Wednesday 6 April 2011

Playing sports can and do cause brain injuries

When the Roman Empire was at its zenith, the citizens flocked to the arenas to see the gladiators kill one another. It was called sport. When the citizens of today go to the arenas and fields to watch the players smash into one another, it is also called sport.

The irony of these two time-periods in history, is that both kinds of activities are really about skill. Watching a hockey player shoot a puck past the goalie after skating across the entire length of the area and watching a football player catch a football in midair while other players are grabbing his legs should be far more exciting than watching players getting their heads smashed in. Alas, I suspect that many of the spectators of these two sports are no different than those who go to car racing events; not to see who wins but to see the spectacular car crashes.

Sports concussions are on the rise, particular among younger players, and neurologists are standing together to address this ever-growing epidemic. Often referred to as the "invisible injury," concussions remain mostly a mystery, even to the doctors who spend their lives studying them. But the human lab that is the NHL has made this much clear – the human brain can only absorb so much pounding.

A concussion is an injury to the brain caused by trauma and it interferes with brain function. A player doesn't have to be knocked out to suffer a concussion. An MRI or CAT scan rarely detects brain injury, making diagnosis more problematic.

From 1997 to 2007, the number of emergency room trips for concussion-related symptoms doubled for youngsters aged 8 to 13 and increased three-fold for teens between 14 and 19. Questions abound as to why physicians are seeing more concussion patients these days than in the mid-90s. Insufficient or improperly fitted equipment could be to blame. Even drastic body-weight disparities in youth programs could be causing the spike in the number of reported cases.

But more likely, those involved — doctors, parents, coaches, and players — are becoming increasingly aware of the hidden dangers of these head injuries, and may finally be taking necessary medical precautions by having a player get checked out when he or she is first suspected of having a concussion.

To that end, the American Academy of Neurology (AAN)released new guidelines this week for an advanced call to action. Under the new provisions, players suspected of sustaining a concussion should refrain from further athletic play until they can be properly evaluated by a physician. The AAN also requested that a properly certified athletic trainer be present at all sporting events, whether championship games or the humdrum of weekday practices.

For a successful initiative, knowledge is key. “We need to make sure coaches, trainers and even parents are properly educated on this issue, and that the right steps have been taken before an athlete returns to the field,” said Dr. Jeffery Kutcher, AAN sports-neurology section chair and director of the Neurosport Program
at the University of Michigan.

With more players likely heading to the hospital for medical evaluation of a potential head injury, clinical-testing procedures will have to evolve to aid physicians trying to determine if a player has, in fact, suffered a concussion. Fortunately, new research by Nadia Gosselin and colleagues suggests that advanced imaging (fMRI, or functional magnetic resonance imaging) and brain-activity tests (event-related potential and electroencephalogram) could gain the necessary resolution to pinpoint even subtle injuries to the brain.

Beyond standard neuropsychological examinations that include simple tests that measure verbal and motor responses, these new diagnostic tools, according to the study authors, may one day provide a clear-cut method to determine if it’s safe for players of all ages to return to their sport.

Kimberly Gorgens, a neuropsychologist at the University of Denver, presented her findings recently at the TEDxDU conference in Denver.

Gorgens found that football players specifically absorb some 103 g’s of force when they’re concussed. (To put that into context, 1 g is the normal force of gravity we experience, and 9 g’s is the feeling that fighter pilots of supersonic jets may feel, albeit without the added perk of blunt force that football players get.) She also highlighted the fact that young athletes often experience brain trauma that can be three times more damaging than corresponding concussions suffered by the more developed brains of adults.

These findings come as the House of Representatives prepares to possibly vote next week on the Concussion Treatment and Care Tools Act, sponsored by Rep. Bill Pascrell (D-New Jersey), which calls for the creation of a panel that will issue national guidelines for diagnosing and managing concussion in young athletes up to age 18. It would also direct the Secretary of Health and Human Services to “require states to utilize, to the extent practicable, applicable expertise and services offered by local chapters of national brain-injury organizations.”

