Heads in the Game

The grand finale: useful links 1-9

Sunday, 09 January 2011 09:40 AM Written by

This is farewell.

Just a song before I go? Nah, but imagine Crosby, Stills & Nash as background music. . . .

Let's close out the Heads in the Game series, and this accompanying blog, with some web portals that may well prove useful for parents, players, coaches, anyone who already has experienced concussions or brain injuries in sports, or, alas, is concerned they may someday deal with them.

> The Center for Disease Control contains a sub-site with a wealth of information available. Experts at UPMC Sports Medicine assisted in formulating much of that information.

The CDC's signs and symptoms card was posted here a few days ago, but here's another form of it.

Like everyone else, they're also on Facebook. . . but it's part of their http://www.facebook.com/cdcheadsup , where some folks have shared their stories and other links. (Though nobody has made them aware of our series.)

"A concussion is a brain injury, and all are serious" -- a CDC quote that should appear in every locker room, preseason physical-examination form and coaching credential.

> UPMC Sports Medicine's sites for head injuries and the concussion program that attracts professional and amateur athletes from all over.

The ImPACT test, founded by program director Dr. Mark Lovell and co-director Dr. Michael "Micky" Collins, already contains millions of tests for young athletes in Western Pennsylvania and throughout America. The majority of Pennsylvania high schools are expected to be subscribers by the end of 2011. Youth teams and associations also can get their players tested, for a nominal fee. As Shawn McCall -- a president, coach and father in the Peters Township Youth Football Association -- put it in the main story of the Heads in the Games first installment, "How much is your kid's brain worth? Come on.

"No pun intended, it's a no-brainer."

> West Penn Allegheny Health System/Allegheny General Hospital sports medicine, while less widely publicized as its counterparts, also performs considerable work with concussions -- as detailed in Part I on this page of PDF presentations and slideshows. The sports medicine  director, Dr. Patrick DeMeo, is also the Pirates' medical director. And Dr. Edward Snell, who assists DeMeo with the Pirates, is so well versed in concussions that he has spent the past decade helping the National Federation of High School Associations to rewrite its concussion guidelines.

> The state of Washington's interscholastic sports, the first to come under the Lystedt law being adopted in much the same form in states across the country -- though Pennsylvania's attempt (see below) is stalled in the senate.

> Keep an eye on the U.S. military, for that's the likely genesis of the next breakthroughs in concussion research. You can find some discussion on that front at this site and this one. Anywhere from 40 percent to 75 percent of all military injuries in Afghanistan and Iraq are concussion-related, experts say. Post-concussion symptoms may even be confused for post-traumatic stress disorder in some soldiers.

> Some supplementary reading, all found in these pages in the past:

Mike Webster's tale (circa 2005-06)--

  His family's fight against the NFL, which helped to pry open the door that lead to today's awareness of Chronic Traumatic Encephelopathy, concussion dangers, later-life difficulties. Interesting to look back that the findings the NFL at long last accepted last year were intially found in 2005 amid concussion and retired-players research at the University of North Carolina, long before Kevin Guskiewicz of Latrobe deservedly became a nationally known expert in the field. And here's a story I'll never forget: fomer NFL player Curt Marsh, whose leg got amputated as a result of injuries, had an annual physical to retain his disability payments, "So every year I go back [to an NFL-selected physician] to see if my leg has grown back, or I have a new hip, or whatever."

  The family's blame.

  The NFL's disability program.

   An early court victory for the estate.

   Webster's family finally wins their appeal.

2010, what some people call The Year of the Concussion, from the Post-Gazette --

   Brain experts call for plans for concussion management. (Me, March 13)

   Experts contend hockey is next. (Me, March 14)

   Chris Henry's brain shows chronic disease. (Me, June 28)

   -- Column on those concussion findings. (Ron Cook, June 29)

   Column on Ryan Clark's concussions. (Ron Cook, Aug. 8)

   Young-athlete trips to ERs on rise. (Jack Kelly, Aug. 31)

   Brain trauma rises in youth basketball. (Jack Kelly, Sept. 15)

   State committee approves proposed bill. (Tracie Mauriello, Sept. 20)

   Editorial about the bill. (Sept. 26)

   Pa. House passes concussion bill. (Me, Sept. 29)

   Mixed reaction to the bill. (Me, Sept. 30)

   Spinal injury is concussion-like (Jack Kelly, Oct. 4)

   UPMC gets NFL grant to study youth concussions. (Me, Dec. 22)

   George Visger's story, first published on this blog, then in the newspaper (Dec. 26)

And, of course, this Heads in the Game Series --

   The links to Parts I through III are located at the left on his blog page.

