Most fans love it when their teams enforcer drops the gloves to defend the honor of a teammate or to change the momentum of a game. Those battles though could end up costing them more than just bloody knuckles or a bruised ego. Chronic Traumatic Encephalopathy or C.T.E. as it’s commonly known is a degenerative and incurable disease whose symptoms can include memory loss, depression, irritability and dementia. A study published in the scientific journal Brain links repeated blows to the head to the development of C.T.E. These blows are not necessarily the bone crunching, knocked out cold variety but the less severe and more common type. For Minnesota Wild Fans C.T.E. came to the forefront after the death of Derek Boogaard. The official cause of death was an accidental overdose of prescription pain killers and alcohol. Stage 2 C.T.E. may have played a role however. Boogaard’s brain was one of 85 included in the study and showed the classic signs of C.T.E. The study was done by Boston University Center for the Study of Traumatic Encephalopathy , Veterans Affairs Boston Healthcare System,and Sports Legacy Institute. To see the entire study click here. 85 brains were included in the study which lasted 4 years. Football players, Hockey players, Boxers and Military veterans made up the study participants, over two thirds of whom showed signs of the disease. One of the biggest problems with C.T.E. is that it cannot be diagnosed while someone is alive. Only a brain study after death can detect the damage the disease has caused. No tests currently exist to detect C.T.E. while the patient is alive. Many of the symptoms of C.T.E mimic those of concussion with short term memory issues, headaches, problems concentrating, irritability, and a foggy feeling. Pictures of the damage to the studied brains are graphic. To see the pictures of Boogaard’s brain and others in the study click here . These images are from the NY Times web site. The damage to Derek Boogaard’s 28-year old brain is shocking when compared to a “normal” one. A large number of dark spots indicate damage to his superior frontal cortex. Damage in this area could explain some of his problems before he died in 2011. As the disease progresses the lesions grow larger, portions of the brain darken and begin to shrink and cognitive issues become more pronounced. C.T.E. is not thought to be triggered by a single blow to the head. It is the cumulative effects years of repeated hits to the head. Hits as routine as linemen crashing together over and over in football, good clean checks in hockey, sharp jabs in boxing, and training exercises for members of the military. For Boogaard the damage came from years of fighting and dishing out some of the biggest checks hockey has seen. He climbed the ranks in hockey with his fists, literally fighting his way to the top. While he “won” many more fights than he lost, he paid a price along the way. When you square off against the biggest and baddest guy the other team has you’re going to take some shots. In interviews Boogie said that it wasn’t just trying to land a punch but trying to defend yourself that was important. In the last year of his career Boogaard was sidelined by concussions. One has to wonder how many times he got hit square in the head and came just short of the concussion diagnosis throughout his rise from junior hockey to the ranks of the most feared fighters in the NHL. The days of “Walk it off'”,”You don’t look hurt”,and “He just got his bell rung a little bit” should be gone. Advances in equipment, medical training, and style of play all contribute to lessening the severity of head blows. C.T.E. seems to come from cumulative standpoint not a single blow. A single blow to the head can cause concussion, severe brain damage and even death or no symptoms at all. The concerns many athletes have now go beyond the initial injury. Concussion protocols in hockey and other sports have advanced greatly in the past few years. The days of a coach asking “are you good to go?” are gone. Asking an athlete if he wants to come out of the game usually results in “NO”. There’s always some other guy ready and willing to take your spot in the lineup. One problem with head injuries is that they are not visible. There’s no cast, brace or crutch. There’s no stitches, limp, or other outward sign of injury. Players are now examined by a team doctor and go through a battery of tests before the decision on when to return is made. It is no longer solely in the players hands. Attitudes are changing as well, athlete are recognizing the debilitating effect repeated concussion and blows to the head can cause. Effects that may not become a problem for years. The foggy feeling, headaches, sensitivity to light and noise, along with other symptoms can fade over time. The cumulative effects leading to C.T.E. are becoming more well known. Several NHL players have been forced to retire due to repeated concussions. For each of those there are many more with unseen damage that won’t present itself for years to come. Hockey can be a violent sport. Players are getting bigger, stronger and faster while protective gear tries to keep up. Players, coaches, and team doctors are more aware of brain injury issues than in the past. Players trying to make the “show” don’t want the injury prone tag and NHL players have admitted to trying to play through a concussion. How many are mortgaging their future taking hits, playing the game they love, with unseen damage mounting in their brain? All they can hope for are scientific advances in the testing for C.T.E. Until then it is a waiting game, waiting to see if the game they love is slowly killing them.