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BRAIN INJURY in the NEWS
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A Town’s Passion for Football, a Retired Doctor’s Concern


Dover High School players at a practice this month. The Green Wave, who are having a losing season, have been playing football for more than 100 years and are big in the community. Credit: Charlie Mahoney for The New York Times

Paul Brownfield | New York Times | Oct. 23, 2012

DOVER, N.H. — The agenda for the Oct. 1 school board meeting did not call for anything particularly exciting. But during a segment called “Matters of Interest,” Paul Butler, a retired doctor and relative newcomer to the board, floated an idea: end the football program at Dover High School.

Speaking in his soothing, deliberative tone, Butler said, “I’m beginning to believe, from what I’ve read of the literature, that as governors of the school district, we have a moral imperative to at least begin the process of ending this game in Dover.”

Butler is a retired surgeon, with no specialty in neurology. But he had followed the growing evidence of the peril football poses to the brains of the people who play it. Butler had no beef with football, for he had played it in high school and in college.

He was, he said, just trying to frame the question of the future of football in the most practical of terms, drawing upon the implications of the class-action lawsuit filed in June against the N.F.L. on behalf of more than 2,000 former players alleging that the league did not adequately warn them of the evidence about the dangers of repeated head trauma and concussions.

Butler warned his fellow board members that if city officials did not end football at Dover High, “the lawyers will do it for us” someday.

The next morning, Butler said, he attended a weekly 7:30 a.m. medical conference at Wentworth-Douglas Hospital, where he was a general surgeon until retiring in June 2011. By the time he and his wife had made the drive down to Arlington, Mass., to baby-sit grandchildren, he was being sought for television interviews. His comments to the board, it turned out, had been reported in the local newspaper, Foster’s Daily Democrat.

By day’s end, Dover’s school board chairman was forced to issue a statement denying the city had any plans to end football at Dover High. Even so, Peter Wotton, the school’s athletic director, had a news truck parked outside his house.

“Our brain is really who we are,” Butler said in an interview last week. “In this society, in this time, if your brain has been altered, you have been fundamentally altered.”

Small Town, Big Interest

Without exactly meaning to, Butler had inserted Dover — about 70 miles north of Boston, a community of roughly 30,000, and a place with a history dating practically to the Mayflower — into the middle of a 21st century culture war.

Foster’s Daily Democrat came out firmly opposed to the notion of ending football. “Here in New Hampshire — as in 38 other states — a law has been passed to mandate precautions be taken any time there is an indication of a head injury in any sport,” an editorial in the newspaper read.

The football program at Dover — the team is known as the Green Wave — is big in the community. But so too are soccer, lacrosse and ice hockey — all sports in which players are vulnerable to concussions and other head injuries. Wotton said that 8 of the 68 students who played varsity, junior varsity or freshman football last season sustained concussions. But there were also five concussions in girls’ basketball, nine in boys’ lacrosse and four in cheerleading, he said.

“I appreciate his concern,” Wotton, sitting in his office last week, said of Butler. “This might end up being a good thing in the end. It’s just a semipainful way to get there.”

Butler is not the first school board member in the country to risk proposing what for many seems heretical. Last June, a member of the Council Rock School Board near Philadelphia said that it was “no longer appropriate for public institutions to fund gladiators.” Rush Limbaugh used the comments as further proof that, as he had said on an earlier broadcast, football’s future was under attack from liberal “pantywaists who want to try to take the risk out of everything in life.”

Butler’s celebrity, if a bit baffling to him, has not seemed to wound him. He has heard from a producer at HBO’s “Real Sports” and a woman who identified herself as part of the N.F.L.’s Health and Safety Improvement program. A caller from Brian Williams’s office at NBC seemed mostly to want to know if Butler had grandchildren. And a company sent him a product called the Guardian Cap, a piece of padding fastened by Velcro over a helmet to mitigate the force of head-on collisions.

More locally, any heat Butler has taken seems to stem more than anything from the notion that he had somehow spoken out of turn about a cherished culture in a tight-knit town. Local officials praise his standing in the community while making it clear they stop far short of siding with him about the need to end football.

Familiarity With Football

Butler does not fit a stereotype. At his home on the Piscataqua River last week, he was wearing a pair of Crocs with the logo of the New England Patriots. He is 6 feet tall, reed thin and broad-shouldered. When he spreads his long fingers, one can see why he was an effective tight end. He gave up rowing the Piscataqua, but at 68 is the oldest guy on the ice in a weekly 6 a.m. hockey game.

