I love hockey and like my fellow Canadians, hockey runs in my blood. I feel exhilarated when my home town teams won or when Canadian teams won in international events. I will even admit I love the Paul Newman starred hockey movie “Slap Shot” (1977). Yes, the movie about a failing ice hockey team that finds success using “constant fighting and violence during games“. If I love “Slap Shot“, then why am I asking “are we willing to see NHLers suffer from brain damages #CTE”? I found “Slap Shot” fun to watch because I can imagine my and the viewers’ ignorance was a bliss in 1977. Because viewers in the last century had no idea about Chronic traumatic encephalopathy (CTE), a progressive degenerative disease found in individuals who have been subjected to multiple concussions and other forms of head injury.
The medical evidences are mounting and lovers of hockey should pay careful attention if we truly love our hockey players and will not risk their long-term health for our entertainment. [note: I read some of the following medical research findings after I posted my tweets last night. The most important article is the CMAJ’s editorial.]
* Editorial of Canadian Medical Association Journal (CMAJ) “Stop the violence and play hockey” – Rajendra Kale, MD, Editor-in-Chief (Interim) (updated Feb 21, 2012) Here is an excerpt (emphasis added),
“What researchers from the Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine have found in the brains of three prominent hockey players — Rick Martin, Reggie Fleming and Bob Probert3–5 — should be enough to sway minds to impose a ban on all forms of intentional head trauma, including fighting, along with severe deterrent penalties such as lengthy suspensions for breaches. In 2009, McKee and colleagues reviewed 48 cases of neuropathologically verified chronic traumatic encephalopathy (CTE) and documented the findings of CTE in one football player and two boxers.5 To date, they have analyzed the brains of 70 athletes, and over 50 have had pathological evidence of CTE (Robert A. Stern, Professor of Neurology and Neurosurgery, Boston University School of Medicine, Boston Mass.: personal communication, 2011). The simple message from the work done by McKee and colleagues is that the brain does not tolerate repeated hits. CTE has been described in boxers and others under various names such as dementia pugilistica, punch drunk syndrome and boxer’s encephalopathy. CTE is associated with memory disturbances, behavioural and personality changes, Parkinsonism, and speech and gait abnormalities. Hockey has now been unceremoniously added to the list of sporting activities that result in CTE. […]
Scientists might argue that three sliced up brains is not enough evidence and that long-term cohort studies are needed to prove beyond doubt that hockey players are at risk of CTE. Evidence from boxing injuries collected over decades shows that repeated head trauma can cause brain damage. This evidence can be extrapolated to hockey. Vested interests will no doubt lobby to prevent a ban on fighting, but I call on all doctors to support a ban on all forms of intentional head trauma and endorse deterrent penalties in hockey.
Fifty-two concerned players have agreed to donate their brains to the brain bank in Boston (Robert A. Stern: personal communication, 2011). But how many brains should researchers have to slice up to convince NHL players that they are at risk of permanent and progressive brain damage? Should we not stop the violence now and get on with the main objective of hockey, which is scoring goals? Maybe the class action suit filed against the National Collegiate Athletic Association by a former student who played for the Panthers and has memory loss, depression and migraines, which he asserts he suffered as a result of concussions playing football, may provide the final impetus for change.6
As I was writing this editorial, a fourth hockey player, enforcer Derek Boogaard, has been found to have CTE.7 At this rate, this editorial may never be up to date.“
[note: The last line is very chilling to me. How many more hockey players do we need to see add to this editorial before we finally change our long-held believe/wish that everything is ok.]
* New York Times, “Brain Damage Found in Hockey Player” (Reggie Fleming) Here is an excerpt,
“Chris Fleming said that his father went through decades of emotional problems after retiring. He was found to be manic depressive in his early 40s, drank excessively during that period, and exhibited striking short-term memory problems in his late 50s. Chris Fleming said that his father had trouble controlling his temper his entire life — that was one of the reasons for his hockey success — but that it worsened post-retirement.
“He’d get in fistfights with people on the street, and kicked out of the racetrack,” Chris Fleming said. “It just didn’t make sense, someone snapping so quickly and violently. Other hockey players didn’t stay like that. But he didn’t know how to react.”
In the 1990s, Chris Fleming said his father would ask him a question, hear the answer, and then five minutes later ask it again. This could happen three or four times as tension mounted.
“I just told you — you didn’t listen!” Chris recalled saying.
“You didn’t listen!” the father snapped back, having already forgotten the previous exchanges.
Chris Fleming posted several videos on YouTube in which his father reminisced about his life from his hospital bed.
C.T.E. can be diagnosed only post-mortem, with brain tissue being subjected to special staining techniques for neurofibrillary tangles and protein deposits. Experts believe those structural abnormalities bring on significant cognitive and behavioral disturbances for years and sometimes decades at the end of the patient’s life.
Some former N.H.L. players have expressed concern about the repeated blows to the head they took during their careers.
