The Concussion Crisis

Anatomy of a Silent Epidemic

Linda Carroll, David Rosner

• Publisher: Simon & Schuster
• Year: 2011
• ISBN:
  9781451627466
• Topic: Sciences biologiques
• Subtopic: Neurosciences

FOR FAR TOO LONG, the menace of concussions has been hidden in plain sight. On playing fields across America, lives are being derailed by seemingly innocuous jolts to the head. From the peewees to the pros, concussions are reaching epidemic proportions. This book brings that hidden epidemic and its consequences out of the shadows. As frightening as the numbers are—estimates of sports-related concussions range from 1.6 million to 3.8 million annually in the United States—they can't begin to explain the profound impact of a hidden health problem that can strike any of us. It is becoming increasingly clear that concussions, like severe head traumas, can rob us of our memory, our mental abilities, our very sense of self. Because the damage caused by a concussion is rarely visible to the naked eye or even on a brain scan, no one knows how many millions might be living lives devastated by an invisible injury too often shrugged off as "just a bump on the head." This book puts a human face on a huge public health crisis. Through narratives that chronicle the poignant experiences of real people struggling with this invisible and often unrecognized brain injury, Linda Carroll and David Rosner bring home its potentially devastating consequences. Among those you will meet are a high school football player whose college dreams were derailed by a series of undiagnosed concussions, a hard-driving soccer star whose own struggles with concussions pushed her to crusade for safety reform as a coach and soccer mom, and an economist who lost her career because of lingering concussion symptoms from a fender bender. The Concussion Crisis weaves these human dramas with compelling stories of scientists and doctors who are unraveling the mysteries of how an invisible injury can wreak such havoc. It takes readers into the top labs, where scientists are teasing out what goes wrong in the brain after a jolt to the head, and into the nation's leading concussion clinic, where patients get cutting-edge management and treatment. Carroll and Rosner analyze the cultural factors that allowed this burgeoning epidemic to fester unseen and untreated. They chronicle the growing public awareness sparked by the premature retirements of superstars like NFL quarterbacks Troy Aikman and Steve Young. And they argue for an immediate change in a macho culture that minimizes the dangers inherent in repeated jolts to the head. The Concussion Crisis sounds an urgent wake-up call to parents, coaches, trainers, doctors, and the athletes themselves. The book will stand as the definitive exploration of this heretofore-silent health crisis. It should be required reading for every parent with a child playing sports—in fact, by everyone who has ever suffered a hard bump on the head.

Chapter 1

Just a Bump on the Head

Concussions caught up with Dave Showalter before he could play a single down of college football.

A big, burly kid whose passion for the sport seemed wound as tightly through his DNA as his large brown eyes and fine chestnut hair, Showalter was playing tackle football almost from the time he could walk. While he impatiently waited to grow old enough to join a team, he made do roughhousing at home with his two big brothers. The three would shove the furniture against the walls and position the couch as a goalpost, turning the living room into a playing field for games of “knee football.” Their objective wasn’t so much to score touchdowns as to rough each other up in the process; casualties of the games often included their mother’s bric-a-brac as well as their own heads.

When he reached fourth grade, Showalter finally got his chance to strap on the shoulder pads, pull on a helmet, and play for real. He was grateful that his parents had chosen to send him to a Catholic school that, unlike the neighboring public schools in central Pennsylvania, allowed kids as young as nine to play tackle football.

Already weighing well over a hundred pounds, he was so big that by league rules his helmet had to be marked with a black X and he wasn’t allowed to carry the ball or to play glamour positions such as quarterback and running back. An offensive lineman by default, he quickly learned to make the most of his size. At the center of all the crashing and crunching on the line of scrimmage, he would often thrust headfirst into opposing linemen with reckless abandon.

By the time he reached high school, Showalter seemed an indestructible force at six foot four and 260 pounds, his imposing size amplifying the sense of invincibility that naturally comes with youth. All of that allowed him to shake off his concussions as if they were common colds. He played through headaches and nausea and a strange metallic taste that exploded in his mouth after hard helmet-to-helmet hits. He kept quiet about the scary symptoms for fear that telling anyone—his coaches, his trainers, even his parents—might cost him playing time; and besides, having been weaned on football’s just-rub-dirt-on-it ethos since fourth grade, he could shrug off each jarring hit as “just getting my bell rung.”

