Issue #96: Concussions and Clarity

(UPDATE: 7/19/2015 – I rarely edit my articles for content, but I’ve been a concussion-addled mess for the better part of a month. I finally noticed a decent amount of clarity last Friday the 16th, and while the first draft of #96 wasn’t embarrassing, upon review I thought it needed some tightening. This update is the post-concussion version of #96, which I hope paints a more-complete picture.)

One of the best sports-themed websites in publication is The Players’ Tribune, which grants professional athletes a forum in which they can convey their unique views and perspectives. The hockey-related content, such as this stellar piece by Pascal Dupuis of the Pittsburgh Penguins, is always must-read material.

One recent article in particular struck a chord with me. It’s a piece by Chicago Blackhawks forward Daniel Carcillo, in which he pays homage to recently-departed former NHLer Steve Montador. Steve Montador, “Monty” to his friends, suddenly died in his home in February 2015. Montador had been instrumental in helping Dan Carcillo, among others, acclimate to life as a professional hockey player and helped Carcillo cope with substance-abuse issues.

Steve Montador was beloved, and his passing reverberated around the League. Montador’s autopsy would reveal that he had a severely-progressed case of Chronic Traumatic Encephalopathy, or CTE. CTE is a degenerative brain condition that mimics dementia.

As per the Montador article, here are some of the symptoms of CTE, as explained by Steve’s father:

“…depression, memory loss, vertigo, nausea, and insomnia.

The concussions “had significant impact in terms of memory loss, thinking, decision-making — all kinds of things that were difficult for him near the end of his life,” Montador’s father said.

“He would forget things within minutes. And he knew it. He realized it. He was trying to relate it to the concussions or depression or whatever was causing those things.”

The effects of CTE and repeated concussions are just heartbreaking, but they are an inherent risk that contact-sport athletes consent to. Stories like Steve Montador’s, tragically, are not so much rarities as they are rapidly-growing concerns, or even an epidemic.

If you want to depress yourself, you can read about former NHL players Bob Probert, Derek Boogaard, Rick Rypien, Wade Belak, and most recently Todd Ewen. These stories will make you sick to your stomach. There’s also the tragic case of former Pittsburgh Steeler Mike Webster, who regrettably has become the textbook example of CTE.

If you skipped the Carcillo article linked above, at least watch this brief video of Carcillo talking about his friend Montador:

 

Carcillo makes a call for a stronger “exit program” for NHL players, as many players end up leaving the League not only in damaged physical condition, but also with very limited job or practical skills. Carcillo is certainly right in calling for the sport to do a better job taking care of it’s players, and his take on the concussion-related issues that afflicted Steve Montador is harrowing.

(UPDATE: Dan Carcillo abruptly retired from the NHL to found the player-support program known as Chapter 5, named after Steve Montador. Say what you will about Dan Carcillo the hockey player, but Dan Carillo is a conscientious human being.)

Montador’s story is tragic, but is hardly the first of it’s type. Other notable athletes whose lives ended due to CTE symptoms include for NFL stars Mike Webster and Junior Seau, among others. You can read their respective tales of tragedy via the links above.

All of this information would be troubling under any circumstances, but here is why all of this is so personally-relevant to me:

Concussion #8 (?)

In mid-June 2015, I took a hard elbow in a hockey game where the lower jaw meets the ear on the back of my head. I don’t remember all of the details, but I remember that I was on a half-breakaway. I’m a left-shot player, and I was cutting across the goaltender from my left to my right on my forehand. I thought no one else was around me except for the opposing goaltender.

The last thing I remember is a player with red gloves/pants nailing me behind the right ear with either his hard-cap elbow pads or the butt-end of his stick.

My legs immediately gave out, and I laid face-down on the ice for what was probably only 15-20 seconds, but felt like an eternity. My eyes were open, but I could only see black. It was the loneliest feeling in the world. I vaguely remember thinking, “that was the hit that finally put the lights out.” I remember that it felt like dreaming.

Slowly, my vision returned, and I realized I was looking at the ice as the black gave way to white. I could now hear a player from the other team calling for the officials to blow the play dead, but as my vision returned I got to my feet and skated back into the play. A teammate of mine later said I was stumbling, and he originally thought that I had injured one of my legs. Hello, concussion walk.

As I write this, I’m getting angry remembering the game. I am not a player who goes down easily or flops to draw calls, but amazingly neither official saw a penalty on the play. I got off the ice as soon as possible because the right half of my head was killing me, but finished the game.