He is at once not of the youth football world in Dover but knowledgeable about the sport, having played it at his high school in Wakefield, Mass., and at Amherst College, where he also played hockey. He speaks wistfully of the character-shaping experience and recalls begging his father to let him play. He thinks football probably gave him a leg up when he applied to Amherst.

“The thought of hurting my brain did not occur to me at all,” he said. Now he figures he sustained numerous subclinical concussions. “I don’t remember ever getting knocked out,” he said, “but I do remember getting up slowly because I was dizzy or couldn’t quite see correctly.”

Over several long chats, Butler emerged as a thoughtful man with an idiosyncratic streak who, restless in retirement, volunteered for a two-year term on the school board as a gesture aimed at giving back.

“I’d just retired and I was trying to get my bearings,” he said. Now he jokes that no one will be sorry to see his two-year term end. “She can see I’m one of these old Yankee cheap guys,” Butler said of the schools superintendent, Jean Briggs Badger.

As much as he sees ending prep football as a moral issue, Butler was also chagrined, he said, that money was spent on reconditioning Dover High’s football helmets when the district was haggling over the current budget, in which 10 teaching positions were eliminated. (Briggs Badger said any money spent on helmets could not have carried over into the current fiscal budget, anyway).

New Hampshire has no sales or income tax, and Dover has a tax cap that puts a ceiling on how much property tax revenue the city can raise. Butler supported ending school bus service to cut expenses. “Walk, ride a bicycle, run, jog,” he said when asked how children would get to school. “I stood up in front of a crowd of very angry parents and said, ‘I think kids should walk to school.’ ”

Sensitivity to Lawsuits

It was around that time that Butler first quietly broached the subject of abandoning football. He e-mailed Wotton and Briggs Badger. More recently, he wrote to the city attorney to ask about the school district’s vulnerability to future lawsuits related to brain injuries on the football field. By then, he had been reading up on the science of brain trauma, and the brain-cell-killing protein called tau found in the autopsied brains of retired players in which chronic traumatic encephalopathy, or C.T.E., was diagnosed.

Butler is perhaps more sensitive than most to a nightmarish hypothetical of a day when a former high school player or his parent sues the district. One of the reasons Butler said he moved his family to Dover in 1977 was because, as a young surgeon opening his first private practice, he could afford the medical malpractice insurance premiums, which in New Hampshire, he said, were considerably lower than in Vermont, where he had done his medical residency.

In Butler’s book group, they’re reading Kafka’s “The Trial.” In a different sort of book group, Butler would have every school official read “Play Hard, Die Young: Football Dementia, Depression and Death,” by Dr. Bennet Omalu, a neuropathologist known for diagnosing C.T.E. after studying the brains of Mike Webster, the Hall of Fame center of the 1970s who died of a heart attack at 50, and Andre Waters, a star defensive back who suffered from depression and committed suicide.

Having brought the issue into the spotlight, Butler now concedes he does not have the votes on the school board to win a recommendation to end football at Dover High. But he said he might put the matter to a vote in December anyway.

Told that Wotton, the athletic director, said that contact in practice was limited to 10 to 15 minutes twice a week, Butler said, “To me, limiting contact in practice is equivalent to what the cigarette industry did when they said, ‘Well, we put filters on our cigarettes, and so they’re safe.’ I think it’s an improvement, but I don’t see how you can take away the danger that I’m concerned about without radically altering the game.”

A Mother’s Perspective

Christine O’Hara’s son Eric, a junior at Dover High, is listed at 5-9 and 220 pounds. He plays middle linebacker and running back. “I think that his concern is very valid,” O’Hara, a nurse for Liberty Mutual Insurance, said of Butler. And yet she says she would not want to see football taken away from her son. Eric, she noted, was taught proper tackling technique by his father at an early age and besides, there are far worse things a teenager can get himself into.

O’Hara said Eric had had two concussions playing high school football. After the first one, she noticed that he was behaving differently on the sideline, but not in a way that would have been obvious to someone who was not his mother. “He always paces,” she said, but this time, she noticed that Eric kept putting on and taking off his helmet. That was enough for her to tell the coach to pull him from the game.

“In reality, most of the symptom-watching comes from the parent,” she said. Butler’s children attended prep schools in the area, and he has never attended a Dover High football game. At the same time, it is not difficult to find people in the stands who are related or have gone to him for a cancer operation, appendectomy or hernia operation.

