Staying Ahead on Head Safety
July 6, 2015
By Rob Kaminski
MHSAA benchmarks editor
Three stacks of concussion-related material offered precious little space on MHSAA Executive Director Jack Roberts’ desk, and perhaps consumed even more room in his head as he tried to wrap his mind around the seemingly daily “latest and greatest” documents outlining signs, detection and return-to-play elements involving head trauma.
Without a doubt, the scene is quite similar on any given day in the offices of his cohorts across the country as school sports leaders are faced with the daunting, dizzying task of devising plans to address concerns aimed at the health of their games.
Lawmakers, rules makers, medical experts and the court of public opinion all want the same thing for student-athletes: a reduction in the chances of head-related injuries. And they all are perfectly willing to offer instant fixes to those in charge.
They often expect those in Roberts’ position to analyze, digest and create action plans as soon as possible without considering the research and resources it will take to get there.
“All parties involved want the same thing. We all want to provide the safest environment for educational athletics through protocols and practices that will offer the most minimal risk of injury,” Roberts said. “But, this can’t be accomplished through unfunded mandates which would stifle the already struggling athletic budgets in many schools.
“Changes have to occur through training and education, orchestrated through state offices and executed locally. And, it takes time to research the best and most effective means. There is so much information, and so many devices in the field today that those in athletic leadership roles almost have to have a medical background as well.”
For instance, there are documents which list as few as five symptoms for concussions, and those listing as many as 15. There are sideline detection methods which purport to take 20 minutes and those which claim to determine concussions in 20 seconds. There are as many return-to-play protocols as there are state associations.
Increasingly, state high school associations are seeking opinions and expertise from local medical personnel. In March, in one of many such meetings, Roberts and other MHSAA staff welcomed several from the Michigan Department of Health and Human Services to their office to discuss sideline detection methods and return-to-play issues.
“There are two areas that concerned us most,” Roberts said. “One, sideline detection of head injuries is inconsistent across the state in terms of both results and resources. Two, we need methods which generate immediate reports and permanent records.”
As the group which convened in March discussed the topic, potential hurdles and new perspectives on sideline management came to the forefront.
On the money and manpower front, who would be responsible for administering sideline tools? Most ideally they would need to be overseen by medical personnel rather than coaches or team managers.
From a perspective standpoint, an interesting view was volleyed out to the group: could sideline detection actually speed up a student’s return to play rather than slow it down? Current protocol prescribes that if competition continues while an athlete is withheld for an apparent concussion, that athlete may not be returned to competition that day but is subject to the return-to-play protocol. And, clearance may not be on the same date on which the athlete was removed from play. Only an M.D., D.O., Physician’s Assistant or Nurse Practitioner may clear the individual to return to activity. With immediate sideline detection, are parties more vulnerable should a student pass immediate tests, only to have undetected effects of the incident increase over time?
“The group shed a different light on the various scenarios, which was a primary purpose for the meeting,” Roberts said. “As one can see, there are so many variables to consider when attempting to determine the next plausible and practical steps toward minimizing and detecting head injuries.
“Further, we have to take into consideration practice sessions as well as competitions, and all sports, not just select sports.”
Adding to the challenge is simply the nature of athletics. Competitors at any level are just that: competitive. Often, students – or their parents – will attempt to hide symptoms or be reluctant to come forward with injuries, particularly head injuries which can’t be seen.
In more cases, perhaps the symptoms simply are not recognized, which is why education is paramount.
First, association leaders have to tackle the due diligence of researching issues and potential solutions to situations currently threatening the well-being of scholastic sports. Considering that some 1,620,000 results are offered when “sideline concussion detection tools” is typed into a search engine, this is a laborious and continual chore.
Such information then needs to be packaged and presented to leaders at the local levels – athletic directors – to pass on to coaches, the individuals who have as much or more influence on students that perhaps any other adults, including parents in some cases.
This is why MHSAA rules meetings, Coaches Advancement Program sessions and other statewide forums continue to bang the drum on health and safety issues; to make sure the messages and procedures reach the student-athletes.