The severity of concussions, both in the short- and long-term, has been often discussed in recent months, with the NFL finally opening up about the concussion-related risks associated with football. However, look at the Philadelphia Eagles’ Stewart Bradley from his team’s season-opening game against the Green Bay Packers. What’s not surprising is that Bradley suffered a concussion. That, most people recognize now, is a risk of playing football.

What is surprising that he went back into the game afterward, showing that there is still much education to be done with athletes, doctors, teams and fans alike.

It has only been recently that the sports professions have recognized that greater care should be undertaken to protect the brains of the players, no matter what sport they are in.

Not only are athletes at risk for psychiatric illness, but they are at risk of suicide. A greater effort has to be undertaken to learn more about suicide in athletes and those suicidal players connected to the sports activities.

Dave Duerson, a two-time Super Bowl champion with the Chicago Bears and New York Giants, tragically chose to take his own life last week.

But when the 50-year-old former NFL safety and successful entrepreneur shot himself in the chest, there was another purpose: he did it so that his brain could be donated to Boston University researchers and studied to assess the life-long neurological effects of playing in the National Football League.

For sure, it has been an incredibly enlightening year in the NFL with regards to the present-day and long-term consequences of concussions and similar traumatic brain injuries caused on the gridiron. Duerson, cognizant of and confident that he was suffering from the effects of chronic traumatic encephalopathy — a debilitating brain injury that has stricken many current and former football players, from college to the pros — texted family members only hours before taking his own life, imploring them to have his brain donated to those who can study it for evidence of the condition.

In fact, when police arrived at Duerson’s apartment, they found a hand-written note: “PLEASE, SEE THAT MY BRAIN IS GIVEN TO THE NFL’S BRAIN BANK.”

More specifically, that would be the team headed by Chris Nowinski, co-director of the Center for the Study of Traumatic Encephalopathy at Boston University’s School of Medicine. Last April, after years of denials and side-stepping on the effects of concussions on football players, the NFL finally donated up $1 million to the center in the hopes of accelerating research into a condition that was long associated with punch-drunk ex-boxers. More recently, CTE (which is also known as ”gridiron dementia” and “concussion-drunk syndrome) has been connected to athletes ranging from 21-year-old college football stars to baseball great Lou Gehrig.

And while it’s true that are any number of complicated reasons why Duerson took his own life — it has been reported that he recently filed for bankruptcy — Duerson wanted to be sure that some good came from his death. Researchers can continue to make progress in studying what a lifetime of hits to the head — each around 20 g’s of force, on average — can do to elite football players, often revered in their playing days yet forgotten upon retirement, when the lasting neurological effects finally start to show their presence.

But this is where we are with pro football, in an era where players are preemptively donating their brains to science, like former Chicago Bears quarterback (and Duerson teammate) Jim McMahon. Football is an inherently violent sport and perhaps always will be so, but with more research into CTE, as well as more study and development into safer helmets, we’ll at least be more educated and aware when we see players knocking helmets during the games.

The suicides and evidence keep piling up. And the latest development should be terrifying for any football player and his parents, from Pee Wee Football to an NFL linebacker.

In what has been stellar ongoing reporting on concussions and football, The New York Times had a Page One story on September 14, 2010 about another football player, Owen Thomas of the University of Pennsylvania, taking his own life. Its headline was “In College Player’s Suicide, Signs of Disease that Haunts the NFL.”

The 21-year-old, a popular kid who never had a problem with depression, hung himself in April of that year. His family allowed brain-injury researchers to examine his brain tissue, and the results of those tests are in. And the results are disturbing.

It turns out out that this young man already had the same brain-trauma induced disease — chronic traumatic encephalopathy, or CTE — that has been discovered in the brains of 20 deceased National Football League players. As The Times notes CTE, linked to concussions, has caused depression and impulse issues in pro football players, who have had lost two colleagues who committed suicide, like young Thomas.