The player who hit me had been running around like an asshole all game long. He had taken two separate runs at one of my team’s better players, and earlier in the game had run our goaltender. He was playing an adult-league game recklessly at best, and at worst he skating around trying to hurt people.

My philosophy in hockey, particularly adult-league hockey, is Shut Up and Play. I remember yelling from the bench at my notoriously-chatty goaltender earlier in the game to “get back in the crease and shut the fuck up,” as he was crowing at the player who ran him, meaning the same player who would later run me.

I didn’t go after the kid earlier in the game, before he had the opportunity to seriously hurt someone, and that was a mistake on my part. I had failed to enforce the Spider-Man Rule, which is that you deal with or neutralize a potentially-problematic person before he or she does something that can’t be undone. Because I failed to act earlier, I ended up the victim of my own restraint, and now the proud recipient of no less than eight concussions.

Anyway, a bit later and with a little encouragement from me, this asshole was kicked out of the game early in the third period. The genius had managed to rack up five minor penalties in just over two periods of play, and that didn’t include the elbow/butt-end on me or the run on my goaltender. But it was too late. I knew I would be spending the next few days, at least, in the quiet room.

To the kid’s credit, he later came and tried to apologize, but I wasn’t having it. He was mercifully pulled away from me before I could fight him. I was livid, as the combination of my throbbing head and my disdain for dangerous beer-league players didn’t leave me in the most diplomatic mood. In fact, I often wonder if the number of knocks to the head I’ve taken have permanently altered my mood, which I’ll try to explain in the next section.

Backstory and Perspective

I need to rewind a bit in the interest of making a few points.

My first point is about who we are versus who we may have become, and I’ll use myself as the example:

I was born intellectually-gifted. I routinely got “99” on those standardized tests that are given to grade-school kids, and I was once reprimanded for bringing home a report card with a “B” on it. I got a 1390 on my SATs, finished high school with a 4.25 GPA thanks to Honors class weighting, and got a large academic scholarship to a very well-regarded private university.

All of that means nothing, as I’ve largely squandered my academic and intellectual gifts by using my head as a battering ram for the past two decades. But there was a point when my brain was an uncashed lottery ticket.

That time has seemingly come and gone, and noting that my memory is basically garbage at this point, a look at my college transcripts can pinpoint the exact time period that everything changed for me.

In January of my Senior year of college, I got my fifth or sixth concussion playing hockey. Within the same month, I got my sixth or seventh concussion playing hockey. I have only the most vague recollection of the situation in which I got each concussion, but I kind of remember getting two big hits to the head within a few weeks of each other early in my Senior year.

Back when I was playing in college – and this was circa 2007 or so, not 1974 – concussions weren’t really treated as a big deal. Are you awake? Can you stand? OK, shake it off, get back out there, and skate a little harder.

In fact, it really took an epidemic of head-shots in the NHL – most notably the shots taken to the head of NHL poster-boy Sidney Crosby – to raise awareness about concussions. As I’ve tried to explain to people, a concussion isn’t like a broken bone or even a bad bruise, because barring a CT Scan or an IMPACT test, there’s no tangible evidence. Because concussions don’t leave telltale signs, historically they have been marginalized compared to more-obvious injuries.

Anyway, after taking two concussions early in my Senior year, I proceeded to fail five of the six classes I was enrolled in. My mother was understandably beside herself, as I hadn’t gotten anything lower than a B-minus in my entire academic history, and also understandably she assumed drugs and/or the alcoholic she-devil I philandered with were destroying my life.

It was infuriating to try to explain the situation to my mother, and of greater concern, I was worried that she would try to make me stop playing hockey if I fessed up and told her the full truth. It’s almost ten years too late, but here’s the truth as I remember it:

My head killed me almost 24/7, but because I was this indestructible meathead college hockey player, I didn’t say anything about it. I basically did the worst things I could have possibly done, which included 1) no medical treatment, 2) continuing to play hockey 4-5 times per week, and 3) liberal drinking with she-devil girlfriend.

I did recognize that I was failing what should have been my final semester of college, so I would do things like put myself to sleep at 7PM on a Monday night, only to wake up at 4PM the next day. A few times, I slept well over 24 hours straight.

While rest – meaning time in the quiet room with the electronic screens dimmed-down – is highly-advisable, sleep is still a very debatable remedy for a concussion. In any event, my body’s response was to try to sleep my way though these traumatic brain injuries I had, and this desire or need for sleep forced me to repeat my Senior year. Here comes the Super-Senior!