And, it’s why the MHSAA is asking coaches and ADs to be accountable in verifying that the plans in place are being carried out.
Less Could Mean Less
There are times when it’s good to say, “less means more,” but in the case of contact sports, practices and competitions, the idea is for less to mean less. As in less time for collisions to occur yielding fewer injures.
It’s early yet, and one year does not constitute a large sample size, but the MHSAA Football Practice Policy instituted last August could be one step toward reducing head injuries.
Beginning this past football season, the number of practices with helmets, shoulder pads and full pads were limited to start the season, and preseason “collision” sessions were limited to one per day. During the season, such practices were limited to two per week, while the length of practices was also regulated.
Dr. Steven Broglio of the University of Michigan Neurosport department is conducting a three-year study of the Ann Arbor Gabriel Richard football program with the assistance of Richelle Williams to determine the “Effects of Concussion and Sub-Concussion.” The study began in 2013, one year prior to the new MHSAA guidelines.
Research in 2013 showed approximately 650 “impacts” per player. In 2014, the number dropped to approximately 500 impacts per player. Impacts are defined as greater than 10 gs of acceleration. Williams stated that a slap on the back is 4 g, coughing is 3.5 g. On average, a helmet hit is 25-45 g. Concussions usually happen (roughly) between 80-150g.
An encoder is embedded into each football athlete’s helmet which monitors head impacts and exactly where the impact is located. Williams sits at each practice and game and through a pager identifies the player’s number and impact from a hit of 90g or more.
They are also looking at those who do not sustain an impact concussion, but rather sustain multiple head impacts and whether those multiple head impacts lead up to brain changes (measured through EEG).
The initial findings, as submitted by the study team, indicated two reasons why there were fewer overall impacts from 2013 to 2014:
Primary reason: The MHSAA adoption that became effective in August 2014 with new limitations that were placed on “collision practices” and conditions that full pads could not be worn until the fifth day of team practice.
Secondary reason: Fewer players evaluated in 2014 than 2013.
Fit for a King?
Editor’s Note: There are many sideline detection tools on the market, as a quick Google on the topic will reveal. The following, the King-Devick test, is among the highly recommended tests, summarized here simply to provide an idea of the types of systems available and how they operate. The following is from King-Devick’s website.
The King-Devick Test is an objective remove-from-play sideline concussion screening test that can be administered by parents and coaches in minutes. The King-Devick Test is an accurate and reliable method for identifying athletes with head trauma and has particular relevance to: Football, Hockey, Soccer, Basketball, Lacrosse, Rugby, Baseball, Softball and Other Collision Activities.
King-Devick Test is an easy-to-administer test which is given on the sidelines of sporting events to aid in the detection of concussions in athletes. King-Devick Test (K-D Test) can help to objectively determine whether players should be removed from games. As a result, King-Devick Test can help prevent the serious consequences of repetitive concussions resulting from an athlete returning to play after a head injury.
How King-Devick Test Works
Concussions are a complex type of brain injury that is not visible on routine scans of the brain, yet are detectable when important aspects of brain function are measured. King-Devick Test (K-D Test) is a two-minute test that requires an athlete to read single digit numbers displayed on cards or on an iPad. After suspected head trauma, the athlete is given the test and if the time needed to complete the test is any longer than the athlete’s baseline test time, the athlete should be removed from play and should be evaluated by a licensed professional.
Remove-From-Play vs. Return-To-Play
Both remove-from-play and return-to-play decisions are crucial in concussion recovery. It is critical to remove a concussed athlete from play in order to prevent further damage. It is also extremely important to keep the athlete from returning to play until they have made a full recovery. There are tools to assist in making both remove-from-play and return-to-play decisions.