What’s unnerving about the Thomas case was that he apparently developed CTE even though he had never been diagnosed with a concussion. His doctors believed that his CTE ”must have developed from concussions he dismissed or from the thousands of subconcussive collisions he withstood in his dozen years of football, most of them while his brain was developing,” according to The Times which added that Thomas is the youngest non-pro football player to be diagnosed with full-blown CTE.

For football, and particularly parents who allow their young sons to play the sport, the news that CTE can develop when a player suffers hard-to-detect-brain damage below the concussion level should be frightening. This is a warning to parents to think twice before permitting their sons to play football. They should be aware that non-concussive brain injury can be inflicted on their sons starting at an early age.

Former Philadelphia Eagles safety Andre Waters, was nicknamed Dirty Waters because of his aggressive on-field behavior. Roughly four years ago Waters took his own life, shooting himself with a Smith & Wesson hand gun when he was only 44.

When he was alive, Waters had stopped counting his concussions at No. 15, according to the Palm Beach Post.

On the heels of Former NFL player, David Duerson’s suicide, the NFL has implemented several on-field additions to player safety. Starting next season all teams will be required to use neurologic test to determine if a player should continue playing on the field. Called “The NFL Sidelines Concussion Exam” the test takes roughly 6 to 8 minutes to complete and includes thinking skills and balance. Participating players will also be asked to submit a written test.

In the aftermath of former NFL player Dave Duerson's death, the NFL is pushing for all 50 states to adopt legislation to help prevent concussions in young football players, but Oklahoma is a step ahead.

The state passed Oklahoma Statute 24-155 of Title 70 last year, which requires an athlete who suffers a concussion to be removed from the game and not allowed to play until he has been cleared by a medical professional.

Oklahoma high school coaches are pleased with the direction the state is going in concussion management, both through the statute and through the actions of the Oklahoma Secondary School Activities Association, which is working to keep coaches and officials informed about concussions.

Eight other states have passed similar legislation, according to the NFL. The topic resurfaced in the last few days after Duerson, an NFL player from 1983-93, died last week of a self-inflicted gunshot wound. For example, Oklahoma, coaches are seeing drastic changes in the understanding of concussions and the dangers for an athlete suffering from one.

"There's a lot more information being made available to us about (football) concussions," Westmoore coach Billy Langford said. "We're going into it with a lot more knowledge than we had even two or three years ago. It's a big emphasis at the high school level and it's something we're all starting to get comfortable with.

"Ten years ago, you got a headache or whatever, and you kept playing. But now, we're seeing the long-term effects and the dangers of playing with a concussion."

Concussions can be scary for coaches, because it isn't always obvious when a player suffers one. Lasngford said, "You never know, because you can't tell a kid has a concussion just by looking," Langford said. "We have to put a lot of trust in our kids, and we've made a big deal about it that they can't be heroes about it. They have to communicate and be honest. Some kids want to stay in the game, no matter what, but you can't do that with a concussion."

The OSSAA makes the rules clear under the new statute, and provides information about concussion management on the front page of its website.

Coaches aren't the only ones being informed about concussions. The Central Oklahoma Association of Athletic Directors, headed by Yukon AD David Fisher, brought in a concussion specialist to speak to the group. Further, officials are required to watch videos about concussions and symptoms before they can officiate an OSSAA event.

"The awareness of concussions has always been there, but the education process wasn't there," said John Marshall football coach Bruce Troxell, who also works as a baseball umpire. He added, "People never really understood how dangerous this was. But now, we're seeing how important it is to understand it and have the proper equipment. We're working to make sure our kids are 100 percent safe."

The baseball profession learned a long time ago that when a pitcher throws a baseball at 90 miles an hour and the ball it’s the side of a batter’s head, the impact can cause serios brain damage. That is why baseball players up to bat wear a hard plastic basball cap that has flaps protecting the area of his brain where his ears are.

Hockey is another sport in which concussions are common.

Hockey player, Kevin Kaminski's career was as a hockey enforcer: With a crazed look in his eyes, he grabbed the target of his fury with one hand and cocked his fist.