This was the divergence event, and it brings me to the greater point within the context of the article: what kind of person would we become if not for certain events within our lives?

If I had never taken those shots to the head my senior year of college, who would I have become? Would I be a more well-adjusted member of society? Would I be less aggressive? Would I have greater impulse control? Would I be “nice”? What line of work would I have gotten into? The world will never know.

The same can be said for any number of people. Almost everyone has a few events that radically alter the course of their lives. But fewer people can pinpoint the exact moments in which their lives take a sharp turn in a different direction, and even fewer can attribute these changes in character to physical (rather than emotional) impact.

There’s a well-known story about an American railroad foreman named Phineas Gage, in which Gage survived a catastrophic injury to the frontal lobe of his brain. Per Wikipedia:

Phineas P. Gage (1823 – May 21, 1860) was an American railroad construction foreman remembered for his improbable[B1]:19 survival of an accident in which a large iron rod was driven completely through his head, destroying much of his brain’s left frontal lobe, and for that injury’s reported effects on his personality and behavior over the remaining twelve years of his life—​effects so profound that (for a time at least) friends saw him as “no longer Gage.”

Again per Wiki, these are the functions of the frontal lobe. My notes are in bold:

“…involves the ability to project future consequences resulting from current actions (need for immediate gratification versus long-term), the choice between good and bad actions (or better and best), the override and suppression of socially unacceptable responses (aggressive/anti-social behavior), and the determination of similarities and differences between things or events (sharp memories versus Vague Memories).

The frontal lobe also plays an important part in retaining longer term memories which are not task-based (the Memento Effect). These are often memories associated with emotions derived from input from the brain’s limbic system. The frontal lobe modifies those emotions to generally fit socially acceptable norms (again, antisocial/nonconformist emotions).”

The story of Phineas Gage is almost-metaphorical, but serves to illustrate the potential severity of head injuries. Educated people can no longer be ignorant to how life-altering concussions and concussion-related conditions such as CTE can be.

Adjustments

Above, I considered who I might have become had I not taken so many hits to the head, i.e. a nice, normal, well-adjusted member of society. By contrast, here are the alterations I’ve made to my life as a result of the brain injuries I’ve incurred:

  • Writing

I’ve mentioned this before, but I write in large part because my memories and thoughts are fleeting, at best. Sometimes driving home from hockey, I’ll have a tremendous idea or a great narrative hook, but if I’m not quick to write it down, I’ll likely lose it forever. I sometimes read things I’ve written and think, “that’s brilliant”, but have little or no memory of having written said piece.

I was writing as far back as middle-school, but I would say the way I write now is as much therapeutic as it is artistic. I literally write ideas down so that I don’t forget them, or so that I don’t forget momentous occasions in my life.

(Funny aside: I was hanging out with my old pal Billy last year. Billy went to college with me, and at one point lived with the she-devil ex-girlfriend mentioned above. We were talking last year, and he starts talking about “Chris.” I’m like, “Who the hell is Chris?”

Billy looks at me sideways and again says “Chris. You know, you dated her for three years???” And I go, “OH, KRISS! Haha, I had forgotten about her  and her soul-sucking drama entirely.” See? Brain damage taketh away, but it also giveth.)

  • The Notebooks

I mentioned the movie “Memento” in the above section. In the film, Guy Ritchie tries to organize his life by keeping a system of notes and learning to trust his own handwriting and instincts. I’ve adopted a similar system.

Those who know me in real life will notice that I frequently carry around these little 4″ Mead notebooks at the expense of looking like a bookie. I use these notebooks for a variety of tasks, mainly to organize my thoughts but also to write out the tasks I need to complete step-by-step. The notebooks are mostly filled with chicken-scratch and strike-throughs and check-marks, reminders of tasks I’ve completed or plan to complete.

If I don’t keep lists, I’m liable to walk into a grocery store and suddenly have no idea what I’m there for. If I’m not careful, I’m capable of doing things like buying half-gallons of almond milk multiple days in a row. Nothing majorly catastrophic, as I consider the Notebook Gimmick part of the cost of my life as a hockey player, but life without these notebooks would be pretty inconvenient.