It wasn’t until the summer before his junior year that a concussion symptom finally brought Showalter up short. He’d be walking around the house and suddenly his vision would fade to black. The blackouts would last several seconds, and though he never lost consciousness, he’d have to grab on to something solid to steady himself. He didn’t understand what was happening, and he was frightened that it meant something had gone seriously wrong with his brain. He suspected that the blackouts were related to a concussion he had sustained during summer football camp when he was kneed in the head and briefly knocked unconscious. As much as he loved the game, he decided to give it up and concentrate on other sports.

That resolve lasted barely a season. One afternoon before basketball practice, his old football coach strode into the locker room looking for Showalter. The coach dropped a plastic shopping bag full of recruiting letters on the bench where Showalter was suiting up and said, “I was going to throw these away, but it’s a federal offense to mess with your mail. This is something you need to think about, something you could be missing out on.” Showalter pulled out a handful of unopened envelopes and saw return addresses from some of college football’s powerhouses—Notre Dame, Nebraska, Penn State. As he ripped open the envelopes and started reading, Showalter for the first time realized that he might be able to parlay one more season of high school football into a college scholarship. The more he mulled it over, the less he could think of any reason not to return to the gridiron, especially since his concussion symptoms had completely disappeared.

His comeback seemed perfect. Showalter was playing better than ever, his team was rolling through the season undefeated, and his head felt fine. Even when he took a hard helmet-to-helmet hit late in the season, he just shook it off and kept playing until his team scored a touchdown. Only after he returned to the sideline did anyone notice something was wrong. The trainer glanced down the bench and saw that Showalter seemed dazed, just staring up at the stars beyond the Friday night lights. After taking a closer look, the trainer determined that Showalter was dizzy and disoriented enough to be pulled from the game. During halftime, Showalter tried to argue his way back onto the field, uncharacteristically crying, yelling, and even cursing at the trainer. This time the concussion was so bad that the trainer sidelined Showalter not only for the rest of that game, but also for most of the next week’s practices. By the following Friday night’s game, Showalter had convinced the trainer that he’d recovered enough to return to action.

As his team moved through the state playoffs, racking up two victories before losing in the quarterfinals, Showalter came more into focus for college recruiters. Now they could see firsthand that not only was he big, at six foot five and 280 pounds, but he was also quick and agile. They recognized raw potential that could be shaped by weightlifting and the right coaching. They could see that this kid had the brawn to excel in major-college football, the brains to shine in the classroom, and the determination to make all those dreams come true. By the time Showalter chose which athletic scholarship would be his ticket out of the depressed railroad town of Altoona, his concussion symptoms were a distant memory and his prospects seemingly boundless.

At Rutgers University, the coaches had big plans for their rough, uncut gem. They would “redshirt” him as a freshman, sitting him out of games through the 1998 season so he’d start his playing career as a sophomore with all four years of eligibility remaining. That gave them a year to sculpt his maturing body through long, grueling hours in the weight room and to teach him blocking techniques that relied more on using his hands than his helmet. He began his sophomore year, an inch taller and forty pounds stronger, as the backup offensive tackle to a senior bound for National Football League stardom.

Then, just a month into his first season on the Scarlet Knights roster, while Showalter was warming up for a game he wasn’t even scheduled to play in, his life was upended in a split, and stunning, second. Since it was just pregame warm-ups, he hadn’t bothered to buckle his chinstrap or to put in his mouthpiece, and he certainly wasn’t expecting his own teammate to crash into him with enough force to knock him to his knees. He knew he was in trouble right after the helmet-to-helmet hit flooded his mouth with that familiar and frightening metallic taste. Although teammates later told him he spent the game on the sideline charting plays as usual, he remembers nothing until halftime, when he asked for Advil to quiet a searing headache. After that, he doesn’t remember anything—not the second half of the loss to Wake Forest, not the plane ride home to New Jersey from North Carolina, not even a minute of practice the next day.

Despite amnesia, insomnia, headaches, and dizziness, Showalter soldiered on all week as if nothing had happened. He continued banging helmets every day at practice, then ratcheted up the intensity on Saturday when he finally got into a game. At the next day’s film session, as he watched replays of the game with his teammates, Showalter couldn’t remember a single play he’d made, not even the block he threw to clear the way for his roommate’s touchdown run. As if by pure instinct, he kept right on practicing each weekday and then playing on Saturdays as a late-game substitute. Every time he made contact, his symptoms worsened—the headaches growing into migraines, the dizziness escalating into vertigo. Within a few weeks, just a hundred-yard sprint down the field was enough to send his head spinning.