That time, however, he was at home, not on the ice, and the eyes blinking back at him belonged to his terrified 4-year-old daughter, Lexi. Kaminski's descent into concussion hell had hit rock bottom and he'd dragged his family there with him.

Nicknamed, Killer, he was small (by tough-guy standards at 5-foot-9 and 190 pounds) but never backed down from a fight, trading punches with the likes of Bob Probert and Tie Domi in a 139-game NHL career spread over seven seasons in the '90s.

But all those blows exacted a toll and his latest concussion rendered him a stranger to his wife Megan and two young daughters. The once doting husband and father was now nasty and mean, to the point where his family stayed out of the house until bedtime.

Kaminski had embodied the Canadian hockey dream growing up, so much so that authors Ken Dryden and Roy MacGregor used him as the main character in the first chapter of their book Home Game. He was in the juniors then, the small-town kid from Churchbridge, Saskatchewan willing to do whatever it took to reach the NHL. "His chin oozes blood from a scuffle," they wrote. "The knuckles of his bare hands are as raw and swollen as those of the first pioneers who came to work this land."

One of those meaty hands now hoisted his tiny daughter in the air and the other was poised to do serious damage. More than seven years later, Megan Kaminski still gets choked up recalling the most frightening night of her life."He was going to nail her," she said.

The NHL doesn't keep statistics on how many pro hockey careers are ended by concussion. "It's not exactly a proud statistic for them, I'm sure," said Jason Botterill, whose career was ended by concussion and now works as director of hockey administration for the Pittsburgh Penguins.

Research by the Toronto Star has found at least 30 hockey players whose careers were ended by concussion – or in large part due to concussion – since 1996, when the issue was given more attention after the early retirement of Brett Lindros. But Colin Campbell, the NHL's executive vice-president and director of hockey operations, believes that number is inflated.

"Some are legitimate," said Campbell. "I think some you might find aren't legitimate. ... I think there's a small percentage, not a great percentage, of players who use it as an excuse, `Oh yeah, I've got a concussion.' They can milk it. It's a hard thing to really say that you haven't, you know, if you're trying to get some extra insurance money out of it to get paid an extra year or something." Meanwhile, the casualties keep piling up.

Boston's Patrice Bergeron may miss the rest of the season after being hit from behind by Philadelphia's Randy Jones. Anaheim's Todd Bertuzzi, who brutally ended Steve Moore's career with a concussion and broken neck, sat out 14 games with a concussion this season. Ottawa's Dean McAmmond missed 10 games after getting clobbered by Philadelphia's Steve Downie.

"You hate to say it, but eventually there's going to be a fatality in this game," said former NHLer Jeff Beukeboom, whose career ended because of post-concussion symptoms.

Primeau believes no player has an accurate count of the concussions they've suffered because "they've been getting bumped on the head since they were a kid" and the injury occurs so often and easily in a high-speed contact sport like hockey. "It's like a moving freight train coming at you and it's just fluid surrounding the brain and all it takes is contact for it to bump off the side of your skull," said Primeau.
NHL players missed a total of 760 games last season because of concussions and related symptoms, a whopping 41 per cent rise from the season before, according to research by the Orange County (Calif.) Register. The NHL counters the number of concussions has dropped dramatically since there were more than 100 in 2000-01 and that this year they're on pace to have between 50 to 55. Statistics are one thing. What's often forgotten is the human cost.

Eric Lindros, now the ombudsman for the NHL Players' Association, believes the most overlooked part is depression.

"It's not just being able to remember a telephone number or being able to read a book," he said. "It is all the elements of your life and how they all interact together that create your every day, your being. And when you go through some of these things, it's hell on wheels, not just for yourself but for everyone surrounding you."