   Here, from Part IV, is the Preston Plevretes story.

   Here is Dr. Julian Bailes' seven points to curtail and prevent concussions.

One final note: My heartfelt thanks to everyone involved in the series -- the doctors, the nurses, the clinics, the parents, the players, the certified athletic trainers, the public-relations folks, the families and athletes who shared through emails and calls their past tales of concussions and brain injuries, . . . . The list is long. Each one had a significant impact, for which I am eternally grateful. Hopefully, we opened some eyes and minds, raised some awareness, with videos, photographs and words.

 

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Blog shutdown notice

Saturday, 08 January 2011 12:00 PM Written by

Hear ye, hear ye:

With the Heads in the Game series having come to a close last Sunday, we're officially going dark on the Heads in the Game blog tomorrow.

Sorry, no Heads in the Game cologne, lunchboxes or action figures are planned.

But the existing threads will remain open, and you'll be more than welcome to post in the Comments section. . . of any of the items from the beginning to tomorrow's final post.

Thanks much,

The head of Heads in the Game

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Crosby's 'upper-body injury' a concussion 1-7

Friday, 07 January 2011 05:43 PM Written by

You can't get more "upper-body" than the brain.

Well, there is the lid of the skull, the scalp and his mop of hair.

Still and all, that's barely 1 inch total, leaving another 5 feet, 10 inches as Sidney Crosby's "lower body" by that definition, eh?

The NHL opens itself for not only levity, but criticism in such matters due to its hazy identification policy on injuries. Concussions, as we all know now, are serious ailments. Penguins coach Dan Bylsma said the team's captain and All-Star vote-getting leader likely will miss a week. (You can read more at the PG+ site, which I believe once you sign up is still free for the first few views.) To many experts in the concussion business, a week is the bare minimum, the industry standard.

The question is: Would that be a week from Tuesday, truly a week and three days from this past Saturday, or longer?

Here comes the criticism part. In Canada, where Crosby is idolized, if not held in greater esteem, there already is considerable eyebrow raising and jaw jutting over the lingering questions. Cam Cole, one of that nation's foremost hockey voices, opined here that the Penguins did a disservice by allowing Crosby to play against Tampa Bay and failing to identify when the injury happened. That's because, Cole wrote, it was apparent to the 6-plus millions watching the Winter Classic that the concussion came in the Dave Steckel hit in Heinz Field Saturday night against the Washington Capitals rather than when the Lightning's Victor Hedmen clouted him -- into the boards? -- three nights later.

This much remains certain: The Penguins and the white coats around them know concussions. Team doctor Chip Burke was a key figure in a league study about concussions years ago and helped the NHL to launch its policy about handling such injuries. UPMC Sports Medicine is their medical provider, so the ImPACT test assuredly will be the prime tool used in opening the bench door and, in the end, ultimately allowing Crosby to return to the ice. Because of Crosby's star status, you would think even greater will be exercised. . . especially if post-concussion symptoms dragged into a 2 1/2- to 3-week window, where missing the Jan. 30 All-Star Game and taking that break could conceivably prove to be a boon. That's a much longer period than what Bylsma offered. . . but that's the thing with concussions: You never know. It's case by case, individual by individual, "mild concussion" by "mild concussion."

 

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Another concussion tragedy 1-6

Thursday, 06 January 2011 09:00 AM Written by

The focus far too often falls upon sports.

But concussions can happen anywhere.

This one came on a school playground, and it claimed the life of a 9-year-old Oklahoma girl.