“My memory has gotten worse the last 10 years or so,” said Ron Duguay, who played helmetless for the Rangers and three other N.H.L. teams from 1977-78 through 1988-89 and who is taking a series of neurological tests as a result of his concerns. He agreed to share the results of his tests in an interview last month.”
Here is one of several videos on YouTube posted by Chris Fleming. It is heart breaking for me to watch.
“Dr. Michael J. Stuart, an orthopedic surgeon at the Mayo Clinic in Rochester, Minn., and the chief medical officer for USA Hockey, acknowledged the range of opinions among medical experts.
“These are opinions, very educated opinions and very experienced people providing their opinions,” said Stuart, who was a chairman of last year’s Ice Hockey Summit: Action on Concussion at the Mayo Clinic.
Stuart said he applauded the N.H.L.’s efforts to reduce the number of checks to the head. But “maybe they’re not ready to eliminate fighting now — I don’t know, but I certainly would hope that we head toward that to minimize risk,” he said.
“If we truly want to make every effort to reduce the risk of concussion in the sport of ice hockey, we should eliminate fighting,” Stuart added. “There’s no doubt about that.”
The N.H.L. finds itself in a position somewhat similar to that of the N.F.L. several years ago, when researchers began diagnosing C.T.E. in the brains of former professional football players. N.F.L. officials and the league’s medical experts initially dismissed the findings. But as more cases surfaced and Congressional inquiries were conducted, the league was forced to make rules changes.
Dr. Michael Cusimano, a neurosurgeon at St. Michael’s Hospital in Toronto who is involved in efforts to reduce sports injuries, criticized the N.H.L. for saying it needed more data.
“We heard this about 40 years ago with cigarette smoking,” Cusimano said. “Sure, there can be more evidence, but there’s some evidence out there that fighting is clearly a cause of brain injuries.
“What’s the threshold of evidence that Gary Bettman needs to see this?””
* Boston University, Center for the Study of Traumatic Encephalopathy, “BOSTON UNIVERSITY RESEARCHERS REPORT NHL PLAYER DEREK BOOGAARD HAD EVIDENCE OF EARLY CHRONIC TRAUMATIC ENCEPHALOPATHY” Here is an excerpt,
“* Derek Boogaard’s brain was donated for study after his death at the age of 28.
* Boogaard had evidence of early CTE at the time of his death.
* CTE is a degenerative brain disorder associated with repeated brain trauma, including concussions and multiple subconcussive blows to the head, such as those found in contact sports.
“It is important not to over-interpret the finding of early CTE in Derek Boogaard,” said BU CSTE Co-Director and SLI Co-Founder Robert Cantu, MD. “However, based on the small sample of enforcers we have studied, it is possible that frequently engaging in fistfights as a hockey player may put one at increased risk for this degenerative brain disease.” Added BU CSTE Co-Director and professor of neurology and neurosurgery at BUSM, Dr. Robert Stern, “Boogaard’s clinical history was complex, so it is unclear as to if or how much CTE contributed to his behavior, addiction or death. However, CTE appears to be a progressive disease in some individuals, so even if it was not directly affecting Boogaard’s quality of life and overall functioning before he died, it is possible it could have in the future.”
“Unfortunately this finding does not contribute to our knowledge of the risks of normal hockey play for most participants, as very few hockey players engage in as many fights as Boogaard,” said BU CSTE Co-Director and SLI Co-Founder Chris Nowinski. “Athletes and parents should know that anyone who experiences repetitive brain trauma may be at risk to develop CTE, but we are hopeful that risk is small in hockey.” Nowinski added that two other young non-NHL professional hockey players studied did not show signs of CTE at postmortem examination.”
* ABC News (with video), “Derek Boogaard: NHL Enforcer Had Brain Disease”
I ended up writing quite a few tweets and replies about my takes re hockey fighting. I’ll link and list the tweets here for the record.
And then I wrote this tweet,
Finally, deep in my heart, I hope Derek Boogaard and more importantly Derek‘s widow Joanne and family will understand I mean Derek no disrespect. In fact, my understanding is Derek’s widow donated his brain (and 500+ living professional athletes, dozen NHLers also agreed to donate their brains) for research in hope to protect future athletes from horrible disease like the Chronic traumatic encephalopathy (CTE) which, as I wrote above, is a progressive degenerative disease found in individuals who have been subjected to multiple concussions and other forms of head injury which are fairly common in NFL & CFL players and the enforcers in NHL.
Given the existing evidence re CTE, I feel I had to do and write what I can. “Slap Shot“‘s viewers had ignorance on their side so they can enjoy the fun but not for me anymore as CTE is a serious disease with a deadly consequence.
P.S. I hadn’t planned to @CoachsCornerCBC Don in all the tweets but then if a question is addressed to us all, I didn’t feel comfortable to leave him out. Oh well, someone will likely filtered out my tweets to him
P.P.S.Derek passing away at 28, not even 29 was just too young and too soon.