Megan Kaminski stood before a room full of players who came to Florida in 2000, expecting to do a little business and play a lot of golf. It was the annual meeting of the Pro Hockey Players Association, representing more than 1,000 players in the minors. She began by passing around a photograph of their girls, Alexia, known as Lexi, and McKenna, 2, their arms lovingly wrapped around one other. "I wanted you to see," she told the players. "This is who's affected by these injuries." Kevin Kaminski sat at the back of the room as Megan described their ordeal. "He cried through the whole thing," she said. "It was difficult for him to hear me talk about it in that way to these guys."

Kaminski was a fan favourite in Washington, where he had 528 penalty minutes to go with three goals and 10 assists. But he made his biggest mark with Portland of the AHL, setting a club record for penalty minutes while leading the Pirates to a championship. He was their most popular captain ever, the hospital visits he made on days off belying his take-no-prisoners demeanour at the rink.

Kaminski lined up an unsuspecting opponent for a big hit in a game on December 28, 1999, while playing for Orlando, but the guy saw him at the last second and jumped up. "His elbow hit me right on the button and that was it for me," said Kaminski. When he came home with a concussion, Megan thought he'd go to bed for 48 hours and return to normal, as he'd done before. She couldn't have been more wrong.

The symptoms were long-lasting: insomnia, irritability, vertigo, sensitivity to light. He couldn't exercise because of headaches as soon as he got his heart rate up. His memory shot, he couldn't find his car after shopping for groceries. He'd forget his PIN number at the bank machine – it was his jersey number. The game Kaminski worshiped brought him to his knees.

"All those dings you'd get fighting in the old days, you'd have a couple of Aspirins and away you went," he said. "They didn't consider those concussions back then. It was basically suck it up and go play. Those dings add up to problems and that's basically what happened to me."

Boston rookie tough guy Milan Lucic wobbled back to the bench after getting rocked at the Islander blue line by veteran Bryan Berard in a game early this season. As one Bruins beat writer described it, he was "put on dream street." He played just one more shift and later couldn't recall the hit. Yet Bruins head coach Claude Julien seemed loath to concede it was a concussion. "If it is (a concussion), then it's a mild concussion at worst," Julien told reporters.

Dr. Charles Tator, a Toronto neurosurgeon who founded ThinkFirst Foundation of Canada, a national brain and spinal cord safety group, scoffs at Julien's diagnosis. "It's always mild – until he can't remember what he had for breakfast," said Tator. This practice is not unusual in the NHL.

A team doctor on one of the other NHL teams said, `Well, we don't have any concussions,'" said Dr. Jamie Kissick, former Ottawa Senators team physician. "He said this facetiously because the coach didn't believe in them, so there were no concussions."

Concussions have been part of the game since the days of Newsy Lalonde. But Lalonde never had Scott Stevens bearing down on him like a runaway freight train.

The players dishing out the hits and trading punches are delivering their blows with the force of heavyweights – the average size of an NHLer has increased to around 6-foot-1 and 202 pounds, roughly four inches taller and 37 pounds heavier than in the 1920s.

The guy doling out the hits – he's going to pay a price, too. "It's not so much who's taking or giving," said Lindros, who did plenty of both. "A car doing 100 kilometres an hour hitting another car that's doing 20? Yeah, one might be coming in with a lot more speed and ploughing ahead. That car's still going in for some body damage. Both cars are going in. I'm not just talking Maaco."

Symptoms appear to vary depending on which part of the brain has been injured, as McAmmond discovered during his last two concussions. "You smash a car against a wall, they're not all going to crumple the same way, even though they have crumple zones," he said.

An ongoing study at the University of North Carolina found that the impact magnitude of hits delivered by youth hockey players aged 13 to 15 was similar to that of college football players. The average head impact among the youth hockey players was around 20 Gs, but some surpassed 100 Gs.

"The best analogy is from the automobile industry with the crash dummy testing that they do," said Dr. Kevin Guskiewicz, who heads the study. "When a car impacts a brick wall travelling at 25 miles per hour, the dummy inside the car impacts the dashboard or the windshield at 100 Gs."

Megan Kaminski had stopped asking her husband to help with the kids. He'd always been a great partner and incredibly devoted to his little girls, but now he couldn't stand to be around them.

