Saturday, May 21, 2011

Could Derek Boogaard’s Death Been Prevented?

By Clinton Riddle

The passing of a man or woman in their prime is always a terrible thing to endure, and perhaps even harder to articulate when we're dealing with emotions for which there really are no words.

The tragic and perhaps preventable death of Rangers enforcer Derek Boogaard at 28-years-old might seem to be inexplicable on the surface. There are friends and family members of Boogaard's who right this moment are searching for answers that they may never find. The answer may be easier to find than they think.

Boogaard was found dead in his Minneapolis apartment last Friday, and while an exact cause was not immediately forthcoming, foul play was not suspected. Authorities received a report around 6:15 PM that evening that a man was unconscious and had stopped breathing, according to the Minneapolis Police Department. City firefighters were the first on the scene and determined that he was already dead. While foul play is not suspected, the homicide unit and the county Medical Examiner's Office are investigating.

Hennepin County Coroner's Office spokesperson Carol Allis stated that an autopsy took place the next day, but that results would not be available for at least two weeks. Boogaard's family has already agreed to donate his brain to Boston University researchers who are studying the effects of brain trauma in athletes.

It's exactly that subject that I believe is most pertinent in the death of Derek Boogaard, as well as numerous other pro and amateur hockey players in past decades.

Let's start with what we know: Boogaard suffered a concussion last year and missed most of last season because of it. He also had been a participant in the NHL's Substance Abuse and Behavioral Health Program for unspecified reasons, though friends who had spoken with Boogaard in the days before his death noticed his decidedly upbeat and positive outlook.

"I got to know him pretty well in three years as his teammate in Minny, and I can tell you that no one ever had a bad word to say about him," said the Devils' Brian Rolston. "He was a friendly, outgoing guy with a big heart who had time for everyone, who loved interacting with fans and who was terrific in the community. He was a great teammate who leaves an enormous number of friends behind."

Head injuries and the NHL have always gone hand-in-hand, despite best efforts of the league administrators to minimize the effects of punishing checks and devastating head shots that have always been an occupational hazard for hockey players, at all levels. Whether accidental or otherwise, a miscalculated hit or an intentional boarding, the most advanced headgear available has only slowed the incidence of head trauma in hockey.

According to a study published in the Journal of Neurotrauma (July 26-27, 2009), which analyzed traumatic brain injuries (TBI) among Iraq and Afghanistan veterans, those veterans with a diagnosed mild TBI were 2.6 times more likely to be discharged for alcohol or drug abuse, while those with a moderate TBI were 5.4 times more likely. The study suggested that substance abuse may be more common in TBI patients due to their efforts in dealing with lingering symptoms (chronic headaches, dizziness, memory problems, inability to concentrate, resultant loss of ability to cope with day-to-day life), and that once the cycle of substance abuse begins it becomes a self-sustaining downward cycle which not only leads to addiction or dependence, but also exacerbates the very TBI symptoms the patient was trying to alleviate. TBI was also found to increase the likelihood of chronic and/or severe depression, which would (and often does) contribute to the abuse of alcohol or drugs.

While this may be seen as being largely conjectural at this early stage in the investigation of Boogaard's death, the potential for this very cycle having manifested itself in the young Rangers forward is very much a possibility, and if this and many other similar neurological studies are to be believed there is at least a measurable connection between these very same conditions and an increase in suicidal tendencies.

In a study published in the Journal of Neurology, Neurosurgery, and Psychiatry (2001, Issue 71) concerning suicide after TBI, it was concluded that "the presence of a co-diagnosis relating to substance misuse was associated with increased suicide rates in all diagnosis groups." In other words, head injuries and substance abuse were found to be close partners in the resultant deaths of those involved in the study. This study involved nearly 150,000 patients over 15 years, by the way.

A condition at the heart of this issue is chronic traumatic encephalopathy (CTE), brought to light by the recent suicide of former Chicago Bears safety Dave Duerson. CTE is a condition which is caused by suffering repeated concussions, many of which may be undiagnosed due to the symptoms being too mild to notice (or too easy to ignore), and the possibility that the injured player may refuse to report the condition for fear that they may lose a starting position or be benched altogether.

Oh, let's not forget the macho male tendency to consider oneself immune to harm. Anyone who tells you that this isn't a significant factor in pro sports is trying to sell you something. Players must be educated against ignoring what their own bodies are trying to tell them, and the potential that exists to mask symptoms of injury with whatever means are available instead of facing and treating them properly. Either this isn't being done or the players are not convinced of its importance.

There's a greater concern here than the death of one hockey player. The very nature of sports such as hockey and football is violence and chaos, and that means every single player running the field or skating the ice is at risk. At risk for the very same downward spiral that quite possibly ended the life of this young man, one of many unfortunate and, perhaps, preventable deaths first triggered by a brain injury. And the longer medical science and technology takes to find a dependable and consistent way to prevent these injuries, the more stories we'll read that are just like his.

We can't know for sure yet if his life off the ice was more to blame for his untimely death, but one thing we can say with confidence: the life he led on the ice played a part in this. It's now up to the NHL and the powers-that-be to do their utmost to help prevent such a senseless death in the future. Sadly, Derek Boogaard's name will likely not be the last on the casualty list, the roll call for those men who (literally) gave their lives for the game they loved.

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