Alyssa Avila of Wyandotte, Okla., died Aug. 19 after falling off a teeter-totter contraption at her elementary school. Even though she landed on wood-chip mulch, as the playground surface was described, she fell on her head and back with such apparent force that Oklahoma medical examiner's office ruled -- and announced just this week -- that she sustained a severe concussion that killed her.

The Tulsa World story included a photograph of the young girl.

Our children cannot wear headgear every moment of every day. Then again, headgear such as football helmets are designed to prevent traumatic brain injury, not the mild brain trauma of a concussion. As experts contend, you cannot wrap a helmet around a brain suspended in liquid inside the skull.

Yet there might be better safety precautions to be exercised in the places where children play games as well as sports.

In other news:

> Sen. Tom Udall, D-New Mexico, officially asked the federal government -- in the form of the Federal Trade Commission -- to investigate manufacturers whom he said "falsely advertise"  concussion-safety claims about their football helmets, particularly ones sold for wear by children.

The story and the text of his letter are linked here.

 


 

 

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Print this out: signs, symptoms of concussions 1-5

Wednesday, 05 January 2011 04:00 AM Written by

If you have an athlete or child who is prone to concussion or involved in an activity where he/she could suffer one -- that's not just football, but skateboarding, bicycling, soccer and, yes, even cross-country (one local girl was concussed by a buck at the state championships) -- don't leave home without this card.

The Center for Disease Control, which on these topics gets assistance from UPMC Sports Medicine concussion specialists, put together this list of concussion signs and symptoms.

A variation of it was handed out to football coaches and referees in Pennsylvania this past fall and elsewhere across America, under the new guidlines of the National Federation of State High School Associations.

It looks something like this:

SIGNS OBSERVED

Appears dazed or stunned

Is confused about assignment

Forgets plays

Is unsure of game, score, opponent

Moves clumsily

Answers questions slowly

Loses consciousness (even briefly)

Shows behavior or personality changes

Can't recall events prior to hit or fall (retrograde amnesia)

Can't recall events after hit or fall (anterograde amnesia)

SYMPTOMS REPORTED BY ATHLETE

Headache or "pressure" in head (Editor's note: In one examination session, I remember a 14-year-old high-school student recalling how his felt like it was a tomato being squeezed; it hurt that much even AFTER he removed his helmet.)

Nausea

Balance problems or dizziness

Double or fuzzy vision

Sensitivity to light and/or noise

Feeling sluggish or slowed down (physical)

Feeling foggy or groggy (mental)

Does not "feel right"

Change in sleep pattern (Editor's note: Here is where the UPMC Sports Medicine concussion program handy card differs slightly from the CDC's.)

Concentration or memory problems

Here is some more info from the CDC.

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10 concussion questions to ask 1-4

Tuesday, 04 January 2011 02:00 AM Written by

A son's friend was concerned about his sister's concussion. So what does a reporter -- or one for the past 30 years, anyway -- find himself doing but asking questions.

Actually, many of those same questions are asked repeatedly by concussion doctors. I heard specialists such as Mark Lovell and Michael "Micky" Collins, the director and co-director of UPMC Sports Medicine's concussion program, pose them to young patients time and again in examinations. Therefore, much like the email I offered, here are some of the concussion queries oft asked by the docs in the know.

1. Do you remember what happened? Memory loss is the leading symptom, the specialists say. It can be the collision itself, a few moments afterward or a gap much longer. Whatever the duration, it's a concerning sign.

2. Did you give you a headache? And, just as important, Do you still get headaches? On a scale from 1 to 10, with 10 being the worst, how bad are the headaches? Does anything make them go away? Sensitive to light or noise? Are you doing anything in particular when they come back? Would you believe, math and English class, if not texting or online time or even video games can exacerbate those painful episodes. That's why specialists joke that they are torturing teen-agers by taking away most, if not all, of their outside-school activities.

3. Did you black out? Loss of consciousness used to be a leading symptom, but not that the specialists are finding nowadays. (See questions Nos. 1, 2, 8 and 10.)

4. Did a certified athletic trainer or doctor see you soon after the injury? Unless it was a high-school game, a young athlete only gets medical attention if a parent/guardian takes them to a health professional or hospital.

