Thursday, September 1, 2011

A concerned hockey mom writes . . .

The issue of fighting in hockey, especially in major junior leagues and below, and whether it’s time for it to go away isn’t going to leave us any time soon.
In fact, there are those in the medical profession who wonder if government agencies will at some point have to get involved to bring the fighting to an end.
Here’s a letter from one of those medical professionals, a hockey mom who lives in B.C., and who deals a lot with Alzheimer’s patients.
(NOTE: The numbers in parentheses refer to notes that are referenced at the end of the letter.)
I believe it is time for the medical community to consider the evidence that we have and to act to pressurize this government to protect our children who play hockey.
Last year, the Western Hockey League, a junior league that has players aged 15-20, reported 100 concussions. A prospective study of concussions in junior hockey in Ontario (1) showed that concussions are under-reported in junior hockey, suggesting that this number is probably a lot higher. This study also found that 25 per cent of concussions were caused by fights.
We now have neuropathologic evidence of an early onset dementia (Chronic Traumatic Encephalopathy — CTE) in two NHL enforcers — Bob Probert and Reggie Fleming.
Clinically Chronic Traumatic Encephalopathy is characterized by memory disturbances, mood disorders, behavioural and personality changes, parkinsonism, and speech and gait abnormalities.
Dr. Ann C. McKee (2) reviewed 47 cases of neuropathologically verified CTE in the literature showing atrophy and neurofibrillary tangles in a characteristic pattern. Ninety per cent of cases in the review were in athletes — 85 per cent were boxers, 11 per cent were football players, one was a professional wrestler, and one a soccer player. They began their sporting activities between 11 and 19 years of age. They first had clinical symptoms between the ages of 25 to 76 years.
Of the football players, two committed suicide and two died in traumatic circumstances. A recent report in The Globe and Mail of brain pathology of four deceased CFL players reveals CTE in two and Parkinson’s disease and ALS in the other two (3).
In the hockey world people are shocked by the recent deaths of  five young “enforcers.”
Probert, 45, died of a heart attack, but was found to have CTE.
Derek Boogaard, 28, died of an overdose after struggling with chronic pain and memory loss.
Barry Potomski, 38, died of a heart attack.
Rick Rypien, 27, died last month, presumed from suicide.
On Wednesday, the apparent suicide death of  Wade Belak, 28, another enforcer, was reported.
The neuropathology is not yet available on the last four men, although researchers are in the process of examining Boogard’s brain.
Boogaard's challenges of substance abuse, memory lapses and depression are highly suggestive of the clinical histories of other athletes with documented CTE. Some NHL enforcers are coming forward to talk about their experiences of impaired memory and chronic headaches, disability and struggles with substance abuse. Marty McSorley is quoted as saying: “Then there are times when I'll walk into a room and I'll stand there and go 'Why am I here again?' — and you just don't know.” (4).
These are the facts we know.
What we don't know is how many concussions are required to cause CTE. We don't know if a young brain is more vulnerable. We don't know if seven concussions in a WHL career will be enough to set in place the cascade of damage that causes CTE.
I believe we don't need to know those facts to act and to push the provincial government to ban fighting in junior and recreational hockey and create increased accountability from the hockey system for head trauma to young athletes. This is a preventable dementia and we need to do what is necessary to prevent it.
The WHL has put in place new rules regarding hits to the head (and has moved to soften shoulder and elbow pads) and that is excellent news. However, there is no movement on banning fights. There is no way of knowing whether fighting or other causes of head trauma pose the bigger risk and I don't think it matters. We do know that the hockey players who have suffered most from this disease were enforcers and that 25 per cent of concussions in Jumior hockey are caused by fights. Fighting is gratuitous and preventable and the coaches and the referees, the fans, the parents and the whole WHL system are accountable for it.
Why is the provincial government not calling in child protection services to disallow adults from sending children out to fight against each other for the entertainment of a crowd?
Surely we need to step up and protect these children? Particularly as we are now aware of a very real risk of long-term devastating damage.
I am a hockey mom — I love the game, I love the kids who play it and I have loved my involvement with junior hockey. We owe it to all of our kids to ensure that they are safe when they go out on the rink.
(1) Echlin PS Neurosurg Focus. 2010 Nov;29(5) A prospective study of physician-observed concussions during junior ice hockey: implications for incidence rates.
(2) Ann C. McKee, MD, J Neuropathol Exp Neurol. 2009 July; 68(7): 709-735.  Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy following Repetitive Head Injury
(3) Allan Maki, Globe and Mail, Tuesday, July 26, 2011 Donated brains of two former CFLers show signs of disease
(4) Globe and Mail March 2011 Young players poorly protected, Marty McSorley says.
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