King-Devick Test for Remove-From-Play Decisions
- Quick, objective sideline testing
- Measures impairments of speech, language and other correlates of suboptimal brain function
- Instant screening feedback in minutes
- Administered by parents, coaches, athletic trainers and medical professionals in remove-from-play decisions
- Neurocognitive Testing for Return-To-Play Decisions
- Computerized concussion evaluation system (in the computer lab)
- Measures verbal and visual memory, processing speed and reaction
- Tracks recovery of cognitive processes following concussion
- Assists clinicians in making return-to-play decisions
Retired Official Gives Alpena AD New Life with Donated Kidney - 'Something I Had to Do'
By
Geoff Kimmerly
MHSAA.com senior editor
May 3, 2024
TAWAS CITY – Jon Studley woke up Feb. 20 with a lot of fond memories on his mind, which turned into a collection of 47 photos posted to Facebook showing how he’d lived a fuller life over the past year with Dan Godwin’s kidney helping power his body.
There was Studley at the beach, taking a sunset shot with wife Shannon and their 5-year-old daughter Maizy. In others Dad and daughter are at the ice rink, making breakfast and hitting pitches in the yard. Studley made it to Ford Field to cheer on the Lions, supported his Alpena High athletes at MHSAA Finals and traveled to Orlando for a national athletic directors conference.
Their faces are beaming, a far cry from much of 2021 and 2022 and the first few months of 2023 as the Studleys and Godwins built up to a weekend in Cleveland that recharged Jon’s body and at least extended his life, if not saved it altogether.
“People that saw me before transplant, they thought I was dying,” Studley recalled Feb. 21 as he and Godwin met to retell their story over a long lunch in Tawas. “That’s how bad I looked.
“(I’m) thankful that Dan was willing to do this. Because if he didn’t, I don’t know what would’ve happened.”
By his own admission, Studley will never be able to thank Godwin enough for making all of this possible. But more on that later.
Studley and Godwin – a retired probation officer and high school sports official – hope their transplant journey together over the last 23 months inspires someone to consider becoming a donor as well.
For Studley, the motivation is obvious. Amid two years of nightly 10-hour dialysis cycles, and the final six months with his quality of life dipping significantly, Studley knew a kidney transplant would be the only way he’d be able to reclaim an active lifestyle. And it’s worked, perhaps better than either he or Godwin imagined was possible.
For Godwin, the reasons are a little different – and admittedly a bit unanticipated. He’d known Studley mostly from refereeing basketball games where Studley had served as an athletic director. He’d always appreciated how Studley took care of him and his crew when they worked at his school. But while that was pretty much the extent of their previous relationship, some details of Studley’s story and similarities to his own really struck Godwin – and led him to make their lifelong connection.
“It’s been rewarding for me. I have told Jon, and I’ve said this to anyone who would listen, that I’m grateful and feel lucky that I’ve been part of this process,” Godwin said. “I don’t feel burdened. I don’t feel anything except a sense of appreciation to Jon that he took me on this journey. I didn’t expect that, but that’s how I feel.”
Making a connection
As of March, there were 103,223 people nationwide on the national organ transplant waiting list, with 89,101 – or more than 86 percent – hoping for a kidney, according to data from the U.S. Department of Health and Human Services and the Organ Procurement and Transplantation Network (OPTN). More than 46,000 transplants were performed in 2023, including the sharing of more than 27,000 kidneys.
Godwin giving one to Studley was among them.
Studley, 43, has served in school athletics for most of the last two decades since graduating with his bachelor’s degree from Central Michigan University. After previously serving as an assistant at Mount Pleasant Sacred Heart, he became the school’s athletic director at 2009. He moved to Caro in 2012, then to his alma mater Tawas in 2015 for a year before going to Ogemaw Heights. He then took over the Alpena athletic department at the start of the 2020-21 school year, during perhaps the most complicated time in Michigan school sports history as just months earlier the MHSAA was forced to cancel the 2020 spring season because of COVID-19.
He's respected and appreciated both locally and statewide, and was named his region’s Athletic Director of the Year for 2019-20 by the Michigan Interscholastic Athletic Administrators Association. Concurrently with serving at Sacred Heart and earning his master’s at CMU, Studley served as athletic director of Mid Michigan College as that school brought back athletics in 2010 for the first time in three decades. He also served four years on the Tawas City Council during his time at Tawas High and Ogemaw Heights.