  • Bright lights/Noise

I’m rarely photographed without a pair of sunglasses in the frame, and I mostly hate anything extremely-bright. As an example, I live at the beach yet go no more often than once or twice per year because the glare off the water makes my temples throb. I’ll wear sunglasses indoors on occasion and draw the requisite Maverick jokes.

That goes double for noise. I just about refuse to go to concerts, and I’m known to get up and walk out of a loud bar or restaurant if the noise is loud or pervasive enough.

Again, these are concessions I gladly make for love of my sport. But I am a little curious what it would be like to actually want to go to a Rise Against concert or spend a day on a boat.

  • Diet/Exercise

Exercise helps clear my head in a very literal way. My theory is that the type of exercise I tend to do (strength training for hypertrophy) and the type of diet I generally follow promotes Anabolism, which spurs regeneration of damaged brain cells in a similar way to the regeneration of damaged muscle cells.

Playing hockey promotes Anabolism via a different pathway, due to the amount of growth hormone and testosterone that is released during high-intensity anaerobic activity. I almost always feel mentally-sharper after a good skate, assuming I didn’t get my head clubbed in.

Is this science bulletproof? No, but I’m both Lead Scientist and Lead Lab Rat. My experience has been that following the diet and exercise protocols of a bodybuilder/anaerobic athlete improves my cognitive function. I’ll save the rest of the science-heavy talk for a future scholarly article.

For health enthusiasts, I’ve also noticed that inflammatory foods increase my headaches and decrease my mental clarity. The most inflammatory foods for me seem to be wheat, dairy, and soy, and when I get lazy and start having pizza with any regularity, I immediately notice a recurrence of concussion symptoms. It’s almost like the brain-bruises feed off these inflammatory foods.

  • Caffeine

My body has a love/hate relationship with caffeine. While it’s great for jump-starting my brain in the morning and aiding cognitive function, it also seems to promote a cortisol release (which makes sense because cortisol often comes hand-in-hand with an adrenaline boost). My body runs hot (hyperthyroid) and loves to burn up muscle, and high caffeine intake seems to erode my explosiveness/strength and invite joint injuries.

So what’s a guy in my position to do? Being a hockey player, I’ll steal a quote from Gordie Howe about why he wore a protective cup but not a helmet:

gordiehowe

I generally opt to be sluggish, stupid, and unbearable before noon rather than let caffeine intake indirectly chew up my lean body mass. But there are periods of time, such as these past two weeks post-Concussion #8, in which I’ve upped my caffeine intake to help with mental clarity.

The Biggest Frustration

Shortly after receiving Concussion #8, I attended the wedding of my best friend from high school. It took a concerted effort just to keep the nausea at bay, but this was my oldest friend and there was no way I was going to miss her wedding. So I rode shotgun while my sister drove the two of us to Boston for the wedding, with a dark pillowcase wrapped around my eyes.

At the wedding, there was a live band, and the wedding featured a lengthy cocktail hour following the ceremony. The cocktail hour was in this confined area near the band, and my head absolutely could not take that much noise in an enclosed area. So I went inside to where dinner was being served, and sat by myself for the duration of the cocktail hour.

Both the bride and the groom came in and did everything in their power to make me comfortable, but neither of them are athletes and really have no understanding what a hit to the head feels like, let alone a severe one. I sat there and nodded dumbly at them like Rain Man and quiet sipped my Absolut-and-soda while the wedding unfolded around me.

The bride and groom didn’t make a big deal about it, but the bride’s sister and several other inebriated guests kept hammering me about how anti-social I was being. I sat there and smoldered, because these drunken fat fucks, who hadn’t so much as broken a sweat since 1999, screeched at me like horny alley-cats because I wasn’t pounding shots of Cuervo or doing the Cha-Cha slide.

This is the battle Hockey Players, from mites to professionals to beer-leaguers, wage: Hockey Players live in various levels of discomfort at all times, ranging from bumps-and-bruises to broken bones and soft-tissue tears. Hockey Players become accustomed to chronic discomfort, and hold decorum while injured as a badge of honor. This is a sacrifice that the rest of society needs to have a better appreciation for.

And while like most Hockey Players I take injuries in-stride, this is the most frustrating part for me about Concussions:

If I had shown up the wedding with my foot in a cast, all parties concerned would have been falling all over themselves to fetch me drinks, dinner, and otherwise dote upon me. I would have gotten a healthy amount of sympathy, and the collective would have worked to make me as comfortable as possible.

But you can’t see a Concussion, so it doesn’t “count” as an injury. In the view of the uneducated masses, a Concussion is just something I’m making up as an excuse to be anti-social and sullen.

