Thursday, June 9, 2011

Day 11, Dublin Ireland - No Blood, No Foul

International Rugby Board

Less than two blocks from my hotel stands the International Rugby Board (IRB), which is responsible for stewarding a game popular on 6 continents. On short notice Dr. McCarthy set up a meeting with Sean Griffiths, head of technical services, who was kind enough to host me.

Mr. Griffiths is keenly aware of the concussion problem, and informed me IRB had just upgraded their concussion guidelines based on the Zurich guidelines, based on the firm principle that any athlete with a suspected concussion be removed from play for the game with no chance for return.

I could not agree more with that policy for athletes 18 and under or for programs without medical experts on the sideline, which Mr. Griffiths pointed out is 99.5% of the rugby population. So I am very proud of the IRB. However, after conversations with multiple experts during the week I found myself in the odd position of advocating for a looser return to play protocol, allowing for a 15 minute evaluation period as the NFL and NHL require in the states.

What I am almost certain will happen is that without a window to evaluate players to confirm that symptoms are definitely caused by brain trauma and not the wind being knocked out of a player, doctors will be scared to pull a player out with mild symptoms because they will have no chance to put them back in when they are wrong.

90% of concussions go undiagnosed in most sports. Some symptoms don’t come on until minutes or hours after the hit. For concussions with delayed symptoms and no chance to evaluate, we are also putting players in the difficult position of recognizing they have to pull themselves out while possessing a malfunctioning brain.

A problem with rugby is that it is a continuous game - there are no stoppages built into the game except for severe injury – and substitutions are restricted. In football we have the advantage of the players coming to the sideline every 5 or 10 minutes. In rugby, there is zero change to discuss a mild concussion. The only temporary substitutions allowed in rugby are for blood, where a player can come off, get cleaned up and covered, and come back in without penalizing the team.

I couldn’t believe it – the IRB made an exception to the rules for blood but not concussion? When I asked why a similar change cannot be made for concussion, Mr. Griffiths stated firmly, “Because it would be abused.” Substitution is such a strategic advantage in rugby that last year a player popped a blood capsule in his mouth to come off the field. It’s a great story – the opposing team doctor suspected a capsule, so after the game, he demanded to see the cut in the mouth of the player. Word is he didn’t have one, so the coach pressured the team doctor to take a scalpel and cut the mouth of the player! Which they did!!!! Once it was discovered, everyone involved was severely penalized, with I believe the coach suspended for a year or more.

Back to concussions - frankly I think the ‘abused’ concern is severely misplaced and premature. As in all rules, the challenge is in the execution. If a lifetime ban was the penalty for faking a concussion, I think it could be enforced.

Besides, if IRB is so concerned about abusing the substation rule, they should drop the blood rule too. A blood capsule? What is this, amateur hour? There are plenty of ways to draw real blood – just ask any pro wrestler. They won’t tell you – kayfabe, after all – but you will know that they know…

I believe the outcome of this policy is that pro rugby will be more dangerous, and I will work to fix it.

After a quick trip to Trinity College to see the Book of Kells and an amazing exhibit on the history of Irish medicine and Trinity medical school – including the skeleton of the Irish Giant – Nicole and I went to meet Dr. McCarthy and Professor Tim Lynch of the Ireland Neurological Institute. Dr. Lynch is a neurologist, an Irish Rugby Football Union team doctor, and a really smart guy who was up to speed on the nuances of the concussions debate in the states. He converted an old Georgian home across the street from Mater Hospital into his clinic, and it’s the nicest clinic you have ever seen. If I get another concussion, I want to be treated there – 15 foot ceilings, fireplaces, a baby grand piano in the waiting room – the works.

Dr. Lynch is also heavily involved in the Dublin Brain Bank, and recruits many patients for other neurological disorders. He even videotapes patients that are donors before they pass to allow or better clinical-pathological correlation. We discussed the possibility of recruiting athletes to the bank – fingers crossed we are able to move forward on this.

Nicole and I then made a quick stop to the Guinness Storehouse, naturally. Guinness has been brewed in Dublin for centuries, and then recently turned a brewery building into a museum. Impressive. To end the tour you have a drink at the Gravity Bar, which, amazingly, is the tallest building in Dublin and provides amazing 360 degree views of the city. I still can’t believe there are no skyscrapers in Dublin. (yes, that pic is at Guinness - it's like they knew I was coming)

I hustled back to the hotel for two quick meetings; first with Eamonn Sayers of the Sports Charitable Trust, a new charity designed to support athletes with catastrophic injuries. Eamonn was a very nice guy who lost someone close to him to a cervical spine injury, and had to raise the money to keep him alive. He now wants to help others who deal with similar problems.

Then Hamish Adams from IRUPA set me up with Sean Rowland, president of the Harvard Club of Ireland and owner of Hibernia College, an online university that is the largest producer of teachers in Ireland. A charismatic man, Sean trained at Boston College and the Kennedy School of Government at Harvard. He took a real interest in the CTE work, and I hope to keep in touch.

To end the day, Nicole and I had dinner at the home of Joyce O’Connor, a former Eisenhower Fellow and President Emeritus of the National College of Ireland, and her husband Pat. They had such great Irish warmth and Joyce provided great advice on how to best use this Fellowship to focus on long range personal and professional plans, and develop a strategy to get there.

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