Toward the end of his senior year of high school in 2001, Studley was diagnosed with Type 2 diabetes. For the next two decades, he managed his diabetes primarily with insulin and other medication. But during that first year at Alpena, his health began to take a turn. Studley had been diagnosed with a heart condition – non-compaction cardiomyopathy – which led him to Cleveland Clinic for testing. A urine test in Cleveland indicated his kidneys might not be working like they should – which led to a trip to a specialist and eventually the diagnosis of kidney failure and the start of dialysis, with a kidney transplant inevitable.
Dialysis long has been a standard treatment for people with kidney issues. But it can take a toll. In Studley’s case, that meant being tired all the time – to the point of falling asleep at his desk or having to pull over while driving. He wasn’t receiving enough nutrients and was unable to lift things because of the port for the dialysis tube. Extra fluid building up that his body wouldn’t flush made him constantly uncomfortable.
The next step was transplant, and in July 2021 he was approved to receive a kidney.
The Studleys thought they had a prospect early on, as an aunt on Shannon’s side was a candidate for a paired match – her blood and tissue types weren’t a match for Studley, but matched another person on the waiting list whose donor would be a candidate to give Studley a kidney. But that didn’t work out.
Others showed interest and asked about the process, especially after Studley’s 20-year class reunion in 2021, but nothing concrete came about. Amid the early disappointment, Studley took some time to consider his next move – and then put out a plea over Facebook that fall to his close to 1,000 connections hoping that someone, anyone, might consider.
“I took a week to really think about it – this is what I’m asking for someone to do. I had to get over it in my mind that it was OK to ask,” Studley said. “I’m going to ask someone to make a sacrifice for me, and that’s not me. I always want to help everybody else.”
Godwin is that way too. And immediately after reading Studley’s post, he knew he needed to consider making a call.
Strong match
Godwin had moved to Tawas City from Midland in 2014, and after a few years off from officiating decided to get back on the court that following winter.
He thinks he and Studley may have crossed paths at some point during Studley’s tenures at Sacred Heart and Caro, but it was at Tawas where they got to know each other. Although Studley stayed at Tawas just one school year, Godwin continued officiating for him at Ogemaw Heights – and in fact, Godwin’s final game in 2018 was there, during the District basketball tournament. That night, during the first quarter, Godwin tore the plantar fasciitis in his left foot. He didn’t know if he’d be able to finish the game – the officials from the first game that night stuck around to step in just in case – but thanks in part to Studley connecting Godwin with the Alpena trainer during halftime, he was able to get through the final two quarters and finish his officiating career on his feet.
They’d become Facebook “friends” at some point, so Godwin had seen Studley’s posts over the years with Shannon and Maizy. And when he saw Studley ask for help, something hit him – “immediately.”
“I have a 5-year-old granddaughter, almost exactly the same age as Jon’s, and I’m the dad of one child, a daughter, so there were those connections,” Godwin said. “It almost didn’t feel like there was a choice. It felt like it was something I had to do.”
Godwin is 66 and always has been in good health. He’s also always been an organ donor on his driver's license and given blood, things like that. But he had never considered sharing an organ as a living donor until reading Studley’s post.
He read it again to his wife Laurie. They talked it over. He explained why he felt strongly about donating, even to someone he didn’t know that well. After some expected initial fears, Laurie was in. Their daughter had the same fears – What about the slight chance something could go wrong? – but told Laurie she knew neither of them would be able to change her dad’s mind.
“It took me a while to get on board with it, even though I knew in the vast majority of cases somebody who donates an organ is going to be absolutely fine. It’s still major surgery,” Laurie said. “I guess he was just feeling so much like it was something he wanted to do, and he is a very healthy physically fit person. So I felt the odds were really good that he was going to be fine.
“And really, probably, the deciding factor was Maizy. We have a granddaughter the same age, so we were just thinking she needs a dad.”
After a few more days of contemplation, Dan called Cleveland Clinic to find out how to get started.
Then he texted Studley.