On a windblown Friday night in October, when the temperature dipped into the 30s and there was a run on hot chocolate at the concession stands, the 1-5 Green Wave took on 5-1 Bedford, a bigger, deeper team.

The game was close throughout. Sandy Patria sat bundled against the cold. She was at the game to support her grandson, who performs in the marching band. Butler did her mastectomy operation 20 years ago, she said. As she spoke about him, her eyes watered, although the cold weather might have contributed. “He’s just trying to make it safer,” she said of Dover football.

Then she let out a groan. Tailback Kyle Seawards had just caught a pass and turned upfield, his shoulders and helmet lowered as a defender from Bedford came in to hit him. It was the sort of battering-ram hit Butler talks about, but it was also just a football play. On the sideline, Dover’s trainer gave Seawards what looked like a Breathalyzer test. He did not return to the game. At halftime, children from youth league teams were introduced, each running the length of the field as their name was announced.

Several days later, Wotton, citing nationally established privacy rules that prevent him from speaking publicly about player injuries, would not comment on whether Seawards had a concussion. But Royce Stegman, whose son Derek is the Green Wave’s starting quarterback, figured Seawards would be held out of the next game.

Stegman is a burly man of 48. In Stegman’s days of high school ball, the game was “three and a half yards and a cloud of dust.” Nowadays, Derek accesses game film on his iPhone using an app called Hudl, studying strategies and formations. Dover runs a spread offense, with more receivers involved, and the game is faster. Rather than go with the Riddell helmet issued by the team, Stegman paid $400 to get Derek the Xenith, whose Web site boasts of its “adaptive air-cell shock absorbers.”

O’Hara, too, has bought helmets for her son Eric.

The focus of some recent research has been on the question of whether children, teenagers or younger, are more vulnerable to injury because their brains are not fully developed. “Big heads on little necks,” Butler called it.

Researchers now use helmets equipped with sensors to measure the force of the trauma absorbed by the brain on otherwise ordinary plays. A study by the Pediatric Brain Trauma Lab at Massachusetts General Hospital, published in the October issue of the Journal of Neurosurgery, found that 486,000 combined head impacts had been recorded over a five-year period among players from the football teams at Brown, Dartmouth and Virginia Tech, as well as two men’s and two women’s hockey teams.

A Focus on Awareness

Dover is one of six high schools in the area that take their cue on sports-related concussions from the Seacoast Center for Athletes in Somersworth, led by Dr. Fred Brennan, the team doctor at the University of New Hampshire and a sports medicine specialist. Brennan’s focus is awareness and making sure athletes have cleared various ascending levels of physical activity before being allowed to rejoin a team.

“We stay on the tip of the spear of what’s happening in concussions,” he said. He was sitting in the athletic trainer’s office at Oyster River High in neighboring Durham, where he had addressed a teachers staff meeting.

When Brennan asked the teachers how many had a student who had sustained a concussion, most hands went up. Brennan stressed the need for concussed student athletes to receive “cognitive rest,” including a reduction in homework until they no longer had symptoms.

Oyster River does not have football; its enrollment will not support it. At Dover High, they have been playing football for more than 100 years. Now realignment is coming; the Green Wave next season are moving into a division with Philips Exeter Academy, one of the local football powerhouses.

Before the game against Bedford, Wotton, checking his BlackBerry for the score of his daughter’s volleyball game, ticked off all the other reasons the Green Wave were 1-5. Some youngsters had taken part-time jobs; others did not want to give up several weeks in August to practice. The team’s prospective 6-foot-6 starting quarterback transferred to Hampton Prep to play basketball.

Wotton still looks like the tree of a defenseman he was on the U.N.H. hockey team. During home games he stands under the scoreboard behind his team’s end zone. “I think the thing that bothers me is, we didn’t talk,” he said, referring to what he regarded as Butler’s ad hoc attack on his football program.

Late in the game, with the score tied, the Green Wave drove down the field, only to fumble on a play in which it was unclear if the ball had crossed the goal line before Bedford’s defense recovered it in the end zone. The referees ruled in favor of the visitors, and Bedford then marched down the field for the winning touchdown.

The losing had continued at Dover — at least for the moment. But football looked safe from extinction — at least for the moment.

Correction: October 25, 2012

An article on Wednesday about the stir created when Paul Butler, a retired surgeon, suggested ending football at Dover High School in New Hampshire because of brain injury concerns misstated the name of a river near his home. It is the Piscataqua, not the Piscataway.

​Please note: The information on this website is not meant to replace the advice of a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.

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