5. Did your school/team give you a baseline test? In this region, and across more than half of Pennsylvania, the ImPACT test is prevalent. But there are other fashions of neurocognitive testing, which offers an important glimpse into the healthy brain of the athlete. If, for instance, the athlete already had taken a baseline ImPACT, they are given a follow-up exam moments prior to this examination by a specialist -- as a tangible tool for assessment. How'd did you think you did on the retest? Did it give you a headache or bring back any of your symptoms? In the majority of patients whose initial post-concussion exams I was allowed to witness, the kids scored in the 10th percentile or lower -- some even as poorly as the 1st percentile, the bottom. And these were kids who scored in the 70- to 90-percentile range on their original baseline test.

6. Do you feel tired or fatigued a lot more than usual? How are you sleeping? Do you nod off in class or have to go to the school nurse for a nap? Sure, kids prefer to stay in bed until noon. . . or later. But the sluggishness of a concussed youth shows itself to be more pronounced in this category sometimes.

7. Any nausea? Mom, Dad, how's his appetite?

8. How's your vision? Any problems? At this point, Dr. Collins offers a series of acuity tests. In one, he holds a pen with writing on it and gradually brings it closer to the kid's nose, asking the kid to read the words  inscribed on it. Sometimes, that act causes a headache -- if you can raise a symptom in the examination room days or even weeks later, it's a telling sign that this could be a troublesome concussion. The specialists also can detect eye movement or pupil sizes that also signal vision problems due to a concussion. More and more, the specialists say, vision problems are becoming a common result.

Come to think of it, Dr. Collins still has a Cedar Point pen he borrowed from me amid one such exam. . . .

9. How are your grades? Any problems in school? This pertains more to the post-concussion patients, three weeks after the injury and beyond. Parent after parent, who initially believed their child's injury had healed or their fatigue and headaches were due to the flu, suddenly comes to a realization when a good student's schoolwork begins to lapse or severely drop: "Oh my gosh, it's the concussion!"

10.Any problems with dizziness or your balance? That's when the specialists pull out a hunk of memory foam, stand the kid atop it and put them through a series of examinations -- balance  on your left foot, balance on your right foot, with your feet together put out your arm and slowly bring it to your nose. . . . Yes, it may resemble to some extent a DUI test administered by police. But, again, specialists are finding more often that vertigo and vestibular problems, related to the eyes and inner-ears for balance, are a leading symptom.

And the bonus-round question: Did you ever have a concussion before? How many times would you say you had your "bell rung?" That dated buzzword hardly exists anymore. Rather, it's a specialist's way of using that old-fashioned parlance to find out: How many potential concussions have you experienced previously without ever really knowing or admitting it?

The best advice that this layman hears often: See a health professional who is trained in concussions and their management.

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Plevretes redux 1-3

Monday, 03 January 2011 02:00 AM Written by

A wheelchair ramp to the back door by the garage. A wheelchair, from which he didn't arise for the first five months and still sits occasionally when weary. Glasses that don't completely help eyes that have no peripheral vision. His speech. His walk. His therapies. His life.

So much is different for Preston Plevretes.

The story of consequence, the story of second impact syndrome -- Preston's story -- was retold in Sunday's Post-Gazette.

It is such a complex, complicated tale that begins more than the collision five years ago at Duquesne University's Rooney Field, a sturdy LaSalle University linebacker complaining of headaches from a month-old concussion being felled by a punt-coverage collision that shook him, his family, even college football to an extent. It is a tale that will go far beyond today and tomorrow and even Preston's lifetime.

While only so much space in a newspaper could be allotted to one story, there is far more to relate about second impact syndrome, about Preston's plight, about his family.

Here are a handful of additional snapshots:

> A few weeks before that LaSalle-Duquesne game, there came a prank call to the Plevretes' Marlboro, N.J., home: Your son was arrested at school. Several frantic phone calls later, they discovered it was a prank.

So when they got a call from UPMC Mercy that they should rush to Pittsburgh, something had happened to their son, for a couple of seconds they wondered if it was another hoax. At least, Ted Plevretes said, he and Tammy hoped it was.

> They usually attended most of LaSalle's games, and they certainly under normal circumstances would've made the trip to Pittsburgh -- Tammy still has family in Westmoreland County, where her parents were raised. But it was Senior Day at Marlboro High for their other son, Perry, two years Preston's junior.