“I was nervous saying yes. At first, I didn’t know what to say – I just kept saying, ‘You don’t have to do this, but I appreciate it,’” Studley said. “I never want to have somebody do something for me unless (the situation is dire) … so I told him thank you and I appreciate it, and no pressure.”
Generally, Studley said, the donor and recipient don’t receive information on how the other person is progressing through the process. Godwin, however, kept Studley in the loop, which was a good thing. “But then you’re wondering if it’s going to happen,” Studley said, “if it’s truly a match.”
The initial blood test showed that Godwin wasn’t just a match, but a “strong” match, meaning they share a blood type – the rarest, in fact – and Godwin also didn’t have the worrisome antibodies that could’ve caused his kidney to refuse becoming part of Studley’s body.
That was amazing news. But just the start. “There was so much more we had to go through just to get to surgery day,” Studley said.
Long road ahead
Studley relates the transplant process to a job interview. After meeting with a potential boss, the candidate must wait for an answer – and it could come the next day, or the next week, or months later.
There were several more tests for both to take to make sure the transplant had not only a strong enough chance of being successful, but also wouldn’t be harmful for either of them.
“Right up until the time of the donation, (things) can happen. Like they did blood work on me the Friday before the kidney transplant on Monday, and if that had showed something they were going to send me home,” Godwin said. “So I just kept thinking, is this going to work? It seemed that there were more things that could go wrong than the possibility that it could go right. And that sets everybody up for disappointment – me, because I was invested in doing it, and of course Jon and his family because it was important to them.”
Godwin made a trip to Cleveland Clinic in November – about three months before the surgery. It wasn’t a great visit. His electrocardiogram showed a concern, and a few suspicious skin lesions were an issue because donors must be cancer-free. Almost worse, he couldn’t get in for a follow-up appointment for six weeks.
The wait felt longer knowing not only that there was a possibility for disappointment for Studley, but also the potential something could be unwell with Godwin. But then came good news – at his follow-up, Godwin aced his stress test, alleviating any heart concerns, and the dermatologist said the lesions were basal cell carcinoma and not considered risky to the transplant.
Over the next three months, both Godwin and Studley continued to do whatever they could to keep the transplant on track. To avoid COVID, Godwin and his wife isolated as much as they could, and Studley began wearing a mask frequently at work. Godwin cut out alcohol and coffee and began walking regularly to keep in tip-top shape.
In January 2023, both got the final OK, and the surgery was scheduled for Feb. 20.
But that wasn’t the end of the anxiety.
Studley also had undergone a series of tests and doctor visits, and two days before the transplant he had to get a tooth removed to avoid a possible infection.
Then, on the way from Alpena to Cleveland, Studley’s vehicle hit a deer.
“How is this going to go now?” he recalled thinking. “This is how it started. What’s going to happen now?”
Both arrived in Cleveland safely, eventually. The families stayed apart all weekend, Studley and Godwin communicating briefly by text to check in. There were a few more stop-and-go moments. Godwin’s Friday blood work showed something unfamiliar that ended up harmless. On the day of the surgery, Studley was wheeled to just outside the operating room – and then taken back to his hospital room for another 15 minutes of suspense. Once Studley made it into the operating room, his doctors had to pause during the surgery to tend to an emergency.
But finally, the transplant was complete. And seemingly meant to be. Godwin’s kidney was producing urine for Studley’s body before the surgeons had finished closing him up.
Back on his feet
Studley said he knew he’d be fine once he could start walking the hallways at the hospital; he started doing so the next morning. Later that same day after transplant, on the way back from one of those walks, he saw Godwin for the first time since they’d both arrived in Cleveland. “It was absolutely emotional,” Godwin said.
Godwin went home four days after the surgery. Studley stayed the next month with appointments and labs twice a week. Shannon remained with him the first week, then friends Mike Baldwin and Josh Renkly and Studley’s father Larry took turns as roommates for a week apiece.
