues his hunt for help.

He has added music therapy to his regimen, often laying in bed with the infrared light device strapped around as his head as steady beats play through his earphones. The stem cell therapy received in May from Premier Stem Cell Institute in Johnstown will ease his joint pain, he hopes, and put off surgery. He recently started neurofeedback at the NeuraPerformance Brain Center in Denver to try to self-regulate and retrain his brain. And, if insurance allows it, he may try Botox, which has been FDA-approved to treat chronic migraines.

“Trying to explain to people, it’s like we have a rope with knots and we’re trying to untie the knots one at a time,” Putzier says. “But when I untied this knot, it led to other problems in between to the next knot.”

Photos

An unshakable love

Stacked on a mounted metal shelf in the closet in Putzier’s basement are nearly 30 commemorative game balls he received during his playing days. Resting on the floor are duffel bags and plastic bins stuffed with autographed jerseys of former teammates. A framed collage of newspaper clippings — “Jeb Putzier’s Walk to Stardom” — leans on a nearby wall, ready to be hung. And, in an unfinished room, old photographs and football playing cards from his early days as a Bronco are strewn across a wooden counter. Ask him about the ones in the middle and his face lights up as he tells the stories behind the images of him, Ed McCaffrey, Jake Plummer and Danny Kanell sitting on the Broncos’ team plane, or the one of him dressed up at a Halloween party.

Jeb Putzier rummages through a closet

AAron Ontiveroz, The Denver PostJeb Putzier rummages through a small closet in his basement where he keeps mementos from his playing days. More photos

The bulk of Putzier’s NFL career is proudly scattered in this 1,100-square-foot space. While he vows he would never play if given the chance again, there is no hiding his love for the “chess match” of football. He still watches NFL games, and for a few years after retiring he parlayed his playing career into one as a radio analyst. But that, too, had to be scaled back and eventually put on hold because of his condition.

“I think it’d be frustrating for any person,” Bailey says. “But for someone who made a career of being a professional athlete and being that big, strong, tough person to not be able to do these things — there’s pride and you don’t want to admit that you need help and that you’re vulnerable.”

His shoulders, pummeled by defenders, became so sore late last year he was unable to lift his kids and help with small projects around the house. His hips took a beating with the constant shifting, cutting upfield and repeated tackles. And his knee pain is a sore reminder of it all.

“But that’s part of the price to pay in playing the game,” says Mark Schlereth, 50, a former Broncos guard who played 12 NFL seasons and had 29 surgeries. “I knew what I was doing to myself. I’m not naive. I didn’t think, ‘Oh, I had no idea that this is what it was going to feel like.’ No, I knew. You didn’t have to tell me that what I did to myself was abusive. I signed up to do it.”

Putzier and Bailey remain hopeful that he will recover enough to resume the activities he enjoyed even just four years ago. But as the many treatments slowly try to untangle those knots, the most obvious question — the one at the heart of players’ search for solutions — can’t be ignored.

“Why do some guys go on to live very functional lives, and some guys, their brains just kind of break down?” Schlereth says. “I always thought your body is such an unbelievable compensation machine. Why do some guys seem to be able to overcome and other guys can’t? I’ve always felt like there’s some genetic predisposition.”

Putzier and Bailey smiling

AAron Ontiveroz, The Denver PostPutzier and Bailey smile as Jeb talks on the phone with his son, Matthew, to see how his baseball game went. More photos

Fear of the future

Dr. Sherrie Ballantine-Talmadge, a physician and pain-management specialist at the University of Colorado’s Sports Medicine and Performance Center in Boulder, has an adage she shares often with colleagues but admits is rarely said outside her clinic’s doors.

“Once you’ve seen one concussion, you’ve seen one concussion,” she explains, “meaning each concussion is different and each concussion within each person is different.”

Old therapy offers hope for concussion treatment

The inner workings of Jeb Putzier’s mind are bound in a 36-page booklet that rests on the desk of Rachel Ragsdale, a neurofeedback specialist and counselor at NeuraPerformance Brain Center in Denver.

The booklet is a guide for Putzier as he sits through a course of self-regulation called neurofeedback. For 20 to 40 minutes at a time, the former Broncos tight end engages in a video game-like activity at Ragsdale’s office while his brain waves are monitored via a quantitative electroencephalograpy (qEEG). The data from the qEEG is then converted by Ragsdale into a complex map of Putzier’s brain.

“That brain map allows us to see where there’s overactivity or underactivity in the brain,” Ragsdale says. “We’re looking at the math of your brain.”

The data is then given to Putzier so he can try to retrain his brain’s activity while playing the video game, which is designed to target certain functions of the brain. If he’s successful, he’s rewarded with various stimuli, such as seeing a virtual airplane let out a blast of smoke.

“Your brain craves and loves novelty stimuli, so when it sees that, it’s going to be like, ‘Oh, how did I do that?’ You might not consciously be thinking, ‘How did I do that?’ but your brain is figuring out all sorts of stuff,” Ragsdale says.

The therapy, which was developed nearly a century ago, is one of many Putzier is trying to alleviate symptoms he believes are a result of the concussions he suffered while playing football. Outcomes often vary, but neurofeedback has shown promise in improving the symptoms of ADHD and has been used by Olympic and professional athletes to improve focus, confidence and reaction time.