This frustration is not unique to me. Any athlete, and especially any contact-sports athlete, deals with very similar frustrations. It’s part of the trade: you don’t get the accolades and the glory without the pain and discomfort. But the overall lack of understanding about the severity of Concussions by the Average Joe remains a major point of frustration.

On Clarity

I’m writing this article in one sitting because for the first time in two weeks I feel reasonably “clear”. I don’t have the mental fogginess or inability to focus that is so commonly associated with concussions, and it’s important to me to get this piece out while I can think straight.

I have been angry – almost furious – for most of the past two weeks, to an irrational degree. I believe I was justified in angrily-refusing to accept an asshole’s insincere apology, but I’ve been irritable or worse for most of the past two weeks. I’m not feeling spectacular as I write this, but at least I recognize that my behavior and manner of thinking over the past few weeks has been uncharacteristic.

These little tastes I’ve taken from the concussion buffet are enough to make me very interested in increasing concussion awareness. I didn’t want to write another article in which I droned on about myself, but I believe it’s necessary that I do my part to increase concussion awareness and to discourage other players from trying to cripple each other with unnecessary head-hits.

I was talking with one of my teammates last week, and we were talking about the difference between “Hockey Players” and “people who play hockey”. Here’s one clear distinction between the two:

My view is that Hockey Players – especially humble A-leaguers such as myself – have a responsibility to protect each other on the rink. None of us are being paid, and most of us are going to work the next day. There’s no need to ever see a blindside head-hit in an adult-league game. Hockey Players need to have a baseline level of respect for each other, because at the end of the day, we’re all pretty similar and most of us share a love for the sport. It’s insane to be throwing head-hits in games that mean nothing.

As for “people who play hockey” – including those types who show up to games drunk and/or high and serve as a danger to others with their disrespectful, reckless play – this recent experience with Concussion #8 has left me far less charitable or sympathetic than I was two weeks ago, and I wasn’t all that charitable or sympathetic to begin with.

So I’m back to my zero-tolerance policy with people who deliberately endanger other players. As explained in Issue #90, I would rather have twenty hockey-fights per year than let some irresponsible clown or coward injure one of my teammates or me with blindside hits or slew-footing in an adult-league game. I’m sure that seems contradictory to embrace fighting while denouncing concussions, but I’ll save the pro-fighting/anti-headshot discussion for another time.

As Dan Carcillo wrote in his Players Tribune article, the concussion and CTE conversation needs to continue. Hockey administrators at the developmental levels need to do everything in their power to discourage head-hits. Adult league managers need to punish high-hits at a level commensurate to Fighting. Professional leagues need to continue constructing concussion awareness and exit programs for their players so that stories like Steve Montador’s have less of an opportunity to repeat themselves.

Thanks for reading,

Jack

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One thought on “Issue #96: Concussions and Clarity

  1. HELLO JACK, ABOUT 3 MONTHS AGO I CAME ACROSS AN ARTICLE YOU WROTE ABOUT SKATE FITTING, TONGUE PLACEMENT ( “IN” OR “FLOPPED”) , KNEE PROBLEMS OCCURRING FROM TAPING THE TENDON GUARD , ECT.
    I BOOKMARKED IT BUT CANNOT SEEM TO FIND IT HERE OR ON REBOOT HOCKEY.
    CAN YOU PLEASE POINT ME IN THE RIGHYT DIRECTION ?
    BY THE WAY, I AM RETURNING TO THE GAME AFTER 20 YEARS AWAY. I BOUGHT NEW GRAFS TO REPLACE MY MICRON MEGA AIR 10-90’S. YOUR ARTICLE HAS HELPED ME GET THE GRAFS TO MOVE LIKE THE MICRONS. SINCE I DID NOT CHANGE GRADUALLY WITH THE EQUIPMENT AND I AM TOO OLD TO CHANGE NOW, I HAD TO WORK MY BACKWARDS ; SORT OF SPEAK.
    BELIEVE IT OR NOT EVEN MY OLD SHIN-PADS PLAYED A PART BECAUSE THEY NO LONGER STAYED UP AND WERE SCREWING UP MY ANKLE FLEX HALF WAY THROUGH A GAME ! I AM AN OLD SCHOOL FLOPPER.
    THANK YOU FOR A VERY INFORMATIVE AND WELL THOUGHT OUT ARTICLE.
    PAT.

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