For the first three months, including his first two back in Alpena, Studley couldn’t go anywhere except for the trip to Cleveland every other week – which has now turned into every other month with virtual appointments the months in between. Total he missed about six months of work – and thanked especially assistant athletic director and hockey coach Ben Henry for shouldering the load in his absence.
Studley’s checkups are full of more good news. His body is showing no signs of rejecting the kidney. And as long as he keeps his diabetes under control, that shouldn’t affect his new organ either.
Shannon sees the difference while comparing a pair of family trips. The Studleys went to Disney World while Jon was on dialysis, and she said he made it through but got home just “depleted.” This past spring break, the family went to Gatlinburg, Tenn., and Jon had visibly more energy for hiking and other activities. The last six months of dialysis, Jon was sleeping a lot, but this spring he’s helping coach Maizy’s T-ball team and overall is able to spend more quality time with her.
“Most of (Maizy’s) life she’s only known him as sick Dad,” said Shannon, a counselor at Alpena’s Thunder Bay Junior High. “He wasn’t able to do a lot of things with her, and I’ve seen a lot more of that, and I think she notices.”
Jon will be taking anti-rejection medicine and a steroid every 12 hours for the rest of his life, but that and some other little life adjustments are more than worth it. All anyone has to do is look at those 47 photos from the Facebook post to understand why.
Godwin said he feels better now than he did even before surgery. He does his checkups with Cleveland Clinic over the phone. He also said that if Studley had been found at some point late in the process to be unable to except the kidney, Godwin still would’ve given it to someone else on the waiting list. “I was so invested at that point,” Godwin remembered. “That kidney was going.”
The two families got together for a reunion in August in Tawas, where they had lunch and walked the pier and the Godwins met Maizy for the first time. She doesn’t really get what’s transpired, but definitely notices Dad doesn’t have a tube coming out of his body at night anymore.
And it’s clear the two men value the connection they’ve made through this unlikely set of circumstances.
“His attitude has been inspiring,” Godwin said. “Because you’ve been through the mill (and) I’ve never heard a negative thing, ‘poor me’ or anything. And I think maybe that’s what helps keep you going.”
“You talk to people who know Dan, and they said, ‘That’s Dan. That’s what Dan does,’” Studley said, speaking of Godwin’s gift and then addressing him directly. “The hardest part for me, the biggest struggle … is there’s no way I’m going to ever be able to thank you for this.
“It’s like the post I posted yesterday on Facebook. I posted pictures of everything I had done in the last year, and a lot of it was stuff that I hadn’t done in a long time. My way to thank Dan is just living my life the best I can, enjoying my family. … For me, it’s changed my perspective.”
As lunch finished up, Godwin did have one ask in return – not for one of Studley’s organs, but to be part of a special moment that helped drive him to donate 12 months earlier.
“This isn’t the venue, but I’ve thought about this a lot. I’ve never asked for anything and I don’t want anything,” Godwin said, “but I would like to go to Maizy’s wedding.”
“Yeah, you … yes. Yes,” Studley replied. “You can go to anything you want to go to with my family.”
“I’d like to be there.”
“You will definitely be there.”
“I was at my daughter’s wedding,” Godwin said, noting again that connection between the men’s families, and the importance he felt in Studley being there for Maizy like he’d been there for his child.
“You say that, but there were times I didn’t know if I’d make it to Maizy’s wedding. I might not make it to see her graduate. So …” Studley trailed off, ready to take the next step in his life rejuvenated.
Studley emphasized the continuing need for kidney donors and refers anyone interested in learning more to the National Kidney Registry.
PHOTOS (Top) Alpena athletic director Jon Studley, left, and retired MHSAA game official Dan Godwin take a photo together on the shore of Lake Huron one year after Godwin donated a kidney to Studley. (2) Studley cheers on Alpena athletes during last season’s MHSAA Track & Field Finals at Rockford High School. (3) Godwin and Studley meet for the first time after the transplant, and again six months later. (4) Studley, his wife Shannon and daughter Maizy enjoy a moment after Jon had returned to good health. (Top photo by Geoff Kimmerly; other photos provided by Jon Studley.)