Still, it wasn’t any of the symptoms he experienced on the gridiron that finally persuaded Showalter to seek help—it was something that happened in the classroom. A month after the Wake Forest game, he dug out his spiral notebooks to prepare for midterms. As he leafed through the pages filled with meticulous notes, he started to get scared. Nothing looked familiar. He tried to recall the lectures that went with the notes and realized he couldn’t remember even being in the classes that the handwriting proved he’d attended.

Showalter had always had the kind of memory that allowed him to read through a page of notes and immediately conjure up an image of the professor actually speaking the words. He was prouder of that detailed and dependable memory—and the academic achievements it helped garner—than any of his athletic accolades. He had graduated near the top of his high school class, earning membership in the National Honor Society with a 3.75 grade point average. He had chosen to attend Rutgers, over universities with stronger football programs, because of the academic opportunities it promised. Once there, despite the full-time commitment of playing big-time college football, he continued to shine in the classroom, making dean’s list with a 3.5 grade point average and securing a spot on the Big East Conference All-Academic Team.

Now suddenly, before he could complete his first season playing for Rutgers, the athletic prowess that had earned him this academic opportunity was threatening to take it away. Worried he was on the verge of losing everything he’d worked so hard to achieve, Showalter finally was able to push past football’s macho code and admit to the team physician, “Listen, I think something has happened to me.” Exactly what that was would remain a mystery until Showalter went to see the team neuropsychologist.

•   •   •

Jill Brooks looked up from the medical charts spread out on her desk as Dave Showalter stepped into her office for his initial consultation. She was struck by his soft, rounded features and his kind brown eyes. The face didn’t seem to fit the powerful, sculpted form towering over her; and his soft-spoken, easygoing manner didn’t match the intense and fierce temperament usually associated with the position he played. Brooks could see this was not your typical jock.

When Showalter started to describe what had happened to him, though, it became clear that his story was all too typical. It was a story Brooks had heard countless times in nearly a decade of treating college and high school athletes for concussions at Robert Wood Johnson University Hospital in New Brunswick, New Jersey.

She started to prod Showalter for more details about the helmet-to-helmet collision in the warm-ups at Wake Forest.

“Do you remember getting a strange taste in your mouth after you got hit?” she asked.

Showalter’s large eyes widened. “Yes,” he said slowly. “How did you know that?”

“Was it a kind of metallic taste?” Brooks asked.

His eyes widened further. He was surprised that this specialist seemed to know all the details of a bizarre symptom he thought he alone had experienced. “Yes. It’s happened every time I got hit hard. Nobody’s ever been able to tell me what it was.”

Brooks explained that the taste was a sign he’d suffered an “impact seizure” and that it was not uncommon for badly concussed athletes to experience one. “What it means is that the force of the hit was so hard and so directed that you had a seizure on impact. The electrical activity in your brain was disrupted because of the force. We call it an impact seizure because you might think you had epilepsy if we simply called it a seizure and typically impact seizures are just one-shot events.”

Showalter was silent, the word “seizure” leaving him too stunned to respond.

“The other symptoms—how long did it take for them to go away?” Brooks asked.

Showalter hesitated. He was getting more nervous. “They haven’t gone away,” he said. “They’ve just gotten worse.”

Showalter told Brooks about his amnesia, the dizziness, and the headaches. He told her that his brain felt foggy and that he’d been having trouble concentrating. He admitted that the symptoms worsened with even the slightest bump by another player.

Brooks wrote it all down, and then, after a brief pause, told him what it meant.

A concussion, she explained, was a serious injury. It wasn’t just a “ding” or just “getting your bell rung.”

“You can’t look at it any other way, because this is an injury to your brain,” she said, “and your brain controls everything that you do—from breathing to moving your extremities to your thinking to your emotions. Your brain controls it all. And if you get repeated injuries and repeated impact seizures, you start having difficulties with thinking in class and with follow-through and with sadness and with all that other stuff.”

A concussion, she went on, needed to be taken as seriously as any visible injury—more seriously, in fact. She told Showalter he needed to give his brain time to heal. He would have to take time off from all physical activities. There would be no football, no weightlifting, no running, no stationary bike. What Brooks couldn’t tell him was exactly when he’d be better. “If you broke your ankle, I could tell you it would take six weeks to heal,” she said, “but with a brain injury, it’s not like that and there’s no way of telling how long it’s going to take.”

Showalter took a few moments to process all the new information. Finally, he said, “I’ll be back by next season, right?”

“Dave, you should not be playing football,” Brooks said, drawing a deep breath. “You should never think of playing football again.”

Showalter stiffened. A swarm of thoughts spun through his mind: “This can’t be right. She’s just being overprotective. I’m young; I’ll heal; I’ll be fine by next season.”