"He'd be mad, he would swear," she said. "It was like living with a complete stranger. He was totally a different person. I couldn't talk to him or rationalize with him. The girls didn't understand anything that was going on with him. It was, `Where's Daddy?'"

But one night she had a deadline to meet for some writing and asked Kevin to get the girls out of the bath and into their pajamas. She soon found Lexi crying at her office door.

"She said, `Daddy's really mad and he's scaring me.' I was bending down in front of her and the bedroom door opened from our master bedroom and he came flying down the hallway and he picked her up by one hand and he cocked his fist back." despite that,
Megan got her daughter out of harm's way and push the feared enforcer into the walk-in closet in their bedroom.

"We just had this huge screaming match in the closet and then finally he just started crying," she said. "He said, `I can't live like this anymore. I don't know what's wrong with me. I don't know who I am.'

"We just sat in that closet and cried. We could hear our daughters standing outside the closet – they were 2 and 4 at the time. They were standing out there, hugging each other, bawling."

Megan called the team's sports psychologist and he came to the Kaminski home immediately. He spent a long time talking with the Kaminskis, explaining to Kevin that he had to stop trying to come back. He told him that if we wanted to know his kids when he got older, he had to stop playing hockey now.

"That was probably the first step in Kevin understanding there was a good chance he wasn't going to be able to go back," said Megan.

"That was a big night for us and it was where I suddenly felt like we were a team again. He was going to listen to my advice and I was going to be more understanding of where he was mentally and that was the way we got back on track."

Dean McAmmond's mind was still fuzzy when he uttered one of the clearest statements yet on the NHL's concussion issue.

"People say I have got concussion problems, but I don't have concussion problems," said McAmmond, in the aftermath of getting knocked cold by Downie. "I have a problem with people giving me traumatic blows to the head, that's what I have a problem with."

McAmmond likes the direction the league has taken with hefty suspensions doled out to Downie (20 games) and fellow Flyer Jesse Boulerice (25 games for a vicious crosscheck to the head of Vancouver's Ryan Kesler), but notes it's a lot easier to put the hammer down on fringe players.

"I think when the real challenge will come is when a high-money, high-profile player makes an infraction," he said.

Montreal's Christopher Higgins said recently that the lack of respect among players is at an all-time low. It seems these days as if players don't want to so much finish their check as to put an opponent right through the boards.

"When you see a guy in the train tracks like that, you don't need to take three, four steps to increase your speed before you hit the guy," said Toronto's Boyd Devereaux, who made a comeback after being told in 2000 his career was over because of a concussion.

Campbell, who acts as the NHL's disciplinarian, cites an interesting discussion with Flyers GM Paul Holmgren after one of numerous transgressions by his players.

"I said, `Homer, he was hitting to hurt him,'" recalled Campbell. "He said, `Well, don't we hit to hurt?' I said, `I'm not so sure. That's a good question.'"Yet Campbell calls the lack of respect theory "a crock."

"I just think that that's overblown and the players who say it don't understand," he said. "Players are competitive. We sell hate. Our game sells hate. You guys, the media, sell hate. ... It was worse (in the '70s when he played), in my opinion."

Wade Belak is one of those who blames the instigator rule."Guys know they can do anything they want and the rules are there to protect them," said the Maple Leaf enforcer. "It drives me nuts."

"It's a shallow argument in my mind," said Campbell. "Murph (Mike Murphy, vice-president of hockey operations) and I were talking today. I said, `I want to take it out because it's not going to prove a thing.'"

One of hockey's foremost safety experts, Pat Bishop, doesn't think the NHL is doing nearly enough. He said it's ridiculous not to ban all head hits from the game, noting such a move by the Ontario Hockey League seems to be helping.

"If this was knee injuries that were threatening players' careers, they'd do something about knee hunting," said Bishop, former chair of kinesiology at the University of Waterloo. "But they seem to be very reluctant to do anything about head hunting."