Putzier, who recently began undergoing neurofeedback, will have 20 sessions, which he hopes will reduce his headaches, stabilize his emotions, improve his mood and ease his dizziness — all symptoms associated with mild traumatic brain injuries.

That, in part, is perhaps why Putzier is a self-described shell of himself and Hall of Fame quarterback Warren Moon, who played 23 years of pro ball, has the mind and the body of a man much younger.

“I had six concussions, and I don’t know how many more times where I was dinged in the head, where I kind of lost my faculties for a few seconds and was able to get everything back and stayed in the game,” says Moon, 59.

The public discourse regarding football-related injuries is louder now than ever, but far more is unknown about traumatic brain injuries than known.

“It’s an awareness problem,” says Dr. Geoffrey T. Manley, a professor and vice chairman of neurological surgery at the University of California, San Francisco. “I see us in the very early days of this. With brain injury in general, we’re at least 20, 30 years behind cancer and heart disease.”

Which is why Moon and some other retired players feel fortunate but anxious — anxious about when the symptoms may hit them.

“Physically I feel really good, but I worry every day when are some signs going to show from concussions and head injuries that I did have in my career,” says Moon, who plans to donate his brain to research for chronic traumatic encephalopathy (CTE). “You live every day wondering if this is ever going to creep into your body, just because you’re seeing so many of your peers who are around the same age struggling with this type of stuff.”

When Moon retired, he received a complete physical assessment in Seattle to determine any physical deficiencies to help him manage his minimal pain and ward off the cognitive symptoms he so fears.

“Football takes a tremendous toll on your body, and you don’t really realize it until you’re actually done,” Moon says. “Once you get away from it, you start to feel those effects.”

Anatomy of the hits

Tyler Polumbus felt it. He felt it before he got away from the game.

The former Broncos offensive tackle retired in April after an MRI showed a herniated disc in his neck that has been causing a shooting pain down his left arm. The images also showed four degenerated discs in his lower back that caused significant pain last season. Surgery on those probably isn’t an option, he says.

Putting a label on persistent concussion symptoms

Jeb Putzier says he recently received a diagnosis of postconcussion syndrome (PCS) that explains the various symptoms — headaches, dizziness, depression — he has been dealing with since retiring from football.

Patients with PCS have symptoms of concussions that persist for at least three months after suffering a concussion. Patients with chronic postconcussion syndrome deal with the symptoms for usually a year or longer. Putzier last played professional football in 2010, in the United Football League.

The diagnosis is typically made from a combination of examination findings, such as balance and eye movements, brain images to detect any abnormalities, and neuropsychological tests for memory and the ability to organize thoughts, among other things. While the symptoms of PCS appear similar to other disorders, including post-traumatic stress disorder, one key factor sets it apart, according to Dr. Erin Manning, a neurologist at the Hospital for Special Surgery in New York.

“What differentiates (PCS) is that it doesn’t progress,” she says. “It doesn’t continually get worse. It can just stay at a level or gradually improve over time.”

PCS has the potential to be lifelong, Manning says, but the effects can often be minimized with therapies, which Putzier continues to do with Dr. Shane Steadman, a chiropractic neurologist in Englewood. But as with concussions themselves, researchers don’t know why lingering effects of concussions develop into PCS for some and not for others.

“We all think we’re invincible,” says Polumbus, 31. “It never once hit my mind until that the concussion stuff, and that was the first time I was really like, ‘All right, I need to be careful here.’ And even then, you never think you’re going to be one of the stats. Now that I’m retired and I’m actually seeing the MRIs and I’m actually seeing the causes of why I’m in pain, it makes me more concerned that while I was playing I just thought it was bumps and bruises.”

Polumbus now counts himself among the fortunate but cautious. In the past three months he has shed nearly 40 pounds through diet and exercise, in part, he says jokingly, to stave off calls that may lure him back to the field. His only surgeries (on his shoulders) came in college, and he was reported to have only two concussions in his NFL career, both in 2012 while he was with Washington. But he has dealt with a persistent headache ever since.

The aura of invincibility and the high pain threshold that helped him get to the NFL and last eight seasons are now causing him to be nervous about the unknown.

“A little bit,” he admits. “Honestly, that’s my worst problem right now. I’ve just been living in pain for so long, I thought it was normal. Now that I realize that I’ve got that many (degenerated) discs, I’m more worried about it than I was.”

Soon, Polumbus will travel to New Orleans for a complete brain and body assessment at Tulane University, coordinated by The Trust, an organization established by the NFL Players Association to support former players. He hopes the examinations, combined with the MRI he received, will give him a solid framework to build a treatment plan — much as the qSPECT images gave Putzier a blueprint for recovery.

Because, like Putzier and Moon and many other retired players, Polumbus knows how he got here. And he, too, is hunting for answers.

“I’m not crippled by any means, but it’s significant pain,” he says. “Honestly, it’s one of those things I never know — our pain threshold is so different from other people that I always wonder, should I be living with this? I’m concerned about it, so I’m trying to be proactive about it.”

Putzier struggles to remember how to play a song on his guitar

AAron Ontiveroz, The Denver PostListening to music and playing guitar has been a hobby of Putzier’s, but he sometimes struggles to recall the lyrics and chords to songs. More photos