As it turned out, not long later, Perry dedicated his senior-season finale to his big brother laying in a UPMC Mercy bed, tubes throughout his head and torso, in a medically induced coma where he would remain for weeks, half the right side of his skull removed for months because his brain was so horribly swollen and bleeding. In that game, Perry wore Preston's Marlboro number. In that game, Perry scored a touchdown.

> The LaSalle team bus, Tammy said, didn't make it directly back to Philadelphia after that Nov. 5, 2005 Duquesne game. The way she told it, so many players became ill about halfway home, they had to pull over and stop for awhile. (LaSalle, citing dwindling competition in the non-scholarship Metro Atlantic Athletic Conference from which Duquesne exited shortly before, dropped football in Nov. 2007.)

> One week after the incident, the clinic director of the CentraState Rehabilition Center -- Brian Mason -- brought his son to Duquesne for a recruiting visit. Little more than one year later, he would become a weekday companion: Preston reports to Mason's clinic five days a week for speech, occupational, physical and even water therapy. As a joke, the day I shadowed him to therapy, Preston signed into the clinic as "Brian Mason."

> Friends and teammates were constant hospital companions. One family friend drove from central New Jersey to Pittsburgh, spent the rest of the day, then turned around and returned to Jersey that night.

> Between the tracheotomy tube and so many other tubes, he was unable to speak for the longest time. So their communication later become fingers, such as one for yes, or index cards. Speech remains difficult. Funny, but the most perceptible part of our conversation came when Ted held Preston's nose, to show how that bypasses the misfiring brain connection and overcomes the partially paralyzed tongue. In short, it provides Preston easier air passage to exhale his words. I tried to joke to the once-wannabe broadcaster: That's no way to go through life, having somebody hold your nose so you can speak.

Preston's clear response: "Hell no."

> Over time, such an incident begins to take its toll. Preston's girlfriend, some of his friends, some of his parents' friends no longer came around -- it hurt too much, or they didn't know what to say or. . . .

Perry dropped out of community college for a spell, declaring that he would stay home to help with his big brother's care. It required some nudging, but he resumed his college education; he's in Florida studying film-making.

> Less than a year after the incident, the Plevretes and therapists got Preston standing, then walking on a walker. Problem was, he didn't want to be seen using a walker to get around his own neighborhood. So he made his father drive him 15 minutes away, or more, to other communities where he wouldn't be instantly recognized.

> Wish I were able to put more tape or photographs into the video, too, but there was a snippet where Tammy showed me Preston's busy month-by-month calendar. Every weekday is filled with some sort of therapy or, currently, hour-long drives one way to Parsippany, N.J., and back for 60 minutes of oxygen treatments in a hyperbaric chamber. They don't let him sit still, his mother said, because he needs to get back as much of his life as possible.

> They have taken two trips to Germany and plan another for this coming summer for stem-cell treatments. Tammy called across the globe -- Russia, Mexico, you name it -- searching for the best available and agreeable methods of stem-cell treatments, particularly the course they wanted to try: implantation of his own stem cells. Millions of his stem cells have been removed from, say, his hips and implanted into his thighs, feet, brain, all over. After a few months, the parents see signs of improvement. However, they've also needed Botox shots in his ankles and thighs after one such treatment due to the pain and the muscle tone.

 

> Tammy had a question: How many football players read the warning label affixed to their helmets? In some places previously, she said, that was most if not all the warning a player received about the potential  for brain injury in a helmet while playing the game.


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Plevretes and second impact syndrome 1/2

Sunday, 02 January 2011 01:11 AM Written by

There are people out there who have been fortunate to escape dire consequences from sustaining one concussion atop another unhealed.

They just haven't become statistics, haven't become noticed, haven't become tragic stories.

Today, in the final installment of the series, we focus on one such tale: Preston Plevretes, whose life changed five years ago in a game at Duquesne U.

More on his story tomorrow.

If you know of athletes who have been through multiple concussions, perhaps even two healing at the same time, or even if you have another tale of concussions to share, please feel free.

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