As Brooks watched him mulling over the unwelcome advice, she worried that she had not driven her point home. The silence was going on too long.

“Dave, this could be permanent,” she said finally. “You’ve had multiple concussions—there’s no way of knowing how many—and the effects can be cumulative. Your brain might not heal one hundred percent. Your memory might never come all the way back.”

•   •   •

The short walk back to campus from the hospital was all a blur as Showalter desperately tried to get his mind around everything Brooks had just told him. As he passed the school’s colonial buildings and the site where Rutgers had hosted the nation’s first intercollegiate football game in 1869, Showalter pondered the doctor’s orders to give up the sport that had defined his identity for as long as he could remember. He had walked into Brooks’s office still harboring dreams of playing in the NFL, and now he suddenly had to resign himself to this new reality that didn’t include football at all.

Over the next few months, Showalter followed her prescription for allowing his brain to heal. By the end of the school year, all the concussion symptoms seemed to have resolved. His memory was back, his brain clear. He felt so much better that he figured he could ignore Brooks’s recommendation to give up football.

He played the next season for Rutgers without being sidelined by concussions—but his transcript was starting to reflect their impact. That semester, he failed a course for the first time ever as his grades spiraled downward. He couldn’t understand why schoolwork, which had always come so easily, was now impossible. He was embarrassed by his grades, and depressed.

To make matters worse, when Showalter’s injured ankle failed to rebound the following spring from a third surgery, his coach pulled him aside and said, “You’re done.” Cut from the team, Showalter tried to concentrate full-time on academics. But by then, not even all the extra study time could help. He would read the same paragraph over and over and over again, and still not remember a word. That semester, he failed three of his four courses. When fall rolled around, Showalter felt even more depressed, and alone. Unable to count on his brain anymore, he decided to drop out of school.

He moved into a tiny one-room apartment above a corner store, just a short walk from the classrooms where he once felt at home. He traded the semester’s scholarship check for a $3,000 car so he could support himself making daily deliveries for a local bagel shop. When Rutgers officials noticed that he had cashed his check but not shown up for classes, they demanded the money back. He immediately started paying down the debt in $25 weekly installments.

In 2007, six years after dropping out of college, Showalter was still living in the same ten-by-ten apartment with a futon for a bed and a hot plate instead of a stove. He still had the delivery job and had begun working with autistic children in the afternoons and evenings at a New Brunswick community center. Some days, he’d sit back and survey his sparsely decorated room and reflect on how his life had turned out. He’d think about the careers he once considered pursuing—teaching, public relations, medicine. This certainly wasn’t where he thought he’d be at age twenty-eight. When he left the modest two-story brick house that his parents bought with money scraped together from their jobs at the phone company, he thought his possibilities were boundless. Of the six Showalter children, Dave had been the one everybody knew would make it big. Now he could only dream of someday going back to Rutgers and resuming his studies.

Trying to make some sense of it all, Showalter started giving occasional lectures on the dangers of concussions to coaches and trainers. “I feel like I got lost in the shuffle,” he’d tell them, “so it’s important to me to raise awareness about brain injuries. They can make a huge impact on a person’s life. I mean, I can’t even remember much of what happened my last two years in college.”

The cautionary tale would always amaze his listeners. Who would ever think that seemingly innocuous bumps on the head could erase entire years from a memory and derail a life?

Chapter 2

The Emerging Epidemic

In the classic image of a concussion, a player is lying motionless on the turf with teammates hovering over him and a trainer racing across the field. Smelling salts are waved under his nose, and the player shakes his head as he comes to. The trainer asks him, “How many fingers am I holding up?” The player’s answer is the same as always: two. That’s because the trainer makes it easy by always holding up the same number of fingers and then rewarding the correct answer by sending the player right back into the game.

That inside joke among players an...

Table of contents

• Cover
• Dedication
• Introduction
• Chapter 1: Just a Bump on the Head
• Chapter 2: The Emerging Epidemic
• Chapter 3: Head Games
• Chapter 4: Sudden Impact
• Chapter 5: Through the Cracks
• Chapter 6: Playing Defense
• Chapter 7: Anatomy of a Brain Injury
• Chapter 8: Deciphering the Damage
• Chapter 9: A Pocketful of Mumbles
• Chapter 10: Ticking Time Bombs
• Chapter 11: Seeds of Change
• Epilogue
• Appendix I: Concussion Symptoms
• Appendix II: Resources for Patients and Families
• Acknowledgments
• About the Authors
• Source Notes
• Index
• Copyright