But again Campbell argues against conventional wisdom, saying outlawing head hits could make players more vulnerable because they'd be more prone to skate with their heads down. He notes that many head hits come from clean body checks.

"That's just part of our game," he said. "The F1 (Formula One auto racing ) – I'm not talking death in our business – but the F1 with a death, do they put restraints on the car so they can only go 110?"

The NHL has made some changes to improve player safety, including making the Plexiglas less rigid and more forgiving. They added a half-inch of foam to the hard shell elbow pads that had become weapons and are looking at a similar change for shoulder pads.

Bishop, who serves on an international standards committee for hockey equipment, said equipment is not the issue.

"If you can't stop concussions wearing a football helmet, you're not going to stop them wearing a hockey helmet," he said. "It requires a behaviour change."

One can only guess at the impact concussions have had on the overall quality of play of the sport, depriving it of stars such as Lindros and LaFontaine and also limiting the effectiveness of those who soldier on through multiple concussions.

"You might test well in many aspects of life, but I don't think you ever get back to being the way you were," Lindros said. "Really and truly, I don't. I can't remember one player who's made it back to that high level.

"After you go through a few of them, no matter how you try and tell your mind things are back to normal, you're never quite the same."

It's not hard to pick out the team Kevin Kaminski runs in the Central Hockey League. The Youngstown Steelhounds are built in his image. With a roster that includes 6-foot-6, 245-pound Milan Maslonka, a.k.a. the Slovakian Smokestack, the Steelhounds lead their division after the first 24 games with a 17-6-1 record and top the league in penalty minutes by a huge margin. They had six fights in one exhibition match against the Johnstown Chiefs.

Kaminski retired from playing as advised in the spring of 2000, but his symptoms persisted for about a year. He finally began to get some relief after an anti-seizure medication was prescribed.

He said he's completely symptom-free now and even laces up the skates for practices and delivers the odd body check.

The Kaminskis now have three girls – Lexi is 12, McKenna is 10 and their youngest, Katarina, is 6. Their marriage, which both feared wouldn't last at the height of his concussion problems, is stronger than ever.

"Anytime that topic comes up, he's always very emotional about it," said Megan Kaminski. "He has very little memory about it."

As the Kaminskis were leaving the meeting room that day in Florida after sharing their emotional story, Kevin was approached by many of the players he once battled against.

"They were pulling Kevin aside and saying, `Can I give you a call some time? Sometimes when I fight, I black out in the middle of it,'" said Megan Kaminski. "One guy said that over the past couple of years, he's had this straight black line that goes across the middle of his eyes. Unbelievable stuff.

"These guys all know that they're replaceable and I know that scares the hell out of them. They want to do whatever it takes. They'll lie. They just don't care. They just want to get back out there and not lose their spot. I understand. This is all these guys know.

"But until you've lived with it and you see it's just an absolute nightmare, you just can't understand how bad it can be to just ignore those symptoms."
I wonder if the players thought to themselves, “Holy shit, that could happen to me also.”

There has to be rules in hockey that clearly makes purposeful hits against an apponent’s head a very serious offence. First offence should be removal from the game and all the rest of the games for one season. Second offence should be removal from the games for two seasons. Third offence should be a removal from all games permanently and such offenders should not be permitted to coach or manage any hockey teams for the rest of their lives.

I appreciate the fact that such rules are extremely harsh but so can concussions, especially when such concussions cause permanent brain injuries.

I realize that concussions in football can be in most instances accidental but if it is established that the impacts on an opponent’s head was done purposely, then the same penalties awarded to hockey players should also apply to football players and any other player in any other game where the concussion is brought about by a deliberate hit again an opponent’s head.

Needless to say, I am not referring to boxing and wrestling. That’s something I will deal with in another article in the future.

Many of these players make millions of dollars a year. But no amount of money is going to protect them from being assaulted by sports bullies who think that striking an opponent on the head is sportsman-like. And after they suffer from concussions and they subsequently commit a homicide or even suicide, what good is making all that money really going to do for them, their friends or their families?

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